Health and Social Care Bill

Baroness Morgan of Cotes Excerpts

Monday 31st January 2011 Commons Chamber

[Nicky Morgan (Loughborough) (Con)]

Thank you, Madam Deputy Speaker, for allowing me to contribute to the debate on a Bill that is essential to implementing the coalition Government’s policies. I had intended to say what an excellent debate we have had so far, with some thoughtful contributions from all parts of the House. The hon. Member for Wolverhampton North East (Emma Reynolds) made a thoughtful contribution, but I am afraid the hon. Member for Eltham (Clive Efford) let his side down completely with his offensive remarks about how Government Members view the national health services.

Although she is not in her seat, I congratulate the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) on her contribution to the debate. I did not agree with it, but she gave her speech extremely well.

I welcome the Bill. It is essential that more power is given to front-line doctors, who are best placed to understand patient needs. It is a tragedy that Opposition Members seem to think that GPs are not capable of stepping up to the mark and taking on those responsibilities. From the conversations that I have had with my GPs, I do not understand why the Opposition believe that; they will be proved wrong.

I support the focus on clinical outcomes. I think that GPs are interested in taking on commissioning and the proposed changes. Three consortia in Leicestershire and Rutland have stepped forward so far. My primary care trust is working extremely closely with them, particularly on transferring community services, and I welcome their close working relationships.

The GPs commissioning arrangements will mean that GPs listen to what patients want. GPs will be responsible for community services in Leicestershire and Rutland, including the walk-in centre in the middle of Loughborough and out-of-hours services, which have not been mentioned in the debate. One of the things that patients feel most passionately about is the fact that some GPs, particularly in the part of the country I represent—I cannot speak for everywhere—are not responsible for delivering out-of-hours services. What patients say to me more than anything else is that when they call someone in the middle of the night, they want their GP or someone who has access to their records to answer the telephone, not a call centre.

[Anne Marie Morris]

I absolutely support what my hon. Friend says. I have the very good example in my constituency of Devon Doctors, which is effectively a not-for-profit organisation that provides all the out-of-hours service and gives the people of Devon exactly what she has suggested.

[Nicky Morgan]

I entirely agree with my hon. Friend. It just shows that GPs, if they are given the responsibility, will step up to the plate and deliver what their patients need.

In the limited time available, I wish to focus on what the proposed changes will mean for mental health services. I speak as a member of the all-party group on mental health, and as someone with a family interest in mental health issues. The NHS in England spends more on mental health services than on any other disease category, including cancer and heart disease, and one in four people will experience mental ill health at some point in their lives. The public health strategy has so far not been mentioned in the debate. I entirely welcome the Government’s emphasis on public health and the emphasis on good mental health as well as good physical health. I recently spoke with Charnwood mental health forum, which is based in my constituency, whose members told me that prevention of mental health problems and supporting people who are perhaps heading down the road to depression and more serious conditions is incredibly important.

There are four keys areas that I want to mention in the time available. My first point, which has already been mentioned by the Opposition, is that we must ensure that GPs get proper support to commission effective mental health services and other specialised services. That support can come from the national commissioning board, third sector organisations and patients. That is why I think GPs will step up to the plate, because they will ask their patients and listen to them when designing and commissioning services.

A recent Rethink survey of GPs found that 31% of GPs did not feel equipped to commission mental health services, compared with 75% who felt that they could commission diabetes and asthma services. It also revealed that 42% of the GPs said that they had a lack of knowledge about specialist services for people with mental illness, and 23% said that they had a lack of knowledge about mental illness in the first place. I will cite a recent case study from my Loughborough constituency, in which I was told that one of my constituents was suffering from complex mental health conditions, but his GP appeared to have no knowledge of personality disorders and saw the problem as largely behavioural. The relationship between the constituent and the GP deteriorated and therefore the local Rethink carers group stepped in to help find another GP. With consortia, a GP in a different practice could have that specialisation, and the first GP, realising their limitations, could speak with that other practice and engage with carers groups, such as Charnwood mental health forum or Rethink to ensure that there are special services available for patients.

[Emma Reynolds]

Is the hon. Lady as concerned as I am that a recent survey by Rethink showed that 95% of GPs did not feel that they had sufficient expertise to commission mental health services?

[Nicky Morgan]

I was just talking about that, but the point that has been made is that GPs do not feel that they necessarily have the specialist skills to commission mental health services. That says not that the underlying plan set out in the Bill is wrong, but that GPs recognise their limitations. From the conversations that I have had with GPs, I think that they will know where to go to commission those services and they will get the support from the national commissioning board.

[Hugh Bayley]

Will the hon. Lady give way?

[Nicky Morgan]

I am afraid that I must make some progress.

My second point relates to joined-up care, which carried on from my previous point. People with mental health problems have complex needs and need a clear pathway of care, which might involve the GP, psychiatric care at secondary care level, a social worker and community support services, such as drop-in services. That is essential, and that is what we want to see happen in the NHS.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

I applaud the hon. Lady for making such an excellent case for mental health services, but I would like to pick up on a point about expertise. Under the new arrangements for consortia and the massive expansion in programmes, who will provide the funding? Will it be via town halls or local authorities for care at community centre level?

[Nicky Morgan]

There is already some excellent provision in Leicestershire. I hear the hon. Gentleman’s point, as, I am sure, does the Minister. I am sure that she and her colleagues will look at that in the debate and in future.

I support the “any willing provider” model, which was first introduced by the previous Government. It is often patients with mental health issues who benefit from care at different levels and with different therapies, but it does not all have to be at primary or secondary care level. As I have mentioned, there are organisations, such as Charnwood mental health forum and other drop-in centres, that offer excellent services, and they must be part of GP commissioning and the services that will be provided under the new arrangements set out in the Bill.

Finally, I wish to look at public health involvement through HealthWatch and the local health and wellbeing boards, which is critical. We must ensure that there is broad representation in those organisations. Research from Rethink has shown that stigma and discrimination affect nine out of every 10 people with mental health problems. The boards and those organisations must ensure that the most vulnerable patients are listened to. At a recent meeting of the all-party group, one of the contributors said:

“We all have mental health—it just depends how good ours is.”

Mental health has for too long been a Cinderella service. I am confident that that will not be the case under the new structure because GPs will do their best to understand it or, if they do not, will get in appropriate services. I support the Bill and look forward to hearing how the points I have mentioned will be addressed. I also look forward to the unveiling of the national mental health strategy, which I understand will happen later this week.