NHS Mental Health Care

Mark Pritchard Excerpts

Wednesday 11th February 2015 Westminster Hall

[Mr Hancock]

Absolutely. I agree with that entirely and I will come to it when I talk about my own personal experiences of spending a long time in a mental hospital trying to recover from a mental breakdown. I know only too well the issues that the hon. Gentleman has raised.

The urgent action plan that is needed cannot be put off for another five years. It needs to be put in place and direct action needs to be taken. There must be a sustainable and long-term work force planning strategy that acknowledges the current challenges facing the mental health world at the present time. We cannot leave it. You yourself, Minister, stated that only 25% of young people with mental health problems have access to mental health services, which you described as “dysfunctional and fragmented”—

[Mark Pritchard (in the Chair)]

Order. May I encourage the hon. Gentleman to address the Chair, rather than the Minister directly?

[Mr Hancock]

I am sorry. I was quoting the Minister, Mr Chairman. He stated that 25% of young people with mental health problems had access to mental health services, which he described as both “dysfunctional and fragmented”. That cannot persist. That cannot be right in a society that claims to care and aims to try to deliver services that are perfect for it. There are serious problems with mental health services and the way in which young people are treated. So many of them have ended up in prison, because there are simply no beds available.

If I may, I will talk about my own experiences. I was very fortunate. I will praise my own GP, Dr Chhabda, who was excellent and got me help. I have praise for Talking Change, where I had several sessions, and for Dr Barker and his intermediate crisis team at St James’s hospital. They were of enormous benefit to me. Subsequently, I was under the care of Simon Kelly, the psychiatrist who looked after me when I was in hospital for a long time.

What did I learn during that long period of mental illness? I learned about the stigma. When I was in hospital for several weeks with major heart surgery, the problem was obvious to people—I did not worry about telling them that I had had major heart surgery—but for the last two months of my being in hospital getting over a mental breakdown, I was worried about how I would explain to people where I had been. I was making myself ill with the worry of how I would explain to people that I, this strong person who could fight off most things, was suddenly unable to do so and had to seek help.

But I was not alone. The other people, who have become close friends of mine, were going through the same thing: the GP who did not know how he was going to go back to face his patients, and the dentist who did not know how he was going to work things out. Many other people, from different professions and none, were struggling with the reality of going home to face their immediate families with what had gone wrong with them, and there was little or no help coming from outside the hospital to give them the support that they needed.

In the rest of the time that I have in politics, and in the rest of the time that I am alive, I want to fight to lift once and for all the stigma attached to mental health issues and be proud to say that I was broken but I got fixed, because of the love and skill of the people who were there to help me.

Some of the people whom I met in hospital had travelled long distances. One was from the Minister’s own constituency in Norfolk. There was not a single bed available, from the coast of the North sea, where this person lived, to the waters of Southampton, where a place was available. That was the nearest place. They were transported down there and eventually transported back.

Other people I met in the hospital came from Truro. They had been brought from the furthest edge of our country to the edge of Southampton, because no bed was available. Ironically, when they arrived at the hospital, they came in an ambulance with a driver plus two nurses, and they stayed for four days. Then they were transported all the way back to Exeter, because a bed became available nearer there.

What sort of society are we living in? Somebody at the lowest ebb of their life is transported across the country, away from their family and support networks, because there are no beds available. The way in which people are treated is a national disgrace. We could see in the faces of the people that they knew it would not be possible for their families to come and visit them, because of the enormous distances involved. We have got to do something about that. We cannot allow that situation to persist.

There is the situation of somebody whom the NHS sends into a hospital for a detox programme. They are given a six-day detox programme, probably costing several thousand pounds, and then, on a Friday night, they are told that they have to go 50 miles up the road to spend two nights in a Premier Inn, with no support available over the weekend to help them. For anybody going on a full-time detox programme, the minimum time is 28 days. The NHS will spend a lot of money several times, but limit it to six days and then give the person little or no support when they are out. That cannot be right. No Government should be proud of the record that we have on mental health issues.

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[Norman Lamb]

It does, absolutely. The next challenge is to bring the improving access to psychological therapies programme into line with Jobcentre Plus. We are working on that, with pilots around the country. It is ridiculous that there are so many people out of work, languishing on benefits through no fault of their own because of their mental ill health and not getting access to the therapies that could help them recover. That has to change. We must link mental health services much more closely with employment services, schools and the criminal justice programme.

There are significant areas where mental health services fall short and, as my hon. Friend rightly said, they have always done so. However, as the Minister responsible, I am on a mission—[Interruption.]

[Mark Pritchard (in the Chair)]

Order. We have a Division, so will the Minister bring his remarks to a conclusion, please?

[Norman Lamb]

I congratulate my hon. Friend and I think that we are on the way to achieving genuine equality for mental health.

Child and Adolescent Mental Health Services

Mark Pritchard Excerpts

Monday 2nd February 2015 Commons Chamber

[Norman Lamb]

I am happy to look into that for the hon. Gentleman. Indeed, he can come along to one of my Monday evening advice sessions and we can discuss it further. It is clearly important that the right provision is available in his area.

[Mark Pritchard (The Wrekin) (Con)]

I welcome the new funding announced by the Minister. Surely one way of reducing pressure on in-patient beds is to expand mental health assessments within youth custody facilities and expand treatment within those facilities. What co-ordination is there between his Department and the Ministry of Justice on that issue?

Oral Answers to Questions

Mark Pritchard Excerpts

Tuesday 25th November 2014 Commons Chamber

[Mark Pritchard (The Wrekin) (Con)]

Cannabis no doubt has some limited medicinal benefits for some illnesses, but will the Minister put it on record that it is not the Government’s intention further to liberalise any licensing of cannabis, especially in the light of the Institute of Psychiatry’s empirical evidence that abuse of the substance can lead to severe mental illness?

[George Freeman]

My hon. Friend makes an important point, and I am happy to give him that undertaking. We have to be careful to maintain a distinction between recognising the damaging effects of the recreational use of cannabis and the specific medicinal benefits of some of its derivatives, when tested and proven, in medicinal products. We intend to make that distinction very clear.

Mitochondrial Transfer (Three-Parent Children)

Mark Pritchard Excerpts

Wednesday 12th March 2014 Westminster Hall

[Jacob Rees-Mogg]

I agree with the hon. Gentleman. I also think that mankind is of a different order of magnitude from other animals. I do not view myself merely as a senior ape—nor indeed do I view Opposition Members as merely being senior apes or monkeys. I think much more highly of them than that. [Interruption.] I will gloss over that point. In their article in Nature, Mitalipov et al showed that they had discovered that 52% of human embryos created through MST had chromosomal abnormalities. If there is a high failure rate early on, how can we be certain that there will not be a similar failure rate later, potentially when people are in their 30s or 40s? It is a life-long, generational experiment.

There are also difficulties with the experiments on fruit flies.

An article in Science on 20 September 2013 states:

“MR in fruit flies had little effect on nuclear gene expression in females but changed the expression of roughly 10% of genes in adult males. The mitochondrial haplotypes responsible for these male-specific effects were naturally occurring, putatively healthy variants. Hundreds of mitochondrial-sensitive nuclear genes identified in that study had a core role in male fertility. For example, one of the five combinations in which mitochondrial-nucleus interactions were disrupted by mismatching was completely male-sterile but female-fertile. In other fly studies MR resulted in male-biased modifications to components of ageing”—

that is very important because we do not know what the effects will be as people get older—

“and affected the outcomes of in vivo male fertility. Together, these results suggest that core components of male health depend on fine-tuned coordination between mitochondrial and nuclear gene complexes and thus the HFEA conclusion that ‘there is no evidence for any mismatch between the nucleus and any mtDNA haplogroup at least within a species’ is incomplete and unsubstantiated.”

It has also been discovered from research in mice and invertebrates that deleterious effects on mitochondrial replacement would not be discovered until adulthood, which goes back to the point that we would have to wait decades.

The second category of risk is moral and ethical. I make no bones about the fact that my thinking on this matter is strongly influenced by the Catholic Church concerning the dignity of the human person. Equally, the Minister and the Government should respond to non-theological, non-religious concerns. I will set out briefly the religious concerns.

Thomas Aquinas wrote in his “Summa Theologica” that

“the soul is in the embryo”.

I certainly believe that to be the case. It means that tampering with embryos is tampering with human souls—tampering with what sets us apart from animals. As Benedict XVI in the Instruction “Dignitas Personae” said,

“the body of a human being, from the very first stages of its existence, can never be reduced merely to a group of cells. The embryonic human body develops progressively according to a well defined programme with its proper finality, as is apparent in the birth of every baby.”

That, too, is absolutely correct. No human, whatever their stage of development, is merely a group of cells.

We must be concerned about the unknown consequences of tampering with the genes of an embryo, and for the unreligious there will be mental issues to be faced by those who find out later life that they have three or even four parents. The gravity of the change is such that it should not be made without the most careful thought and properly tested research. [Interruption.]

[Mark Pritchard (in the Chair)]

Order. I am sorry to interrupt the hon. Gentleman. Will whoever has their phone on please turn it off, or put it on silent or vibrate? This is an important debate and it needs to be heard with respect.

[Jacob Rees-Mogg]

Thank you, Mr Prichard. Silence is golden.

The third risk is legal, and I am slightly reluctant to raise it because it concerns the European Union charter of fundamental rights. It is not a document I often quote in support of an argument, but there is a question about its applicability in the United Kingdom. It is not directly applicable in UK law except when it coincides with EU law. There is considerable debate about how far the overlap between UK and EU law goes. Article 3(2) refers to the

“prohibition of eugenic practices, in particular those aiming at the selection of persons”.

I have established that this is eugenics, so it would be in contravention of the Charter of Fundamental Rights. I do not believe that the Government would want to contravene that accidentally.

Essentially, the Government have started too early and are putting the cart before the horse, which makes travel difficult, by consulting on regulatory approval before sufficient research has been done into the safety of the therapy.

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[Jane Ellison]

If my hon. Friend will forgive me, I will not. I have been left with very little time to respond. I doubt that I will even get through the remarks that I have prepared. However, I would be very happy to talk to him after the debate, and of course we will have much lengthier opportunities to debate the issue, so I do not think that I am cutting off debate.

Allowing the new treatments would give women who carry mitochondrial DNA mutations the choice to have genetically related children without the risk of serious disease. Recent estimates from the scientists leading the UK research in this area are that about 10 to 20 families a year could be helped initially. The scientists and clinicians at Newcastle university believe that allowing these techniques will also advance their understanding of mitochondrial function and mitochondrial diseases. It will enable them to gain a greater understanding of the way in which mitochondrial DNA mutations are passed from mother to child. It could also provide them with a better understanding of how mutations vary in different cells, which may lead to the development of new treatments for those currently suffering from mitochondrial conditions.

The use of the techniques would also keep the UK at the forefront of scientific development in this area and demonstrate that the UK remains a world leader in facilitating cutting-edge scientific breakthroughs. I know that that might be an uncomfortable point for some hon. Members, but other hon. Members have expressed great support for that. There are different sides to the argument. I completely accept that.

I understand that some hon. Members—this has been touched on today—are concerned about a slippery slope. Let me be very clear. Parliament has only provided a power to allow

“a prescribed process designed to prevent the transmission of serious mitochondrial disease”.

That is all that is prescribed in relation to the regulation-making power. We are proposing only to allow the donation of mitochondrial DNA, not nuclear DNA, so that is a further strengthening in terms of the regulation-making power. There is no intention or legal mechanism to go any further.

The draft regulations that are now out for consultation set out how the techniques would be allowed in treatment, the regulatory tests that the Human Fertilisation and Embryology Authority would have to use to give approval to a clinic on a case-by-case basis and how the mitochondrial donor would be treated in terms of information available to any children conceived through the new techniques.

In 2010, the Newcastle researchers approached the Department and requested that, in the light of their progress, we give consideration to the introduction of regulations. Recognising the complexity and sensitivity of this subject, we asked the HFEA to arrange public consultations and oversee a number of independent scientific reviews. An expert advisory group was established and a report passed to the Department in spring 2011. It found that the techniques were not unsafe, but recommended that some further research be undertaken.

After careful consideration of the report, the Department of Health and the Department for Business, Innovation and Skills commissioned the HFEA in autumn 2011 to undertake a comprehensive public dialogue and set of consultations in order to understand the public’s views on and understanding of this issue. The HFEA consultation was held between July and December 2012. It looked at the social and ethical issues raised by mitochondria replacement, as well as addressing a range of practical regulatory issues. Sciencewise, which plays a key role in helping the public to understand complex scientific issues, commended that public dialogue and the HFEA as an exemplar in its approach to gathering public views on a complex issue. As I am sure colleagues can understand, it is never enough, on an issue as complicated as this, to do a press release-style consultation. A simple “for and against” does not suffice to explore the complexity of the issue and ensure that when people express an opinion, they are doing so with a slightly wider understanding of it.

The HFEA gave a full set of advice to the Government in March 2013 based on the findings of the public dialogue and including further advice from the expert panel that it had reconvened. That concluded that although there continues to be nothing to indicate that the techniques are unsafe, further research on some specific aspects should be undertaken. Overall, the advice from the HFEA, informed by the balance of views from the public and stakeholders, was that the new treatment techniques should be allowed so long as they are safe and carefully regulated.

We have also taken account of other published reviews—for example, the 2012 report by the Nuffield Council on Bioethics entitled “Novel techniques for the prevention of mitochondrial DNA disorders: an ethical review”.

Some press headlines have suggested that a child born as a result of the new techniques would have three parents. My hon. Friend the Member for North East Somerset also alluded to that. I do not have time now to go into the detail of why we do not believe that that is the right characterisation. It is important to understand that mitochondrial DNA comprises a very small proportion—0.1%—of total DNA. However, these are issues that we can explore further. I have heard the concerns that have been put on the record today. It is also the Department’s view that this process does not constitute a form of human cloning. The techniques are not equivalent to reproductive cloning, because any children resulting from the use of the techniques would have arisen from fertilisation and be genetically unique.

However, there is clearly a great deal more for us to explore. Today’s debate has been a very helpful chance to hear the concerns of hon. Members expressed on the record. It gives me time to go away, look at the issue with officials and with the experts and ensure that we put in place the right advice and the right level of consultation as we go through the parliamentary process, in terms of—

[Mark Pritchard (in the Chair)]

Order. We now come to the final debate of the day.

Hospices (Children and Young People)

Mark Pritchard Excerpts

Wednesday 18th December 2013 Westminster Hall

[Stuart Andrew]

I certainly agree. I got to know Haven House through my time working in various hospices. It and the other hospices do tremendous care—even at the most difficult and challenging times, they manage to do it with a great sense of dignity, which we should all be proud of.

Ensuring that the families are supported through the most difficult period is paramount, but also beyond that, through bereavement support. What is good about many of the hospices, Martin House included, is that the services are offered not only at the hospice, but in the family home, to ensure that as much as can be done is being done. The first head of care at Martin House was an inspirational lady called Lenore Hill. I remember that her phrase to the families was: “The answer is yes; now, what is question?” Such a philosophy is what makes the hospices so wonderful.

Time has gone on and medical advances have been achieved, so many of the children are now living longer. For example, when I joined Hope House children’s hospice in Oswestry, boys suffering from Duchenne muscular dystrophy would invariably live to about 18. By the time I left Martin House, however, some 14 years later, some sufferers were living into their mid- and late 20s. Naturally, that is good and wonderful news, but it presents new problems.

[Mark Pritchard (The Wrekin) (Con)]

I pay tribute to my hon. Friend’s dedication and loyalty to the hospice movement over 16 years and for representing the movement today in Parliament. He mentioned Hope House. Will he join me in paying tribute to all the volunteers and staff at Hope House in Shropshire and at the Severn hospice, which my hon. Friend also knows? They do such a great job week in, week out.

[Stuart Andrew]

During the course of the debate, all the hospices are going to be mentioned, which is wonderful and exactly what I want from the debate. My hon. Friend is absolutely right.

Care Quality Commission (Morecambe Bay Hospitals)

Mark Pritchard Excerpts

Wednesday 19th June 2013 Commons Chamber

[Mark Pritchard (The Wrekin) (Con)]

The Secretary of State rightly said that individuals must be held accountable for their actions. To what extent does he think some former Labour Ministers were complicit in this disgraceful cover-up?

[Mr Hunt]

They need to explain why Barbara Young made the comments that she did. I think there was a general desire to talk up the NHS and not to talk about some of the very deep-seated problems that have now come to light. It is our duty in all parts of the House to make sure that we have a more mature discussion about the NHS when problems arise, and that we do not always seek to throw party political stones but recognise when problems arise. We should talk about them, not cover them up.

Health and Social Care (Re-committed) Bill

Mark Pritchard Excerpts

Wednesday 7th September 2011 Commons Chamber

[Nadine Dorries]

I have spoken to organisations that provide counselling and have 80,000 registered counsellors throughout the UK. [Hon. Members: “Who?”] The British Association for Counselling and Psychotherapy. I asked, “If somebody required counselling, was at a GP’s practice and a telephone call was made, how long would it take to get a counsellor to a particular woman?” The answer was that counselling could be delivered in the GP’s practice, at another venue or in the woman’s home, and that it could be anything from immediate to within 48 hours.

Registered counsellors, who have e-mailed me regularly since the amendment was tabled, say that they would love to work—counselling is a growing industry—and to have the opportunity to work with women in that situation. Unfortunately, however, counselling is available on the NHS only via the abortion provider or via the hospital.

[Mark Pritchard (The Wrekin) (Con)]

I am grateful to my courageous and honourable Friend for giving way. As 147 babies were terminated after 24 weeks in the past year—a 29% increase on the previous year—does she agree that such counselling should also include the fact that many of those terminated babies, who had minor disabilities such as cleft lips, cleft palates, half an ear or having only one ear, could have been dealt with through modern cosmetic reconstructive surgery?

[Nadine Dorries]

I thank my hon. Friend for that comment. That is a different debate, but he highlights an important issue, and it is abhorrent that 147 babies were aborted for cleft palate, hare lip and minor cosmetic issues. I have a godson who had a club foot, and he was a wonderful young boy and is a wonderful young man. I find it quite amazing that anybody would choose to abort a baby because they had a club foot, but that is an issue for another day. The amendment does not cover it, but it is an important point.

--- Later in debate ---

[Nadine Dorries]

I know that others want to speak. I have been speaking for a while and I want to get to the end, so I will keep going for a bit longer. I will take interventions in a minute. [Interruption.]

[Mark Pritchard]

Soubry, zip it! [Interruption.] Sorry, Mr Speaker.

[Mr Speaker]

Order. The hon. Gentleman should withdraw that remark.

[Mark Pritchard]

I withdraw it, Mr Speaker.

[Mr Speaker]

I am grateful to the hon. Gentleman. Let us try to maintain proceedings on an even keel. The hon. Gentleman has said that he is sorry, and that is fine.

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[Ms Abbott]

I would be more willing to give way were we not so far advanced in a debate that will last for only an hour and a half. I was not aware that so many Back Benchers wanted to contribute, because they have not hitherto tried to intervene.

Some colleagues have expressed their surprise that yet again we are discussing women’s reproductive rights in this House, but they should not be surprised. Abortion has never stood on its own as a technical issue; it is part of a century-long debate about women’s sexuality, womens’s rights and women’s freedoms. Sadly, for some people that is apparently still contested ground in 2011. Some even argue that the proposals are best seen as part of a wider push on the socially conservative agenda that has been so successful for right-wing politicians in America. Thankfully, in this country, that agenda has come up against a determination to keep such issues above party politics, the absence of a Fox News pumping out socially conservative propaganda 24 hours a day and British common sense.

I could say many things on the lack of an evidence base behind the amendments, but let me say this: women—both individual women and women in general—have been called in aid in this debate, and indeed they face very real problems in this society, here in 2011. They face spiralling unemployment as a direct consequence of the coalition’s policies and the sexualisation of our culture, which affects younger and younger female children—[Interruption.] I hope that hon. Members listen to this, because it is a point that many mothers and fathers will understand. Too many young women in communities up and down the country think that the only road to fame and fortune is to pump their bottom and their breasts full of silicone and tout themselves as some sort of media celebrity. Another issue is the number of very young women who have been badly parented, who have children too young and who, with all their good intentions, parent their own children badly in turn. Even in an era of financial constraint, those are the issues that this House should be addressing.

Nobody is saying that arrangements in relation to counselling cannot be improved. I believe that the hon. Member for Cambridge (Dr Huppert) has tabled a good amendment to that effect, which some of us hope finds favour in another place. However, the Bill and the amendment are not appropriate for a full and careful debate on abortion. The amendments deal with matters that are amply covered by existing law and regulations.

[Mark Pritchard]

rose—

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

rose—

Oral Answers to Questions

Mark Pritchard Excerpts

Tuesday 26th April 2011 Commons Chamber

[Mr Lansley]

On the contrary—the hon. Lady should know, because I made it clear on 4 April, that my objective, and that of the Prime Minister, the Deputy Prime Minister and all of the Government, is further to strengthen the NHS, and we will use this opportunity to ensure that the Bill is right for that purpose. The reason Government Members supported the Bill on Second Reading, and Labour Members should have done so, is that, as the right hon. Member for Wentworth and Dearne (John Healey) said, the general aims of reform are sound.

[Mark Pritchard (The Wrekin) (Con)]

As part of the listening exercise, will the Secretary of State confirm that the public, patients and medical professionals will be listened to? Many of them want to see root-and-branch reform of the NHS in order to improve its effectiveness and efficiency and improve patient outcomes.

[Mr Lansley]

Yes, my hon. Friend is right. We have an opportunity, which we want to realise to its fullest potential, to improve many of the ways in which patients and the public are involved. For example, we want to arrive at a point where patients feel that the invariable response of the NHS to their need is that there is no decision about them without them. We are proposing in the Bill to strengthen the scrutiny powers of local authorities. We are also proposing to bring in a patient voice through HealthWatch and HealthWatch England that has not existed since the Labour Government abolished community health councils, and we are going to strengthen substantially democratic accountability through health and wellbeing boards.

NHS Reorganisation

Mark Pritchard Excerpts

Wednesday 16th March 2011 Commons Chamber

[John Healey]

I will give way in a moment.

The test for the Prime Minister is whether the Government’s proposals are always under review, as the Health Secretary said on Sunday, or whether this is not about significant changes to the policy, but about reassuring people as the Bill goes through the House, as people in the Department said on behalf of the Health Secretary on Monday.

[Mark Pritchard (The Wrekin) (Con)]

Does the right hon. Gentleman not accept that with an annual budget of £100 billion and rising, there is room for efficiency savings and reform? Why has he set his face against fundamental reform, which even the public accept needs to take place?

[John Healey]

Nobody can doubt our commitment to the NHS, and to both investment and reform, during our 13 years in office—often in the face of opposition from trade unions. Of course there is room for efficiencies, and there are ways to get much better value for money out of the NHS but, as the Select Committee on Health has said, the reforms will make it harder, not easier, to meet that challenge.

Hospital Services (Shropshire)

Mark Pritchard Excerpts

Wednesday 9th February 2011 Westminster Hall

[Daniel Kawczynski]

I will reciprocate by referring to the hon. Gentleman as my hon. Friend. We are from different parties but we are colleagues. We get on well, and across the parties we have a passion for Shropshire. I will come later to the importance of retaining services in Shropshire. However, constituents do not pay attention to services that come to their area; they are focused on those that are leaving. That is why they are pressing me to highlight these issues in Parliament.

My other concern is that there is no plan B. This is a consultation process in which the chief executive and the board come forward with proposals. However, there are no shades of grey—it is take it or leave it. I speak purely as a layman, but if there is only one option, it is difficult for a large group of people, many of whom do not have medical experience, to scrutinise that proposal. Surely, if we are to genuinely engage with local people, differences and alternative options could be put forward so that the community as a whole could come together, debate them and make recommendations.

[Mark Pritchard (The Wrekin) (Con)]

Does my hon. Friend accept that in an ideal world, both hospital sites would have all-singing, all-dancing acute and clinical services? However, we do not live in an ideal world, but in a time of constrained public finances. Does he accept that the current consultation recognises the importance of having an accident and emergency ward at both Shrewsbury and Telford? That is a breakthrough from the original consultation process and shows that the hospital trust has listened to Shrewsbury and Telford on that important point.

[Daniel Kawczynski]

I concur with my hon. Friend and with the point that he makes in his usual eloquent way. I have been told by the chief executive, and others, that if we do not go for the proposals, we will potentially put our foundation trust status at risk. If we put that at risk, there is the possibility of losing services—and the management of those services—out of the county. Again, I speak without medical experience, but I do not understand how we could enter into a consultation process but be told that if we do not go for the proposals, services will be lost from Shropshire.

I cannot envisage a time when we have no maternity or paediatric services in the whole of Shropshire. That is unthinkable to me, so I do not understand the logic of the trust. It is saying, “Take it or leave it, but if you leave it, that’s it. We won’t get our foundation trust status and you’ll lose your services.” That position needs to be clarified because many people see it as a gun being pointed at their heads and are therefore frightened to challenge the proposals.