Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 15th November 2016 Commons Chamber

[David Mowat]

My hon. Friend is right that there was an inadequate CQC rating for that care home. It is therefore right that the care home must either improve or go out of business. That is what the CQC regulatory environment will ensure. She makes a point about the issue with the hospital in Paignton; that is out for consultation at the moment, and I would expect the local care situation to be part of that consultation.

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

The National Audit Office report “Discharging older patients from hospital” said that

“there are…far too many older people in hospitals who do not need to be there”.

Delayed discharges reached a record level in September. The Minister says that this is complex, but I can tell him that the main drivers for that increase were patients waiting for home care or for a nursing home place; those issues are both related to the underfunding of social care. Does he agree with NHS England chief executive Simon Stevens that any extra funding from Government should go into social care?

[David Mowat]

As I said earlier, we accept that the system is under pressure, but we also make the point that there is a massive disparity between different councils. Some 13% of local authorities cause 50% of the delayed transfers of care—DTOCs. The real point is that those local authorities that go furthest and fastest in integration, with trusted assessors, early discharge planning and discharge to assess, have the most success.

Social Media and Young People's Mental Health

Barbara Keeley Excerpts

Wednesday 2nd November 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Alan. I congratulate the hon. Member for Cheltenham (Alex Chalk) on securing this important debate. I draw attention to the contributions made by my hon. Friends the Members for Neath (Christina Rees) and for Ogmore (Chris Elmore). There is not enough time for me to mention everybody who spoke because, as usual at the end of these short debates, we are tight for time, but I particularly thank the hon. Member for West Aberdeenshire and Kincardine (Stuart Blair Donaldson). He spoke of a painful experience, which is always so difficult to do.

Young people are growing up in an age in which online culture and social media are so central to everyday life. That is particularly true of social networking sites, to which more than 85% of children now belong. We have heard some interesting statistics relating to that throughout the debate. Commenting on social media and mental health, the Children’s Commissioner said:

“Excessive use of social media has been linked to poor mental health…When combined with bullying it can have a terrible effect.”

Consultant child and adolescent psychiatrist Dr Sebastian Kraemer gave evidence to the Health Committee as part of the inquiry into young people’s mental health mentioned by the hon. Member for Cheltenham. On the impact that digital culture can have, he said:

“It makes intimidation more alarming and more chronic. You can be teased in the playground and it has gone with the wind, but if you have got your photograph on Facebook then it stays there forever…The medium is not the cause, but it certainly facilitates different ways of harming each other, of abusing each other, and that is what young children do.”

Parents are seeing the link. In a survey of more than 1,000 parents with children under 18, four fifths blamed social media for making their children more vulnerable to mental health problems. It seems that the excessive use of social media can be linked to depression and can play a role in heightening underlying anxieties and lowering self-esteem—we have heard about some interesting cases.

These days, there is much concern about body image and appearance, which is another potential cause of anxiety and low self-esteem. It is clear that social media can intensify such feelings. A small study in the United States found that teenagers were affected by the “like” culture, with photos with more likes being more attractive to them. This like culture was found to affect self-esteem, as the hon. Member for Cheltenham and my hon. Friend the Member for Ogmore both said.

The damaging impact of social media has been seen as one of the causes leading to the increase in the number of children and young people self-harming in the past 10 years. ChildLine has seen a 35% increase in the number of contacts from young people with anxiety. That increase has been linked to the rise of social media, which has increased the pressure to attain a so-called perfect life. With increasing numbers of young people self-harming or being diagnosed with depression or anxiety, will the Minister tell us what action is being taken to understand the possible links between social media and depression, anxiety and other mental health issues? I agree with the hon. Member for Cheltenham that we need a robust strategy and some research that proves the links.

We have heard much about cyber-bullying, which is a growing problem, with more than one in 10 young people admitting they have been affected by it. We heard about Declan; I am very glad to hear that he has moved past the bullying phase that was so affecting him. Bullying UK found that 43% of young people aged between 11 and 16 had been bullied via social networks. Bullying has been found to be a factor associated with children’s mental health issues. One study reported by the Office for National Statistics found that children who had been bullied at 13 were more than twice as likely to have depression at age 18.

Stress and anxiety have also been linked to cyber-bullying. Will the Minister outline what action the Government are taking to tackle cyber-bullying and what measures will be put in place to help young people who are affected? Following the debate on young people’s mental health in the main Chamber last week, my concern is that help is not getting through to children before mental health problems escalate. Indeed, in 2015 the Children’s Commissioner found that one in four young people experiencing serious emotional or psychological problems were being turned away from specialist mental health treatment.

Early intervention can help. Lorraine Khan of the Centre for Mental Health said:

“There is good evidence for a range of interventions to boost children’s mental health, and the sooner effective help is offered the more likely it is to work.”

However, Government cuts to local authority budgets have meant the loss of services for children and young people. Cuts have been made to the numbers of social work staff and educational psychologists, and to mental health services in schools, leading to a reduction in care and support for young people. In the face of such cuts to early intervention and prevention services, will the Minister outline what steps are being taken to develop better early intervention?

From pressures about body image to cyber-bulling and the pressures caused by social networking sites, it is clear that we need to do more research on the impact that social media are having on young people’s mental health. Although Ministers have pledged extra funding for mental health services, we know it is not reaching the front-line services that children and young people need. Schools and colleges must be supported to help their students to cope with the challenges of online culture that we have heard about in this debate. The internet and social media are clearly here to stay, so it is vital that the Government ensure that young people receive the help, support and guidance that they need in this digital age.

[Sir Alan Meale (in the Chair)]

Before you begin, Minister, may I ask you to be so kind as to consider leaving up to a minute at the end of your speech for Mr Chalk to sum up?

Young People’s Mental Health

Barbara Keeley Excerpts

Thursday 27th October 2016 Commons Chamber

[Tim Loughton]

The hon. Gentleman is right; he pre-empts a couple of my comments. From my experience as a former Minister—and, I am sure, from his—the term “joined-up government” is a complete illusion. Joined-up government does not happen in practice. On becoming a Minister, one is cocooned in a Department, and instead of having a dialogue with colleagues in the Division Lobby or wherever, a huge wall suddenly comes between you. Trying to get interdepartmental action becomes really frustrating.

I remember setting up something called the youth action group, which consisted of Ministers from nine or 10 Departments and representatives of six major children’s charities. It was co-chaired by the Prince’s Trust and Barnardo’s. The charities came to us with problems—often complex ones—affecting young people. One example related to housing benefit and accommodation for children in care. I cannot remember what the specific problem was, but it involved housing, which was the remit of the Department for Communities and Local Government, and benefits, which were the remit of the Department for Work and Pensions, as well as children in care, who came under the remit of the Department for Education. Normally there was a vicious circle that involved people being pushed from pillar to post. Alas, that committee has not met for the past 15 months or so, but our meetings used to consist of at least six actual Ministers—not just civil servants—from the relevant Departments as well as their officials. We would get Ministers together and ask them to go away and solve the problem.

Mental illness falls into that category, in that it is not simply the remit of the Department of Health or the Department for Education. There are many other implications and knock-on effects that can relate to the underlying cause of somebody’s mental illness problems. The hon. Gentleman is absolutely right that the structure of government needs to be much better. We need taskforces that genuinely cut across Government Departments, but in my experience they will flourish only if they have the buy-in and direct engagement of Ministers at the top. One welcome initiative from the hon. Gentleman’s party was the appointment of a Cabinet-level Minister for mental health. I think that that appointment has slightly gone by the wayside now, but the principle behind it was absolutely right, in that it tried to join up all the relevant Departments at the top table.

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

May I remind the hon. Gentleman that I am the shadow Cabinet Minister for mental health? That post has not gone away on this side of the House.

[Tim Loughton]

I am delighted to hear that; I did not in any way mean to underestimate the hon. Lady’s contribution. However, when the hon. Member for Liverpool, Wavertree (Luciana Berger) held the position, she sat at the Cabinet table. I hope that that is still the case, and I would very much like to see my own party replicate that position in government, because this is such an important cross-cutting issue.

Mental health remains the Cinderella service of the NHS. Indeed, the report describes child and adolescent mental health services—CAMHS—as the Cinderella service of a Cinderella service. The whole question of parity of esteem and funding is important. We can have arguments about how much the NHS budget has increased and kept up with inflation, but in every year in which the funding for mental health remains static or, worse still, declines as a portion of the overall NHS budget, we are sending out a clear message that it is a secondary priority within the NHS, and therein lies part of the problem.

I do not want to be too negative, however. We are making progress, as are other countries. For example, when you go in through the main entrance of a hospital in Copenhagen, in Denmark, you turn left if you have diabetes and you turn right if you have a mental illness. And nobody cares whether you turn left or right; there is no stigma attached to mental illness. People are treated on exactly the same basis, and that is how we need to treat mental illness here. Despite the best intentions of many Ministers, that is just not happening in practice at the sharp end where our young constituents are trying to access the mental health support that they desperately need. It is certainly not happening in a uniform way across the whole country. As a result, at least one in four people in this country is still suffering from a mental health problem.

I have a particular interest in perinatal mental health, and I declare an interest in that I chair the all-party parliamentary group for conception to age two—the first 1,001 days. I am also chairman of the trustees of the Parent and Infant Partnership Projects charity. We now have seven parent infant partnerships—PIPs—across the country providing direct support and specialist perinatal psychological help to mums and dads with newborn babies. About half of all cases of perinatal depression and anxiety go undetected, and many of those that are detected fail to receive evidence-based forms of treatment. Alarmingly, at the time of the publication of the all-party group’s report, “Building Great Britons”, in February last year, just 3% of clinical commissioning groups in England had a strategy for commissioning perinatal mental health services. The upshot of all that, as the Maternal Mental Health Alliance has calculated, is a cost to the NHS of £8.1 billion for each one-year cohort of births in the United Kingdom. That is the equivalent of almost £10,000 for every single birth in this country, and it is a cost that the NHS can ill afford.

Why is this relevant to young people? Nearly three quarters of that cost relates to the adverse impacts on the child rather than the mother. Followers of attachment theory, which the hon. Member for West Ham (Lyn Brown) mentioned, will appreciate the strong link between achieving a strong attachment between the child and the primary carer and good nurturing from the earliest age—that is, from conception to the age of two, as our report puts it—when the synapses in the brain are developing at a rate of some 40,000 a second and the child’s brain, character and development are being formed. The earliest experiences shape a baby’s brain development and have a lifelong impact on that person’s mental and emotional health.

Research shows a direct link between what happens to a mum during the perinatal period and her child in later life. If a teenager aged 15 or 16 is suffering from some form of depression, there is something like a 90% chance that his or her mum suffered from perinatal depression. The link is that clear, so it is absolutely a false economy not to help mum out at that early stage. And let us not forget dad, who also plays a crucial role. Getting it right with parents and children early on is crucial to the good mental health of children and young people. This is not rocket science—technically it is neuroscience—and we should be doing it better, sooner.

Certain other factors have been flagged up in the report. My hon. Friend the Member for High Peak (Andrew Bingham) spoke about many of them, including the peer group pressure that our children and young people experience. In fact, I have no children any more. My youngest is now over the age of 18, but we went through the teenage years together and I have seen these things at first hand. No one can go out in the morning without the latest iPhone, without checking Facebook and without tweeting what they are having for breakfast and Instagramming a photograph of it. And that all happens just after they have got up. The pressure to succeed in school and the hothouse of exams and testing are not conducive to the best mental health, and young people need support to help them through the challenges. We never had those challenges in my day, which I guess was even earlier than that of my hon. Friend the Member for High Peak. Social media is a huge influence on young people, and it was just not around in my day. I would hazard a guess that it was not around in your day either, Madam Deputy Speaker.

--- Later in debate ---

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

It is a pleasure to speak in this important debate on the Youth Select Committee’s report, “Young People’s Mental Health”. I too want to thank the Backbench Business Committee for allocating time for the debate, but I agree with the Conservative Members who suggested that this matter should have been debated in Government time. We must underline the importance of this report.

I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) and the hon. Member for South Cambridgeshire (Heidi Allen) on securing the debate. My hon. Friend talked about the focus on the need for early intervention, as did many other Members. She also talked about the need for beds, saying that sending seriously ill young people away from home had to stop. I think we all support that view. She made it clear that, in her view, the state of the service was a national scandal, and she raised a number of points that we hope the Minister will respond to. They included the recommendations for ring-fenced funding for CAMHS and for co-production involving young people in the design of CAMHS, and the need to improve mental health education in schools. I will talk about those issues as well. My hon. Friend also referred to the notion in the YMCA report on stigma, “I am Whole”, of young people feeling as though they are

“trapped inside a thousand invisible prisons”.

We should keep that in mind.

The hon. Member for High Peak (Andrew Bingham) acknowledged the legitimacy of the Youth Parliament. He also talked about the pressures on young people and related that back to his own experience when he was young. That has been a bit of theme in this debate. My hon. Friend the Member for West Ham (Lyn Brown) stressed the need for early intervention. That subject that has come up many times today, and quite rightly, because early intervention can decrease the severity of mental ill health. She made a powerful case for the Government’s funding pledges to be fulfilled.

The hon. Member for East Worthing and Shoreham (Tim Loughton) talked about the importance of the status of the report and rightly said that it should have been debated in Government time. I am glad to have his support for the fact that Labour has a shadow Cabinet Minister for mental health, which is me. It is interesting that the Scottish National party Government also have a dedicated Minister for mental health. I think we are moving towards a position in which that is seen as something to be supported. The hon. Gentleman also talked about the effect of the pressures of social media on the mental health of young people. It is interesting to note that we shall debate the impact of social media on the mental health of young people in Westminster Hall next Wednesday.

My hon. Friend the Member for North Durham (Mr Jones) talked about the real problems that parents and grandparents face in navigating mental health services. He talked about commissioning and made some important points about the difficulty of working through GPs in our medical model. He also talked about local government cuts and said that they were a false economy. I shall talk about that as well. He also talked about the need for open-access services, given the difficulty in navigating the system.

The hon. Member for Wealden (Nusrat Ghani) talked about a teenager with an eating disorder, the suicide rate and the problems faced by young men. Although there is a focus on the impact on women of mental health issues, young men are also badly affected.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) talked about access to mental health specialists in schools and training for staff, which has been a theme this afternoon. She also mentioned the need to modernise approaches. We keep hearing about the importance of IT and social media, and she referred to the SafeSpot app. Like several hon. Members, she also talked about online bullying.

The hon. Member for Bexhill and Battle (Huw Merriman) is back in the Chamber. He came out of a Bill Committee to speak today and regards this topic as very important. His clear commitment to mental health was shown by it being the subject of his first question at PMQs. He also talked about social media and the need for early intervention.

I did not know that my hon. Friend the Member for Ilford North (Wes Streeting) was elected an honorary president of the British Youth Council. He quite rightly thanked the Speaker for his support for the British Youth Council and the Youth Parliament. It is important, as he has done, to listen to young people’s concerns about mental ill health because that can lead to open, candid and courageous discussions. It is good that groups of young people can become more at ease with discussing mental health—there is hope for the future. He also talked about the exceptionally high incidences of mental health issues among LGBT young people, including high rates of self-harm and suicide. He referred to the poor standards of care at Brookside adolescent unit. It took a damning report from the CQC to highlight its problems, the consequence of which was the death of the young man Simon.

My hon. Friend the Member for Neath (Christina Rees) gave us the first speech of Matthew, a member of the Youth Parliament who works in her team, and talked about the lack of full and proper support for young people’s mental health. She also mentioned the difficult experience of a young person who had to visit the GP seven times before getting help and felt crushed by the lack of support. Like other Members, she referred to training for teachers and having a trained counsellor in every school.

My hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury) talked about hospital wards not being safe for young people with mental health problems. A headteacher in her constituency reported having three children sectioned from school, which is a sobering thought indeed.

The hon. Member for Linlithgow and East Falkirk (Martyn Day), the SNP spokesperson, talked about many local groups. It is a sign of the difficulties facing support within the NHS that there is a need for all the groups he mentioned.

Before I move on, I want to pay tribute to the work of my predecessor, my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger). She has campaigned tirelessly for improvements to the mental health system. Her work helped to raise the profile of many issues that had not previously been given the attention they deserve. I join other Members in congratulating the Youth Select Committee on its excellent report.

The Secretary of State for Health recently admitted to failings in mental health services for children and young people. He said:

“I think we are letting down too many families and not intervening early enough when there is a curable mental health condition, which we can do something about when a child is eight or nine, but if you leave it until they are 15 or 16, it’s too late”.

People working in mental health services know all too well the truth of what the Secretary of State says. We know that on average one in four people experience a mental health problem, that 50% of adult mental health problems start before the age of 15, and that 75% start before the age of 18. Yet just 8% of our mental health budget is spent on children, with CAMHS, which have been referred to extensively, representing just 1% of the NHS budget. Members have quite rightly referred to that as the Cinderella of the Cinderella service. Does the Minister agree that 8% is far too small a proportion of the budget to spend on youth mental health, and does she agree that more needs to be done to intervene earlier when mental health issues are involved? Demand is clearly outstripping supply. Demand for child and adolescent mental health services is growing, but Government action is not meeting that demand. Funding for overstretched mental health services is not reaching the frontline, where it is so badly needed.

As my hon. Friend the Member for North Durham said, essential support services are being lost as a direct consequence of Government cuts to local authority budgets. Ofsted has reported that between 2010 and 2015 there was a 38% cut—£538 million—in funding for children’s centres, and a 53% cut, which is £623 million, in funding for youth services. Very many children and young people are not receiving the help that they need until they reach crisis point, and those cuts in local authority services are part of the problem. By failing to address these critical issues, Ministers are letting down vulnerable children and young people.

Sarah Brennan, the chief executive of Young Minds, has said that children’s mental health services have been “woefully” underfunded for years and that:

“While the government’s extra investment is welcome, it’s unclear whether it’s making a difference to frontline services. Even if the new money is spent where it’s intended, the Chief of NHS England has admitted that it will only be enough to reach a third of the children who need help.”

She goes on to say:

“Because of long waiting lists the threshold for accessing specialist services has got higher. Without treatment, problems are very likely to escalate and children are more likely to self-harm or become suicidal, to be violent and aggressive, or to drop out of school, which can ruin their prospects for the future. Delays can also have a disastrous effect on families, with parents forced to leave their jobs to look after their children”.

A report for the British Medical Association underlines that by telling us that the number of young people aged under 18 attending accident and emergency because of a psychiatric condition more than doubled between 2010 and 2015. The number of children and young people self-harming has also risen dramatically in the past 10 years, with the upward trend more pronounced among girls and young women. We have heard examples of that in the debate.

The number of referrals to child and adolescent mental health services increased by 64% between 2012-13 and 2014-15, but 28% of children and young people referred to CAMHS were not allocated a service. Members have referred to that fact in this debate. A report by the Children’s Commissioner found that 79% of CAMHS imposed restrictions and thresholds for children and young people accessing their service—I could go on. We have a tale in this debate of an increasing number of referrals to CAMHS, high thresholds for care and long waiting times. What all those things mean is that many children and young people are not receiving help.

Let me come back to the Secretary of State, because in reference to the quality of care that CAMHS teams provide, he said:

“I think this is possibly the biggest single area of weakness in NHS provision at the moment.”

Does the Minister recognise that the statistics we have heard in this debate show that demand for mental health services has clearly outstripped supply? Can she tell us what actions Ministers plan to take to address those issues?

I want to talk about regional variation, because it is an important aspect of the issues we are seeing. The Children’s Commissioner’s report also highlighted regional variations in treatment, suggesting that access to CAMHS is, in effect, a postcode lottery. The data gathered suggest that in England the average waiting time between referral and receipt of services from CAMHS ranged from 14 days in the north-west to 200 days in the west midlands. Does the Minister agree that that level of variation is totally unacceptable? Can she highlight what Ministers are doing to achieve swift access to care across the country at the same levels? A recent report on the state of mental health by the Public Accounts Committee warned:

“Good access to mental health services matters. Many people can make a full recovery if they receive appropriate, timely treatment. However, a high proportion of people with mental health conditions do not have access to the care they need.”

I wish to dwell for a moment on the state of CAMHS services, because that has been an important aspect of this debate. There is a lack of crisis services, a lack of accountability for transformation plans, and a lack of co-production with parents, carers and service users. One person asked, “Who cares for the carers because it certainly isn’t the mental health service?” That view of CAHMS is borne out by nurses who work in CAHMS. In a survey of 631 CAMHS nurses, 70% said that the services were “inadequate” or “highly inadequate”—I put it to the Minister that it is very worrying that the very people who work in CAMHS refer to the services in such a way—73% said that the main problem was too few nurses, 48% said that there were too few doctors, and 62% said that there were too few beds for patients.

Last December, the Secretary of State made this pledge:

“CCGs are committed to increasing the proportion of their funding that goes into mental health.”

However, as we have heard in this debate, increased front-line funding is not being delivered, and that is clear in the provision of services.

Let me refer to a matter that was raised by a number of my hon. Friends. In the responses to the freedom of information requests made by my hon. Friend the Member for Liverpool, Wavertree, 73 out of 128 CCGs—more than half those that responded—admitted that they plan to cut the amount they will spend on mental health, which underlines the fact that the funding issue is just getting worse.

Does the Minister agree that the Secretary of State has clearly broken his promise and that many CCGs are not increasing funding for mental health? As we have heard in this debate, the pledge to achieve parity of esteem is repeatedly being broken. Despite Ministers’ promises about achieving parity of esteem between mental and physical health, there is still a great difference in the treatment of families of children with physical rather than mental health needs—a number of Members referred to that disparity. Indeed, many physical health hospitals now have family rooms or flats in which parents can stay to support a child, and parents can, in some cases, get help with transport costs. By contrast, the families of children in mental health units feel isolated. There is no provision for families to stay, and no support with transport costs, which can become prohibitive. Often a child can be sent home with no transition plan. It is clear from this debate that the Government are failing to achieve parity of esteem.

We had four questions on mental health at Prime Minister’s questions yesterday, which is an indication of the level of concern among hon. Members. The hon. Member for Bexhill and Battle made mental health the subject of his first such question. As my hon. Friend the Member for Ilford North said, there was real disappointment about the responses from the Prime Minister, so I hope that we get better answers from the Minister today.

Much has been said about education and the role of schools. A report by the Education Committee on the mental health and wellbeing of looked-after children made the clear recommendation that schools should have a role in teaching about mental health and wellbeing. That report said:

“The interface between schools and health services needs to be strengthened to ensure that teachers and schools are better equipped to identify, assess and support children and young people with mental health difficulties.”

It has been quite clear in this debate that Members feel that schools and colleges should play a key role in promoting the good mental health of children and young people. More young people are experiencing serious psychological distress because they are under unprecedented social pressures. It is a credit to Members that those pressures are recognised.

Although we will not have time to cover this subject today, I have to say that easy access to the internet poses new challenges for young people. Cyber-bullying is increasing with more than one in 10 children now saying that they have experienced it. Young people cannot get away from bullying even when they have closed the door of their homes.

A number of Members have stressed the role of schools in ensuring that these problems are spotted as early as possible and addressed. Counselling services are vital. As a Salford MP, I am pleased that Salford has launched a register of approved providers of counselling in schools, and that one provider has already been appointed to deliver a two-year pilot to train and support a cluster of schools in counselling. My hon. Friend the Member for North Durham talked about the importance of counselling, but we recognise that there are funding problems. Many schools will not be able to afford to pay a trained counsellor.

Clear guidance is needed for schools on how to commission high-quality mental health support programmes and how to tackle mental health discrimination and stigmatisation. Will the Minister outline the Government’s plans to ensure that education, health and social services work together to provide an extra layer of support to spot and treat mental health problems? The hon. Member for East Worthing and Shoreham talked about how cross-departmental working can help.

Clearly, the best way to deal with a crisis is to prevent it from happening in the first place. It is critical that people can access the right information and that better support is provided in childhood and adolescence. That can help to reduce the incidence of young people developing mental health problems.

Overall, it is clear from the debate that actions speak louder than words. If Ministers are serious about tackling these issues, they must follow through with their funding pledges. Government cuts to local authority budgets, which I and others have referred to, have meant that many of the local services providing early intervention have had to scale back services or close their doors. I have talked about cuts to children’s centres, social workers, educational psychologists and mental health services in schools. There has been a reduction in care and support for under-18s, so we need urgent action. The Minister has been urged by Government Members, as well as Opposition Members, to relieve that pressure on overstretched CAMHS, but we also need to develop prevention and early intervention strategies. Crucially, the right help and support must be available for vulnerable children and young people when they need it, not 200 days later. I look forward to the Minister answering my questions and those of my hon. Friend the Member for Dulwich and West Norwood, and telling us what action will be taken to improve provision in this vital area.

--- Later in debate ---

[Nicola Blackwood]

One of the ways in which we are ensuring that money reaches the frontline is through driving accountability through transparency. Mental health services have lagged behind the rest of the NHS in terms of data and our being able to track performance. That is why the NHS will shortly publish the mental health dashboard, which will show not only performance but planned and actual spend on mental health. This is real progress.

[Barbara Keeley]

Let me make a couple of points in addition to the useful points made by my hon. Friend the Member for West Ham (Lyn Brown). First, it is clear that CCGs are ignoring the Government’s requests, so we will need more action than the dashboards and transparency that the Minister has mentioned. The Secretary of State will need to go back to CCGs and make the position very clear to them. Secondly, as other hon. Members and I have said, there is the question of local authority funding. Over £1 billion has been taken out of various services for children and young people such as children’s centres and youth services. That is a factor too. Those two things need to be addressed.

[Nicola Blackwood]

It is not fair to say that CCGs are ignoring the funding that is coming through. Moreover, it will not be possible for them to ignore what is going on when transparency and accountability is put in place with data sets that clearly show not only performance down to CCG level but the amount of funding that CCGs are given and the amount they are spending. These data will be much more detailed than before. In January, we introduced the first ever provider-level data set on children’s mental health services, and that will provide data on outcomes, length of treatment, source of referral, and location of appointment.

[Nicola Blackwood]

I am happy to look at it. We are very clear that there is a vital role for the voluntary sector to play in delivering some of these services. We hope that local transformation plans will be part of the way in which this is clarified. The programme to deliver transparency and accountability will be essential if local areas are not only to design effective services that match the needs of their local populations, but to be held to account for delivering them. I will not beat about the bush. We recognise that a complex and severe set of challenges faces children and young people’s mental health services. This area has been undervalued and underfunded for far too long.

While I am happy to investigate funding formulas such as those mentioned by the hon. Member for Ilford North in relation to Redbridge, I agree with him that leadership and accountability are also key to making the changes that we need. That is why we are committed to delivering real changes across the whole system, not just in funding, and to building on the ambitious vision set out in “Future in mind”. I pay tribute to my predecessors for the work they have done to bring those forward. As the hon. Member for Dulwich and West Norwood has said, we need to go further to drive through these changes, which young people have told us they want to see.

Children want to grow up to be confident and resilient, and they want to be supported to fulfil their goals and ambitions. We are placing an emphasis on building in that resilience, on promoting good mental health and wellbeing, on prevention—it is so important, as the shadow Minister has said—and on early intervention, as a number of the recommendations propose. We are looking, in particular, at how we can do more upstream to prevent mental health problems before they arise.

[Barbara Keeley]

The Minister is about to move on to intervention. Before she leaves funding, which has been pretty key, does she believe that the 8% of the budget spent on young people’s mental health—1% for CAMHS—has been anything like adequate? I did put that question to her. If she does not think that that is adequate, could Ministers tell us what they think it should be? If CCGs are ignoring Ministers’ continual urges to them to make pledges, will there be sanctions against CCGs that do not put in that extra funding?

[Nicola Blackwood]

I think I have already answered those questions. The Government have been clear that we think that mental health funding for children and young people, as well as for other areas of mental health, needs to increase. That is why we have increased mental health funding to local areas and we are putting in place measures to improve accountability and transparency, and the STPs, to make sure that that can be tracked locally. We are going to see how it works in the first instance.

Health Service Medical Supplies (Costs) Bill

Barbara Keeley Excerpts

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

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

I thank all Members who have made contributions to the debate. We find ourselves in a situation where we have some time available, which is amazing.

Let me refer to the interventions we heard in the early part of the debate, because a range of interesting points have been raised. The hon. Member for Totnes (Dr Wollaston) made the point that the Bill provides the opportunity to look at drugs that have not been licensed, such as Lucentis and Avastin, which is not licensed for age-related macular degeneration but is so needed by that group of people. I was pleased to hear the Secretary of State say that he would look at that.

My hon. Friend the Member for Wolverhampton South West (Rob Marris), in a number of amusing interventions, talked about policy on profit control of the pharma sector and found that the Conservative party is marching on to the centre ground—or has perhaps gone past the centre ground.

My right hon. Friend the Member for Leicester East (Keith Vaz) talked about the proportion of the NHS budget spent on dealing with diabetes. He was concerned about the increase in the drugs bill and suggested the use of structured interventions, not just more drugs, because such a large proportion of the NHS budget is being spent on diabetes.

My hon. Friend the Member for Alyn and Deeside (Mark Tami) made the important point that we need to ensure the measures in the Bill do not act as a disincentive for pharma companies to conduct research into rarer conditions. I think that hon. Members who have contributed know we are walking the line in terms of making savings but making sure there are not disincentives.

The right hon. Member for Chelmsford (Sir Simon Burns) welcomed the Bill. He talked about our ageing population—we returned to that with our last speaker—and the increasing drugs bill. He talked about the importance of new drugs, but also the need to deal with unacceptable profiteering, something referred to by a number of Members.

The hon. Member for Central Ayrshire (Dr Whitford) talked about the UK having the biggest research network in the world. She talked about change and the fact that the pharma companies would be nervous and anxious. She welcomed the tidying up aspect of the Bill and I think the general view of Members in all parts of the House was to welcome that. Like a number of hon. Members, she talked about not just enabling the management of cost pressures but doing something more radical. That has been a real flavour of the debate: using this as an opportunity to do something different. I agree with her concerns about the data collection aspects of the Bill and I will say more about that. I also agree that we need to do something more radical. She talked about tackling the five-year delay to access new medicines and rightly pointed out that that is probably where our poorer survival rates are coming from.

The hon. Member for South West Bedfordshire (Andrew Selous) commended The Times for investigating this issue. He also talked about the information powers and questioned whether the Department of Health had the analytical ability to use the data being gathered. That is an important question. If new data needs to be gathered, what are we going to do with it?

The right hon. Member for North Norfolk (Norman Lamb) acknowledged the value of the competitive market, but talked about the sometimes outrageous increases in the price of generic drugs—and we have heard some staggering examples today. He gave the example of a rise of £600 per item dispensed in one particular case, and he hopes, as other hon. Members do, that the Competition and Markets Authority will take action. That has been a key theme in tonight’s debate.

The right hon. Gentleman also talked about not wanting to pit the needs and interests of some patients who need drugs such as PrEP against those who need other drugs. I agree, and I do not think that we should go there in our debate. He spoke about the slippery slope when we get into debating whether to delay adopting even approved treatments. In his view, that provides more evidence that the NHS needs more resources.

The hon. Member for Vale of Clwyd (Dr Davies) talked about the impact on his constituent of a drug prescribed to her that helps her to work and increases her energy levels, the cost of which has increased by 645%. We must maintain a focus on the impact on individuals of the decisions that we make. She has found a drug that suits her, and it would be dreadful for her if it were withdrawn. The hon. Gentleman also talked about the difficulties of introducing new competition into the market. His constituent is hoping that the Bill goes through, as are many others here tonight, and wants action on competition and markets. Let us all hope this goes through.

The hon. Member for Torbay (Kevin Foster) talked about intervention to deal with market failure. In his view, we need to separate out the companies that are doing good research, such as the brain tumour research that he has recently seen, and those that have nothing to do with producing new and innovative products, but are just making money.

[Rob Marris]

I would like to cite for my hon. Friend and the House the Library briefing, which shows that it is not exactly as cut and dried as the hon. Member for Torbay (Kevin Foster) seemed to think. It tells us that the Competition and Markets Authority took action against pharmaceutical companies with regards to generic pricing, and that GlaxoSmithKline and a number of other companies were fined £45 million when it was found that payments had been made in order to prevent the antidepressant medication Paroxetine being offered on the generics market. GSK is a great pharma company for coming up with new drugs, but it crossed the line in this case, according to the Library briefing, so it is not always either/or when it comes to these pharma companies.

[Barbara Keeley]

No, but I think the hon. Member for Torbay was talking about companies that are not doing any research, but just buying up generic products and profiteering from them. There has been general condemnation of those sort of companies on all sides.

[Kevin Foster]

I want to be clear about this point. I think the shadow Minister would probably agree that certain names keep on popping up, particularly in The Times investigation, of companies that seem to be regularly involved in some of the most eye-watering price increases and involved in the mixed model. This Bill is about tackling anyone else who might be thinking of following that kind of business model as a way of exploiting the NHS for money.

[Barbara Keeley]

Very much so.

The hon. Member for Bury St Edmunds (Jo Churchill) welcomed the Bill and talked about the fact that individual CCGs could save £1 million on unused repeat prescriptions. A number of different forms of savings could clearly be made. She talked about the pressure on social care, and I join her in my concern about that. The right hon. Member for Chelmsford spoke earlier about an ageing population and the need for drugs, but older people also do not want to be isolated. It is worrying that 16,000 cases of malnutrition were found last year with an average age of 64 among those cases. People need social care, and I hope that the new Chancellor will listen and bring forward funding for social care in the autumn statement, because people need more than drugs.

As my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) made clear earlier, Labour supports the broad aims of the Bill and what the Government are seeking to achieve—better control of the cost of medicines. However, as my hon. Friend also outlined, we have a number of concerns, and I hope that the Minister will address them in his closing speech.

As well as taking the understandable measures to collect pharmaceutical data and manage costs, the Bill also introduces provisions to manage the purchase of other medical supplies. I was glad to hear the Secretary of State raise in his opening speech the issue of the impact on the medical supply sector, but I have heard concerns expressed that the medical technology sector sees the new information measures as “onerous”. The hon. Member for Erewash (Maggie Throup) mentioned that, too. There is a concern that measures in the Bill fail to take into account the unique characteristics of medical devices and the medical device industry. I hope that they will start to be taken into account as the Bill progresses. There is seen to be a danger that the measures will put additional burdens on that sector and the NHS, and lead to higher costs. I hope that that is not the Government’s intention; it would be ludicrous if costs were increased by a Bill that is designed to manage them.

We need to bear it in mind that the medical technology industry employs around 89,000 people in the UK, has an annual turnover of over £17 billion and has seen employment growth of around 11% in recent years. Some 99% of the UK’s 3,310 medical technology firms are SMEs, with 85% of them having a turnover of less than £5 million. The cap levels at which data could be collected were mentioned earlier. We should bear it in mind that we are talking about an awful lot of small companies.

The Bill imposes a regulatory burden on all companies in the supply chain. The reporting requirements will affect all firms producing medical supplies, including the very small organisations. The issues we have extensively discussed on pharmaceutical pricing bear no relation to the price of other medical supplies. The example of a particular type of product was mentioned earlier, but they are or seem to be treated the same way in the Bill.

On the scale of the burden being imposed, the Government’s impact assessment is not much help. It says:

“The main costs will be on manufacturers, wholesalers and dispensers. These costs have not been quantified, as their magnitude will not be known until after consultation on subsequent regulations.”

Measures seem to have been bolted on to this Bill, as Members have mentioned, at the last minute, but because they could have a negative impact on the medical technology sector, we need to be very aware of them. The new information powers proposed by the Government are being put forward at a time when manufacturing firms are going through the uncertainty surrounding this country’s leaving the EU. These measures can only add to that uncertainty. As I said, 99% of the medical technology firms are SMEs, with 85% of them having a turnover of less than £5 million.

Notes on the financial implications of the Bill put forward a curious position that

“no policies will be directly implemented as a result of these changes. Their implementation would require additional future changes to secondary legislation and additional Impact Assessments to assess their cost effectiveness.”

Ministers are asking us to change primary legislation to give the Government new information powers, but the details and impact of those new powers on the supply chain will emerge only in future. That level of uncertainty is unacceptable, and we will seek to amend the relevant clauses in Committee if we feel that this still needs to be resolved.

Importantly, the information powers will also impact on dispensing GPs and pharmacists. I note that the BMA was not represented at the workshop held by the Department of Health on the information powers. We wait to hear, but I would find it unusual if our hard-pressed dispensing GPs would welcome the additional work required of them to provide and disclose information to the Government.

The other part of the supply chain affected by the new information powers will be pharmacists. The Government have just imposed punitive cuts on pharmacists, which we discussed in the House last week. I am still deeply concerned about those cuts. Ministers do not seem to understand what they are doing to the sector. On Friday, an independent community pharmacist in my constituency told me that he estimated that the Government cuts would cost him £86,000 a year, and that he envisaged an average cut of £60,000 for many pharmacies. That will certainly mean staff cuts, but it also means potential bankruptcies for the pharmacies that will be hardest hit.

In relation to that, and the new information powers that the Bill imposes, Pharmacy Voice told me that

“small volume pharmacies are the hardest hit by the proposals and many face a funding cut of around 20% in 2017/18 from the imposition of cuts announced…They do not have teams of administrative staff who can respond to demands for information, and the likelihood is that the NHS would insist on information being provided in a specific format.

It could be information that they do not currently analyse. For example, when a pharmacy buys stock for dispensing, it may also include purchases of medicines for sale over the counter. The overall discount the pharmacy gets on the order is not allocated to each item, and pharmacies could not provide the actual price paid per item.”

On behalf of the pharmacists that it represents, Pharmacy Voice wants to ensure that the cost of meeting the Government’s information requirements is fully funded by the NHS. It feels that the imposition of cuts has already jeopardised the future of the pharmacy sector, and that of small pharmacy businesses in particular. Can the Minister assure me that the cost of the information that must be gathered under the new information powers will not impose an additional burden on pharmacists?

The Labour Opposition support the broad aims of the Bill and the measures to control the costs of medicines, but, as I said earlier, we are concerned about the information powers that the Government want to take, which are considered to be “onerous” by the medical supplies sector. We want to be reassured that they are not. The work and the costs involved could deal yet another blow to the pharmacy sector, which, as I have said, is still counting the costs of the Government’s imposition of funding cuts amounting to 12% for the rest of this year and over 7% next year. We will table amendments in Committee relating to the work and the costs involved in information-gathering.

We also ask Ministers to give serious consideration to using all future rebates from the pharmaceutical sector to improve access to treatments for patients. A number of Members have referred to the need to examine that much bigger issue of access to drugs and treatments, and I hope that Ministers will take the opportunity to do so as the Bill progresses.

[The Minister of State, Department of Health (Mr Philip Dunne)]

What a great pleasure it is, Mr Deputy Speaker, to stand before you after this important debate, with a little time in which to satisfy as many Members as I can, while recognising that the Committee stage will begin shortly and we shall then have an opportunity to discuss points with which I cannot deal today. I thank everyone who has taken part in the debate. We have heard a number of excellent contributions, some of which showed a surprising knowledge of the intricacies of pharmaceutical pricing but were none the less very welcome.

The Bill deals with a treasured national institution, our national health service, and with the need to secure the best possible value for the taxpayer. Medicines represent the second largest cost to the NHS, after staff, and it is important that we do not pay over the odds. The level of interest and the quality of the contributions that we have heard today have shown how important that is to all Members. I find it refreshing that a debate involving the NHS should feature the degree of consensus that has erupted across the House today. I am led to believe that—as has been pointed out by other Members—this is a relatively unusual occurrence, so I shall enjoy it for as long as I can.

The debate reinforces the principles of securing the best possible value for the NHS, making decisions on the basis of good-quality information, and supporting this country’s innovative pharmaceutical industry, to which several Members have referred. Those are principles on which we can all agree. However, the debate has raised a number of other issues, some of which I hope to clarify for the benefit of Members who have commented on them. In one of her closing comments, the hon. Member for Worsley and Eccles South (Barbara Keeley) sought to link last week’s announcements about community pharmacy funding with the Bill. I can reassure her that there is no link whatsoever between the Bill’s provisions on information collection and the announcement about decisions on community pharmacy funding. The funding changes will come into effect in December and are not reliant on any of the provisions in the Bill, and the provisions in the Bill will not change those decisions.

[Barbara Keeley]

Perhaps I was not clear enough, but I was not making that point. I was making the point that the cuts imposed by the Government will mean that some community pharmacies—the smaller ones; the independent ones—will not have the necessary staff. If the Government are imposing a new information-gathering requirement, who will carry out that task? As I said, there may be staff cuts amounting to between £60,000 and £80,000, and people will simply not be able to absorb a new requirement.

[Mr Dunne]

Just to reassure the hon. Lady, I can tell her that the establishment cost for each pharmacy is currently £25,000, and there will be a reduction in that cost rather than a much larger cost. She must be referring to companies that have several establishments, rather than to individual ones. I will touch on the points that she has raised about information gathering in a moment.

We have heard a number of allegations during the debate, starting with those made by the hon. Member for Ellesmere Port and Neston (Justin Madders), who I am sure will be joining us shortly, that the Conservative party appears to have broken out in a rash of Corbynism. I can assure the hon. Gentleman categorically that that is not the case. What we are seeking to do through the Bill is address points, which have been made by hon. Members on both sides of the House, about the potential for exploitative pricing, particularly of unbranded generics that are of low volume, in circumstances where there is no competition from an alternative supplier in the market. I believe that there is considerable agreement on that across the House.

I welcome the support for the Bill from the Labour Front Bench, from the Front Bench of the Scottish National party and from the Liberal Democrat spokesman, the right hon. Member for North Norfolk (Norman Lamb). They all support the principles behind the Bill. I look forward to what I hope will be a rapid conclusion to proceedings on this short Bill in Committee. Doubtless hon. Members will be raising important points in Committee, but I am sure that we will continue to have constructive contributions throughout.

The hon. Member for Ellesmere Port and Neston mentioned difficulties of access and funding for new medicines. These points were also raised by the hon. Member for Central Ayrshire (Dr Whitford). The NHS is investing in innovative medicine and, in the first year of the current voluntary scheme, medicines covered by the innovation scorecard saw an increase of more than 18% compared with growth of about 5% in medicines not on the scorecard. That illustrates that we are prepared to fund patients’ use of innovative medicines under the existing scheme. However, we recognise the need to continue to ensure patient access to new medicines. That is why my right hon. Friend the Secretary of State referred earlier to the accelerated access review, which was announced earlier today. That will accelerate the speed at which 21st-century innovation in medicine and medical technologies can be taken up by patients and their families through the NHS. That will present a real advantage—bringing forward innovations from pharmaceutical companies, not only in this country, and driving them through for use in the NHS.

A number of hon. Members have referred to the investigative work of The Times in helping to highlight the problems with unbranded generics. I would like to add our welcome to the investigation that was undertaken by those journalists, but gently to point out that the Government were already aware of some of the problems. Indeed, we published a consultation in December last year raising that issue, and I think it was partly in the light of that that The Times decided to do its work. I do not wish to decry that work in any way, however. It was clearly helpful.

We have referred cases to the Competitions and Markets Authority, as the hon. Member for Wolverhampton South West (Rob Marris) mentioned. The CMA has imposed fines in one case, as he said, and it is expecting to reach a final decision on another in the coming months. Two more cases were opened in March and April this year. We are looking to refer examples of bad practice to the relevant authorities when we come across them.

The hon. Member for Central Ayrshire asked how the data collection would work. That point was also raised by other hon. Members. We already collect significant data from the supply chain for medicines under the voluntary scheme and the statutory scheme. We collect data from manufacturers and wholesalers of generics, and from pharmacies themselves. As part of developing the regulations, and of the consultation that will take place before we introduce the scheme, we are looking to identify as many automated data collection solutions as possible, in order to minimise the burden to which the hon. Member for Worsley and Eccles South referred. In particular, we recognise that some of the medical products companies are small companies, and we want to make their burden as light as possible.

The hon. Member for Central Ayrshire referred to the devolved Administrations and how we will work with them. Our intention is that they would be able to access data not on a timing of our choosing, but as they require, and that, again, will be undertaken in a manner that we hope to capture in a memorandum of understanding so that there is clarity between each Administration and ourselves as to how that will work.

The right hon. Member for North Norfolk asked in particular about how we intend to control the medicines bill overall, and a number of Members have mentioned that. The cost of medicines across the NHS is rising quite rapidly. That is a concern, and it gets to the heart of why we have sought to introduce this legislation.

We are looking in the first place to align the statutory and the voluntary cost control schemes for the supply of medicine. At present, companies may decide to join either scheme depending on the other benefits they perceive in the schemes, but we believe that the financial benefit to the NHS of each scheme should be the same. Our proposals will put beyond doubt the Government’s powers to amend the statutory scheme to achieve this objective, which the impact assessment has indicated should save the taxpayer some £90 million a year. Draft regulations of these provisions will be available at the Committee stage.

The second element of the Bill strengthens the Government’s powers to set prices of medicines where companies charge unreasonably high prices for unbranded generic medicines. In most cases, competition works well to keep prices down. However, when it does not, and when companies are making excessive profits, the Government should be able to take action. This Bill closes a current loophole in the legislative framework. We are all agreed across the House that we cannot allow profiteering at the expense of the NHS.

Thirdly, the Bill will strengthen the Government’s powers to collect information on the costs of medicines, medical supplies and other related products from across the supply chain. Putting existing voluntary provision of information regarding medicines on a statutory footing will enable the Government to set more accurately and fairly the reimbursement arrangements for community pharmacies and dispensing GPs. In addition, the power will provide vital data to underpin the reformed statutory scheme for controlling medicine pricing, and will give us more evidence about whether companies are making excessive profits at the expense of the NHS.

I want to reiterate what my right hon. Friend the Secretary of State said in his opening remarks to assure the House about the impact of the information powers on the medical technologies industry. It may surprise Members, and in particular Opposition Members, that the powers to require information from suppliers already exists in section 260 of the National Health Service Act 2006—[Interruption.]—which the hon. Member for Wolverhampton South West says from a sedentary position he remembers bringing into effect, but we think that those enforcement powers are draconian and wish to make them more proportionate. The Government have never in fact used the powers under the 2006 Act, and we want to marry powers for information gathering with those we will have for medicines, so that there is no confusion in future about which information regime applies.

Community Pharmacy in 2016-17 and Beyond

Barbara Keeley Excerpts

1st reading: House of Commons
Thursday 20th October 2016 Commons Chamber

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

I thank the Minister for allowing me advance sight of his statement.

Community pharmacies play a crucial role in our health and social care system: indeed, 80% of patient contact in the NHS is in community pharmacies. The Government’s decision to press ahead with damaging cuts which represent a 12% cut for the rest of the year, on current levels, and a 7% cut in the following year will therefore cause widespread concern and dismay. The public petition that was launched when the funding cuts were first proposed became the largest petition ever on a healthcare issue. It now bears 2.2 million signatures. The message is clear: people want their community pharmacies to be protected.

In the face of unprecedented demands on health and social care services, the importance of local pharmacies is greater than ever. They help to safeguard vulnerable people and signpost them to other services; they are very important to carers; and, crucially, they reduce demand on GPs and out-of-hours services. Do Ministers not recognise the extent of the support that those pharmacies offer, and the impact that their loss will have on communities?

As the Minister said, the Government’s latest funding offer was rejected by the Pharmaceutical Services Negotiating Committee, because it was clear that there was little substantive difference between that settlement and their original proposal in December 2015, and that the outcome would be the same. Earlier this year the Minister’s predecessor, the right hon. Member for North East Bedfordshire (Alistair Burt), said that up to 3,000, or 25%, of community pharmacies could close, and clearly the thousands of remaining pharmacies could be forced to scale down their services. If the Minister does not agree with his predecessor, will he now tell us how many community pharmacies he expects to close as a result of the Government’s cuts? Pharmacies that do survive the cuts will be under significant pressure, which will result in job losses and service reduction. That is putting patient safety and welfare at risk.

The Government’s plans are not only deeply unpopular; they are short-sighted, and will hit the areas with the greatest health inequalities hardest. A study by Durham University has shown that pharmacy clusters occur most in areas of greater deprivation and need. Will the Minister reassure us that the areas of greatest deprivation will not lose pharmacies on which they rely, and will not be disproportionately hit by the cuts? I was not reassured by what he said in his statement.

The cuts will have a significant impact on older people, people with disabilities or long-term illnesses, and, I reiterate, carers, who do not have time to look after their own health and often do not even seek GP appointments. The Minister has said nothing today about releasing an impact assessment. Given that the effect of the cuts is likely to be substantial, with rural, remote and deprived areas most affected, when will we see an impact assessment to justify them?

Community pharmacies help to relieve pressure on our already overstretched health and social care services, and in recent years they have delivered more than 4% of savings for the NHS in cost reduction and quality improvement year on year.

It seems to me that Ministers are ignoring the conclusion of a recent PricewaterhouseCoopers report showing that community pharmacies contribute a net value of £3 billion through just 12 of their services—not all of them; just 12. Therefore, if one in four community pharmacies were to close, that value would be lost and the cost to the NHS would be significantly increased. Has the Minister considered the long-term impact that that will have on other NHS services?

We know that there is concern in many parts of the healthcare sector about these proposals. Can the Minister reassure us that all parts of the health service, including NHS England, support the proposals? Earlier in the week, he said that no community would be left without a pharmacy, but he was then unable to say which pharmacies would close and where. Will he repeat the pledge that no community will be left without a pharmacy?

We recognise the need, as does the Minister, to integrate pharmacy services better with the rest of primary care, but introducing cuts on this scale to community pharmacy services will not improve health services—it will damage them.

[David Mowat]

Frankly, a lot of that was scaremongering, which does not help what we are doing here and does not help with some of the difficult decisions we have had to make. Those difficult decisions are directed at modernising the service, bringing it up to date, making it much more dynamic in terms of added value and less static in terms of dispensing and all that goes with that.

I will answer some of the specific points that were made. There is a full impact assessment and it will be released immediately after the statement.

The hon. Lady asked about the PwC report. I have said on the record on a number of occasions that the report is an excellent piece of work. It does drive home yet again the value of community pharmacies, which we on the Conservatives Benches and in the Government accept. What it does not address is the extent to which those services could be delivered for less cost to the NHS. That is what I have to address and that is what we have done.

The hon. Lady asked whether NHS England supports the changes we are making. She might have heard the comments made by Simon Stevens, but I will read out, in answer to her question, a quote from the chief pharmaceutical officer of NHS England:

“NHS England, as the national commissioner of community pharmacy services in England, can reassure the public that the efficiencies which are being asked of community pharmacy will be manageable and there is sufficient funding to ensure there are accessible and convenient NHS pharmacy services in every community in England.”

[Barbara Keeley]

How many are closing?

[David Mowat]

The answer to that question is, I do not know. It is possible that none will close. I do not believe that 3,000 will close. However, I would say this. The average operating margin that the pharmacy makes on the numbers that I quoted earlier is 15%. That is after salaries and rent. The cuts that we are making, or the efficiencies that we are asking for, are significantly lower than that. Of course there is no such thing as an average pharmacy, which is why I cannot guarantee that there will be no changes. What I can say is that, if there are mergers and if there is some consolidation, that demand does not go away—it goes to the other pharmacies in the cluster. To say that those pharmacies will be put under more pressure is plain wrong.

I say again that what we are doing is building an industry that is fit for the future, that is modern and that is adding value in a way it has not been able to do in the past.

Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Hunt]

I can do better than that, because I have said that I am prepared to go to the health centre. I remember a very good visit to Thornbury community hospital during the general election campaign. I understand what those at the health centre are trying to do and they are absolutely right to be thinking about how they can improve out-of-hospital services.

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

Will the Secretary of State look into the creation of a sideways move for a chief executive of a trust that was criticised for failing to investigate patient deaths? Six weeks after the special recruitment exercise by Southern Health, Katrina Percy has resigned from her advisory role, with a substantial 12-month salary payoff that has been signed off by the Department of Health and the Treasury. The campaign group, Justice for LB, has called that “utterly disgraceful” and I agree. Will the Secretary of State investigate?

[Mr Hunt]

I agree with the hon. Lady that the way this case was handled was by no means satisfactory. The truth is that it took some time to establish precisely what had gone wrong at Southern Health. As this House knows, because we made a statement at the time—I think it was an urgent question, actually—there was a failure to investigate unexplained deaths. I do not think the NHS handled the matter as well as it should, but we now have much more transparency and we do not have a situation where people go on and get other jobs in the NHS, which happened so often in the past.

NHS Sustainability and Transformation Plans

Barbara Keeley Excerpts

Wednesday 14th September 2016 Commons Chamber

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

Does the hon. Lady agree that there is a startling fact about the underfunding of social care that Ministers cannot get away from, whatever they do or say? We have heard today of the case of care workers who are suing the contractor that they work for because they were paid only £3.27 an hour. How can somebody be discharged from hospital in an adequate way when that is the domiciliary care that will be waiting for them? It was interesting to hear the former care Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), say this morning that

“we have not got the cost of…adult social care really sorted out.”

[Dr Whitford]

I totally agree with the hon. Lady. I am not sure whether she took part in the carers debate that we had not that long ago, where I pointed out that unless we develop social care as a profession, then we all face a fairly miserable time in our old age. Nursing is a profession that is recognised and valued, and caring for our older ill population should also be recognised. We need to recognise them, to give them time to do their jobs, to pay them adequately, and to give them a career development structure that means that we bring the best people up and get them running teams.

As I said, I am disappointed by the aggression on both sides of the House. I know that such a debate is always a good tennis match for point-scoring, but the development of the STPs is an opportunity to do things that everyone in this House would agree with. However, if it is not done properly—if it is just a fig leaf whereby we pretend that something is being done—the NHS will suffer and we will be the generation of politicians who moved the deckchairs on the Titanic.

--- Later in debate ---

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

The Nuffield Trust has said that the sustainability and transformation plans could lead to

“fundamental changes in the shape and nature of health and care services.”

As we have heard in this debate, despite the significance of the plans, there has been very little opportunity for patients, the public, NHS staff or Parliament to scrutinise them. The BBC has seen draft STPs that propose ward closures, cuts in bed numbers and changes to both A&E and GP care. The Nuffield Trust, which has examined the STPs, sees the same possible changes plus a questioning of the role of community or cottage hospitals, which Conservative Members have referred to. Those are the reasons why many people, including my constituents, are concerned about the lack of consultation on the plan.

In Greater Manchester, the devolution document “Taking Charge”, which was published last year, is being used as the basis for the STP for Greater Manchester. It outlines the need for integrated health and social care, and reform plans for cancer, mental health and a number of other services. Our health and social care partnership believes that it made significant efforts to reach out to local people with the “Taking Charge” document, but when I looked at it I found that the actual number of people who were definitely reached was quite a small proportion of the 2.5 million population of Greater Manchester. A number of information booklets were sent out, there were 200 meetings and 6,000 people completed a survey, but we have 2.5 million people living in Greater Manchester.

The document does not include detailed plans about which services will be changed or any cuts that will be made in Greater Manchester under the STP. The document does outline savings totalling £1.5 billion—including from things such as prevention, reform of NHS trusts, productivity savings and joint working—but it provides no detail about how that will be done.

The health and social care partnership board is now finding a number of gaps that need addressing, including in the delivery of the nine “must dos” in the five-year forward view. As with savings, decisions about how to deliver those “must dos” are bound to have a significant impact on existing local services. The financial situation of our health and social care sector is, to me, one of the most important issues. I am concerned that the Government are passing the buck to local authorities and NHS trusts, leaving them to make plans without sustainable funding.

In Greater Manchester, as the Minister probably knows, we have revised down the size of the funding gap to £1.75 billion, but that is still a very significant financial challenge for our area. There are plans to centralise mental health, pathology and radiology, but what will it mean? Will services close? Those are the sorts of decisions that local people are entitled to know about before the STPs are signed off. We have an opportunity in Greater Manchester to tailor services to local needs, but that opportunity for positive change will be lost if we do not have a more sustainable financial model for our health and social care services.

Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 5th July 2016 Commons Chamber

[Mr Hunt]

I recognise the important role that community hospitals play in many of our constituencies, and that role will change as we get better at looking after people at home, which is what people want. We can all be proud of significant progress on dementia in recent years. Dementia diagnosis rates have risen by about 50%—indeed, we think we have the highest diagnosis rates in the world. However, it is not just about diagnosis; it is about what happens when someone receives that diagnosis, and the priority of this Parliament will be to ensure that we wrap around people the care that they need when they receive that diagnosis.

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

The Health Secretary has just promised 5,000 new GPs, and GP Forward View mentions recruiting 500 GPs from overseas. I understand that Lincolnshire GP leaders are looking to recruit GPs from Spain, Poland and Romania. As we have heard, EU nationals who live in the UK and work in the NHS are seen by the Home Secretary as bargaining chips, which has made them incredibly nervous about their status. How successful does the Health Secretary think that that GP recruitment will be?

[Mr Hunt]

This is a time when all sides of the House should be seeking to reassure many people from other countries who do a fantastic job in our NHS that we believe they will have a great future here. The Home Secretary has prioritised doctors, paramedics and nurses in the shortage occupation lists, and in all countries that have points-based systems—look at what happens in Australia or Canada—the needs of the health service and health care system are usually given very high priority.

Carers

Barbara Keeley Excerpts

Thursday 9th June 2016 Commons Chamber

[Huw Merriman (Bexhill and Battle) (Con)]

Thank you, Mr Deputy Speaker, for calling me to speak in this important debate. I thank my hon. Friend the Member for Eastleigh (Mims Davies) not only for securing the debate, but for bringing to the Chamber her powerful experiences and sharing them with us. I also want to thank the Minister for all that he does to ensure that carers are given the support they need and deserve.

I want to sign up to the suggestion made by my hon. Friend the Member for Chippenham (Michelle Donelan) that we should extend the pupil premium to all young carers. There are 160,000 young carers whose life chances are disadvantaged by the amazing duty that they perform. Extending the pupil premium to all those young people seems to me to be a very fair exchange for all that they do.

Looking at the other end of the age spectrum, 28% of my constituents in Bexhill and Battle are over 65. By comparison, the national average is 17%. Accordingly, I have a very high number of older carers in my constituency. That is what I want to focus my contribution on today. The 2011 census revealed that there are over 1.8 million carers aged 60 and over in England—almost 16% of the population in that age range. The number of carers aged 85 and over grew by 128% in the past decade, according to a report published last year by Carers UK and Age UK, and it is expected to double over the next 20 years, according to a Government report from 2014.

East Sussex has the highest proportion of over-85s in the UK. Again, that group will be highly pertinent to my constituency. Supporting this army of carers is absolutely essential if we are to ensure that our NHS continues to function. Given the Government’s welcome desire to support keeping people at home in their advancing years, rather than placing them in hospital, that support is even more important. I welcome the passing, by this Government when in coalition, of the Care Act 2014. The Act granted significant new rights to carers in England and placed duties on local authorities to ensure that support is delivered, advice is given and information is provided. It also placed a duty on NHS bodies to co-operate with local authorities in delivering Care Act functions, which, if the clinical commissioning groups in East Sussex can work as a whole, will lead to a “Better Together” integrated health system in East Sussex.

I am conscious that the delivery of those rights is contingent on local authorities having the necessary financial resources in place. I welcome the devolution of business rates to my county, but the yield in East Sussex is low and the demands from a population with above-average ageing is high. Our county will need more time to deliver and more investment in infrastructure to attract new businesses to the coast if this is going to provide for carers and other groups who need local authority finance and support.

I welcome the new 2% levy that local authorities can apply to council tax, provided that it is spent on adult social care. While I champion the rights of carers within the home, many carers are caring for loved ones who reside in care homes due to complex or advanced needs. It is absolutely essential that those carers have the comfort of knowing that their loved ones will be well cared for when they are not in the home to deliver it. I have championed the care home industry, which features heavily in my constituency. Funding them properly via the new 2% levy will, I hope, result in better Care Quality Commission ratings than those that have been awarded following recent investigations.

Across East Sussex, 60% of our care homes were found to be inadequate or needing improvement. It concerns me greatly that, because of these poor ratings, many of our carers may choose to soldier on at home when a care home would be the better choice for their loved ones. All the care homes that I have visited in my constituency have been fantastic. It is important that those that need to improve do so with the extra funding that the Government have procured.

In a rural constituency such as mine, social isolation can be a particular concern. This is exacerbated for older carers looking after loved ones. According to a report published in 2011, more than two thirds of older carers reported not getting breaks away from caring at all, with a further third getting a break only once every two or three months, or less. Let me therefore take this opportunity to thank all those constituents who do so much to give carers a break. While I am at it, let me name-check my mother and my two sisters, who regularly host teas at home attended by carers who do not get the chance to get out of the house and get looked after by someone else for a change. While it is right to look to the Government to be the ultimate support, very often it is the community and their acts of kindness, via visits, conversations, moral support and basic errands, who improve the welfare and wellbeing of our elderly carers. I salute all those who do it.

I am keen for the Government to look at the following suggestions that were made to me by the fantastic Care for the Carers team in East Sussex. First, we should help national partners reach more carers. Would it be possible to make it a duty for the NHS to identify carers, in the same way that the Care Act does for local authorities? Secondly, we should ensure that carers have good support. Would it be possible to ensure that local authorities do not charge carers for the support that they are entitled to? East Sussex is currently not charging carers, which I recognise and celebrate.

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

I thank the hon. Gentleman for his point about the NHS having a duty to identify carers. I have tried three times to introduce that in a private Member’s Bill, so I am really pleased to find support for it among Conservative Members.

[Huw Merriman]

I am pleased, as a novice in the House, that there is agreement across the House on that cause.

Thirdly, there should be help for carers in complex situations—those caring for people with dementia or mental health problems. It seems to me to be an obvious ask to promote good practice recommendations to commissioners and health professionals and to promote it in national policy making.

Finally, I thank and express huge admiration for all those who care for others in my constituency and beyond. I know that they seek little praise, but it is right that we should praise them this afternoon.

--- Later in debate ---

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

It is a pleasure to speak in this important debate on carers. I thank the Backbench Business Committee for allocating time for the debate and the hon. Member for Eastleigh (Mims Davies) for the thoughtful way in which she opened it.

There have been some interesting and thoughtful contributions from hon. Members. We heard from my hon. Friend the Member for Workington (Sue Hayman), the hon. Members for Chippenham (Michelle Donelan), for Ayr, Carrick and Cumnock (Corri Wilson), for Paisley and Renfrewshire North (Gavin Newlands), for Bexhill and Battle (Huw Merriman), for South Antrim (Danny Kinahan) and for Strangford (Jim Shannon), and the SNP spokesperson, the hon. Member for Central Ayrshire (Dr Whitford). We also heard briefly from the hon. Member for Dudley South (Mike Wood) and my hon. Friends the Members for Sheffield, Heeley (Louise Haigh) and for Foyle (Mark Durkan).

There are more than 6.5 million carers in the UK. We have all used different figures in the debate, but I tend to use that one. In my constituency, there are nearly 11,000 carers. I have known ever since I became a Member of Parliament that many of them have a heavy workload due to the ill health in my constituency.

In many areas of the country, people are living longer. As the population ages, we are living with increasingly complex care needs. Three in five of us will become carers—the hon. Member for Eastleigh touched on that. There are also more older carers. In England and Wales, almost 1.3 million people aged over 65 give unpaid care to a family member or friend. The hon. Member for Bexhill and Battle (Huw Merriman) spoke about the fact that, between 2001 and 2011, the number of carers who are over 85 increased from 38,000 to more than 87,000. More than half of carers aged over 85 give 50 hours or more of care every week. That is certainly something to think about.

We are failing to address key issues for carers. Inadequate support for carers and the people they care for damages carers’ quality of life. I will argue that Ministers must do more to recognise the importance of carers and to put in place policies to address their needs.

First, many carers continue to suffer financial hardship because of their caring responsibilities. As we have heard, a recent report by the New Policy Institute found that 1.2 million carers are in poverty. It is shocking to think that so many carers are struggling to make ends meet. In the Carers UK report, “State of Caring 2016”, half the carers surveyed reported cutting back on essentials such as food and heating. Others are having to borrow money, and more than a third use their own savings. The hon. Member for Strangford raised those issues. I feel very strongly that no carer should be pushed into poverty because of their caring responsibilities. I thank my hon. Friend the Member for Workington for talking about financial hardship among carers. It is an increasing problem.

Secondly, too many carers are left to cope on their own with little or no support. As we have heard, one in five of the carers who give 50 hours or more of care each week receive no practical support with their caring role. More needs to be done to protect carers’ health and wellbeing. We must ensure that carers are identified at the earliest possible stage so that they can find the help and support they need. As I said earlier, in the past I have introduced private Members’ Bills to place a duty on GPs and NHS bodies to identify carers and ensure that they are referred for support. The last time I introduced such a Bill, the coalition Government did not support it. However, that duty on the NHS to identify carers was included as a pledge in Labour’s manifesto in 2015.

The Government have promised a new carers strategy to give carers

“the support they need to live well while caring for a family member or friend.”

However, to achieve that aim, any new strategy must include a duty on GPs and NHS bodies to identify carers. After all, the NHS is nearly always the first point of contact for carers as they begin caring, and so is best placed to identify them. I welcome the support of the hon. Member for Bexhill and Battle for a vital change that we can make for carers.

Thirdly, I want to talk about the chronic underfunding of social care and the impact on carers. I have raised that many times with the care Minister and most recently with the Chancellor. In the previous Parliament, there were five years of funding reductions for adult social care, totalling £4.6 billion. Local authority spending on social care for older people fell in real terms by 17%, even as the number of people aged 85 and over rose by 9%. Three hundred thousand fewer older people receive publicly funded adult social care now compared with 2009. In the Carers UK survey, 60% of carers who had seen a change in the amount of support they received said that that support had been reduced due to cost or availability.

I hope that the care Minister will not repeat the Chancellor's mantra about the 2% social care precept and the increases in the better care fund arriving by 2019-20. The 2% social care precept is inadequate to meet even the Government’s minimum wage policy. In my local area of Salford, the cost of paying increases in the national minimum wage in the care sector will be £2.7 million, but the 2% social care precept will raise only £1.6 million. In effect, the council tax payers of my local area are paying for that Government policy of increasing the national minimum wage. The Minister knows that there is no increase in the better care fund this year and only £105 million extra next year. It is hard to understand why Ministers have refused the reasonable request from the Local Government Association to bring forward £700 million of better care funding to address the financial pressures that it faces this year and next year.

We know that there are real concerns about the financial viability of many of our social care providers. In evidence this week to the Public Accounts Committee inquiry on discharging older people from acute hospitals, the president of the Association of Directors of Adult Social Care, Harold Bodmer, said that the sustainability of the residential care and domiciliary care sectors was the main concern for social services directors. He also pointed to significant regional differences. He said:

“I wouldn't underestimate the impact of the differential effect on the social care market in different parts of the country, because there isn’t a domiciliary care problem in the north-east, but there is in parts of Hertfordshire, Oxfordshire and Norfolk. It is really difficult to get domiciliary care in north Norfolk."

I thank the hon. Member for Central Ayrshire for talking about home care not being valued. It may be that people in parts of the country where they cannot get domiciliary care are voting with their feet. People do not want to work in a sector that does not value or pay them properly. Home care should be a much more valued role.

I have real concerns that this fragility in care provision could leave more people without adequate care and put more pressure on unpaid family carers. This is worrying because more people are already providing care for more hours than ever before: 1.4 million people now give more than 50 hours of unpaid care a week, and that number is rising faster than the increase in the general population of carers. There has been an increase of 25% in people caring more than 50 hours a week in the past 10 years compared with an increase of just 11% in the total number of carers.

The Care Act 2014 entitles all carers to a timely assessment of their needs. However, one in three carers who have had an assessment in the past year had to wait six months or longer for it. Worryingly, nearly 40% of carers caring for someone at the end of life also had to wait six months or more for an assessment. That is unacceptable. Carers for people at the end of life should be prioritised. We have talked about that in different meetings here.

Timely assessments are surely one of the starting points in providing support to carers, but even when carer assessments take place it seems that they do not properly address carers’ needs. Almost 70% of carers in the Carers UK survey felt that their need to have regular breaks from caring was not considered in their assessment. Members have rightly repeatedly referred to the importance of breaks for carers. Seventy-four per cent. of working age carers did not feel that the support they needed to juggle care with work was sufficiently considered. We need those important assessments to be more than box-ticking exercises, but that can happen only if the Government invest in support for carers and give local authorities the resources that they need to provide care and support. I hope that hon. Members have been able to meet and listen to a number of carers this week—indeed, I understand from the debate that that is already happening.

At the carers week parliamentary event I met Katy Styles, who cares for her husband Mark, and she told me about a number of issues that she has encountered as a carer for a person with motor neurone disease. What I felt most in talking to Katy was that she wanted to be recognised and listened to as a carer, but she also raised issues of financial hardship. Katy and Mark Styles told their story to the all-party group on motor neurone disease, and Katy said:

“We told them about how we were once two professionals and how our lives had been devastated by Mark’s condition. I explained that as a teacher I had earned £150 a day and now I receive £62.10 a week in carer’s allowance for providing never-ending care and support for my husband. Mark explained how he was forced to retire at 46, that our income had fallen off a cliff, but our bills continued to increase. He told the group about how we travel miles and miles to receive care, and how we had to make adaptions to our home which were paid for with savings that we will never be able to replace.”

The MND Association found in its survey that more than half of carers for people with MND care for more than 100 hours per week, yet only a third have had a carer’s assessment, and four out of 10 people were unaware of their right to one. Caring for more hours each week can mean carers having to give up work and facing financial hardship, and we have touched on that in this debate. Some 2.3 million adults in the UK have given up work to care, and almost 3 million have reduced their working hours.

I do not want to leave the issue of financial hardship without mentioning women born in the 1950s who are carers, but who are now not getting their state pension until later in their 60s. I have spoken about carers such as Marian, who has given up work at the age of 62 to look after her mother and her brother, both of whom have dementia. Her only source of income is a small private pension of £2,500, and her husband will have to support her until she gets her state pension at 65. The Minister has probably not been involved in many of the debates on the state pension age, but many women born in the 1950s are in such a situation and now face financial hardship.

We have mentioned those who give up work to care or who struggle to manage their working hours, and about combining care with work, and the feeling in the debate has been that more needs to be done to ensure that employers provide carers with enough support. Some companies are leaders in providing support for their staff who are carers. For example, Centrica offers flexible working, access to counsellors, and an employee-led carers network that is supported by the company’s senior leadership. Its carer’s leave policy offers up to one month matched paid leave per year to help with caring responsibilities, and it also takes into account that caring responsibilities may fall to people who are not immediate family members.

I have concerns that members of this House are not able to provide those levels of support. IPSA contracts for Members’ staff offer only five days’ leave for caring reasons, and even that is stated as being for emergencies and dependants only. That minimal policy does not reflect good practice—the Minister will know what that is—and we could do better for our staff. I invite the Minister, the hon. Member for Eastleigh and others who have raised that issue, to join me in talking to IPSA to request a change in that policy. It is not good enough not to have better practice when supporting our staff who are carers.

As has been said, carers week is an important annual event because it provides us with an opportunity to recognise the contribution that carers make to society, and to highlight the challenges they face. I thank all organisations that support carers and provide hon. Members with so much information about caring issues: Carers UK, Age UK, Carers Trust, Independent Age, Macmillan Cancer Support, the MND Association, and the Multiple Sclerosis Society. My constituency contains the excellent Salford Carers Centre, and an amazing group of young carers are supported by the young carers project. I look forward to meeting them tomorrow. I also thank Marie Curie, which launched a report on end-of-life care for LGBT people in the House yesterday, as well as Together for Short Lives and the Rainbow Trust Charity for their support for children with life-limiting conditions and their families. Finally, I thank the UK’s 6.5 million carers, and especially the 11,000 carers in my constituency, for the essential role that they play in supporting our health and care system. Carers need and deserve so much more respect and support than they are currently given.

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

I congratulate my hon. Friend the Member for Eastleigh (Mims Davies) on securing this debate and on the way she opened it, and I thank the Backbench Business Committee for allocating time for this important debate during carers week. I will start where the hon. Member for Worsley and Eccles South (Barbara Keeley) ended, and thank all those who are involved in caring in our society. As we have heard from every speaker, carers make an invaluable contribution to the UK that we could not do without, and perhaps I can illustrate that by citing some of the remarks made by colleagues during the debate.

I will touch on some of the points raised by my hon. Friend the Member for Eastleigh in the remarks I have prepared for this debate, and I will also comment on her other points. She started with a graphic description of what might happen if carers were not around and if they decided not to do what they do every day, which brought the point home to us. She spoke about how people become a carer, and said that it could happen to any of us at any time. At last year’s national care awards I remember watching a video in which the point was made vividly that any of us in that hotel room could become a carer within 24 hours, and we can all understand that. As others pointed out, carers are no longer a minority group but people we all know—many of us are closely connected to carers, if not carers ourselves—and we are all only going to become more closely involved in the future. She, like others, made that point very well.

My hon. Friend also spoke, as did others, about the need to identify people not solely as carers but as husbands, wives, partners, employees—everything else they still are—and about the great danger of someone being pigeonholed because they have become a carer. It is important to remember that someone does not lose their identity when they become a carer. Hon. Members also highlighted the importance of carers week. I am proud to be the president of Carers in Bedfordshire—I have been for some years—and I thank it for its work. All hon. Members have thanked their local groups.

My hon. Friend was not the only colleague to speak of her personal experiences of caring. As I have mentioned from the Dispatch Box before, the range of Members’ experiences goes far beyond what the media are keen to portray and touches on virtually all aspects of life outside. When I hear the cares and experiences that colleagues bring to this place, I always hope that people outside read our debates and understand a bit more about us, why we want to be representatives in Parliament and the personal experiences we bring.

The hon. Member for Workington (Sue Hayman) and others spoke about finances, on which subject I could spend the whole 15 or 20 minutes. I know that this subject is particularly important to the hon. Member for Worsley and Eccles South, the spokesperson for the Opposition. On carers allowance, which the hon. Member for Workington focused on, the Government keep the earnings limit under review and keep under consideration whether an increase is warranted and affordable. The increase of 8% in 2015 far outstripped the increase in wages. The earnings limit is currently £110 a week, but that is a net figure, and if allowable expenses, such as childcare and pension contributions, are deducted, a claimant might earn significantly more. The limit enables a carer to maintain some contact with the employment market and achieve greater financial independence, but I recognise and would not minimise the constant financial pressures and difficulties facing families. The limit is kept under review. Also, as I said, there is a wider review of the carers strategy, which has allowed a lot of people to make contributions on finance, not just the amount but the important interlinking of benefits. That point will not be missed, and I thank her for raising the matter.

[Barbara Keeley]

Carers charities often raise with us the link with things such as the national minimum wage. The Minister talked about the figure last year, but the national minimum wage changed in April, and many of the carers trying to keep a part-time job going will be at that level, so it seems sensible to link the threshold with the national minimum wage so that when the national minimum wage increases, so does the threshold.

[Alistair Burt]

I cannot make that specific commitment, but I understand fully the hon. Lady’s point. As I said before, the earnings limit and all the factors affecting it are kept constantly under review, but I am sure that Treasury colleagues will not have missed the remarks made today.

My hon. Friend the Member for Chippenham (Michelle Donelan) also made the point about carers not being a small minority. She commended Carers in Wiltshire, and I commend her for being a volunteer—another example of the experience we all bring to this debate—and she raised the important issue of entitlement to benefits and signposting. In our call for evidence as part of the review of the carers strategy, respondents raised the importance of people being directed towards the things they need as soon as possible. The moment someone becomes a carer, their world changes, and they need as much information as possible at that time. She was right to mention the importance of signposting in particular. She spoke with great passion on the subject.

The hon. Member for Ayr, Carrick and Cumnock (Corri Wilson), who also spoke from personal experience, made a point about access to work. I shall talk about employment later, but she made her point strongly, and again she was not the only person to recognise that, although we all wish for a world in which burdens are shared equally, in truth they are not. Women carry the biggest burden when it comes to caring, and will probably continue to do so for some time. Recognising the extra pressures on women is particularly important. The hon. Lady made that point very well.

The hon. Member for Paisley and Renfrewshire North (Gavin Newlands) was particularly helpful in saying that although it is carers week for us, it is just another week for carers. I also liked it when he said that it was a week to talk “with”, not “to” carers. That was a particularly well made point. He spoke forcefully about the reality of life—the sleepless nights and other issues that carers experience.

My hon. Friend the Member for Bexhill and Battle (Huw Merriman) brought up the issue of care homes. I am not going to linger on that subject, but, as some colleagues know, I am particularly exercised about safety in care homes. It is my belief that someone in the care of the state, whether it be the NHS, local authorities or anyone else, needs to be as safe in a care home, a mental health institution or in learning disability facilities as they would be in an intensive care unit. As I expressed in yesterday’s debate about Southern Health, that is simply not the case.

I am very conscious of issues surrounding care homes. I have a round-table meeting on Monday with those responsible for the monitoring and regulation of care homes, and I pay tribute to the Care Quality Commission and others who are trying to do a good job of regulation, but this also involves some of the groups that are critical of regulation, want to see more done and want to ensure that there is safety in care homes. Some of the stories of abuse that we read about in the papers need to become fewer and fewer until they are extinct.

I want to praise the National Care Association because there are many good care homes, as my hon. Friend the Member for Bexhill and Battle said. It is important to keep the right balance in recognising the quality of good homes without minimising the pressures on them. When things that should not be happening are going on, it is quite difficult to maintain that balance. I appreciate the fact that my hon. Friend mentioned this important issue. I commend, too, the ideas coming forward from the carers team in East Sussex, and I urge members to ensure that the ideas put to my hon. Friend will be put into our national call for evidence. They have until the end of this month to do so. I do not envisage a statutory instrument to extend that still further, should there be a rush of evidence at the end of the month, but we never know in the present circumstances. Getting that information in would be very helpful.

The hon. Member for South Antrim (Danny Kinahan) was not the only one to refer to the pressures on our own caseworkers, who do so much work to look after people in the House. I appreciated his mention of that point. He hoped that the carers strategy would be a long-term strategy. I hope it will, too. The strategy should be reviewed from time to time—this is the first review for two or three years—and that is certainly the aim. That is why I would like the strategy to look slightly beyond the immediate and consider how to build for the future rather than simply having a snapshot now.

My hon. Friend the Member for Strangford (Jim Shannon)—I call him my hon. Friend—is exceptionally generous and courteous to all Front-Bench Members when he speaks. I would like to tell him how much that is appreciated—it really is—when he is so genuine in expressing his views. He spoke of his personal experiences, pressures in Northern Ireland and the Crossroads young carers in Newtownards who particularly stressed the difficulties faced by young carers and the things that they often miss out on. My hon. Friend spoke about a singing group. A few weeks ago, I went to Biggleswade at the request of the Alzheimer’s Society to join a singing group, and I sang some songs with the people there. It was certainly an uplifting experience that morning. I commend those groups and the carers who work with them.

The hon. Member for Central Ayrshire (Dr Whitford) made a considered and thoughtful contribution, as usual. She spoke about all the financial pressures. Particularly telling was her comment that although there are a relatively fixed number of carers and although it is steadily growing to 6.5 million, it is a replaceable 6.5 million and about a third leave for all sorts of reasons.

On bereaved carers, I was contacted through Twitter by someone in that position who asked whether the strategy and review would cover them, and I answered “Yes, it will and it should”. The moment that caring for someone stops because of bereavement, the carer’s life has changed—perhaps in an anticipated way, but it is has still changed. Caring for people in those circumstances is really important. We must not forget this group, so I greatly appreciated what the hon. Lady said. She also spoke of the need to ensure that social care is seen as a profession as much as nursing and domiciliary care are throughout the NHS and elsewhere, and I thoroughly agree with her.

The hon. Member for Worsley and Eccles South (Barbara Keeley), whose background in caring requires her to be listened to seriously every time she speaks about this issue, made a number of comments. I shall deal with the subject of finance a little later. Let me say first that I will ensure that the review that we are conducting will cover early identification in the NHS. We are trying to ensure that it takes place earlier and earlier. The issue of GP identification is very important, and I am pleased that the hon. Lady raised it again.

[Barbara Keeley]

I should be happy to send the Minister a copy of my Bill and the explanatory notes if that would help to elucidate the points that we have made.

[Alistair Burt]

I have no doubt that those are already deep within the recesses of the Department of Health, but if it would speed things up and provide encouragement, I should be grateful if the hon. Lady did indeed do that.

The hon. Lady also made an important point about our staff in the House. She said that we should look after them. I appreciate the point that she made about the staff of the Independent Parliamentary Standards Authority, and I will look into how we can best ensure that we recognise properly—in line with best employment practice elsewhere—that those who work for us bear considerable burdens of caring from time to time.

I am grateful for the opportunity to come to the House and share the important work that is under way to develop a new cross-Government strategy for carers. I continue to be humbled by the many powerful, honest and informed contributions that we have heard throughout the afternoon from Members who have described the carers whom they know and represent, as well as their personal experiences. Those views, and the many others that we have received so far, will be fully taken into account as the Department works with Government colleagues, stakeholders and, crucially, carers themselves to develop the new strategy.

Today we have been reminded that behind the statistics stand spouses, partners, parents—in fact, all manner of relatives, friends and neighbours—who are providing care right now in our communities. Their commitment can scarcely be quantified or questioned, and we must ensure that our own commitment to support people is demonstrated clearly as well.

I pay tribute to the national care awards, which are sponsored by LloydsPharmacy, Carers UK and The Sun. I was at the awards ceremony a couple of weeks ago, and we met the winners at lunchtime. The Prime Minister was kind enough to offer No. 10 Downing Street for a lunchtime reception, and we took people round. We are always struck when people like that say that it is a privilege to be there. We say to them, “No, it is our privilege that you are here with us. It is the other way round.” Those people were a great group—great winners. We went to a dinner that night. Radio 2 was very good: there is always a table of wonderful people to support the awards. When we hear the personal stories—which have been reflected in some of what we have heard in the House today—we are all immensely impressed. Let me again pay tribute to those awards: they do one of the jobs that we have all been speaking about this afternoon—valuing and recognising carers for what they do in so many different circumstances.

Before we go any further, may I offer a small philosophical comment? I picked this up from a piece in The Guardian by a writer called Madeleine Bunting. I do not read The Guardian all the time, contrary to the belief of many of my colleagues, but every now and again I am struck by something that is really good, and what Madeleine Bunting wrote is important. She was writing about what care is. We talk about it—we talk about the facts and figures and the finance here in the House—but what is it precisely, and where is it going? Madeleine Bunting wrote:

“We recognise instantly when we experience it: an interaction that acknowledges a moment of human connection. It may be brief, but it expresses and confirms a common humanity, a recognition of the individual—and always involves a particular quality of attention.

But the characteristics needed to provide this kind of care are losing cultural traction. Attentiveness requires two crucial ingredients: patience and the willingness to put one’s own preoccupations aside and to be available to another. Yet in a myriad of ways we are all being groomed by consumerism and digital media—to be the opposite: impatient and self-preoccupied. That impatience makes us easily distractable, addicted to the next stimulus.”

I think that Madeleine Bunting was making a really important point. The people about whom we have been talking have avoided that: they have patience, and a commitment to others that is beyond many of us. However, there is concern about society—concern about where it is going and the pressures that it is under. Demographics suggest that we will need more care, and yet certain pressures are making it more difficult for that to be realised. What will carers be like in the future if they have become too distracted and too self-occupied? That is not the case with carers now, but it is a valid point to raise with regard to the future.

We owe a duty of care to this vast army of people, who show their patience and their compassion for others. I am talking about not just providing them with the support, tools and information that they need to care well, but ensuring that their own health, wellbeing and life goals are not compromised. Our respect is unreserved, but respect is not enough. We must never lose sight of that fact if a new carer strategy is to succeed.

I should say at this point that I do not wish to paint a negative picture of caring. Although personal sacrifices are made each and every day, many carers have told us that it remains a privilege to care, and that they have a strong desire to repay the kindness of others. Indeed, carers derive immense satisfaction and peace of mind from being the primary source of comfort and reassurance for friends and loved ones. However, that satisfaction must not be at the expense of carers’ own mental and physical health.

We have also heard this afternoon about the great diversity in types of caring. There is no such thing as a typical carer—carers are people of all ages and from all walks of life, and those for whom they care have different needs. In particular, we neglect at our peril the needs of children and young people with caring obligations. They are most at risk of having not just their health and wellbeing compromised, but their education and career ambitions too.

There is no “one size fits all”. We must be alert to that as we attempt to craft new and improved support for all those providing care in our communities. It is no surprise that one in six of us is currently caring. As lifespans extend and our population grows, caring for others has already become part of the fabric of our lives. All those who have spoken today have made it clear that they are not affected by the lazy mindset that tells us that carers are other people; carers are all of us. As a constituency MP, I have had the privilege of visiting carers and carers’ groups in Bedfordshire. As a Minister, I have spoken to carers’ groups in relation to pulling together the new carers strategy. I strongly commend those who work in my own county.

Almost 20 years after the Carers Act 1995 first gave official acknowledgement to those providing “regular and substantial” care, the Care Act 2014 now gives carers new rights, including parity of assessment, advice and support with those for whom they care. Those new rights are a historic step forward. We have provided local authorities with £433 million in 2016-17 for new burdens arising from the Act.

We know that the Care Act is taking time to bed in. The hon. Member for Worsley and Eccles South referred to the matters that affect assessment, and I understand them very well. Care varies from place to place. A group from the Association of Directors of Adult Social Services working with the Department is looking at those variations in care, so that in places where assessments are much slower than in others, we are looking at what can be done and how things can be improved. That is very much on our mind.

[Barbara Keeley]

Having been present during discussions about certain groups of carers, perhaps the Minister will tell us whether he believes that carers of people who are at end of life should be prioritised for assessment. It is pointless to have people waiting six months when the person for whom they care may have only a few weeks or a few months to live.

[Alistair Burt]

I will ensure that that is considered as an important point of the assessment. I will write to the hon. Lady in relation to that.

Let me turn to finance now. There is always concern about the amount of finance that is available. It is almost impossible to get the right amount. By spending around £2.5 billion a year on benefits in Great Britain, benefiting more than three-quarters of a million carers, we are trying to respond to the needs that are there. That money provides a measure of financial support and recognition for people who give up the opportunity of full-time employment in order to provide care. As I said earlier, those allowances remain constantly under review. As this debate has made clear, it is not just about finance, but about all the other things, including supporting young carers and making sure that they are not forgotten and remembering that employers play an important part. I commend NHS England for the important work that it has done in relation to carers and for its commitment to carers.

I also want to mention the results that our call for evidence has produced, just to give people some assurance that these things are on our minds. We have received 3,800 responses so far, 85% of which are from carers themselves. A great number of the responses have been candid and honest, and it will frighten my officials if I read them out. They describe financial hardship; a lack of recognition and involvement; the impact on carers’ health and wellbeing; the difficulty of maintaining life outside caring; and frustration with access to assessments and services. All these issues are on our minds.

The need to ensure that carers get the recognition they deserve has been well illustrated in the compassionate speeches that we have heard today. Carers are vital, and not just in carers week. There is also a young carers awareness day—it was on 27 January this year—sponsored by the Carers Trust. I also commend my hon. Friend the Member for Truro and Falmouth (Sarah Newton) for holding a round-table about carers recently. This matter is on the minds of everyone in the House and I appreciate the courtesy of hon. Members in giving their time to deal with this important issue this afternoon.

Support for Life-shortening Conditions

Barbara Keeley Excerpts

Tuesday 7th June 2016 Westminster Hall

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

It is a pleasure to speak with you in the Chair, Mr Percy. I also thank the hon. Member for Pudsey (Stuart Andrew) for securing this important debate, to which he has been able to bring considerable knowledge. I congratulate him on how he opened the debate. We have had many important contributions this morning from the hon. Members for Strangford (Jim Shannon), for Castle Point (Rebecca Harris), for Lanark and Hamilton East (Angela Crawley), for Eddisbury (Antoinette Sandbach) and for Colne Valley (Jason McCartney). We have also had some shorter contributions from my hon. Friend the Member for Torfaen (Nick Thomas-Symonds) and the hon. Members for East Londonderry (Mr Campbell), for Foyle (Mark Durkan), for Eastbourne (Caroline Ansell) and for Glasgow Central (Alison Thewliss).

Many of us have talked about the charity Together for Short Lives. We thank it for its input to the debate, which it has welcomed. It feels that discussion of children who are dying and the support they need is hindered by a public taboo. The palliative care needs of children can be coupled inappropriately with those of adults, when, as we have heard, their needs are much more complex and focused as much on quality of life as on quality of death.

A key point that has been made in this debate is that we do not have enough data to commission and fund appropriate services to support children with life-shortening illnesses and their families. The most recent estimate is that 49,000 children under the age of 19 are living with life-limiting or life-threatening conditions, although I understand that that is based on data from 2009-10. Without Government monitoring of changes in the data, there are real difficulties in providing the care and support needed by children, young people and their families. Local authorities and CCGs already find it challenging to commission and provide palliative care locally because relatively few children in any given area will need that care. Without more accurate data, it is harder to commission and provide the services needed. Cross-departmental collaboration and better co-ordination among organisations are also needed.

The issue with funding is clear. There are different funding streams from different Departments and from local organisations. As we have heard, a remarkable amount comes from fundraising. We have specialised children’s palliative care commissioning, general children’s palliative care commissioning and the commissioning of children’s social services. NHS England, CCGs and local authorities all have a part to play in funding palliative care services for children, but as we have heard it is often unclear who is responsible for funding different services. There is terrible uncertainty about the availability of future funding for services. Indeed, Together for Short Lives found that CCGs contribute just 10% on average to the cost of the care that children receive in hospices, compared with an average contribution of around 30% to the cost of care in adult hospices. As we have heard from the hon. Member for Eddisbury, the Department of Health is testing per-patient funding for children’s palliative care for commissioners to use in 2017, but I understand that is not going to be mandated, so there will be no obligation for clinical commissioning groups to adopt that level of funding. Will the Minister clarify how the Government plan to ensure that adequate funding will be provided in future for palliative care services for children?

We know that funding from local authorities for children’s social care has become even more stretched. Local authorities can of course raise additional funds for adult social care through the social care precept, but that does not apply to children’s services. We also know there has been a significant increase in the number of referrals to children’s social services since 2009. The Local Government Association has raised concerns that the 40% real-terms reduction in core Government funding over the previous Parliament and subsequent budget cuts have meant that local authority services are being reduced significantly. The 2014-15 budget figures show a reduction of 20% for spending on children’s centres and early-years services since 2010.

We have heard quite a bit about breaks. Although local authorities are required to provide short breaks for disabled children, the funding for this has decreased, which means families are receiving less support, despite having significant caring responsibilities. We have heard about the extent of the caring responsibilities for carers of children with life-limiting conditions. The Every Disabled Child Matters partnership found that 58% of local authorities had cut their short-breaks spending by an average of 15% between 2011 and 2015, with some councils cutting this funding by up to 26%. In carers week, the fact that family carers are receiving less support and fewer short breaks should be of real concern to us.

I do not often go to my iPad for notes, but I had a look at Lucy’s blog; what she says about her mother as her carer is important.

“In reality, it is all down to my mum. She phones person after person, arranges blood tests and appointments and sorts out all of my medication, one of which has to be couriered down from London every few months, and when I’m on intravenous antibiotics, she drives to the hospital to pick up the drugs and picks up the equipment from the district nurses. My mum does my TPN and medication every day, she administers IVs and takes blood from my hickman line, gives injections, dresses wounds, can catheterise me, mixes and prepares medication, and so much more; she can do things many nurses can’t do...She liaises between consultants and departments. She sorts out my prescription and collects medication. She deals with my personal budget and pays my carers. She’s my mum, nurse, carer, PA and best friend. It’s all down to her. She’s given up her life to keep me alive, not having a holiday or break in 6 years.”

She should be able to have a holiday and a break.

As has been said in this debate, we need to find a way to hold local authorities to account for the money to spend on short breaks for disabled children. I hope the Minister can tell us what action he will take to make sure that seriously ill or disabled children and their family carers can access short breaks.

In March 2015, the Health Committee published a report of its inquiry into palliative and end-of-life care. It called on the Government to ensure that future funding proposals fully recognise the importance of the voluntary sector. The report also called on the Government to set out how they intend to ensure the sustainable long-term funding that we have talked about in this debate. It is clear from the many contributions today that improvement is needed to ensure a sustainable funding settlement for children’s palliative care in future.

I want to touch briefly on the importance of social and community palliative care and support services. Hospices do a wonderful job, but children are not always in a hospice. The Rainbow Trust children’s charity supports more than 2,000 families across England whose children have a terminal or life-threatening illness. This includes families in my constituency. The trust supports 99 families in Greater Manchester, including nine families in Salford. The family support officer for the team in Greater Manchester says that the most common concern raised by parents is the reduction in the statutory hours of support they receive. Increasingly, families are reporting having the number of hours of support reduced with no alternative service offered. It is important that the support provided by charities such as the Rainbow Trust should not be seen as a substitute for inadequate statutory support. The Greater Manchester Rainbow Trust team works closely with the Diana nursing team in Salford to provide all-round support to children’s families at home and in hospital. Both services are vital.

Charities such as the Rainbow Trust provide an essential service to families outside a hospice setting, and we must make sure that those community palliative care services are supported. I can tell the Minister that the statistics are very impressive for a small charity. In 2014-15, the Rainbow Trust provided nearly 3,000 hours of sibling support, more than 10,000 hours of home support, 7,700 hours of hospital support and more than 1,000 hours of bereavement support. Members have referred to the importance of bereavement support, which is a key aspect of the issue. Sadly, the Rainbow Trust receives only 3% of the funding needed for all those services from statutory authorities. I hope the Government will recognise the value of community palliative care and support and how it can work alongside hospice care to provide families with the support they need from the moment a diagnosis is made.

Children’s services provide excellent care in an age-appropriate environment, but, as we have heard, young adults tend to have different needs from young children and older adults. As more children with life-shortening conditions live longer—we are all grateful that they do—they are more likely to make the transition into adult care settings. Unless suitable age-appropriate services are offered to help with this transition, young adults may be lost in the system. The hon. Member for Castle Point spoke of the impact on Lucy and the travel she had to do to find services. What will the Minister do to ensure that young adults making the transition to adult palliative care services have the support that they need?

As we have heard in this debate—like everyone else, I want to touch on this—changes in benefit eligibility could also help to ensure that families get the level of support they need. Most people would not think of the importance of the mobility component of the disability living allowance and perhaps not register that the fact that it does not apply to children under three was such an issue, but of course those children need special equipment such as ventilators or the permanent wheelchairs that we have heard about, and families need to transport that equipment. It is a dreadful thought that with precious and limited time for children and families to spend together, the families are unable to get out and are stuck at home because of equipment issues. Will the Minister raise with his colleagues at the Department for Work and Pensions the need to change the eligibility criteria of the DLA mobility component so that the families of children under three with life-shortening conditions can access it? It has been said that it is easy to fix: I hope that he thinks it is.

Many hospices, hospitals, social care providers and charities provide excellent care and support for children with life-limiting conditions and their families. I want to join others in this debate in thanking them for all that they do, but it is clear that more needs to be done to develop a sustainable funding system that can provide a fully integrated service for families at all stages of their child’s illness. The importance of those services for families with a child who has a life-limiting illness cannot be overestimated. We are talking about people who give up their lives to provide support, as Lucy’s mum has done. We are talking about parents who get very little sleep. We should really think that through during carers week. I hope the Minister will assure us that more will be done in future to make sure that every family with a child living with a life-limiting condition can access the support that they need when they need it.