Southern Health NHS Foundation Trust

Alistair Burt Excerpts

Tuesday 3rd May 2016 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Urgent Question: To ask the Secretary of State to make a statement on the safety of care and services provided by Southern Health NHS Foundation Trust.

[The Minister for Community and Social Care (Alistair Burt)]

I thank the hon. Member for Liverpool, Wavertree (Luciana Berger) for her question. At the outset of my response, I want to express my deep concern and apologies to the patients and family members who will again have felt let down by the contents of last week’s report from the Care Quality Commission. Our first duty to patients and their loved ones is to keep them safe. This applies to all of us with a role to play in the NHS, from the frontline to this House, and the Government are therefore clear that it is imperative to be open and transparent about what has gone wrong in order to minimise the risk of similar failings occurring throughout the NHS as a whole. We must ensure that the trust itself continues to be scrutinised and supported to make rapid improvements in care. If that means intervention from the regulators, they will not hesitate to take the necessary action, and we will not hesitate to back them.

Last week’s CQC report followed a focused inspection announced and requested by my right hon. Friend the Secretary of State in December 2015. The report from the CQC set out a number of concerns, including: a lack of robust governance arrangements to investigate incidents; a lack of effective arrangements to identify, record or respond to concerns about patient safety; and a need for immediate action to address safety issues in the trust environment. The report also found that the senior management and board agendas were not driven by the need to address these issues. None of those matters is acceptable.

NHS Improvement has taken action in recent months to address the issues at the trust. It has been working closely with the CQC and the trust, and on 24 March, NHS Improvement appointed an improvement director to the trust. On 14 April, following a CQC warning notice on 6 April, NHS Improvement placed an additional condition on the trust’s licence, asking it to make urgent patient safety improvements to address the issues found by the CQC. That condition gave NHS Improvement the power to make management changes at the trust if it did not make progress on fixing the concerns raised.

On 29 April, following the resignation of the trust chair Mike Petter, NHS Improvement announced its intention to appoint Tim Smart as the chair of the trust. As chair, Mr Smart will have responsibility for looking at the adequacy of the trust’s leadership. Given the centrality of issues of governance to the CQC’s report, I welcome the action taken by NHS Improvement. The direct appointment of a new chair by a regulator is a relatively rare step, and it reflects the seriousness of the issues at the trust. NHS Improvement will continue to monitor the situation closely in the coming weeks and months.

I understand that the CQC is considering the trust’s response to its warning notice, and the risks it highlighted, before deciding whether to take any further enforcement action, and none of its options is closed. The notice required significant improvements to be made by 27 April. Dr Paul Lelliott, the deputy chief inspector at the CQC, was directly responsible for the report, and I spoke to him this afternoon. He informs me that the delivery plan required by 27 April has been received and is in the process of being evaluated. NHS Improvement is working closely with the CQC and the trust, and the improvement director appointed by NHS Improvement is on site regularly, so there is constant independent oversight of the progress being made, as well as the formal monthly progress meetings between NHS Improvement and the trust.

In addition to the action we are taking on Southern Health, it is vital that we learn the wider lessons for the NHS as a whole. First, I hope the whole House can agree that it is right that we have robust, expert-led inspection from an independent CQC that provides an objective view about issues of safety and leadership, and that this is backed with action from NHS Improvement where that is required. Secondly, it is vital that we take the issue of avoidable mortality as seriously for people with learning disabilities and mental health problems as we do for other members of our society. To that end, the learning disability mortality review programme has been put in place by NHS England to ensure that the causes of this inequality are understood, and with the aim of eliminating them. In addition, the CQC will be leading a review of how all deaths are investigated, including those of people with learning disabilities or mental health needs. There can be no question but that the CQC report makes for disturbing reading, and that it demands action at local and national levels. We owe our most vulnerable people care that is safe and secure, and I am determined that we will do all we can to ensure patient safety.

[Luciana Berger]

I thank the Minister for very brief advance sight of his response. Patients and parents have a right to be angry at the failure of Southern Health NHS Foundation Trust, and we in this House have a duty to be angry on their behalf. To read the litany of failure, missed warnings, reports and recommendations ignored, and secrecy over the last four years would make any reasonable person angry, too. Friday’s CQC report shows that very little has been done since the House last discussed the matter in December.

The scandal at Southern Health has happened on this Government’s watch, and Ministers must take responsibility for what has happened to some of the most vulnerable people in our country. We should be angry that Connor Sparrowhawk was left to drown in a bath. We should be angry that Angela Smith took her own life. We should be angry that David West died in the care of this NHS trust—his father was repeatedly ignored when he raised his concerns. All of them were denied the care that they so desperately needed. Last week, the BBC reported that over the past five years, 12 patients who had been detained for their safety or that of others have jumped off the roof of a hospital run by this trust. Access to a roof was still permitted to people at risk of suicide. If all those tragic incidents were the only signs of systemic failure, we should be angry, but there is a much bigger story of neglect and malpractice, which aggregates into a major scandal.

When the Secretary of State responded to the urgent question on Southern Health in December, he rightly said:

“More than anything”

people will

“want to know that the NHS learns from”

such

“tragedies”.—[Official Report, 10 December 2015; Vol. 603, c. 1141.]

The CQC report published on Friday shows that that clearly has not happened. So I ask the Minister: first, what guarantees can the Minister give to the 45,000 patients currently in the care of Southern Health, and their families, that they are safe? Secondly, where is the accountability, the culpability and the responsibility? There seems to be very little. I heard what he said about the chair, but does he agree that the chief executive’s position is now untenable, and that she should be sacked? Thirdly, will he listen to the heartfelt pleas of the victims’ families, the campaigners, and all of us who are demanding a full public inquiry into Southern Health and broader issues, such as the abject failure adequately to investigate preventable deaths?

As the Secretary of State said in December, such issues are not confined to one trust. The Ofsted-style ratings that he previously mentioned will make a difference only if there is proper accountability and the ability to take action to make real improvements to patient care and patient safety. The families have behaved with such dignity and tenacity, and we owe them a debt of gratitude, but it should not be left to them alone to push for accountability.

I listened carefully to what the Minister told the House, but I remain unconvinced that enough has changed. Four months ago, we heard similar reassurances. Today, we are debating the Government’s failure to act. The time for yet more warm words and hollow reassurances is over. We need action, and we need it now.

[Alistair Burt]

I thank the hon. Lady for her response. We are not actually debating the Government’s failure to respond at all. The Secretary of State did exactly what he said he was going to do, and the CQC’s inquiry and work that followed can be seen in the report that was produced last week. The report contains a number of further concerns—there is no doubt about that—and people are right to be angry, but there is a process to find out what is going on and to do something about it and that process is in place. That is what NHS Improvement is doing and it is important that that is done.

There is an issue of urgency, which is really important. There are things that are discovered and things take time to get done. I am not content with that in any way, but the process is in place to do something about that. The CQC has been engaged and has ruled out no option for further action. Its options are quite extensive, including prosecution for things that it has found. The process started by the Secretary of State is not yet finished. That my right hon. Friend has demonstrated his commitment to patient safety from the moment he walked into that office cannot be denied by anyone, and this is a further part to that.

I asked the same question that the hon. Lady asked about safety directly to the CQC this afternoon, and I spoke to Dr Paul Lelliott who compiled the report. I asked whether people are safe at the foundation trust today. People are safe because, as we know, the CQC has powers to shut down places immediately if there is a risk to patients. It has not done so, but I am persuaded that if it had found such a risk it would have closed things down. There is therefore no risk to safety in the terms that the hon. Lady suggests.

On the chief executive’s position, the power to deal with management change is held by NHS Improvement. I also offer a brief word of caution. There is a track record of Ministers speaking out, at great cost, about the removal of people in positions over which they have no authority. That is understandable in situations of great concern when an angry response seems right, but it is not an appropriate response. The chair has gone, and processes are available should any more management changes be necessary, which is important. Colleagues in the House can say whatever they like, but a Minister cannot and must say that appropriate processes can be followed, because that is right and proper.

I do not yet know about an inquiry, and I want to wait and see what comes out of the further work being done in the trust. I do not rule out some form of further inquiry, but an inquiry is physically being carried out now by the actions taking place on the ground. What needs to follow is urgent action to respond to what the CQC has said, and a long drawn-out public inquiry is not necessarily the right answer. More work might be necessary, but I need to consider that in relation to further work being done at the trust.

On preventable deaths, as I made clear in my statement, I am sure that not enough attention has been given to those cases that require further investigation across the system, often dating back many years and preceding this Government. We have turned our attention to that issue, and we will make changes because such inequality must end.

[Dr Sarah Wollaston (Totnes) (Con)]

The report on Southern Health makes disturbing reading, but we will never tackle unacceptable levels of health inequality and early deaths among those who live with learning disability and mental health issues unless we address safety and risk. Will the Minister go further on the mortality review and set out how we can see where differences exist around the country? Will he reassure the House that duty of candour will in future be more than a tick in the box?

[Alistair Burt]

A tick in the box for duty of candour, which the report mentioned, was unacceptable—it must mean much more than that. The learning disability mortality review programme is important and will support local areas to review the deaths of people with learning disabilities, and use that information to help improve services. In time, it will also show at a national level whether things are improving for people with learning disabilities, and whether fewer people are dying from preventable causes. That review is already under way in a pilot in the north-east in Cumbria, which will help to inform us how the programme operates as it is rolled out. Plans are in place to roll out that review across all regions of England between now and 2018, with pilots commencing in other parts of the country between 2016 and 2017. That work has never been done before, and it is right that we are doing it now.

[Dr Alan Whitehead (Southampton, Test) (Lab)]

As the Minister and other hon. Members have said, Friday’s report makes grim reading for the many families and patients in the care of Southern Health NHS Foundation Trust. The Minister said that those failings are not isolated to that trust, but are on a much wider scale. In light of that, is he seriously considering a public inquiry that will get to the heart of the underlying factors in those matters? Patients and families who use this trust—some of whom are my constituents—must be reassured that those underlying issues are being properly considered and not brushed under the carpet.

[Alistair Burt]

It is vital that they are not brushed under the carpet, and I will come to that in a second. It is important to put it on the record that there are some positive aspects of this report, some of which relate to Southampton. I am sure the hon. Gentleman will already have seen those, with the trust being commended for its work on the community pathway. On the substance of his question, I spoke honestly a moment ago when I said that I really do not know at this stage whether an inquiry is the right thing to do. I am well aware of the seriousness of this matter, of the questions the families have raised, and of the fact that this has been going on for some time. The important thing is both to effect change and to find out what has happened. The CQC report—the extensive work that has already been done—is in depth, public and transparent. That may well have the answers that are required, but if not, something further may be needed, which is why I have an open mind on this. The most important thing is to give the reassurance that certain things have happened, which the CQC report cannot yet do because that is where the work is needed and where the work is going on now.

[Mrs Maria Miller (Basingstoke) (Con)]

Our constituents, particularly those with learning disabilities, need to have confidence in the complex set of services provided by Southern Health. The failings that have been identified are completely unacceptable and disturbing, and I welcome the Minister’s statement and the CQC’s action with the warning notice it has issued. Will he join me in paying tribute to the dedicated staff at Southern Health facilities that are not implicated in these serious problems, including Parklands hospital in my constituency, which provides acute wards for adults needing intensive psychiatric care, in a much needed facility that has very dedicated staff running it?

[Alistair Burt]

Absolutely. When I got the report over the weekend and turned to the summary of findings, I saw that the first positive summary finding was:

“Staff were kind, caring, and supportive and treated patients with respect and dignity. Patients reported that some staff went the ‘extra mile’.”

It is important to put that on the record; it does not minimise the things that are wrong, but in a trust that is so large, covering such a wide area and so many people, it is important that that good work is recognised, and that errors and faults of management and governance should not be laid at their door. I pay tribute to those staff, who work in incredibly difficult circumstances.

[Several hon. Members rose—]

[Ann Clwyd (Cynon Valley) (Lab)]

I will attempt that, Mr Speaker. I just want to ask the following: how long does it take to effect change? Some 45 years ago, the Ely hospital inquiry took place, under the chairmanship of Geoffrey Howe, and recommendations were made. I took part, writing a report on the condition of mental health facilities throughout Wales. We are talking about some 45 years here, and it seems to me that things are going at such a slow pace that we will be asking the same question again in 45 years’ time.

[Alistair Burt]

The frustration in the NHS is that although what the right hon. Lady says is not true in some places, it is in others; the special measures process in effect at the moment has effected change and has done so more quickly. There are other places where that does not happen. I am concerned that in mental health the sense of defensiveness which we know has characterised parts of the NHS for too long has probably had too great a grip, and we have not always got things done more quickly or demanded that things are done with the degree of urgency that we would expect, on behalf of constituents. I am very determined that any difficulties in getting things done locally in trusts when they need to be done will not be aided or abetted by any lack of urgency in the Department or the upper reaches of the NHS with which we have contact. The concern to make sure that urgency is there is rightfully expressed by the House, and we have to see that that is delivered.

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

In 2011 and 2012, I was locked in a bitter confrontation with Southern Health Foundation Trust over the determination of its top management to close no fewer than 58 out of its 165 acute in-patient beds for people suffering from mental health illnesses and breakdowns. It is the only constituency issue over which I have ever suffered sleepless nights, and I failed to stop the trust closing the Winsor ward in the relatively new Woodhaven hospital in my constituency. Today, apart from this terrible issue about the deaths, the system remains overfull, the beds remain too few and I understand that at least 80% of the in-patients are people who have been sectioned, leaving people a very low chance of getting an elective bed from Southern Health unless they are prepared to wait a long time. Can the CQC look into this wider issue, given that it has so many other serious concerns about the trust?

[Alistair Burt]

The CQC’s powers are extensive and I know that it will absolutely know what my right hon. Friend says. The debate comparing the provision of beds for treatment with community treatment has been going on for some time in mental health, and different pathways are taken by different trusts. Some trusts put more people into beds, while others are doing more in the community. The general sense is that more should be available in the community, but that must not preclude the availability of emergency beds when they are needed. I will ensure that the CQC is aware of my right hon. Friend’s concerns about that particular trust.

[Paula Sherriff (Dewsbury) (Lab)]

Are the failures at Southern Health a symptom of the growing and unsustainable pressure being placed on the mental health and learning disability services? In the context of increased demand, significant pressure on beds, higher thresholds for care, staffing cuts and shortages, how can the Minister guarantee that mental health and learning disability trusts are able to do their jobs?

[Alistair Burt]

Let me point out that we have announced an increased resource for mental health of £11.7 billion. The extra £1 billion that the Mental Health Taskforce recommended being spent by 2020 will be spent, and it will be spent right across the board from perinatal mental health to crisis care. It will also improve baselines to ensure that the governance and quality of foundation trusts are good enough, and we are watching what CQCs are spending. Yes, we recognise that there has been historical underfunding from Governments of all characters, but we are determined to improve it and the money is there.

[Caroline Nokes (Romsey and Southampton North) (Con)]

All too often it is our constituents with mental health problems and learning difficulties who find it hardest to get their voices heard. Those who are patients of Southern Health are not in a position to call for urgent change. I note that the Minister has said that the delivery plan is being evaluated, but can he reassure us that that is being done with the utmost speed so that we see improvements on the ground and not just more reports gathering dust?

[Alistair Burt]

Today, I met departmental officials and spoke to the regional director responsible for NHS improvement and, as I mentioned earlier, the deputy chief inspector of the CQC who is responsible for this report. I can assure my hon. Friend that, in so far as it is up to me or the Department, that change will be adequately delivered with a sense of urgency, because, as she rightly says, patients and families have, in some cases, waited much too long for this. If warm words are to mean anything, we must show that delivery follows.

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

The failure of care for people with mental health issues, learning disabilities and autism has been shocking and the board should go. Equally shocking is the fact that, 11 months before Connor Sparrowhawk’s tragic and unnecessary death, failures had been identified but not acted on. What can the Minister do to ensure that, as part of a robust inspection regime, when failures are identified they are acted on and done so very quickly to prevent such failures again?

[Alistair Burt]

Over the past 12 months I have met a number of families who have been victims in similar circumstances—some had children who had been placed badly in an inappropriate place, and, in one or two cases, death had been the result. My colleagues and I are determined to do whatever we can to break down those situations where people feel that they have to fight for everything, and where they find doors closed against them when they want to challenge something. All too often in mental health, when people are challenged, they respond defensively. The whole transforming care process stems from Winterbourne View and the determination of the NHS and the board that monitors and oversees that process, including those who have mental health issues themselves and their advocates. The concerns that have been expressed in the past will not go completely, but I am sure the system is better placed now to deal with them and to listen to people more seriously than was the case, tragically, in the past.

[Suella Fernandes (Fareham) (Con)]

Does the Minister agree that the resignation of the chairman is a measure of the seriousness of the issue, and that after two damning reports, serious changes in the leadership are needed? What reassurance can he provide to my constituents in Fareham, such as the family of David West, that the regulatory bodies have the powers necessary if intervention is required?

[Alistair Burt]

I know that my hon. Friend has followed these matters closely for her constituents. Since last year there have been nine changes to the board, and the chair of the board left last weekend. NHS Improvement has the powers to alter governance, and I know from speaking to NHS Improvement that it takes that power and responsibility extremely seriously. The balance is between ensuring continuity and stability so that what the trust has promised is delivered, and wholesale change, which would provide an opportunity for further delay and prevent the work going on, but I know that NHS Improvement is very aware of its responsibilities in relation to governance, as I hope is the trust itself.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

It is right that this House legislated for parity of esteem for mental health care; I am proud that we did that. I recognise the Minister’s commitment to quick resolution so that we can implement recommendations to address the failings of the trust. Will he consider an independent inquiry similar to the first independent inquiry into Mid Staffs that my right hon. Friend the Member for Leigh (Andy Burnham) initiated in 2010?

[Alistair Burt]

I can do nothing more than repeat what I said earlier. I am aware that there might be circumstances in which an inquiry would bring out more and would demonstrate the degree of concern that colleagues in the House might find appropriate and that the families and others would understand. My first duty is to make sure that everyone is safe in the trust and to ensure the completion of the work that needs to be done to deliver what the CQC has found. Even after this very thorough work by CQC, which is transparent—that is why we are talking about it today—if anything further is needed, I will give it genuine and serious consideration.

[Kit Malthouse (North West Hampshire) (Con)]

The Minister is right to call the report disturbing. It has caused alarm and uncertainty across my constituency, and it is with the uncertainty that I hope he can help. In common with other Members, I am keen to know whether he has a hard date by which the trust is to be reviewed again. If it were to fail that hurdle, what would the next action be—revocation of the licence or further improvements? He will understand that most of my constituents want to see a deadline for compliance, and after that significant change that might mean a new era at Southern Health.

--- Later in debate ---

[Alistair Burt]

The best way that I can convey it is to say that constant monitoring is being done. First, the improvement director, who was appointed not by the trust, but by NHS Improvement, is there. In due course he will have a constant presence, but the monitoring needs to be done on a very regular basis. Also, the CQC has made it clear that should there be any need for further unannounced inspections, it will carry them out, so the trust is on constant notice that there can be a further inspection at any time. Further powers of the CQC include issuing another warning notice, varying and removing conditions of registration, monetary penalty notice for prescribed offences, suspending registration, cancelling registration, and prosecution. I understand from speaking to Mr Paul Lelliott that none of these measures has been ruled out.

[Marie Rimmer (St Helens South and Whiston) (Lab)]

It is that very point I wish to talk about. The duty of candour was going to give us so much more strength, but it is not being applied as yet. It is a statutory duty, placed on people carrying out regulated activities. It can lead to prosecution by the CQC, including without a warning notice. Will the Minister assure me that he will watch carefully to make sure that the CQC uses those powers appropriately? If it does not, we are once again failing these very vulnerable people.

[Alistair Burt]

Absolutely. If we now have a system where there is, quite rightly, a degree of autonomy, and Ministers’ responsibility is to make sure that the process and the system work well, Ministers cannot make all the decisions personally, but we do have to make sure that decisions that need to be taken are taken and, if not, that there is a good explanation of why not.

The CQC’s powers have been strengthened. Just a few months ago, we had the first case of a care home owner being jailed because of the care given to people in their home. While I recognise that the work done in caring for vulnerable people is complex and difficult, and that prosecution will not be the right answer in every case, knowing that powers are there is really important. The hon. Lady’s anger is appropriate, and I know the CQC takes these powers very seriously.

[Bob Stewart (Beckenham) (Con)]

Does the NHS improvement director now have the power to go into any Southern Health NHS Foundation Trust facility to assess and neutralise threats we have learned about that have resulted in people dying?

[Alistair Burt]

I hope my hon. Friend will forgive me, but I will not say things from the Dispatch Box that I do not know, and I do not know the precise powers of the improvement director, although I know the CQC has exactly the powers my hon. Friend suggests. However, the purpose of appointing the improvement director, and indeed of NHS Improvement’s appointment of the new chair, Tim Smart—the former chief executive of King’s College Hospital NHS Foundation Trust—is to put in place people who know what they are doing, know what they are looking for and can authorise others to make sure that nothing is being covered up and that everything is transparent.

[Chris Heaton-Harris (Daventry) (Con)]

In this sorry saga, what assurances can the Minister give about current levels of care and safety to the families of patients with learning disabilities who are in the care of Southern Health?

[Alistair Burt]

I think the best thing, genuinely, is to refer to the CQC report. It highlights good practice and good work in relation to staff in a variety of places and community pathways and in relation to work being done for those with learning disabilities. This is a large trust, covering many areas and many different facilities, and it would be quite wrong to assume that the standard of care is uniform across the board in terms of the criticisms that have been made. The criticisms are very real and very strong, but the work done by individual members of staff caring for people is reported by the CQC to be good. Again, in terms of safety, I am reassured that the CQC has powers and that it has assured me that, if it needed to use those powers in relation to safety and risk to patients, it would do so.

[Mr Speaker]

I thank the Minister and other colleagues who have taken part in these exchanges. I content myself simply with the observation that they have been a very important treatment of a very important subject. Perhaps, on behalf of the House, I can express the hope that the Hansard text of these exchanges will be supplied to Southern Health NHS Foundation Trust. It needs to know that we have treated of it and what has been said—politely and with notable restraint, but with very real anxiety—in all parts of the House about the situation within its aegis. [Hon. Members: “Hear, hear!]

Mental Health Services: Haringey

Alistair Burt Excerpts

Thursday 28th April 2016 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

I begin by congratulating the right hon. Member for Tottenham (Mr Lammy) on securing this debate on an issue that I know is important to him and his constituents. I thank him for his courtesy in letting us see a copy of his speech; that was much appreciated. I also thank the hon. Member for Hornsey and Wood Green (Catherine West) for raising the issues that she did.

I have to say that I have a soft spot for Haringey. Shortly before I first came to Parliament, 33 years ago, I was in the Hornsey and Wood Green Young Conservatives, and was a councillor in the London borough of Haringey, which taught me a great deal about the issues faced by an outer London borough with inner London problems. I still very much remember that time and the work that was done by very good councillors who were trying to do their best in that area.

My speech will necessarily be short, but I say right at the beginning that I share the concerns expressed by both colleagues. I will ensure that the meeting that the right hon. Gentleman was looking for takes place. He raised a number of detailed current issues in Haringey, which really need the specialist advice of those involved in the NHS and the clinical commissioning group. Unfortunately, it has not been possible for them to find time to speak to me in the last couple of days before this debate—I appreciate that it has been a very busy time in the NHS—but I know that they will find time, at the senior level, to meet him, me and others at Richmond House, at a time that we will put together as soon as we can. That will enable us to go into rather more detail on some of the issues that I simply will not be able to touch on today.

I share the right hon. Gentleman’s passion, which he illustrated very well in his speech, about these important issues. Some raise national issues; I will touch on those briefly, as they are important. I can understand his frustration about hearing comments made from a Dispatch Box about national amounts of money and then seeing what happens locally. I have got used to going round the country, talking about what successive Governments—in particular, the coalition Government and ourselves—have done and how there has been an increase in investment, and hearing people say, “Well, not round here, there hasn’t.” That is a very real issue: we must make sure that what we commit to flows through to the local NHS and CCGs. We are on to that in terms of monitoring and transparency, and can discuss it further when we meet.

I am very proud of what we are currently doing on mental health. We are investing unprecedented amounts, with spending expected to increase to £11.7 billion. CCGs are required to continue increasing their spend on mental health each year, and we are watching them. We have committed to investing £1.4 billion on children and young people’s mental health, and eating disorders. That will be spent by the end of this Parliament. The Prime Minister has said that an additional £1 billion will be spent to improve perinatal health, mental health liaison and 24/7 crisis care; I am grateful for the welcome that the right hon. Gentleman gave to that. Mental health really is a priority for all of us.

We have had the conclusions of the Mental Health Taskforce. The Department has accepted the recommendations directed at ourselves, as has the NHS. I am making sure that there is transparent delivery, and there will be constant reference back to the recommendations, so that people will be able to see what is actually being done, in order to counter the scepticism.

As for what the hon. Lady said, first, the issue of suicide is extremely important. I have asked for local suicide prevention plans to be revamped. We have a national suicide prevention strategy, but we do not have local suicide prevention plans in every area. That will change. She is right to talk about the link with homelessness. We need to do much more, and I am grateful to Samaritans, Cruse and all those in our national health service and other agencies who work hard on this issue. Crisis care concordats are in place everywhere—that was one success from the time of the right hon. Member for North Norfolk (Norman Lamb)—and they have placed a renewed focus on crisis and suicide prevention. I am glad that the hon. Lady mentioned carers because they are also important. Indeed, she could hold an entirely separate debate on those three issues, and I urge her to secure one so that we can discuss them.

In Haringey we introduced the first waiting time standards for mental health, starting with psychological therapies this year. Barnet, Enfield and Haringey Mental Health NHS Trust exceeded the standards for improving access to psychological therapies, with 90% of patients treated within six weeks of referral, and 99% within 18 weeks. In February 57% of patients referred for early intervention psychosis received treatment within two weeks, which exceeded the minimum standard set at 50%. This is not as simple as pulling a lever because capacity must be built up over time—that is something we should discuss. I, too, watched the “Panorama” programme, and the Haringey example well illustrated the national pressures.

One of the three priorities in Haringey clinical commissioning group’s health and wellbeing strategy 2015 to 2018 is improving mental health and wellbeing. In Haringey an estimated 3,000 children and young people have some kind of mental health problem at any time, and more than 34,500 adults have a common mental disorder such as anxiety or depression. About 4,000 adults with a severe mental illness live in Haringey.

Over the next three years the CCG aims to ensure that people living with mental illness experience a more seamless service from hospital to GP. It intends to strengthen support for people to manage their mental ill health in primary and community care settings. Just over £34 million funding has been awarded to mental health services in Haringey—an increase of 9% since 2013-14. Of that, £31 million is for Barnet Enfield and Haringey Mental Health NHS Trust. In 2013 to 2014, compared with 11 other CCGs in north and central London, Haringey spent the fifth highest proportion of its budget on mental health.

The right hon. Gentleman mentioned St Ann’s and in-patient mental health beds have reduced there, as they have over the whole country in line with national policy. That has taken place as more appropriate alternatives have been developed in the community, and the trust has used a number of private bed placements owing to capacity constraints. The trust is also operating at extremely high levels of bed occupancy, and it is working with the CCG to reduce that. There will be a new development at St Ann’s hospital, for which an outline planning application was given in March 2015. NHS Improvement is working with the trust and its partners to develop a strategy for mental health estates across the sector, and we can discuss that in more detail.

I do not wish to conclude without mentioning equality and diversity. We know that different ethnic groups have different rates and experiences of mental health problems. Black people across Barnet, Enfield and Haringey were the subject of four times as many applications to be detained under section 2 of the Mental Health Act in 2014-15 as they constituted a proportion of the population at the 2011 census. The trust’s rate is broadly in line with national data and reflects a wider challenge that is the subject of extensive national research and action.

Our commitment to tackling inequalities in access to mental health services is set out in the mental health action plan “Closing the Gap”, published in January 2014, and the mental health taskforce made that a central issue in its recommendations. This week I met a group to discuss issues of equality and diversity in mental health. It was the first meeting that I have had on the back of the mental health taskforce, illustrating the priority that I attach to the issue, and we are working up some proposals for that. Along with our commitment to the other recommendations, the right hon. Gentleman will not find us lacking in commitment to deal with this issue, and I know how important it is. We also want to ensure that BME communities have access to more important psychological therapies, and we are working with the sector to find out why they have had less access to them, and what we can do to change that.

We have heard about the challenges facing mental health services in Haringey. The Government are committed to transforming mental health, and ensuring that patients receive the best treatment. I mentioned our initiatives at local level, and it is clear that Haringey is working hard to address those challenges, but there are many. Therefore, when we get together with a group of MPs and senior representatives of the NHS and trusts, we will discuss this matter with a little more time and detail. I look forward to that meeting, and will do my best to help the right hon. Gentleman and the hon. Lady in their quest to support their constituents still further.

Question put and agreed to.

World Autism Awareness Week

Alistair Burt Excerpts

Thursday 28th April 2016 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

It is just about 24 years since I first walked into Richmond House as Parliamentary Under-Secretary at the then Department of Social Security. In that time, I have had the privilege of being involved in many debates that belie the common view outside this place that we either know nothing about a subject or are not personally involved and do not care. I would put this debate right up there with the very best that demonstrate that neither of those things is true.

We have heard remarkable speeches, including 25 Back- Bench contributions, which is a tribute both to colleagues and to the Chair. As the hon. Member for Liverpool, Wavertree (Luciana Berger) mentioned, it is impossible to cover everything, or even everyone’s speech, as we normally do, but the contributions from my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan) and the hon. Members for Birmingham, Yardley (Jess Phillips), for Stalybridge and Hyde (Jonathan Reynolds) and for Angus (Mike Weir) were particularly noteworthy in giving a sense of what things must be like. We are indebted to all of them for being able to say what they said in the way that they did.

I want to mention a couple of other speeches, such as that of the right hon. Member for North Norfolk (Norman Lamb). I am trying to do something about the fog, and I will mention that a little later, and many of us heard the moving and difficult story of the nine-year-old boy. The hon. Member for Barrow and Furness (John Woodcock) talked about the media response, and both the programme and the book he mentioned will make a significant contribution. I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for the way in which she brought the young man’s case to me, and I assure her that it is not all done and dusted yet. Some very difficult aspects of that case worried me hugely, and we will be talking about it further. I made absolutely certain that the parents were involved in the case review, because, as she and the right hon. Member for North Norfolk said, all too often people are not involved and are somehow excluded, and that has got to stop. It is vital that people will be thoroughly engaged.

I wish to start by commending the Member who moved the motion—I cannot remember who that was now. [Laughter.] Let me add my congratulations to my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) on securing the debate and on the extraordinary work she has done over the years in this area. We really are all indebted to her. In a recent Adjournment debate, I recognised the need for a fuller discussion and mentioned that we could do with this debate, and I am grateful that we have had that opportunity today.

A number of hon. Members have highlighted the importance of recognising that autism is not a person’s defining characteristic. Many colleagues, particularly those with children, made moving points about the qualities that autistic people have, and that is very important. In a couple of weeks’ time, I am going to the Hitchin LEGO club, which was started by parents of a child whose particular skills related to detail and the bits and pieces the club does. I am looking forward to going to see that. It is important that we do not just define people in this way, and the changes we make every day to attitudes, services and facilities can mean the difference between ambition thwarted and opportunity fulfilled. The best campaigns, at least those intended for the benefit of the common good, are led not from the top or from some central point of government, but by people on the ground.

Autism awareness is being addressed directly by the National Autistic Society in its excellent new campaign, which was launched during world autism awareness week and to which I gave my support. I went to see not only the little boy who is the subject of the film, but his family, because there are often siblings of those who have autism and they need to be cared for and valued as well. Sometimes issues can arise in that regard. It was nice to see the whole family and it is a remarkable piece of film. I also wish to highlight the work the Department of Health has taken forward with the Autism Alliance UK, a large network of autism charities, on the “Connect to Autism” project, which encourages local organisations, services and companies to become autism champions by training staff in autism awareness—there is a lot more to do.

I have no time to deal with all the subjects that have been raised, but in accordance with what has become my usual practice, because I seem to speak in vastly oversubscribed debates, I will pick out the questions that colleagues have raised and answer them by letter. If colleagues do not mind, I will answer them in the same letter and then put a copy in the Library, so that everybody will get a chance to see all the answers to the various questions that have been raised, which my hard-working team have noted. Let me just say a couple of things in answer on the key issues of what the Government are doing, and of diagnosis and data.

First, although it is easy sometimes to be overwhelmed by what there is still to do, it is important to recognise where we have come from—many Members made that point—and to realise what we are doing on a day-to-day basis. I commend to the House the “Progress Report on Think Autism: the updated strategy for adults with autism in England” which was published in January. I put that together along with the Under-Secretary of State for Disabled People, my hon. Friend the Member for North Swindon (Justin Tomlinson), the Minister for Children and Families, my hon. Friend the Member for Crewe and Nantwich (Edward Timpson) and the Under-Secretary of State for Justice, my hon. Friend the Member for South West Bedfordshire (Andrew Selous), who deals with prisons, probation, rehabilitation and sentencing. It sets out progress against 33 of the “Think Autism” actions and describes some of the work going on across government, because it absolutely involves education, employment and all sorts of other things. The report details case studies and it demonstrates what is being done in different places around the country.

Let me come straight to the challenge of diagnosis, which is so important to many Members. There is no doubt that, in some parts of the country, the demand placed on services—it is often the sheer weight of numbers—means that the NHS and its partners can struggle to meet the standards set out by NICE. The Department of Health’s mandate to NHS England for 2016-17 calls on the NHS to reduce health inequality for people with autism. Waiting too long for a diagnosis can be one of the health inequalities that autistic people face. The mandate has already got that, and it is very important that it relates to autism.

Clinical commissioning groups and NHS England are working to bring down the waits in line with NICE guidelines. What is happening right at this moment is that the Department of Health and NHS England, supported by the Association of Directors of Adult Social Services, have initiated a series of visits to CCGs and local authorities. The visits aim to develop a better strategic oversight of the challenges in securing timely diagnosis across all ages and to share good practice. In essence, that means that we should look at the variability in diagnosis times and do something about it. Sometimes there is an issue of capacity. It is not a question of just pulling a lever and the waiting times will come down. For waiting times to make any sense, we must recognise the capacity to deal with them. NHS England is trying to understand the difference in variation in order to do something about it.

NHS England will complete its work this month and then report to the cross-Government Adult Autism Programme Board in June. That report and the discussion at the board will be made public. The Department of Health is also funding the University of York to report on the type of support that is available after a diagnosis.

My right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) asked that NHS England should collect, publish and monitor key information on how long people are waiting for diagnosis and how many people are known to their GP to have autism. She said that waiting times standards on mental health, which are currently in development, should reflect national guidance that no one waits longer than three months between referral and being seen for diagnosis. I can assure Members that I am keen to ensure that we collect more data and that the data are made public. I am keen that the NHS collects what is known locally and finds a way in which we can use that nationally. New datasets have been put in place—I will say something about them in a minute—but it is important that we acquire more data. I have been made aware of that matter and I am trying to do something about it.

[Norman Lamb]

rose—

[Alistair Burt]

I will take just this one intervention, because I am on a tight timetable.

[Norman Lamb]

Will the Minister consider setting a maximum waiting time standard of three months to enter diagnosis? We all know that once we set a standard, the system responds to it, and we need that for anything to change.

[Alistair Burt]

I do understand that, but, equally, the capacity has to be there to do the job. It is a fine balance. To set a waiting time limit as some sort of token, knowing that it cannot be reached, would not work. Equally, the pressure on the system through collecting data, asking for data, and seeking transparency has its effect as well. There is a real sense in the Department that we have to meet that challenge, and I am looking at what data can best be collected, what data need not be collected centrally, but can be handled locally, and how we make the difference and how that is transparent and made known.

The Department of Health does not set out how NHS England should monitor waiting times. How NHS England holds commissioners to account is for it to determine, though it will need to demonstrate effectiveness in meeting the mandate requirement through which we expect NHS England to strive to reduce the health gap between people with mental health problems, learning disabilities and autism and the population as a whole. Even now, in the configuration of the NHS, the NHS does not directly report to me on this particular issue. I am really interested in how the NHS ensures that CCGs are doing their job, and I suspect that Members of the House are very interested, too. I can use that concern and interest and make sure that that monitoring job is done and that it is transparent.

My right hon. Friend also mentioned GPs. GPs already maintain a register of people with learning disabilities, which may include patients on their lists who also have autism where this has been diagnosed. As a number of Members mentioned, autism may not be the only condition that an individual may have.

The Royal College of General Practitioners’ autism initiative, part-funded by my Department, is looking at the idea of an autism indicator in general practice. That work is at an early stage. I hope that is helpful to my right hon. Friend. As recommended by the independent Mental Health Taskforce, the Department of Health is developing a five-year plan for the development of mental health data, to be published by the end of this year. The plan will set out future data requirements and timings for developing data to inform pathways of care, which will include data requirements for autism. This will be of great interest to the hon. Member for Liverpool, Wavertree, and I will make sure that she keeps up to date with data, as she keeps me up to date with data requests.

This has been a terrific debate which has covered many different aspects. To sum up, autism should never be a barrier to enjoying the access and opportunity afforded to others. The National Autistic Society, the Autism Alliance, the all-party parliamentary group on autism and many other charities are doing great work, helping more of us realise that sometimes we are the barrier, beyond legislation. It is only through empathy and understanding that true progress can be made and sustained.

Finally, there are two quotes that everyone should take from this debate—first, “Everybody feels like it’s a fight.” I have heard that too often, as too many of us have. Everything the Department does must make that sense of fight a little easier, until no one needs to fight because their needs are taken for granted. Secondly, “Think differently about thinking differently”—absolutely. That is what we should all do. I hope that that is a message from a very consensual House of Commons this afternoon.

Lewy Body Dementia

Alistair Burt Excerpts

Tuesday 26th April 2016 Westminster Hall

[The Minister for Community and Social Care (Alistair Burt)]

It is a pleasure to serve under your chairmanship, Sir Alan. I congratulate the hon. Member for St Helens North (Conor McGinn) on securing the debate and raising the important issue of awareness and recognition of dementia with Lewy bodies. I thank him for his kind personal remarks about my weekend activities, when I ran the London marathon. He is probably unaware that the Chair and I also have a sporting connection. Many years ago, we took part in a charity penalty shoot-out between English and Scottish MPs at Ibrox stadium in front of 50,000 people. That is not the normal size of crowd that the Chair or I play football before, but we enjoyed the occasion immensely. A sporting connection runs through us all.

I congratulate the hon. Member for St Helens North on his recent appointment as ambassador for the Lewy Body Society, and on the way in which he has raised the debate and brought the issue to the Chamber. As always, I thank colleagues in the House who show an interest. I thank the hon. Members for Strangford (Jim Shannon) and for Foyle (Mark Durkan) as well as my hon. Friend the Member for Vale of Clwyd (Dr Davies) for their attendance.

I agree with the hon. Member for St Helens North about Lewy body dementia touching many families. My wife’s uncle has recently been diagnosed, and I would like to thank her and all the other members of the family who are caring for her uncle as well as the staff at the care home and social services, who have also been involved. That brings home that dementia and its variants is something that many families can expect to experience. The debate is therefore timely and raises issues that are important to all of us.

The hon. Gentleman set out well some of the symptoms of DLB and issues relating to diagnosis. I cannot better that; I will not describe the symptoms because he did that extremely well. Diagnosis can be difficult. A GP can do some simple checks to see whether there is a chance that someone could have dementia and then refer them to a memory clinic or other specialist clinic if necessary. At the clinic, the person will be asked about symptoms and have a physical check-up and memory test, and they may also have blood tests and brain scans. The results of those checks and tests will give the doctor a good idea as to whether the symptoms are caused by dementia with Lewy bodies, another type of dementia or something else entirely. It is complex and, as the hon. Gentleman said, it is reckoned that perhaps 4% of all recorded dementia may be accounted for as DLB, but it may in fact account for 10% of all cases because it tends to be mistakenly diagnosed as another condition.

That brings up the question of research, which I will turn to before more general remarks about our approach to dementia generally because the hon. Gentleman raised that as a matter of some importance. The 2020 challenge sets out the aspiration to see research funding in dementia double by 2025 and relates to funding from all sources, including industry and charity. Through initiatives including Dementias Platform UK, the Dementia Research Institute, Join Dementia Research, the international drug discovery fund and the accelerated access review, we are creating a highly attractive environment for industry investment, including new targets for drug development. We also anticipate that greater public awareness achieved through the 2020 challenge and charity campaigns will lead to increased philanthropic donation to research charities.

On how particular funding is determined and which research projects are selected, funding panels made up of academic researchers, subject experts and patient and public advisers advise on decisions as to which projects should be funded within NIHR funding programmes, within the remit of each programme, determined by quality. On DLB specifically, as the hon. Gentleman said, the National Institute for Health Research funds the NIHR Newcastle biomedical research unit in Lewy body dementia, which is part of the NIHR dementia translational research collaboration, TRCD. However, other biomedical research units and centres that make up TRCD also do research in the area, including the NIHR Maudsley biomedical research unit. That accelerates the translation of dementia research from basic science to early-phase clinical trials, focusing on the three common late-onset dementias—Alzheimer’s, vascular and Lewy body dementia—and on fronto-temporal dementia with motor neurone disease.

Other major NIHR investments include improving the diagnosis and management of neurodegenerative dementia of Lewy body type in the NHS DIAMOND-Lewy study, which the hon. Gentleman mentioned. The chief investigator, to whom we pay tribute, is Professor John O’Brien of the University of Newcastle. Funding for that major programme of work is just over £1.9 million, which lasts from January 2014 to December 2018, and it is expected to result in an increase in the number of dementia with Lewy bodies cases diagnosed and to improve their care considerably.

We are very keen to see NIHR research programmes and to fund high quality proposals in dementia where those are within remit. In terms of future spending, there will be announcements on the Dementia Research Institute in due course about competition for membership. The content of the scientific programme will depend partly on the composition and directorship of the DRI, which is to be determined by competition, but I will ensure that the hon. Gentleman’s specific pleas in relation to DLB are passed through into the process and go to the Minister who is primarily responsible.

Let me say a little about further recognition of dementia into which this fits, because that is important. The hon. Gentleman was gracious enough to recognise that this issue continues to be of the highest priority for the Government. It is not a party matter in any way, as he made clear. In 2015, the Prime Minister set out his vision for dementia over the next five years, with his challenge on dementia 2020. The implementation plan, which was published last month, sets out the actions that partners—including those across health and care—will take to ensure that those commitments are delivered.

An accurate diagnosis of dementia is key to helping people live well with the condition. As my hon. Friend the Member for Vale of Clwyd said, more people now receive a diagnosis of dementia than ever before and it is reassuring to know that in the constituency of the hon. Member for St Helens North, 87.9% of people with dementia have received a diagnosis, which is significantly above the national average. I commend and praise the relentless efforts of those providing care and support to people with dementia. Again, he set out a moving case in relation to that.

[Mark Durkan (Foyle) (SDLP)]

In the context of the Prime Minister’s commitment in challenge on dementia 2020, which is very welcome, he has committed to roll out a national standard for tailored packages of post-diagnosis support. Will the Minister commit to ensuring that, when that standard emerges, it will be articulate enough to address DLB specifically?

[Alistair Burt]

It would be best for me to take specific requests on DLB back to the Department. I will write to hon. Members who have taken part in the debate with a response to that in due course. I hear and understand the hon. Gentleman’s point, but let me reflect and come back.

I return to those who are looking after people. The families and carers and the hundreds and thousands of health and social care staff who work tirelessly to deliver high quality, compassionate, personalised care always require and deserve a mention in any discussion of dementia and those involved.

The work we have done to improve diagnosis rates has meant that more people than ever can access the advice, care and support they need to help them, their carers and families live well with the condition. We now need to focus our efforts on reducing local variation in diagnosis rates and the care and support that people require. The diagnosis is only the start. We also need to ensure that every person diagnosed with dementia, and their carers, receive meaningful care following their diagnosis. To be clear, the needs of the person with dementia, their family and carers, should be at the heart of everything we do. We therefore want to see more consistent provision of innovative and high-quality dementia care delivered in a way that is personalised and appropriate to the specific needs of the individual. I have been fortunate enough to see at first hand some of the high- quality dementia care provided across the country and have been impressed with the culturally sensitive care and support, catering for a diverse range of dementia needs.

We also want people across England to have a greater understanding of dementia and what they can do to make a real difference to people living with the condition. I am pleased to say that there are now more than 1.5 million dementia friends in England and the Alzheimer’s Society is working to deliver an additional 3 million by 2020. I am grateful to the representative who talked to me and gave me some basic advice to help me become a dementia friend. In St Helens North there are reckoned to be over 6,500 dementia friends. Furthermore, local work such as that undertaken by the Dementia Action Alliance, the Life Story Network and National Museums Liverpool in neighbouring cities is helping support people, their families and their carers live well with dementia in their local communities.

I thank the hon. Gentleman for raising the nature of the debate and for being so specific, mentioning the work of the Lewy Body Society. I note that when he was appointed as an ambassador to it, he was quoted as wanting

“a commitment from the Department of Health to ensure that recognition for DLB is an integral part of strategies to tackle dementia.”

I assure him that we want everyone diagnosed with dementia to receive meaningful care following their diagnosis, and that very much includes those with dementia with Lewy bodies.

The fact that the hon. Gentleman has taken the trouble to raise the issue for debate, that he did so in the way in which he did and that he paid tribute to those who work in this area has done an immense amount just in this debate to raise the profile of Lewy body dementia and to secure commitment and recognition from the Department.

As a result of the debate, I will write to the hon. Gentleman with some answers to the specific questions he asked. I thank him for the way in which he did that and I hope that, through what we have said this morning, our commitment to dementia—to those suffering from it, to those who care for them and to all those involved in its research and treatment—has been made clear. This is a Parliament-wide commitment, which we all share. I am pleased to have had the chance to answer the debate.

Motion lapsed (Standing Order No. 10(6)).

Mental Health Taskforce Report

Alistair Burt Excerpts

Wednesday 13th April 2016 Westminster Hall

[The Minister for Community and Social Care (Alistair Burt)]

It is a pleasure to serve under your chairmanship, Mr Wilson. I thank my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) for this debate.

Among several impossible jobs I have, responding to a debate of this quality in 10 minutes simply cannot be done, so in accordance with my normal practice, if I do not answer any question, I will write to the hon. Member and, with colleagues’ permission, I will link the questions so that everyone gets the same letter, so that virtually everyone who has spoken will get a letter. I will put a copy in the Library so that other colleagues can see it.

There are many things on which there is no disagreement. To give some one-liners, My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) said that we now deal with mental and physical illness in an holistic way; that is absolutely right and ensures that money goes to the right place. I will cover that later, but no one disagrees.

On psychiatric liaison, we are on to that. The importance of housing and so on is now understood as part of dealing with mental illness.

My hon. Friend the Member for Halesowen and Rowley Regis spoke about valuing the public sector; yes, that is not said often enough and it is vital to do. The right hon. Member for North Norfolk (Norman Lamb) spoke of the economic case for dealing with mental illness. No one now disagrees with that. The priority that the hon. Member for Coventry North East (Colleen Fletcher) mentioned is absolutely right, and when it comes to waiting times, we are on to those. We are funding waiting times differently from when the right hon. Gentleman set them up, but they are being funded and I am happy to write to him separately on that. His worry is not shared in the Department and I can clear that up.

We are accepting the taskforce’s recommendation that we act on out-of-area placements by 2021. I would like to do it sooner if possible. I am determined to do it, but it takes time and the attitude to tier 4 will need to change. My recent experience in Hull showed me how inept current NHS processes are in deciding where new tier 4 beds should be. The situation is unacceptable and they have got themselves into a complete mess. That must change and be done properly, and I am determined it will be.

My hon. Friend the Member for Bexhill and Battle (Huw Merriman) rightly spoke about the importance of early intervention, as did the hon. Member for York Central (Rachael Maskell). I pay tribute to the knowledge and work of the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) in this area. Perinatal care is very much on everyone’s agenda.

My hon. Friend the Member for St Albans (Mrs Main) talked about the importance of work. There is now a joint unit between the Department of Health and the Department for Work and Pensions to do more of that. A White Paper or Green Paper is expected later this year and will show its importance.

On the importance of young people, the hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned our work with the Department for Education on new technology, apps and earlier intervention. She is absolutely right.

I do not want to dwell on any of those matters, although I could spend 10 minutes on each, but we have all grasped how important they are. I would like to respond to the key issues raised by my hon. Friend the Member for Halesowen and Rowley Regis and the hon. Member for Liverpool, Wavertree (Luciana Berger). I can cover transparency and implementation right up front.

I thank Paul Farmer, Jacqui Dyer and colleagues for their very important report. I am determined that it will not gather dust and as a way forward I have suggested—and we will do it—that an implementation plan is published by the end of the summer. I am not sure whether that will be in August, but it will be by the end of the summer. It will detail how we intend to implement the recommendation. There will not be one response; there will be a series of responses, and there will be a website where people can see what is being done and monitor what is planned. It will be transparent. There will be monitoring by all those who have been engaged but there will be constant reference back to the taskforce’s work, so that people can see that what is being done is related to that. The Department is putting in place a robust process with people to monitor it. That is how we will do it.

I want to cover the cross-Government issues not by interministerial committee, but by way of bilaterals with colleagues to drive things forward. I think that is the right way to do that.

My hon. Friend the Member for Halesowen and Rowley Regis mentioned data, particularly in the context in which the hon. Member for Liverpool, Wavertree mentioned them. I think there is recognition that the way in which data have been collected in the past has not been good enough, and there is also recognition that we are trying to lever up standards in all places. The “Panorama” programme and the hon. Lady’s questions over a period exposed the difficulty of getting all the data in the right place. This needs a separate debate and a separate set of answers. I have put in place an investigation into where the deficiencies in the data are, and how data that are collected elsewhere but centrally can be brought together. That will not be necessary in some cases and a written question may not provide all the answers.

In relation to the matters raised in “Panorama” on Monday and the difficulty for the right hon. Member for North Norfolk, it should be possible to answer the question. The problem is in terminology and deciding at what point a young person might be in the mental health system. I have agreed to meet Deborah Coles of INQUEST to talk about the information they have gathered. Plainly, it cannot be right that one Minister says “none”, I say “one”, the NHS says “four” and INQUEST says “nine”. That cannot be fair to the people involved.

A lot of attention is paid to the death of any young person with mental health problems. My hon. Friend the Member for Derby North (Amanda Solloway) raised this in a personal context. I can reassure colleagues. There are serious incident reviews, a child death overview panel, and the Care Quality Commission is involved.

[Oliver Colvile]

Will my right hon. Friend give way?

[Alistair Burt]

If my hon. Friend will forgive me on this occasion, there is just too much to cover in a short period.

There is a national confidential inquiry into suicide and homicide by people with mental illness and the Office for National Statistics is involved. Unfortunately, there is a gap in the data between national and local sources due to commission arrangements changing. That is an explanation; it is not an excuse or an answer, so my officials are looking urgently into how we can make sure our data collection is more unified and that we are working collaboratively with INQUEST to make sure we get an accurate number and resolve any discrepancies. Most importantly, as my hon. Friend the Member for Halesowen and Rowley Regis said, we must make sure we learn from every tragedy so that we can apply the learning to make things better. We are on to that. I promise the hon. Member for Liverpool, Wavertree that I will find a way of responding to the House to put that right. I will be in touch with her further.

I thank my hon. Friend for his work with the all-party mental health group. He and other colleagues have been responsible for raising these issues over a period.

A figure from the National Institute of Health Research indicates that it spent £72.6 million on mental health research programmes in 2014-15, which in terms of particular research is £27.7 million higher than in any other disease area, including cancer. We are determined to do more research, but I am not convinced the figures are quite as bad as people say None the less, we need data and we need research. Again, the taskforce is right. The Department has accepted all the taskforce’s recommendations.

I agree with my hon. Friend that there is a need for better commissioning. We are changing the tariff terms. He said it could not be done from tomorrow, but it is being done from April 2017. To end the block payments, there will be two new payment approaches with two different tariffs. I agree with him on leadership.

The funding will be there, but it must build up over time. The money is being delivered through the spending review and how we intend to fund the national health service generally. The commitment for the £1 billion of extra funding the taskforce asked for is very important and I believe it will make a significant difference.

Commitment, money and determination from the whole of Parliament will be of huge importance in this area and I thank colleagues for their engagement.

Points of Order

Alistair Burt Excerpts

Tuesday 12th April 2016 Commons Chamber

[Mr Speaker]

Extremely important questions are raised by this matter and by the broadcast, although not for me. We cannot have Question Time on the basis of points of order, but as the Minister of State is in the Chamber and apparently willing to say some words, we are happy—exceptionally—to hear him.

[The Minister for Community and Social Care (Alistair Burt)]

Further to that point of order, Mr Speaker. I am very grateful to you for allowing me to respond. I appreciate the fact that the hon. Member for Liverpool, Wavertree (Luciana Berger) gave me notice of her point of order. Some very serious questions were raised by the “Panorama” programme last night. I have agreed to meet Inquest’s Deborah Coles, the lady who put in the FOI request. There is a discrepancy in the numbers. There are difficulties in definition in relation to this matter, but the present situation is not acceptable. I will look as quickly as possible at finding a way of correcting the record as soon as we know exactly what the figures are, and at making sure we have sorted out this data problem effectively for the future.

[Mr Speaker]

I am extremely grateful to the Minister for his courtesy. On a personal note, may I wish the Minister very well in that important meeting with Deborah Coles? She is a very formidable character, as I know myself, because we knew each other at university. She is very formidable indeed, and I wish him well.

Oral Answers to Questions

Alistair Burt Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Ann Coffey (Stockport) (Lab)]

2. What recent representations he has received on the effect on health budgets of the administration of deprivation of liberty safeguards.

[The Minister for Community and Social Care (Alistair Burt)]

I have received a range of representations on the effect of the deprivation of liberty safeguards, including on the impact that the current system has on health and care budgets. The hon. Lady is a respected voice on the challenges that these safeguards pose, and I can reassure her and the House that there is ongoing work to address those challenges.

[Ann Coffey]

I thank the Minister for his reply. Deprivation of liberty assessments are costing Stockport Council £1.2 million this year, as a result of the Cheshire West judgment. Not one single penny of that is providing social care. This is clearly unsustainable at a time when social care budgets are under intense pressure. Something needs to be done now; we cannot wait for the Law Commission. Will the Minister consider, as a small step forward, scrapping costly automatic annual reassessments and the necessity to reassess every time an elderly person leaves a care home to go into hospital?

[Alistair Burt]

I will happily look at anything that might assist us. As the hon. Lady knows, we are caught in the process of trying to deal with a court judgment and the issues surrounding mental capacity in relation to deprivation of liberty safeguards, which are genuinely serious and cannot be easily changed at the stroke of a pen, as well as the extra costs that the problem has raised. We are now close to hearing the Law Commission’s post-consultation proposals. I understand that it will publish its latest analysis in mid-May and will have drafted detailed legislation by the end of December. I will look at any suggestion of hers that might ease the situation practically.

[Mr David Nuttall (Bury North) (Con)]

Will the Minister confirm that when the new legislation is finally introduced, it will be simpler to understand and result in fewer bereaved relatives facing distressing delays when a loved one dies in care?

[Alistair Burt]

My hon. Friend is absolutely right. What has caused the confusion has been a definition of loss of liberty and dying in state detention that bears no relation to anyone’s common-sense understanding of the situation. Whatever new legislation is proposed by the Law Commission, it must meet the test of being much simpler, but it must also meet the legislative test of meaning what it says so that it does not get disrupted in the courts again.

[Roger Mullin (Kirkcaldy and Cowdenbeath) (SNP)]

3. If he will make it his policy to eliminate hepatitis C.

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[David Rutley (Macclesfield) (Con)]

5. What steps the Government is taking to improve support for children and young people with mental health problems.

[The Minister for Community and Social Care (Alistair Burt)]

The Government are committed to delivering the vision set out in “Future in mind” and are driving forward a major system-wide transformation programme, working alongside our partners in Government and arm’s length bodies to improve access to high-quality support across the country.

[David Rutley]

I thank my right hon. Friend for the steps he has set out. Will he join me in congratulating the charity YoungMinds on the important work it does in highlighting the mental health challenges young people face, not least from the so-called dark net and social media. Does he agree that we must ensure that the internet is a positive and not a negative force in tackling young people’s mental health challenges?

[Alistair Burt]

Yes, the work that YoungMinds and a range of other partners have done and continue to do to ensure that children and young people can access information safely is commendable. Children, young people and their parents have expressed the need to access both high-quality and reliable information and support online. That was reflected in the “Future in mind” report on children’s and young people’s mental health. We are investing with MindEd and a number of groups and organisations to work on apps for young people. It is important that they have access to safe material to exclude that which is rather darker.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

The Minister will recognise that walk-in centres run by experienced GPs can offer important support to children with mental health problems, yet popular walk-in centres that were established by local GPs in my constituency are being put out to tender, putting at risk the leadership and involvement of those experienced GPs in the centres. Will the Minister give guidance to the NHS Procurement Authority that walk-in centres should be led by local GPs with experience of that area?

[Alistair Burt]

I will look at what the hon. Gentleman says. As he will appreciate, I am not responsible for individual commissioning decisions. The commissioners will have full regard to the needs of the local population when they are putting those services out. It is important that access is increasingly available at GP and primary level, as well as in other areas where the Government are investing further money. I will have a look at what he says.

[Jeremy Quin (Horsham) (Con)]

20. Will the Minister inform the House of what dialogue is maintained between his Department and the Department for Education to ensure that those issues are picked up and that help is signposted as early as possible?

[Alistair Burt]

There is a growing relationship with the Department for Education—it is better than it has ever been. For the first time, there is a Minister responsible for mental health in the Department, and there is a schools champion for mental health, whom I met the other day at a conference in Cambridge. The Departments work closely together to deliver the vision set out in “Future in mind”. For example, there is a £1 million pilot project, working across 22 schools, to find the right people in schools to deal with mental health issues. There is much greater recognition that, the earlier we pick up these things, the better it is for youngsters and their future mental health.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

Eating disorders among children and teenagers cause life-threatening health problems and even death. What steps is the Minister taking to enable early detection and intervention, which result in better prognoses and support closer to home?

[Alistair Burt]

There are two things that can help the hon. Lady. The first is the commitment to build £30 million a year into budgets over the next five years to support those with eating disorders, about which I spoke at a conference last week. The second is the earlier detection of eating disorders. We reckon that, by 2020, 95% of urgent eating disorder cases will be seen within a week, with routine cases seen within four weeks. There is recognition of the real danger now posed by eating disorders.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Earlier this month, school and college leaders reported a large rise in the number of students suffering from anxiety. Two thirds said that they struggle to get mental health services for their pupils, and of those who had referred a student to child and adolescent mental health services—CAMHS—most rated them as “poor” or “very poor”. Despite the Minister’s warm words, things are getting worse, not better. Will he confirm that every single penny promised to children’s mental health will reach those services and that none of this money will be used to plug the gap in hospital budgets?

[Alistair Burt]

Following long and frank conversations between me, the NHS and the Treasury, I can give the hon. Lady that assurance—every penny of the £1.4 billion pledged in the 2015 Budget for CAMHS and for eating disorders will be spent on children’s mental health by the end of this Parliament. It is not fair continually to say that nothing is going on. The first tranche of money—£173 million—is being spent: £75 million to the clinical commissioning groups; £30 million to tackle eating disorders; £28 million for the expansion of children’s IAPT—improving access to psychological therapies—services; £15 million for perinatal services; and £25 million to address other issues involving training. That is money already committed and it is being spent now. The problems that she mentions are a high priority and are being dealt with.

[Luciana Berger]

I listened carefully to the Minister, but by his own admission—in response to parliamentary questions—he is going to underspend this year by £77 million on his pledge to spend £250 million on CAMHS, and by £11 million on his £15 million pledge regarding perinatal mental health. He talks about the importance of intervening earlier. Does he agree with Labour that every child should receive personal, social, health and economic education so that young people are equipped with the resilience better to support their mental health?

[Alistair Burt]

We cannot have it both ways, it would seem. I have given a pledge, which the hon. Lady asked for in her first question, that the £1.4 billion committed to CAMHS will be spent by the end of this Parliament—and it will be. It is known that the first tranche has not been fully committed, but this is the first year and some money has to roll over. However, I have made absolutely sure that that money will be spent, including on perinatal services, which will reach a much better place than when we came into office, and that is very important. The work will be done. PSHE is not a matter for this Department, but I fully agree that it is important that children have such information. The pressure caused through social media, sexting and the like means that children these days need to have a very up-to-date, modern understanding of issues associated with personal health and social education, which I fully support.

[Mr Speaker]

May I gently point out to colleagues that, very useful and comprehensive though these exchanges have been, as usual at this stage we have got a lot to get through and we need to speed up a bit? There is a long waiting list of colleagues and we must get through that list.

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[Alex Chalk (Cheltenham) (Con)]

7. What progress the Government have made on achieving parity of esteem for physical and mental health services.

[The Minister for Community and Social Care (Alistair Burt)]

We remain committed to achieving parity of esteem between mental and physical health, and we are investing more than ever in mental health. We welcomed the publication of the Mental Health Taskforce report last month and will work to embed its recommendations in our policies.

[Alex Chalk]

Steph Cater, a 17-year-old at Pate’s Grammar School in my constituency, is concerned that mental health in-patient services are distributed unevenly, meaning that those needing treatment can end up being cared for hundreds of miles away from their families. What more can be done to ensure that those in crisis are treated closer to home?

[Alistair Burt]

A review of beds in 2014 partly redressed that uneven distribution. In my hon. Friend’s area, an analysis of the impact of the new beds shows that the average distance travelled to child and adolescent mental health services units in the south-west has improved from 114 miles in 2014 to 39.9 miles in 2016. It is not enough simply to provide more beds, however. We have to provide more community-based support and treatment—that is at the heart of “Future in mind”. The number of out-of-area treatments also has to be reduced.

[Mr Speaker]

If anything, questions are getting longer, not shorter. I say with great courtesy to the right hon. Gentleman, whom I hold in the highest esteem and whose track record is greatly respected across the House, that his question was far too long.

[Alistair Burt]

Two things: the first set of waiting time standards—the first ever by a Government—are already in place from April 2015, with 50% of people experiencing an episode of psychosis treated within two weeks and improved waiting times for talking therapies; and, secondly, we have to get the database right. The right hon. Gentleman will know that we are doing an extensive and much greater data trawl to find a base on which those waiting times can be set, but it remains our determination to get them introduced by 2020.

[Mr Gavin Shuker (Luton South) (Lab/Co-op)]

8. What improvements have been made to child and adolescent mental health services since the publication of the Government’s strategy, “Future in mind”, in March 2015.

[The Minister for Community and Social Care (Alistair Burt)]

Progress has been made on many of the key ambitions set out in “Future in mind”. Of greatest significance is the development of local transformation plans that cover the full spectrum of children and young people’s mental health issues, from prevention to intervention for emerging or existing mental health problems, for every clinical commissioning group in the country.

[Mr Shuker]

This month, the Mental Health Network, representing NHS providers, said that very little, if any, of the money promised for child and adolescent mental health has yet materialised and that some services are experiencing cuts in-year. The Minister must accept, despite his assurances to my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), that the Department’s efforts in getting this money out the door has been woeful. What will he change?

[Alistair Burt]

I do not necessarily, despite the energy of the hon. Member for Liverpool, Wavertree, accept everything that she says. I gave a list of where the money is being spent. However, I think I can help both the hon. Gentleman and the hon. Lady. Much more is being done to ensure that CCGs deliver what they need to deliver in relation to mental health. This year’s figures will show that, whereas there has been a 3.7% uplift for CCGs, there has been an uplift of 5.4% in mental health spending. With more transparency and more determination by the NHS on CCG spending, hopefully what people are saying and feeling will become less justified in the future.

[Kelvin Hopkins (Luton North) (Lab)]

9. How much was spent on healthcare as a proportion of GDP in (a) 2009-10 and (b) 2014-15; and what estimate he has made of the amount that will be spent on healthcare as a proportion of GDP in 2020-21.

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[Dr Tania Mathias (Twickenham) (Con)]

T5. Successful cardiopulmonary resuscitation often involves people knowing where the nearest public access defibrillator is located. In my constituency, however, it is difficult to find out exactly where such defibrillators are located. Will the Minister ask the Department of Health to carry out a live mapping of public access defibrillators as well as ensuring that every workplace with a first aid point has a clear sign showing where the nearest defibrillator is located?

[The Minister for Community and Social Care (Alistair Burt)]

This work is already in hand through the British Heart Foundation. I should like to add that last week the Chancellor announced another £1 million to make public access defibrillators and CPR training more widely available in communities across England. Coupled with last year’s funding of £1 million, that means that there are now over 690 more publicly accessible defibrillators in communities across England. That mapping work is important, however, and my hon. Friend is right to raise it.

[Rosie Cooper (West Lancashire) (Lab)]

I believe that the Capsticks governance review, published today, will show that serious harm was caused to patients and staff, that there was a culture of bullying and harassment even after the Francis inquiry, and that Liverpool Community Health NHS Trust is the community equivalent of Mid Staffs. In the spirit of openness and transparency, will the Secretary of State instigate a public inquiry to establish the full extent of the harm caused to patients and staff?

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[Philip Davies (Shipley) (Con)]

T10. A number of my constituents are unable to access an NHS dentist. May I ask the Minister to look at the availability of NHS dentists in my constituency and use his good offices to ensure that there is enough capacity for all of my constituents who want to use a good NHS dentist to be able to access one locally?

[Alistair Burt]

Overall access to NHS dentistry is good, but it does vary from area to area, and West Yorkshire, as the hon. Member for Dewsbury (Paula Sherriff) well knows, is one of the areas that worries us and that we are trying to do something about. Work is being undertaken in the West Yorkshire area to look at issues around NHS dentistry. I have met a number of hon. Members to discuss this matter. It has my attention, so I will be monitoring it closely, and my hon. Friend was right to raise it.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

The King’s Fund analysis revealed that there will be not a £10 billion, but a £4.5 billion real-terms increase to the NHS. Will the Health Secretary apologise for misleading not just this House but the public as a whole?

NHS (Charges and Payments) Regulations 2016

Alistair Burt Excerpts

Friday 11th March 2016 Written Statements

[The Minister for Community and Social Care (Alistair Burt)]

Regulations have today been laid before Parliament to increase certain national health service charges and voucher values in England from 1 April 2016.



In the 2015 spending review, the Government committed to support the five-year forward view with £10 billion investment in real terms by 2020-21 to fund front-line NHS services. Alongside this, the Government expect the NHS to deliver £22 billion of efficiency savings because we must make the best use of NHS resources.

We have increased the prescription charge by 20p from £8.20 to £8.40 for each medicine or appliance dispensed. 90% of prescription items are dispensed free, and this will remain the case. To ensure that those with the greatest need, and who are not already exempt from the charge, are protected we have frozen the cost of the prescription prepayment certificates (PPC) for another year. The three-month PPC remains at £29.10 and the cost of the annual PPC will stay at £104. Taken together, this means prescription charge income is expected to rise broadly in line with inflation.



Charges for wigs and fabric supports will also be increased by an overall 1.7%.

The range of NHS optical vouchers available to children, people on low incomes and individuals with complex sight problems are also being increased in value. In order to continue to provide help with the cost of spectacles and contact lenses, optical voucher values will rise by an overall 1%.

Attachments can be viewed online at http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-03-11/HCWS607/

[HCWS607]

NHS (Dental Charges) (Amendment) Regulations 2016

Alistair Burt Excerpts

Friday 11th March 2016 Written Statements

[The Minister for Community and Social Care (Alistair Burt)]

Regulations have today been laid before Parliament to uplift dental charges in England from 1 April 2016.

In the 2015 spending review, the Government committed to support the five-year forward view with £10 billion investment in real terms by 2020-21 to fund front-line NHS services. Alongside this, the Government expect the national health service to deliver £22 billion of efficiency savings because we must make the best use of NHS resources.

We have taken the decision to uplift dental charges for those who can afford it, through a 5% increase this year and next.

This means that the dental charge payable for a band 1 course of treatment will rise by 80p in 2016-17, from £18.90 to £19.70, and by 90p in 2017-18, from £19.70 to £20.60. The dental charge for a band 2 course of treatment will increase by £2.60 in 2016-17, from £51.30 to £53.90, and by £2.40 in 2017-18, from £53.90 to £56.30. The charge for a band 3 course of treatment will increase by £11.20 in 2016-17, from £222.50 to £233.70, and by £10.60 in 2017-18, from £233.70 to £244.30.

Dental charges remain an important contribution to the overall cost of dental services, first introduced in 1951, but we will keep protecting the most vulnerable within society. NHS dental treatment will remain free for those under the age of 18, those under the age of 19 and receiving full-time education, pregnant women or those who have had a baby in the previous 12 months, and those on qualifying low-income benefits. If someone does not qualify for these exemptions, full or partial help may be available through the NHS low-income scheme.

Attachments can be viewed online at:

http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-03-11/HCWS606/.

[HCWS606]

Autism Diagnosis Waiting Times

Alistair Burt Excerpts

Tuesday 8th March 2016 Westminster Hall

[The Minister for Community and Social Care (Alistair Burt)]

It is a pleasure to serve under your chairmanship, Sir Roger. I congratulate the hon. Member for Batley and Spen (Jo Cox) on securing the debate and on how she has represented her constituents’ particular interests and also the wider interests of those with autism. I thank colleagues for their interventions. The hon. Lady is right: there are a number of colleagues in this room with considerable experience in autism. Before I get into specifics, let me say that I will not have time to answer all her questions, but I will write to her on those that I cannot answer.

The debate raises once again one of those issues that in the course of my parliamentary lifetime has changed markedly. Only a generation ago, recognition and understanding of autism was extremely vague, but now it is very different. Recognition of the need to treat and to understand the families involved is beyond where it was, but that creates pressures in the system.

I want to say a little bit about what is happening locally. What the hon. Lady has described is a good example of how things can be recognised over a period of time. As she said, it is not the responsibility of one particular Government, but the responsibilities have grown over time, and what has been done about them might be a pattern for others. I will also say something about what we are trying to do nationally. I also want to recognise the work done not only by parents and those who are intimately involved, but by the National Autistic Society and the Autism Alliance—organisations that have done much work to represent those involved and will continue to do so.

Before I forget, I should respond to the hon. Lady’s last question: I would be very happy to spend more time discussing autism in the House. We ought to have a three-hour debate, or longer, and I would be very happy to respond to that. There are a number of questions out there about autism, not only in the House but in other places, and I would be happy to try to answer them, although I would have to deal with the general rather than the specific.

[Mrs Gillan]

As chair of the all-party group on autism, I am hoping to apply for a three-hour debate so that we can celebrate national autism week. I hope that the Backbench Business Committee will look on my application favourably, and I am sure that several colleagues present would not mind signing up to it as well.

[Alistair Burt]

I am sure it is of little interest to the Backbench Business Committee whether or not a Minister welcomes a debate, but if it is in any well helpful, colleagues can be sure that I would indeed welcome such a debate.

Before addressing the national picture, I shall discuss briefly the situation in Batley and Spen. Why has it taken so long to resolve the issues there? The list built up over a period of time because of pressures on both autism services and child and adolescent mental health services, and because of how services were commissioned. The number of referrals has increased to a level greater than one would expect based on national prevalence, so the clinical commissioning groups involved—North Kirklees and Greater Huddersfield—had to identify a service that had the right capacity and expertise to meet requirements. Colleagues who made points about training and the need to ensure that professionals are in place were absolutely right.

The CCGs have been working on the service for some time. As the hon. Member for Batley and Spen said, the issue has been identified and they are investing £340,000 over the next 12 months to bring down the backlog, including agreed funding for additional diagnostic capacity. The CCGs recently appointed Socrates Clinical Psychology, an independent sector organisation, to deliver extra assessments over a 12-month period, and they are about to begin writing to parents and guardians to inform them of developments. Appointments will be prioritised based on the length of time patients have been waiting for an assessment. As the hon. Lady said, the extra capacity will see the number of assessments rise from four a month to around 16.

The CCGs are currently in the process of redesigning adult social care services to meet national guidelines, to provide a greater number of assessments and to avoid the development of long waiting lists in future. A draft service specification and business case, which includes several options, will be discussed by the CCGs in the coming months, and the new service is to be in place by, at the latest, March 2017, when the existing contract comes to an end. Their response in recognition of the pressures that have built up is to be commended.

It is important to understand what is happening nationally as well as locally. We are all agreed on the importance of the timely diagnosis of autism. Although diagnosing someone with autism can be complex and involve a number of different professionals and agencies, it is clear that some children and adults can wait too long. Getting an autism diagnosis can be particularly important for families who are worrying about their children or for adults who did not have their condition recognised when younger and who need support to live their lives.

Yes of course early diagnosis saves money, but as my hon. Friend the Member for Tonbridge and Malling (Tom Tugendhat) said, it is not simply a question of saving money later in the system: early recognition makes such a difference for the families involved, as well as the individual. That is taken as read, which is why there is now much more concentration on early diagnosis than there used to be.

Young people with autism face challenges to their education and wellbeing in all areas of their lives, and that can have an impact on their academic attainment and their ability to make the transition to independent adulthood. For adults who have not been diagnosed, their life to date may have been affected by a sense of not fitting in and not understanding the way they respond to situations or why they find social settings difficult.

Let me outline the framework that is in place to improve the lives of adults with autism. The 2010 cross-Government autism strategy, which came out of the Autism Act 2009, was updated in 2014 as “Think Autism”. New statutory guidance was issued in March 2015 which set out what people seeking an autism diagnosis can expect from local authorities and NHS bodies. The aim of the adult strategy is to improve the care and support that local authorities and NHS organisations provide for people with autism.

Nevertheless, we know that there is more to do to ensure that all those with autism get the help and support they need. In January, the Government published a progress report to further challenge partners across Government in areas such as education, employment and the criminal justice system—the latter was mentioned by my hon. Friend the Member for Tonbridge and Malling. The reforms to the special educational needs and disabilities system that came into effect in September 2014 represent the biggest change to that system in a generation. They are transforming the support available to children and young people, including those with autism, by joining up services across education, health and social care to identify and meet their needs.

The Department of Health’s mandate to NHS England for 2016-17 sets the priorities for the NHS and signals what the Department will hold the NHS accountable for. It includes an important call on the NHS to reduce health inequality for autistic people. Waiting too long for a diagnosis can be one of the health inequalities that autistic people face. Local authorities and the NHS should work in collaboration so that there is a clear pathway to diagnosis that is aligned with care and support assessments. Commissioning decisions need to be based on knowledge and awareness of autism and the needs of the local population, and, importantly, informed by people with autism and their families.

We know that in some parts of the country more needs to be done on developing diagnostic assessments. The hon. Member for Batley and Spen referred to the bane of the NHS system: local variability and the fact that things are not always done in the same way in the same place. I absolutely support the call by the National Autistic Society to ensure that good practice is shared across all areas. It is essential that the practice of the best becomes the practice of all, and I know that right hon. and hon. Members support that.

To help to standardise and improve the care and management of autism, particularly around diagnosis, and to enable health and social care services to support people with autism more effectively, NICE has published three clinical guidelines on autism and a quality standard. It recommends that there should be a maximum of three months between a referral and a first appointment for an autism assessment, and the NHS should follow that recommendation. Local areas will continue to be asked to assess their progress on implementing the adult autism strategy through Public Health England’s informal local area self-assessment exercise.

Let me address the point made by my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan), as well as by the hon. Member for Batley and Spen. The Department of Health has discussed with NHS England the difficulties that can arise in getting a diagnosis. As a first step, NHS England, with support from the Association of Directors of Adult Social Services, is currently undertaking visits to CCGs and local authorities with the specific purpose of developing an understanding of the existing diagnostic process for children and adults, including engaging with people who have had experience of accessing the process, and their families. The focus is on identifying local barriers and how they can be overcome; how local areas measure quality and outcomes; the alignment with care assessments; and the identification of positive approaches that can inform learning for other areas. NHS England will issue an initial report in April, once the visits are complete.

To help with local planning, NHS England has also made a new commitment to collect data on the number of people in touch with learning disability and mental health services who have a diagnosis of autism. It is not for me as a Minister to task NHS England formally with monitoring waiting times; it is for NHS England to determine how it holds commissioners to account. Nevertheless, it will have to demonstrate effectiveness to me in meeting its mandate requirement. It is essential that waiting times are monitored locally by commissioners and included in their oversight of provision. I am interested to see the information that will be collected on the commissioning exercise that was mentioned. That information must be made public and will help with the provision of much-needed extra data about this subject. I hope that will help the new commission, the all-party group and others.

It is important to note that there are others involved. I draw particular attention to the service provided by our hard-pressed and excellent GPs. They are, of course, usually the gatekeepers to diagnostic services, and need to have a good understanding of the autistic spectrum and the diagnostic pathway that has been developed in their area. To build knowledge and expertise among health professionals, the Department has provided financial support to the Royal College of General Practitioners’ clinical priorities programme on autism, which is undertaking practical work on autism awareness and training for GPs. That will enable people who may have autism to be supported more effectively from the start of the assessment process.

In recent years there has been considerable progress on how effectively we identify and support the needs of people of all ages on the autistic spectrum. I do not deny that the complexity of autism and the multifaceted nature of the needs of those on the spectrum pose particular challenges to professionals and commissioners. CCGs locally and NHS England at a national level are working to bring down the waits in line with NICE guidelines, working with many different agencies, along with service users and their families, to create a more responsive environment of diagnosis and support. I know that the House will welcome that, although there is more to do.

Question put and agreed to.