Psychological Therapies

Andrew Selous Excerpts

Wednesday 16th October 2013 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

Like my colleagues, I congratulate my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) on bringing this important debate before the House. We know from this morning’s radio bulletins that the discussion is topical and timely, and I am pleased to have the opportunity to contribute to it.

My focus will be on the need to broaden the scope of what is offered under IAPT, particularly in relation to couple relationships. I strongly believe that it is hugely in the interests of the NHS and the Department of Health to realise the significance of strong couple relationships to good health, which is essential to protecting the NHS budget. That point is really important—[Interruption].

[Sir Edward Leigh (in the Chair)]

Order. Officials should not talk to a Member of Parliament while the debate is continuing.

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[Andrew Selous]

As colleagues have already stated, data on the type of therapies available under IAPT show that couple therapy is available in less than a quarter of cases. The data came from the “National Audit of Psychological Therapies for Anxiety and Depression, National Report 2011”, so they are official. The figure for couple therapy is only 24.6%, while interpersonal therapy is available in under half, or 48.3%, of the settings in which provision is made. For psychodynamic and psychoanalytic therapy, the figure is under 40%, at 39.8%, whereas cognitive behavioural therapy is available in 94.9%—just under 95%—of cases.

Those figures demonstrate the significance of CBT, which for some people with mental health issues is absolutely the right treatment, but it is important to realise that CBT is clearly not the appropriate treatment for all those with mental health conditions. We should also remember that all those therapies are approved and recommended by NICE, and the evidence shows that all such treatments are effective for the right patients.

I am particularly concerned that the benefits of a relational approach to the treatment of depression are not being realised and that, in many cases, individual CBT counselling is given where it is not appropriate. I want to tell a true story of one young couple’s experience of interacting with the IAPT programme. Figures and sums of money give the broad picture—they are our stock in trade as Members of Parliament—but they are a bit high-level and do not capture the essence of mental health provision on the front line.

Let me tell the story of Polly and Mark—to protect their anonymity, those are not their real names—who experienced considerable challenges in having two children, with several miscarriages and a stillbirth. Polly became very low and left her successful career. The hon. Member for Feltham and Heston (Seema Malhotra) has already pointed out the cost to the economy when people have mental health issues. Polly’s husband, Mark, had a very difficult childhood, and he was badly affected by his parents’ violent and stormy relationship.

When Polly and Mark’s youngest child was two, Polly confessed that she had had an affair seven years earlier, which left her feeling guilt and shame long after it ended. On learning that, Mark was utterly devastated by the revelation and fell into a deep depression, with unmanageable rages during which he threatened to kill the other man. Polly developed severe headaches, so she went to her GP and was sent for tests. On finding nothing wrong, the GP recommended that Polly have individual counselling focusing on the stillbirth four years previously. After being unable to work and having three weeks of sleepless nights, Mark also visited his GP. Mark was referred to a psychiatrist, who diagnosed him as suffering from acute depression and prescribed him antidepressants.

The couple were acutely conscious that their relationship was about to break down. Not having been offered any form of couple therapy by IAPT, they approached a voluntary sector service, and for six months, they went to weekly couple therapy. At the same time, they were offered cognitive behavioural therapy through IAPT. They believed that the problem was their relationship, but health professionals clearly thought that the depression needed treatment. In couple therapy, Polly was able to share her anxieties about her parents’ divorce and about how she did not want her children to suffer as she had. As the couple therapy progressed, Mark and Polly became more open with each other and began to understand how their relationship problems were a product of both recent and past difficulties.

An important point is that that couple therapy—it was not provided through IAPT; Mark and Polly had to go to the voluntary sector for it, because IAPT had offered them CBT that they did not need—was voluntary help that lasted for six months. My concern is that IAPT provision, whether of CBT or other measures, is often given for only a short period, which is not always appropriate or likely to be successful in such cases.

That true story illustrates powerfully why we need to look again at the IAPT programme, excellent though much of it is, and to take a relational approach to many of the issues where appropriate. I hope that it has been helpful to Members to put that real-life case study on the record.

Academic studies show why what I have said is important and matters. Evidence reveals links between relationship quality, depression and re-employability. For example, a meta-analysis conducted by McKee in 2005 concluded that lack of social support by partners in a relationship has negative impacts on the physical and psychological health of the unemployed person and is especially associated with more frequent development of psychosomatic symptoms, stress and depression.

The all-party parliamentary group on strengthening couple relationships, which I chair, and the newly formed Relationships Alliance published only last week a report that said that relationships were the missing link in public health. That report showed that relationship quality is often a key determinant of health and well-being, and that it has strong links with the ability to deal well with cardiovascular disease, obesity, alcohol misuse and mental health issues. All those issues link up, and strengthening the health of couple relationships is often right at the heart of them.

If we look at what has happened since the IAPT programme began—I understand that it receives funding of about £400 million a year—we can see that the investment has been very much towards cognitive behavioural therapy, with interpersonal psychotherapy, counselling for depression, brief dynamic therapy and couple therapy the poor relations in the area.

In a written parliamentary question, answered on 8 January 2013 and printed in volume 556, column 258, of the Official Report, we learn that of 1,225 sessions in 2012-13 only 99 were for couple therapy, whereas 459 were for CBT low-intensity therapy and 322 for CBT high-intensity therapy. If we look at the period from 2008-09 all the way through to the projections for 2013-14, we will see that of nearly 8,000 different sessions—7,958 to be precise—only 297 were for couple therapy. The story that I have just given of Polly and Mark shows that such sessions are needed up and down are country and can indeed make a significant difference.

[Seema Malhotra]

The hon. Gentleman is making a powerful speech on the importance of having a relational base to services. In my own constituency of Feltham and Heston, I visited a service that was started a year ago by the National Society for the Prevention of Cruelty to Children. It works with children who have parents with drug and alcohol problems. I am struck by what the hon. Gentleman is saying. Is he able to talk a bit more about, or perhaps give a comment on, how having such a focus in a service can help children who are the victim of the illness of their parents?

[Andrew Selous]

I am grateful to the hon. Lady for her comments. May I extend to her a very warm invitation to come to the next meeting of the all-party parliamentary group on 6 November when we will consider such issues further? She is absolutely right that these issues are intergenerational. If she was following the example of Mark and Polly, she would have learned that it was their own parents’ stormy relationships that had affected them. Of course their children were suffering deeply from the problems that they were having in their own relationship or marriage. Such issues are deeply related, and she is completely right to say that the children suffer hugely when there are relationship problems between the parents. It is vital that we get this matter right for the children, and I would welcome her support on a cross-party basis on these important issues; they are just too important to be bipartisan about. I would love to have cross-party agreement on the importance of relational issues in public health, because I feel so passionately about the matter.

Another concern is the geographic differences in the ability to get couple therapy through IAPT at the moment. Ruth Sutherland, the chief executive officer of Relate, told me only yesterday that the programme is very geographically bound. Provision is better in the north of England—I note that there are not many colleagues from the north of England in the Chamber today—than in the south, so there is an inequality of access geographically, as well as there being fewer of these sessions available across the UK as a whole.

Let me make one further point to the Minister about why one part of IAPT provision is an incredibly serious matter for the whole NHS. As a clinician, he will know about the huge importance of long-term conditions, which are faced by so many of our constituents. He will be well aware of the significant demands that they will make on the NHS in years to come. I am talking about strokes and dementia and all sorts of other long-term ailments that many of our constituents will live with for a very long time.

I heard a moving story a couple of weeks ago from a gentleman who was visiting his elderly parents in Manchester. He said that between them as a couple they could function. Between the two of them, they had one pair of eyes, ears and legs that worked. They were both sick in different ways. They could cope and look after each other, but what would have happened if they had split in younger years? They might have been like Polly and Mark and had difficulties and not been able to receive the type of help that I have outlined. Let us say that they did sadly split up, like so many couples do today. They would be in two different flats in different parts of Manchester needing far more help from their GP and far more adult care, and that would fall on the clinicians for whom the Minister is responsible and on adult social services. Yes, it would have an impact on their families, and we would all be paying more through our taxes and there would greater burdens on business as well from having to look after that couple in two different settings. The importance of strong couple relationships in older age, in later life, is critical not least to deal with the increase in long-term conditions, which are becoming more and more prevalent and which many of our constituents will be coping with for many years to come. That is my final pitch to the Minister.

We are talking specifically about mental health and IAPT. I understand that a lot of good work is being done under IAPT and that it is an excellent programme, but I ask the Minister, when he goes back to his Department and talks to his colleagues and the Secretary of State, to take back with him the absolute centrality of strong relational health up and down are country as far as public health, the burdens on the NHS and his Department are concerned.

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[Dr Poulter]

The hon. Gentleman is right. We UK Health Ministers work collaboratively on many issues. However, on veterans, we have to recognise that, although we have UK-wide armed forces, health is a devolved responsibility. We need to share different initiatives better between the devolved Administrations. Some remote areas of Wales, in particular, could learn from best practice in the NHS about how we are using, to good effect, specialist mental health teams for veterans. I should be happy to share that and meet my counterpart in Wales to talk that through in greater detail.

I will focus in particular on the important contribution of my hon. Friend the Member for Halesowen and Rowley Regis. He addressed a number of issues that are central to the provision of good mental health care, and he threw down some challenges on how we could make things better. In particular, he praised the scale of the Government’s ambition to have genuine parity between physical and mental health, which has to be right; it is at the centre of everything that we are looking towards in the good commissioning of services locally.

I reassure the hon. Member for Liverpool, Wavertree that, with the addition of IAPT, there has been a substantial increase in the NHS’s total investment in psychological therapies. As she will be aware, however, it is down to local commissioners to prioritise their resources to meet local need, based on the local population that they serve. In the past, the challenge has been that good commissioning has too often been seen purely through the framework of physical health. Through the NHS Commissioning Board’s mandate, we are now ensuring that there is parity between mental and physical health. That journey is already well under way to ensure that good commissioning is no longer just about commissioning for acute services, such as stroke and heart attack, but about looking at the whole patient and considering the importance of upstream interventions, which are central to IAPT’s role in looking after patients.

My hon. Friend the Member for Halesowen and Rowley Regis also talked about the need to consider CBT and its evidence base. As he knows, it is not the role of Ministers to question the integrity of NICE, but NICE keeps its criteria under review, and there is a very strong evidence base to support CBT. The evidence base for IAPT is continually being developed and adapted, and a number of pilots are already in place to consider the potential to extend the scope of therapies, including to older people. I hope that that is reassuring. NICE will be listening to this debate, and it continues to evaluate the evidence. With mental health, there has always been controversy on how evidence is collated, because mental health is different from physical health, and NICE will keep that under review when it adapts and introduces future guidelines.

The debate has been called because all hon. Members in the room believe that, for too long, there has been too much focus on crisis management and acute response when patients with mental health conditions become very unwell. We would all like to see much more focus on upstream intervention, which is what IAPT is all about. We need to move the focus away from SSRIs—selective serotonin reuptake inhibitors—and drug-based therapy towards upstream, proactive intervention for what is sometimes a very vulnerable patient group.

The benefits of early intervention have been outlined by many hon. Members. There are clear health benefits, but there are also economic benefits, benefits to the family and benefits from getting people back to work, education and training, and from supporting people to have more productive and happier lives. That is why we will continue to ensure parity of esteem in commissioning for physical and mental health, and it is why we will continue to support upstream interventions in the early years—I will address early-years IAPT later. We will also ensure that we continually drive good commissioning to encompass mental health as well as physical health. That holistic approach to health care, by prioritising mental health, is good for people’s health care, good for families and good for the economy. That is why we will ensure that it remains a priority.

As hon. Members will be aware, the mandate set by the Government for NHS England last year establishes a holistic approach as a priority for the whole NHS for the first time. Improving access to psychological therapies is fundamental to the success of improving mental health. The mandate makes it clear that everyone who needs them should have timely access to evidence-based services. That is particularly important for mental health. By the end of March 2015, IAPT services will be available to at least 15% of those who could benefit—an estimated 900,000 people a year. We are also increasing the availability of services to cover children and young people with long-term physical health problems and those with severe mental illness to ensure that everyone can access therapies. There is an emphasis on those who are out of work, the black and minority ethnic populations and older people and their carers.

IAPT is being made available throughout the country. The programme was started by the previous Government in 2008, and we now have an IAPT service in every clinical commissioning group. There are more than 4,000 trained practitioners, and more than 1 million people are entering and completing treatment. Recovery rates have consistently been in excess of 45%, and they are much greater in many areas. The programme already has a clear track record of evidence-based success, and it is helping to reach some of the most disadvantaged and marginalised people in our society, which we would all say is a good thing.

[Andrew Selous]

My hon. Friend is absolutely right about the evidence. Although this is a little premature, he might be aware that the Department for Education has just commissioned evidence on the efficacy and cost-benefits of couple counselling. I have sometimes heard it said that there is no evidence for anything other than CBT, so will he say a little about the range of provision available under IAPT, specifically in relation to couple counselling?

[Dr Poulter]

My hon. Friend is absolutely right. I will address children’s IAPT in a moment, because the hon. Member for Upper Bann (David Simpson) made an important point on that.

My hon. Friend is right that, through not only IAPT but other programmes that consider health care more holistically—particularly the family nurse programme, which is aimed at vulnerable teenage mums—upstream intervention supporting those vulnerable groups helps to keep couples together and helps reduce rates of domestic violence. The programmes also support a stronger bond between mum and baby, so the child does better at school and mum and dad are supported to get back into education, training and work. So it is a win-win situation for the economy, and it helps vulnerable younger parents to have a better start in their own lives and provides a better start in life for their children. That is not exclusive to family nurses; we are also considering how the approach may be developed with IAPT, so that we can have a more joined-up approach both to children’s health generally and to families.

Earlier this year, I launched a system-wide pledge across education, local authorities, the voluntary sector and the NHS to do everything we can to give each and every child the best start in life. Part of the pledge is to do exactly what my hon. Friend outlines, which is to focus on getting early and upstream interventions right to support children in having the best start in life. We are also seeing the benefits of supporting families and reducing rates of domestic violence. I hope that is reassuring, and we will continue to develop and press those policies.

Briefly, our children’s IAPT programme is no less ambitious in its aim to transform services. In 2011, we announced funding for children and young people’s IAPT of £8 million a year for four years, and in 2012, we agreed significant additional investment of up to £22 million over the next three years, which is a total of £54 million up to 2015. That additional funding will be used to extend the range of evidence-based therapies to include systematic family therapies and interpersonal psychotherapy, to extend the range, reach and number of collaborators within the project and to develop interactive e-learning programmes to extend the skills and knowledge of professionals such as teachers, social workers and counsellors. Again, there is a multi-agency approach to improving the support and care available to children, because this is not just about the NHS, but about local authorities and education working together to get it right for young people. Behind those facts and figures are the people whose lives and services have been transformed by IAPT.

To conclude, it might be worth outlining a recent conversation that I had with a GP. When talking about IAPTs in West Sussex, he said, “I hear from GP colleagues that this is the single most positive change to their medical practice in the last 20 years, and I echo this. Our local service reaches out to the community, and it is always looking at ways to improve. It is continually developing new evidence-based interventions for people with anxiety and depression, delivered one-on-one and in groups in a flexible way that means patients have real choice. They have filled a huge gap in need and are a force for good.” That is absolutely right, and it is why we will continue to develop parity between mental and physical health and continue to expand the IAPT programme.

Accident and Emergency Departments

Andrew Selous Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

I do not have the figure at my fingertips, but I will happily write to the hon. Gentleman.

[Andrew Selous (South West Bedfordshire) (Con)]

I would like to praise very highly the A and E staff at Luton and Dunstable hospital, whose work I have seen at close quarters on a number of recent occasions. If A and E staff had access to GP records, would there not be better diagnosis and would not time be saved? If some of our smaller hospitals are doing that, it raises the question why all of them are not.

[Mr Hunt]

My hon. Friend is absolutely right. The truth is that many in the NHS had their fingers burnt when the previous Government, with the best of intentions, tried to address the problem, unfortunately with abysmal results and billions of pounds wasted. I do not think that we should let that failure stop us doing what we know can transform services. When we look at the changes that have been made in the banking, airline and retail industries, we see that we need to use the benefits of modern technology in the NHS. It will save thousands of lives.

Brain Tumours in Children

Andrew Selous Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Mr Raab]

I will make a bit more progress, because otherwise the Minister will not have a chance to respond at length, which I know she will want to do.

The HeadSmart campaign has developed an online education module to help health professionals to recognise the signs and symptoms of brain tumours in children and young people. There is now a network of clinical champions in each of the neuro-oncology centres around the UK giving presentations to fellow health professionals on the subject. There is also, critically, a network of local champions. David’s mum, Sacha, who is also here for the debate, is the first of those.

HeadSmart awareness packs have been distributed to more than 1,000 doctors’ surgeries around the country, and more than 625,000 symptom cards have been distributed across the UK. Only one year after the launch of the HeadSmart campaign, the diagnosis delay has fallen from an average of 9.3 weeks in 2011 to 7.5 weeks in 2012. This year, it is down further to 6.9 weeks. That is terrific progress, and we should welcome it.

[Andrew Selous (South West Bedfordshire) (Con)]

Will my hon. Friend give way?

[Mr Raab]

I am just going to make a bit more progress, if I may, but I will come back to the hon. Gentleman. The progress has been good, but it has also highlighted how easy it is, with practical steps, to save lives and prevent the serious and permanent damage that tumours can inflict on their survivors. HeadSmart’s explicit aim is to get the average diagnosis delay down to five weeks, which represents best practice in the west. That would save countless lives and reduce the number of permanent disabilities.

There are various aspects to the ongoing campaign, and hon. Members have intervened already with particular dimensions that they want to explore. I want to focus on three basic steps, which are well within our gift as politicians, to help us reach that critical five-week target. The crux of the debate, compared with so many others that we grapple with, is that that target is reachable and these three measures are in the “eminently doable” category. We really ought to stretch our sinews as politicians to ensure that the target is reached.

First, and most importantly, the HeadSmart campaign has made it a priority to get its credit card-sized awareness cards into every school and nursery in the country, as my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) has mentioned. I have got one here. It can fit into the smallest wallet or purse; it explains the early symptoms of a brain tumour; it differentiates between symptoms depending on the age of the child; it tells you what to do if you are worried; and it gives contact details and a website to find out more information. If the cards are handed out to children at school to take home to their parents, that will go a long way towards heightening awareness and ensuring that children and parents have an easy reference tool to hand.

HeadSmart is already making progress. As we have heard, distribution has been carried out in Wiltshire, East Sussex, Sutton and Reading. Those areas are the trailblazers, and other councils are expected to follow their lead soon. I will be visiting Surrey county council with Sacha tomorrow. To date, the campaign has benefited from local co-ordinators who make contact with councils to encourage them to disseminate the cards through their internal mail system. Critically, because the Brain Tumour Charity pays for the cards and bundles them for distribution, the measure costs the councils nothing.

What we need now from Government is co-ordination and, frankly, political will, rather than pounds and pence. I have a very simple request, which is the most important purpose of the debate. Will the Minister write to every head of public health in all our councils, given their new responsibilities in the area, and urge them to back the campaign by sending out these cards for distribution via every school and nursery? That is the single measure that can contribute the most towards nailing the five-week target.

[Andrew Selous]

Brain tumours are the main cause of cancer deaths in children. Does my hon. Friend share my concern that they get only 0.8% of research funding, given that they are so significant?

[Mr Raab]

Although I am focusing on three practical aspects of the campaign, I thank my hon. Friend for that wider point about research funding. It was well made and I am sure that it has been registered.

The second key measure under the HeadSmart campaign is for the Government to encourage secondary school head teachers to invite the Teenage Cancer Trust to do a one-hour talk on the subject, because that has a proven track record of spreading awareness. Will the Minister take the lead and team up with her colleagues at the Department for Education to deliver on that important step?

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[Andrew Selous]

As my hon. Friend the Member for Esher and Walton (Mr Raab) has said, local authorities are already writing to schools and putting stuff in the post. If MPs do that too, it will cost the public purse. It strikes me that that already happens, and cheaply.

[Anna Soubry]

I do not agree. I do not know about my hon. Friend, but I write to all my schools. In truth, I do not have that many schools, so there are not that many letters. A letter from a Member of Parliament to all their schools and to their health and wellbeing board could be very powerful. I am more than happy to talk to my colleagues in the Department for Education, but I am not sure that a letter to cabinet members will have any weight.

Managing Risk in the NHS

Andrew Selous Excerpts

Wednesday 17th July 2013 Commons Chamber

[Andy Burnham]

Promises were made before the reorganisation to my hon. Friend and his colleagues in St Helens, Knowsley and Halton about the future of the hospital, because there was concern that certain commitments would not be honoured by the new organisations. And it came to pass: they were not honoured. My hon. Friend asked whether the Secretary of State had been to an A and E. We know that he did not turn up at one until April, yet he had already stood up and criticised hospitals for “coasting”. How on earth could he make such comments when he had not bothered to get his feet on the ground to see what was happening in the NHS? Unbelievable.

The Government took a huge gamble when they proceeded with the reorganisation at a time of financial stress and in the teeth of opposition from the public and the professions. If the Secretary of State truly believes, as he said yesterday, that transparency is a disinfectant—he is nodding—and if he wants to show leadership from the front from today onwards, should he not now commit to publishing the risk register that accompanied the Government’s reorganisation of the NHS? [Interruption.] He claims again that this was all about the last Government, but let me explain the difference to him. This Government withheld the risk register in defiance of the Information Rights Tribunal and the Appeal Court. Is he proud of that? What message does he think that that sends to the boards of those NHS organisations that he is now asking to act with maximum transparency? I am afraid that it sends absolutely the wrong message. He will not foster the right culture in risk management in the NHS if there is one rule for the Department and another for everybody else.

[Andrew Selous (South West Bedfordshire) (Con)]

What is the right hon. Gentleman’s view of the previous culture of secret board-to-board meetings, at which the boards of a local trust and a strategic health authority met in private to try to deal with issues? In retrospect, does he agree that that was probably not the best way to deal with serious issues, because the very people who were responsible would perhaps not get the blame?

[Andy Burnham]

Let me give the hon. Gentleman a direct answer. One of the things that shocked me most when I received the Francis report, which I commissioned under the previous Government, was the revelation that on receiving foundation trust status, the board of Mid Staffordshire NHS Foundation Trust had begun to hold its meetings in private, rather than in public. It had taken the freedoms, yet decided to become more secretive. That was fundamentally unacceptable, and I made that point loud and clear to the NHS when I received that report. I do not think that there is any difference between us on this. I believe in openness and transparency too. Ours was the Government who brought in the Freedom of Information Act and independent regulation for the NHS. On that matter, we can make common cause.

Tobacco Packaging

Andrew Selous Excerpts

Friday 12th July 2013 Commons Chamber

[Anna Soubry]

I think this is important. I also spoke with one of the leading experts who have been involved in the legislation in Australia, and I was quite surprised that even after about three or four months, they could not give me a picture of any emerging evidence. That is why we need this time. I believe all good legislation should be based on firm, good strong evidence.

[Andrew Selous (South West Bedfordshire) (Con)]

I am all for evidence-based policy making, not least from Australia—I declare an interest in being half Australian myself—but the Minister will be aware that my step-sister died of lung cancer at the age of 49, leaving four children. The Minister was kind enough to meet her late husband, whose children have set up the Deborah Hutton campaign to do work, particularly with young people, to prevent them from taking up smoking through innovative use of film and suchlike. What are the Government doing to prevent young people—particularly girls, whose lungs are more severely damaged by smoking—from taking up smoking?

[Anna Soubry]

I am grateful to my hon. Friend, and it was a great honour to meet members of his family. My own father died, after a lifetime as a heavy smoker, from lung cancer, so we are all well aware of the health risks. My hon. Friend makes the good point about what we are doing specifically to stop children from taking up the habit. I have explained about vending machines. Of course, there is also an EU directive; although it may not find a great deal of favour with some Members on my side of the House, it is a very good directive. Work began on it only a few weeks ago, which will mean, for example, that we will not—[Interruption.] The hon. Member for Streatham (Mr Umunna) is chuntering, Mr Speaker, and it is not always very helpful, as I know.

Accident and Emergency Waiting Times

Andrew Selous Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham]

My hon. Friend is absolutely right. Two-thirds of NHS finance directors have identified social care and its collapse as the single biggest driver of the pressure on A and E. The Government do not like to talk about that because of the record my hon. Friend just outlined, and I will come to that later in my remarks.

The Secretary of State visited his first A and E in April, and NHS England requested action plans only on 9 May, when hospitals had already been battling with the problem for months. It is simply not good enough. The NHS needs leadership and he has not provided it; instead, he has stuck to the spin. He continued to blame the GP contract, even when experts queued up to tell him it was not the cause of the problem. The NHS Confederation, the Royal College of General Practitioners, the King’s Fund and the Foundation Trust Network all told him that the causes lay elsewhere, but he was not listening because it did not suit his argument. When the NHS needed a Secretary of State, it was left with a spin doctor-in-chief.

That brings us to the crux of this debate and the charge that I lay directly at the Secretary of State’s door. By persisting with spin and by diverting attention elsewhere, the real causes of this crisis have been left neglected.

[Andrew Selous (South West Bedfordshire) (Con)]

If the right hon. Gentleman looks at the graph of A and E attendances, he will see that the figure was pretty constant at 14 million until 2003-04, when it rose steadily to 21 million. Why does he think that there was that big rise in A and E attendances at the time of the change to the GP contract?

Immigrants (NHS Treatment)

Andrew Selous Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

My hon. Friend might be right—we need to look at that—but as I have told my hon. Friend the Member for Dover (Charlie Elphicke), one factor is that a number of our pensioners retire to sunnier climates, which leads to that imbalance.

[Andrew Selous (South West Bedfordshire) (Con)]

Is the Health Secretary aware that general practitioners have been calling for the measures to be taken for some time? The Bedfordshire and Hertfordshire local medical committee wrote to me some time ago expressing its concerns that overseas nationals were coming here for expensive operations. It will be very pleased at what he has done today.

[Mr Hunt]

My hon. Friend speaks wisely. NHS professionals on the front line have been conscious of the problem for a long time, but have been frustrated that nothing has been done. I therefore hope that they very much welcome today’s announcement.

Accountability and Transparency in the NHS

Andrew Selous Excerpts

Thursday 14th March 2013 Commons Chamber

[Andrew Selous (South West Bedfordshire) (Con)]

The NHS saved my life when I was 24 with an emergency operation in the middle of the night. It was there for me when I needed it, which is why I care so deeply for it.

We have heard some bad examples of what goes on in the NHS, but there are also many examples of excellent care in the NHS every day. NHS staff, especially nurses on busy wards, work extremely hard. They often rush around, have to miss their breaks and get home exhausted. We must all acknowledge that.

Today, we are debating what happened in Mid Staffordshire, but, as others have said, it was, sadly, not an isolated case. We know that 6,000 deaths in 14 other hospitals are being looked at. One area that no other Member has mentioned so far today is the training of our nurses and our doctors. Of course we want our nurses and doctors to be professionally well trained, but it is important that they do not just have academic skills. However good their biology, chemistry or maths, if they are not kind, if they are not compassionate and if they are not caring individuals, perhaps the people responsible for their training need to say to them that a career in the NHS might not be the right career for them and that research or something else might be more appropriate.

The most worrying thing that I have heard in the debate today is the comment that was allegedly made by a nurse to a patient and that was quoted by the right hon. Member for Cynon Valley (Ann Clwyd): “I am a graduate, I don’t do sick.” That is not acceptable. Other Members may also have read the article by Charles Moore in The Daily Telegraph a number of weeks ago, in which he looked in detail at whose job it is to make sure that patients are cleaned up if they need to go to the lavatory and do not get there in time. The faculty of health sciences at Southampton university made the point that ward sisters always have this responsibility, but went on to say that it is everyone’s job.

When I go round a school, I find that if a head teacher picks up the litter on the ground, surprise, surprise, there is not a lot of litter. When a doctor, however senior, sees a patient to give a diagnosis or a prescription, if that patient needs basic nursing care, no level of seniority in the NHS should be above that. That would send a powerful message that that was everyone’s job, as the faculty of health sciences at the university of Southampton said.

I am pleased that in Bedfordshire clinical commissioning group, the excellent Dr Paul Hassan has told me that there will be unannounced GP visits to the wards of the Luton and Dunstable hospital and other hospitals to which Bedfordshire sends its patients. There will be private TripAdvisor-style patient reports coming back—not report forms handed by a sister to a patient and filled in while the sister is leaning over them, but done genuinely in privacy so that GPs can get a proper report of what is happening. There will be real-time alert buttons on the keyboards of GPs and clinicians so that they can flag it up immediately if things are going wrong. That is excellent. That is the way to get an early indication of what is going wrong.

In addition to outstanding nursing care by caring, compassionate nurses, we need clinical leadership. We need the medical directors and the chief nurses of hospitals to step up to the plate. We need medical directors who are front-line clinicians—that is really important—and we need hospital boards to make sure that they have the proper data. Data on bedsores, for example, should be available at every trust board meeting. If the incidence of bedsores is increasing, that may be an indication that things are going wrong in the hospital. That information should be seized on and acted on urgently.

Above all, we need the medical director and the boards of hospitals to foster an esprit de corps and to create an understanding among all the staff that “we don’t do average” and that excellence is what they should aim for. We need a culture where peer review and challenge are normal, natural, accepted and of benefit to everyone. In that vein I commend the “Getting it Right First Time” report by Professor Tim Briggs, which is looking at a clinically-led hub and spoke peer review model in orthopaedics. That could usefully be extended across the whole of the NHS.

NHS Funding

Andrew Selous Excerpts

Wednesday 12th December 2012 Commons Chamber

[Andy Burnham]

This is the reality on the ground, as my hon. Friend says. There is also the mental health budget cut. There has been a mismatch; people see all those things, yet they hear the statements from the Government, and it does not make any sense, but now the truth and the facts about our NHS are being told, and things will begin to make sense to people.

What I find most troubling about all this, and most revealing about the Government’s style and the way that they work, is that even when they are warned by an official watchdog, they just carry on—as they are doing today—as if nothing had happened. When they admitted cutting the NHS in 2011-12 by amending their website, what was the excuse that they offered to Sir Andrew? Labour left plans for a cut; that is what the Prime Minister said at the Dispatch Box last week. It is what the Secretary of State said in a letter replying to Mr Dilnot. Again, that is simply untrue.

According to Treasury statistics, Labour left plans for a 0.7% real-terms increase in the NHS in 2011-12. From then on, we had a spending settlement giving real-terms protection to the NHS budget. It was this Government who slowed spending in 2010-11, who allowed the resulting £1.9 billion underspend to be swiped back by the Treasury, contrary to the Secretary of State’s promise that all savings would be reinvested, and who still have published plans, issued by Her Majesty’s Treasury, for a further 0.3% cut to the NHS in 2013-14 and 2014-15, contrary to the new statement that the Conservatives have just put on their website. The Secretary of State has a lot of explaining to do.

[Andrew Selous (South West Bedfordshire) (Con)]

I should be interested in the right hon. Gentleman’s comments on the statement by John Appleby, the chief economist of the King’s Fund, who said that before the general election, the former Chancellor left plans for 2011-12 and 2012-13 that would see a cut in real terms. What does the right hon. Gentleman say to that?

[Andy Burnham]

I have not seen the quote, but I did the deal with the former Chancellor of the Exchequer just months before the general election, protecting the NHS in real terms. A deal was done for schools and for the Home Office too. Those were the plans. At the election I was arguing for real-terms protection. The Secretary of State was on the hustings calling for real-terms increases. I said it would be irresponsible, yes, to give real-terms increases over and above real-terms protection because the only way he could pay for that would be taking it off councils, hollowing out the social care budget. That is what I said at the election, but the right hon. Gentleman has not even given real-terms protection. He has cut the NHS in real terms, so it beggars belief that he has the nerve to heckle and shout out from the Front Bench, when he has cut the NHS lower than the plans that I had left in place.

Winterbourne View

Andrew Selous Excerpts

Monday 10th December 2012 Commons Chamber

[Norman Lamb]

I thank the right hon. Gentleman for his important questions. First, we want to ensure that advocacy is available to help those families and individuals, ensuring that they are placed in appropriate settings and away from these long-stay institutions that we all find completely unacceptable. I very much agree with him on that, and I find myself in agreement with him again on prisons. We shall come forward next year with some clearer proposals on approaches to diversion—assessing someone’s needs before they end up in prison, diverting them, if at all possible, to much more appropriate settings.

[Andrew Selous (South West Bedfordshire) (Con)]

I was not sure I heard the Minister correctly when he said that the average fee was £3,500 a week, which is £182,000 a year. Is it not possible to pay some of the caring staff slightly more and demand not only the highest level of skills, but the highest level of compassion for that level of fee from the state?

[Norman Lamb]

I thank my hon. Friend for that question. He is absolutely right that an extraordinarily high sum was being paid to put people at risk of abuse —and to be abused, as it turned out in Winterbourne View. Pay rates are not ultimately the responsibility of Government, but one would hope that responsible organisations look to train their staff to a high standard—that is absolutely a prerequisite and they will be held to account by the Care Quality Commission for proper training—and, wherever possible, to provide better pay rates so as to ensure that people are rewarded for the incredibly important work in our care sector.