Designated Settings Indemnity Scheme Extension

Gillian Keegan Excerpts

Tuesday 14th December 2021 Written Statements

[The Minister for Care and Mental Health (Gillian Keegan)]

Further to the written statement on 29 June 2021, I am tabling this statement for the benefit of hon. and right hon. Members to bring to their attention the undertaking of a contingent liability. This relates to an extension of the designated settings indemnity support (DSIS), which offers targeted and time-limited state-backed indemnity arrangements to care homes registered, or intending to register, as “designated settings”, and which are unable to obtain sufficient insurance cover.

On 18 January 2021, the Minister for Covid Vaccine Deployment announced in a written ministerial statement, and accompanying departmental minute, provision of these temporary indemnity arrangements under the DSIS. The DSIS includes cover for clinical negligence, employer’s and public liability where a care provider seeking to become a designated setting is unable to secure sufficient commercial insurance, or where an existing provider has been operating without sufficient cover. Employer’s and public liability is covered under the new coronavirus temporary indemnity scheme; clinical negligence is covered by the clinical negligence scheme for trusts. The DSIS is supervised by DHSC and administered by NHS resolution, and to date, has proved to be an effective package of support to designated settings.

DSIS initially provided cover for designated settings until the end of March 2021 and was subsequently extended until 30 September 2021. Now, following a further review of DSIS, it has been extended until 31 March 2022, in order to maintain the current level of support for these vital settings. This extension will benefit current DSIS participants, as well any additional settings that may wish to apply for the support and who meet the criteria for inclusion. We will review the progress of the support ahead of this end-date.

I regret that in this circumstance, due to the need to ensure that there were no gaps in DSIS cover after the former 30 September end date, the normal 14 sitting days for consideration was not possible. A departmental minute will be laid in the House of Commons providing more detail on this contingent liability.

[HCWS476]

Dignity in Dying

Gillian Keegan Excerpts

Wednesday 8th December 2021 Commons Chamber

[The Minister for Care and Mental Health (Gillian Keegan)]

I begin by thanking my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell) for securing a debate on this issue and for not only outlining his views on assisted dying, but taking many interventions on both sides of the debate.

It remains the Government’s view that any change to the law in this sensitive area is a matter for Parliament to decide and an issue of conscience for individual parliamentarians, rather than one for Government policy. I have the utmost sympathy for all those who have suffered the pain of watching a loved one battle a life-threatening or degenerative condition; many of us will have witnessed that, and it will inform our decisions.

As my right hon. Friend mentions, in order to develop more precise estimates of suicide risk for people with specific debilitating and terminal illnesses, the Office for National Statistics is consulting with clinical experts and is due to publish its report next year. We will consider its findings carefully.

We know that this issue is also being considered across the wider UK family, with—as my right hon. Friend mentioned—an ongoing consultation with the Scottish Parliament and legislation being drafted by Jersey’s Council of Ministers. We will await further details of any proposals that may be presented, at which point we will be able to say more about how medical professionals can work within the different countries. The Government are, however, committed to ensuring that patients of all ages are treated with dignity at the end of life, and have the opportunity to benefit from high-quality personalised care that takes account of their wishes.

The NHS constitution states our commitment to putting respect, dignity, compassion and care at the core of the way in which patients are treated. Dignity means different things to different people, but as the Parliamentary and Health Service Ombudsman pointed out in a 2014 report, there are some key actions to ensure that people have dignity at the end of life They include allowing patient choice through appropriate care planning and promoting good and timely communication, with patients and their families and between the people and organisations supporting them.

We have seen many changes in the health system over the last decade, including an ambition to move more care out of acute, in-patient settings and make it available to people at—or closer to—home. The place where care is provided is particularly important for people at the end of life, and palliative and end-of-life care services have adapted to allow patient choice wherever possible.

We know that the covid-19 pandemic brought new challenges, with a sudden and significant increase in both the number of deaths overall and the proportion of people who passed away at home, but despite those challenging circumstances, our dedicated and exceptional palliative and end-of-life care workforce demonstrated their pragmatism and resilience and continued to provide world-class care for patients around the clock, working hard to adapt to meet the needs of patients and their families and ensure that dignity was maintained. We are immensely grateful to them. They have truly gone above and beyond throughout the covid response, and they deserve our unwavering support and recognition.

However, despite the efforts of our health and care colleagues across the system, before and during the pandemic, we know there is still more that we can do. Improving quality of care requires a confident workforce with the knowledge, skills and capability to deliver high-quality palliative and end-of-life care. Health Education England continues to provide comprehensive training for all health and care staff involved in palliative and end-of-life care through the availability of resources from the End-of-life care programme.

Furthermore, NHS England and NHS Improvement have committed themselves to supporting the transformation of palliative and end-of-life care services, as was pointed out by my hon. Friend the Member for Devizes (Danny Kruger). They have developed a three-year strategic delivery plan, aligned with the long-term plan, which prioritises the importance of improving access, quality and sustainability. They are committed to providing dignified, personalised care for people at the end of their lives, including opportunities for shared decision-making conversations about their treatment and support. Those conversations between healthcare professionals and patients ensure that patients’ preferences and needs are taken into account when their care is being planned.

NHS England and NHS Improvement will be publishing advance care planning principles in early 2022. They will focus on the importance of providing opportunities for a person and his or her family or carers to engage in meaningful discussions, led by the person concerned, which consider that person’s priorities and preferences when he or she is nearing the end of life. The Health and Care Bill presents a fantastic opportunity to strengthen the existing partnerships across the health and care system and continue the excellent work that non-statutory integrated care systems have started.

NHS England and NHS Improvement are already supporting commissioners through their strategic clinical networks. These networks are using integrated whole-system collaborative approaches to continue to drive improvements in outcomes for patients at the end of life, including through encouraging innovation and sharing best practice. One example is the work of the north-west palliative and end-of-life care strategic clinical network, which is focused on delivering activities to promote equity and reduce health inequalities in palliative and end-of-life care across the region.

If passed, the legislation will increase integration between health and social care further by removing barriers to data sharing and enabling joint decision making and collaborative practice. As a Government, we value collaboration at all levels, and just this morning I met colleagues from Marie Curie to discuss services for people at the end of their life. I am keen to continue to work with our passionate and dedicated stakeholders to further consider the opportunities for embedding best practice at local and national level, and to ensure that there is no postcode lottery or patchy services. Building on the great work that is already happening and looking to the future, we know that demand for palliative and end-of-life care services has increased and will continue to do so as our population ages. The Government will continue in their commitment to enable high quality personalised palliative and end-of-life care, and we are committed to ensuring dignity and choice for all, even at the most difficult of times.

Question put and agreed to.

Mental Health Units (Use of Force) Act 2018: Commencement

Gillian Keegan Excerpts

Tuesday 7th December 2021 Written Statements

[The Minister for Care and Mental Health (Gillian Keegan)]

Today, I am delighted to announce the commencement of the majority of the provisions of the Mental Health Units (Use of Force) Act 2018, and alongside this, the publication of:

the Government’s response to a public consultation on the draft statutory guidance; and

the revised statutory guidance, which has been reviewed considering the public consultation held earlier this year.

The provisions specified within the commencement regulations will be brought into force on 31 March 2022. This will allow reasonable time for mental health units to prepare for the new requirements the Act will place on them, and enable them to take account of the statutory guidance which is being published in advance of commencement, alongside the response to the recent public consultation on the statutory guidance.

The Mental Health Units (Use of Force) Act 2018 was introduced in the House of Commons by the hon. Member for Croydon North (Steve Reed) in July 2017 and received Royal Assent in November 2018. The Act, also known as Seni’s Law, is named after Olaseni Lewis, who died as a result of being forcibly restrained by up to 11 police officers while he was a voluntary patient in a mental health unit. Seni was 23 at the time of his death, doing a postgraduate Masters in IT and business management at Kingston University and should have had his whole life ahead of him. Following their son’s death, Aji, Conrad and the Lewis family campaigned and fought for justice for their son, and the answers to what happened to him on that day. It took seven years before there was an inquest, which ruled:

“The excessive force, pain compliance techniques and multiple mechanical restraints were disproportionate and unreasonable”.

The Act aims to clearly set out the measures which are needed to both prevent the inappropriate use of force and ensure accountability and transparency about the use of force in mental health units, encouraging a human-rights, trauma-informed and person-centred approach to patient care. The statutory guidance sets out how we expect mental health units to meet the requirements of the Act. The requirements of the Act and the statutory guidance provide a much needed opportunity to embed a consistent approach across services nationally.

I believe that every individual has the right to be treated with dignity, in a caring therapeutic environment which is free from abuse. The use of force can sometimes be necessary to secure the safety of patients and staff. However, it is always accompanied by risk and can often be a traumatic experience for patients when they are most vulnerable and in need of compassionate care. For too long mental health services have relied on the use of force, with data showing the use force is at an all-time high.

This Act represents a vital step in efforts to reduce the use of force in mental health units, which affected over 13,000 individuals in 2020-21 and disproportionately those with protected characteristics under the Equality Act 2010.

I am encouraged that this landmark piece of legislation enjoys the support of patients, people with lived experience, voluntary and charitable sector organisations and the NHS. Today’s commencement of the majority of the Act represents a significant step forward in our efforts to prevent the use of inappropriate force in mental health units, which would not have been possible without the tireless campaigning of the hon. Member for Croydon North, Aji and Conrad Lewis and their daughters Kemi and Lara. Aji Lewis, with the support of her family, continues to campaign to reduce the use of force and improve mental health services for all patients. I am privileged to have had the opportunity to meet Aji and hear her family’s and Seni’s story directly from her.

This is part of the Government’s wider reform agenda to improve support for individuals with severe mental illnesses. The Government published their Mental Health Act White Paper on 13 January 2021 which sets out proposals for once in a generation reforms to the Mental Health Act, responding to and building on the Independent Review of the Act, led by Professor Sir Simon Wessely’s. As part of this, NHS England and NHS Improvement has developed the Patient and Carers Race Equality Framework to support mental health services to improve the experience of care for people from ethnic minority backgrounds by increasing staff understanding of their racial and cultural differences.

We are also working hard to achieve our NHS long-term plan commitment to give 370,000 adults and older adults with severe mental illnesses greater choice and control over their care and support them to live well in their communities by 2023-24. Through this plan, we are also expanding services for people experiencing a mental health crisis including working towards 24/7 crisis resolution and home treatment services and investing in a range of local complementary and alternative crisis services. In addition, all NHS mental health providers have now established 24/7 all-age urgent mental health helplines for those experiencing a mental health crisis or those supporting them.

[HCWS446]

King's College Hospital: Covid-19 Recovery

Gillian Keegan Excerpts

Friday 3rd December 2021 Commons Chamber

[The Minister for Care and Mental Health (Gillian Keegan)]

I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for securing a debate on this important issue, which I know is one on which she campaigns regularly. I also thank her for all the work that she has done with the hospital as a member of the trust and for her work in encouraging everybody to come forward for boosters or first vaccinations. I am grateful to her for thanking us for writing off the debts—Government seldom get thanked, so that was wonderful to hear—which I know made a massive difference. At the start of the pandemic, we wrote off £13 billion of debt, supporting 110 hospitals and freeing them up to cope with the unbelievable circumstances they have faced without having to worry too much about the impacts of their debt.

As every Member of this House and the wider public know, covid-19 has had a monumental impact on the NHS, without which we would have all been lost. King’s College Hospital trust has seen an increase in the number of patients waiting for routine procedures and operations, with about 1,000 people waiting more than a year for treatment. That is similar to the national picture, with currently more than 303,000 people waiting more than 52 weeks for treatment and a total waiting list of 5.86 million people, up from 4.4 million before the pandemic. Further, we are seeing impacts on emergency services such as A&E caused by winter pressures and covid-19. King’s College Hospital Trust sees about 69% of people in A&E within four hours, which again reflects the national picture of about 74% of people being seen within four hours.

The trust is now making good, significant progress to reduce waiting lists, with the number of people waiting more than a year for treatment reducing significantly from a high in February 2021 of almost 7,000 patients to about 1,000 now, as I stated. We thank all the teams working on that. The trust has found new and innovative ways of working, including a weekend operating list and greater partnership across local systems. To support that, £3 million has been provided to build an additional modular theatre at Orpington Hospital, which is due to open in the new year. That will certainly help.

Amazing work has also been carried out at the trust on diagnostics. It has seen a reduction in the number of people waiting more than six weeks for a test from 40% in January to 7% in November. Again, our thanks to all the teams involved in that effort. Ministers often read out numbers, but behind those numbers and achievements there is a lot of hard work. We recognise that.

To support the work of King’s College Hospital Trust, since the start of the pandemic it has received £64 million in additional revenue funding to support its covid-19 response, as well as an additional £18.5 million in elective recovery funding. The trust will also receive an additional £18 million of capital funding to complete its critical care unit and increase its overall critical care capacity by 59 beds.

I thank all the staff who work at King’s College Hospital for the work that they have done over the pandemic and since, not just in the areas that I have covered, but in the delivery of the national vaccination programme, during which they have administered more than 250,000 covid-19 vaccines, with I am sure more to come. I add my condemnation of anyone who abuses our wonderful health and social care staff who work so hard to do their best. The last thing they need is abuse from members of the public.

Staff members, led by their chief executive Professor Clive Kay, have given their all during the pandemic. They are at the heart of the effort to build our NHS back better. As such, I am pleased that staff have access to comprehensive staff support programmes, which focus on supporting and building the resilience of teams and provide psychological interventions to staff at high risk of developing mental ill health.

Further, the trust has established a psychological support team and a specific occupational health team to help staff who may be experiencing symptoms of burnout or poor mental health, including bespoke support for staff coping with the symptoms of long covid. We know that the staff have been through an awful lot and we need to provide that support to ensure that we take good care of their mental health.

We are also supporting trusts through national work such as community diagnostic hubs. We have allocated £2.3 billion to increase the volume of diagnostic activity and to roll out at least 100 diagnostic hubs by 2024-25 to clear the backlogs. Those hubs will provide a one-stop shop for diagnostic tests, which will mean that people can have multiple tests in the same place rather than returning for multiple appointments, so it will be much more convenient and efficient. That increase is expected to allow the NHS to carry out an additional 4.5 million scans.

Further, we have given £8 billion over the next three years to step up elective activity and transform elective services. That supports our aim for the NHS to deliver about 30% more elective activity by 2024-25 compared with pre-pandemic levels.

This winter, NHS England and Improvement has led work with NHS providers, regions and stakeholders to ensure that robust operational plans are in place, including plans to meet increases in the demand for emergency care driven by seasonal flu and/or covid-19. We have given it an extra £55 million to boost staff numbers ahead of winter to help to recruit more 999 call handlers and clinicians to work in control rooms and to bolster frontline staffing capacity. We have also invested an extra £98 million in NHS 111 to help to meet increased demand and to boost capacity.

“The health and social care approach to winter” has been published today; we heard the statement earlier from the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar). That is a joint publication from the Department of Health and Social Care and NHS England and Improvement, which sets out the wide range of preparations that we have made to ensure that health and social care services remain resilient, joined up and available to patients over the coming months. It also announces the allocation of the £700 million targeted investment fund.

I thank the hon. Member for Dulwich and West Norwood for the points she made in the debate, which we take on board. We are doing everything we can to support our NHS. I also thank our wonderful NHS staff, and while I am here, our social care staff as well, who continue to work so hard to overcome the problems that the pandemic has created and to look after vulnerable people in their time of need. We remain committed to supporting the NHS, so that we can reduce waiting times and ensure that everybody gets the care that they need.

Question put and agreed to.

Acquired Brain Injury

Gillian Keegan Excerpts

Thursday 2nd December 2021 Written Statements

[The Minister for Care and Mental Health (Gillian Keegan)]

The Government are committed to supporting all people living with an acquired brain injury (ABI) and those living with other neurological conditions and seek to prevent acquired brain injuries wherever possible.

The Government recognise the strength of support for a more collaborative and cross-departmental approach to ensuring that people with ABI receive the support that they need from statutory services. I would like to express my gratitude to both my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) and the hon. Member for Rhondda (Chris Bryant) for continuing to champion this important cause and recognise their significant contributions to improving services for people living with an ABI. As the Prime Minister announced on 24 November 2021, the Department of Health and Social Care will be leading work to develop a cross-Government strategy on ABI. I am pleased to confirm today some further details regarding the strategy.

The content of the strategy will be informed by a call for evidence which will be launched early in 2022, inviting stakeholders nationwide, including healthcare professionals, people living with an acquired brain injury, their families and carers, to put forward their views about what should be prioritised within the strategy. These priorities could include guidance on action to prevent acquired brain injury, including through concussion in sport; on research into the societal, congenital, medical and environmental causes of ABI; on the provision of relevant services for the purpose of diagnosing ABI, including in prisons, schools and the armed forces; on the identification of adults and children with ABI; on the assessment of their needs; and on the planning of relevant services. We will also ask for feedback on whether there are other related neurological conditions which should be considered for inclusion.

Development of the strategy will be overseen by a dedicated programme board, which, in my capacity as Minister for Care and Mental Health, I will co-chair with the hon. Member for Rhondda. Senior officials in all relevant Government Departments will be invited to join the board to ensure that the strategy addresses the wide range of issues that affect the day to day lives of those living with an ABI. This will include representatives from the Welsh Government and other devolved Administrations, as appropriate.

Following publication, the strategy will be kept under review and may be revised periodically to ensure that it continues to reflect the priority areas and actions needed to best support people living with ABI and their families.

[HCWS438]

Adult Social Care

Gillian Keegan Excerpts

Wednesday 1st December 2021 Commons Chamber

[The Minister for Care and Mental Health (Gillian Keegan)]

With permission, Mr Speaker, I would like to update the House on our plans for adult social care.

Today we are publishing our ambitious 10-year vision for adult social care—our White Paper: “People at the Heart of Care”. It is a product of years of work, not only by every level of Government, but by many involved in the sector, including people who give care, people who draw on care, and their families. I wish once again to underline my appreciation and admiration for everyone who works to deliver this most vital of public services, especially through this challenging pandemic.

Those working in social care—both paid and unpaid—deserve our deepest respect, yet they also deserve a system that works for them, and it is fair to say that that has not always been the case. Time and again, we in this House have heard about the challenges: the high turnover in the workforce; the lottery of how people pay for care; unsustainable local markets; the varying quality and safety of care; the low uptake of technology; those carers who are not just unpaid, but under-appreciated; and the complexity of the system for everyone involved. I am sure hon. Members will have their own challenges to add to that list. Make no mistake, these are complex issues—so complex, of course, that successive Governments, over decades, have decided to duck rather than deal with them. This Government, however, are determined to get it right. After all, we cannot be serious about levelling up unless we are also serious about social care.

In September we took a vital first step on the road to fixing this generational problem when the Prime Minister, the Chancellor, and the Secretary of State announced our new health and care levy. The focus on how we must pay for it is absolutely right, but we were clear then, and we are clear now, that there is much else we need to do. The White Paper contains more detail on what we plan to do over the next three years to transform the sector over the next decade. It is underpinned by three core principles: first, that everybody has choice, control and support to live independent lives; secondly, that everyone can access outstanding personalised care and support; and thirdly, that adult social care is fair and accessible for everyone who needs it.

The principles we hold are important, but we know we will ultimately be judged on our actions. I will therefore set out some of those actions before the House. First, giving everyone the choice, control and support to live independent lives requires both physical and digital infrastructure. We are investing £300 million in housing. That investment will support local authorities to increase the range of new supported housing options, because it is vital that people live in homes that meet their needs and give them the independence they require. Moreover, we are setting up a new practical support service to help people with minor repairs and changes, which will help them to live independently for longer. That is in addition to increasing the upper limit of the disabled facilities grant for home adaptations, which includes things such as stairlifts, wet rooms and home technology.

The digital infrastructure we put in place can be equally transformational, because we know that digital tools and technology can support independent living and improve the quality of care. We are therefore putting at least £150 million of funding to drive the greater adoption of such technology, with the ambition to achieve widespread digitisation across social care. We are setting up a new national website, which will explain all the upcoming changes, and we are piloting innovative new ways to help people understand and access the care and support they need.

Our second principle is to ensure outstanding personalised care and support, and at the heart of that is looking after the people who work in care. We are spending at least half a billion pounds on the social care workforce over the next three years. Some of those funds will help us to deliver new qualifications and better career routes in care, which we know is crucial for holding on to our caring and compassionate workforce. We are also directing funds into stronger mental health and wellbeing support for care staff, because colleagues cannot care for people unless we care for colleagues. We are putting funds behind a change in the services we provide to support unpaid carers, and we will find and test what works best for those who are caring under challenging circumstances. Regardless of whether that solution is old or new, if it works, we want to do it. We are also considering funding local areas to support their efforts to innovate around the care they provide, so that they can provide more options that suit people’s individual needs. Those new models of care, including housing with care, have the potential to play a pivotal role in delivering care that promotes prevention, is more personalised, and enables people to live independently.

Our third principle is care that is fair and accessible for everyone. We are introducing a cap on care costs so that no one will have to pay more than £86,000 over their lifetime. That cap will be there for everybody, regardless of any conditions they have, how old they are, or how much they earn. It is a universal cap. Importantly, it will provide everyone with the peace of mind of knowing that the days of unlimited and unpredictable costs are coming to an end. The reforms will also make the existing means test far more generous, compared with both the current system and with previous abandoned proposals. Crucially, the £100,000 upper capital limit will be available to those in home care, and we expect many more people to be in home care. Let me be clear: no one will be worse off compared with the current system, and many, many people will be better off. All the ambitious plans that we are setting out today must be underpinned by a sustainable care market. The £3.6 billion we are giving to reform the social care charging system will help all local authorities to pay a fairer rate for care, and put back into the system the fairness we all want.

Before I conclude, Mr Speaker, allow me to put on record once again my thanks to everybody who has played their part in developing this important White Paper. The reform of social care in this country has been ducked for far too long, but we will do whatever it takes to take on this tough challenge, and we will get it right. Today’s White Paper is an important step on our journey to giving more people the dignified care that we want for our loved ones, setting out important changes that will last for generations and stand the test of time. As a Government we are determined to get this right—I am determined to get this right—so that we can build the healthier, fairer, and more caring country that we all deserve. I commend this statement to the House.

[Liz Kendall (Leicester West) (Lab)]

I thank the Minister for advance sight of her statement—but really, is that it? There are some things she said for which Labour has been calling for some while, and which we support, such as improving housing options for older and disabled people, and the potential for technology to improve standards of care. However, there are two central flaws to the Government’s approach. Ministers have utterly failed to deal with the immediate pressures facing social care, as we head into one of the most difficult winters on record. They have also failed to set out the long-term vision and more fundamental reforms we need to deliver a care system that is fit for the future.

Last week we learned that a staggering 400,000 older and disabled people are now on council waiting lists for care, with 40,000 waiting more than a year. There are more than 100,000 staff vacancies, and turnover rates are soaring. Because of those shortages, 1.5 million hours of home care could not be delivered between August and October alone, and half of all councils report care homes going bust, or home care providers handing back contracts. Hundreds of thousands of older and disabled people are being left without vital support, piling even more pressure on their families and the NHS at the worst possible time, yet the Minister has announced absolutely nothing new to deal with any of that.

Where was the plan to end waiting lists for care? Unless people get support when and where they need it, they will end up needing more expensive residential or hospital care, which is worse for them and for the taxpayer. The Minister was silent on that issue. Improving access is the first step we need to deliver a much more fundamental shift in the focus of support towards prevention and early intervention so that people can stay living in their own homes for as long as possible. But without enough staff with the right training, working in the right teams, that will never be achieved.

Where was the long-term strategy to transform the pay, training, terms and conditions of care workers, to deliver at least half a million additional care workers by 2030 just to meet growing demand, and to ensure that care workers are valued equally with those in the NHS? Can the Minister tell me why the Government persist in having separate workforce strategies for the NHS and social care when the two are inextricably linked? And can she tell me how some kind of website is going to pay a care worker’s bills or put food on the family table? No wonder staff are leaving the sector in droves.

The proposals for England’s 11 million family carers, who provide the vast majority of care in this country, are frankly pitiful. Unpaid carers have been pushed to the limit looking after the people they love. Almost half had not had a single break for five years even before the pandemic struck, but I understand that the additional funding in the White Paper amounts to just £1.60 a year more for each unpaid carer. Families deserve so much better than this.

What we needed today was a long-term vision to finally put social care where it belongs—on an equal footing with the NHS, at the heart of a modernised welfare state. At its best, social care is about far more then helping people get up and be washed, dressed and fed, vital though that is; it is about ensuring that all older and disabled people can live the life they choose, in the place they call home, with the people they love, doing the things that matter to them most—in other words, an life equal to everybody else’s. That should have been the guiding mission of the White Paper, with clear proposals to make people genuine partners in their care by transforming the use of direct payments and personal budgets and ensuring that the views of users and families drive change in every part of the system, from how services are commissioned to how they are regulated and delivered.

This White Paper falls woefully short of the mark, and the reality of the Government’s so-called reforms is now clear—a tax hike on working people that will not deal with the problems in social care now and will not even stop people having to sell their homes to pay for their care, as the Prime Minister has repeatedly promised. Under the Conservatives’ plans, if someone owns a home worth £1 million, over 90% of their assets will be protected, but if their home is worth £100,000, they could end up losing it all. Millions of working people are paying more tax not to improve their family’s care or stop their own life savings being wiped out, but to protect the homes of the wealthiest. This is not fixing the crisis in social care, let alone real social care reform. It is unfair, it is wrong, and the Government must think again.

[Gillian Keegan]

I thank the hon. Lady for her warm welcome for the White Paper. [Interruption.]

[Peter Kyle (Hove) (Lab)]

It’s not a laughing matter.

[Gillian Keegan]

It is not a laughing matter—it certainly is not. Of course, calling for something is much different from delivering something. We are taking steps to fix social care. We are grappling with this challenge, and we will meet it. In 13 years, what did Labour do? Two Green Papers, one royal commission, one spending review—and the result? Absolutely nothing. They are good at calling for things, but they are not very good at delivering things.

The hon. Member for Leicester West (Liz Kendall) mentioned immediate pressures. It is right to say that there are immediate pressures on all our workforces as we bounce back from the pandemic, but in particular on our health and social care workforces. We have always said that. We have challenges across the winter, and we know that we need to meet those challenges. That is why we put a winter plan in place, and it is why we have given additional funding to the sector. We have given additional funding to the sector all the way through the pandemic. We have given an extra £2.5 billion.

For the workforce specifically, we gave £120 million for January to March this year. That resulted in 7.5 million extra hours in the sector and 39,000 new recruits. As that was a successful intervention, we have repeated it for this period. In fact, that money—£162.5 million—has just started landing in councils’ bank accounts, and that is to take them up to March. We know there are pressures, and we know there is a lot of competition for labour, but we hope that that will be as successful as the previous interventions.

Of course, this is a 10-year vision, and we have to start with that vision. [Interruption.] I know that the hon. Lady and Opposition Members will look forward to reading the White Paper and seeing the vision.

[Peter Kyle]

It won’t take long.

[Gillian Keegan]

It will take long. It is over 100 pages, so it will take a reasonable time if Members are interested in actually finding the solutions.

The hon. Member for Leicester West also asked about workforce strategy and the NHS compared with social care. Obviously, the people in the NHS are employed by the NHS, which is a public body. Social care is largely a private system. There are 18,000 or more businesses. That is why it is a different sector and why we deal with workforce strategy differently. However, we have £500 million to invest in the social care workforce and to make sure that we invest in the knowledge and skills framework, careers options and so on.

There are 1.54 million workers in the sector and they are hugely valued. The hon. Lady said they are leaving in droves. Actually, what we have in the sector is a continual demographic shift in terms of need, and it grows by 1% to 2% every year, so we are always trying to recruit new workers into the sector. Of course, it is very important that these fundamental reforms take place so that we get more people attracted to the sector, more people staying in the sector, more people progressing in the sector and more people providing excellent care all day, every day, providing a lifeline to people across the country.

[Jeremy Hunt (South West Surrey) (Con)]

I thank the Minister for her work putting the White Paper together in a very short period. I know that she has put a lot of effort into it, but it is hard to see it as more than three steps forward and two steps back. The step forward, which we should acknowledge, is the introduction of a cap. Whatever the arguments about what counts towards the cap, having a cap will make a big difference to many people, and that is welcome.

However, these measures do not really give confidence in two crucial areas. The first is the funding to local authorities for their core responsibilities. The White Paper barely gives them enough to deal with demographic change and national living wage increases, and it is a long way off the £7 billion-a-year increase the Health and Social Care Committee called for by the end of the Parliament. It is also hard to see the NHS and social care systems being fully integrated, as they should be, and an end to the workforce crisis, which sees 40% turnover in many companies.

This is a start. The Minister is a very capable new Minister and I personally have great confidence in her, but will she bring forward further measures to deal with those huge problems? Otherwise, we will see hospital wards continuing to be full of people who should be discharged, and older people not getting the care they need because the carers do not exist.

[Gillian Keegan]

My right hon. Friend is right that this is a start. It is a 10-year vision, and obviously we had a three-year spending review and the spending that we set out was a three-year spending settlement, so of course it is just a start.

On the steps to ensure that local authorities move to a fair rate and a fair cost of care, we are exploring a number of options, and we will set out further detail at the local government finance settlement later this year. Local authorities moving towards a fair rate of care is key to building a solid foundation for the future adult social care system, so we will be working closely with them to shape the best possible approach to implementation across different local markets. We will shortly be engaging with local authorities and providers, and we will publish further guidance in due course.

My right hon. Friend is absolutely right about the workforce. I have never worked in a business where the workforce was not key to anything that needed to be delivered, but in the care sector in particular, it is impossible to deliver anything without the workforce. It is also difficult to look at the workforce structure. As I say, it is the largest workforce in the country, with 1.54 million people working in it, but with 40% churn and very high amounts of zero-hours contracts and of retraining. I have never seen something that has that—[Interruption.] This has been the case for decades, and nobody has done anything to address it. [Interruption.] Nobody has done anything to address it. We do need to address it, and that is what we are here to do today, but—[Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Please do not shout at the Minister.

[Gillian Keegan]

Thank you, Madam Deputy Speaker. As was clear from their 13 years in Government, Labour Members are not interested in finding the answer, and they are certainly not interested in listening to my version of giving the answer.

Having 40% churn and such a high degree of insecurity in the workforce is not sustainable, so we need to fix that. We need to put the knowledge and skills frameworks in place. We need to invest in training and learning. We need to ensure it is captured and transferable. We need to have career routes that mean people can progress in the workforce. In my short time in the job, that has been immediately identifiable. The hon. Member for Sheffield, Heeley (Louise Haigh) and I worked on professionalising the social care workforce about four-and-a-half years ago, when we set up the all-party parliamentary group on social care. The issue has been recognised. It is not easy to fix. It is a large private sector. There is very large and increasing demand, but we are going to take the steps to fix it and the White Paper starts that process.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The challenges in social care of increasing need and demand are the same across the four nations, but until now the approach has been very different. The Scottish Government have always believed in seeing social care as an investment in allowing everyone to participate in society and live as independent and satisfying lives as possible. I therefore welcome the change in narrative and tone in the statement.

The Feeley review, which was carried out last autumn in Scotland, plans a human rights approach to social care, and sets out a path to developing a national care service to ensure high quality standards right across Scotland for its users, and also fair terms, conditions and career development for staff. As has been said, workforce is absolutely central to all services and social care is delivered by people for people. The Scottish Government pay the real living wage—not some pretendy living wage, but the real living wage. Will the Minister commit to raising pay for social care staff in England to £10 an hour, as the Scottish Government have planned from this month?

Brexit and the loss of freedom of movement have, unfortunately, exacerbated workforce shortages in both the NHS and care systems, with a shortage of well over 100,000 in care. Will the Minister urge the Home Secretary to widen the eligibility of the health and care worker visa to actually include care workers? It is quite bizarre that it does not include care workers.

Scotland is the only nation that provides free personal care, which is now being valued by the UK Government at £86,000 a head. Will the Minister consider, in this redevelopment, providing free personal care to people in England? While the Scottish Government are planning a 25% uplift in social care funding over this Parliament, the national insurance uplift will go largely on tackling the NHS backlog over the next three years. Does she not recognise that the care crisis is right now? The problems in A&E are not caused by people coming to A&E, but by the difficulty of getting patients into beds due to delayed discharges, which are due to the lack of social care provision. Will she state, as has been called for, what funding will go to social care right now to tackle the crisis as we go into this winter?

[Gillian Keegan]

Many countries across the world are grappling with this issue. We have an ageing demographic and we now live in different ways. We live much longer with more complex needs, and often we are not close to our families as we have increasingly globalised. Many countries are looking to address those challenges, including Scotland. It is important that we build the talent pipeline here. It is important that we not only invest in and train our own people, but that we build sustainability. We cannot always rely on taking workers from many other countries. We have a visa route for senior social care workers and we have reduced salary levels—I think £20,480 is the salary level—so in Scotland that probably fits the minimum hourly rate. Of course, we have had different approaches. We had a commission on adult social care which gave results in 2011. That is what we have used to build the basis of our reforms and I know Scotland has taken a different approach.

[Damian Green (Ashford) (Con)]

I congratulate my hon. Friend on reaching this point, which we all agree is just the first step, but it is long awaited. I welcome the principles she set out, but I hope she can expand in particular on the changes that will allow more people to live in their own homes for longer through technology and home adaptations. That would not just reduce the need for residential care and therefore save money, but cut pressure on the NHS and, above all, improve the quality of life of many, many frail older people. What can we expect to see on that front?

[Gillian Keegan]

I thank my right hon. Friend for recognising that reaching this point is actually a milestone. It is the first time that any Government have reached this point.

Housing is key. We will increase the capacity of local areas to deliver supported housing. We will increase local expenditure on support services for those living in supported housing. We will adapt more supported housing units to make them suitable for use, as well as incentivising longer-term investment in new supported housing by local areas and housing providers. In the coming months, we will be working in partnership with local authorities, housing providers and others to design and establish our new investment in housing.

[Mr Clive Betts (Sheffield South East) (Lab)]

I welcome the measures to enable people to stay in their own homes. That is exactly what the Housing, Communities and Local Government Committee recommended some years ago in our report into older persons’ housing.

Will the Minister confirm that in the statement there was no money to improve the pay and conditions of the workforce, without which we will carry on getting churn; no money to help companies that are now exiting the social care sector; and no money to deal with the crisis in funding that local authorities are facing, which both the Health Committee and the Housing, Communities and Local Government Committee recognised? Does she accept that without money for any of those things, nothing at all will change?

[Gillian Keegan]

There is money to invest in the sustainability and professionalisation of the workforce. Local authorities have a local government settlement for this three-year period. We are exploring a number of options and we will set out further detail at the local government finance settlement later this year. That is when the hon. Gentleman will hear more about the costs that councils will have.

[Caroline Dinenage (Gosport) (Con)]

I congratulate my hon. Friend on bringing forward this milestone piece of work. It really is very long awaited. The devil, of course, is in the detail, and I look forward to reading that detail with great interest. I know she recognises that the care cap alone will not solve the adult social care crisis. We need imaginative and bold system reform. We need much better integration, and, above all, a plan to improve how we recruit, retain and value the care workforce and the army of unpaid carers out there. It is a massive task, but I know she is up to it. I am really keen to get her reassurance that once and for all, we have the Government’s commitment to fix this problem.

[Gillian Keegan]

I thank my hon. Friend for all her work in this area. Obviously, I have just come in at the end of the journey and many, many people have been working on this issue for many, many years. They should all take credit for that work and for reaching this point. She has my firm commitment that the Government are absolutely committed to fixing social care. As I said, we cannot level up without fixing social care, and of course we all have a vested interest in having a very good social care system.

[Daisy Cooper (St Albans) (LD)]

This statement is incredibly thin. It feels as though the Government are trying to fiddle with the light bulbs on the Titanic as it is starting to go down. We have an enormous crisis, where people who need care cannot get it and end up going into ambulances, ambulances are now queueing up outside hospitals, and hospitals cannot discharge patients back into their homes or the community because the care is not there. The statement and the White Paper do not address the fundamental problem of fragmentation and integration. The Minister has already accepted that this is now just a first step. Will she be clear with us today on when she will bring forward concrete proposals for how to tackle the problem of fragmentation and integration between the NHS and care?

[Gillian Keegan]

The hon. Lady is absolutely right that the complexity is broad. We have always anticipated that we would have winter challenges to deal with. With the global pandemic, there is a backlog of all kinds of things that people need—diagnosis, operations, electives and so on—plus all the other challenges such as winter flu and new variants of covid, which are still here. That is why we have specifically put a winter plan in place; we have also set out hundreds of millions of pounds of extra funding to look specifically at the winter challenges and the discharge process. It is not easy, because of the absolute growth in demand. We knew that it was always going to be challenging, and we regularly monitor and measure it with our NHS colleagues.

The hon. Lady mentions a fundamental pillar: the integration of health and social care. That will be subject to another White Paper, which will come early next year and will have more details about integration. She is absolutely right that it is another solid foundation on which social care reform will stand.

[Steve Brine (Winchester) (Con)]

Obviously I will study the White Paper that has been published today, and I welcome the cap that we are introducing. Opposition Front Benchers may have turned up in force today, although they have scuttled off now, but they did not do anything about the issue in 13 years in government. As far as I can tell from the response today, there is absolutely nothing coming back across the Dispatch Box from any of the Opposition parties.

I think I am right in saying that the upper limit of the disabled facilities grant for home adaptations is being increased. Can my hon. Friend confirm that that will help my Winchester and Chandler’s Ford constituents with things like stairlifts and wet rooms, which are really important to people’s day-to-day quality of life? Will she say exactly when it will kick in, please?

[Gillian Keegan]

We will commit a further £573 million per year to the disabled facilities grant between 2022-23 and 2024-25. We are also taking steps to ensure that the disabled facilities grant can benefit more people in need. We will consult on some of those steps in 2022.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

It has been two and a half years since the Prime Minister stood on the steps of Downing Street and promised to

“fix the crisis in social care once and for all with a clear plan we have prepared”.

I think we can all be forgiven for asking what on earth the Government have been doing during that two and a half years—a time when the social care crisis has got worse. Right now, more than 100,000 vacancies exist in adult social care. Care homes are refusing new admissions because of staff shortages. Providers are haemorrhaging staff to better-paid roles in hospitality, retail and distribution. The sector is on its knees as we head into the harshest winter in living memory.

The Minister’s statement today was completely tone-deaf on the scale of the crisis. Can she say, because it was not clear from the statement, how she expects the sector to get through the winter? What does she have to say to the families who are waiting right now for a care home place that simply does not exist under her Government’s failing social care system?

[Gillian Keegan]

The hon. Lady seems to be the only person in the whole world who has missed the global pandemic, but it occurred during the same period. To answer her specific question, she is absolutely right that there are pressures right now. There are pressures continually in the system, because there is always a need for growth every year, but right now the winter pressures are challenging. As we bounce back from the pandemic, everything is opening again and there is a lot of competition for labour—there are 1.2 million vacancies in the country.

We have invested £162.5 million, which is on its way—it has probably just landed in most councils’ bank accounts. That investment is there for short-term fixes, similarly to what we put in place for January to March this year, which was very successful; it brought forward 7.3 million extra hours and 39,000 new recruits. We have invested in that funding for the workforce, and we keep it under review—we get data every month through a capacity tracker system. We work closely with the sector and will continue to monitor its needs.

[Robert Jenrick (Newark) (Con)]

Does the Minister acknowledge that one of the flaws with the increase in national insurance is that only 15% of the additional revenue will flow through to local authorities to improve the quantity and quality of care? The remainder will go to protecting relatively asset-rich families’ inheritances and to the very important task of tackling backlogs in the NHS.

Many councils listening to the announcement today will be very concerned about how they will tackle the demographic changes that they face in the years ahead. What does the Minister have to say to them? In the more substantial White Paper that is to follow, what more can she say about reforming the system to integrate care, which might enable efficiencies to help those local authorities to face the future?

[Gillian Keegan]

On the latter point, I cannot say much more at this point, but a White Paper is being developed and will be available early next year. My right hon. Friend is absolutely right that that is another key part of making sure that councils can deliver on the obligations in the Care Act 2014.

The levy raises £12 billion a year, more or less. For the three-year period, the majority of that sum will go towards catching up with electives in our NHS. There are now 6 million people in urgent care, so that is the right thing to do. However, we know that we will need an increasing share of that fund as we go beyond the three-year period. Many of the reforms in the White Paper and many of the things that we will be working on will help to inform the discussions with the Treasury.

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

Social care is a vital service that has been in crisis for a decade. What we need is reforms to bridge the funding gap so that unmet needs can be met and more care packages can be delivered; a dramatic improvement in pay and conditions for care staff, to halt the exodus out of care work; and decent support for the 11 million unpaid carers who have done so much extra caring during the pandemic. Sadly, what the Minister has announced falls far short of what is needed. Does she actually believe that these half-hearted measures in any way match up to what the care sector needs to survive?

[Gillian Keegan]

This is a big reform that needs to take place, and it is based on demographic changes in the population all over the world. It is complex, and it will take a lot of time: it is a 10-year vision. I know that the hon. Lady has not had the chance to read our White Paper yet, but I am sure that she will see that there are a lot of things in it.

If we are actually looking to fix something—if we are looking to put a sustainable system in place that offers independence, choice, a great place to work and a great career—we need to fix a lot of solid foundations. I know that the Labour party always wants to throw money at the problem, but actually we need to make sure that the foundations are in place and that proper and sustainable funding is in place. That is what the White Paper delivers.

[Chris Grayling (Epsom and Ewell) (Con)]

I congratulate my hon. Friend on the progress that she has made so far. Care is a real challenge in a county such as mine, where we have high costs and a fast-ageing population; I ask her to bear that point in mind as she works on the next White Paper.

Closer to the immediate challenges, very many families are uncertain about whether they will be able to visit relatives in care homes over Christmas. A patchwork of measures is in place among different care home providers around the country. Obviously we are dealing with a difficult situation right now, but may I ask my hon. Friend to ensure that a very clear set of guidelines is given to care homes for the Christmas period, so that families know where they stand and so that the elderly, who are among those who have suffered the most over the past two years, get the chance to see their family where possible?

[Gillian Keegan]

My right hon. Friend makes a very good point. My grandmother was in a care home with dementia; the thought of not being able to see family has been one of the very difficult things throughout the pandemic. I pay tribute to all the care workers, who in some cases took the place of family during the height of the pandemic and were there with their loved ones day and night.

My right hon. Friend is absolutely right that it is very important that visitors can go into care homes, but of course care homes also have to make sure that they are safe, and we need to get the balance right. We have updated the guidelines for visitors and ensured that there is a named essential care giver who always has access to their loved one in care. We have recently updated that guideline, but obviously we will keep it under review as we learn more about the new variant.

[John McDonnell (Hayes and Harlington) (Lab)]

The Minister has talked about a 10-year vision, but most unpaid carers are just trying to see how they can get through the next week, or the week after that, or the week after that. As has already been pointed out, there are 11 million unpaid carers in the country, many of whom depend entirely on carer’s allowance, a legacy benefit. They never gained the additional £20 of universal credit, and they are living in poverty. What is there in this strategy that will assist unpaid carers and lift them out of poverty?

[Gillian Keegan]

I agree with the right hon. Gentleman. Unpaid carers are an essential part of the system, and I want to pay a massive tribute to all the people who have been offering care, usually to their loved ones, during this period. As the right hon. Gentleman suggests, during the pandemic many vital services on which carers generally rely, such as respite or day care services, have not always been fully open to everyone, so I have urged all local authorities and providers of those services to ensure that they are.

The White Paper provides for money to help local providers to develop the services that carers would appreciate. There is a specific fund for them to work with carers, and there will obviously be input into that as well. We will ensure that we build services to support this vital sector, and, in addition, carer’s allowance will rise to just over £67 in April 2022.

[Mr Andrew Mitchell (Sutton Coldfield) (Con)]

Notwithstanding the somewhat churlish approach of the Opposition Front Bench, today’s announcement marks good and steady progress on the part of a Government who have, after many years, started to tackle this important problem, and I think the House should give the Minister credit for that.

Does the Minister appreciate how much this matters to us in Sutton Coldfield, which has a more elderly demographic? In this context, I agree with my right hon. Friend the Member for Ashford (Damian Green). We need coherent policies enabling older folk to stay in their homes for as long as possible. In particular, the newly agreed and enhanced role of the services emanating from the Royal Sutton Coldfield Cottage Hospital in keeping people in their homes is at the front and centre of our plans for ensuring that the White Paper and the accompanying policy have a real impact in Sutton Coldfield.

[Gillian Keegan]

Of course I am trying not to be too disappointed by the reactions of Opposition Members; I did not really expect an awful lot more.

Areas such as Sutton Coldfield and Surrey are expensive to live in, and we need to recognise that. Most of us, when asked about our future care arrangements, would say that we would like to stay in our own homes, and we want to make that possible. There is a great deal of technology that will help, but it is also important to adapt more supported housing and to work with local groups to deliver the right approach for the right areas, and that will include local hospitals as well.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her statement, and for the progress that she is clearly trying to achieve.

Workforce availability for care homes is vital. Today a representative of a care home bordering my constituency rang to say that a quarter of its staff are off work owing to close covid contacts, although they are now treble-jabbed, and it has no more staff and a lack of agency staff to employ. What can be done through this strategy, Minister, to ensure that the recruitment and retention of care workers are improved?

--- Later in debate ---

[Madam Deputy Speaker]

I thank the hon. Gentleman very much for that. I can say “Minister”; it is the hon. Gentleman who cannot. Minister!

[Gillian Keegan]

Thank you, Madam Deputy Speaker.

The hon. Gentleman has asked a good question. Dealing with covid is very challenging for many workforces, which is one of the reasons for our taking the difficult step of making vaccination a condition of deployment in this sector, and also offering the third dose—the booster—which many of those people have now had. It reduces the likelihood of transmitting or contracting covid, although it does not eliminate it altogether. The hon. Gentleman is right about the pressures on the workforce, which are increased by the need to manage covid in the case of residents and also people who are in their own homes. We have invested £162.5 million to help with those pressures in the short term.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I congratulate the Minister on getting a grip on an issue that consecutive Governments have simply ignored since the 1940s, but does she accept that there is a certain irony in our having two White Papers to deal with a matter involving integration?

Will the Minister say a little about how what she has announced today may help to resolve the crying shame of elderly, vulnerable people languishing in acute hospital beds for weeks on end when there is no active medical management plan for them, often at the end of their lives, when they should be being cared for appropriately in homely settings in the community? Will she recognise that until we deal with that, and the huge pressures that it puts on them, their families and our NHS, we will make no progress whatsoever?

[Gillian Keegan]

My right hon. Friend is absolutely right. People are in expensive hospital beds when they would rather be at home because of a lack of services, or a lack of joined-up service, and that affects hospitals throughout the country. It is a large element of the current pressures, and it happens every winter. It happened every winter when I was a hospital governor. This integration, and the Health and Care Bill which the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), steered through the House so ably, will help to solve the problem.

[Liz Twist (Blaydon) (Lab)]

Our social care staff, whether they work in residential care homes or in people’s own homes, are at the heart of a real change in social care. The Minister has talked about some improvements, but does she accept that improving the pay and terms of employment of those staff is crucial to fixing the problem? What steps will she take to ensure that that is dealt with quickly?

--- Later in debate ---

[Gillian Keegan]

Of course pay is important, but it is not just a question of pay. I joined a group of carers in a domiciliary care round earlier, and I spoke to them about this. They said that the most important thing for them was changing the way in which the profession was perceived, and that they never wanted to hear themselves described as “just a carer”. That struck me as very important, because it was an aspect of professionalising the workforce. Recognition is also valuable. These are private companies, but of course the council is a big buyer of care services as well, and that will feature in the local government spending settlement towards the end of the year.

[Mr Mark Harper (Forest of Dean) (Con)]

As chair of the all-party parliamentary group on learning disability, I welcome what I understand has been extensive engagement with the sector in the production of the White Paper. I know that it has been much appreciated.

As for the issue of resources, many Conservative Members found it hard to vote for a tax increase of £12 billion a year, but what is really important is for the money to be used effectively. May I pick up what was said by my right hon. Friend the Member for Newark (Robert Jenrick), and suggest that when the local government settlement is published, it should show the settlement for not just one year but a number of years? We could then see a big share of those funds moving from the NHS to social care, which would enable local government to plan appropriately and the NHS to accept that it will not keep that money forever once it has dealt with the backlogs. Many of us are quite sceptical about that. I think that the more transparency there is, the easier the Minister’s job will be in getting those resources into the social care sector.

[Gillian Keegan]

My right hon. Friend is absolutely right. More than 250 organisations worked with us to develop this White Paper, and I want to thank them for their input. Of course they welcome the steps that we are taking. I do not know how many Green Papers, White Papers and other papers they have tried to get some change from, but this one is finally starting on the road to deliver and transform the sector. He is right to say that the longer we can have some understanding of the settlement for funding, the better, and I am sure that my colleagues who are working on that will have heard his question.

[Derek Twigg (Halton) (Lab)]

It is disappointing that the Minister does not take seriously our genuine concerns about the crisis in social care. She will have received a copy of the letter sent to MPs recently from the Association of Directors of Adult Social Services. Why does she believe that it said that, in its professional judgment, these measures as they stand

“will not fix the crisis in social care”?

[Gillian Keegan]

What I have said is that this is a huge step forward. I do not think that I can stand here and say we will fix the whole crisis in social care overnight. As I have said, this is also something that countries all over the world are grappling with. I think that when that letter was written, the short-term funding of £162.5 million had not been sent out to local councils. I hope that they are using that money wisely to increase capacity and retention in the care sector.

[Sara Britcliffe (Hyndburn) (Con)]

I find it incredible that the Opposition can come here again with no plan and then criticise the Government. It is the same thing for their social media. I really welcome the fact that we are trying to do as much as possible to keep people in their homes, and that the Government are doing something to tackle that, but can the Minister assure me that she is still looking at the regional disparities?

[Gillian Keegan]

Yes of course. There are regional differences in care. There are lots of regional differences. There are differences in how much the care cap of £86,000 is worth, which is what I think my hon. Friend is concerned about. There are regional differences in how much people pay for care: it is much cheaper in various areas compared with the more expensive areas. I am asked why we will have a fixed sum of £86,000, and that is a good question. If we are looking at it as a percentage of assets, £86,000 will be different for different people, of course. The question was: why should we not base this on a percentage of assets? When I looked at the system we would have to build, I saw that it would be absolutely unworkable. It will be difficult to implement the cap anyway, because we will need a metering system that every council will have to operate for everyone who is paying for social care at different rates and different times. The system that we will have to build is very complex. Having a cap that will also enable us to talk to other players such as insurers, to see what other insurance products come forth, was considered the only implementable way.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I gently suggest to the Minister that the rule about facing the Chair when addressing the House is not just about courtesy and politeness—I know that she is the most courteous and polite person on the planet. It is also because if she is looking at someone who has asked a question, the microphone does not pick up her voice. I say this to everyone. That is why it is important to face this way; if she does so, she can be properly heard.

[Margaret Greenwood (Wirral West) (Lab)]

The Minister said that there was a lottery in how people paid for their care. There certainly is, and this is raised with me on a regular basis by my constituents. A quarter of Wirral adults with ongoing health needs were denied continuing healthcare over the summer, according to figures from NHS England. I think the Minister would agree that the CHC—continuing healthcare—system is unfair. Just at the very time when families need support, they often find themselves facing huge bills for care and having to consider selling the home of the person who needs care. Can she tell us what action she will take to ensure that no person has to sell their home to pay for their care, or was that just another hollow promise from the Prime Minister?

[Gillian Keegan]

I thank the hon. Lady for her question, because this is something that bothers me. It happened to my grandmother. We had to sell her council house, which she had bought under the right to buy that was introduced by a Conservative Government. It is very important that we start to fix this, because under today’s system, everybody out there can go down to their last £14,250. That is all that is protected. It is therefore a very unfair system today. That is why we are making these changes and introducing this cap, to ensure that nobody will ever have to pay more than £86,000. In addition to that, we are putting the means test up to £100,000, so that the cost of care is shared as a person’s assets get below £100,000. That will also slow down the depletion of assets. It will be a much fairer and better system than the one in place today.

[Paul Bristow (Peterborough) (Con)]

I draw the House’s attention to my entry in the Register of Members’ Financial Interests.

A few months ago, I spoke with a social care service user who told me that living in supported housing made him feel like a king, because he had access to his own private shower. These small, incredibly significant, humanising differences between long-term hospital care and being supported to live independently are striking. Can my hon. Friend confirm that one of the drivers behind this White Paper is to ensure that people can live as independently as possible for as long as possible, and does she recognise that this can be achieved through the integration of social care, mental health and supported housing?

[Gillian Keegan]

My hon. Friend is absolutely right. Half of the social care budget today is spent on working-age adults. It is not just spent on elderly people. Of course, many people with disabilities or learning disabilities want to continue to work and they want to be supported in that. A supported house and the right mental health support are obviously the right approach, and that is something that we will be working on in this White Paper.

[Paul Blomfield (Sheffield Central) (Lab)]

The Minister was right in the way she described the crisis in social care. We have residential and domiciliary provision that falls chronically short of what is needed, care staff who are undervalued and grossly underpaid, and an army of unpaid carers—particularly young carers—who do not have the support they deserve. The problem is that what she has announced does not address any of that. It is frankly extraordinary that she says that this is the product of years of work. Where is the substance? As questions from both sides of the House have recognised, does today’s statement not show that when the Prime Minister promised a plan to fix social care, all he ever had in mind was an asset protection scheme for the wealthier, paid for by the many who would never benefit from it?

[Gillian Keegan]

I want to pay tribute to the 1.54 million people who work in this sector, because they offer the most incredible care, and also to unpaid carers. The hon. Gentleman mentioned young carers, and it is important that we support them. We will work with the Department for Education, which will amend the schools census at the earliest opportunity to include young carers so that we can identify them and put in the support around them. I do not agree with what the hon. Gentleman said about today’s statement. In 13 years, the Labour Government produced two Green Papers, a royal commission and a spending review, but absolutely nothing that has made a difference to anybody. Of course, none of the Opposition Members have yet had the pleasure of reading the plan, but I can assure them that it is a plan that will deliver on a 10-year vision and start the changes that, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said, have been ducked since 1940.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I thank my hon. Friend for all her work on this, as a Back Bencher and as a Minister. As she will know from our many conversations, I am a fan of the German system, not least because of its greater focus on domiciliary care and on personal budgets, which allow people, instead of relying on the professional workforce, to pay a loved one or a neighbour to provide their care. In many cases, that is much more beneficial for that individual. Is that going to be a feature of the White Paper, which I have obviously not yet had a chance to read?

[Gillian Keegan]

I know my hon. Friend’s views on that system, because we have discussed it many times. There are two things that I think he will welcome in the White Paper. The first is the focus on people being supported to stay in their own home or in supported housing for as long as possible. The second is personal budgets, which we will be exploring for people after they have been metered towards the cap. There is some use of personal budgets today, but we will be exploring what greater use of them we can put in place.

[Mohammad Yasin (Bedford) (Lab)]

With 100,000 vacancies in the social care sector, the Future Social Care Coalition has made it clear that failure to act immediately on care workers’ wages will have devastating consequences for the NHS, for the elderly and for other people who are in desperate need of care. Will the Government listen to the sector’s warning that the current and forthcoming hourly rates for care staff are insufficient to retain or recruit staff?

[Gillian Keegan]

As I said, we have put in place £162.5 million-worth of funding and it has only just gone into councils’ bank accounts. We expect councils will use the funding to retain and grow the workforce.

Earlier I mentioned the all-party parliamentary group on social care, which I set up four years ago with the hon. Member for Sheffield, Heeley (Louise Haigh). At that time the vacancy rate was 122,000, even greater than it is today. We have 1.54 million people working in care, and the need grows by 1% to 2% every year because of changing demographics.

[Mr Philip Hollobone (Kettering) (Con)]

The number of stranded and super-stranded patients at Kettering General Hospital has recently been increasing. Thankfully it is not at the level it was a few years ago, when as many as 200 of the 550 beds were occupied by stranded and super-stranded patients. They are mainly elderly and vulnerable people who, as the Minister will recognise, should not still be in hospital because they have completed their medical treatment. They need to be placed in an appropriate social care setting or at home with appropriate social care support. When can we expect firm proposals from the Government to address this issue? Unless we can get these very vulnerable people into the care they need, not only will it make life very unhappy for them but it will be extremely expensive and will clog up our NHS.

--- Later in debate ---

[Gillian Keegan]

My hon. Friend is absolutely right, and this is something that happens pretty much every year. For the short term, we have around £500 million as part of our winter plan to focus on the discharge process and to make it work as effectively and as efficiently as possible. Of course, a big part of that is making sure social care is in place. In the longer term, the integration White Paper is key to making sure we have much better processes so that people get the care they need, with the right care in the right place.

[Robert Buckland (South Swindon) (Con)]

I congratulate my hon. Friend on introducing the White Paper. I see the Secretary of State for Health and Social Care in his place, and I am grateful to him, too, for ensuring the Government published the major part of the White Paper process before the end of the year. We know the integration White Paper is to come, and that will be important.

Other hon. and right hon. Members have asked about accountability on funding and ensuring that we have a share of the pot for social care. In particular, I am interested in the excellent initiative of £300 million going to local authorities for supported housing and increased choice. How will we make sure that money is used to enrich the lives of, in particular, adults with disabilities, who currently do not have the choice they deserve?

[Gillian Keegan]

I thank my right hon. and learned Friend for his question and, indeed, for all his work in this area. I know this is dear to his heart. I look forward to working with him on a solution.

The £300 million is specifically to help to solve supported housing and to provide much better supported living and mental health support for young adults with disabilities or learning disabilities. Based on conversations with my right hon. and learned Friend, we have also put something in the White Paper on further help to get these young people into work, as many of them want help and support getting into work, and not enough of them are getting that support today.

Access to Salbutamol Inhalers

Gillian Keegan Excerpts

Monday 29th November 2021 Westminster Hall

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a pleasure to serve under your chairmanship, Mr Hosie. I will start by acknowledging the tragic death of Lauren Reid, aged just 19 with so much to live for, having achieved so much already, and to offer my sympathies to her mum Elaine and her family and friends. I also thank my hon. Friend the Member for Don Valley (Nick Fletcher) and all those who signed this petition for ensuring that this issue has been brought to the attention of the House, and thank all Members who have taken part in today’s debate.

On 25 August the Government responded to the petition, which seeks wider availability of non-prescribed salbutamol inhalers. I will build on that response in my speech. Asthma inhalers are a mainstay treatment for patients with acute asthma. Ready access to prescribed inhaler can save lives in an emergency. The safe sale and supply of prescribed medicines, including inhalers, is carefully and thoroughly regulated in the UK, through the Human Medicines Regulations. Some medicines are classified as prescription only because they could result in harm if used without medical supervision, even if used correctly, or they are frequently used incorrectly and may cause harm as a result. Prescription inhalers are in that category.

The Medicines and Healthcare products Regulatory Agency, as the licensing authority in the UK, has advised that exemptions can be made in the relevant Human Medicines Regulations, and that any such change would depend on the careful and thorough review of evidence supporting it. As the hon. Member for Strangford (Jim Shannon) says, we need to do that very carefully and ensure that safety is at the heart of everything. We would need to ensure that the benefits of such a change would outweigh any risks, and any change would also depend on the advice of our independent expert advisory committee, the Commission on Human Medicines.

I am pleased that the MHRA met my hon. Friend the Member for Don Valley on 25 November to provide detailed advice on the type of information needed to support a change. I understand that the discussion focused on the evidence needed to enable a full assessment of benefits and risks by the MHRA and the CHM. I hope my hon. Friend found that helpful.

For the benefit of the House, and for the record, I will give some detail. A full assessment would need evidence clearly showing the intended benefits, including an outline of the magnitude of the issue, such as how many people are affected by serious asthma attacks and the locations where having such medicine available would be of the greatest benefit. The evidence would also need to consider any risks and how they could be managed—for example, that the medicine could be stored, handled, and used safely in an emergency.

Once adequate information is collected, the MHRA seeks independent advice from the CHM. At that stage, it would also consider guidance to stakeholders on the safeguards that would need to be in place. Feedback from a public consultation would be considered before a final decision on implementing any legislative change. The MHRA welcomes any submission of evidence from interested parties and is committed to ensuring that the UK becomes an even greater place to develop, manufacture and supply medical products, and that, most importantly, we have continued access to safe medical products.

As many hon. Members have mentioned, an amendment was made to the Human Medicines Regulations in October 2014 to allow schools to procure and store non-prescribed salbutamol inhalers. At that time, the potential advantages and disadvantages were tested through pilot schemes placing inhalers in some schools and tracking their usage. Information was collected by surveys of patients, teachers and schools, and was analysed by the MHRA and CHM.

The Health and Safety Executive owns guidance on reducing the risk of asthma in the workplace. The Department will be looking further into this matter, along with HSE and MRHA. Once that information-sharing exercise has taken place, the Department will be in a better position to decide whether further action needs to be taken. It will explore commissioning research to examine this issue further.

I have heard the concerns in this House, and indeed among the wider public, about this issue. I thank all those who have taken part in this debate, and mostly the 102,058 people—patients, stakeholders, and families of asthma sufferers—who signed the petition.

I will also update the House on additional public health measures that we have put in place to improve outcomes for people with asthma. The 2019 NHS long-term plan sets out commitments and objectives for the NHS for the next 10 years. It includes respiratory disease as a national clinical priority and aims to improve outcomes for patients, including those with asthma. The respiratory interventions proposed in the NHS long-term plan include early and accurate diagnosis of respiratory conditions, because the earlier diagnosis of conditions may prevent avoidable emergency admissions for asthma. Pharmacists in primary care networks will undertake a range of medicine reviews, including educating patients on the correct use of inhalers.

Since 2019, several initiatives and publications have been announced in support of the long-term plan. NHS England and Improvement’s national patient safety team has prioritised work on asthma as part of the adoption and spread safety improvement programme. That will support an increase in the number of patients in acute hospitals receiving every element of the asthma discharge care bundle from 38% to 80% by March 2023.

Since April, the academic health science networks in England, in partnership with the patient safety collaboratives, have been working with provider organisations to improve the uptake of all elements of the asthma care bundle for patients admitted to hospitals in England. Compliance with the elements of good care, as described in the bundle, is measured as part of the national asthma audit. The care bundle includes actions that should help to reduce the number of patients who are readmitted following discharge and ensure that all aspects of the patient’s asthma care are considered. The bundle assesses inhaler technique and includes care follow-ups. Those interventions should prove more beneficial than relying on emergency use inhalers to provide temporary relief.

To the question asked by the hon. Member for Strangford, the Department works closely with the MHRA, the pharmaceutical industry, NHS England and Improvement and others operating in the supply chain to help to prevent shortages. The team has advised that there are currently no shortages in the supply chain.

I would like to take a moment to remember Lauren and to send our sympathies to her family and friends. I thank all those involved in bringing forward this important debate. I hope that what I have set out demonstrates our commitment to the issue. We want to facilitate changes that will protect public health, so we will look into it with the relevant bodies. We are working hard to ensure that asthma care improves for all, as outlined in the NHS long-term plan, and that asthma sufferers have access to the best care available.

Down Syndrome Bill

Gillian Keegan Excerpts

Friday 26th November 2021 Commons Chamber

[The Minister for Care and Mental Health (Gillian Keegan)]

I, too, congratulate my right hon. Friend the Member for North Somerset (Dr Fox) on securing the Second Reading of his private Member’s Bill, the Down Syndrome Bill.

My right hon. Friend’s passion to help address the challenges faced by people with Down’s syndrome has been unwavering, and I want to thank him and all those who support the Bill—and many colleagues are here today—for bringing forward a Bill to address these challenges. I thank all hon. Members for their contributions, and I have really enjoyed the debate. I, too, have learned a lot, and it is such an important time for such an important debate. I also want to pay tribute to Sir David Amess, who cared deeply about supporting people with learning disabilities. He was arranging for us to have a cup of tea to discuss how we could work together to do this. Sadly, this cannot happen now, but I want today to mark Sir David’s passion for improving the lives of all those people with learning disabilities.

People with Down’s syndrome should have the opportunity to enjoy all aspects of our society, and to have access to the services and support that will enable them throughout their lifetime, and I wholeheartedly support the Down Syndrome Bill. Sometimes we are lucky enough to be in the right place at the right time, and this is one of those occasions for me, because my nephew, Joseph Gibson, is one of the estimated 47,000 people in the UK who have Down’s syndrome. Joseph is a funny and bright teenager. He loves his school, has a great group of friends and is a huge football fan, supporting Liverpool, of course, and also his local team, the O’s—Leyton Orient. Most importantly, Joseph is happy and thriving. He is learning and developing, and he demonstrates his ability, not his disability every day, as all young people and adults with Down’s syndrome do.

However, my brother and sister-in-law, Marcus and Sara, have had to work incredibly hard to access the services that have made it possible for Joseph to develop his confidence and independence. We have heard from many other families—and I pay tribute to those who are up in the Gallery today—about how difficult they have found it and how much they have been fighting that battle. I want everybody to know that through this Bill, with our support for it and everybody’s support for it in this Chamber, I hope those battles will become a lot easier. I know that today people with Down’s syndrome are struggling to access the services they need, and I have seen this with my own family. It is not right, it must change and we will change it.

I recognise that the legal duties and frameworks are already in place to ensure services are tailored to people’s needs, but we know this does not always happen for people with Down’s syndrome and their families. There is a pressing need to raise awareness of the unique needs of people with Down’s syndrome and how they can be met, so that public authorities know how to meet their existing duties and people with Down’s syndrome can thrive in their community. That is exactly what this Bill seeks to address.

For the first time, the Government will be required to publish guidance on the specific needs of people with Down’s syndrome and how to meet them. The relevant public authorities providing health, care, education and housing services must have due regard to it in carrying out their functions. This is a significant obligation on authorities, and there can only be strong reasons for not following this guidance. Importantly, people with Down’s syndrome and their families will be at the heart of this. They will be involved in the development of the guidance, as well as with those responsible for planning and designing these services.

I believe the impact of the Bill will be wide-reaching. It creates the foundation to ensure that people with Down’s syndrome stay well, receive the right education for them, and secure the appropriate living arrangements to support their transition into employment and into their old age, and to help them be a part of our society in the way that they want to be.

Why do we have before us a Bill that focuses specifically on people with Down’s syndrome, and why now? Down’s syndrome is a genetic condition. Every person with Down’s syndrome is a unique individual but they often face common health risks: almost half of children born with Down’s syndrome have a heart condition; they face significantly higher risk of becoming unwell through infection, which can be life-threatening; and they may, and often do, also need additional support with their speech, hearing or vision. Evidence tells us that people with Down’s syndrome have specific patterns of development unique to this condition. Sadly, there is an increased risk of early onset dementia. The NHS recommends regular check-ups to look for signs of that from the age of 30. I also wish to acknowledge that mental health and physical health are two very different things, and we will very much look to focus on the mental health of people with Down’s syndrome, through our mental health strategy, which we will be working on throughout the coming months.

Thankfully, people with Down’s syndrome are living longer. This is not 1983 or 1984, when the hon. Member for Nottingham North (Alex Norris) was born and when people with Down’s syndrome lived, on average, to 25 years old. In 2021, people with Down’s syndrome are living, on average, to 60—I am pleased to see that this is continuing to increase, as is the pace of increase. It is clear that this Bill is not about giving people with Down’s syndrome more rights or enhanced treatment relative to others; it is about ensuring that there is a level playing field, so that they can access the services that they are entitled to in the same way as everyone else and that their needs are understood, so that services will be developed to meet those needs.

On redress, I fully recognise that, despite the legislation, there may still be occasions when people with Down’s syndrome and their families do not feel that their needs are being met, and there must be clear, accessible and fair processes for people with Down’s syndrome and their families to raise concerns. We want people with Down’s syndrome and their families to be able to resolve concerns with authorities directly. These processes should be easily navigated and not at great cost to families. We are considering how the routes to redress are working for people with Down’s syndrome and whether they are delivering the outcomes they need, but it is essential that we get this right and I anticipate returning to this subject as the Bill moves through the House.

This is a hugely important Bill, for all the reasons I have spoken about today. I recognise that providing the right support for people with Down’s syndrome is a matter that resonates across the whole of the UK, and we have heard some contributions from those from other parts of the UK today.

[Douglas Chapman]

Is the Minister in a position to open discussions with the Scottish Government, Welsh Government and the Administration in Northern Ireland to make sure that this is put on the agenda, either during formal meetings or informal discussions, so that the information she has can be shared across the rest of the UK and the benefits of the Bill shared also with those with Down’s syndrome and their families?

[Gillian Keegan]

Yes, some of those conversations have happened but I will very much continue them. The scope of this Bill covers only England, but of course health, care, education and housing are also devolved matters. I know that there is a commitment to improve the outcome for people with Down’s syndrome in Scotland, Wales and Northern Ireland, including through legislation, and I look forward to working with other Health Ministers on this matter. I know that they are committed to doing that as well. I look forward to aligning policy, practice and the guidance wherever possible, so that best practice for social inclusion for all people with Down’s syndrome can be realised across the whole of the UK.

[Sir Charles Walker]

I heard a lovely story a few years ago of a young man who was living at home but was travelling to a day care centre independently on a bus. He did that for many months and then his parents got a telephone call saying, “We haven’t seen your son for a month. Where is he?” They said, “Well, he is leaving in the morning and he is coming home in the evening.” So the next morning they followed him discreetly. Halfway along the bus route, he got off the bus and walked into a builder’s merchant, where he had got himself a job. That was surprising, but perhaps we should not be surprised—we should liberate these young people to make great decisions.

[Gillian Keegan]

I completely agree. As several hon. Members have mentioned, employment is important—to all of our lives, actually: it gives us purpose, structure, friendships and relationships. The shocking statistic that only 6% of people with Down’s syndrome are in employment was mentioned and we all must work hard to overcome that problem. That is the case for other learning disabilities, too: the figure for young people with autism is, I think, 22%, which again is not good enough. I hope to address that in my role as Minister for Care and Mental Health, whose brief includes learning disabilities.

To conclude, we are working towards an inclusive society for people with Down’s syndrome. The Bill takes one more step towards making sure that authorities are supported in delivering services that meet the unique needs of people with Down’s syndrome, and making sure this can happen consistently across the country. Once again, I congratulate my right hon. Friend the Member for North Somerset on this important work. I was happy and glad to be the Minister in place when he came forward with his private Member’s Bill and am delighted to be able to offer the Government’s full support.

Oral Answers to Questions

Gillian Keegan Excerpts

Tuesday 23rd November 2021 Commons Chamber

[The Minister for Care and Mental Health (Gillian Keegan)]

We recognise that carers perform a difficult role and often find it challenging to access support. The Care Act 2014 secured important rights for carers, including a responsibility for local authorities to assess and support their specific needs where eligible. We will work with unpaid carers and stakeholders to co-develop further detail in a White Paper for reform later this year.

[Paul Blomfield]

The Minister will know that among those unpaid carers are 800,000 young carers, who play an extraordinary role—some from as young as seven or eight years old—in looking after parents with long-term conditions. Too many are unidentified, and as a consequence struggle without the support that they deserve. Does the Minister agree that integrated care boards could require GPs, who are uniquely placed to do this, to identify young carers and signpost them to support services? Will she also work with ministerial colleagues to require schools to create a young carers lead, as with special educational needs co-ordinators, to co-ordinate the identification of and support for young carers?

[Gillian Keegan]

We will certainly be looking at all those points within guidance. Local authorities have a duty to assess the needs of young carers under the Children and Families Act 2014, and that duty has remained in place throughout the pandemic. Authorities must ensure that young carers are identified and referred to appropriate support if needed, and that the young carer is not taking on excessive or inappropriate care and support responsibilities. We have also announced an additional £1 billion of new recovery premium funding, which schools can use to support young carers’ mental health and wellbeing, alongside their academic recovery.

[Caroline Dinenage (Gosport) (Con)]

The carers action plan published in 2018 was a two-year cross-Government attempt to try to change the way we identify and support the millions of unpaid carers across our country. They save our health and care system a fortune, but for their loved ones they are literally the world. What plans are there to publish a progress report and set out the next steps for how the Government intend to keep focused on this really important issue?

[Gillian Keegan]

I pay tribute to my hon. Friend for her work in this role and also to all unpaid carers. There are 5.4 million unpaid carers in England and they do a fantastic job. In the forthcoming Bill that we are co-producing with unpaid carers, we will make sure that we continue to make progress in this area. I look forward to sharing that with her before the end of this year.

[John Mc Nally (Falkirk) (SNP)]

Carers UK recently called for an additional payment across the UK for unpaid carers after its survey found that more than one in five unpaid carers are worried that they may not cope financially over the next 12 months. In Scotland we already have a carer’s allowance supplement, and the Scottish Government will once again make a double payment this December, recognising the impact that the pandemic has had on our carers. Will the Minister now urge her colleagues in the Department for Work and Pensions to make a commitment to match the Scottish Government’s offer?

[Gillian Keegan]

There is a carer’s allowance in the UK as well, but in most cases financial incentives are not the main driver for those providing unpaid care. However, we may see a shift towards less intensive caring activities or a reduction in the hours spent caring as people become more eligible for state support and we push through some of the reforms. Charging reforms bring an end to the unpredictability of care costs for care users and will do the same for those who provide unpaid care for them, allowing them to make informed choices. We need to do more to support them in providing respite and day services.

[Theresa Villiers (Chipping Barnet) (Con)]

What action have the Government taken to support the charities and community groups that provide help to unpaid carers, because many of these charities found it very hard to operate and raise funding during the covid shutdown?

[Gillian Keegan]

My right hon. Friend is absolutely right: charities are also a vital part of the network of support for our unpaid carers, and some of them did have to close during the pandemic, so we have been encouraging them to open up now that we can all open up. Additional financial support was provided for the charitable sector to make sure that it could continue its vital services during the pandemic when fundraising activities were very difficult.

[Liz Kendall (Leicester West) (Lab)]

Many families are pushed to breaking point because they cannot get the help they need to look after the person they love. Will the Minister now confirm that somebody who is trying to hold down a job and care for their elderly mum whose house is worth £100,000 will face a tax rise that will not improve their mum’s care or give them a break from caring, and will not even stop them from having to sell their mum’s home, because under the plans Tory MPs voted through last night, she will never hit the cap on care costs? Will the Minister further confirm that this tax rise on working people will be used to protect 90% of a home worth £1 million? If she disputes these figures, why does she not publish the impact assessment before MPs are asked to vote on the Health and Social Care Bill tonight?

[Gillian Keegan]

From October 2023, the Government will introduce, for the first time in our history, a new £86,000 cap on the amount any adult in England will need to spend on their social care. That will protect them from unpredictable and unlimited costs. But as well as that there is a more—[Interruption.] The hon. Lady may like to listen to the answer. As well as that, there is a more generous—[Interruption.] Please listen. On top of that, a more generous means test for adult social care will come into effect, allowing more people to benefit from the means-tested support. Under the current system, about half of all older adults in care receive some state support. This rises to roughly two thirds under the recently announced charging reforms, which will help many adults, including unpaid carers. Everybody will benefit from this system.

[Laura Farris (Newbury) (Con)]

5. What steps he is taking to reduce waiting lists for (a) children and adolescent mental health services and (b) other mental health services for young people.

[The Minister for Care and Mental Health (Gillian Keegan)]

We are committed to ensuring that children and young people get the mental health support that they need. That is why we are expanding mental health services through the NHS long-term plan so that 345,000 more children and young people a year have access to services by 2023-24. This year the Government and the NHS, under NHS England, have provided an additional £109 million on top of long-term planned funding. This additional funding will allow 22,500 more children and young people to access community health services this year, earlier than planned, and that will accelerate the roll-out of mental health support teams in schools and colleges.

[Laura Farris]

In West Berkshire, a family seeking a child and adolescent mental health services diagnosis of autism spectrum disorder or attention deficit hyperactivity disorder can face a waiting time of up to two years. The Berkshire West clinical commissioning group has recently made £1.6 million available to recruit extra staff, but when I spoke to it, I was struck by the absence of any hard targets to reduce waiting lists and any consequences if it fails to deliver. These waiting times are causing misery to my affected constituents, so can my hon. Friend say what steps can be taken to ensure accountability in the provision of this service, and will she meet me to discuss waiting times in West Berkshire?

[Gillian Keegan]

I share my hon. Friend’s concern that waits for autism assessments and diagnosis are often way too long, and that is why we are investing an additional £13 million of funding this year. That funding will allow local systems to test different diagnostic pathways—including working on a multi-disciplinary basis, which will shorten the diagnosis time—and to find new solutions for addressing long waits. The precise allocation of funding for diagnostic pathways are decisions made at the local level, and those should be compliant with National Institute for Health and Care Excellence guidance. NHS England is working with local systems to evaluate what works well. Since November 2019, we have been reporting on waiting times between referral and first assessment, and that is important, because we use that to drive up local performance. I would be very happy to meet my hon. Friend to discuss this further.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

When the Government talk about waiting times, they refer to how long it takes simply to get an assessment, and not to when treatment may start. Most children face an incredibly long wait after that first step, or even have their referral closed. The real truth is revealed when we look at how long it takes for children to complete treatment. In Yorkshire and the Humber, it took one child more than 13 years to complete treatment for their anxiety. In the north-west, some children took three years to complete treatment for eating disorders. In the midlands, it is not uncommon for treatment completion to take five years. Will the Minister commit, as we have, to the provision of a counsellor in every school, a mental health access hub in every single community and regular mental health assessments for children in all key stages?

[Gillian Keegan]

We know that the prevalence of children and young people with a mental health condition has increased—in some cases, it has increased massively. That is why we remain committed to increasing investment through the long-term plan. Also, we have consulted on the potential to introduce five new waiting times standards, including for children and young people and their families and carers presenting to community-based mental health services. In addition, NHS England and NHS Improvement have announced an additional £40 million to address the impact of covid on children and young people’s mental health, including for eating disorders. Since 2014, extra funding has been going into children and young people’s community eating disorder services every year, but we know that we have more to do. This extra funding will enhance the development of more than 70 new and improved community eating disorder teams, but there is no doubt that there is much to catch up on. We are also introducing services into schools for young people.

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

When the chief inspector of hospitals placed St George’s in Tooting into special measures, he warned that the

“emergency department was not large enough for the number of patients that passed through it and privacy and dignity were compromised.”

Given the report by the British Red Cross in this morning’s edition of The Times highlighting the causal link between A&E attendance and deprivation, does the Minister understand the further huge impact that moving acute services from St Helier to wealthy, healthy Belmont will have on A&E attendances at St George’s?

--- Later in debate ---

[Chris Grayling (Epsom and Ewell) (Con)]

20. What steps he is taking to tackle staff shortages in the social care sector.

[The Minister for Care and Mental Health (Gillian Keegan)]

We recognise the considerable challenges the adult social care sector faces in recruiting and retaining staff. We have put in place a range of measures to support local authorities and care providers to address workforce capacity pressures. These include a new £162.5 million workforce recruitment and retention fund, and the latest phase of our national recruitment campaign, launched on 3 November, which highlights adult social care as a rewarding and stimulating place to work.

[Chris Green]

I thank my hon. Friend for her reply. The latest figure I have for the vacancy rate for carers in August was significantly worse than those from before the pandemic, and it is likely to worsen still further due to the requirement for compulsory vaccination. When does my hon. Friend believe the vacancy rate will return to pre-pandemic levels?

[Gillian Keegan]

The first thing to say is that obviously the vaccine saves lives, and it is our responsibility to do everything we can to reduce the risk for vulnerable people. As of 14 November, 92.5% of care home staff have had their second dose. We have put in place measures, as I said earlier, to support workforce capacity, which have only just gone to local authorities. The Department continues to closely monitor workforce capacity, bringing together the available data, including the vacancy rate, with local intelligence. Longer term, we have committed at least £500 million to support and develop the workforce, and that will go some way to addressing the barriers to people taking up work in adult social care, which has been an issue for a number of years.

[Bill Esterson]

There are 105,000 vacancies across all social care workforce grades, but employers are unable to recruit across those grades. The Government have accepted the need to add senior care workers to the shortage occupation list—they did that in April—but the Migration Advisory Committee is not due to report until next April on the need to recruit social care workers. It is no good the Minister saying employers need to pay more money to recruit UK workers, because this Government are the ones underfunding the employers, who cannot then compete with the likes of Amazon. When will the Government admit that they need to add all grades of social care workers to the shortage occupation list if they are to have any hope of addressing this shortfall and providing the care that is needed to address the care crisis?

[Gillian Keegan]

As I mentioned earlier, we have sent out £162.5 million, which has not yet been put into effect. For example, Sefton received £1,032,474. That money has only just gone into the bank account, and has not yet been utilised to retain staff, or to recruit agency or other staff. As the hon. Gentleman says, adult social care providers can recruit key adult social carers from overseas from the shortage occupation list. That provides lower fees and a reduced salary threshold of £20,480 for someone to be eligible for the skilled worker visa.

[Helen Hayes]

The adult social care sector faces the worst staff shortages in living memory. A recent survey by the National Care Forum found that one third of managers of registered care homes are limiting or stopping admissions from hospital, due to staff shortages, with direct consequences for both the NHS and for vulnerable people who cannot access the care they need. The care sector needs action now, not warm words and job adverts. Will the Minister commit to paying a retention bonus to frontline care staff, to help stem the tide of those exiting the care sector this winter? Will she commit to a fully funded, permanent pay increase, to bring the minimum level of pay for care workers up to £10 an hour—the minimum rate at which Amazon is recruiting in many areas where the care shortage is at its most acute?

[Gillian Keegan]

We have committed to bring forth new measures in the White Paper, and to spend at least £500 million on recruiting that workforce. To address the emergency now, as I mentioned, there is £162 million. In addition, we have put around £500 million particularly to address discharge processes, and to ensure a discharge to assess process, which means it can be much quicker. We must ensure that those teams work together to shorten the discharge process. There is no doubt that our NHS and our whole system is under extreme pressure this winter, and we thank it for all the work it is doing.

[Chris Grayling]

There is a particular challenge in a county such as Surrey that has a rapidly ageing demographic, high housing costs, and where the cost of living is high generally. Could I urge the Minister and the Secretary of State to ensure that they consider all possible avenues to assist with what is becoming an acute shortage of key staff? We cannot end up in a position where the elderly do not receive the care they need, and we need maximum flexibility to ensure they get that care.

[Gillian Keegan]

There is no doubt that the sector is facing extreme pressure. It always faces pressure as the demographic need grows by 1% to 2% every year, but we have set out money to help with the short-term impact of that. Surrey will receive £2,704,702, so just over £2.7 million. We recently started the biggest national recruitment campaign we have ever done, Made with Care, to thank our care workers and to show what a fantastic and rewarding career it would be. We will continue to work with local authorities to help as much as we can.

[Tony Lloyd (Rochdale) (Lab)]

In the context of what the Minister has announced about increased money for staff terms and conditions, what does she make of the Alternative Futures Group, which operates in the north-west? It refuses to take up the real living wage, even when councils offer to fund it, and is in a process that is seeing the terms and conditions of its workforce deteriorate? Is there a need to look at that group, and to have a collective agreement for the whole sector?

[Gillian Keegan]

Yes, and I would be grateful if the hon. Gentleman would write with the details. We have a skills shortage in many areas across our economy. Because of the success of the Plan for Jobs, and our bounce back from the pandemic, anybody who does not treat their staff well will find that their skills shortages become very acute indeed.

[Chris Loder (West Dorset) (Con)]

11. What steps he is taking to ensure booster doses of the covid-19 vaccine are available to all eligible people in West Dorset.

--- Later in debate ---

[Andy McDonald (Middlesbrough) (Lab)]

T4. Now that the cap on care costs has unravelled, many of my constituents feel misled and betrayed, especially those with modest capital in the value of their home. How can it be that those with the most will contribute the least and that those with the least will contribute the most? Where is the equity, where is the fairness, and where is the justice in any of that?

[The Minister for Care and Mental Health (Gillian Keegan)]

I thank the hon. Gentleman for his question. We are trying to solve something that has not been solved for decades, and the Labour party does exactly what it always does when it comes to this point: it picks one specific part without looking at the package as a whole and misleads the whole country. I want a better system not only for our grans and grandads, but for our mums and dads and all of us. If this system had been in place for my grandmother when she had dementia before dying in 2018, she would have been a lot better off. While we sit here doing nothing, the reality is that everybody loses—

[Mr Speaker]

Order. Questions and answers are meant to be short and punchy. We cannot get into a full-blown debate.

Social Care Update

Gillian Keegan Excerpts

Wednesday 17th November 2021 Written Statements

[The Minister for Care and Mental Health (Gillian Keegan)]

On 7 September 2021, my right hon. Friend the Prime Minister set out the Government’s new plan for adult social care reform in England. This included a lifetime cap on the amount anyone in England will need to spend on their personal care, alongside a more generous means test for local authority financial support.



Today we are publishing a technical note to complement the announcement, which:



provides further detail of the new charging reform framework and confirms key policy details, including the standard level at which ‘daily living costs’, will initially be set.

marks the start of a period of co-production of the statutory guidance with the sector, with the intention to publish a public consultation in the new year, and lay regulations and publish updated statutory guidance in spring 2022.

The key policy details that the technical note confirm are that:



from October 2023 both new entrants and existing social care users will be able to progress towards the cap.

the increase in the Upper Capital Limit of £100,000 will apply universally, irrespective of an individual’s care setting or circumstances.

between the Upper and Lower Capital limits, if individuals are not able to pay for their care from their income, they will be expected to contribute up to one in every £250 from their chargeable assets towards the cost of their care.

the notional level of ‘daily living costs’, a key concept of the reforms, will be set at £200 per week.

for individuals who receive financial support for their care costs from their local authority, it is the amount that the individual contributes towards these costs that will count towards the cap on care costs.

This last point requires an amendment to section 15 of the Care Act 2014. For this reason, the Government will bring forward an amendment for the purposes of introducing a clause into the current Health and Care Bill. This clause will seek to amend section 15 of the Care Act 2014 such that individual contributions—based on local authority rates—will count toward the cap.



This change will reduce complexity; it will ensure individuals receive the support they need through the means test but are not unfairly reaching the cap at an artificially faster rate than what they contribute.



I have ensured a copy of the technical note will be deposited in the Libraries of both Houses.

[HCWS399]