Mental capacity )Amendment) Bill: EVEL and Commons Consideration of Lords Amendments

Caroline Dinenage Excerpts

Monday 25th March 2019 Written Statements

[The Minister for Care (Caroline Dinenage)]

I am today placing in the Library of the House the Department’s analysis on the application of Standing Order N^o. 83L in respect of the Government amendments tabled for Commons consideration of Lords amendments for the Mental Capacity (Amendment) Bill.

[HCWS1441]

Services for People with Autism

Caroline Dinenage Excerpts

Thursday 21st March 2019 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I would like to start by adding my voice to those paying tribute to my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan). It is thanks to her pioneering autism private Member’s Bill that we now have an adult autism strategy. This year, it will be 10 years since that Bill passed into legislation as the Autism Act—10 years during which she has been the most fantastic, steadfast and passionate champion for autism and autistic people. I think that I speak on behalf of the whole House when I say that we all send our love and our thoughts both to her and her loved one.

I thank my hon. Friend the Member for Bexhill and Battle (Huw Merriman) for so beautifully representing my right hon. Friend and her words today, and indeed all the other Members who have contributed to the debate, as well as the Backbench Business Committee for selecting it, particularly in the run-up to World Autism Awareness Week next month. Several Members have made some excellent points. I will try to get on to as many of them as possible in the time allowed, but I will write to anybody I miss out.

Much progress has been made to improve the lives of autistic people since the first cross-Government autism strategy. There is now improved diagnosis and greater awareness, and more organisations are ensuring that they make reasonable adjustments. However, 10 years on, it is very clear that there is still so much more that we can do to ensure that public services meet the needs of autistic people. The autism strategy was updated in 2014, but this year we are undertaking a comprehensive review, “Think Autism”, to ensure that it remains fit for purpose. As the hon. Member for Strangford (Jim Shannon) pointed out, it is so important that young people and their families feel supported. We want our autism strategy to work for autistic people of all ages, and that is why, working closely with the Department for Education, we will be extending our strategy to include children. That refreshed cross-Government strategy will be published towards the end of this year.

People with a learning disability and autistic people continue to face significant health inequalities. This must be addressed. It is absolutely that right that learning disability and autism are both now clinical priorities in the NHS long-term plan. Autistic people must be at the heart of any improvements we make to their care and support. That is why last week the Government launched a national call for evidence to hear the views of autistic people, their families and their carers, as well as those of professionals. We want to know what is working, but also what needs to be done to transform care and support. In the week since that call for evidence, we have already had 875 responses. I would urge hon. Members across the House to share our call for evidence in their constituencies and via their social media networks.

I am delighted that so many Members across the House have taken the opportunity to highlight some of the amazing work and fantastic organisations in their communities. Autism-friendly communities such as the one in Bodmin that my hon. Friend the Member for North Cornwall (Scott Mann) spoke about—he wins the prize for the most intriguingly named constituent: Tigger Pritchard—sound like a way to support people much better.

As many Members have said, raising awareness is not enough. It is acting on that awareness that makes a real difference. We recently launched a consultation on mandatory training on learning disability and autism for health and care staff and will report the findings in the summer. Crucially, that applies to not only medical professionals but all health and care staff. For example, we all know that a negative encounter with a receptionist or front of house staff can immeasurably change our experience or perception of services. Work is under way in other sectors such as education, employment, prisons and transport to raise awareness of autism and adjust services to make them more accessible.

The hon. Member for Liverpool, West Derby (Stephen Twigg) and many others talked about the importance of early identification and timely and accurate diagnosis of autism. No one should have to face a long wait for an autism diagnosis, but we hear far too often that the NICE recommendation of a wait of no more than three months is exceeded. There is a geographical disparity, and this postcode lottery must end. The NHS long-term plan commits to testing and implementing the most effective ways to reduce those waiting times. Critically, we are collecting data to support that, which will be published later this year for the first time. This will mean that each area can be held to account and action can be taken.

As my hon. Friend the Member for Copeland (Trudy Harrison) said, it is not just getting a timely diagnosis that matters but having timely information, support and services after that. This summer there will be new and improved guidance for health and care commissioners and a best practice toolkit, to improve diagnosis and post-diagnosis services for autistic people. Health Education England is also developing an autism core skills and competency framework for health and care staff and staff in organisations with public-facing responsibilities.

My hon. Friend the Member for Dudley South (Mike Wood) and a number of other Members highlighted the particular challenges that autistic children face in schools. My hon. Friend the Member for Bexhill and Battle said that children have to fail before they get the support they need, and that is why including children and young people in the autism strategy for the first time is so important.

The SEND reforms that the Government introduced were intended to support all young people to achieve their potential in education. Since 2014, we have invested £391 million to help implement those reforms, but we know that there is more to do. We have funded the Autism Education Trust to provide autism awareness training for more than 195,000 school and college staff—not just teachers, but administrators and support workers—which I hope will go some way to helping diagnose women and girls, who we know are very much under-represented in the diagnosis statistics. We also know that a disproportionate number of autistic children are excluded from school; my hon. Friend the Member for Dudley South mentioned that. Edward Timpson is currently reviewing how schools use exclusions, so that we can better understand why that is the case and what we can do about it.

The hon. Member for Bristol West (Thangam Debbonaire) and many other Members highlighted the need to do more to support autistic people into employment. It is a lost opportunity all round that only a relatively small number of autistic people are in work either full time or part time. Through the Disability Confident scheme, we are helping employers to promote the talents and abilities of autistic people, and Access to Work has a hidden impairments group that gives guidance to employers.

My hon. Friend the Member for Torbay (Kevin Foster) spoke about the huge value of these people in the workplace. My hon. Friend the Member for Berwick-upon-Tweed (Anne-Marie Trevelyan) told me something I did not know—that autism spectrum automatically disbars someone from the military. I will be raising that with the Minister for the Armed Forces, not least because I fear her infinitely more than I fear the Minister.

My hon. Friend the Member for North Cornwall, the hon. Member for Dulwich and West Norwood (Helen Hayes) and many others spoke about some of the tragic cases where autistic individuals have not received the right care and support in mental health in-patient settings. We are committed to learning from those and working harder than ever to improve how care and support is provided. Some people will need access to time-limited in-patient services, but this should be as close to home as possible for as short a time as possible, with discharge plans in place. When people do need to go into hospital, they must be safe from harm and abuse, and they should never be subject to inappropriate or restrictive practices.

The hon. Member for Cardiff West (Kevin Brennan) and my hon. Friend the Member for Henley (John Howell) spoke about improving the criminal justice system. In the initial police learning and development programme, police officers are already given training, and many police forces have developed their own. Liaison and diversion schemes are being rolled out with 100% coverage expected by 2021. My hon. Friend the Member for Berwick-upon-Tweed also spoke about how autism should not be classed as a mental disorder. We will be keeping this very closely under review, as she made a very good point.

The Government are fully committed to improving the lives of autistic people, but there is much more to be done, and Autism Awareness Week is a great reminder of that. Our refreshed cross-Government autism strategy, which we will publish later this year, will help to deliver this and provide the route map for the years ahead.

GP-Patient Ratio: Swale

Caroline Dinenage Excerpts

Tuesday 19th March 2019 Westminster Hall

[The Minister for Care (Caroline Dinenage)]

It is a great pleasure to serve under your stewardship, Ms Buck, and I congratulate my hon. Friend the Member for Sittingbourne and Sheppey (Gordon Henderson) on securing this incredibly important debate. He speaks very passionately about his constituency and has raised a number of pressing issues that, to a greater and a lesser extent, I have responsibility for tackling. He has described the pressure that primary care is under in Swale very well. We know that Swale is not alone; I have received representations from other hon. Members, including my hon. Friend the Member for Horsham (Jeremy Quin), who raises very similar points about these pressures.

When my hon. Friend the Member for Sittingbourne and Sheppey talks about the impact of inadequate road infrastructure and excessive housing development exacerbating the challenges with GP accessibility, he could almost be speaking about my own constituency—it is like looking in a mirror in so many ways. I completely recognise the challenges he describes, because my constituency faces almost identical issues with accessing GPs, inadequate roads, housing developments and trying to attract GPs to the area. The Government recognise that this is an issue that affects the care patients receive. We are working very hard to address it and are pushing harder than ever to grow the workforce by the extra 5,000 GPs to which we have committed.

A growing, ageing population and patients with long-term conditions are putting strain on the system. We need to look very closely at recruiting and retaining GPs, but that is not the whole story; we must also look at what GPs are telling us are the biggest issues, including workload, indemnity and risks associated with the GP partnership model. There are a number of tasks that we have to consider.

We recognise the importance of general practice, which is the absolute heart of our NHS. In 2015 we set the ambitious target to grow the workforce by 5,000; we are a long way from achieving it, but more GPs are now in training than ever before. The NHS long-term plan made a very clear commitment to the future of general practice, with primary and community care set to receive at least £4.5 billion a year more in real terms by 2023-24. That was followed by the new five-year GP contract, which will see billions of pounds of extra investment for improved access to family doctors, expanded services at local practices and longer appointments for patients who need them.

The new GP contract will address workload in general practice as a result of the workforce shortage that my hon. Friend the Member for Sittingbourne and Sheppey so beautifully articulated. We need a culture change in the range of health professionals who people are prepared to see when they go and visit their local health centre. NHS England has committed to expanding community-based, multi-disciplinary teams, which will provide funding for 20,000 other staff in primary care networks, such as physician associates and social prescribers.

[Gordon Henderson]

I welcome the Minister’s words and accept that the Government are doing something. I also accept that it is not just my area that has a problem. Does she recognise, though, that Kent has a particular problem? To give an example, somebody living in north Kent can travel 20 minutes up the A2 and get £6,000 or £7,000 a year extra. Although the Government are expanding the opportunities for the other professionals, we cannot even get them. It is not just doctors; it is all the professionals.

[Caroline Dinenage]

My hon. Friend makes an excellent point, and I completely understand that places in the London catchment area can very easily lose key public sector professionals. It is very difficult to compete with the potential extra wages that they might be able to achieve by working in the Greater London area. It is important to acknowledge that diversifying the range of different medical professionals who people can see will immeasurably help general practice to cater for the additional number of patients. It means bigger teams of staff providing a wider range of care options for patients, which effectively frees up more time for GPs to focus on those with more complex needs.

I was very pleased to hear that the CCG general practice in Swale is already using the skills of a wider workforce, including pharmacists working alongside GPs and paramedics providing home visits. We are training more GPs than ever before, and last year Health Education England recruited the highest number of GP trainees ever: 3,473. As my hon. Friend said, a new medical school is opening in Kent next year.

It has been made easier and quicker for qualified doctors to return to the NHS through the national GP induction and refresher scheme. Yesterday NHS England launched a new “Return to Practice” campaign, which is aimed at promoting the support that is available to GPs who have left practice, with a view to trying to tempt them and encourage them back. To bridge the gap while that training is ongoing—my hon. Friend rightly says that it takes a very long time to make a GP—NHS England’s international GP recruitment programme is bringing suitably qualified doctors from overseas to work in English general practice.

[Helen Whately]

I completely agree with what the Minister is saying about the importance of a greater range of healthcare professionals—it is not always about seeing a GP, so there needs to be a shift in expectations—and the plans to increase the number of GPs in the system, including through the Kent medical school, for which I campaigned very hard. I urge the Minister to come, if she can, to my point about an access metric. It would be really helpful to have a better way for patients to know what level of access they should expect. At the moment, we seem to have the proxy of a GP-to-patients ratio, but it is not good enough. It would be helpful if she could address that.

[Caroline Dinenage]

It is quite tricky. As my hon. Friend knows, general practices are independent contractors. Each general practice is required to meet the reasonable needs of their registered population, so there is no exact metric or recommendation for how many patients a GP should have, as the demand that each individual places on a GP can be significantly different. There is obviously much greater pressure on a practice in an area with a much older population—with more retired people and those with more complex needs—than on practices in other areas. That is where the complicating factors arise.

It is really important to work on innovative ways not only to bring in a new raft of GPs, but to hold on to the ones that an area already has. I understand that Swale CCG is working with GP practices across the area to improve retention. Supported by funding from NHS England, it is shortly due to launch a pilot GP recruitment and retention scheme. It is being proactive in recruiting the next generation of general practice staff and has been working with local schools and colleges to encourage local students to consider healthcare, and particularly primary care. I understand that three training practices in Swale offer placements for trainee medics, to give them the opportunity to experience general practice and consider general practice training. As of December, there were 11 direct patient care apprentices working in general practice across Swale.

My hon. Friend the Member for Sittingbourne and Sheppey rightly made the point that three of the areas with the highest patient to GP ratios are in Kent. I have been advised that, alongside the CCG’s work, the Kent and Medway sustainability and transformation partnership has set up a primary care workforce group, and has secured £1.5 million from Health Education England and NHS England to implement its workforce transformation plan.

The range of other issues that deter medical graduates from general practice include the spiralling cost of purchasing professional indemnity cover, which is a major source of stress and financial burden. We have addressed that in the new GP contract and from 1 April this year, the new state-backed clinical negligence scheme for general practice will bring a permanent solution to indemnity costs and coverage. That will help drive recruitment and retention of GPs.

We recognise the huge contribution that the general practice partnership model has made to patients over the lifetime of the NHS, but we also recognise that increasingly that model faces challenges, as fewer young GPs want to become partners. An independent review, led by Dr Nigel Watson, reported in January and made seven recommendations on workforce business models and risk, to which we will respond shortly.

My hon. Friend made the point well that air pollution, road infrastructure and congestion contribute massively to the pressure on general practice. The Government recognise that air pollution poses one of the biggest environmental threats, particularly in the case of frail elderly people and young children. Removing congestion from roads is certainly one of the sure-fire ways to reduce some of the air pollution hotspots. My Department will always be happy to furnish him with data that he needs on the health impact of pollution, to support any of his activities for attracting the local road investment that will tackle the problem and help his constituents.

My hon. Friend also raised a concern that housing targets placed on Swale Borough Council by the Government put additional pressure on doctor’s surgeries. The national planning policy framework, which was published last year, makes it very clear that strategic policies must make sufficient provision for community facilities, such as health education and cultural infrastructure. As he says, it is not enough to build a building; we need staff inside it. The views of local clinical commissioning groups and NHS England must be sought with respect to the impact of any new development on health infrastructure and demand for healthcare services.

Examples of primary care being delivered in an innovative way can be found across the country, for example using other professionals to deliver care or GP practices grouping together to work more collaboratively. That is exactly the kind of innovation and co-operation envisaged in the long-term plan, which seeks to change the balance in how the NHS works by shifting more activity into primary and community care. That is enabled by expanding multidisciplinary team working. The NHS long-term plan also commits to the recruitment of 1,000 social prescribing link workers by 2020-21. I encourage my hon. Friend to have a conversation with Swale CCG to see if any of those innovative measures could be introduced to help his constituents.

[Gordon Henderson]

I assure the Minister that I meet my local CCG regularly—I have done since it was set up and will continue to do so.

[Caroline Dinenage]

That was never in any doubt as far as I am concerned, but sometimes CCGs may not have thought of some of the more innovative ideas that are used in other parts of the country. I am sure that my hon. Friend, in his highly esteemed role in the local community, is best placed to raise that issue with the CCG.

The Government are well aware that recruitment and retention of GPs is a huge issue. We know that there are problems and we are doing everything that we can to tackle them. We will keep my hon. Friend updated and I thank him for his contribution to the debate and for raising this very important matter.

Question put and agreed to.

Community Hospitals

Caroline Dinenage Excerpts

Tuesday 12th March 2019 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I would like to start by thanking my hon. Friend the Member for Congleton (Fiona Bruce) for bringing forward this incredibly important matter for debate, and for articulating so beautifully the great value of the Congleton War Memorial Hospital to her constituency. I would also like to reiterate the important role that community hospitals play in local areas. She could not have articulated those great values more beautifully this evening.

Community hospitals provide vital in-patient care for people who need it most. As a whole, patients should be supported to recover in the most appropriate setting, which is quite often back in the heart of their local community and closer to home. However, community hospitals do far more than just provide hospital beds. They also offer a range of out-patient services that provide much-needed support to patients, including physical therapy, lab tests, X-rays and counselling. They can also contain minor injuries units, which, as we have heard, can have people in and out and back to work or back home much more quickly. They also offer a welcome local alternative to the big emergency facilities at an acute hospital that is many miles away. To its credit, Congleton Hospital already does all this for its local community and for local people. It is these services, this outreach and these minor injuries units that place these institutions firmly at the heart of their local communities.

The Government are absolutely committed to ensuring that patients have access to care that is as close as possible to where they live. This is very evident in the NHS long-term plan, which focuses on shifting to a new way of delivering care, with services in the community at the very forefront of planning. Community hospitals represent much more than just medical services. Many, such as Congleton Hospital and my own, the Gosport War Memorial Hospital, were originally built through the donations of local people to address local need many decades ago. It is this history, along with the important services that they provide, that make community hospitals the object of affection and appreciation in local communities. It is therefore important that any planning decisions about these much-loved institutions must be taken locally, and with enormous care and the utmost sensitivity. Fundamentally, this is about developing sustainable health and care services in the community. We care deeply about ensuring that residents in all areas can access excellent health and care services, both now and in the future.

[James Heappey]

Our social media timelines are busy enough at the moment, so in order to avoid attracting the ire of a quarter of my constituents, I must remedy the fact that I neglected to mention the brilliant Weston-super-Mare General Hospital in my intervention. I am putting it on the record now.

[Caroline Dinenage]

I am glad that my hon. Friend said that, because if he had not, I would have been forced to do so. We should all celebrate the hospital provision in Weston-super-Mare and the great work that is being done there.

We care deeply about ensuring that residents in all local areas can access excellent health and care services, both now and well into the future, and that is why the NHS is this Government’s No. 1 spending priority. The NHS budget will increase by £33.9 billion in cash terms by 2023-24, which is the single biggest cash increase in the NHS’s history. We have set out the what, and we now have to set out the how, which is why we are focusing on successfully implementing the NHS long-term plan. The NHS will develop a clear implementation framework, setting out how the long-term plan’s commitments will be delivered by local systems. This will be shared shortly, and it is being led by NHS England.

My hon. Friend asked whether some of the additional resources from the NHS funding settlement could be earmarked for community care so that valuable community resources such as Congleton Hospital can continue to deliver their vital services. I can confirm that we have prioritised investment in primary and community healthcare through the long-term plan, in which we have committed at least an extra £4.5 billion a year to primary medical and community health services. That additional money will fund expanded community multi-disciplinary teams and will help to ensure that, within five years, all parts of the country will have improved community health response services that can be delivered by flexible teams working across primary care and local hospitals, and developed to meet local needs.

[Gareth Snell]

I fear that the Minister may have been about to answer my question, so I apologise if she was. I welcome the suggestion that community care should be the focus of part of the new investment that is coming into the NHS. Where CCGs take a decision to reduce the number of community facilities in their area, what recourse will the public have to say, “The Minister said this, but your actions are different”? In places such as Stoke-on-Trent, what the Government are outlining is not what our CCG is doing.

[Caroline Dinenage]

The hon. Gentleman makes an incredibly strong point. I often stand at the Dispatch Box—usually during Adjournment debates—having listened to hon. Members talk about CCG decisions that they feel may not be in the best interests of their local area, but it is up to local areas to decide. The whole point of devolving money and decision making down to CCGs is that we trust them to be able to make the best decisions in the best interests of local communities to deliver services that best meet needs and priorities. If the hon. Gentleman feels that that is not happening and if he has had the opportunity to discuss that with his CCG, it could be a good idea to take the matter up with NHS England.

CCG funding allocations are decided by an independent committee, which advises NHS England on how to target health funding in line with a funding allocation formula. This objective method of allocation supports equal opportunity of access and reduces health inequalities. That way, the decision of where taxpayers’ money goes is decided in an independent and impartial manner.

As my hon. Friend the Member for Congleton will be aware, it is down to the CCG—in this case Eastern Cheshire CCG—to decide how it spends its allocation and to determine which services are the right ones for the local community it serves. One would hope that CCGs have the necessary clinical knowledge and local expertise to make informed decisions on how to spend taxpayers’ money. To support the long-term planning of services, NHS England has already informed all CCGs about how much funding they can expect to receive between 2019-20 and 2023-24. My hon. Friend may be interested to know that Eastern Cheshire CCG’s funding will increase from £270.2 million to £311.6 million over that period—a substantial increase. I hope that she will agree that that information gives CCGs the stability to plan appropriately and establish their services for the long term.

[Karin Smyth]

I do not disagree with much of the thrust of what the Minister is saying, because CCGs—I used to work for one—do spend taxpayers’ money. She will often have heard hon. Members say that there is no link between the accountability for that money, the work that we do as Members of Parliament and the decisions that are made by CCGs. The new NHS plan looks like it may want to do something about that, but will the Government send a message to NHS England and the CCGs that local democratic accountability must somehow start to be built into the CCG decision-making process?

[Caroline Dinenage]

The hon. Lady makes an interesting point, and it is one with which I have a certain sympathy. When NHS England comes up with the implementation plan for the long-term plan, I hope it will include suggestions as to how such issues might be addressed.

It is important to remember that the NHS is close to all our hearts. Fundamentally, it belongs to the people of this country. It is founded on a common set of principles and values that bind together the communities and people it serves. For that reason, it is welcome to hear my hon. Friend the Member for Congleton talk so highly of the open and honest relationship between her local NHS and the residents of Congleton. The examples she gave of the decision-making process for introducing car parking charges highlights how local people in Congleton are being listened to and, if I might say so, it says a lot for the people of Congleton. It takes a lot for the people of Congleton to demonstrate, but this shows that they do so effectively when they decide to take such action.

I commend my hon. Friend for the role she has played in the work to protect her local hospital and for all her activities in that direction. I also commend her for her ongoing efforts in forging constructive relationships, which are so important. These open conversations between health systems and the people they serve will, ultimately, allow us to continue building a sustainable future for the NHS.

Question put and agreed to.

Safeguarding Vulnerable Adults: Care Homes

Caroline Dinenage Excerpts

Tuesday 26th February 2019 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I would like to start by congratulating the hon. Member for Tooting (Dr Allin-Khan) on securing this debate. Her speech this evening has been described as brave, but she took the time out yesterday to talk me through this incredibly distressing case, so she has been brave twice. She deserves all our respect and credit for doing that, because, as has been pointed out by others, she is not just talking about her own individual case, tragic though that is, but by articulating it in such an incredibly courageous way, she is also helping to support others who do not have this opportunity to share their voice and raise their concerns in the same way.

Everyone in this House has the same motivation, which is to ensure that our care services for the most vulnerable people are safe and of the highest quality. The hon. Lady talks powerfully about dementia, which is a priority for me personally. I have experienced what it is like to have a close family member, my grandmother, living with dementia. So many people up and down the country share that experience, and I think we all recognise that a dementia diagnosis is one for not only the individual concerned but their whole family. That is why I am so passionate about the need to ensure that those affected by this condition and others are cared for in the best possible way and that a robust complaints process for redress is in place if their care falls short of that.

It would be bad enough if the terrible situation that the hon. Lady describes were taking place in care homes—that would be disgusting and terrible—but she is talking about an extra care facility. Such a facility is where people have their own self-contained homes; they have their own front doors and their own legal right to occupy. So this is a failure of care in someone’s own home—it is a domiciliary care situation. That is why I am even more concerned about what can happen behind closed doors in an individual’s own house. To have a loved one affected by a degenerative illness is terrible for the individual and a matter of huge worry for their family. So I have previously said in this House that every allegation of abuse and neglect should be thoroughly investigated, with prosecutions brought where this is found.

[Alex Sobel]

First, I wish to pay tribute to my hon. Friend the Member for Tooting (Dr Allin-Khan) for her courage and alacrity in her speech. Some constituents came to me about their mother, who had been sexually assaulted in a care home, not by the staff, but by another patient. I was dismayed to hear that unlike nurseries, care homes have no minimum staffing ratio. Will the Minister look into having minimum staffing ratios in care homes, so that these events do not happen?

[Caroline Dinenage]

That is a very interesting question. I have not considered the minimum staffing issue before. We are of course very concerned about training and ensuring that all care staff have a care certificate, so that there is a minimum level of skills training. However, the point about ratios is interesting, and I will take it into consideration.

I do not have a massive amount of time left, so I am not going to discuss in full the details of the individual case raised by the hon. Member for Tooting. However, I must reassure her that what she has raised today is something I take very seriously. My officials have informed me that her raising her concerns so effectively and our inquiries from our office as well have prompted Wandsworth Council to hold another meeting today to discuss her case and review the evidence. As a result, there will be an outcomes meeting—

[Dr Allin-Khan]

Will I be invited?

[Caroline Dinenage]

It will be held for all parties to consider recommendations going forward and the hon. Lady will be able to attend. We look forward to hearing the outcome, and we will all be keeping a close eye on what transpires.

[Tracey Crouch]

Does my hon. Friend agree that this is slightly shocking to us all and in particular the family member of the victim in question, who has not been told by the council that this meeting is taking place? In many respects, that is part of the issue raised by the hon. Member for Tooting (Dr Allin-Khan): the family of the victim have not been included in any of these discussions or any of this process in the first place.

[Caroline Dinenage]

That is a very fair point and I am very keen that family members should be involved in the next stage of this meeting going forward. I will be keeping a very close eye on whether that does happen.

In the last few moments available, I want to talk about some of the things we have been doing to protect vulnerable people and some of the actions people can take if, heaven forbid, they find themselves in a similar situation. The Competition and Markets Authority published its care homes market study in 2017, shining a light on some instances of very poor and unacceptable consumer practices in the care homes sector. We accepted all its recommendations and have been putting forward a package of measures to address this. The CMA has also recently published guidance that it provides to care homes on how to meet their consumer law obligations. That has been a key milestone for the sector, and I am encouraged by the commitment some providers have already made to challenge some unfair practices.

Individuals and their families always have a right to complain about the care in a care home or about a domiciliary home care provider. Care homes must make it easy to complain and deal with the complaint quickly and fairly. Any care home that does not meet its obligations is in breach of consumer law, as well as many other things, and could face enforcement action by bodies such as trading standards or the CMA. The CQC encourages the public to share their experience through an online feedback mechanism.

Of course, it is only worth having a complaints system if people know about it and how to access it, which is why, through a joint sector initiative called Quality Matters, we are taking action to improve access to complaints systems and improve the feedback culture in the sector. That is an ongoing piece of work involving the local government and social care ombudsman—to which complaints and concerns about adult social care should be raised—and Healthwatch.

We are committed to preventing and reducing the risk of harm to adults in vulnerable situations. We have made it clear that there is statutory guidance to support the Care Act 2014, and we expect local authorities to ensure that the services they commission are safe and of high quality. We also expect those providing the service, local authorities and the CQC to take very swift action if there are any allegations of abuse, neglect or poor care.

Under section 42 of the 2014 Act, local authorities have a duty to carry out safeguarding enquiries. To aid them in that, they have the power to request information from a provider’s business. The CQC monitors how well providers are giving that information. As part of its inspection regime, the CQC also has to check whether there are effective systems to help to keep adults safe from abuse. The CQC has a duty to act promptly whenever safeguarding issues are discovered during inspections. As the hon. Member for Tooting said, abuse is ultimately a police matter, and if it is suspected, the police must carry out an investigation to determine whether offences have been committed.

We have introduced the new wilful neglect offence specifically to help to eradicate the abuse of people who depend on care services. We have also introduced tougher inspections of care services by the CQC. Thanks in part to this strengthened regime, we have seen a steady improvement in the quality of services, with 83% of adult social care settings now rated as good or outstanding by the CQC. Obviously, every single incident like the one the hon. Lady described and every single concern raised by worried family members makes us want to redouble our efforts to raise the quality. We have been supporting the CQC to understand how it can better hold providers to account where there is any failure.

Let me end by highlighting the hon. Lady’s enormous dedication, representing not only her constituency but the whole country. Whether someone is looking after their own father, mother, husband, wife, son or daughter, we all expect the care provided to be caring and of good quality. We must work and redouble our efforts to ensure that where failure happens, it must be stamped out and cannot be allowed to continue.

Personal Budgets: Consultation Response

Caroline Dinenage Excerpts

Thursday 21st February 2019 Written Statements

[The Minister for Care (Caroline Dinenage)]

Today I am publishing the joint response from the Government and NHS England to a recent consultation exploring extending legal rights to personal health budgets and integrated personal budgets. The response is available at: https://www.gov.uk/government/consultations/personal-health-budgets-and-integrated-personal-budgets-extending-legal-rights and a copy has also been deposited in the Libraries of both Houses.

Across the health and social care system, there is an ever growing shift towards personalising care, including an increasing amount of people choosing to take on a budget. It is clear that people value being involved in the planning of their care, being able to make choices and personalise their support in a way that best meets their bespoke needs. The evidence is clear; through personalised care, people are more satisfied, have better outcomes, and are able to explore more innovative approaches that better meet their individual needs.

The Government are therefore committed to increasing the extent to which people can exercise greater choice and control over their care. Personal health budgets, and all other features of a personalised care approach as set out within the “Comprehensive model of Personalised Care”, including shared decision making and personalised care and support planning, are the key mechanisms for delivering this change.

Given this commitment, we consulted on potentially extending the legal rights to personal health budgets and integrated personal budgets, to the following five groups:

People with ongoing social care needs, who also make regular and ongoing use of relevant NHS services.

People eligible for section 117 aftercare services and people of all ages with ongoing mental health needs who make regular and ongoing use of community based NHS mental health services.

People leaving the armed forces, who are eligible for ongoing NHS services.

People with a learning disability, autism or both, who are eligible for ongoing NHS care.

People who access wheelchair services whose posture and mobility needs impact their wider health and social care needs.

The outcome of the consultation was hugely positive, with 87% of respondents, on average, agreeing with each proposal made. At the same time, respondents outlined their positivity for personalised care more broadly, citing the positive impacts personalised care can bring to people’s lives.

We are committed to delivering an ambitious package of personalised care that will enable up to 5 million people to benefit in the next decade. As part of this ambition, we now intend to take forward work to extend the legal rights to people eligible for section 117 aftercare services, and people who access wheelchair services whose posture and mobility needs impact their wider health and social care needs. We will also continue to further explore both the other groups we consulted on, and additional groups who we believe could also benefit from having a right to have a personal health budget.

We want personalised care to become business as usual; and the ambitious package set out in this response, the “NHS Long Term Plan”, and universal personalised care will enable us to do this.

[HCWS1349]

Oral Answers to Questions

Caroline Dinenage Excerpts

Tuesday 19th February 2019 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

In December, NHS England announced plans to increase funding for children’s palliative care services to as much as £25 million a year over the next five years through match funding investment from clinical commissioning groups.

[Martin Vickers]

St Andrew’s children’s hospice, based in Grimsby, which serves my constituency and the wider Lincolnshire area, is greatly valued and much treasured by the local community. Will the Minister clarify exactly how the funding will be delivered and how St Andrew’s can benefit?

[Caroline Dinenage]

I am grateful to my hon. Friend for mentioning his local hospice. We all have wonderful stories about the fantastic care delivered by hospices, particularly children’s hospices, in our local area. NHS England will match fund clinical commissioning groups that commit to increase their investment in all children’s palliative and end-of-life care services by up to £7 million a year by 2023-24. This, added to the children’s hospice grant, which is currently £11 million a year, could therefore more than double NHS support to a combined total of £25 million.

[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

But the fact is that, even with those significant investments, most children’s hospices will still be reliant almost exclusively on fundraising and philanthropic donations. Does the Minister agree that, for there to be a proper footing for children’s hospices, there needs to be a much quicker move towards significant support from the state for these important facilities?

[Caroline Dinenage]

The hon. Gentleman talks about how children’s hospices, and indeed hospices, have traditionally been funded, but what we are looking at is an incredible commitment by NHS England to the value that hospices, and particularly children’s hospices, deliver not only in end-of-life and palliative care, but in respite care breaks and the immensely valuable outreach services that so many of them offer.

[Jack Brereton (Stoke-on-Trent South) (Con)]

Will the Minister join me in thanking the Donna Louise children’s hospice for its hard work in my constituency—it does incredible work—and in welcoming the new facility for young adults that it is hoping to open in the spring?

[Caroline Dinenage]

My hon. Friend is absolutely right to raise this. When children’s hospices expand and include facilities for young adults, it can make such an immeasurable difference in their local area. In my area, the Naomi House children’s hospice has opened Jacksplace, which has been such a valuable resource. Hospices should be incredibly celebrated for all such facilities they offer.

[Jim Shannon (Strangford) (DUP)]

Will the Minister take this opportunity to guarantee that the £11 million children’s hospice grant will be protected for children’s hospices, and indeed further increased as a result of the long-term plan to reflect the growing demand and the complexity of care provided by these lifetime services?

[Caroline Dinenage]

Yes. I think this is a really strong signal to clinical commissioning groups about how the NHS values the services provided by children’s hospices—not just end-of-life and palliative care, as I say, but the other respite and outreach services they provide. That is why giving them access to up to £25 million will make an immeasurable difference.

[Nick Smith (Blaenau Gwent) (Lab)]

7. What progress his Department has made on contingency planning for the UK leaving the EU without a deal.

--- Later in debate ---

[Bim Afolami (Hitchin and Harpenden) (Con)]

8. What steps the Government are taking to support charities and other organisations working on treating acquired brain injury.

[The Minister for Care (Caroline Dinenage)]

Everyone who has an acquired brain injury deserves to receive the best possible care and rehabilitative service. To ensure that, the NHS long-term plan included £4.5 billion of new investment to fund primary and community health services over the next five years.

[Bim Afolami]

I thank the Minister for that answer. The NHS has a good strategy on community-based care. On acquired brain injury, will the Minister advise me and Headway Hertfordshire, a brilliant local organisation, on how we can be more proactively involved with the strategy and attract more funding from local clinical commissioning groups? Will she meet me and the organisation to discuss this matter further?

[Caroline Dinenage]

I am delighted that my hon. Friend mentions Headway, which is a fantastic organisation that does great work. I meet it regularly in my own constituency and I would be more than happy to do so with him. The partnership boards of local integrated care systems, which will plan and shape those services, will include the voice of voluntary services and the voluntary sector in their area. His local Headway branch would be well advised to engage with that group.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

Some 1.3 million people are living with traumatic brain injury and related disabilities. Brain injury can be caused by excessive alcohol consumption, particularly among young people. What support will the Government be giving to local health services to increase the use of technology, particularly using creative industry developments, that can help rehabilitation for those with brain injuries?

[Caroline Dinenage]

There are several points here. On local community services, as the hon. Lady heard, we are putting an extra £4.5 billion into community and local health services. Through the National Institute for Health Research, we fund brain injury research into how technology and other innovations can be used to better support people.

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

9. What plans he has to ensure that improvements to dementia care are included in the forthcoming Green Paper on social care.

[The Minister for Care (Caroline Dinenage)]

The social care Green Paper will bring forward proposals to ensure that all adults, including those living with dementia, receive high-quality care whenever they need it. The Government also remain committed to delivering Challenge on Dementia 2020, making dementia care in England the best in the world.

[Ms Rimmer]

Sadly, there are an estimated 3,000 people over 65 living with dementia in my constituency. It is clear that the social care crisis is a dementia crisis. Alzheimer’s Society research shows that dementia care providers often charge a premium rate of over 40% more than the standard rate. Will the Minister consider introducing a new dementia fund, as part of the Green Paper process, to end the unfairness facing dementia patients and their families?

[Caroline Dinenage]

The hon. Lady is absolutely right to raise dementia. It is a massive issue in everybody’s constituency and there is hardly a family that is not affected by it in some way. We are on track to meet our pledge to invest £300 million in dementia between 2015 and 2020. We continue to fund research for dementia treatments and cures. The Care Act 2014 introduced a national threshold that defines the care needs local authorities must meet, eliminating the postcode lottery of eligibility across the UK.

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

When the Minister of State looks at the proposals for the Green Paper on social care reform, will she consider the German system of compulsory social care insurance? The rate has increased by only 0.94% since its introduction in 1994, while delivering care for dementia and other impacts that were not assessed back in 1994.

[Caroline Dinenage]

My hon. Friend tempts me to do some big reveals about the contents of the Green Paper. I will say that it will look at a number of different funding options.

[Stephen Lloyd (Eastbourne) (Ind)]

On dementia in the community, many people with low-onset or mid-onset dementia can, with the right social care, stay in their home. The crucial part is to have the funding necessary to allow people to get social care support. Will the Minister, in the Green Paper, commit specific sums for social care to keep people with dementia in their homes?

[Caroline Dinenage]

The adult social care Green Paper will look at the long-term sustainability of the funding of the adult social care system. In the meantime the Government are investing by giving councils access to up to £10 billion over the current three-year period, to help to address some of the shortfalls in adult social care funding and to ensure that people have the right services in their local areas.

[Mr Philip Hollobone (Kettering) (Con)]

The best way to help dementia patients is to have joined-up NHS and social care provision. Will my hon. Friend work with the Secretary of State to take advantage of local government reorganisation in Northamptonshire to develop a combined NHS and adult social care pilot?

[Caroline Dinenage]

My hon. Friend is absolutely right to raise this point. Integrated health and care systems are very much the way forward if we are to deliver the future of adult social care that we all want. The long-term plan for the NHS was developed in tandem with the adult social care Green Paper and has already shown some of the innovations that we think will make a massive difference, such as the roll-out of the enhanced health in care homes model.

[Giles Watling (Clacton) (Con)]

10. When his Department plans to publish the Green Paper on social care.

[The Minister for Care (Caroline Dinenage)]

The Green Paper on adult social care remains a priority for the Government. We will shortly be publishing this document, which sets out proposals to reform the adult social care system.

[Giles Watling]

I thank my hon. Friend for her answer. This issue was raised with me recently by Councillor John Spence of Essex County Council. I am concerned that two years later, we are still waiting for the publication of the Green Paper. Of course, we must get it right, but people need change to the social care system and they need it now. What further steps can she take to speed up this process?

[Caroline Dinenage]

I understand that my right hon. Friend the Secretary of State has met the gentleman my hon. Friend refers to. I understand and share my hon. Friend’s frustration. We need to ensure that the social care system is sustainable in the long term and we have taken some time to get these big decisions right, but I can assure him that the Green Paper will be published at the earliest opportunity.

[Mr Speaker]

Order. The hon. Member for Blackburn (Kate Hollern) could very legitimately shoehorn her inquiry on question 18, which might not be reached, into this question, which has been. It is not obligatory, but don’t be shy—get in there.

[Mr Speaker]

Nobody can accuse the hon. Lady of failing to take full advantage of my generosity.

[Caroline Dinenage]

I do not agree with the hon. Lady. What the Government have done is try to tackle the geographical inequalities in care across the country. We have increased councils’ access to funding by up to £10 billion. That is a 9% real-terms increase in funding, but in addition to that, we have established a national threshold that defines the care needs that local authorities must meet under the Care Act. That has really started the work of eliminating the eligibility postcode lottery across England.

[Mr Chris Leslie (Nottingham East) (Ind)]

It is two years since the Government promised the social care Green Paper. In that space of time, we have had a lot of words from the Government, but we have also had a lot of neglect from them on this particular issue. Does not this delay, this prevarication, putting long-term issues to the back burner, typify what is wrong with the broken politics in this country?

[Caroline Dinenage]

First, I welcome the hon. Gentleman to his new location in the Chamber. From that location, he might recognise that actually, there has been a failure of successive Governments to get to grips with this very thorny issue of the long-term funding of adult social care. We are the Government who have decided to tackle the issue. We will no longer put it in the “too difficult” pile, and we will be publishing this document shortly.

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

But the Government are not tackling the problem of the long-term funding of social care, are they? Age UK found that 50,000 people who had applied for social care had died waiting in vain for that care in the 700 days after the Government first announced their Green Paper. How many more people will have to die waiting in vain for social care before the Government fix the crisis they have created?

[Caroline Dinenage]

I cannot stress enough how much money we have made available. The Government have given councils access to almost £10 billion—a 9% increase—to address this issue. Local authorities have a statutory duty to look after the vulnerable, the elderly and the disabled people in their area, and we have given them access to the funding to do it.

[Gavin Newlands (Paisley and Renfrewshire North) (SNP)]

11. What steps he is taking to ensure a sustainable workforce in the health and social care sector.

--- Later in debate ---

[Dr Sarah Wollaston (Totnes) (Con)]

T3. Key parts of our NHS workforce are registered and regulated by the Health and Care Professions Council. Does the Minister share their concern about the steep rise in professional fees that they face—in particular, the loss of the 50% discount that applied to graduates within two years of qualifying—and will she look again at whether anything can be done to assist this key group of our workforce?

[The Minister for Care (Caroline Dinenage)]

My hon. Friend is absolutely right about the need to support and enhance the protections for allied health professionals. One of the recent planned HCPC increases was to raise its annual fees by £16, but it would still remain one of the lowest of any of the UK-wide health and care regulators. It is also important to remember that regulation fees are tax deductible.

[Peter Kyle (Hove) (Lab)]

T6. The head of NHS Improvement, who is also a Tory peer, has said the biggest problem facing the NHS is that not enough people want to work in it. How did the Secretary of State take Britain’s best-loved institution and turn it into something nobody wants to work for?

St Helier and St George’s Hospitals

Caroline Dinenage Excerpts

Tuesday 19th February 2019 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing this incredibly important debate on the future of St Helier and St George’s hospitals. I thank her for her continuing interest in healthcare services in south-west London over many years. She has been a passionate, highly motivated and extremely effective advocate for the interests of her constituents, and I am sure many of the points she has raised today will be heard beyond these four walls.

The hon. Lady is rightly concerned about the future of services at St Helier Hospital, which is run by Epsom and St Helier University Hospitals NHS Trust, and particularly about the future of its A&E service. She is right that the organisation of acute services in south-west London appears to have been discussed for a number of years. In the interest of time, I will not set out the timescales and all the things that have occurred over that period, as she has already articulated it well.

In June 2018 the clinical commissioning groups published an issues paper, which outlined the challenges faced by the local healthcare system and the four key local aims: improving the health of the population; delivering care as close to patients’ homes as possible; ensuring high standards of healthcare across all providers; and maintaining the provision of major acute services within their combined geographies. The issues paper set out a provisional shortlist, with three potential options for acute care: locating major acute services at Epsom Hospital and continuing to provide all district services at both Epsom and St Helier hospitals; locating major acute services at St Helier Hospital and continuing to provide all district hospital services at both Epsom and St Helier hospitals; or locating major acute services at Sutton Hospital and continuing to provide all district services at both Epsom and St Helier hospitals.

The CCGs invited comments and suggestions from local stakeholders over a period of three months. The CCGs stressed that the proposals do not involve closing any hospital. At this stage, they say, they do not have a preferred local proposal. I understand they are continuing to work with local partners to further develop the proposals, which will include a full options appraisal, an impact assessment and the development of a pre-consultation business case that will, of course, have to undergo NHS England assurance. I am sure the hon. Lady will make her thoughts known to NHS England.

[Paul Scully]

Does my hon. Friend agree that one thing many people in Sutton and Merton do not have, because St Helier is such an old hospital, is a possible £400 million brand-new facility, which would bring benefits no matter where it is located?

[Caroline Dinenage]

My hon. Friend makes an excellent point, and that is why it is important that no significant changes are made without consultation so that local people’s views can be taken into consideration. The CCGs will need to consult the public fully before making any decisions about a new hospital or changes to the configuration of acute services, but clearly any form of investment is welcome.

[Siobhain McDonagh]

Lists of NHS capital programmes in London have appeared in various newspapers, with Imperial College Healthcare NHS Trust at the top of those lists—Charing Cross and other hospitals are in that group. St George’s is desperate. Sewage came through the sinks and toilets in its A&E only a few weeks ago. It is not sure whether the electrics are going down, or whether the plumbing, the water and the water systems have caused considerable health problems to patients. Who is getting the money? Is it all going to south London? It would certainly all have to go to south London if there were to be a brand-new hospital anywhere.

[Caroline Dinenage]

The hon. Lady asks an excellent question. The CCGs are working closely with NHS England and NHS Improvement to develop the programme’s capital scheme prior to the next spending review, with a view to NHS England and NHS Improvement presenting the scheme for funding. They expect the public consultation on their proposals not to take place until after the next round of capital bids is concluded, which is likely to be after the autumn. There is a duty to carry out a travel times analysis when developing proposals, and this will be included in the consultation. CCGs also have duties to reduce inequalities. She spoke a lot about the inequalities in her area, and an impact analysis of that has to be done.

I understand that the hon. Lady is also concerned that any potential changes could increase pressure on St George’s hospital, and she is absolutely right to raise that important point. The Department is clear that NHS England and local NHS organisations must think about potential impacts on other services, which is why we are developing a more strongly regional approach in designing NHS services. CCGs must consider the impact on neighbouring hospitals close to the CCG boundary, such as St George’s. Changes to A&E services at any one hospital potentially have an impact on a number of surrounding hospitals, so the three CCGs have to engage with their neighbours throughout this process. In addition, the neighbouring CCG can respond to any public consultation and its response must be taken into account.

On the next steps, the hon. Lady will be aware that the reconfiguration of services is a matter for NHS England and local NHS bodies. Such matters have to be addressed at local level rather than in Whitehall because local organisations understand the needs of their community. No changes to the services people receive can be made without formal public consultation. They must have support from GP commissioners, demonstrate strengthened public and patient engagement, and have a clear clinical evidence base. They must also be consistent with the principle of patient choice. The NHS England test on the future of use of beds requires assurance that the proposed reduction is sustainable in the longer term. The Department is very clear that throughout the service change process local NHS organisations have to engage with the wider public and with the local MP on these issues, so I am sure that she and her constituents will take part in any local engagement as plans move forward.

The challenges facing the health economy in south-west London have been widely understood for a number of years. I recognise and appreciate that potential changes to local health services are often a cause of great worry and that they inspire impassioned debate among those involved. It is time for local partners to work together to find a solution which, as the hon. Lady said, has to be right for the people of south-west London and will secure a sustainable configuration of health services in the future. I thank her again for her continued dedication to these health matters.

[Paul Scully]

The Minister mentioned the fact that the consultation might be done after the spending review. I have written to the Secretary of State asking whether he would consider looking at that again, because the mayoral election is coming up next year and the purdah period will mean that this will, in effect, be delayed for a whole year. Anything more that can be done to bring it forward would be very helpful.

[Caroline Dinenage]

In the nick of time, my hon. Friend makes that point well, and I will definitely make sure that it is passed on.

[Siobhain McDonagh]

Will the Minister unequivocally put on the record that any consultation document has to go everywhere or nowhere, and that some consideration must be given to how much things cost? I am amazed that the NHS gets so few people to turn up to events that it spends so much money on.

[Caroline Dinenage]

The hon. Lady makes an excellent point. It always amazes me how few people engage in some of the consultations, which are often discussing huge sums and affect really important day-to-day provision of essential care services in their area. Yes, consultation has to go to the whole area—indeed I have already spoken about how it needs to go beyond the area and look at the impact on other local services and the people who use them. She is absolutely right to say that consultation has to be effective and it has to ask everybody who might be affected by any changes. With that in mind, I thank her again for her continued dedication to her constituents.

Question put and agreed to.

NHS 10-Year Plan

Caroline Dinenage Excerpts

Tuesday 19th February 2019 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I thank hon. Members from across the House for their contributions to this debate. It is clear there is agreement on the importance and value we place on our national health service. That is why the long-term plan is such a historic moment for the public, for patients and, of course, for the staff who work tirelessly to make our NHS one of the most enduring British success stories.

I will try to respond to as many of the speakers as possible, but I agree we need a much longer debate to fully do justice to this important subject. It has been quite a collegiate debate, with Back Benchers from across the House having welcomed many of the promises in the long-term plan, although not so much the shadow Front-Bench team, whose attitude I will quickly sum up: they do not like it unless they thought of it first, and we are not putting in enough money, although considerably more than they promised in their 2017 manifesto until they did a back-of-the-fag-packet recalculation. Why can they not celebrate our NHS? Why can they not celebrate the fact that the Government are making the single biggest cash investment in our NHS in its history? Some will question, of course, whether the funding is enough for the health service to implement this vital transformation, but I remind them that this is a fully costed plan developed by NHS leaders and clinicians within the budget agreed by the NHS and with the Government.

We must also remember that the future of the NHS is not just about the additional £33.9 billion cash injection by 2023-24; it is about spending every single penny of taxpayers’ money wisely—in five years’ time the NHS budget will be £148.5 billion—which is important because our NHS is under more pressure than ever before. As my hon. Friend the Member for Mid Worcestershire (Nigel Huddleston) said, demand on A&E from type 1 attendances was 6.8% higher this January than last January—that is 2,700 more people through the doors every single day.

Of course, publishing one document will not translate all the long-term plan’s objectives into reality, which is why the NHS will develop a clear implementation framework by the spring to set out how the commitments should be delivered by local systems and ensure transparency for patients and the public. It is also why the Secretary of State has commissioned Baroness Harding, working closely with Sir David Behan, to lead a number of programmes to develop a detailed workforce implementation plan. The first stage of that will be revealed in the spring, and the rest will come forward in the autumn.

A key focus of the long-term plan is the importance of improving the patient experience, safety and flow through hospitals. The plan will support the reform of urgent and emergency care services to ensure that patients get the care they need quickly, relieve pressure on A&E departments and manage winter demands. Improving out-of-hospital care will ensure that people are treated in the most appropriate setting to avoid unnecessary visits to hospital and support quicker discharge.

Hon. Members spoke about the importance of local provision, community hospitals and local GP services. It is important that these services be decided and led by local NHS organisations that understand the local community healthcare needs, but of course we expect the NHS to work collaboratively to ensure that both urgent and routine care needs are met in a way that ensures the best possible use of NHS resources. Investment in primary and community services will increase by at least £4.5 billion, and spend on these services will grow faster than the rising NHS budget. Funding will be provided for an extra 20,000 other staff working in GP practices.

The long-term plan sets out how we will improve prevention, detection, treatment and recovery in respect of major diseases, including cancer, heart attacks and strokes—hon. Members have mentioned those today. Patients can expect the introduction of new screening programmes, faster access to diagnostic tests and new treatments and the use of technology, such as genomic testing. NHS England is already testing innovative ways of diagnosing cancer earlier, with sites piloting multidisciplinary diagnostic centres for patients with vague or non-specific symptoms, such as those common in blood cancers. The Government have pledged to roll out rapid diagnosis centres nationally to offer all patients a range of tests on the same day with rapid access to results.

Mental health has also been raised. The long-term plan renews the commitment to grow investment in mental health services faster than the NHS budget overall, with at least £2.3 billion in real terms.

The Government’s commitment to the health service is clear and undeniable. Our historic funding settlement has enabled the NHS to create a plan for the future of the system which will benefit patients now and generations to come. We will continue to support this system as it begins to put our plan into practice.

I thank the Members who have spoken this evening, and I will write to those to whose points I was not able to respond.

Question put and agreed to.

Resolved,

That this House has considered the NHS Ten Year Plan.

NHS Menopause Services

Caroline Dinenage Excerpts

Wednesday 13th February 2019 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I congratulate my hon. Friend the Member for Redditch (Rachel Maclean) on securing this debate on health services and the menopause, and I want to start by celebrating the fact that we are discussing this subject. For too long the things that only affect women have been taboo; they have been brushed under the carpet—they have not been discussed in this place. One of the most magnificent of the many great side-effects of having a more gender-equal place is that we begin to discuss these subjects and those last taboos get addressed properly. It is wonderful to hear and see the men present in this Chamber who also care passionately about this subject; that must be celebrated too.

My hon. Friend has been a passionate and highly effective campaigner for improved awareness of the menopause and better support for women who are dealing with some of the difficult symptoms. I am very grateful and supportive of her work on this issue; in my eyes she is an absolute hero. I believe it is vital that we provide effective support and treatment for women with menopausal symptoms. It is of the utmost importance that we continue to work to improve that and to tackle the misconceptions attached to the menopause.

My hon. Friend raised the issue of HRT and expressed her concern that some GPs are not prescribing or recommending it to women who need it. No two menopauses are exactly alike and GPs play an important role in ensuring patients are given treatment that is appropriate to them. It is worth bearing in mind that the menopause is a natural stage in a woman’s life, and that many women will experience the menopause without troublesome symptoms or the need for treatment. Where symptoms do arise, HRT can be very effective in relieving them, and GPs should give menopausal women information about HRT as a treatment option, highlighting its risks, if they see that there are any, and its benefits. However, every patient is different and HRT might not be suitable for everyone. It is not the only treatment for menopausal symptoms, and GPs should also, where appropriate, talk women through all the non-hormonal and non-pharmaceutical treatments that are available.

My hon. Friend is right to say that there has been real confusion in the past about the safety of HRT. Concerns were raised in the early 2000s, as she mentioned, when a study said it was associated with an increased risk of breast cancer and heart disease. As a result, many women were advised by their doctors to come off HRT and the number of HRT users in the UK fell significantly. I cannot stress strongly enough that, as my hon. Friend has noted, the evidence base has since become clearer and the NICE guidance on the menopause is clear that HRT is a perfectly safe treatment in the majority of cases, and in most cases there is a far lower health risk in taking HRT than in drinking a couple of glasses of wine every day or in obesity, as my hon. Friend said.

The NICE guidance on the menopause also provides GPs with advice on how to recognise symptoms of the menopause. This guidance has helped prevent misdiagnosis, and my hon. Friend spoke very powerfully about how sometimes menopause can be mistaken for depression, which is incredibly worrying. Improving treatment of the symptoms of the menopause is also important.

We are also taking a range of other actions to improve support for women experiencing menopausal symptoms. This includes the work of the royal colleges, which of course play an important role in the education, training and professional development of healthcare professionals who treat women with menopausal symptoms. The Royal College of General Practitioners has produced a toolkit that includes learning resources for GPs on diagnosis and management of symptoms of the menopause. In addition, the Royal College of Nursing, in collaboration with the British Menopause Society, has produced a guide providing information for nurses who wish to become specialists in the menopause. That is very important, too. The Royal College is also aiming to develop a GP specialty that focuses on women’s health, which will be warmly welcomed.

Correct diagnosis and treatment of symptoms of the menopause are important, but we also have to focus on improving wider awareness of the menopause. An important part of this will be to have more open conversations around the menopause, so that we can start tackling the taboos that are attached to it. Taking this wider, bigger-picture approach is vital, given the huge impact that the menopause can have on all parts of a woman’s life.

In raising awareness and tackling taboos, we need to ensure that we reach out to all demographics, including boys and men. I cannot help thinking that if a similar hormonal transition affected men for an average of four years in the second half of their life, we would never hear the end of it—[Interruption.] Present company excepted, of course. As it is, the menopause has become something of a taboo, and we have to get over that. That is why it is so incredibly faith-restoring to see these incredibly liberated and forward-thinking gentlemen in the Chamber tonight, including my hon. Friend the Member for Walsall North (Eddie Hughes), who has talked about the menopause café that he runs. He should be championed for that. I was also pleased to see that the debate that was held on world menopause day last October was called by a male MP. These men are champions, in my eyes, and they deserve to be celebrated.

As my hon. Friend the Member for Redditch mentioned, education is absolutely key to promoting awareness and understanding of the menopause. The Government are making relationships education compulsory in primary schools and relationships and sex education compulsory in secondary schools. The underpinning focus in these subjects is to equip young people to develop positive attitudes to health, relationships and wellbeing. Schools will then have a really good opportunity to improve pupils’ understanding and awareness of the menopause.

Hon. Members will be aware that women represent 51% of the UK population and 44% of our workforce. They play a vital role in the nation’s health, but they do not always receive the most timely or appropriate healthcare. My hon. Friend mentioned the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who is the Minister with responsibility for mental health, inequalities, and suicide prevention. She is doing sterling work on this issue, and she has set up a women’s health taskforce. This taskforce will work to ensure that women receive timely and appropriate care in relation to a whole range of issues, and as part of its upcoming early work, it will consider the menopause.

This work will be informed by a collaborative discussion that will be led by the brilliant chief medical officer and include the Royal College of Obstetricians and Gynaecologists, a number of academics who work in menopause research and GPs who specialise in the menopause. These discussions will feed into the taskforce’s wider objectives: to empower women to speak more confidently; to raise awareness and break taboos around women’s health problems; and to improve the access, quality and experience of care for women. I hope that that will help to address some of the important issues that my hon. Friend has raised today, and I am sure that my ministerial colleagues in the Department of Health and Social Care will be absolutely delighted to work closely with her on the taskforce’s developing work around the menopause, because she has done such sterling work in this area so far.

We need to ensure that workplaces provide the necessary and appropriate support for women. A recent study found that 41% of women aged 50 to 60 said that the menopause had affected their job, but that 70% did not tell their employer about their symptoms. This demonstrates the work that needs to be done to move beyond shame and silence to an open conversation about the menopause, because half the population will go through it. Giving better support to those women in work is not only right but fundamentally good for the economy. Women over 50 are now one of the fastest growing groups of employees. They have invaluable skills and experience, which means that they are incredibly difficult to replace. We should be looking to support them to stay in work whenever we can.

I am particularly proud to be responding to this debate tonight not only because I am hurtling very fast towards the menopause myself but because, when I was Minister for Women and Equalities, I chaired the very first parliamentary roundtable on awareness and taboos around the menopause in the workplace. This was the first ever meeting in Parliament that brought together important stakeholders and interested parties to discuss this important issue. We heard some incredible evidence. I remember one lady telling us that she had had to leave her workplace because all she wanted was a desktop fan to help her deal with the hot flushes, but the company would not let her have one and so lost an employee with incredible experience and huge amounts of skill, which just makes no sense at all.

[Jim Shannon]

I thank the Minister for her positive response. There is an old proverb that a problem shared is a problem halved, and the Minister has clearly indicated a method of doing that. I encourage her to get that message out across GP surgeries, education and all the relevant bodies.

[Caroline Dinenage]

The hon. Gentleman is an enlightened man. The work that we did at the very first roundtable led to an evidence review that was published in 2017, which talked about raising awareness and about the effects on women’s economic participation. The review led to the Women’s Business Council developing a toolkit to enable employers to support their employees more effectively, and I think we can all agree that that can be nothing but a good thing.

[Rachel Maclean]

I thank the Minister both for the measures she is outlining and for the work that she did originally. Is she aware that the menopause used to be called the silent passage? The work that she and the others in the Chamber tonight are doing is helping to bring some sound to this passage, which can only be a benefit for every member of society.

[Caroline Dinenage]

My hon. Friend is right. I had not heard that description before, but it sums up what we are talking about.

The toolkit that the Women’s Business Council produced when I was in the Government Equalities Office sets out positive action that employers can take around flexible working and improving awareness and understanding around the menopause. It also provides practical and often simple adjustments that employers can make. We also support actions taken by individual organisations to raise awareness. My hon. Friend mentioned some wonderful examples of such work, including at West Midlands police and the Bank of England. I pay tribute to them and encourage more employers to think about what more they can do to support women through the menopause.

I thank my hon. Friend for raising this important issue. The menopause is about valuing people, equality and rights. We have shown we can make progress on such issues elsewhere, and we must and will do the same here.

Question put and agreed to.