NHS Winter Crisis

Clive Lewis Excerpts

Wednesday 10th January 2018 Commons Chamber

[Dr Whitford]

Attendances at A&E tend to be higher in the summer, when kids are on bikes and trampolines, and up trees. It is admissions that are higher in winter, when A&E is dominated by people who are sick. Of course we want primary care and the 111 system to work, so that people do not use A&E as a first port of call, but the problem comes when that all gets too complicated and patients cannot work out where they should go. That is when they go to A&E. It is important to make it really clear where they should go to address which problems.

Having seen the crisis last year, when there was no flu, snow or ice to blame, I believe that there are underlying structural problems. The target was met comfortably until 2013, when the Health and Social Care Act 2012 changes kicked in and NHS England started to become fragmented and to be based on competition instead of co-operation. I would welcome the establishment of a cross-party group here to work on this, so that we did not always have to have these debates, but it would have to look at the structure and unpick what has been done to NHS England in the past four and a half years. Carrying on breaking it apart will not provide a solution.

[Clive Lewis (Norwich South) (Lab)]

Does the hon. Lady agree that the Government’s plans to establish accountable care organisations, which will exacerbate the fragmentation in the NHS, through secondary legislation are completely wrong and will make the NHS crisis even worse?

[Dr Whitford]

I completely agree that establishing accountable care organisations only through secondary legislation is utterly wrong. We have had multiple debates about STPs, and I have said that going back to place-based planning is the right way to integrate and develop a local service, but there should not be a private company at the top making the decisions. There needs to be a publicly accountable body. There is going to be yet another big reorganisation in NHS England, and the proposed structure needs to be debated in this place, not behind closed doors. Yes, money is tight, with the NHS seeing rises of just over 1% a year in the past seven years compared with almost 4% in the past, but it is estimated that between £5 billion and £10 billion is being wasted in the healthcare market itself, through bidding, tendering and profits, and now through this habit of companies suing if they do not win a contract.

It is crucial to move back to developing services for a community. It is also crucial that health and social care should be integrated, and I welcome the combination of both titles in the Secretary of State’s role, if that means that we are going to work towards meaningful integration, but it must be done in a structured, responsible and legalistic way.

Oral Answers to Questions

Clive Lewis Excerpts

Tuesday 14th November 2017 Commons Chamber

[Steve Brine]

I thank the hon. Lady for her question. I am open to offers from any Select Committee. It would be premature to consider issues of liability before considering the strength of the evidence and seeing the report, which we will study carefully. The report will conclude whether there is a causal association between the use of HPDs such as Primodos and adverse outcomes of pregnancy. We look forward to seeing its outcomes and its recommendations.

[Clive Lewis (Norwich South) (Lab)]

13. What the timetable is for sustainability and transformation partnerships to become accountable care systems.

[The Minister of State, Department of Health (Mr Philip Dunne)]

There is no fixed timetable for sustainability and transformation partnerships to become accountable care systems. Evolution from an STP into one or more ACSs is dependent on an STP demonstrating that it is working in a locally integrated health system. Both commissioners and providers, in partnership with local authorities, will need to choose to assume collective responsibility for resource and public health, and the criteria for that were set out in NHS England’s next steps in the “Five Year Forward View”.

[Clive Lewis]

Last week, NHS doctors took out a judicial review against the Secretary of State’s plans to use secondary legislation to enable private companies to run big parts of the accountable care organisations. I think the Government understand that doctors, nurses, patients and the public want an NHS that is run for the public by the public using public funds. Ultimately, will the Minister ensure that we have time in this place for Members to discuss and scrutinise the ACOs, because they are a drastic change to our NHS?

[Mr Dunne]

I can honestly say that the best thing the hon. Gentleman can do to understand what STPs are really all about is talk to the recently appointed chair of the Norfolk and Waveney STP, which covers his local area. He will find that the former Labour Secretary of State, Patricia Hewitt, can give him very good advice.

Mental Health Units (Use of Force) Bill

Clive Lewis Excerpts

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

[Victoria Prentis]

I thank my hon. Friend for his intervention. We have begun to understand and talk about mental health only very recently. As we do so, we learn both from those patients who have suffered tragedies and those who have had better experiences with law enforcement agencies. It is important that we learn and listen as the debate progresses. Issues may well come up in Committee that nobody has given a moment’s thought to. A constituent will have a story to tell and we can learn from it as we go forward.

From my own constituency casework, I know that for those at the point of crisis the use of restraint can be both humiliating and traumatising. I discussed this issue with the Causeway Carers, a great organisation comprised largely of parents and other family members of victims with very severe mental health problems. They meet in Bicester once a month. Many have first-hand experience of sectioning and restraint, which they shared with me. That was a great privilege and I do not feel able to share any of those stories with the House today. From what we have heard about Seni, we can all imagine the sort of stories that are taking place even on the high street in Bicester from time to time, often at night. They are also taking place in all our communities. They are not isolated stories, and none of us can feel that we are untouched by them.

These families are suffering enormously because they are dealing with a very ill family member, often a child, and restraint is added to that dreadful suffering that they already have to cope with. I recognise that the use of police cells in England as places of safety under the Mental Health Act 1983 is declining, and that more cases than ever are now referred to health-based places of safety, which is real progress. We should also welcome the significant reduction in the number of deaths in, or following, police custody since 20 years ago. I imagine that this reflects improved training, guidance and practices in a number of areas, most significantly in suicide prevention. My background is as a lawyer for the Prison Service, and it strikes me that this is in sharp contrast to the dramatic and worrying rise in suicide rates recorded in the last 20 years in prisons.

[Clive Lewis (Norwich South) (Lab)]

We are being consensual across the House, and I would like to retain that spirit, but would also make the point that one of the linking factors in terms of both prisons and mental health is funding for the institutions. Staff and service users at the Norfolk and Suffolk mental health trust, which is in special measures, are concerned that a reduction in the number of staff—nurses and doctors—over the past five years means they have less ability to watch and monitor patients, so it is more likely that those patients are using medication, and that means restraint is more likely to be used, so we end up with the situation that the Lewis family were in. Will the hon. Lady comment on that?

[Victoria Prentis]

Rather than get too party political, I think it is appropriate to talk about other difficulties that have led to reductions in staffing in real terms in the Prison Service, because we on this side of the House can give lots of facts and figures about how much more is being spent. The difficulty that I know about personally now in my Banbury constituency is in recruiting and retraining staff—not with the money to pay for them, but with finding the right people. I pay tribute to all who choose to work in the very difficult mental health sphere, with patients who suffer from dreadful illnesses; the House should pay tribute to the work they do day in, day out with people who are often very difficult to deal with while they are ill.

One matter on which I am sure we can agree is the importance of reducing further the number of black, Asian and minority ethnic people detained for mental health reasons in police cells. The figures are disproportionately high. It simply cannot be right that black people are four times more likely to be detained under the 1983 Act than white people. The hon. Member for Croydon North mentioned the Angiolini review and the importance of standardised data recording. I apologise for again referring to my Prison Service experience, as the mental health system is completely different from the criminal justice system, but there are themes that run through the way BAME people are treated in both systems which we increasingly find utterly unacceptable.

--- Later in debate ---

[Oliver Dowden]

My hon. Friend is absolutely right. I do not think anyone is suggesting that police officers are actively seeking to treat mental health patients in an incorrect fashion, but there is a need for training so that they understand the correct way to behave.

[Clive Lewis]

We on the Opposition Benches do not think that this is only about the money that is going in now. If we look at the figures, we can see that there has been an increase in recent years, but the fact is that the years of cuts that went before have had an impact on staffing levels. In my trust, the Norfolk and Suffolk mental health trust, we have seen a 20% drop in the number of doctors and nurses on the payroll in the past five years. We can train up a lower number of doctors and nurses in restraint techniques, but the fewer there are, the more risk there will be of a need to restrain. We cannot get away from that fact.

[Oliver Dowden]

I am not sure that I entirely agree with the hon. Gentleman. Of course there have been historical problems with the funding of mental health. I hope that Opposition Members will recognise, as we do on the Government Benches, that over the decades there has not been enough funding going into that area. On the question of the NHS, however, despite this Government inheriting the largest budget deficit in our peacetime history and an appalling fiscal situation in which we were spending £4 for every £3 we earned, we made a decision to prioritise health. Health spending has risen every year under this Government and we are committed to implementing Simon Stevens’ recommendations. He, after all, was a Labour special adviser who advised this Government, and he recommended £8 billion of additional funding. I am very pleased that we have been able to do that.

Oral Answers to Questions

Clive Lewis Excerpts

Tuesday 10th October 2017 Commons Chamber

[Jackie Doyle-Price]

My hon. Friend is right to raise this issue. Certainly, in CQC inspections in the past, the whole issue of “do not resuscitate” orders has been an area of concern. This is something we will very much look at as part of the end of life policy, but I would like to hear more about the case my hon. Friend mentioned, if he would like to write to me.

[Clive Lewis (Norwich South) (Lab)]

T5. Accountable care systems are a systemic change to the way the NHS will be managed and a significant step towards an Americanised care system, so will the Minister explain why NHS England is having a fundamental reorganisation take place under the radar without a national consultation?

[Mr Hunt]

Accountable care systems are supported by such rabid right wingers as Polly Toynbee, writing in The Guardian, because they are about health systems coming together to co-operate to give the best care for patients. That is what is happening across the NHS, and it is already delivering great results.

Contaminated Blood

Clive Lewis Excerpts

Tuesday 12th April 2016 Commons Chamber

[Clive Lewis (Norwich South) (Lab)]

Does the hon. Lady agree with the sentiments of my constituent Steve Bertram, who I believe is here today, who came to my office last week? He has a face that many would recognise. He looks like someone who has been repeatedly kicked in the teeth. He said:

“Our government needs to act for English Haemophiliacs – generously and properly. Like me, I hope anyone who responded to the consultation told the government in no uncertain terms how paltry, mean and demeaning the offer is.”

[Chloe Smith]

I will let the words of a fellow Norwich person speak for themselves. I am glad that the hon. Gentleman has been able to vocalise them for his constituent.

It is up to us in this place to get this right and to listen to all such points carefully. Annie Walker once said to me that she did not have the strength to keep on fighting. Sadly, that has now come true. It is up to us to continue to speak out. It is up to us to right this historical wrong. It is up to us to do that with both finance and NHS treatment. I urge the Minister to listen carefully to what has been said today, but to listen even more carefully to the consultation.

NHS Bursary

Clive Lewis Excerpts

Monday 11th January 2016 Westminster Hall

[Paul Scully]

Well, I think a lot of it is down to affordability. [Interruption.] No, there is a big difference. Someone might have an amount of £50,000 or something like that, for example, but it is about the repayment. Whether someone is paying £5 or £50 a month, that is the figure that lenders will look at to work out whether they can afford to repay the loan. As I said right at the beginning, that top line figure is not the crucial one. The crucial one is actually the amount that someone will pay out of their salary each and every month.

Looking at the current case and at positions that are particular to nurses, we have talked about the fact some people going into the nursing profession may already have a degree and are doing a second one. There are mature students. The average age of those applying to study is about 28 or 29. I believe I have covered my take on people’s concerns about the diversity of the workforce changing.

Under the current rules, people cannot usually access the student loans system if they have already done a degree to the same level. The view of the Council of Deans of Health is that the Government should make those courses exempt from that rule. I will be interested to hear what the Minister says about whether that is the case. If it is, in the new system, people would be able to access student loans if they wanted to—that would be an equivalent or lower qualification exemption. As repayment amounts are based on salary and not on the total loan, the amount repaid would be the same whether someone has one or two loans. Effectively, that makes it a graduate contribution, not a traditional loan. The system is slightly different from a graduate tax, which was discussed a few years ago, because it is finite—it finishes after 30 years, and a graduate tax, as we might have had under other suggestions, would have carried on going past a graduate’s retirement. As I said to the hon. Member for Hampstead and Kilburn (Tulip Siddiq), the introduction of tuition fees and loans for other degree courses has not led to a drop in applications and has not affected the diversity of applicants.

[Clive Lewis (Norwich South) (Lab)]

One of the chief concerns that many student nurses have when listening to these proposals is that, unlike many other students who can take second jobs to help pay back their student loan, student nurses are sometimes working up to 40 hours a week for the NHS. They have no opportunity to make any other money to be able to pay off a student loan, but that is not taken into account. Student nurses are very different from any other group of students, which is not taken into account by the proposal.

[Paul Scully]

The hon. Gentleman has not listened to what I have said, because the whole point about the loan system is that the loans will not kick in until after a student has graduated, so the repayments will not start until that point. Student nurses will not be making any repayments while they are studying and doing those placements, but I absolutely take the point that nursing is a very different proposition from a normal degree in so much as placements take up 37 or 38 hours a week and beyond, which is a considerable strain on nurses.

Mental Health

Clive Lewis Excerpts

Wednesday 9th December 2015 Commons Chamber

[Clive Lewis (Norwich South) (Lab)]

The Norfolk and Suffolk NHS Foundation Trust was the first mental health trust in England to be placed in special measures, where I am afraid it still languishes. Let me praise the staff who have held that trust together, and kept it going throughout this tough time. Despite that, throughout the coalition years, we heard—and still do—much about parity of esteem between mental and physical health. Unfortunately, the reality is very different. Unison members in my constituency worked out that if my local mental health trust were funded using the same formula as my local acute trust, it would have an additional annual income of about £69 million. Instead, however, it was cut by £30 million. Ultimately, were parity of esteem a reality rather than empty rhetoric, those cuts would not have been made.

In the face of severe financial constraints, my trust has been forced to cut services such as early intervention in psychosis, assertive outreach and the specialist homeless teams that were once in place. Each and every cut was a false economy. The impact has been catastrophic. People in crisis in my constituency have been left without access to a local NHS bed. Instead, they have been sent hundreds of miles from Norwich, separated from their families and care teams, to places as far away as Harrogate, Bradford, London and Brighton.

Forgive me, therefore, if I do not sound too excited by the announcement in the Chancellor’s recent autumn statement of an additional investment of £600 million for mental health services. An investigation by the BBC and the Community Care magazine in March found that £600 million had been cut from mental health services since 2010. It is therefore an affront to call this £600 million an investment. In reality, it is barely a replacement. Unfortunately, it is too late for those in my constituency who have lost their lives or suffered life-changing injuries because help was not there when they needed it. The Government have failed patients, failed their families, failed staff and ultimately failed my community.

Junior Doctors Contract

Clive Lewis Excerpts

Friday 20th November 2015 Commons Chamber

[Clive Lewis (Norwich South) (Lab)]

When the NHS is facing a winter crisis, why have the Government decided to pick a fight with the very people who will get it through that crisis?

[Alistair Burt]

The Secretary of State has not picked a fight. Three and a half years of negotiation on a new contract, publicising the offer, and being willing for negotiations—which he did not withdraw from—to restart, is a funny definition of picking a fight.

Green Investment Bank

Clive Lewis Excerpts

Thursday 29th October 2015 Westminster Hall

[Kevin Brennan]

If it was the fault of the hon. Member for Beverley and Holderness that we descended into partisanship, credit should go to the hon. Member for Warrington South for raising the tone once again, bringing us back on topic and pointing out that it is important that the UK shows leadership in this area. Perhaps we can all agree on that, even if we do not agree on the extent to which that is currently being displayed by the Conservative Government.

As I said, this has essentially been a very successful innovation. One problem—we have had differences of opinion about this during the debate—has been the restrictions placed on the Green Investment Bank in relation to borrowing. Obviously, the Treasury does not want that to appear on the books, because of the targets that it has set in relation to deficit reduction. However, we have come to a strange pass when even something that we could all agree would be a good thing, even good borrowing, is bad if it is on the Government books, simply because it is on the Government books. Hon. Members touched on this during their contributions. Sometimes in this country we seem to be the prisoners of public accountancy convention, rather than common sense, in relation to when borrowing is a good and effective thing to do—when it is to invest to grow our economy in the future in a sustainable way.

[Clive Lewis (Norwich South) (Lab)]

I want to touch on my hon. Friend’s point about good investment. What we need to look at is this. Over the last three or four years—since 2012, I think—one third of all the growth in the UK, during very difficult years when we were sometimes in recession, came from the green economy. It accounted for about 1 million jobs in the low-carbon sector, worth £128 billion. It is now very disappointing—in fact, tragic—that the Government seek to undermine one of the key drivers of that sector, as we have heard today from so many hon. Members.

My last point is that if we were able to tap into one third of our country’s potential in respect of wind, wave and tidal power, we could create another 145,000 high-quality jobs. When we look at those figures and at how the Green Investment Bank has performed so far, we see that we have to protect it.

[Kevin Brennan]

My hon. Friend will not be surprised to learn that I agree with that point. In relation to wave power, we are all very interested to see how the Swansea lagoon project proceeds. That is a very interesting development in the sustainable generation of energy; if it is a success, it could lead to even larger projects, particularly in the part of south Wales that I represent.

--- Later in debate ---

[Kevin Brennan]

The hon. Gentleman is right: that was the ruling in relation to state aid. For what it is worth, I find it difficult to see how we could meet our obligations in coming decades without some investment in nuclear. The hon. Gentleman and I may not agree on that—[Interruption.] The expression on the face of the hon. Member for Brighton, Pavilion tells me that she does not agree with me either, and I am not surprised by that. However, that is my view, and it is shared by quite a lot of people with strong green credentials. None the less, the hon. Gentleman is right to point this issue out, because it is absolutely an implication of privatisation.

Is the Minister concerned that these things will provide further uncertainty for low-carbon investors, at a time when there is great concern about the Government’s retreat on investment in wind power, for example? Do they send the right message to our international partners, on the cusp of the Paris summit, about the importance of renewables?

[Clive Lewis]

My hon. Friend talked about sending the wrong signals. There is a growing global divestment movement, which is moving funds and investments away from high-carbon fuels and into low-carbon fuels. In my constituency, I have Aviva, one of the largest insurance companies in the world. It is very concerned about the effect of climate change on its business models, and one of its clear goals is to divest its funds from high-carbon investments. We have heard about the Green Investment Bank perhaps changing its shape and becoming, in effect, another privatised bank. The Environment Agency, which has a £2.9 billion pension fund, has recently been looking to invest £450 million in low-carbon energy, but it has now said that that will be very difficult without a Green Investment Bank. Will my hon. Friend comment on that?

[Kevin Brennan]

Again, my hon. Friend makes an important and appropriate intervention—I can see why he has taken on a shadow Front-Bench role in a similar area, given his level of knowledge. It is a shame that the fact that he is not on the Front Bench for this debate precludes him from making a speech, which would have added greatly to our proceedings. There are a great many speeches that might have been made here in the last hour or so, although we have heard snippets of them in the form of interventions. I do agree with my hon. Friend.

The hon. Member for Beverley and Holderness asked about using the European fund for strategic investments, and I just want to remind the Minister—he is getting a barrage of questions, but he has plenty of time to answer them—that that question was asked.

Are the principles being used by the ONS that are causing the Government such a problem and dilemma used in other European jurisdictions? We have had evidence in today’s debate that that is perhaps not the case. Are we, therefore, allowing an accounting convention to undermine a key green policy initiative?

Have the Government considered structures other than privatisation for the Green Investment Bank? There have been suggestions that other legal structures might get round some of the issues the Government face.

The key question is, why are the Government in such a rush, given all the problems that have been identified in the debate? We know one of the reasons: they want to get the bank off the books—that is part of their deficit-reduction strategy. They are keen to do that as quickly as possible, and we know that significant cuts are coming in the autumn statement. However, it really would be a big mistake and an act of vandalism to rush things just for that reason and to get them wrong, with the Green Investment Bank ending up just like any other bank and perhaps being gobbled up by some Chinese bank. Would it not be better to pause, step back and get this right so that that does not happen? We have learned over many years that making policy in haste is not wise. It is certainly not wise to privatise in haste, because we repent at our leisure. That is not a sustainable way to make policy.

Oral Answers to Questions

Clive Lewis Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

NHS England will be updating the House on the results of that trial. It was a very important trial because it was designed to stop the dispatch of ambulances to people who did not need one within eight minutes, in order to make sure ambulances were available for people who did need one. South Western was very helpful in taking part in that trial and we will update the House shortly on the results of it.

[Clive Lewis (Norwich South) (Lab)]

Yesterday 400 people in my region expected to begin a paramedics course put on by the East of England Ambulance Service only to discover that there is no course and they are now £4,000 out of pocket. That is because the University of East Anglia and Anglia Ruskin University could not get accreditation for the courses. Does the Secretary of State think this event is going to help the ambulance service in the east of England where staff are already overwhelmed? It is a critical service—a vital service. Does he think this will contribute to hitting those targets, which at the moment are being inadequately met?

[Mr Hunt]

I welcome the hon. Gentleman to his place. It is important that we train more paramedics. It is one of the most challenging jobs in the NHS and I will take up the issue he raises with the Secretary of State for Business, Innovation and Skills to understand precisely what the problem was and to try to resolve it as quickly as possible.