Social Care

Jackie Doyle-Price Excerpts

Thursday 7th December 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

This oral statement is the Government’s response to the recent Opposition day debate on social care on Wednesday 25 October. Since that debate, the Government announced further plans for the Green Paper on care and support for older people on 16 November. This oral statement reiterates the substance of that announcement while providing further detail to the House in some specific areas.

An ageing society means that we need to reach a longer-term sustainable settlement for social care. That is why the Government have committed to publishing a Green Paper by summer 2018 setting out their proposals for reform. An inter-ministerial group is overseeing this work. This builds on the additional £2 billion over the next three years that we have already provided to meet social care needs.

In developing the Green Paper, it is right that we take the time needed to debate the many complex issues and listen to the perspectives of experts and care users, building consensus around reforms which can succeed. That is why we are starting a process of initial engagement over the coming months through which the Government will work with experts, stakeholders and users to shape the long-term reforms that will be proposed in the Green Paper. The Government have asked a range of independent experts in this area to provide their views, including the leads of the two most recent reviews on social care, Andrew Dilnot and Kate Barker. We are also engaging closely with key stakeholders, and with people who use services and their carers. The Government will host a number of roundtables to hear a range of perspectives from those representing different constituencies, including carers, service recipients, providers, health services, financial services providers, local government, and working-age adults.

Once the Green Paper is published, it will be subject to a full public consultation. The Government recognise that there is broad agreement across Parliament that reform of social care is a priority, and we look forward to working with parliamentarians to hear a range of views. We have already written to the chairs of relevant all-party parliamentary groups to invite them to meet us to discuss their priorities for and perspectives on reform.

The Prime Minister has been clear that the consultation will include proposals to place a limit on the care costs that individuals face. To allow for fuller engagement and the development of the approach, and so that reforms to the care system and how it is paid for are considered in the round, we will not take forward the previous Government’s plans to implement a cap on care costs in 2020. Further details of the Government’s plans will be set out after we have consulted on the options. The Green Paper will focus primarily on reform of care for older people, but will consider elements of the adult care system that are common to all recipients of social care.

We are committed to ensuring that people with disabilities and complex conditions can live healthy, independent lives, and participate fully in society. Many of the issues and questions about the sustainability of the care system will be relevant to adults of all ages. To ensure that issues specific to working-age adults with care needs are considered in their own right, the Government have committed to taking forward a parallel programme of work on working-age social care, which is being led jointly by the Department of Health and the Department for Communities and Local Government. This work will be overseen by the inter-ministerial group to ensure close alignment with the Green Paper.

Of course, carers are vital partners in the health and social care system. It would not make any sense to pursue strategic issues related to carers in isolation from the wider work on the future of social care, so they will be a key part of the Green Paper. A sustainable settlement for social care will not be possible without focusing on how our society supports carers. I am committed to making sure that the issues raised with us through the call for evidence on carers in 2016 are central to any proposals for the wider social care system.

Alongside this, we must continue to work to improve the experience of carers today. The Government remain fully committed to supporting carers in providing care as they wish to, and in a way that supports their own health and wellbeing, and their employment and life chances. In the new year, ahead of the Green Paper’s publication, the Department of Health will publish an action plan for carers, setting out priorities for a cross-Government programme of work to support them over the next two years.

In the short and medium term, we are taking important steps to ensure we have a stable adult social care sector. We are promoting quality care across the system and supporting the wider networks and services that keep people living independently for longer. It is important to recognise that quality across the adult social care sector remains good overall: the October 2017 state of care report from the Care Quality Commission found that 80% of adult social care settings had been rated good or outstanding. However, it underlined that there are substantial variations in the quality of care depending on where people live. The Department of Health is working with the adult social care sector to implement Quality Matters, a shared commitment to taking action to achieve high-quality, person-centred adult social care. Through our programme of sector-led improvement, we are supporting councils to make savings and improve services by promoting good practice, including new approaches.

Looking beyond social care provision, it is important to highlight the broader support and services that help people to live independently for longer. Well-adapted, specialised housing is becoming increasingly important. The means-tested disabled facilities grant helps with meeting the cost of adapting a property to the needs of a person with a disability or support need. This year’s autumn Budget has provided an additional £42 million for the rest of the 2017-18 financial year, taking funding for this year to £473 million.

Getting social care right means a better system that everyone can have confidence in, in which all people understand their responsibilities, can prepare for the future, and know that the care they receive will be to a high standard and help them maintain their independence and wellbeing. This Government want to take the time to consult and build consensus on a long-term, sustainable settlement for the future, which includes looking at the quality of care being delivered, the funding of the system, and how it will be paid for in the round.

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

I thank the Minister for giving me advance sight of her statement, but it is a woefully inadequate response to the Opposition day debate we held in this place on Wednesday 25 October and in no way addresses the motion passed by the House.

That motion called on the Government to note

“the Conservative Party’s manifesto commitment to a funding proposal for social care which would have no cap on care costs and would include the value of homes in the means test for care at home”,

and we called on the Government not to proceed with their commitment to those proposals. The Minister has today finally confirmed what many of us on the Opposition Benches suspected: they will not be proceeding with their plans to cap care costs by 2020, as legislated for by the House. This a shameful waste of taxpayers’ money. Over £1 million in today’s money was spent on commissioning the Dilnot review, and it was a waste of parliamentary time enacting the cap. It is no good for her to say that the Government are consulting on the cap. They consulted on this during the general election, and their proposals were rejected by the electorate. Meanwhile, very many people are still faced with the catastrophic costs of paying for their care.

The motion also called on the Government

“to remove the threat to withdraw social care funding from, and stop fines on, local authorities for Delayed Transfers of Care”.

During the debate, I talked about how Ministers had previously threatened councils with fines and further funding cuts to social care if targets for cutting delayed transfers of care could not be met—fines for targets that half of social services directors believe to be unrealistic. Will the Minister confirm that the Government have listened to the will of the House and will stop these fines, which merely threaten to make the crisis in social care worse?

The motion also called on the Government

“to commit to the extra funding needed to close the social care funding gap for 2017 and the remaining years of the 2017 Parliament.”—[Official Report, 25 October 2017; Vol. 630, c. 312.]

At no point today has the Minister confirmed how the Government intend to enact the will of the House in meeting the funding gap—and of course, shamefully, there was no mention of social care in the recent Budget. Our social care system remains in a perilous state because of the cuts that this Government have chosen to make. The Care Quality Commission has told us that the social care system still remains at a “tipping point”. Will she now confirm that the Government will enact the will of the House and meet the funding gap?

The Minister in her statement addressed the Government’s decision to include the views of carers in the upcoming Green Paper and their failure to respond to the consultation of 6,500 other carers that has already taken place. As I mentioned in the debate, Katy Styles, a carer and a campaigner for the Motor Neurone Disease Association, contributed to that consultation and hoped that her voice would be heard. She told me:

“Not publishing the National Carers Strategy has made me extremely angry. It sends a message that carers’ lives are unimportant. It sends a message that Government thinks we can carry on as we are. It sends a message that my own time is of little worth.”

Will the Minister give more details on the scope of the carers action plan and reassure those 6,500 carers that their time was not wasted?

The Government announced recently, and the Minister confirmed today, that working-age people with disabilities would be consulted as part of a “parallel” workstream to the Government’s Green Paper consultation. Why a parallel workstream? This is an extremely short-sighted approach to reforming social care, and far from one that looks at the system in the round. Will she give us more details about the parallel workstream for working-age people with disabilities who have social care needs?

It is clear that only a Labour Government can deliver much-needed reform to our social care system. Over the coming months, we will also consult experts on how we can move from the current broken system of care to a sustainable service for the long term. We will look at funding options for social care in the long term, such as a new social care levy, an employer care contribution and wealth taxes. These experts will help to clarify our options for funding our planned national care service, and our approach will be underpinned by the principle of pooled risk, so that no one faces catastrophic care costs, as they do now or as they would have done under the Conservative party’s earlier dementia tax proposals.

[Jackie Doyle-Price]

The hon. Lady will not be surprised to hear that I did not agree with much of what she said, but I will address some of her points.

Fundamentally, we are setting out, as has long been established, how to get a longer-term, sustainable system for funding our social care. It is absolutely clear from our debates during the past year that, as far as the public are concerned, there is a real lack of understanding about how, at present, the cost of care has to be met by the person who requires it. That is what leads to catastrophic care costs, and the dementia tax that she keeps mentioning, and that is exactly what we are going to tackle by having a cap on the overall cost. In doing so, it is very important to take the public with us and to have a fully informed public debate. It does not matter how far we think we have had such a debate in this place when legislating in the past, because it is quite clear that the public do not understand this. [Interruption.] We are only going to get public consent for a long-term solution if we have a public debate that is handled with maturity, and so far we have not seen very much of that.

The hon. Lady raised the issue of carers, and she suggested that carers’ voices are not being heard in this debate. [Interruption.] I say to her that they very much are being heard. [Interruption.] She can sit there and chunter, or she can listen to the answer to the question. It is entirely up to her, but it is rather a waste of my time in coming to this place if I am just going to be talked over. [Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I say to the Government Whip that I think I can control the Chamber. I thank him for his help, but I have already told him once that he does not need to worry. [Interruption.] Order. The Whip is well aware that he is testing my patience. I do not need any help.

[Jackie Doyle-Price]

Carers’ voices very much are being heard, and there is no way we can actually tackle the broad picture of how we fund and manage social care need without properly considering the needs of carers. I am very grateful to the 6,500 people who responded to the call for evidence. We have listened to them, and we will consider what they have said in bringing forward the Green Paper. In the meantime, it is very important to pull together exactly what support there is at present and then respond to that, and we will publish our action plan in January.

On working-age adults, the hon. Lady is right to some extent in that there are some common issues in the adult social care system that affect both care for the elderly and care for working-age adults, and those common issues will be considered as part of the Green Paper process. At the same time, however, we are going through massive change in how we deal with people with disabilities. We have the very brave ambition of getting more and more people into work and we are on a journey of getting people with learning disabilities out of long-term residential care and into work in the community, and that brings a separate set of challenges. That work will go on in parallel, but the work on the Green Paper will look at the common issues as well as at the specific area of care for the elderly. I hope that gives her some reassurance. We cannot look at this in a silo—[Interruption.] She says this should all be looked at together, but care for the elderly and care for working-age adults face very distinct challenges, and I do not think we should diminish either constituency by grouping them all together.

On the funding gap, as the hon. Lady is well aware, we have made £9.25 billion available to local authorities to meet their needs over three years. The reality is that if we are to tackle social care in this country so that everyone gets the care they need as they come to the later part of their life, we need to build a longer-term, sustainable funding system. That is why we are taking forward this debate in the Green Paper, and I hope that everyone with an interest in this subject will get involved in that debate, because we can fix this problem in the long term only if we can take the public with us.

[Dr Sarah Wollaston (Totnes) (Con)]

The House of Lords Select Committee on the Long-term Sustainability of the NHS rapidly concluded that it would be impossible to carry out its task without investigating the interrelated nature of social care, and it changed its remit accordingly. The Committee changed the scope of its inquiry because it recognised that we will not see a long-term, sustainable solution unless we address both. I am afraid that a Green Paper that focuses entirely on social care will fail to rise to the challenge. Has the Minister read the Committee’s findings, and as she listens to those she consults at an early stage, will she be prepared, if the advice from them is to consider health and social care together—that has been the advice of all the commissions that have looked at this—to go back to the drawing board and start again by looking at both health and social care?

[Jackie Doyle-Price]

To reassure my hon. Friend on the terms of reference for the Green Paper, let me say that part and parcel of getting a long-term, sustainable solution very much involves looking at care, and I pointed out in the statement that we need to look at holistic areas of policy to deliver it. Housing is one area, because if we get housing conditions right, we can obviously enable people to live for longer. The whole purpose of having a Green Paper and a debate is to make sure that we consider this issue not in a silo, but holistically, with a person-centred approach.

[David Linden (Glasgow East) (SNP)]

I thank the Minister for advance sight of the statement. I very much hope that we will not regularly have an Opposition day debate that is followed, months down the line, by the Government deciding to sneak in a statement on a Thursday morning, but this is perhaps a one-off.

If we are to have a consultation, we should start to look seriously at some of the challenges that we face with an ageing population. The Government currently have their head in the sand when it comes to who will actually look after these people when we restrict freedom of movement. The Government’s antics on social care have been far from the strength and stability that was talked about at the beginning the 2017 election campaign.

I very much welcome what has been said today about the cap, but I want to press the Minister about a point on which there is cross-party consensus in Scotland; in particular, it has the support of the Conservative party. In Scotland, the Scottish Government are extending free personal care to under-65s—under the so-called Frank’s law—on which her colleague Miles Briggs MSP has been working very hard. That will benefit about 9,000 people, but the UK Government have no intention of bringing in such a policy. Will she agree to meet me and colleagues from Scotland to look at this on a cross-party basis?

[Jackie Doyle-Price]

The whole purpose of a Green Paper is to allow us properly to debate and challenge all options available. I am interested in what has happened in Scotland. The hon. Gentleman says that personal care is met by the Government there, but the lion’s share of costs for the elderly is of course the residential component, which is not met by the Scottish Government. We need to make sure that we are learning from the experience of everybody not only in these four nations, but across the world.

[Tim Loughton (East Worthing and Shoreham) (Con)]

I appreciate the importance the Government attach to adult social care, but the title of this statement is “Social Care” and, as the Minister knows, I have a strong interest in children’s social care. At a time when the number of children coming into care continues to rise, the thresholds for intervention are rising and preventive work is I fear going south. As the number of adoptions has also diminished, will she and the Government reassure me that they attach the same importance to dealing with the challenges faced by children’s social care services up and down the country at the current time?

[Jackie Doyle-Price]

I absolutely give my hon. Friend that assurance. If I may, I will suggest to my hon. Friends in the Department for Education that they respond to him on those points.

[Diana Johnson (Kingston upon Hull North) (Lab)]

May I say how nice it is to see my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) back in her rightful place on the Front Bench? I endorse what the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), has said to the Minister. Does the Minister regret that the Chancellor failed to mention social care at all in the Budget?

[Jackie Doyle-Price]

I think we are in danger of getting into a false debate. When I talk about social care, I do not talk about it to the exclusion of health but automatically include it. When people talk about the failure of the Chancellor to mention social care, the reality is that more money was made available to the NHS, which will benefit the social care system.

[Sir Desmond Swayne (New Forest West) (Con)]

In the absence of any provision I may make—Dilnot might have encouraged me to make such provision—is it reasonable for me to expect my social care costs to be paid for by the state while my heirs inherit my substantial housing assets?

[Jackie Doyle-Price]

In a nutshell, my right hon. Friend has neatly summarised one of the debates we need to have in this area, which is how we can ensure that people obtain care when they need it and have it paid for, while at the same time achieving intergenerational fairness. I hope he engages fully in the debate on the Green Paper when it comes out. That is exactly that kind of thing we need to discuss to inform the public about the challenges and encourage everyone to think about how to plan for their long-term care needs.

[Liz McInnes (Heywood and Middleton) (Lab)]

The leader of Rochdale Borough Council says that he needs about £20 million to meet growing demands on the adult care service. Given that social care was not mentioned in the Budget, will the Minister give the leader of my council some advice about where to find that £20 million?

[Jackie Doyle-Price]

As the hon. Lady knows, we have made an additional £9.25 billion available to local authorities, and they are now able to raise more through the social care precept. Some local authorities are very creative and imaginative in how they tackle that need, and we have increased the money available through the disabled facilities grant. That is taking a lot of demand out of the system, not least because it enables people to live independently at home without the need for care support, because of the extent to which it reduces falls. I encourage the hon. Lady to look not just at money, but at what else local authorities can do better.

[Rebecca Pow (Taunton Deane) (Con)]

I welcome the report and the focus on carers and the elderly—that is really important in Somerset. Let us not forget that four out of five social care institutions already offer good and outstanding service. As the Minister said, this is not just about funding; it is also about other measures that can be introduced to help. For example, hospitals such as Musgrove Park in my constituency link up with social care providers. It is doing a great job, and its end-of-life care has recently been rated outstanding.

[Jackie Doyle-Price]

I thank my hon. Friend for that point because although, quite rightly, we focus on the challenges and difficulties of this issue, a hell of a lot is going right. As she says, the Care Quality Commission found in its recent “State of Care” report that 80% of institutions were good or outstanding. That is a pretty good deal for a sector that is constantly and publicly criticised.

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

I welcome the Green Paper, and I hope that we can build cross-party consensus for the long term. However, any change will be years away from that Green Paper. The problems are here and now for local councils, and the Minister simply did not deal with them in her statement. The Local Government Association estimates for next year a funding gap of £2.6 billion on a cross-party basis. The Competition and Markets Authority states that care homes are failing because local authorities do not have the necessary resources to pay the fees. What will the Minister do about that? Where is the money to ensure that an inadequate social care system does not get even worse next year?

[Jackie Doyle-Price]

I welcome part of the hon. Gentleman’s comments. He is right: one reason we are at this stage is that the absence of long-term security means that some of these issues are crystallising rather more quickly than they ought to. We have made more money available to local authorities, but clearly they, more than any others, are desperate for a solution. It is incumbent on us all to hold a constructive discussion about the solutions to this issue. I am well aware of the challenges. The hon. Gentleman highlighted the CMA report, and it contains a lot that, frankly, did not surprise me. In the new year we will be bringing forward a response that deals with some of the issues raised.

[Jeremy Lefroy (Stafford) (Con)]

I thank my hon. Friend for her statement, and I encourage her—as others have done—to engage with the whole House on an issue that so many Members care deeply about. As the hon. Member for Sheffield South East (Mr Betts) said, it is important to recognise the crises that exist now in certain areas of the country. We must engage for the long-term on a cross-party basis, but also on the crises now, including in my county of Staffordshire.

[Jackie Doyle-Price]

I do not disagree with much of what my hon. Friend says. Colleagues are talking about a crisis, but local authorities and the care sector have been put under a lot of pressure this year getting ready for winter, and they have stepped up to the plate. I pay tribute to everybody who works in that sector. They work incredibly hard and with real care. The work they do is not putting us in crisis but delivering great care outcomes for many people.

[Karin Smyth (Bristol South) (Lab)]

This is a shocking statement for thousands of families who live in this country with the misery of social care. The Minister referred to the previous Government, but the 2015 Conservative party manifesto was clear about what it was seeking to do, and about introducing a cap on care costs in 2016. A few weeks into office, the Government changed that, and moved the cap forward until 2020. I have written to the Minister about her exchanges in the House on 25 October with the right hon. Member for New Forest West (Sir Desmond Swayne), during which she inadvertently misled Parliament about the 2020 date and legislation—that was subsequently changed when I went to the Library. The key issue is that this issue is causing silent misery for thousands of people now. I am 53. Will my children be suffering the same level of misery about my care costs in the next 30 years? When will we see the actual date published?

[Jackie Doyle-Price]

I think we made it clear in the recent general election that we will be revisiting this issue. The hon. Lady wants certainty about how we fund the care system in future, and on what obligations individuals and their families will or will not have. It is therefore important to have that full public debate, and work together to bring forward proposals that will put our long-term care system on a sustainable footing. In the absence of that we will not achieve any resolution, and that is contributing to misery for people who do not currently have a limit on their overall care costs. That is what we are trying to address through this process. [Interruption.] I hear noise from Labour Members about needing cross-party consensus, then I look at the behaviour of those on the Front Bench—lacking.

[Kevin Foster (Torbay) (Con)]

I welcome the Minister’s pledge to consult more widely about a long-term solution, given the pressures on Torbay due to this issue. One problem is people’s complete lack of understanding about how the current system works with unlimited liability. If we just put in a blunt cap, that will mean little to someone who has worked for their whole life and bought a house in Torbay, yet quite a lot to someone who has a multi-million pound pile in the south-east. We must look carefully at how we do this on a long-term basis.

[Jackie Doyle-Price]

My hon. Friend encapsulates the problem in a nutshell. Many people do not understand that care must be paid for by the individual; nobody understands that they have to pay for it for as long as they have to pay for it. That is why we cannot simply implement the previous proposals because people do not understand them. If we are to expect people who are living longer to fund that care, we must take them with us. That is why we need a fully informed public debate, which is what the Green Paper is designed to achieve. I implore all hon. Members to engage with that and to help to inform the public about exactly what our care system is now, and how it can be improved for their long-term security and that of the country.

[Jack Dromey (Birmingham, Erdington) (Lab)]

After years of confusion for which the Government bear some responsibility, tens of thousands of carers engaged in sleep-ins will at last receive justice on the national minimum wage. However, the costs are formidable to the providers, and thousands—potentially tens of thousands—of individuals on individual care packages could face bankruptcy. Why was there no reference to that immediate and looming crisis, and when will the Government act to avoid what would be a catastrophe for the care sector?

[Jackie Doyle-Price]

I know that the hon. Gentleman cares deeply about this issue and he has rightly raised it with me before. I reassure him that the Government are now acting, and we are in close contact with providers to address those issues. It is important to ensure that employers uphold their obligations under minimum wage legislation, and we must not put at risk anybody who is dependent on long-term care—I am satisfied that no one is at risk. We are working in detail with providers to ensure that we get them through this.

[Jeremy Quin (Horsham) (Con)]

West Sussex has some specific social care issues currently under investigation, and it would be inappropriate for the Minister to comment on those at present. However, I warmly welcome the expert panel. Will the Minister please ensure that it is fully acquainted with the lessons learned on financing from previous scandals, such as that at Orchid View in my constituency?

[Jackie Doyle-Price]

Absolutely. My hon. Friend mentions the expert panel, and it is important that we take the advice of those who have front-end experience of the sector. As he says, this is not just about money; it is about quality and getting the right blend of packages of support and help. We really need to think about achieving the best possible care for individuals, as well as how that care is paid for.

[Mrs Madeleine Moon (Bridgend) (Lab)]

A recent Barnardo’s report showed that two thirds of child carers start caring in primary school, some as young as four, with long-term damage to their mental and emotional health. Will the Minister ensure that one of the Government’s primary responsibilities is to tackle the issue of child carers and take them out of a responsibility that we really should not be placing upon them?

[Jackie Doyle-Price]

I thank the hon. Lady for those comments. She highlights what is literally the Cinderella in this debate. It is appalling that so many children are acting as carers, stoically and fantastically but, as she says, to their long-term detriment. As a society, we would be failing if we did not do more to support them.

[Lucy Frazer (South East Cambridgeshire) (Con)]

The fact that we need to tackle the challenge of social care has cross-party support and agreement. It was in the manifestos of both main parties. In fact, the Labour party’s manifesto said that it wanted to implement change through “consensus” and that the issue transcended party politics. Would the Minister welcome a cross-party approach, rather than political point scoring?

[Jackie Doyle-Price]

I am very keen to approach this matter through consensus. To be frank, I do not think that we can deliver change without consensus. We have written to all-party groups in the first instance to engage with them. Over the course of the next six months, I hope to engage in conversations and discussions with Members from all parts of the House.

[Mr Chris Leslie (Nottingham East) (Lab/Co-op)]

Of course, there is a short-term series of pressures. The Minister has cited the CQC’s state of social care report, which talks about decreasing numbers of beds in nursing homes and contracts being handed back to local authorities because of the acute financial pressure. She has also recognised that there is a longer-term issue that all Members have alluded to—the need to set aside some of the yah-boo party politicking and find a cross-party way forward. The hon. Member for Totnes (Dr Wollaston), the right hon. Member for North Norfolk (Norman Lamb) and my hon. Friend the Member for Leicester West (Liz Kendall) wrote to the Prime Minister saying, “Let’s have a convention across all the parties on social care reform.” Please will the Minister talk again to the Prime Minister? Let us do that, because it is the only way that we will really crack through this problem.

[Jackie Doyle-Price]

I welcome the spirit in which the hon. Gentleman makes his comments. It is fair to say that we are hearing exactly the same sort of plea from local authorities, which are at the front end of dealing with this problem. He is absolutely right that we need to separate the short-term pressures from the long term, and we ought to be able to have a more sensible conversation on the long-term pressures. Yes, let us save the politics for the short term and have consensus for the long term.

[Stephen Lloyd (Eastbourne) (LD)]

I appreciate the opportunity to speak, Mr Deputy Speaker, as I missed the beginning of the Minister’s statement—my apologies. I concur totally with what a number of colleagues have said about the issues in the here and now. At the minute, there are significant issues for a lot of councils and a lot of care homes that cannot wait for a few years. The here and now must therefore be the priority.

I have two points to make on that. The first is negative and I would like the Minister to take it back to the Chancellor. I call on the Government to make a public commitment to fund the back-pay bill for sleep-in carers. I do not know how many colleagues know about this issue, but if it is not sorted very soon, a number of very reputable charities and organisations are likely to go bust. On a positive note, I wonder whether the Minister has read the recent BMJ report that indicated how exercise can be a significant miracle cure for older people. May I meet the Minister to share the report with her?

[Jackie Doyle-Price]

I would be happy to meet the hon. Gentleman; I am always looking for solutions. He is absolutely right that if we can look after our own wellbeing—both physical and mental—more effectively, the need for care will diminish. That is another reason why we need to have this public debate. Like the hon. Member for Birmingham, Erdington (Jack Dromey), the hon. Gentleman has mentioned sleep-ins. It is a big issue, but we are working closely with the sector to make sure that we can address it.

[Rachel Maclean (Redditch) (Con)]

I am currently caring for my 80-year-old mum who has dementia and lives on her own many hundreds of miles away from me. I pay tribute to the fantastic support she receives from the Cumbria services—it is excellent and it reassures me, when I am standing here, that she is being looked after.

My experience of door-knocking during the election demonstrated strongly that the public do not understand this issue. Dementia patients in particular are not able to understand how care can be funded. When I spoke to people from the Alzheimer’s Society in Redditch, they welcomed the focus in our manifesto on this difficult issue. Will the Minister also comment on the fact that countries across the world face a similar challenge? This is really not about who is in power or in government; it is a feature of ageing societies. That is why we must look at it in the round.

[Jackie Doyle-Price]

My hon. Friend is right. I mentioned that local authorities are very keen for us to find a solution to this problem, but it is the Alzheimer’s lobby that is keener than anyone. At the moment, one in 10 people faces long-term care bills. Therefore, if we are looking at an individual’s risk, making financial provision is not necessarily something that they will do, so we do need a solution. The one in 10 people who face long-term care costs generally do face them as a consequence of dementia and the costs are very significant. That is exactly what we are trying to tackle by introducing a cap on the overall costs. That is why it is important that we all get involved and why the Alzheimer’s lobby is so keen that we establish cross-party consensus.

My hon. Friend raises an interesting point. The fact is that over the past 50 years, our lifestyles have changed significantly. Looking at my family, everybody lives within half a mile of each other, so as we get older it is very easy for the family to pick up caring responsibilities and share them about. I live 300 miles away from them. That is increasingly the pattern. Like her, when I knocked on doors during the election, I saw people in their late 80s whose families were living many miles away. That is something that we have failed to address over decades, and we need to address it now.

[Nick Smith (Blaenau Gwent) (Lab)]

Will the Minister update us on the financial stability of the Four Seasons group, which cares for over 17,000 vulnerable residents across the UK?

[Jackie Doyle-Price]

I am aware that there has been considerable press reporting on what is happening with Four Seasons. What I can say is that since Southern Cross, the CQC has been involved in market oversight and in stress testing exactly what is happening. We are satisfied that there is no risk to any of the people who currently experience care through Four Seasons. Beyond that, I cannot say very much because there are obviously commercial issues. However, the hon. Gentleman is right to raise the matter and I hope I can reassure him that the CQC is very close to what is happening there.

Autism Community: Mental Health and Suicide

Jackie Doyle-Price Excerpts

Thursday 30th November 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I have greatly enjoyed listening to the debate, because I have heard so much good common sense and so much passion and care expressed about this important issue. It has been a pleasure. I am glad that we reached it in the end, although it was slightly truncated.

I congratulate the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) on securing the debate, and I congratulate all the other Members who have participated in it. Everyone was absolutely right to say that we need to understand more about mental health, autism and suicide, and to understand more about what constitutes appropriate mental health treatment and treatment for people with autism. The existence of the suicide statistics, unpleasant as they are, demonstrates that we really must do better in this regard.

As I have said, I enjoyed all the speeches today, but I pay particular tribute to the hon. Member for East Kilbride, Strathaven and Lesmahagow for the expertise and the personal passion that characterised her arguments. She has given me a lot to think about, but let me reaffirm to her that my door is always open so that I can hear more. I particularly want to hear what the strategy in Scotland has delivered, because she is absolutely right: when we see good practice, we should all share it and ensure that it becomes the norm for everyone.

We can never debate autism without considering the issue of waiting times, and, as Members have pointed out, in some areas they are very poor indeed. As we have confirmed, we will be publishing more data from April which will provide us with the tools with which to “give challenge”. However, it is clear that waiting times are not good enough, especially in the north-east, and we are failing people when we do not give them an early diagnosis.

The hon. Member for Cardiff West (Kevin Brennan) mentioned the criminal justice system, which is where people with autism and mental health issues often end up. As he said, we need to improve the sensitivity with which the criminal justice agencies deal with such conditions. I can tell him that the Ministry of Justice is working with the Home Office and the Crown Prosecution Service to develop new guidelines to help officers to support people. I think I need to do more with the MOJ to ensure that we do not put people in a setting that will damage them further, but I am pleased that there are now liaison and diversion services covering 80% of the country to achieve exactly that.

The hon. Member for East Kilbride, Strathaven and Lesmahagow also described very well, as did the hon. Member for Washington and Sunderland West (Mrs Hodgson), how for some people with autism accessing support from GPs can cause distress in itself. This is where debates such as this can be so useful, because sometimes the most simple, practical things can make the biggest impact. It surely cannot be beyond the wit of any of us to make sure that GPs receive appropriate advice about things like lighting, and even having a quiet area. We often now have multi-service GP and health centres, and there must be space in them to have a quiet area.

[Mrs Moon]

One of the risks is that, rather than going to their GP, people will look on the internet, where, sadly, they will find far too much information about how to take their own life and what methods to use. Also, if they go into chatrooms to share, they find encouragement to take their own life. This is an area that we must tackle.

[Jackie Doyle-Price]

I thank the hon. Lady for that intervention and the work she does in this area; I know she cares about it a great deal. She is absolutely right that there is a serious vulnerability among people who feel uncomfortable about accessing medical care. We must consider the proximity of the internet where it is possible to buy drugs and where nobody really understands what they are buying. We can do a lot more to enable people to protect themselves. The internet is a great source of information, but it can be less than benign when people want to use it for these purposes.

I have limited time and know I will not be able to do justice to all the contributions to the debate, but I will do my best. If I do not cover them all, it is not because I have ignored any of the points raised; rather, it is because there were too many good speeches to address in a short space of time.

The hon. Member for Bristol West (Thangam Debbonaire) made some extremely good points. She rightly highlighted the issue of unemployment, and I, too, am particularly concerned about that. We have just published the work and health strategy, and this is an area where we need to do better. The reality is that there is a great skillset here for particular disciplines, and enlightened employers recognise that. We can do a lot more to spread good practice here, as with GP surgeries, such as about what would be sympathetic interview styles for people with autism, so that we can enable them to become integrated. The hon. Lady is right that work is probably the best tool with which to protect our mental health, and we will look at that.

I was also intrigued by the hon. Lady’s autism surgeries, and wonder whether she might consider making that a toolkit that all of us with an interest in the issue could roll out in our own surgeries. Again, a lot of this is about raising awareness of the challenges people with autism face. We are in the public eye and have the ability to do that, so I ask the hon. Lady to tell me how she organised those surgeries.

My hon. Friend the Member for Bexhill and Battle (Huw Merriman) rightly mentioned schools. There is a problem with provision, and whether we always get it right—whether it should be mainstream or alternative provision, and whether we have enough places for alternative provision if that is the appropriate setting. That is particularly challenging in my local area, but it is not fair to fail individuals by excluding them because maintaining them in mainstream schools is either challenging or not appropriate for them. The state needs to ensure they get appropriate schooling.

My hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan) spoke at length about her own experience and set me a number of challenges. I will be happy to report to her on them. I can also give her every guarantee that the data she asked for will be made public next year.

I shall now turn to some of the things we are doing to develop the autism pathway and autism strategy. We have set an expectation in the NHS mandate that the NHS will reduce the health gap between people with mental health problems, learning disabilities and autism and the population as a whole, and support them to live full, healthy and independent lives. We acknowledge, however, that the complexity of autism and the multifaceted nature of the needs of those on the spectrum poses particular challenges to professionals and commissioners. I am keen that mental health should be considered by the new task and finish groups that are being established to implement the autism strategy, and I will ensure that progress is made in implementing the strategy in line with the Autism Act 2009.

It is important that the NHS accommodates the requirements of vulnerable groups such as autistic people through staff training, awareness raising and reasonable adjustments to services, as we have heard. Autistic people should be able to access mental health services like everyone else if they are supported to engage with services and helped to explain their problems so that they can receive treatment. They should not fall between two stools—between autism or learning disabilities services on the one hand and mental health services on the other. We need to ensure that we are giving bespoke treatment and care to people with both issues.

A lot of the treatments that we are developing in mental health will not be suitable for people with autism. We are therefore looking at what we can do to alter the psychological therapies that are available to make them more user-friendly and sympathetic to people with autism. I was horrified to hear what was said about group therapy. I am a lay person, but it is pretty obvious to me that group therapy is not appropriate for people with autism. Clearly, the fact that that is happening is an indication of how much more we have to do to ensure that society is more sensitive to the needs of those people.

I am running out of time, and I really want to hear from the hon. Member for East Kilbride, Strathaven and Lesmahagow, but I just want to emphasise that research will play an important role. We are looking at many projects at the moment. There is a research theme on neurodevelopmental disorders, and a project at Avon and Wiltshire Mental Health Partnership NHS Trust looking into guided self-help for depression in adults with autism, as well as work at Leeds and York Partnership NHS Foundation Trust. In the East of England, a project is being led by Professor Simon Baron Cohen focusing on suicide, autism and autistic traits, which will obviously be of interest to everyone who has participated in the debate today. I am grateful, too, for the research undertaken by Autistica, which has really highlighted this issue and brought us to where we are today. I am pleased to say that Autistica has met the national suicide prevention strategy advisory group, which advises the Government on the national suicide prevention strategy, to talk about its research. We will be reflecting on the advice that it has given us.

I thank everyone once again for participating in the debate. As I have said, I am always interested to hear about good practice and what more we can do. Rest assured, we still need to do much more to support people with autism, and particularly to ensure that they can access appropriate mental health services.

NHS Continuing Care

Jackie Doyle-Price Excerpts

Monday 27th November 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I thank the right hon. Member for North Norfolk (Norman Lamb) for securing the debate and giving the House a chance to discuss NHS continuing healthcare. He has achieved a pretty good attendance here tonight, given that it is a Monday on a one-line Whip, which is symptomatic of the interest in the subject. I find that heartening, and he spoke with great sincerity and passion about his concerns. We are grateful to him for that; I know that he thinks very deeply about this subject.

This subject provides challenges, as the right hon. Gentleman pointed out, and he made some valid points about the problems facing the continuing healthcare system. In particular, the Government are aware of issues around variation and the complexity in the system. He highlighted some important examples of that. He also highlighted discrepancies, which he was right to raise. We all recognise the frustration that many members of the public sometimes have with the current system. For those with complex needs, and their families, the process can be very difficult to understand, which can lead to stress and confusion at an already difficult time in their lives. He will know that variation in the system has been a concern for some time. First, I will set out what the Government are doing to address those things and to try to achieve consistency, before I turn to some of the other concerns.

Decisions about NHS continuing healthcare are important and have a big impact on people’s lives, which is why it is right that there is a careful and considered decision-making process in place, which must take into account each individual’s care and support needs. My officials are currently working on updating the NHS continuing healthcare national framework, which is the national guidance that underpins the system. That will help health and social care professionals across the country to apply the framework more consistently and effectively, and improve the experience for individuals. We are working with NHS England, local authorities and key stakeholder organisations such as the Continuing Healthcare Alliance and other charities on this update, to ensure that we draw on the full range of experience and knowledge. Members of the public with experience of NHS continuing healthcare have also made a valuable contribution to this process.

I would like to reassure the House that this update to the national framework will not affect eligibility for NHS continuing healthcare, or the extent of the service provided by the NHS. Instead, the update aims to clarify the process and improve outcomes for patients, carers and their families, and those working in the health and care system. The Department will publish this update to the national framework in the new year. However, we understand that these changes alone are not enough to deliver all the necessary improvements, particularly on issues such as the variation in eligibility decisions that the right hon. Gentleman highlighted. That is why we are working closely to support NHS England with its NHS continuing healthcare improvement programme.

The aim of the improvement programme is to consider how NHS continuing healthcare services can be improved by addressing key areas of concern—namely, variation in patient and carer experiences, and ensuring that assessments occur in the right place and at right time. That issue has also been raised in the debate tonight. The programme will set national standards of practice and strengthen links between other NHS England work programmes that promote the personalisation of care.

To some extent, there will always be some variation in NHS continuing healthcare eligibility rates, and that can be due to wide range of reasons, such as the age dispersion within a local population, variation in levels of health need between geographical areas and the availability of community services, including step-down beds, intermediate care, rehabilitation services and end-of-life services. However, NHS England analysis shows that variation in NHS continuing healthcare eligibility is reducing over time. Work to address variation has already seen improvements, with an approximate 7% reduction in the distribution of variation across standard NHS continuing healthcare eligibility decisions since 2013-14, but the National Audit Office report shows that we obviously have some way to go.

The NHS continuing healthcare assessment process has also been mentioned tonight, and NHS England has introduced a quality premium for 2017 to 2019 to incentivise clinical commissioning groups to carry out more than 80% of assessments within 28 days. Clinical commissioning groups with the highest number of delayed cases are required to establish improvement plans setting out key milestones and planned improvement measures.

The right hon. Gentleman mentioned the claim that budgets are effectively being capped, but I want to emphasise that the national framework for NHS continuing healthcare makes it clear that the starting point for agreeing an NHS continuing healthcare package and the setting where NHS continuing healthcare services are to be provided should be based on the individual’s preferences. However, in some situations, a model of support preferred by the individual will be more expensive than other options and clinical commissioning groups can take comparative costs and value for money into account when determining the model of support to be provided. None the less, the principle that healthcare is free at the point of delivery should and does stand.

Right hon. and hon. Members also raised the breach of human rights and the challenges made to some CCGs. We are interested in the thinking behind that and will explore such issues further.

The right hon. Gentleman discussed the wide variation in the conversion rate of assessments. In his constituency, the conversion rate of 24% appears low when compared with the national average of 31%, but that has to be set against the fact that standard NHS continuing healthcare is currently available for 68.13 per 50,000 people compared with a national average of 43.04 per 50,000 people. I make that point because meaningful comparisons are difficult, but he is right to highlight such issues so that we can satisfy ourselves that we are delivering the commitments in the Care Act 2014, which states that no one should be deprived of care if it is based on their need.

The right hon. Gentleman suggested that some clinical opinions were being questioned, so I want to make the Government’s position clear. CCGs must have regard to the guidance, which states:

“Financial issues should not be considered as part of the decision on an individual’s eligibility for NHS continuing healthcare, and it is important that the process of considering and deciding eligibility does not result in any delay to treatment or to appropriate care being put in place.”

All hon. Members should ensure that that is being adhered to and make appropriate challenges where we believe it is not. The Government and NHS England are looking at strengthening our assurance processes to ensure that those standards are met and that CCGs comply with the national framework. Since April this year, that now includes extended quarterly reporting of NHS continuing healthcare data metrics and robust improvement monitoring, including on eligibility and assessment conversion rates.

I know that the right hon. Gentleman wrote to NHS England about the performance of North Norfolk CCG. I am sure that he is waiting for the outcome of the review with some interest, and I will not be surprised if I hear from him again on this. I am grateful for his interest in this subject and for the spirit in which he made his comments.

As we are all living longer, the challenges to the health service and the care system are becoming ever greater, and he is absolutely right to highlight the need for cross-party co-operation as we address these issues and set the long-term future of care and health on a more sustainable footing.

[Rosie Cooper]

I understand how the system should be and how the Minister wishes it to be, but our comments tonight have been about how the system is. We can make information available to the Minister about instances that show the system is not working as she describes. I have a constituent with a severe spinal injury who was getting continuing healthcare. There was a tick-box exercise that she thought was just a review, but, nine or 12 months later, the care has been taken away.

[Jackie Doyle-Price]

I would be happy to look into that case. I have received advice that continuing healthcare packages for lifestyle or physical conditions are often altered depending on progress. The guidance under the framework is quite clear on what is applicable, who is eligible and what conditions are not eligible. Where there is a question on whether obligations are being met under the law—the obligations are enshrined in the Care Act and under the NHS principle that all treatment should be free at the point of delivery—the hon. Lady is right to make that challenge. I am more than happy to investigate that case.

I am running out of time, and I am sure this will not be the last time we address this issue, so I conclude by thanking the right hon. Member for North Norfolk for securing the debate and thanking all hon. Members who have shown an interest. This debate bodes well for our discussions over the coming months on these vital subjects.

It is vital that we continue to work closely with NHS England, local authorities and key stakeholders to improve the system for everyone. There is a lot of work to do and, although the direction of travel in some respects is positive, as with all these things, we are all less patient than we would like to be.

I hope the right hon. Gentleman can appreciate that the Government and NHS England are very much aware of the challenges in this area, both in his constituency and in the constituencies of other hon. Members. I am confident that the steps we are all taking to improve the system are the right ones and will deliver an improved experience for patients, families and carers based on a more consistent application of eligibility and variation.

Question put and agreed to.

Shepton Mallet Community Hospital

Jackie Doyle-Price Excerpts

Tuesday 21st November 2017 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Gray. It is also a pleasure to respond to my hon. Friend the Member for Wells (James Heappey), who has brought the required amount of passion to this argument. He is doing exactly what he should do to stand up for his constituents after the local health establishment made a very rapid decision regarding his hospital. It certainly came out of the blue for many people, but I would like to give some explanation as to why the decision was made and perhaps a message about where we may go in the future.

In the short term, we have the closure, but what happens beyond that is very much up for review. I commend my hon. Friend on the constructive way in which he has engaged with local health practitioners while still giving them a challenge. That is always the way to go with these debates. As we all know, the challenged situation we are facing is not only in terms of money. As he acknowledged, in this case the issue is not money; it is workforce across the trust. The challenged situation means that we will have to make some difficult decisions, and we should make them on the basis of constructive dialogue, not who shouts loudest. I certainly agree to his request to have more discussions on this matter in January. Although the decision-making process is independent, we as Ministers will want to satisfy ourselves that processes are being properly followed and representations are being properly heard.

The reality is that any decision of this kind has to be taken with full transparency and full accountability. Robust argument will withstand challenge. I look forward to taking the dialogue with my hon. Friend further. I also welcome the forward-looking points he made about the future campus and looking at future needs. All too often in such debates we look at the immediate short-term challenges without addressing the long-term ones. If we looked more at the long term, we might come to better decisions, rather than short-term ones.

I understand my hon. Friend’s concern about the impact that changes at Shepton Mallet Community Hospital will have on his constituents. I reassure him that changes will always be in the best interests of patients and the local community. Decisions must be driven by what is best clinically, what is best for the health service in the area and what is of most benefit to the greatest number of people in the area. He asked me to direct the trust to reverse the closure. We are very much of the opinion that it is right that such matters are addressed at the level where the local healthcare needs are best understood, rather than in Whitehall. I give him the assurance that I will join him in holding local decision makers to account to ensure that their decision making has been properly accountable and robust.

It is worth reiterating that all proposed service changes should meet the four tests for service change: they should have support from GP commissioners, be based on clinical evidence, demonstrate public and patient engagement, and consider patient choice. In addition, NHS England introduced a new test applicable from 1 April 2017 for the future use of beds. It requires commissioners to assure NHS England that the proposed reduction is sustainable over the longer term and that key risks, such as staff levels, have been addressed.

I will first outline what led Somerset Partnership NHS Foundation Trust to announce on 11 October the temporary closure of in-patient wards at two of its 13 community hospitals across the county. As my hon. Friend has pointed out, the decision was not financial; it was based on patient safety. Overall, Somerset Partnership provides 222 community hospital beds, spread out over 13 community hospitals. Plans drawn up for an expected increase in patients over this winter made it clear that although sufficient funding was in place to maintain services, the trust was facing vacancies in a quarter of its registered nursing posts, meaning that the trust nursing workforce was spread far too thinly at the time. Following a review, it was found not to be sustainable to continue to safely deliver in-patient services across all 13 sites.

To address safety concerns, the trust made the decision to move 10 beds at Shepton Mallet hospital and 14 beds at Chard hospital, along with their staff, to other community hospitals in Somerset. I fully appreciate the case that my hon. Friend has made about the services at Shepton Mallet being robust. I understand why the move feels particularly unfair, but we will have to address that in consultation as we take the matter forward.

The trust has said that the two in-patient wards are likely to be temporarily closed until at least the end of March 2018, but that the current total of 222 community beds and all current services across Somerset will be maintained. Somerset CCG has endorsed the move and is in the process of considering community hospital services and provision as part of a wider clinical services review across the county next year.

We talked earlier about criteria and how trusts should come to decisions: in full openness and consultation with staff and the public. I understand that the trust communicated with a wide range of staff and stakeholders on its plans to temporarily close the wards, including with the local county council, which supported the action taken by the trust on the grounds of patient safety. I am also pleased to say that the trust held all day face-to-face drop-in sessions with members of the public, as well as a public meeting organised by the League of Friends of Shepton Mallet Community Hospital, which was attended by 120 people, including my hon. Friend and local councillors.

The trust has also organised a workshop event in the town for key local stakeholders on 30 November to seek the views of patients and carers while the ward is temporarily closed, and has developed a wider consultation document to inform its next board meeting on 6 February. I urge my hon. Friend and his constituents to engage in that process and make their voices heard. I want to reassure him that Somerset CCG has not put the trust under any financial pressure to temporarily close the wards at Shepton Mallet Hospital.

As my hon. Friend has pointed out, the issue is not about money. It is solely down to the issues around nurse recruitment, and the trust is working hard to improve on that. It has recruited two specialists who have extensive experience of specialised nursing recruitment. It is also offering more intensive support for potential recruits to increase the rate at which they take up posts. It is also working with Yeovil District Hospital to recruit nurses from the Philippines. I am pleased to learn that already there is a large number of interested nursing staff, which the trust hopes will be recruited and in post from April 2018. Furthermore, the trust is revisiting its current golden hello bonus of £1,000 to see how it can be better tailored to individual needs and it is looking at how else it can attract nurses to the trust.

Owing to staffing issues, the CCG supports the closure on the basis that, as my hon. Friend has pointed out, it is temporary and has been made on patient safety grounds, not on financial ones. It has been made clear that there can be no permanent closure of the wards at the community hospitals without prior patient and public engagement and formal public consultation. The CCG fully expects the beds to be reopened after the winter.

By taking planned measures now, the CCG is reassured that that represents the safest way of avoiding the potential risk of disruption to patient care should we see severe winter weather or the predicted higher than average levels of sickness from flu.

[James Heappey]

There is some concern locally about what the consultations look like. The Minister, briefed by local health authorities, has relayed that a “consultation” was conducted in the last few weeks of November ahead of the temporary closure. The reality is that that, including the agreement of Somerset County Council, was done after the solution was presented as a fait accompli. Can the Minister reassure me that the health authorities will be explicit with the community and all other stakeholders when having such a consultation about permanent closure and that the discussions going on right now about the temporary closure will not in due course be dressed up as the consultation leading to permanent closure?

[Jackie Doyle-Price]

My hon. Friend has the nub of the issue completely. To inspire confidence among his constituents, we as decision makers need to be very clear about the basis on which the decision was made and how future decisions will be made. The short-term consultation was about a decision made purely to get us through winter for patient safety reasons. For any long-term closure there would have to be a full consultation, fully transparent and fully accountable. I know he will hold me as well as his local trust to that. I do not think I can be firmer. We inspire confidence in the public and in patients who use the services only if we are fully transparent in making decisions. It is unfortunate that the speed with which this particular decision had to be made in order to get us through the winter will have undermined confidence. Of that there is no doubt, but rest assured I will continue to engage with him to make sure we can restore public confidence among his constituents in future.

As I have mentioned, the decision taken has allowed the trust to consolidate beds and staff into fewer hospitals, but larger wards. Closing the wards has reduced the number of unfilled shifts by 60 shifts a week: the equivalent of 13 nurses. Regrettably, since the closure, three Shepton Mallet patients have been admitted to surrounding community hospitals—one patient is in West Mendip and two are in Wincanton. I am advised that, as a result of the temporary closures, the trust has provided support budgets to enable carers and relatives who need financial assistance to visit patients. I should also add that all of Somerset CCG community hospitals have free car parks, so if people are visiting their loved ones, they will not have to pay. I should point out that that is not a privilege enjoyed by many other areas.

My hon. Friend talked about the long-term plans for a health campus. Both Chard and Shepton Mallet have been assessed as requiring significant redevelopment. Chard Community Hospital infrastructure was assessed as not fit for purpose by a 2015 Care Quality Commission inspection. As he pointed out, Somerset CCG is developing a clinical services review that will take into consideration the views of patients before developing a series of service proposals, which will ensure that family doctors, community hospital and district hospital services are joined up with social care services and provide financially sustainable and high quality care. It expects to engage with the public on those proposals in the new year. I know he will engage in that process.

The decision to temporarily close wards at the hospital is an important issue and the decision was not taken lightly. However, the decisions made by the trust have not been made because of financial concerns, but because of nurse recruitment issues. I know that the decision will cause concern to the residents of Chard and Shepton Mallet and the surrounding villages, but I urge my hon. Friend to encourage his constituents to attend the trust’s local public meetings and listen to what is said about addressing the issues that have caused the temporary ward closures, as well as making sure their voice is heard. We will all understand each other better with that dialogue. The people affected by the changes need to be involved in expressing their views and making key decisions.

Our starting point for discussing service change is that no permanent changes to the services that people currently receive will be made without formal public consultation. I reiterate that strongly to my hon. Friend. I conclude by encouraging him to continue to engage with Somerset Partnership Trust, Somerset CCG and me in the new year as the proposals are brought forward.

Question put and agreed to.

Oral Answers to Questions

Jackie Doyle-Price Excerpts

Tuesday 14th November 2017 Commons Chamber

[Colin Clark (Gordon) (Con)]

9. What plans the Government have to improve the availability of access to innovative treatments and technologies in the NHS.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

On 3 November, we published our response to the accelerated access review. We set out plans to give patients quicker access to life-changing treatments and to make the UK the best place in the world for industry to invest and innovate. We are delighted that Sir Andrew Witty will chair the group overseeing the accelerated access pathway, which will fast-track around five breakthrough products each year and support adoption and uptake of innovation across the NHS.

[Colin Clark]

The technologies used at the neonatal unit at Aberdeen Royal Infirmary are now considered essential by my constituents in Gordon. The unit serves 500,000 people who live within 90 minutes of Aberdeen. What assessment has the Minister made of the importance of proximity of medical innovations to regional communities?

[Jackie Doyle-Price]

I am pleased to hear that from my hon. Friend. It is good to know that we are on track to achieve our ambition to reduce the rates of stillbirth, neonatal and maternal deaths and perinatal brain injuries by 20% by 2020. Innovations such as those in Aberdeen have contributed to that work. It is important that our regional communities have access to specialist care of the kind my hon. Friend describes, and we hope to deliver more through the accelerated access pathway.

[Lucy Powell (Manchester Central) (Lab/Co-op)]

Is the Minister aware that more than 60% of health innovation research funding goes to the “golden triangle” and less than 13% goes to the north? Given that Manchester and the north-west have a life-sciences hub and that the devolution of health provides great opportunities, is it not about time we got our fair share to ensure that we can close the gap in some health outcomes?

[Jackie Doyle-Price]

I cannot disagree with the hon. Lady’s point. One reason why we set up the accelerated access review and pathway was to make sure that we invest where innovation is taking place. There is no reason why Manchester cannot be a part of that.

[Mr Speaker]

I call David “Top Cat” Davies.

[David T. C. Davies (Monmouth) (Con)]

22. Thank you, Mr Speaker. [Laughter.] It goes back a long way, and one day it will be no more.One of the innovative treatments that is being offered in my constituency that concerns me is the use of puberty blockers and hormone replacement therapy for children who identify as transgender. Does the Minister agree that an improvement would actually mean the restriction of such treatments for under-18s?

[Jackie Doyle-Price]

My hon. Friend makes a serious point. Health is a devolved matter in Wales. The NHS in England has strict guidelines on the prescription of puberty-blocking and cross-sex hormones for youngsters. Such treatments may be prescribed only with the agreement of a specialist multidisciplinary team and after a very careful assessment of the individual. We keep a watching eye on these matters.

[Several hon. Members rose—]

--- Later in debate ---

[Jackie Doyle-Price]

I can confirm to the hon. Lady that we have offered mutual recognition. She is right to raise this important subject because it is obviously vital that we maintain safety throughout the NHS, and access to pharmaceuticals is part of that.

[Clive Efford (Eltham) (Lab)]

10. What discussions he has had with local commissioners on changes to the cost of the contract for musculoskeletal services in Greenwich; and if he will make a statement.

--- Later in debate ---

[Mike Amesbury (Weaver Vale) (Lab)]

11. What progress he has made on the contaminated blood inquiry and on providing people affected with financial support.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

After the Prime Minister announced an independent inquiry into infected blood, the Department of Health consulted on the form of that inquiry. The Cabinet Office updated the House on 3 November, stating that it would be a statutory inquiry under the Inquiries Act 2005, and that the Cabinet Office would be the sponsoring Department. The NHS Business Services Authority started administering the new English infected blood payments support scheme on 1 November.

[Mike Amesbury]

From April next year, those affected by contaminated blood, including Michael in my constituency of Weaver Vale, could face considerable cuts in their discretionary support as the whole matter is currently under review by the Business Services Authority. Will the Minister give a clear-cut guarantee that absolutely nobody will be left worse off as part of that review?

[Jackie Doyle-Price]

I can absolutely give the hon. Gentleman that assurance, and that will form part of my statement on the response to the consultation, which we announced earlier. Those discretionary payments will be maintained.

[Sir Vince Cable (Twickenham) (LD)]

The Minister will be aware that the integrity of blood products is underpinned by a common European agreement on standards. Can she reassure the House that she has spoken to other Ministers across Europe to ensure that, whether or not there is a deal, those standards will be fully maintained subsequent to Brexit?

[Jackie Doyle-Price]

I can confirm that that is very much part of our current discussions. In truth, those common standards are shared across Europe in any case, and we will continue to abide by them.

[Hannah Bardell (Livingston) (SNP)]

12. What the timetable is for the publication of the report of the expert working group on Primodos.

--- Later in debate ---

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

T5. Could I raise the issue of mesh implants, which has been raised with me by constituents? A report in the United States indicates the associated pain—the headaches and the aches and pains in joints. Are Her Majesty’s Government looking at this issue? Rather than Ministers saying that this is merely a matter for the devolved Administrations, it would be instructive if they could give me an answer, because that would help inform the Scottish Government.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

The hon. Gentleman raises an issue that is of concern to many women up and down the country, and no one can fail to be moved by some of the horrendous injuries they experience. We now have 18 centres of specialist care that can treat those women. However, the advice we still receive is that, in some very narrow cases of stress incontinence, mesh remains the best possible treatment. The issue will be kept under review, and my noble Friend Lord O'Shaughnessy is due to meet the all-party group on surgical mesh implants to consider it in greater detail.

[Peter Aldous (Waveney) (Con)]

T4. The James Paget Hospital at Gorleston, which is doing great work under great pressure, has highlighted the fact that it and the clinical commissioning group have two different regulators. Does my right hon. Friend agree that it would be sensible for one body to oversee both organisations, so as to avoid duplication and redirect funds to the front line?

--- Later in debate ---

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

The Health Committee heard that to obtain a diagnosis of autistic spectrum disorder, many struggling children and families face a postcode lottery. Will the Department seek to publish baseline data so that we know where trained clinicians are positioned across NHS England, to ensure that workforce planning is undertaken appropriately?

[Jackie Doyle-Price]

I give the hon. Lady an assurance that we will be publishing those data in the new year. It is important that we work hard to make sure that people with autism get a timely diagnosis. That means that we are working to get referrals seen more promptly, while recognising that to give a full diagnosis will take some time.

[Matt Warman (Boston and Skegness) (Con)]

Recruitment and retention is just one reason why United Lincolnshire Hospitals Trust is currently going through the special measures process. Will the Secretary of State join me in paying tribute to the staff in Lincolnshire, and does he agree that part of the challenge that the trust faces on recruitment and retention will be solved by the establishment of a medical school in Lincolnshire?

Diffuse Intrinsic Pontine Glioma

Jackie Doyle-Price Excerpts

Tuesday 14th November 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I pay tribute to the speeches of the hon. Members for Edinburgh South (Ian Murray) and for East Lothian (Martin Whitfield). The House needed to hear about the bravery of Luke and Alex, and no one could fail to be moved by their courage and the courage of their families or by the commitment of the community in raising the much needed funding for their treatment. I thank both hon. Gentlemen for bringing those stories to life, and my thoughts go out to the brave boys and their families and friends. I agree with everyone who has spoken that research is crucial in the fight against cancer, and childhood cancers in particular. Nobody wants to hear the news that those families heard about their children, but the fact that they are approaching things with so much hope is quite inspirational, and I have the utmost respect for them.

To bring the House up to date with what the Department of Health is doing, research is absolutely critical, which is why the Department invests a billion pounds a year in health research through the National Institute for Health Research. The Department also works closely with a wide range of partners for research funding. Spending on cancer research specifically has risen to £137 million in this financial year, which is the largest NIHR spend in any disease area. However, the challenges of increasing research into brain tumours persist, and I wholeheartedly agree that that research is essential in order to improve treatment for sufferers and their families. The hon. Member for Edinburgh South referred to the Westminster Hall debate on brain tumours in 2016, and the Department has established a task and finish group on brain tumour research to investigate what more can be done. I am pleased that that report will be published before the end of the year. It has been slightly delayed—not because we are obfuscating, but because its impact can be increased by taking a little more time. I hope that that will reassure hon. Members.

The hon. Member for Edinburgh South and the hon. Member for Ilford North (Wes Streeting) both referred to the treatment in Mexico experienced by their constituents, and I acknowledge that that has come at great expense to the families and could not have happened without the generosity of the many people who have been inspired by the stories. I can tell the House that leading experts from Great Ormond Street and Alder Hey Children’s Hospital, as well as their colleagues from Europe and the USA, have reached out to the team in Mexico to better understand the treatment that is being given to patients. Without further data and discussion, it is not possible to say whether the exact treatment being offered in Mexico could be considered in the UK as part of a clinical trial, but I can assure the House that there is certainly an openness among UK experts to understand more about the treatment, which I hope will be welcomed.

[Wes Streeting]

I am grateful to the Minister for giving way on that point. One of the important functions that Great Ormond Street provided for Kaleigh Lau’s family was support when she was back in the UK. Immense pressures on Great Ormond Street at one point meant that a lack of access to beds and support led to a delay in her being admitted to the hospital. Will the Minister ask her officials to look at that particular issue? The nature of the condition and the time pressures—there is often a lack of time—make some of those delays even more stressful to the family. The Minister ought to probe and examine that issue.

[Jackie Doyle-Price]

I acknowledge the hon. Gentleman’s point, but the stress would be removed if we could actually investigate whether the treatment could be offered here, rather than have people travelling to Mexico. My priority will be to encourage discussions to enable that to happen.

Turning to some of the research that is happening at Great Ormond Street, which is the centre of excellence where we want childhood cancers to be tackled, research is being undertaken to develop T-cell immunotherapy delivery to tumours and selective therapies based on the molecular profiles of tumours. The research centre at University College London is also researching tumour markers and drug uptake. I am pleased to say that the NIHR clinical research network is supporting the NHS to deliver three clinical trials of new treatments for children with diffuse intrinsic pontine glioma. In the summer, Cancer Research UK announced its intention to fund up to two brain tumour centres of excellence to support multidisciplinary research, and the NIHR stands ready to provide full support to those new centres, together with other centres already funded by other charities, in delivering their research in the NHS. The working group is chaired by Professor Chris Whitty, the Department’s chief scientific adviser. The report is being finalised, and it should be ready before Christmas.

We know that early diagnosis is essential for all cancers if we are to provide the best treatment and support from the very start. I therefore welcome initiatives such as HeadSmart, which is working to increase awareness of the common signs and symptoms of brain tumours in babies, children and teenagers. The Department encourages the use of that initiative by professionals to signpost specialist advice, if needed, and the Department has promoted the awareness campaign with colleagues in NHS England, health visitors and school nurses.

The Government are also funding a radical upgrade of equipment to treat cancer, including £130 million to modernise radiotherapy across England. In April 2012 the Government announced a £250 million investment to build proton beam therapy facilities at the Christie Hospital in Manchester and at University College London Hospitals. The more precise targeting of radiotherapy afforded by this treatment means that higher doses can be delivered with fewer side effects and fewer long-term consequences, which is particularly important for paediatric patients.

We support the Less Survivable Cancers Taskforce, which also launched earlier this year. The taskforce aims to raise awareness of five cancers, including brain cancer, where survival rates have remained stubbornly poor for decades. The taskforce is also working to increase the number of clinical trials and treatments approved for those cancers as well as the level of research invested in them.

Despite the difficulties involved in researching new treatments for diffuse intrinsic pontine glioma, important studies are under way.

[Ian Murray]

I am grateful to the Minister for giving us a fairly comprehensive answer, and indeed some hope that progress is being made on this issue. Will she pick up on the issue raised by Luke’s parents? They would like to meet her to discuss not just their experience but how Luke could perhaps help with some of that research. It would be great for her to hear directly from the parents so that she can get a full picture. It is not just about research and development; it is about their whole experience of being parents of a child with the disease.

[Jackie Doyle-Price]

I would be more than happy to meet Luke and his parents. As well as researching the symptoms and the possible treatments for this disease, we need to understand the experience that families go through, because support for families has to be part and parcel of the treatment. I would be delighted to hear from Luke’s parents to learn from their experiences.

We often look at these things in a very clinical way—it is clinical practice—but we are talking about human beings and we are talking about lives. There is no substitute for bringing home exactly what we are talking about when young children are suffering with such a pernicious disease.

We will build on the studies I have outlined, and we will ensure that the funding provided for research results in better outcomes for those who are suffering, particularly where they are children, but we should remember there is hope. We heard Luke’s story, and we heard that he is at school. He has lived longer than his initial prognosis, so we wish him well. We have much hope.

Here on the Front Bench next to the Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Hexham (Guy Opperman), and looking at the hon. Member for Sheffield Central (Paul Blomfield), I am struck by the fact that both have lived through brain tumours and come out the other side. They are an inspiration, and they show that, with the right treatment, people can live despite having a potentially killer disease.

It is my job as a Minister, and it is the job of the Department of Health, to ensure that we leave no stone unturned in making sure that we get the best possible treatment for anyone who suffers from these conditions.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Here’s to Luke.

Question put and agreed to.

Abortion Act 1967: 50th Anniversary

Jackie Doyle-Price Excerpts

Monday 6th November 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I congratulate the hon. Member for Kingston upon Hull North (Diana Johnson) on securing this debate to mark an historic occasion: the fiftieth anniversary of the passing of the Abortion Act 1967. As the hon. Lady explained, the Act was introduced as a private Member’s Bill by the then hon. Member for Roxburgh, Selkirk and Peebles—now the right hon. the Lord Steel of Aikwood—and clearly defines the grounds under which an abortion may be carried out in England.

With the exception of emergencies, when it is necessary to perform an abortion to save the life of the woman, two doctors must certify that, in their opinion, which must be formed in good faith, a request for an abortion meets at least one ground set out in the Act, and they should be in agreement as to which ground this is. The hon. Lady asked whether it should remain the case that the opinions of two doctors are required. Well, as long as that remains the law—clearly it is—my emphasis, from a Minister’s perspective, is on delivering the safest possible treatment for women in accordance with that law. The hon. Lady also raised some important issues regarding waiting times, which I would like to go away and reflect on. I am sure that everyone in this House agrees that no woman undertakes a termination lightly. For many, it is extremely traumatic, so it is incumbent on all of us to make that experience the least painful and least traumatic it can be, and as safe as possible. Central to being as safe as possible is that it takes place as early as possible.

[Fiona Bruce]

The Minister is talking about the requirement for two medical practitioners to give their agreement. A ComRes poll of 2,000 adults last week showed that 72% of the public think that abortions should continue to be subject to that legal requirement, because it ensures protection for women, particularly for those in an abusive relationship. It might be the opportunity they have to talk to someone in a safe environment about the pressure that they might be being put under to have an abortion.

--- Later in debate ---

[Jackie Doyle-Price]

Central to this is that Parliament needs to be satisfied that the regime is safe for women. The law has been on the statute book for 50 years, and until Parliament decides to change that, that is the law that I will implement as safely as possible. I hear many polls quoted but, frankly, when it comes to this issue, on which people have very strong views, we need to ensure that we maintain the law with integrity.

Thanks to the dedication, hard work and expertise of the doctors and nurses working in abortion clinics, termination of pregnancy is now an extremely safe procedure. In marked contrast to some of the statistics before the Act, which the hon. Member for Kingston upon Hull North outlined, data for 2016 show a complication rate of just one in every 630 abortions, which is substantially lower than just 10 years ago, when the rate was one in 500. The choice of early medical abortion, which is less invasive than a surgical procedure and does not involve use of anaesthetics, has helped to increase the overall percentage of abortions performed at under ten weeks gestation from 68% in 2006 to 81% in 2016. Clearly, the more we can encourage that, the better it will be for the welfare of women undertaking terminations.

[Mary Glindon (North Tyneside) (Lab)]

I congratulate my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) on securing the debate. The Minister is talking about what happens to women during the procedure and about how much care should be taken. However, does she share my concern that, as the report “Abortion and Women’s Health” from the Society for the Protection of Unborn Children highlighted last week, counselling and support for women who suffer mental distress after they have had an abortion is seriously lacking in this country?

[Jackie Doyle-Price]

At the risk of being really controversial, I think there are lots of elements of counselling for women that are seriously lacking. That possibly reflects the fact that decisions about the welfare of women have generally been taken by men. It is great that there are now lots more women in this House able to influence exactly that.

[Paula Sherriff]

Does the Minister agree that it is imperative that we offer women choice in the decisions they take about their body? Will she give an undertaking this evening to investigate why the Government thought it was appropriate to award the largest sum from the tampon tax fund to an anti-choice organisation?

[Jackie Doyle-Price]

I understand that the hon. Lady feels strongly about this issue, and nobody can doubt her passion and commitment to women’s welfare. My understanding of the grant she referred to is that it went strictly towards the support of women who chose to go through with the birth. I am happy to look at that further. I am not entirely sure it was the largest donation, but I am happy to look into that. However, the hon. Lady is right when she says there should be genuine choice. We do not want anyone to feel that they cannot have an abortion, any more than we want them to feel that they have to have one. We really want women to be able to make informed choices and to feel empowered to have the child, if that is what they would like to do. The important thing is that we empower women. That is the whole purpose of what we are trying to do here—to empower women and allow them to make choices that are safe for them.

Since the Act was passed, there have been regular calls from all sides of the debate for changes to the legislation, and the hon. Member for Kingston upon Hull North has outlined her views clearly today. As she said, this Government and previous ones have always viewed legislative change as a matter for the House to take a view on, and there are no plans to change that.

The Act was last amended in 1991 by the Human Fertilisation and Embryology Act 1990. This reduced the time limit for most abortions from 28 weeks to 24 weeks. No time limit applies where there is a substantial risk that the child will suffer from a serious handicap or that the pregnancy would cause grave permanent injury to the physical or mental health of the mother or put her life at risk. So amendments are possible, and it is ultimately Parliament that decides the circumstances under which abortion can be legally undertaken. The Government will always ensure that regulation works to make that as safe as possible.

The hon. Lady outlined clearly her belief that abortion should be decriminalised, and the Government will no doubt take a view as and when she brings forward her Bill, as indeed will the rest of the House. It is true that any abortions conducted outside the grounds in the 1967 Act currently remain a criminal offence, and there is no intention for that issue to be dealt with by anything other than a free vote.

Turning to the impact of the Act in practice, it is important that we remember that, in the years before the Act, abortion was, indeed, the leading cause of maternal mortality in England and Wales. For example, the first confidential inquiry into maternal deaths in 1952, reported 153 deaths from abortion alone. The most recent confidential inquiry report found there were 81 reported deaths in 2012-14 for all direct causes of maternal mortality, such as obstetric complications, interventions and omissions. So since the Act came into force, women in Great Britain have had access to legal and safe abortion services.

[Jim Shannon]

Does that figure include those who committed suicide as a result of having an abortion and the effect it had on them?

[Jackie Doyle-Price]

The figures include those who have died as a result of maternal complications. I am not aware of any figures that detail suicide. However, we need to look at the whole issue of counselling for women who are facing any kind of unwanted pregnancy.

In 2016, 98% of abortions were funded by the NHS, whereas in 2006 just 87% were NHS-funded. That shows that the NHS is providing more and more of this service. Ninety-two per cent. of abortions were carried out at under 13 weeks’ gestation, and 81% were carried out at under 10 weeks, illustrating the fact that the procedure is becoming safer. Sixty-two per cent. were medical abortions, more than double the proportion in 2006—again, a good sign of progress. This data clearly shows that improving access and choice within the existing framework can be achieved. I am sure that all hon. Members will welcome the fact that the vast majority of abortions are taking place at earlier gestation times, which is safer for women and offers increased choice of medical abortion.

On home use, abortions in England can be performed only in an NHS facility or in a place approved by the Secretary of State for Health. At present, a patient’s home is not an approved place for abortion. I am aware that the Scottish Government have recently granted approval for the second stage of early medical abortion treatment to be undertaken in a patient’s home in certain circumstances. As I have said repeatedly, our overriding principle is that all women who require abortion services in England should have access to high-quality and safe care. We will continue to engage with women and with stakeholders on ways to make our safe and regulated services even more effective.

A key part of an abortion service is providing information and services to enable women to make informed decisions and to support good sexual health. This includes information about, and provision of, contraception and testing for sexually transmitted infections. Abortion providers should be able to supply all reversible methods of contraception—including long-acting reversible methods, which are the most effective—and offer testing for sexually transmitted infections as appropriate. Before the woman is discharged, future contraception should have been discussed and, as far as possible, the chosen method should be initiated immediately. All women should be offered testing for chlamydia and offered a risk assessment for other sexually transmitted infections such as HIV and syphilis. Provision of effective contraception is essential if we are to make progress towards our ambition to reduce unintended pregnancies in women of all ages. For women aged 24 and under, we have seen significant reductions in the abortion rate, most notably in under-18s, where the rate has reduced from 18.2 per 1,000 in 2006 to just 8.9 per 1,000 in 2016. Rates in women aged over 24 have remained stable or increased slightly. We know that we have more work to do to ensure that we see improvements across all age groups.

Over the past 50 years, there have been significant improvements in women’s health, in the regulation of abortion, and in the safety of abortion. It is appropriate that we look back, take stock, and congratulate ourselves on that, and that we continue to ensure that the way in which we allow for legal abortion makes it, at all times, safe and well regulated.

Question put and agreed to.

Mental Health Units (Use of Force) Bill

Jackie Doyle-Price Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I join Members across the House in congratulating the hon. Member for Croydon North (Mr Reed) on bringing the Bill before us today. I thank him for the constructive way in which he has engaged with me and my officials. I look forward to taking this Bill further—hopefully completing its journey—so that we can bring Seni’s law to the statute book.

The death of the hon. Gentleman’s constituent, Seni Lewis, was a tragedy. I know that the hon. Gentleman has been deeply touched by the incident—so touched that he has brought forward this Bill, with an impressive coalition of interests behind it. May I send my very best wishes, through the hon. Gentleman, to Seni’s family? It must be an incredibly difficult time for them and I extend my deepest sympathies to them.

As we have heard, the Bill seeks to reduce the inappropriate use of force or restraint against people with mental ill health, to allow greater scrutiny of the use of force in mental health units, and to ensure that police officers use body-worn video cameras in the course of their duties in relation to people in mental health units. It also seeks to guarantee that the mental health system learns from and applies appropriate lessons in relation to the use of force. For too long, restrictive interventions have been accepted as the norm in health and mental health care settings, and we want to change that culture. That is why the Government support the principles set out in the Bill.

[Eddie Hughes]

It is important to note that there were 67,864 incidents against NHS staff in 2015, 67% of which took place in a mental health setting. We need to appreciate that there is a need for force, because staff working in these situations sometimes need to be protected.

[Jackie Doyle-Price]

My hon. Friend makes a valid point but I think that we are all agreed in this House—certainly in this debate—that we need to balance rights and liberties with the need to achieve safety. I can say, quite categorically, that this Bill goes a long way towards achieving that.

The Government support the principles set out in the Bill, but we accept—as I think the hon. Member for Croydon North would—that there is still some work to do on the detail regarding the right mechanisms and processes. We can explore those matters in Committee and we are fully behind the Bill’s Second Reading.

[Tom Pursglove (Corby) (Con)]

Does the Minister agree that the thrust of the Bill is about accountability, and that the measures provide protection for the individual patient and for the professionals working around them?

[Jackie Doyle-Price]

I agree with that point very ably made by my hon. Friend. The Bill brings real accountability and transparency, which will protect everyone in the system.

I welcome the opportunity to debate the Bill, and to highlight some of the progress we have already made on some of the provisions that the Bill seeks to introduce and strengthen. First, we should examine the issue of restrictive restraint. It is not a great picture, to be frank. Information from NHS Digital shows that more than 6,000 people who spent time in hospital in 2013-14 were subject to at least one incident of restraint. Collectively, these people experienced more than 23,000 incidents of restraint, with 960 people having been restrained five or more times in a year. As colleagues across the House have said, that can cause real trauma and should be avoided at all costs. The group who experienced the highest proportion of restraint per 1,000 inpatients was the category labelled “mixed ethnic group”, with 101 incidents of restraint per 1,000 in-patients. We need to get to the bottom of why that is the case. There is a link between the use of restraint and particular points in the patient pathway. For example, in 2015, the survey of restraint commissioned by the Government found that 23.6% of restraint incidents occurred in the first week of admission. We have discussed gender, and I can confirm that 54.7% of people who were restrained were men, compared with 42.5% being women. That clearly does not reflect the gender balance of people in detention.

Members have referred to the fact that on Monday the House welcomed the publication of Dame Elish Angiolini’s independent review of deaths and serious incidents in police custody, and the Government response. The report is thorough and identifies room for improvement at every stage in procedures and processes surrounding deaths in police custody. It makes 110 recommendations on the use of restraint, on training for officers and on making it easier for families facing an inquest into a death in police custody to access legal aid. The hon. Member for Croydon North is concerned about that issue.

The extent to which restraint techniques contribute to a death in custody and whether current training is fit for purpose is a crucial aspect of Dame Elish’s report. Police training and practice emphasise that under certain circumstances any form of restraint can potentially lead to death, so the National Police Chiefs Council and the College of Policing continue to ensure that legal, medical and tactical advice are embedded in the national personal safety manual, especially in relation to the challenges of prone restraint and mental health issues.

Members have expressed views on the use of restraint, particularly prone restraint, with some of them suggesting that that type of restraint should be banned altogether. I was at Broadmoor yesterday, and I was told about a man who had experienced a head injury and needed stitches. Because of the challenges of his behaviour and mental health condition, prone restraint was used. I am not condoning the use of prone restraint in that situation or in any other, but I will say some words of caution. We need to understand restraint and define it clearly before introducing an outright ban. The guidance says that prone restraint should be used only as a last resort, and we must be careful not to put staff at risk by introducing a blanket ban without understanding more about the circumstances in which that type of restraint might be necessary.

In August this year, the CQC published its report, “The state of care in mental health services 2014-2017”, which identified variations in the frequency with which staff used restrictive practices to manage people with challenging behaviour. It is looking at the issue more closely, and it has committed to reviewing how it assesses the use of restrictive interventions, including developing and regularly updating tools for inspection teams to ensure consistency of assessment and reporting. We believe that the variations are as much due to the principles behind the making of reports as differences in behaviour.

As part of its annual report, “Monitoring the Mental Health Act”, the CQC is developing a publication to highlight areas of good practice in reducing the need for restrictive interventions. Colleagues at the CQC have indicated that they support the principles of better reporting, improved training and accountability, and greater transparency under the Bill, and it is vital that we engage with that as we take this forward.

Turning to the measures in the Bill, there is provision for front-line staff to receive training in equality and non-discrimination, as well as awareness of conduct prohibited under the Equality Act 2010; a trauma-informed approach to care; and, critically, techniques to avoid and reduce the use of force. Individual providers are expected to ensure that all their staff are appropriately trained in the use of force, and there are many training programmes available to health service providers The Bill will help us to address the variation across the system in the training received by staff. Healthcare providers are encouraged to focus training on de-escalation and on understanding the causes of challenging behaviour, and to reflect on incidents of restraint to see how they can be reduced or avoided for both the individual concerned and for all service users.

Treating and caring for people in a safe, compassionate environment both for patients and staff is a priority for this Government. We know that restrictive physical interventions are risky for all individuals involved and that they have a negative impact on patients’ dignity and their trust in services. We have made progress since the publication of “Positive and proactive care: reducing the need for restrictive interventions” in April 2014. This guidance focuses on the use of preventive approaches and de-escalation for managing behaviour that services may find challenging. It also recommends that all restrictive interventions should be for the shortest time possible and use the least restrictive means to meet the immediate need. The guidance introduced an expectation that services develop restrictive intervention reduction plans. These plans, along with organisations’ relative use of restraint in comparison with other organisations, form a key focus of the CQC inspections. We expect the CQC to use its regulatory powers to ensure that services minimise the use of force and other restrictive interventions, including face-down restraint.

Our colleagues in the police are training officers on how to respond to calls that relate to those with mental health conditions and people with learning difficulties. The revised national police guidance on authorised professional practice on mental health was published by the College of Policing in October last year. It aims to give officers the knowledge they need to resolve situations and ensure that the public get the most appropriate service. While the police are not, and are not expected to be, mental health professionals, they are often first on the scene at incidents involving those experiencing a mental health crisis. The aim is therefore to ensure that officers can respond appropriately.

On data collection, the Bill seeks to gain more detailed information in relation to incidents of force used in mental health settings. From January 2016, NHS Digital has collected information about the use of face-down restraint as part of the mental health services dataset. There is still a lot of work to be done on the quality of the data, as the hon. Member for Croydon North said, as they do not currently go into the amount of detail that the Bill would require. However, we are confident that we can make changes to improve the transparency of the information that we collect.

[Mr Alan Campbell (Tynemouth) (Lab)]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Question put accordingly, That the Bill be now read a Second time.

Question agreed to.

Bill read a Second time; to stand committed to a Public Bill Committee (Standing Order No. 63).

Medical Technologies and Treatment: Accelerated Access Review

Jackie Doyle-Price Excerpts

Friday 3rd November 2017 Written Statements

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

Today, the Government and its partners (NHS England, National Institute for Health and Care Excellence, National Institute for Health Research, Medicines and Healthcare Products Regulatory Agency, NHS Improvement, Academic Health Science Networks) are publishing a joint commitment to deliver the vision of the independently chaired accelerated access review (AAR). We thank Sir Hugh Taylor and his team for their excellent work to develop the compelling arguments and recommendations in the AAR.

The Government’s ambition is that NHS patients should be among the first in the world to get life-changing treatments. Achieving this goal is only possible by working in close partnership with our world-leading life sciences sector. Our response to the accelerated access review (AAR) sets out how we will work with industry and the health system to create a streamlined and sophisticated approvals system so that cost-effective breakthrough products—be they drugs, devices, digital or diagnostics—can get to NHS patients as fast as possible.

There are already many excellent examples of innovation taking place across the NHS, including world-leading advances in genetic technology, new treatments for conditions such as hepatitis C and ground-breaking methods to diagnose conditions. We are committed to building on this excellent work to ensure that the NHS is one of the most pro-innovation healthcare systems in the world, and that it is recognised as such by patients and industry.

It is essential that we balance our commitment to accelerating patient access to life-changing treatments with the financial sustainability of the NHS. To achieve this, it will be vital that our policies are affordable for the NHS and deliver value for money to the taxpayer. We shall leverage our world-leading research base and the NHS’s status as the biggest single-payer healthcare system to make the UK even more competitive and attractive to industry as a place to design, develop and deploy innovative products.

Key elements of our response include:

A new accelerated access collaborative (AAC) chaired by Sir Andrew Witty, that will develop an accelerated access pathway (AAP) to bring breakthrough products to market and then to patients as quickly as possible—streamlining regulatory and market access decisions.

£86m Government funding to support innovators and the NHS in overcoming barriers to getting new, innovative technologies to patients quickly.

Improved NHS England commercial capacity and capability to deliver deals that achieve better value for the NHS and innovators.

The AAR response (17-11-03 AAR Response FINAL.pdf) can be viewed online at:

http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-11-03/HCWS223/.

[HCWS223]

Health

Jackie Doyle-Price Excerpts

Friday 3rd November 2017 Ministerial Corrections

[Jackie Doyle-Price]

My right hon. Friend is indeed correct.

[Official Report, 25 October 2017, Vol. 630, c. 321.]

Letter of correction from Jackie Doyle-Price:

An error has been identified in the response I gave to my right hon. Friend the Member for New Forest West (Sir Desmond Swayne).

The correct response should have been:

[Jackie Doyle-Price]

My right hon. Friend is incorrect.