NHS Future Forum

Barbara Keeley Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend. The Future Forum has made recommendations in relation to public health. One of them, which I announced today, is that we want to combine the direct integrated work on health protection and response to emergencies through Public Health England with continuing independence for expert advice, so I am proposing that Public Health England should be established as an executive agency. What is critical is that we create through the legislation a greater opportunity for local authorities to lead health improvement plans locally, so issues such as alcohol abuse and problem drinking will need not only national leadership, which we will give, but local leadership, which the Bill will empower.

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

Accountability is not at all clear. The Secretary of State said that clinical accountability will be in one place and democratic accountability in another. We are replacing one organisation—the PCT—with five. My constituents will just want to know where the accountability lies for important local NHS decisions. That has not become clear from the statement so far.

[Mr Lansley]

I repeat: from the public’s point of view, we know that what they wanted was genuine accountability, in the sense that the doctors, nurses and other health professionals who care for them should be able directly to design and influence the shape of services locally to meet their needs, but they also want a patient voice and a public voice. That has not existed in the past; we will enable it to happen. They will come together at the health and wellbeing board, where they will establish a strategy for their area.

Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 26th April 2011 Commons Chamber

The Secretary of State was asked—

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

1. What progress the NHS North West Specialised Commissioning Group has made in reviewing neuromuscular services in the region; and if he will make a statement.

[Mr John Leech (Manchester, Withington) (LD)]

14. What progress the NHS North West Specialised Commissioning Group has made in reviewing neuromuscular services in the region; and if he will make a statement.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I understand that the North West Specialist Commissioning Group received a report from its neuromuscular services review group at the end of March, and that it has since circulated it to all primary care trust chief executives with a request that it is shared with board members and GP commissioning consortia leads.

[Barbara Keeley]

The north-west has not seen the investment in extra services, such as transitional care and extra care advisers, that the report recommends, and now the Government’s proposed reforms are causing turmoil in specialised commissioning and real worries about how the commissioning of tertiary services will work in future, so will Health Ministers issue guidance to commissioners to ensure that the investment is made to cover those critical gaps in the north-west, and that emergency admissions are avoided?

[Anne Milton]

I thank the hon. Lady for her question, but I reject her assertion that the changes to the NHS—the modernisation of the NHS—have thrown the process into difficulty. Clearly, she feels that there is a problem in the first place. As I am sure she will agree, however, it will be down to the commissioning of the GP consortia and the primary care trusts to decide the best way to provide services in the light of all the information that they have. I understand that the commissioners will feed back to the specialised commissioning group on how they will deal with the recommendations.

NHS Reform

Barbara Keeley Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend. We will do that, not only formally across the country but in the informal manner that we do in the House. His point of view exactly illustrates the purpose of my statement. He served on the Committee that debated the Bill. Notwithstanding the good progress that the Bill has made and that we are making around the country, people have legitimate concerns and questions. They want to raise those and to know that we will listen and act on them.

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

Can the Secretary of State say more about the future of care trusts? Integration of health and social care is vital to all our constituents. With all the uncertainty, staff are being lost and more could be lost. During this natural break, what can the Secretary of State say to preserve the continuity of those people doing that vital work and the continuing support for care trusts?

[Mr Lansley]

I reiterate the point that I made a moment ago. There is nothing in what I have said today that should do other than give people on the ground confidence that they are building the improvement of services that they need for the future. At the heart of that is the integration of health and social care. We as a Government have made available in this new financial year £648 million through the NHS specifically to build that kind of integration between health and social care. It has been insufficient in the past; we are building it now. As the hon. Lady knows, the Bill allows care trusts to continue in formation, but it is also possible for care trusts to redesign around commissioning consortia on the one hand and health and well-being boards on the other.

Health

Barbara Keeley Excerpts

Tuesday 21st December 2010 Commons Chamber

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

I want to talk about support for the 6 million unpaid carers who provide social care to a family member or friend. More people are having to step in to provide high levels of care to family members. The 2001 census, about which we have heard so much today, found that 10% of all carers in the UK were caring for more than 50 hours per week, but figures published more recently by the NHS information centre show that that has now more than doubled to 22%. In Salford, the proportion has been much higher for some time: 24% of Salford carers cared for more than 50 hours per week in 2001, which was more than twice the national figure.

Carers are key partners in care for the NHS, but full-time care takes a toll on the carer’s own health, and their health needs should be recognised. Carers who care for more than 50 hours a week are twice as likely to suffer ill health as the general population, and those caring for a person suffering from dementia or stroke disease are also more at risk. Importantly, carers who do not receive a break from caring are much more likely to suffer mental health problems—that is, 36% of carers compared with 17% who do get a break.

The Government have announced £400 million of funding for carers’ breaks over four years, to be delivered through primary care trusts initially, but there are problems with this because the funding is not ring-fenced. The Labour Government allocated £150 million over three years to primary care trusts for carers’ breaks, but a survey by the Princess Royal Trust for Carers in 2009 found that less than a quarter of the first tranche of that funding had been used as intended to support carers. Given the financial pressures that are now facing primary care trusts, and their impending abolition in the NHS reorganisation, it is hard to see them doing a better job for carers now than they did last year when they did not have those pressures. There is great concern among carers and carers’ organisations about the impact of the NHS reorganisation and cuts to local authority budgets. Carers UK says that carers are worried that when commissioning is handed over to GPs they will lose services on which they rely. Many carers have negative experiences of dealing with GPs who do not have a good understanding of social care or of the specialist conditions that are giving rise to the care.

There is also much concern about cuts to social care that councils are making in response to the 27% cuts in their budgets over the next four years. The cuts are front-loaded, so together with the loss of area-based grants that were targeted at deprived areas, councils such as those in my area of Salford will have to make cuts of £40 million next year alone. The Government are putting £2 billion into councils’ social care budgets over four years, but that is only half of the £4 billion that the Association of Directors of Adult Social Services has estimated is needed to meet increasing levels of need. In addition, social care is one of the biggest areas of each council’s budget, yet the new money is not ring-fenced either, so councils are facing budget cuts of £5.6 billion over the same period. It is hard to imagine that social care will not be part of that.

We have already seen councils cutting funding to social care. Even before the comprehensive spending review, five councils with a “moderate” threshold were proposing to tighten their eligibility criteria to “substantial”. Birmingham council and the Isle of Wight have now proposed to raise their thresholds to meet critical needs only, and other councils are considering that. North Yorkshire county council plans to reduce its number of residential care homes by two thirds, and others are taking similar action. Councils are increasing their hourly rates for care and removing maximum weekly caps, which can mean charges doubling. For very many people, that will mean that the care is not available or they cannot afford it.

In Salford, we are very fortunate to have an excellent carers centre run by the Princess Royal Trust for Carers, with Dawn O’Rooke as the manager and Julia Ellis doing a fantastic job as the primary care project worker. Staff there are concerned about what they see as a marginalisation of carers support services owing to the twin changes of GP commissioning and council budget cuts. Salford carers centre has worked with GP practices to enable GPs to identify many carers and refer them on for advice and support. That identification and referral can make a significant difference for carers in their getting benefits, using personal budgets and getting checks on their own health. However, with GPs handling commissioning, there will be significant extra pressures of time. One reads day in, day out about GPs being very concerned about that. There is a real fear that GPs in Salford will no longer prioritise the development of support for carers.

Given our record in Salford, I hope that our GP consortiums and the city council will continue to support carers’ services so that the excellent work can continue. However, with GPs handling commissioning, there will be significant extra pressures, and it is hard to see councils and GP consortiums up and down the country prioritising carer support when they have so many other calls on their time and resources. Many people rely on unpaid carers, and more will have to do so over time. It is projected that that figure will reach 9 million in 25 years’ time. I therefore urge Health Ministers to put their support for carers high on their agenda and to keep it there throughout 2011.

It is an unusual experience for me to speak in this pre-recess Adjournment debate rather than answer it, which is what I used to do. I think that the Deputy Leader of the House has opted out a little bit by cutting his work load. However, I would like to wish everybody a very happy Christmas.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I welcome all the contributions. We have had an excellent run-around of some hon. Members’ interests and specific issues relating to their constituencies.

I start with the hon. Member for Worsley and Eccles South (Barbara Keeley). As she rightly pointed out, the Government have recently announced that they will provide additional funding of £400 million to the NHS in the next four years to enable more carers to take breaks from their caring responsibilities. I commend her for her continued interest in the subject. I trained as a nurse and worked in the NHS for 25 years, and the question is now, as it always has been: who cares for the carers? The hon. Lady is right to highlight the problems that carers suffer—the impact on their physical and mental health and well-being, as well as the immense emotional burden that many bear.

The spending review has made available additional funding in primary care trust baselines to support the provision of breaks for carers. The new moneys will go into PCT budgets from April 2011 and into GP consortium budgets from 2013. The 2011 NHS operating framework, which was published on 15 December, makes it clear that PCTs should pool budgets with local authorities to provide carers with breaks as far as possible via direct payments or personal health budgets, which will doubtless ensure some progress.

The new funding is part of a package of measures that we announced in the recently published update to the carers strategy. The next steps set out the priorities for action in the next four years, focusing on what will make the biggest impact on carers’ lives. It is important to recognise that the subject is of interest to hon. Members of all parties. I do not think there is division along party lines. The hon. Lady’s insight into and knowledge of what is happening on the ground will be important to ensure that future policy and direction is well informed.

[Barbara Keeley]

Will the Under-Secretary say more about what will happen if PCTs do not spend the money on carers’ breaks? The Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who is responsible for social care, campaigned in the House when the Labour Government had a similar problem. As I said earlier, the problem is that, according to a survey, only a quarter of the money had been spent on carers’ breaks. It is fine to allocate it, but the trouble is getting the PCTs to spend it.

[Anne Milton]

I thank the hon. Lady for that intervention. She is right to suggest that there can be an intention at Westminster, but the point is ensuring that it is effected on the ground. I will say a little more about that shortly.

We do not believe that a legislative approach is always the way to proceed when requiring health bodies and GPs to identify patients who are carers or have a carer and refer them to sources of help and support. Indeed, often it is not. We feel more comfortable with that as a weapon, but it does not necessarily produce the result that the hon. Lady wants.

It will be for PCTs and subsequently the GP consortiums to decide their priorities in the light of their local circumstances. However, we believe that GPs and their staff will play a vital role in identifying carers; many carers have not yet been identified. That is why we are investing £6 million from April 2011 in GP training, which will mean that more GPs and their practice teams gain a better understanding of carers and the support that they may need. That is important.

I believe that GPs are much better placed truly to understand the value and needs of carers. I do not need to tell the hon. Lady that the considerable social, human and, indeed, financial value that carers offer cannot be overestimated—she is aware of that. However, centrally driven methods are not always the best way forward. I welcome her continued feedback to ensure that we get the money spent where it is needed most.

Let me deal now with the speech made by my hon. Friend the Member for Colne Valley (Jason McCartney). I take the opportunity to pay tribute not only to midwives but to all the staff who will be working to deliver babies safely into the world, while we are enjoying our turkey or whatever we choose to eat on Christmas day.

The Government are committed to devolving power to local communities—to people, patients, GPs and councils—which are best placed to determine the nature of their local NHS services. I pay tribute to my hon. Friend for raising the matter previously and for continuing to raise his constituents’ concerns.

The Government have said that, in future, clinicians and patients must lead all service changes, which should not be driven from the top down. To that end, the Secretary of State has outlined new, strengthened criteria that he expects decisions on NHS changes to meet. They must focus on improving patient outcomes, consider patient choice, have support from GP commissioners and be based on sound clinical evidence. I think that that was what my hon. Friend was getting at.

The Department has asked local health services to consider how continuing schemes meet the new criteria. Some will be subject to further review. That does not necessarily extend to reopening previously concluded processes, as in Huddersfield—I would not like to lead my hon. Friend down an alley—or halting those that have passed the point of no return, with contracts signed and building work started. However, NHS Yorkshire and the Humber has advised that the decision to implement the looking to the future programme and change in maternity services in Huddersfield was clinically driven, with strong emphasis on patient safety and quality of care. It was also made after considerable scrutiny and consideration, including a formal period of public consultation and advice to the then Secretary of State for Health from the independent reconfiguration panel, whose recommendations were endorsed in full.However, I know that my hon. Friend will continue to gather local evidence and experience and feed it back, which I welcome.

Let us look at the problem described by the hon. Member for Blaenau Gwent (Nick Smith). I disagree with much of what he said. We have a bold public health strategy for the first time, and it has been widely welcomed. He should not believe everything he reads in the newspaper—it could lead him into all sorts of misapprehensions. The Government alone cannot improve public health; we need to use all the tools in the box.

The hon. Gentleman should note that health inequalities grew, rather than decreased, under the previous Government. There are massive opportunities to improve public physical, mental, emotional and spiritual health and well-being in England. As he rightly pointed out, we have some of the highest obesity rates of any country in the world. People living in the poorest areas die on average seven years earlier than people living in richer areas, and they have higher rates of mental illness, disability, harm from alcohol, drugs and smoking, and childhood emotional and behavioural problems. Changing people’s lifestyles and removing health inequalities could make double the improvement to life expectancy that we could make through health care, so we must address public health.

The Government published our strategy in our White Paper “Healthy lives, healthy people”. We will establish Public Health England, a national public health service, return public health leadership to local government, and strengthen professional leadership nationally by giving a more defined role to the chief medical officer, and locally through strong and inspirational leadership roles for directors of public health.

Historically, all the big public health improvements came via local authorities, and I am convinced that returning public health responsibilities to local authorities will achieve what we need, which is social and economic change as well as health change.

NHS Reorganisation

Barbara Keeley Excerpts

Wednesday 17th November 2010 Commons Chamber

[John Healey]

Yes, of course; we had been doing that for some years before the election and we had plans to do it after the election, but the fact is that we did not win the election, and the Secretary of State is in power now. He is making the decisions and he is the one who is entrusted with the future of our NHS. He is the one who needs to answer to the House for his plans.

The problem with broken promises is worse than I have already suggested. The coalition agreement promised:

“The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs.”

The Secretary of State’s plans will do precisely the opposite. He is abolishing the PCTs, not building on the best of what they do.

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

There is a great deal of talk about reducing bureaucracy and administration, but PCT staff work on issues such as NHS treatment for people with learning disabilities. Ministers have talked about that role continuing, but will those staff not be really worried about their futures now? They will be looking around, and if they see another job, they are not going to wait two years; they are going to jump now, and the PCTs will lose that expertise. It will drain away and the PCTs will be unable to carry out all those important residual functions.

[John Healey]

This is precisely why those who understand the health service, including those who run it, say that it is going to be so hard, at a time when the NHS has never faced such a tough financial challenge, to see through the biggest reorganisation in its history at breakneck speed.

Whether on funding, reorganisation or the role of the PCTs, the Secretary of State is doing precisely the opposite of what was set out in the coalition agreement. He is running a rogue Department with a freelance policy franchise, in isolation from his Government colleagues. He claimed on the “Today” programme yesterday that he had been saying all this for four years before the election. So when did he tell people, and when did he tell the Prime Minister, that GPs will be given £80 billion of taxpayers’ money—twice the budget of the Ministry of Defence—to spend? When did he tell people that, in place of 150 primary care trusts, there could be up to three times as many GP consortiums doing the same job? When did he tell people that GP consortiums will make decisions in secret and file accounts to the Government only at the end of the year?

When did the Secretary of State tell people, and the Prime Minister, that nurses, hospital consultants, midwives, physiotherapists and other NHS professionals will all be cut out of care commissioning decisions completely? And when did he tell the Prime Minister that hospitals will be allowed to go bust before being broken up, if a buyer can be found for them? When did he tell people that NHS patients will wait longer, while hospitals profit from no limit on their use of NHS beds and NHS staff for private patients? When did he tell people that lowest price will beat best care, because GPs will be forced to use any willing provider? When did he tell people that essential NHS services will be protected only by a competition regulator, similar to those for gas, water and electricity? And when did he say that he was creating a national health service that opens the door for big private health care companies to move in?

--- Later in debate ---

[Mr Lansley]

I will give way to the hon. Member for Worsley and Eccles South (Barbara Keeley) first, and then to my hon. Friend the Member for Bexleyheath and Crayford (Mr Evennett).

[Barbara Keeley]

The Secretary of State talks about protecting social care, but he must be aware that at the same time cuts of 28% are being made to local council budgets, of which social services and social care account for the largest component. Even before the comprehensive spending review, six or seven councils were already saying their situation was moving from moderate to substantial, and for one council that has now risen from substantial to critical—and that is before the Government implement their cuts of 28%. There is no such protection in place, therefore. Instead, this radical NHS reorganisation is happening at the same time as those huge council budget cuts, and next year will be terrible. My right hon. Friend the Member for Leigh (Andy Burnham) was right to protect social care, as well as in the other things that he did with the NHS.

[Mr Lansley]

The hon. Lady is simply completely wrong. Local government budgets are not being cut by the figure she cites. The formula grant from central Government is having to be cut because of the debt we inherited from Labour, although she, like the rest of her party, is in denial about that, but that does not mean a cut—

[Barbara Keeley]

Will the Secretary of State give way?

[Mr Lansley]

No; I am addressing the point that the hon. Lady made. That cut in formula grant does not mean a corresponding cut in council tax, so that revenue is available to local authorities. In addition, the NHS is going to support social care activity in the ways I have described, such as through telehealth, re-ablement and equipment adaptations. We are transferring the learning disability transfer grant and other adult social care grants collectively representing £2.7 billion a year from the NHS to local authority funding, without reductions in those grants. I am afraid the hon. Lady is just simply wrong, therefore.

Diabetes (Young People)

Barbara Keeley Excerpts

Wednesday 15th September 2010 Westminster Hall

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

It is a great pleasure to serve under your chairmanship, Mrs Riordan, for the first time, or certainly the first time in my experience. I congratulate my right hon. Friend the Member for Knowsley (Mr Howarth) on securing the debate.

We have heard a number of telling statistics about diabetes. As has been said, of the young people and children who have diabetes in the UK, about 98.6%—a very large proportion—have type 1 diabetes. It is estimated—and it is a pity that we have to talk of estimates, and do not really know the true figures—that type 1 diabetes affects more than 25,000 children and young people. As we have heard—there are some very useful definitions—it is a chronic condition, which can be life-threatening, and which occurs when the body’s immune system attacks insulin production cells in the pancreas. It is usually diagnosed in childhood, but as with most other conditions children are often kept waiting for a diagnosis. People must live with and manage the condition for the rest of their lives. Even when it is managed through regular injections, type 1 diabetes can bring long-term complications, such as heart disease, stroke or blindness, as my right hon. Friend the Member for Knowsley mentioned.

[Claire Perry]

On that point, a shocking statistic that I was told this morning is that the management of the disease is so sub-optimal that it is estimated that more than 80% of relevant children have blood sugar levels that are too high, despite the best efforts of their parents, the community, hospitals and support groups. That has enormous long-term health and economic consequences. Surely better management of the disease at an early stage would save the children, the family and the taxpayer enormously in the long run.

[Barbara Keeley]

Indeed, and we heard earlier that the incidence of type 1 diabetes is increasing by about 4% each year. The biggest increase is in children under five. A fivefold increase in the past 20 years, as my right hon. Friend the Member for Don Valley (Caroline Flint) said earlier, is a matter of great concern. It is important that more attention be paid to helping GPs, pharmacists, other health practitioners and teachers to identify type 1 diabetes in children and young people. As with many long-term conditions, early identification is the key, because the later the diagnosis of diabetes, the greater the impact.

My right hon. Friend the Member for Knowsley asked the Minister in an Adjournment debate on diabetes last week to introduce protocols for GPs on dealing with certain symptoms. That would ensure that GPs were better equipped to diagnose diabetes. The Minister said then that he would consider the point and would have more to say on it during today’s debate. I hope that we shall hear his answer.

As we have heard, the Government’s NHS White Paper proposes to give GPs the power to commission services, instead of primary care trusts, which will be abolished. I have raised on a number of occasions recently the fact that there is great concern that many GPs do not have the depth of knowledge required to commission specialist services for conditions such as diabetes. GPs may not have the skills, experience or desire to assess whole-population health care needs, to manage the market, to negotiate contracts and to monitor performance. That is becoming a key point of concern, because GPs did not necessarily come into medicine to do those things. Indeed, I understand that the Royal College of General Practitioners is urging the Secretary of State for Health to put back his plans for GP commissioning. The college’s report on the Government’s consultation has unearthed “major concerns”. That is in line with the responses from medical charities such as Rethink and campaigns such as the Muscular Dystrophy Campaign, which also have concerns that GPs lack the skills and experience for commissioning across such a range of conditions.

There are also concerns that in taking on such a wide role, GPs’ primary role of making diagnoses and providing patients with all the information and support that they need could be affected. Some of the statistics are already becoming a cause for concern. Surveys by Diabetes UK have found that 20% of young people feel that they rarely, if at all, discuss their goals for their diabetes care during check-ups. Further, only 26% have attended a course to help them learn about managing their diabetes. The essence of managing a long-term condition is recognising that people must become expert patients. If they are young, their family members must become expert carers. Will the Minister outline what steps the Government will take to make sure that GPs are better equipped to diagnose conditions such as type 1 diabetes and to continue, and improve, their support for people with the condition?

There is a clear need for people with diabetes to be given better information about how to manage their condition. The hon. Member for Torbay (Mr Sanders), who chairs the all-party group on diabetes, has tabled early-day motion 72, which notes that 65% of the 2 million people in the UK with diabetes are not taking their medication as prescribed, because two out of three do not understand what those medications are for or how to take them. We have heard from my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) what it is like to land at home with a host of medications, without having a real idea of what to do with them.

[Mr Sanders]

It is helpful that the hon. Lady has raised that point, because it is an important element of the issue. There are enormous savings to be made by preventing wastage, but we are not just talking about tablets—there is also medical equipment. Increasingly, people with chronic conditions depend on medical equipment. Being able properly to take and analyse a blood sugar reading is a very important aspect of a diabetic’s ability to treat themselves.

[Barbara Keeley]

Indeed. I understand that the early-day motion argues that people with diabetes have a right to expect a personalised information prescription, so that they receive clear and consistent information on diabetes, which will enable them to start to understand their condition and treatment options.

Will the Minister outline what action the Government plan to take to ensure that the NHS at a local level provides diabetes care and support in line with the standards set out in the EDM? The Minister will know that I am always concerned to ensure that we consider carers’ issues in the House, and my hon. Friend the Member for Mitcham and Morden has just touched on some of those issues. We should consider the effect that long-term conditions, such as type 1 diabetes, have on family members and carers. My hon. Friend described it as a soft issue, but carers are the backbone of support for children and young people in this situation, and there is an impact on them.

The Juvenile Diabetes Research Foundation states:

“Type 1 diabetes pervades every aspect of a person’s life.”

Of course, it also affects their family. As we have heard, everyday activities, such as eating and drinking, which are often difficult enough with children—particularly young children—involve much thought and planning on the part of carers of children and young people with type 1 diabetes.

My hon. Friend the Member for Mitcham and Morden mentioned the survey carried out by the parent group, Children with Diabetes. As she said, it found that 83% of parents said that their family life was affected by a diagnosis of type 1 diabetes—quite understandably—and 84% of parents said that the treatment that they received was affected by where they live. That should not be the case; we should not have a postcode lottery. Some 60% of parents said that their children were most worried about being seen as different—children are, of course, always worried about that—and, most worryingly, 50% reported that their children had been bullied as a result of having type 1 diabetes.

The hon. Member for Torbay talked about the stigma associated with treatment by injection. Clearly, bullying in schools can be a result of stigma and perceived difference in children. That is of great concern. Diabetes UK has found that many parents of children with diabetes are forced to give up work, for reasons outlined in today’s debate. In a recent survey, half of primary school pupils with type 1 diabetes and a third of their secondary school counterparts reported that their parents had to reduce their hours or give up work to help to administer insulin injections.

The report also revealed that two thirds of primary school pupils and four fifths of secondary school pupils questioned think that school staff do not have enough training in diabetes. That is not surprising given the findings of an earlier 2008 survey of primary schools. It found that 42% of schools that had children with diabetes did not have any policy advising staff about the supervision of blood glucose monitoring by the child, 48% did not have a policy advising staff on how to help carry that out, 41% did not have a policy advising staff on how to supervise medication of any sort, and 59% did not have a policy advising staff on how to give medication. So the load is falling directly back on to the parents, because the schools do not have a policy.

When we consider type 1 diabetes, it is important to look at the people around the child or young person with the condition and to consider the level of support, information and training that is needed. The children’s charter for diabetes states that discrimination in education should end and that children with diabetes should be treated with respect. I hope that the Minister agrees with that sentiment.

As I say, one of the major concerns among diabetes charities and groups, such as the Juvenile Diabetes Research Foundation, is the postcode lottery that they feel exists regarding the treatment of type 1 diabetes. We have talked a lot in this debate about insulin pump therapy, because that is rightly viewed as the gold standard of treatment for the condition. Insulin pump therapy reduces hypoglycaemia and long-term complications, and it can make life easier. As we have heard, the treatment involves a bleeper that delivers small amounts of insulin throughout the day.

Those pumps are a cost-effective treatment that can help reduce contact with primary care, reduce hospital out-patient and in-patient admissions and, most importantly for children and young people, deliver a better quality of life. As we have heard, less than 4% of the population with type 1 diabetes use a pump. As right hon. and hon. Members have said, that figure is far below the level of use in Europe, where it is at 15% to 20%, and the United States, where it is at 35%. In fact, given the number of children and young people who go on holiday to the States, it is likely that they will run into pump therapy when they are there. Of course, people also read about the therapies available in other countries on the internet.

It is clearly important that insulin pump therapy becomes available. As we have heard, it can be used by adults and children over 12 and, as my right hon. Friend the Member for Knowsley mentioned, NICE guidance also recommends that children under 12 with type 1 diabetes have access to insulin pump therapy if multiple daily injections are considered impractical or inappropriate.

The hon. Member for Torbay provided a vivid description of the stigma, bullying and other issues that arise in school. For example, he mentioned how hard it is to find a clean and private place in which to administer injections. I have touched on the difficulties of schools not having policies, and teachers not supervising the situation. Clearly, children of almost any age will almost always find it impractical in a school setting to administer injections. In those cases, insulin pump therapy will always be better for the child or young person.

As we have heard, it is worrying that there is considerable inequity in insulin pump provision across the country. My hon. Friend the Member for Mitcham and Morden talked about the figures released this month by the Medical Technology Group, which show that there is a postcode lottery, in terms of access to insulin pumps in the UK. We can compare the cost of insulin pumps, which are £3,000, with the cost of bariatric surgery for the morbidly obese, which is about £7,000. Both of those treatments have beneficial effects, save the NHS money and improve the quality of life for the patient. Bariatric surgery use has increased tenfold from 2000 to 2007 but, as we have heard, our levels of prescribing insulin pumps are only a quarter—or a fifth—of levels of usage in Europe. Given that GPs are to take on a commissioning role, will the Minister state what action the Government plan to take to ensure that insulin pumps become much more readily and evenly available across the UK?

I would like to thank the Juvenile Diabetes Research Foundation, the Eye Health Alliance, Diabetes UK and, of course, the Members’ Library for their excellent briefings on the subject, which have helped us all in today’s debate. I started my preparation for the debate not really understanding very much about the condition, and particularly how it affects children and young people, and I feel that I do understand it now. Given the number of people involved with the issue in every constituency and the prevalence of the condition, all hon. Members should understand it as well as I hope we will by the end of the debate; the discussion has been excellent from that point of view. I pay tribute to the children and young people who are living with this condition, and to their parents. I hope that through this debate and the questions that we are asking the Minister, we can improve the service and support that they receive from health and other services in future.

--- Later in debate ---

[Mr Burstow]

I will come shortly to the point, which was absolutely well made, and certainly line up with the right hon. Lady’s comments on that. As has been mentioned, the Minister for Equalities has done a sterling job on behalf of the Government to place the issue at the front and centre. She has not resiled from the issue and will continue to pursue it as she has done so far. I was more anxious about that concern being aligned with the Government’s direction of travel on GP commissioning, which I will return to because it was raised, quite fairly, in the debate.

We have heard today about type 1 diabetes—a complex, lifelong, progressive condition that requires careful long-term management to prevent the severe and sometimes fatal complications that have been described. A 2009 survey of children with diabetes in England revealed that 23,000 children and young people currently have type 1 diabetes. There has also been a national diabetes audit, which included a separate report on paediatric diabetes that gives us a fair picture of the extent of childhood diabetes and how well it is being managed. Although Britain has one of the highest numbers of children diagnosed with diabetes in Europe, we have one of the lowest numbers of children controlling their diabetes well, and we have heard what the implications can be for those children and their families. That is extremely worrying, because poor glucose management increases the chance of the child experiencing complications. I echo the view, expressed by many Members in the debate, that that is an area where we can make significant and sustained improvements. I want to describe what we are trying to do about that.

The first question is: how can we ensure that more children receive an early and accurate diagnosis of diabetes? The challenge for GPs is that type 1 diabetes can be difficult to spot. A child might present with the vague symptoms of extreme tiredness and weight loss, which can be mistaken for other illnesses. Type 1 diabetes is quite rare, so GPs might not come across many cases in their practice. That explains why there have been instances of the sort that have been described today: tragic cases of symptoms being overlooked and children diagnosed only after becoming seriously ill.

The National Patient Safety Agency is currently looking at a number of reports of misdiagnosis and delayed diagnosis and is working with the national clinical director for diabetes to look at what we can do to improve diagnosis rates and reduce emergency admissions. Clearly, we will have to look at protocols and how they might serve as a tool that can be used, but we need to ensure that the work is properly concluded before we decide whether that is an appropriate mechanism.

It is true that building professional awareness is key to improving diagnosis rates. We need GPs and A and E staff, in particular, to consider diabetes as a possibility when they see children with appropriate symptoms, and we must ensure that they are equipped with a range of diagnostic tools to do so. NHS Diabetes, the improvement body for diabetes care, is working with various royal colleges and other bodies to improve professional standards and ensure that best practice is reflected in their training curricula. NHS Diabetes is also working with Diabetes UK to publish best practice guides on how a child with type 1 diabetes should be cared for. Therefore, material is being generated that will help a wide range of professionals not only in the NHS, but in education and social services, to recognise the symptoms and understand what good care looks like. In addition, the Juvenile Diabetes Research Foundation has been placing posters in GPs’ surgeries, highlighting the signs and symptoms to help people recognise the condition.

Once diagnosed, children need a combination of high-quality clinical care and wider support to ensure that they manage their diabetes effectively. I concede that across the NHS we have a mixed picture, as has been well described. That is the picture the Government have inherited, and we are determined to improve it. Children with diabetes often need multiple referrals to different specialist services, so well integrated multidisciplinary care is crucial to service delivery.

The right hon. Member for Knowsley broke the ground for the building of the centre in Aintree that he described, which I understand will bring diabetes clinics closer together and make it much easier to access those services. We want to see more such centres of excellence. I welcome that development but stress, rather as he did, that too often the focus is on how many hospitals, doctors and nurses there are. Beds and buildings are not as important as good services, particularly when it comes to managing long-term conditions such as diabetes, as well co-ordinated and well thought-out services that are closer to the patient and can respond to their personal circumstances and fit around their lives will meet their needs better.

[Barbara Keeley]

While preparing for the debate, I noted that my right hon. Friend the Member for Knowsley (Mr Howarth) and the hon. Member for Torbay (Mr Sanders) are lucky enough to represent the two parts of the country where integrated health and social care is thought to be working the best. While talking with the King’s Fund the other day, I learned that there are only six places in the country where it is judged to be working that well. On GP commissioning—several Members touched on this point—how can the Minister ensure that that will improve, because our fear is that that major, top-down reorganisation will mean that those five or six places will be the only ones in the country?

[Mr Burstow]

Had I turned to the next page in my brief, I would have reached an answer to that question, so I will come back to it in a moment. My final point about care is that the latest paediatric diabetes service survey suggests that the picture is improving. It is important to stress that there is movement in the right direction, but there are still deficiencies.

On the question of GP commissioning and how we better integrate the commissioning and joining up of services, a point that the hon. Lady and others have missed in much of the commentary on the White Paper is the clear intention for local authorities to hold a new role in assessing population need. That assessment will be critical to the future of the commissioning of health and social care and to the new role of local authorities in public health, which is key to early prevention of type 2 diabetes. The notion that there is fragmentation and atomisation is far from the truth. The intention is to ensure that we have that alignment of services, which would be much better achieved through the partnership between local authorities and GP consortiums.

--- Later in debate ---

[Mr Burstow]

The right hon. Gentleman and the Juvenile Diabetes Research Foundation seem to be in different places. The foundation takes the view that the condition is best managed through primary care. As I said, we must upskill, ensure that the signs and symptoms are better understood, and use the clinical skills of GPs more effectively.

[Barbara Keeley]

Will the Minister give way?

[Mr Burstow]

I will give way in just a moment—I want to pick up on another point. I am surprised that the hon. Lady keeps going on about GP commissioning, when it was her Government who introduced practice-based commissioning. We are building on those reforms, and see them as an essential way of ensuring that taxpayers’ money is most effectively geared to delivering the best possible health outcomes for people with diabetes and other conditions.

[Barbara Keeley]

I do not think that Opposition Members are alone now that the Royal College of General Practitioners has expressed major concerns about GP commissioning and is pleading with the Health Secretary to put the reforms back.

I want to raise a point about local authorities and coterminosity with PCTs. We have a better coterminosity situation—and have struggled to get to it—but I know that some local authorities around Greater Manchester will be faced with having not one but two, four or five GP consortiums. As I said, health and social care integration is working in places such as Knowsley and Torbay, where great work has been done to bring things together. The fragmentation is coming out because of the nature of the reorganisation.

[Mr Burstow]

Again, I do not recognise that characterisation, in that coterminosity does not exist in many parts of the country under the current model. As the hon. Lady has rightly said, integrated models of care, and collaborative approaches and behaviours are not present in many places. The desire and intent behind the White Paper is to make them the norm.

I want to do justice to this debate. We could have a debate about the White Paper, and I am sure that at some point the Opposition will choose to do so. If they do that, we would be only too happy to meet them point by point, but I want to talk about some of the key developments that will bear down on this problem and really help to transform lives.

The coalition Government want to make a significant move in respect of their commitment to introducing a much stronger payment system for children’s diabetes services, which will help to bring them out of the shadow of other NHS services. As a start to the process, a new mandatory tariff, which we plan to introduce in stages from April 2011, will recognise paediatric diabetes care as a clear and discrete specialism within the NHS, and will provide a clear funding stream to support such services over the long term.

At present there is a non-mandatory tariff, which was rushed in for April 2010, but it is wholly inadequate because it fails to take into account the complex nature of paediatric care, which this debate has articulated. As a result, under the current system, many paediatric diabetes services either continue to be under-resourced—we have heard about that today—or are funded through other budgets. Hence, they can sometimes be relegated to a second-class status in the NHS. The new tariff, as part of a more patient-focused funding model, will help to put us on the right track.

Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 7th September 2010 Commons Chamber

[Mr Burstow]

I am very happy to give that confirmation.

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

It is of great concern that medical charities such as Rethink tell us that most GPs that they have surveyed feel that they lack the expertise needed to commission mental health services, and also that campaigning groups such as the Muscular Dystrophy Campaign feel that GPs have too little knowledge of muscle wasting conditions to commission services for their patients. Given Government plans to hand commissioning over to GPs, to abolish primary care trusts and, according to the White Paper, to reduce the role of the Department of Health in training, can the Minister say more to the House about how the considerable shortfall in expertise in commissioning services will be tackled over the next year or two?

People with Learning Disabilities (NHS Treatment)

Barbara Keeley Excerpts

Wednesday 14th July 2010 Westminster Hall

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

It is a pleasure, Mr Hood, to serve under your chairmanship. I congratulate my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke) on securing this debate, which is on a most important subject.

As we know, my right hon. Friend is chair of the all-party group on learning disability, and I pay tribute to his work on the matter in Parliament and with Mencap, which supports the all-party group. My right hon. Friend has highlighted a series of reports that make a compelling case for improving the treatment of people with learning disabilities, making it equal to the treatment received by others.

At the extreme, inequality of treatment in the NHS can lead to unnecessary death, as in the six cases highlighted by Mencap’s report “Death by indifference”. Those six cases of unnecessary death led to the health ombudsman’s findings of failure in NHS service provision. Since then, Mencap has received more accounts of tragic cases from families and carers whose loved ones died because health professionals did not know how to treat, assess or care for people with learning disabilities; they did not listen to what the families and carers said about the patients’ needs, and they made no effort to communicate with the patients using methods such as photo symbols.

Some time has elapsed since the “Death by indifference” report and the ombudsman’s findings of failures in service provision. Will the Minister tell us what progress the Department of Health has made in achieving equality of provision in health services for people with learning disabilities? As my right hon. Friend said, there is a moral case for equal treatment but it is also a legal requirement under the Disability Discrimination Act 1995, the Human Rights Act 1998 and the Mental Capacity Acts. The cases that have been highlighted show that people with learning disabilities do not always get the right health care; failures in provision can have fatal consequences.

Given that people with learning disabilities are more likely to have major illnesses, and at a younger age, failures in provision or barriers to accessing treatments or services are more likely to lead to fatal consequences. Members may know of such things from their casework. I spent time battling for appropriate care for a young constituent with physical and learning disabilities. Her parents wanted her medical needs to be assessed alongside her physical needs, but we had a battle with the primary care trust on that. We finally won, but it was too late; my young constituent died before the improved services could be put in place.

My right hon. Friend spoke of the problem of diagnostic overshadowing, whereby physical illness is seen as part of a learning disability and is therefore ignored or sidelined. In our debate last week on mental health and autism, we said that similar difficulties resulting from mental health symptoms are being treated as if the symptoms were part of the autistic spectrum disorder and are also ignored. We need health professionals to be trained to treat, assess and care for people with disabilities or learning difficulties.

We heard earlier that a poll of more than 1,000 health professionals commissioned by Mencap found that a third of health care professionals are not trained in how to make reasonable adjustments for patients with learning disabilities. As has been said, that is no longer acceptable. The fact that more than 80% of people with a learning disability also have a severe communication disability points to the need for training and specialist support. I make no apology for repeating points made by others; we need to underline their importance.

Good communication is vital between patients with learning disabilities and health care professionals and, as we heard, that is at the heart of NHS provision. I therefore look forward to hearing the Minister’s comments on access to special provision for communication within the NHS, and on appropriate communications skills training for NHS staff. The NHS White Paper says that the Department of Health will reduce its role in the education and training of staff. How will the Government ensure that professionals have proper training in providing health care for those with learning disabilities?

I turn from training to health checks for people with learning disabilities. The Labour Government’s “Valuing People Now” strategy accepted a recommendation to introduce a directed enhanced service of annual health checks for people with learning disabilities who are known to local authorities. That has meant that all primary care trusts in England are under direction to commission annual health checks from GP practices in their area and to arrange appropriate training for GPs and their practice staff. Such arrangements were initially set to run until 31 March 2010, but there has been an extension until 2011.

In addition, the Department of Health planned to work with groups representing patients, families, carers and professional groups to review the effectiveness of those arrangements and consider improvements for the future. Will the Minister update us on that work and say what commitments he can make to continue annual health checks for people with learning disabilities? Will he also update us on the development of practitioners with a special interest in learning disability, as that, too, was part of the strategy? It was envisaged that such practitioners could serve as a resource to other health practitioners in their area.

Given the announcements made by the Secretary of State on Monday, will the Minister further update us on what the commissioning process will be for the directed enhanced service? Will the new NHS commissioning board require GP consortiums to provide annual health checks for people with a learning disability? What expertise in commissioning care for people with a learning disability will the Government expect GP consortiums to have? That is an important question. Will the Minister tell us whether the Government plan a wider roll-out of annual health checks for people with a learning disability, as my right hon. Friend has already asked him, and what systems will be put in place to monitor the quality of such health checks?

People with a learning disability will receive health checks only if they are known to the local authority. A further recommendation accepted in “Valuing People Now” was that the Department should ensure that it collects the data and information necessary to allow people with a learning disability to be identified by the health service and have their care pathways checked.

Will the Minister update us on the work of the NHS information centre and the public health observatory for people with learning disabilities to identify practical changes that are needed to ensure more systematic recording of learning disability within general practice? “Valuing People Now” said that the directed enhanced service for annual health checks would help GP practices ensure that the registers they maintain under the quality and outcomes framework reflect information from local authority registers of people with learning disabilities known to those services. Will the Minister tell us whether that has been a successful way of collecting the data and information needed? Has good practice emerged on comparing data from GP practice systems with data from other NHS sources to allow better analysis of the uptake of health care interventions and health outcomes for people with learning disabilities?

Finally, “Valuing People Now” recognises the important role that carers play and the importance of working in partnership with them in the provision of treatment and care. Carers should always be included as partners in care, but the “Death by indifference” report showed that health care professionals did not listen to families and carers about patients’ needs.

The hon. Member for Kingswood (Chris Skidmore) told us of a case in which the carer was not involved in any communication about the person for whom they cared. The national carers’ strategy included a commitment to issue information prescriptions to carers and to enable carers to receive other appropriate information, especially in cases when mental capacity is an issue.

The national carers’ strategy also recognised that the additional stress of caring may affect the carer’s own health, so there is a need for annual health checks for family carers, too. We must ensure that carers get regular access to short-break services and to support.

In this time of cutbacks and austerity budgets, will the Minister assure us that he understands and prioritises work to ensure that carers are treated by the NHS as partners in care? Will he also tell us whether work on a refresh of the national carers’ strategy will continue to prioritise annual health checks for carers, access to respite care and breaks for all carers, especially those who care for people with a learning disability?

The Government White Paper uses the slogan “Nothing about me, without me”, which clearly owes a debt to the slogan “Nothing about us, without us”, which was used for many years by disability activists. “Nothing about us, without us” was also the title of a strategy paper for learning disability produced in 2001 by the Department of Health and the service users’ advisory group, which included representatives from a number of learning disability organisations.

I trust that the Minister will value the contributions and questions that have come from this debate, as Ministers have valued reports from, and the themes and slogans used by, organisations for people with disabilities and learning disabilities over the last decade.

[The Minister of State, Department of Health (Mr Paul Burstow)]

I thank the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke) for securing this debate, because it is a timely opportunity for the new coalition Government to set out their intentions and approach to the issue. I also pay tribute to him because I know from my time in the House, over the past 13 years, that he has been a true and consistent campaigner on behalf of people with learning disabilities and their families. He has brought many issues to the attention of the House and regularly challenged Ministers of the previous Government—I am sure that he will continue to do so with this Government—to strive to achieve better outcomes for people with learning disabilities.

I made it my business to attend the first meeting of the all-party group on learning disability after the general election to signal my intention and commitment as a new Minister. Despite the fact that I could not make yesterday’s meeting, I hope that my good faith and my desire to collaborate with the all-party group will be recognised. I also pay my respect to Lord Brian Rix who, along with the right hon. Gentleman, provides exceptional leadership in that area.

I also thank the hon. Member for Kingswood (Chris Skidmore) and the hon. Member for Worsley and Eccles South (Barbara Keeley), who speaks for the Opposition, for their contributions to this debate. I will clearly have ample time to respond to their many points and questions. If I miss anything out, I will write to right hon. and hon. Members later. It is right that such issues should arouse strong feelings and that they should be kept at the top of the agenda. The right hon. Member for Coatbridge, Chryston and Bellshill drew attention to the Disability Rights Commission report “Closing the gap” and the impact that it had when it came out. No one should be in any doubt of the extent to which the Mencap report “Death by indifference” provided a wake-up call to the NHS and the Government of the day. The health ombudsman’s report has also been very important in alerting us to the failings in the system.

Four years on, a great deal has been written and said about this subject. None the less, despite the “Valuing People Now” strategy and the many worthy efforts to improve services, there are still some parts of the NHS that are not delivering well enough for people with learning disabilities. We have inherited that legacy and we are determined to take action on it. I welcome and support the principles set out in Mencap’s “Getting it right” charter, and we will try to collaborate with the charity to ensure that we address and take forward the additional challenges. I want to work very closely with Mencap to ensure that we translate the words on the page into real change in hearts, minds and practice across the country.

The right hon. Gentleman and the hon. Member for Kingswood were right to pay tribute to the work of many dedicated NHS staff around the country. Constructive feedback also needs to be part of any good process of continuous improvement, and is certainly essential when it comes to the NHS. My hon. Friend the Member for Kingswood put his finger on the pulse when he said that one of the key things that the Government White Paper on the NHS will do is provide a far better focus on early intervention, early diagnosis and prevention. Prevention will be an important part of this Government’s agenda in the delivery and improvement of health care.

I want to make it clear that this Government support “Valuing People Now” as a strategy. Our approach to it is one of continuity and change. I will not be reinventing the wheel, but I will be doing everything I can to make the wheel spin faster—if I can put it that way—because we need continuity but we also need to accelerate the pace of change on the ground.

I have listened very carefully to the points that have been made by right hon. and hon. Members during this debate and I will try to respond to those points. I will start with the point about evidence and information. Gathering evidence and information must be a key part of informing the development of practice on the ground. The right hon. Gentleman and the hon. Member for Worsley and Eccles South, the shadow Minister, were right to say that this is an area where we must do more. Gathering better information and evidence is vital. We need better information and evidence to subject the NHS to proper scrutiny and so that the NHS can conduct proper self-appraisal; consequently, any shortcomings in care can be identified and acted on quickly, both at a local and a national level.

I can confirm that we are pressing ahead with the confidential inquiry and the public health observatory that were recommended by Sir Jonathan Michael’s inquiry. The confidential inquiry will ensure that premature and avoidable deaths of people with learning disabilities are investigated and that lessons are properly learned and applied at a national level. The public health observatory will give us a much stronger evidence base about the needs of people with learning disabilities and the difficulties that they face, which in turn will inform better practice. I am particularly pleased that we will have representatives from Mencap, the National Forum for People with Learning Difficulties and the National Valuing Families Forum on the group that will scrutinise the progress of both the confidential inquiry and the public health observatory.

In addition, all areas of the country have completed, or are in the process of completing, the new health self-assessment framework. That framework brings together strategic health authorities, primary care trusts, hospital trusts and people with learning disabilities and their families. Those organisations and individuals are coming together to assess local NHS progress and to ensure that health services continue to improve for people with learning disabilities. Their work will be shared with the public health observatory to inform its work. The framework offers a strong means of ensuring accountability and it can help us to ensure that NHS services are making the right adjustments in line with their duties under the Disability Discrimination Act 2005 and other legislation, which is a point that has quite rightly been made by all right hon. and hon. Members who have contributed to this debate.

[Barbara Keeley]

As I think all of us who have been involved in today’s debate understand, there will be a great deal of churn in the organisations that the Minister has referred to, such as the SHAs, the PCTs and the hospital trusts. Greater accountability for, and greater scrutiny of their work is clearly important, but those organisations are now threatened with closure. People will be leaving their jobs, so I want to ask the Minister if there is a follow-on plan for when those organisations expire, as it were?

[Mr Burstow]

The hon. Lady must have a copy of my speech in front of her, because the answer to that question is in the next paragraph. She is absolutely right. In executing the change that the White Paper sets out, which means removing the sense of central dictation and direction that we have seen in the NHS for the last 13 years, ending that sense of command and control and making the system one that is about delivering outcomes and one that is facing the patient and working alongside them to deliver those outcomes is an important transformation. Therefore we need to ensure that, in the transition planning that is now well under way for the change that will take place during the next two to three years, the institutional knowledge and learning in the existing system properly migrate to the new system, and that best practice is firmly embedded in the front-line services. Those services will remain as they are now, but they will receive more support and investment to do even better.

[Mr Burstow]

I am very grateful to the right hon. Gentleman for his intervention and his question. He raises a point that I will move on to shortly, but I certainly see advocacy as being very important in this area. Looking forward, we will need to ensure that we reflect what we are learning from the work that is going on at the moment in the new commissioning landscape and in the new frameworks for accountability at a local level.

Both the right hon. Gentleman and the shadow Minister have referred to annual health checks, so let us look at that issue. It is quite encouraging that many more people with learning disabilities are now receiving an annual health check from their GP. Last year, just over one in five people with learning disabilities received an annual health check and the latest figures show that two in five people with learning disabilities have received their annual health check within the last 12 months. However, that is clearly not good enough, as it means that three in five people with learning disabilities still do not receive an annual check. As a Government, we are determined to push that process forward to ensure that the training and development that has taken place delivers in that regard.

I have heard many stories about how those health checks have identified, for example, cataracts or cases of diabetes. Furthermore, as has already been said in this debate, if we put ourselves in the position of a person having such a health condition but being unable to communicate the symptoms, we can begin to understand the difference that these health checks can make. I am therefore certainly keen to see annual health checks continue for people with learning disabilities, and we are looking at the most cost-effective way of ensuring that.

Reference was also made to the training of staff in relation to carrying out health checks. Undertaking training is certainly part of the requirement for all the GP practices that are delivering the annual health checks for people with learning disabilities. That training is about raising awareness of people with learning disabilities and their families, and particularly about ensuring that communication issues are understood, that advocacy is provided and that there is also liaison with staff in the acute sector. So there are a number of aspects about training and I will say more about that shortly.

The right hon. Gentleman referred to the training, as did the hon. Member for Kingswood. Reference was made to the recent Mencap poll, which makes disturbing reading as it shows the number of staff who have not had training to help people to make reasonable adjustments to different situations.

The shadow Minister talked about the need to look at people in the round, so that we do not only look at either their learning disability or their physical needs but at both elements. In that way, we will not allow diagnostic overshadowing to take place. That issue must be properly addressed in training. Therefore I wanted to ensure that right hon. and hon. Members were aware that the Council for Health Regulatory Excellence is working with professional bodies to support better training and to improve professional standards. That relates to a point that the hon. Member for Kingswood made about the need for professional ownership of that training, so that it is not just something that is imposed from the top but is seen by professionals as an essential way of learning to do their job better.

As a Government, we are working with the council to reach not only doctors and nurses but the full range of health care professionals. That is clearly important when it comes to meeting the often complex needs of people with learning disabilities. For example, speech and language therapists have a key role in tackling feeding issues of the type that the right hon. Member for Coatbridge, Chryston and Bellshill talked about. However, he referred to a case that I fear I cannot talk about any further, because it is before the courts. Occupational therapists are also important in helping people to develop the skills that they need to live independently, so I am pleased that all the regulatory bodies are reporting progress on that work and I will certainly keep in touch with them to ensure that that progress is maintained. I also want to ensure that that learning is embedded as we move towards delivering the vision that is set out in the Government’s health White Paper published on Monday.

Meanwhile, at a primary care level staff in all GP practices that are delivering annual health checks now have the appropriate training. The Royal College of General Practitioners is due to publish additional training materials for all GPs this summer, which are about getting health checks right for people with learning disabilities. I hope that that reassures right hon. and hon. Members that the Government are not about to shelve the issue of training but are determined to see training programmes develop.

[Barbara Keeley]

I think that the point about annual health checks has been emphasised. Does the Minister see those checks continuing? Will there be funding for them to continue? He has helpfully quoted some figures that show that we have moved from a situation in which one in five people with learning disabilities receive an annual health check to a situation in which two in five receive such a check. Does he know whether that gap—a gap that means that three in five people with learning disabilities do not receive an annual health check—exists because those people are not known to services or because GPs are just not carrying out those checks? In other words, is there an information gap or is there a practice or provision gap? If he does not know now, perhaps he can tell me in writing later.

[Mr Burstow]

Regarding the hon. Lady’s point about funding, given the tone and the substantive nature of what I have said about annual health checks it would be surprising if the Government were not determined to see those checks being continued. However, we are obviously in the middle of a spending review and therefore we must ensure that we achieve value for money in those checks. I think that this debate underscores that point only too well. I will write to the hon. Lady on the other point, because I want to get the answer absolutely right, and I will ensure that other hon. Members involved in this debate are copied in.

The hon. Lady also mentioned the value that we all rightly attach to the contribution made by family carers. I hope that she and others, while perusing the White Paper during the past two days, will have seen that one thread running through it from principles to practicalities is the value that this Government attach to the role of carers. For the first time in a Government White Paper, we have stated clearly that we see carers as partners in recovery and the provision of good care, which we want to ensure is provided appropriately in different circumstances. It is an important signal that we hope will be taken on board.

On annual health checks, the hon. Lady will know that the Government are in the midst of a series of pilots to evaluate the best way to implement health checks for carers. We will await the outcomes of the pilots before making further decisions about their wider roll-out.

On engagement, which all hon. Members have mentioned, it is crucial that patients and families are at the heart of all health care services at all levels. The White Paper makes that clear by borrowing from an important past report. We want the aspiration “No decision about me, without me” to inform how the health service develops. We need people with learning disabilities to be fully involved in the planning and design of services at a local level. If we can create an NHS that genuinely listens and responds to patients, in line with the White Paper, we will ensure that people with learning disabilities get the support and advocacy that they need to make their voices heard. That is clearly important, just as it is important to ensure that the values and principles behind the Mental Capacity Act 2005, which I supported during its passage through the House, are understood and translated into practice.

Some parts of the country are already doing great work in that area by, for example, bringing in user-led organisations to advise staff and help them offer patients the right advocacy. We want to see more of that. We will also work through the new body proposed by the White Paper, HealthWatch, which will not only handle patient complaints but be responsible for providing advocacy and support in pursuing them. HealthWatch will have a key role in ensuring that the voices of those whom we are discussing are heard fully across the NHS. It will be a powerful champion for people who are not always heard.

Hospital passports have not been mentioned, but they none the less address some issues raised in this debate. The hon. Member for Kingswood discussed, among other things, the role of liaison nurses. Hospital passports are another helpful development and were one of the top suggestions in Mencap’s charter. The passports are short, accessible booklets that can be carried by people with learning disabilities to give NHS staff information about their medical history, any drugs that they are taking and their likes and dislikes. They are a low-cost but effective idea and are offered by many hospitals throughout the country. I want to see them spread to every hospital. I suspect that the case mentioned by the hon. Gentleman involving poor communications in hospitals might have been avoided if such a passport had been available.

Clearly, acute liaison nurses also have a role to play. All strategic health authorities recently reported on the issue to the Department of Health, and all referred to the value of acute liaison nurses. The number of posts is increasing as such nurses demonstrate their value. They play a part in building capacity, training colleagues, raising awareness across the work force, improving the patient experience and, importantly, reducing length of stay and getting people back into the community appropriately.

I have mentioned commissioning structures. As we migrate from the old system to the new, we must ensure that the learning is carried over. That creates opportunities and possibilities for organisations such as Mencap and others to play their part in ensuring that they work alongside commissioners at a local level to deliver it.

[Barbara Keeley]

While the Minister is on that point, will he enlarge on how the commissioning of the services that we have been discussing will take place? Will they be locally commissioned, or will the NHS independent board commission them from GPs?

[Mr Burstow]

The NHS commissioning board will commission the family practice services that GPs provide, but the GP commissioning consortiums will be responsible for a wide range of commissioning services, some of which they may do collectively at a sub-regional or regional level, while others will be discharged by the NHS commissioning board. The important thing is the expertise available, and we say in the White Paper that GP consortiums will have access to that expertise in a number of ways. They might choose to bring it in-house, use their local authority’s commissioning expertise—some local authorities have exceptional expertise—or work with third sector organisations. There are already examples of that happening, such as with Turning Point. I suggest that opportunities exist for organisations to offer commissioning expertise in order to develop services that are much more in tune with the needs of particular patient groups.

The right hon. Member for Coatbridge, Chryston and Bellshill was absolutely right to flag up the wider societal challenges of discrimination, particularly the discrimination faced by people with learning disabilities. He was therefore right to identify, as the Government do, that we must not approach the issue in a narrow, health-focused way. We need a wider social perspective in taking forward strategies on the matter, and that will be part of our thinking throughout.

The right hon. Gentleman also asked me about the Mansell report, which I know was the subject of discussion last night at the meeting of the all-party parliamentary group on learning disability. I thank Professor Mansell for his important work, not least because I understand that the work reported yesterday was commissioned by the Department of Health. It demonstrates the vital importance of improving services and outcomes for people with learning disabilities and provides important examples of good service and good practice that we must ensure sit firmly in the strategy going forward. My officials will work further to ensure that we see how the findings fold into the ongoing work on the strategy.

The right hon. Gentleman asked about the DVD. We are happy to ensure that it can be accessed on the website and to discuss other ways we can collaborate to maximise awareness of it and the Mansell report. We are keen to ensure that people have access to it and will do what we can to achieve that.

I am told that financial matters, to which the right hon. Gentleman referred, were discussed last night at the all-party group meeting. How can we maintain and accelerate progress in the straitened financial circumstances that the Government have inherited? Part of the answer is that the NHS has benefited from this Government’s commitment to real-terms growth. However, we have inherited a debt legacy that must be tackled, and we have made it clear that the sick should not have to pay the price for that, nor should people with learning disabilities. The NHS will have to be even more creative and willing to work in new ways with the third sector and other organisations to maintain and quicken the pace of reform. I am confident that we can do things differently and achieve with less, and that we can do more for people with learning disabilities.

Ultimately, we need to achieve real change to make an impact on the ground. Yes, we need better training, evidence and engagement but, ultimately, we need better services driving better outcomes for patients. We need services that are integrated—the White Paper provides a way forward on that—as well as more responsive. They must be built around the individual needs of patients and families, meet their expectations and give them a say in their treatment and ongoing care.

In conclusion, the NHS White Paper can be the catalyst that we need to drive change. The message is simple. We want an NHS that is focused on outcomes and judged by what really matters to people: the extent to which it helps them live longer and healthier lives. We will need to consider how we measure those outcomes in the right way for people with learning disabilities, and I look forward to working with the all-party group, Mencap and many other organisations on that. Reducing preventable mortality might, for example, be a helpful starting point, and we want to consult on that.

The shift away from process-led measures towards outcomes will bring a cultural shift in care and help the NHS to shake itself free of any of the lingering discrimination that has been talked about in this debate—any sense of looking at the disability rather than the individual as a whole in terms of how treatments are decided. That is the opportunity the Government’s White Paper presents and I am determined to work with the right hon. Member for Coatbridge, Chryston and Bellshill, the all-party group, Mencap, families and others to ensure that we grasp that opportunity and deliver the best outcomes possible.

Child and Adolescent Mental Health Services

Barbara Keeley Excerpts

Wednesday 7th July 2010 Westminster Hall

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

It is a pleasure to serve under your chairmanship again, Mr Benton, and I congratulate my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) on securing an important debate to which many hon. Members have contributed.

I pay tribute to my hon. Friend and to those parents—we heard about them again today, and our debate has been enriched—who have campaigned for vital improvements to services. As of yesterday, 136 Members from all parties, including my hon. Friend and, I expect, others here today, had signed early-day motion 160, which highlights the fact that 10,000 children with autism use child and adolescent mental health services every year. It also highlights a survey showing that using such services will not improve the mental health of two thirds of those children. As my hon. Friend said, the children are not getting the support that they need.

Children with autism are particularly susceptible to developing mental health problems, and many Members mentioned the fact that there is a range of reasons for that. Such children may experience social isolation, and 70% of children with autism struggle to make and keep friends, compared to 10% of other children. Children and young people with autism also find it challenging or impossible to express how they are feeling. The struggle to communicate causes frustration and anger, which can lead to mental health problems.

With the right support given at the right time, many of those problems can be prevented. Given that one child in 10 who accesses child and adolescent mental health services has autism, that should be a priority for the professionals in that service. However, only just over half the parents surveyed by the National Autistic Society thought that staff working in CAMHS had a good understanding of autism. Many of the professionals to whom the society spoke felt strongly that there were not enough training opportunities—many hon. Members touched on that point. Professionals need to develop their clinical expertise in order to work with children with autism and mental health problems. There is good experience of that happening up and down the country.

The high number of children with autism, coupled with the lack of skilled professionals, leads to many children being seen by professionals who are unable to meet their needs or simply being turned away. I have some questions for the Minister; I may be repeating some of them, but it will not hurt to do so. Will the Government ensure that all child and adolescent mental health professionals are provided at least with basic autism training, so that they can meet their duties to make “reasonable adjustments” under the Disability Discrimination Act 1995 and provide services that meet children’s needs? How will the Government ensure that specialist autism support is available within CAMHS?

As we have heard, autism is a complex disability. When mental health problems arise in children with autism, they are harder to recognise, evaluate and treat. Professionals need a good working knowledge of autism to do those things. Providing mental health support to children with autism is a specialist skill, and research conducted by the National Autistic Society found that if an autism specialist is involved in the support of such children, outcomes and service satisfaction improve dramatically. Indeed, those parents whose children had received support from a specialist in autism were twice as likely as those whose children had not to agree that the child and adolescent mental health service had improved their child’s mental health. Sadly, coverage is not good, and only two in five parents say that their child has had such support.

Specialist autism support is vital. We need to adapt therapies and interventions so that they are effective. Skilful adaptations will obviously make them relevant and useful to children with autism. Many Members spoke of the importance of early intervention. Autism specialists can also help other professionals to develop their skills, and they should share their experience with schools and social services.

The subject of commissioning was mentioned by a number of Members. It is particularly important, given the radical changes that the Government have indicated that they wish to make to local commissioning. The way services are commissioned locally for children with autism and mental health problems is clearly important.

Commissioners obviously need to know how many children with autism live in their area, how many of those children also have mental health problems and how local services are working. They need expert advice on what is needed to deliver the right mental health services. They then need to use those data to plan the right services for the children. If the commissioning changes that have been signalled are to be made, it is important to take those factors on board.

Commissioning must also take account of CAMHS waiting times, rates of return and family outcomes for children with autism. Specific local pathways should be developed for the mental health support of children with autism. Parents and children affected should be involved in the commissioning process, together with front-line professionals.

The Labour Government introduced a vital new duty, which came into force in April 2010. Children’s trusts now have to plan to meet the needs of children with special needs and disabilities. That represents a significant step forward. What action will the Government take to build on Labour’s work, to ensure that services are planned and commissioned at the local level so that every child with autism and mental health problems starts to get the support they need? How will the Government ensure that parents and young people are involved in the development of services to ensure that they meet local needs?

We know that the number of children with learning disabilities and of children with autism who use such services are similar. It is clear from improvements to services for children with learning disabilities achieved under Labour that having the right measures in place does make a difference, which was mentioned during the debate. As my hon. Friend the Member for Stalybridge and Hyde said, the Labour Government achieved improvements to services for children with learning disabilities through the 2004 national service framework. That highlighted the importance of providing adequate child and adolescent mental health services for children and young people with learning disabilities.

Specialist training, the adequate resourcing of learning disability specialist support and access to specialist in-patient support were also recommended. As we heard, a specific indicator was recommended for local authorities to rate themselves on their provision. As a result, specialist support for children with learning disabilities more than doubled between 2005 and 2007. In 2010, two thirds of primary care trusts rated themselves four out of four for their provision of CAMHS for children with learning disabilities. Based on the improvements for children with learning disabilities made under Labour, I urge the Government to commit themselves to achieving the same benefits in the coming months and years for children and young people with autism.

I shall speak briefly about early intervention. As was said by my hon. Friend the Member for Dumfries and Galloway (Mr Brown) and my right hon. Friend the Member for Oxford East (Mr Smith), putting support in place early makes a big difference in the long run. It can help to prevent difficulties from escalating into mental health problems. Over recent years, there has been a strong focus on improving support for children with autism and improving the emotional well-being of children with autism in schools. I hope that that continues.

The autism inclusion development programme has helped to improve teacher training. The social and emotional aspects of learning programme has helped pupils at school to gain emotional and social skills, and has helped them with self-awareness and managing their emotions. The early support programme has helped families of disabled children under the age of five to get co-ordinated support and information early, so that problems do not escalate.

Hon. Members touched on the fact that Labour initiatives, such as the Every Child Matters agenda, also helped to ensure that agencies work together, which is important in providing support to our most vulnerable children. Parents at the Every Disabled Child Matters reception in the House yesterday wanted assurances from the Minister that schools would continue with the initiative. They felt that they had created the initiative, and that it was not just a Government thing.

Government leadership over recent years has made a significant difference to aspects of the mental health system for children. In today’s debate, we are asking for similar action for this other group of children. We must continue to prioritise children and young people with autism because they are among some of the most vulnerable people in our society.

The Minister with responsibility for care services, the hon. Member for Sutton and Cheam (Mr Burstow), spoke about the campaign to make good mental health for children with autism a reality:

“There is no doubt that these changes can happen, where there is a will on the ground to make them happen.”

I hope the Minister confirms that the Government have that will, as many hon. Members from all parts of the House have shown that they have in the debate today.

--- Later in debate ---

[Anne Milton]

I am sorry, there is no time. I already have far too many questions to answer. If hon. Members feel that their questions have not be answered or addressed, I urge them to write to me and I will make sure that we respond.

[Barbara Keeley]

When there have been a great number of questions, it is more usual for the Minister to agree to write to us rather than expect us to write to her.

[Anne Milton]

I am sorry for that error. I thought that I said that I would write. I thank the hon. Lady for raising that.

I have only two minutes left. The hon. Member for Stalybridge and Hyde said that staff working in child and adolescent mental health services should have the necessary values, competences and skills. That is vital. The coalition document made it clear that we are committed to supporting the most vulnerable and to tackling health inequalities, and we will make more announcements about public health. Appropriate tier 4 child and adolescent mental health services should be available to all children who require them, including children with autism. There are a number of other vital issues, including diagnosis and transition. I am proud of my own field, which was highlighted by the previous Government, for some of the things that they achieved on transition. I should also like to pay tribute to Sara Truman, who has done a huge amount of work with the National Autistic Society.

We have not touched on the health outcomes for people with autism and mental health problems, but if we look at them we will find that they are truly shocking. Parents and carers carry a huge burden. There are many issues that we have not covered, including respite and research. We still do not understand why people get autism. We also need to look at those children who are not yet diagnosed. There are significant challenges that will require real commitment and buy-in from the staff who work hard in CAMHS across the country, but I am greatly encouraged by the number of contributions here today and by the amount of expertise that is sitting here. There is a role for Government to play. I hope that hon. Members appreciate that we cannot provide all the answers—

Supporting Carers

Barbara Keeley Excerpts

Thursday 1st July 2010 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Benton, and to speak in this important debate on carers. I thank the Minister for his comments on my new role. He may know that carers issues were of importance to me before I came to this place. I have always made it a priority to champion carers and carers organisations. It is very important that a number of hon. Members who have spoken today feel the same way and might take on that role, too. If we believe that carers have been a silent army, it is up to us, as Members of the House, to be a voice for them in relation to Government. Many hon. Members here today will be able to do that, and I hope that they do.

I pay particular tribute to the work of the all-party carers group, which has always been a very strong voice in the House. The chair, the hon. Member for Banbury (Tony Baldry), has just spoken. The group is ably supported by Carers UK. I pay tribute to the work of the Princess Royal Trust for Carers, Crossroads Care, Age Concern and the many other organisations that provide vital advice and support to carers. I also pay tribute to the standing commission on carers—whose chair, Philippa Russell, is with us today—because it provides a voice for carers.

In relation to supporting carers to have a life outside caring, I think that the key issues are respite care and breaks, supporting carers financially and supporting young carers and the people for whom they care, so that those young people do not have to take on the heavy burden of caring that many of them do. In the debate, we have already touched on most of those issues.

The Labour Government’s vision for carers as detailed in the updated national carers strategy identified the following outcomes. It stated that

“carers will be respected as expert care partners and will have access to the integrated and personalised services they need to support them in their caring role; carers will be able to have a life of their own alongside their caring role”—

the subject of our debate—

“carers will be supported so that they are not forced into financial hardship by their caring role; carers will be supported to stay mentally and physically well and treated with dignity; children and young people will be protected from inappropriate caring and have the support they need to learn, develop and thrive, to enjoy positive childhoods and to achieve against all the Every Child Matters outcomes.”

I hope that the Minister supports those or similar outcomes in the refreshed carers strategy that he announced. New Members may not know that we did not have a national carers strategy at all until 1999. It has been refreshed once, but however good those strategies are, looking at them again and taking them forward is very welcome.

I support the comments of the hon. Member for Blackpool North and Cleveleys (Paul Maynard). The revised NHS operating framework mentioned making dementia a priority, but did not mention support for carers, which carers organisations have noted. I hope that it is an omission that can be corrected in the next revision. We did not have an oral statement in the House when the important changes in the revised operating framework were announced, so today has been the first chance that we have had to ask questions about that. I hope that it can be taken on board. Ministers and civil servants need to understand that these days there is so much support in the House for carers that if carers are not mentioned in a document, it will be noticed pretty quickly.

My hon. Friend the Member for Llanelli (Nia Griffith) and other hon. Members rightly highlighted the importance of respite care and breaks for carers. The coalition agreement states that the Government will use better community-based provision to improve access to respite care. I asked the Minister yesterday to tell the House how the Government planned to deliver that promised increase in access to respite care through improved community support provision, because support provision is already starting to fall away. Carers organisations are reporting that cuts in local authority funding are already leading to cuts in funding for charities and other providers of care. The Minister repeated the commitment that the Government will deliver on their promises to carers, but he did not give us any more information. Carers and carers support organisations need to know exactly how community support provision will be improved.

A 25% cut in local authority budgets, together with further pressure from the council tax freeze, could pose a substantial risk to essential care and support services. My hon. Friend the Member for Hammersmith (Mr Slaughter) made a passionate case against the local council action to axe the carers centre in his area. I am very glad that he was able to do that. I hope that his contribution helps to highlight the case against what sounds like a damaging and unnecessary action by that council.

In debates last year, both the Minister and the former shadow Minister for care services, who is now the Under-Secretary of State for International Development, expressed concerns about whether the £150 million allocated to primary care trusts for emergency respite care was used for the purpose for which it was intended. If the Minister and his Conservative colleagues were concerned to see ring-fencing of budgets for respite care, I hope that now that they are in government, they will be committed to ring-fencing of budgets for essential social care services. I am not convinced that the transparency at local level that he mentioned is enough. History has proved that ring-fencing is the best way to ensure that money goes where it is intended to go.

The coalition Government say that they understand the urgency of reforming the social care system to provide much more control for individuals and their carers and to ease the cost burden that they and their families face. The Minister said yesterday that an announcement will be made soon about the commission on long-term care; I should be grateful if he would tell us more about that today. I am pleased that all the options for funding care will be considered, including an inheritance levy, which the Opposition support.

The Government have pledged to extend the greater roll-out of personal budgets to give people and their carers more control and purchasing power. The Labour Government made the social care reform grant available to local authorities to enable the development of personalised care and personal budgets, but that grant is now in its final year. How will the Government encourage local authorities to extend the roll-out of personal budgets and to provide more control to individuals and their carers, given that, as we heard earlier, local authorities are facing cuts to their social care budgets?

I shall touch on the caring with confidence programme. Training for carers in their caring role is a vital way of supporting them and giving them confidence. The hon. Member for Banbury mentioned that aspect. The Minister announced the decision to cancel the caring with confidence programme; will he consider how local carers groups and carer centres are to fund that vital training? Offering materials for free is to be welcomed, but the organisations also need trainers and premises and to have their costs covered if they are to run that training. The carers strategy aims to ensure that carers will be supported so that they are not forced into financial hardship through their caring role. I hope that the Minister will support that aim. However, many carers are now concerned about Government plans that will hit disability and carer benefits. We have heard quite a bit about that this afternoon, and rightly so.

Concern was expressed this afternoon about the measure to increase benefits annually by the consumer prices index rather than the retail prices index. Carers UK estimates that indexing carers allowance by the consumer prices index over the past 10 years would have cost carers £5 a week, or about £270 a year. The Labour Government did not do that. As my hon. Friend the Member for Stretford and Urmston (Kate Green) said, whatever the country’s financial difficulties, carers should not have to take the biggest hit. Under the coalition Government’s plans for indexing benefits, carers allowance would be worth £62.95 by 2015 if uprated by the retail prices index, but only £60.35 if the consumer prices index is used. That is a difference of some £130 a year. Does the Minister think it fair to hit carers in that way? Carers and those whom they care for will also be affected by a similar change to the attendance and disability living allowances. Carers UK has said that single parents caring for a disabled child, a partner or elderly parent may have to rely on carer’s allowance, disability living allowance and the other means-tested benefits as their only source of income. Carers UK believes that making savings in that way will hit hard the incomes of the most vulnerable—those who are already struggling to make ends meet—and I agree.

Hon. Members have referred to the extreme concern among unpaid carers caring for relatives with disabilities about the introduction of a medical assessment for the disability living allowance. If the person cared for becomes ineligible for the allowance, the carer’s own income would be hit, as carer’s allowance and other benefits are based on the disabled person receiving a certain level of disability living allowance. A poor medical assessment could spell financial disaster for carers and their families. I understand that the Office for Budget Responsibility questions whether savings could be achieved, given the cost of implementation and the large volume of subsequent appeals. I urge the Minister and his colleagues to ensure that any changes are fully thought through, and that they avoid the stress and anxiety that a new system or poor decision making, or both, could cause.

My final thought about carers and financial hardship is on the axing by the Government of the savings gateway scheme, mentioned by my hon. Friend the Member for Stretford and Urmston. The savings gateway would have given carers in receipt of carer’s allowance an additional 50p for every £1 that they saved. I am sure that Members will have seen research by Carers UK showing that carers spend their savings over the years, which leaves many of them caring unpaid around the clock, and with no savings and no buffer against large purchases. That places an enormous strain on carers.

My hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) made a strong case for raising carer’s allowance. When the Minister was in opposition, he asked the then Minister for a timetable by which carer’s allowance would be raised. He also asked for its eligibility to be extended so that pensioner carers would get proper recognition in the payments that they receive. Will the Minister take on board comments about the coalition’s plans for benefits for carers and those whom they care for, and will he consider giving us the timetable that he asked for when in opposition for increasing carer’s allowance and dealing with the eligibility of pensioner carers?

A further matter is the work being done by carers organisations, with primary care trusts and schools, to identify carers and refer them to sources of advice and support. In Salford, The Princess Royal Trust for Carers has two excellent projects to identify and support carers. One works with primary care teams and the other with local schools. The primary care project run by the excellent Julia Ellis has developed effective partnership working with teams at Salford primary care trust and at Salford Royal hospital. Over recent years, Salford has moved from having a low level of recognition of carers to a situation that sounds as good as might exist elsewhere. There is a carers link in most GP practices and a new GP toolkit; NHS staff and staff at the Salford Royal hospital act as the lead on carers issues; there are carers information files on all wards at Salford Royal; and there is increased awareness among carers’ social workers at the hospital. Another recent development is that pharmacists and other professionals in Salford are now supporting the work of identifying carers.

The coalition Government propose radical changes to primary care trusts; they also propose that schools could opt of local authority control. I am anxious that excellent practice in identifying carers, such as that developed in Salford, will be affected by the changes. How can carers organisations ensure that a strategic view of the needs of carers in an area can be taken once GPs and schools are acting independently?

The importance of signposting carers to sources of information should not be underestimated. Signposting is done by carers centres and carers support groups, but I believe that it can and should be done more by GPs, their primary care teams and by hospital staff. However, we must be realistic about the work that it entails. Members have spoken of the big society and volunteers, but identifying carers means reaching a large number of people working throughout the health service. The figures for NHS and social services staff in 2008 are as follows: there are 33,730 GPs and 88,435 hospital doctors; 92,000 people working in primary care trusts, including 4,200 doctors involved in primary care delivery; and 49,800 social workers, of whom 2,205 provided health-related social work.

The role of reaching out to all those GPs and primary care staff, hospital doctors and health-related social workers cannot be left to primary care projects such as the one in Salford. The Princess Royal trust has recently worked with the Royal College of General Practitioners in developing an action guide to help GPs and their teams to support carers. That guide has been distributed to every GP practice. The royal college also piloted a training programme for GPs. I believe that the Government could give more of an incentive for GPs to undertake the vital task of identifying carers.

I commend to the Minister and the House the private Member’s Bill that I introduced to the House in April 2007—the Carers (Identification and Support) Bill. The Bill would require health bodies to identify patients who are carers or who have a carer, and would require identified carers to be referred to sources of help and support. It would also require health bodies to ensure that health services for patients and carers took the carers’ needs into account. In a second version, it would have required schools to have a policy to identify and support young carers. Without such legislation, GPs have as an incentive only three points in the quality and outcomes framework awarded for work undertaken to identify carers in their practice population. That does not seem much of an incentive. I hope to reintroduce my Bill to the House, and I hope that the Minister and all present today will support it. I understand that the Minister has said that he wants to see GPs identifying carers more often.

An important link has been identified today—that of raising the matter with GPs and developing similar guidance for schools. Ofsted highlighted in a report that local authorities were identifying fewer young carers than might have been expected. We do not know the precise number of children and young people who care for family members. In my Worsley and Eccles South constituency, the young carers project supported by Salford carers centre is doing some excellent work on identifying and supporting young carers in two local high schools. I met the young carers on an adventure day out and also when they launched their DVD on bullying—bullying is a serious problem for young carers.

Family pathfinder projects have done some good work on improving support for young carers. The Labour Government provided funding to the Princess Royal Trust for Carers and the Children’s Society to help them raise awareness of the issue and to build skills in supporting young carers. They published guidance for schools, developed information sheets for GP practices and produced other materials, such as DVDs on listening to young carers. I hope that the Minister and his colleagues in the now Department for Education support the continuation of that funding, and adopt and develop the good practice coming out of the 19 young carer pathfinder projects.

My hon. Friend the Member for Hartlepool (Mr Wright) spoke movingly about the needs of young carers and the difficulties that vulnerable young people have in their transition to adult services. A possible impact of the personalisation agenda might be that a family that includes a young carer of a person who is self-funding through an individual budget may have little or no contact with professional agencies. If professional agencies are not good at identifying carers when they have contact, they will definitely not be good at it if the family is managing the budget themselves. There is concern about that, and it makes awareness-raising work with professionals important. The role of schools and GPs in identifying carers becomes crucial to ensure that the child or young person gets help and support.

It has been a pleasure to be part of this debate today. Some 10 Members and the Minister have made contributions. As the hon. Member for Banbury said, the Minister understands the issues for carers and for social care. He also understands, I think, the strength of our expectations that he will continue to be a champion for carers. It is delivery on commitments that matter to them.

[Mr Burstow]

I absolutely agree with that point, and that is why we will not promise to pay cash sums into the NHS baseline that therefore cannot be delivered to where Ministers claim that they will be delivered, and it is why we will ensure that we, as a Government, will provide both leadership and, when appropriate, direction to deliver the sorts of things that hon. Members on both sides of the Chamber have outlined today.

This helpful and useful debate will help to take our thinking forward as we begin our work on refreshing the carers strategy. Hon. Members cited many examples of good practice on the ground, and they offer beacons of hope for how services might look across the country. Challenging those who commission services locally to ensure that they learn from such examples of good practice is a task for not just the Government, but everyone. Examples of best practice do not come from the statutory sector alone, even though the most innovative parts of that sector are themselves beacons. As many hon. Members have said, we also have to applaud and encourage the social enterprises and social entrepreneurs who have spotted opportunities to do something for their communities and found the resources to do so.

I have identified a number of key issues from this debate: what we can do better to identify carers, whether they are young, old or from ethnic minority communities; what we can do to provide information and support for carers so that they can navigate their own way through the system; and what we can do to make the system simpler so that it is not the maze of benefits and complex rules about which we have heard so much in the debate. We realise that people who wear the label “carer” are not all the same. Carers are unique individuals confronting unique circumstances that require individualised and personalised responses. I agree entirely with hon. Members’ points about the need to empower carers as well as the people being cared for.

I will try my best to answer the questions that have been put today, but if I miss anything out, I guarantee that I will write to hon. Members with a fuller response than I can give today. I will also ensure that the points that have been made, particularly in respect of benefits, are raised in cross-ministerial and cross-departmental discussions on the carers strategy at the right place and at the right time. I want them to be taken into account as the work around simplifying and modernising the benefit system is taken forward.

The hon. Member for Worsley and Eccles South (Barbara Keeley), who spoke for the Opposition, made a number of points, many of which we can work on together. Many hon. Members will be aware of her track record inside and outside the House. Elements of her speech made me feel that she expected me to take full responsibility for the things that the previous Government did not quite get right, such as the times when their implementation of a measure was flawed or when they failed to take note of representations. Although it is entirely fair for her to rehearse the points that I made in opposition—I certainly take those to heart—she will understand if I say to her that the last Government’s record left a lot to be desired, by which I mean that the improvements for which carers were hoping were not actually delivered.

Reference has been made to the huge financial pressures in many of our public services at the moment. I was struck quite strongly by the way in which the cuts that have been in train in local authorities for many months are somehow being laid at the door of this Government. In reality, those cuts were initiated and conceived under the last Government, and I just wish that there was a bit more humility and understanding of that. We have a shared challenge when it comes to dealing with the huge public sector deficit in this country. It is all well and good challenging this Government about what they will do in terms of the spending review over the next few months, but it would also be appropriate for a responsible Opposition to offer up suggestions that they believe would be painless that we could do instead.

[Barbara Keeley]

I do not know whether the Minister has experienced this during his parliamentary career, but the constituency that I represented between 2005 and 2010 covered two local authorities, and it was interesting to see the different priorities that those authorities gave to their work in social care and for carers. We heard a very good example of that in the debate, as Hammersmith and Fulham is adopting a swingeing policy that could take away a vital resource from carers, which I hope that something can be done about. I have heard the leader of Salford council hotly defend the fact that he would rather spend money on adult social care than on potholes, yet quite a lot of people in the city want money spent on potholes. Transparency and localism is one thing but, as with other aspects of health and support services, we could end up with a situation whereby a council such as Hammersmith and Fulham could remove a service, leaving its carers with nothing, while another area, such as Salford, would have excellent voluntary organisations and a council that prioritised social care.

[Mr Burstow]

The hon. Member for Hammersmith (Mr Slaughter) made some important points about the situation in his constituency and what his local authority was doing. The hon. Member for Banbury (Tony Baldry) also made references to the impact of tendering. Those are issues to consider, but I am not going to become a Minister responsible for micro-managing every single local authority and the decisions that they take on the allocation of resources—that is not a Minister’s job. However, we do need to ensure that there are not unintended consequences with respect to the rules and procedures followed by local authorities that fall under the Government’s responsibility. I will be very happy to hear further from both hon. Members, either in this debate or afterwards, to ensure that we have the correct rules. We want to support local services that are appropriate to a local community and that the community actually values.

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[Mr Burstow]

I wish that I had not put it that way, but there we go. That is the trouble with putting things on record.

We heard about the National Audit Office report on Jobcentre Plus, and it is important that the Government pay close attention to the work of the NAO. I was a member of the Public Accounts Committee during the last Parliament, and when the NAO identifies opportunities to obtain value for money and get more out of existing resources, it is important that we take them. If the report is not already required reading for DWP Ministers and officials, it should be.

The hon. Member for Blackpool North and Cleveleys also discussed the care to share forum that was set up to consider respite. We see peer support as a powerful part of what the big society is all about. It enables people to step up and support each other, rather than seeing local authority services as the solution to everything. The right to respite has been discussed a lot in this debate. It is often not the case that a carer wants a week off; a matter of hours can make a huge difference. When I was visiting some services in Newham recently, I met the people who run a telecare project and several carers who had benefited from it. It was clear that what was important to them was the knowledge that the person for whom they cared was safe so they could have a cup of coffee with a friend, a chat and a bit of real life, as that refreshed them. We need more such opportunities for many others.

The hon. Member for Llanelli (Nia Griffith) discussed how we can ensure that carers can both stay in work and return to work. She also mentioned Alzheimer’s and dementia, and research into those diseases. I am sure that she will know that, in the coalition programme for government, we indicated a clear commitment to prioritise dementia research. I am the Minister who chairs the board with responsibility for considering the issue, and we will be making announcements about how we will take it forward in due course.

The hon. Member for Banbury said some kind things, as a result of which I now feel immense pressure—thank you very much! He also made a good point about carers week that I read in this way: carers week is not an annual event; it is every week. We need to find ways to make that not just a platitude but a reality for carers throughout our country. He spoke a lot about the role of GPs as commissioners and the difference that they can make. They are one of the universal services and they see many carers. We must ensure that all GPs understand that when someone comes to see them because of a sickness or disability, the person with them is often the carer, who needs to be identified and offered the signposting and support that will make a difference for them.

The hon. Member for Banbury mentioned the caring with confidence programme, as did several other hon. Members. I purposely included it in my opening remarks because I wanted to be up front about what I had decided to do. My view, having considered the evidence about the programme, was not that the training materials were not excellent—they are well regarded by the carers who have been through the programme—but simply that we were not getting value for money from the delivery. Not enough carers had been through the programme, and there was no evidence that delivery would accelerate significantly. Now the money will be reinvested into delivering more training—including GP training, which has been mentioned—and more support for carers. We will make further announcements in due course.

[Barbara Keeley]

As with other developments, I did not hear about this in the House; I heard about it from carers organisations. Does the Minister realise the extent to which carers support groups and organisations are concerned? They were geared up and trained to deliver the programme. Having useful materials will be a good thing, but materials are not enough to run a course. They need somewhere to run it, a trained person—probably paid—and resources during the day. It would be useful if some of the money could be diverted to training GPs, but that is a mainstream NHS matter. I emphasise that there is a great deal of concern among carers organisations about the programme, so anything that the Minister can do will be a help.

[Mr Burstow]

I am grateful to the hon. Lady for that point. I spent time earlier this week on the phone with all the carers organisations that have a direct interest in the matter. We are discussing actively with them the best way to reinvest the money to deliver good outcomes for carers. As and when that becomes clearer, I will certainly make further announcements to the House.