Mental Health In-patient Services: Improving Safety

Daisy Cooper Excerpts

Wednesday 28th June 2023 Commons Chamber

[Steve Barclay]

Having discussed that harrowing evidence with my right hon. Friend, I do not think any Minister could either forget it or not be moved. I found it an extremely moving experience to hear her talk about the experiences of a number of her constituents. She is right to praise those who come forward, and to recognise that it is often a difficult ask to relive the most awful circumstances, but it is important that families come forward so that we learn lessons and ensure this is not repeated.

My right hon. Friend is also right to highlight the two broad elements of learning the lessons of what happened in the past and maintaining services for the future. I am therefore happy to give her an assurance that we will work closely with her on support for Essex as lessons are learned through the statutory inquiry and as services continue to be delivered. We are working closely on that with the chief executive.

[Daisy Cooper (St Albans) (LD)]

My thoughts are, first and foremost, with the bereaved families and all those involved, because this process must be utter agony for them. It is right that the inquiry is put on a statutory footing.

In his statement, the Secretary of State quoted from a letter he received from Dr Strathdee, in which she said:

“I am very concerned that there are serious, ongoing risks to patient safety.”

The Secretary of State did not expand on that, and I do not know whether he is able to do so. If I may extrapolate, we know that, more broadly, there are risks to patient safety when there is not enough workforce and when there are not enough beds. Hertfordshire is the most under-bedded area of the country. When we see the workforce plan, potentially this week, will it include estimates of the number of qualified mental health staff we need in in-patient settings, NHS community settings and schools? Will he meet me and my local mental health trust to discuss the number of beds we have in the county and our plan to expand them?

[Steve Barclay]

Dr Strathdee did not particularly focus on staffing numbers, as far as I recall; she focused on some of the issues with care from staff. That was the nature of the concerns. On the ongoing risk, part of the reason why we commissioned the rapid review was to look, in particular, at the quality of data. There was a quantity of data that was not effective, and that often distracted staff from spending time with patients. There were also gaps in the quality of data that needed to be filled, and the document that will be placed in the Libraries of both Houses speaks to that point. That is why we are so keen to move at pace on learning lessons.

Mental Health Treatment and Support

Daisy Cooper Excerpts

Wednesday 7th June 2023 Commons Chamber

[Daisy Cooper (St Albans) (LD)]

I welcome this debate because, like every other Member, my inbox is often full of cries for help from people who are suffering mental ill health or from family and friends trying to help them. Looking through recent cases I have had in St Albans, I see a litany of problems with the system. Many constituents have told me that they have had to wait for more than a year for diagnosis. Some have needed an urgent medication review. One parent told me they feared for their and their child’s safety while the child was on a particular medication. They sought an urgent medication review, had an urgent referral from their GP, but the matter then sat with the psychiatrist for weeks and weeks. They were terrified during that time, waiting for a decision.

Other constituents have told me of their relief when they finally secured a mental health care package, only to find that it takes many weeks or months before the package can be put in place in practice. Those who have mental ill health and are also neurodiverse or have learning difficulties have told me about the hoops that they have to jump through. In some cases they have been told, “We can offer you mental health support, but it is not tailored or suitable for you because of your neurodiversity or your learning difficulties.” I have heard about the frustration that those individuals feel because those services are not tailored to them as a person.

Then we have the emergency A&E admissions. Again, just a couple of weeks ago, I had a parent email me in total desperation from a hospital corridor because one of their children had attempted suicide and had been rushed to A&E. They were not safe to be left unsupervised, but they were supervised by somebody who was inappropriate to supervise them. The family were desperate to get their child to a safe place, but that did not happen for days and days—it was only with my intervention that it happened. As I am sure many Members know, it is really pleasing to be able to make a difference in those cases, but it is worrying to think about all those families who have not got in contact—others out there who are struggling alone.

There are real problems with A&E pathways and with children’s mental health services. I hope that the Government will focus on those areas, but from speaking to my local mental health trust and hearing about the pressures that it is facing, is it really any wonder that we are having these issues? There were warnings at the start of the pandemic of an explosion of mental ill health, and I believe that the Government could have done a lot more to get ahead of that problem. For example, my local mental health trust has told me that there is not only an increased number of people looking for help but higher acuity. Therefore, instead of having a 2:1 staff-patient ratio, it often has to be 3:1. So even with the same staff headcount, there is less staff time for more people seeking help.

Those who work for the trust tell me of their frustration that the waiting lists are getting too long. They accept that medication reviews are often delayed because of staffing and resourcing issues, and there are huge pressures on the trust’s budget. Not only is there the demand; there is the cost of out-of-area placements, having to pay for private beds where none are available in the NHS, and paying for agency staff to cover vacancies that are not filled. Our mental health trust in Hertfordshire is the smallest bedded mental health trust in the country. We have huge ambition to open a new bed unit in the west part of the county, but we need the Government and the NHS to get behind that ambition.

So what do we need to see? We need to see prevention, and we need to see it early. Research from New Zealand, which is often cited here in the UK, indicates that three in four people with mental health problems show symptoms before the age of 25. That reinforces the need for prevention and the need to see it early, so I would like there to be a qualified practitioner in every single school. We need mental health community hubs in every community. We need to empower the charity sector—a sector that has barely been mentioned today. In St Albans, we have Time To Talk, Youth Talk and the OLLIE Foundation, which are all fantastic mental health charities that are working on tiny budgets. In Hertfordshire, we need support for mental health beds and, of course, we need to tackle the workforce problem. Until the Government publish their workforce plan, the lack of a workforce remains the biggest risk to service delivery in mental health in every single part of the country. I urge the Government to take action on those points.

Oral Answers to Questions

Daisy Cooper Excerpts

Tuesday 6th June 2023 Commons Chamber

[Daisy Cooper (St Albans) (LD)]

I recently learned that my local integrated care board is not allowed to spend the money it wants to spend on securing the best location for a new GP practice and health centre. The reason is that Treasury rules, which are used by the District Valuer Services, are not keeping up with market rents. Will the Secretary of State speak to his colleagues in the Treasury to fix that, before we face an epidemic of health centres and GPs leaving town and city centres, and moving to ring-road locations away from the populations they serve?

[Steve Barclay]

I am very happy to look at that specific issue and raise it with Treasury colleagues.

New Hospitals

Daisy Cooper Excerpts

Thursday 25th May 2023 Commons Chamber

[Steve Barclay]

It is not just the Eden Project North on which my hon. Friend has been a vigorous campaigner: he has raised this assiduously as well. As he knows, the trust is at a very early stage in its consideration of what public consultation will be needed around the reconfiguration of services across Lancaster. We are not letting that stop our work to open a new surgical hub at the Royal Preston Hospital, for example. As he knows, I know the geography very well in terms of the interaction with Lancaster. There are a number of options on consolidation and expanding to two sites. I look forward to discussions with him as we take that forward.

[Daisy Cooper (St Albans) (LD)]

Having asked the Government 14 times to release funding to West Hertfordshire Hospitals NHS Trust and other hospital trusts, I am relieved that they now have approval to proceed, but the Secretary of State will know, as the rest of us do, that the construction industry thinks that the 2030 date is pie in the sky. The Government have not been looking after our hospitals, so we have lost huge parts of the workforce and of our supply chains. Building magazine says that the contract notice for a delivery partner will not even be published until September. Of course, as I understand it, none of the major construction companies has even started to put together project teams to bid for the work. For all the talk of 2030, could the Secretary of State tell us how much progress he is prepared to promise before the next general election?

[Steve Barclay]

The announcement and the manifesto commitment were to build by 2030. The hon. Lady touches on the engagement with industry; Lord Markham has been engaging with industry. We have had a significant team, both within the Department and in NHS England, working on the standardised designs. The whole point is that we have seen in other sectors how standardisation allows us to construct much more quickly. It will also allow internal processes in government to be much quicker because we are not looking at each scheme in a bespoke way; we will have much more standardisation. That is how we will move at a much quicker pace. It has required us to take a little more time over recent months as we have finalised the plan, but now that we have that plan and clarity about the RAAC hospitals in particular, we will be able to move with much more pace.

Patient Choice

Daisy Cooper Excerpts

Thursday 25th May 2023 Commons Chamber

[Steve Barclay]

Yes, I can. Part of this is allowing patients to choose according to a number of factors. Some may have had treatment previously and want to go back to a particular consultant-led team. Some may want to look at CQC ratings and other performance metrics. Some may want the convenience of not travelling—relatively small numbers say they are not willing to travel; far more are willing to do so. Patients will look at a range of factors when shaping their decision. The key is to have transparency and the technology that enables patients to take control.

[Daisy Cooper (St Albans) (LD)]

Of course we all want to see real patient choice, but for millions of people who are waiting in pain, a choice between travelling miles away or paying to go private is no choice at all. We all know that the key to unlocking millions of people from the NHS backlog is tackling the crisis in the workforce. Why on earth are we spending precious parliamentary time talking about the NHS app instead of the NHS workforce?

[Steve Barclay]

We are talking about the wider workforce. The hon. Lady mentions private capacity. This patient choice will enable people to make much better use of the independent sector and to do so free at the point of access. Given the size of the challenge of pandemic backlogs, the question is: how can we make full use of capacity across the NHS and in the independent sector?

Recovering Access to Primary Care

Daisy Cooper Excerpts

Tuesday 9th May 2023 Commons Chamber

[Steve Barclay]

My hon. Friend raises a great point. I am extremely keen on how we can improve diagnostic testing and make it more accessible. As she knows from her time in the Department, early treatment is more effective and more cost-effective. Looking at more home testing, more testing at pharmacies and more work with employers to accelerate early detection is a win for patient outcomes and for delivering care in a more affordable way.

[Daisy Cooper (St Albans) (LD)]

Liberal Democrats and many others in this House have called for a pharmacy first approach for a long time, but there appear to be two major problems with today’s announcement. The first is that the Government’s own plan says that the money will be re-targeted; I would be grateful to know from the Secretary of State which other service will miss out.

In my constituency two pharmacies have already closed, and across England 16% of pharmacies have said that they do not think they will survive another year. How does the Secretary of State expect people to access a pharmacy first if their pharmacies continue to close?

[Steve Barclay]

As I said, there are more pharmacists than in 2010 and more people working in the pharmacy sector—the numbers have gone up by 24,000 since 2010—so to address the hon. Lady’s second question, there are more. On funding, as I said in my statement, this is new funding for primary care. That is the commitment that we made, and it should be welcomed in the primary care sector.

NHS Strikes

Daisy Cooper Excerpts

Monday 17th April 2023 Commons Chamber

[Steve Barclay]

I agree with my hon. Friend. The fact that even the Labour party does not support 35%—the Leader of the Opposition himself says that is not affordable —indicates how out of step the junior doctors committee co-chairs are on what is realistic to get the balance right in bringing down inflation and on the wider economic pressures we face. We stand ready to engage constructively with the junior doctors committee but, as my hon. Friend says, that has to be on the basis of a meaningful opening position.

[Daisy Cooper (St Albans) (LD)]

On 5 July, the British public will want to celebrate 75 years of our amazing NHS, but if they are still feeling the brunt of NHS strikes at that time, does the Secretary of State think it would still be right for him to be at the Dispatch Box?

[Steve Barclay]

We have agreed an offer with the Agenda for Change staff council. That is something that the staff council and the majority of trade unions have recommended to their own members, and that the largest health union has voted in favour of. I think we should allow that ballot to take place; it reflects meaningful and constructive engagement. That was reflected in the fact that trade union leaders themselves recommended the deal to their members. I hope that, when we come to the 75th anniversary, we can celebrate that.

Covid Pandemic: Testing of Care Home Residents

Daisy Cooper Excerpts

Wednesday 1st March 2023 Commons Chamber

[Helen Whately]

I completely agree with my hon. Friend about the covid inquiry being the right place for people to go through the details of what happened—who said what and, as he said, the genuine debates that took place behind the scenes. This was a new virus and, at the time, we had only limited information about it. For instance, when it first hit our shores, it was not known who would be most vulnerable to it. We also did not know about asymptomatic transmission. There was a huge amount of uncertainty at the time, but the best possible decisions were made. As for the timing of the public inquiry, that is not within the control of Ministers.

[Daisy Cooper (St Albans) (LD)]

The leaked WhatsApp messages from the then Health and Social Care Secretary, the right hon. Member for West Suffolk (Matt Hancock), showed that, despite a shortage of covid tests in September 2020, one of the Minister’s advisers sent a test to the home of the right hon. Member for North East Somerset (Mr Rees-Mogg) by courier. This is yet more evidence that it is one rule for Conservative Ministers and another for everyone else. Can the Minister please inform the House how many other Government Ministers, Conservative MPs and their families received priority tests during the pandemic when there was a shortage of tests?

[Helen Whately]

It is difficult for me as a Minister to see WhatsApp messages from me in the pages of a newspaper. If the hon. Lady has read those, she will have seen that I was seeking a test for a member of my family and that I used exactly the same test app as everybody else to try to access a test that was needed.

NHS Workforce Expansion

Daisy Cooper Excerpts

Tuesday 28th February 2023 Commons Chamber

[Daisy Cooper (St Albans) (LD)]

A healthy population and economic growth are two sides of the same coin, but, because the Conservative Government have failed to invest in our health and social care services, the ticking time bomb of ill health is starting to explode, and the Government wonder why they cannot get sustainable economic growth.

I welcome this motion today for two reasons: first, because it focuses on recruiting many of the staff that our NHS needs; and secondly because it focuses on training more district nurses and more health visitors, which would help us to shift the focus of healthcare in this country away from urgent and reactive care towards community and preventive care.

I wish to touch on GPs, dentists and social workers today. GP appointments have become increasingly difficult to secure, with some patients now resorting to DIY doctoring, by carrying out medical treatments on themselves. Our GPs are not to blame. They are overstretched and understaffed like every other part of our NHS, but the Conservative Government have repeatedly broken their promise to recruit more GPs, so where is the plan to turn that around?

There is now a crisis in this country on access to dentists, in part because of the lack of staff. The Government’s response last year was to create a one-off, time-limited £50 million emergency fund for dentists to create emergency catch-up appointments, but the uptake has been modest in most regions. In the east of England, just 13.7% of the allocated funding has been spent, and in my own constituency of St Albans that money created zero new appointments—absolutely zero.

To make matters worse, dental practices are now being penalised for under-delivery, because the funds will be clawed back from their frontlines instead of being ringfenced. The Health Service Journal reported last week that there is due to be a record Government underspend of £400 million on dentistry this year, while patients face an access crisis. Will the Government commit to ringfence this funding for NHS dentists to ensure that it is not clawed back?

The Government’s disastrous dental contract has created this access crisis. Not only has it created a two-tier system between rich and poor, but children’s life chances are being set back because of the impact of poor oral health. Our children, more than anybody else, need good teeth to set them up for later in life, but eight in 10 NHS dental practices are not taking on children.

Last November, I visited the Royal London Dental Hospital and its Tooth Fairy Project, a dedicated new surgical centre for children waiting too long for operations, which removes problematic teeth or performs multiple fillings. It was a fantastic facility to see, and the staff were extraordinary, but the statistics on child tooth extractions are terrifying. I have had cases in my own constituency of St Albans where parents simply cannot get NHS dental appointments for children. I have also been made aware of just how bad the situation has become in other areas, such as North Yorkshire, where only half of children managed to see an NHS dentist last year. In fact, last week, I was told that, in Harrogate, if a person was lucky enough to find an NHS dentist taking on any new patients, they face a two-and-a-half-year wait to see them. That is a shocking state of affairs. A Minister should visit places such as Harrogate in North Yorkshire to speak to patients and dentists and see the situation for themselves. The Government must urgently reform that broken dental contract, ringfence unspent funds and retain our experienced dental practitioners so that more patients can see a dentist when they need to.

When people cannot see a GP or a dentist, they end up in A&E. More than ever, the Government need to get around the table and agree a fair deal with all our NHS staff. We know why A&Es are under so much pressure. It is, in part, because people cannot get out of hospital when they need to as social care is collapsing as well. The number of vacancies in social care stands at 165,000, and it is rising alarmingly: in the past year alone, it increased by 55,000.

The Liberal Democrats are calling for the introduction of a carers’ minimum wage. We would pay £2 per hour more than the current minimum wage for all carers, meaning that by April this year, the hourly pay would be £12.42. A staggering 850,000 care workers would benefit from that increase in pay, and more than 80% of them would be women. Social care needs serious solutions from a serious Government, so will the Minister seriously consider introducing a carers’ minimum wage?

Our health and care services are one ecosystem. Whatever claims the Government make about how much they are spending and what they are trying to do, the British public can see that it is too little, too late. Targets are being missed left, right and centre, and everything that the Government say is worlds apart from the lived experience of our constituents, who are struggling to get the help that they need. Never again will the British public trust this Conservative Government with their NHS or their care services.

Urgent and Emergency Care Recovery Plan

Daisy Cooper Excerpts

Monday 30th January 2023 Commons Chamber

[Steve Barclay]

Within my right hon. Friend’s question is, I think, how we get more flow into hospital: once bed occupancy goes above a certain threshold, lack of flow is the key interaction that drives inefficiency within hospitals. That is why we are putting in the extra capacity. It is also a question of reducing the numbers going to hospital in the first place and speeding up the discharge of those who are fit to leave. Whereas at the moment someone might sit on a ward for three days because they have to have antibiotics every day, if one continuous dose of antibiotics can be administered through new kit at home, not only is that a much better patient experience but it relieves pressure on the wards.

[Daisy Cooper (St Albans) (LD)]

I welcome the additional transparency on data for 12-hour wait times, because it is only by shining a light on the problem that we can see just how bad it is, but the targets set out in the plan today are utterly woeful. The Royal College of Emergency Medicine says that we need 13,000 beds; the Government are offering 5,000. The percentage of patients who are seen within four hours should be 95%; the Government are aiming for 76%. Heart-attack and stroke victims should be seen within 18 minutes; the Government are aiming for only 30 minutes. Surely the truth is that this woeful lack of ambition means that our emergency care services are themselves on life support and that patients will continue to die needlessly for a very long time to come.

[Steve Barclay]

First, I thank the hon. Lady for recognising the steps that we have taken on transparency. That has been an area of challenge and it is part of my wider commitment to transparency.

The ambition of the targets has to be realistic, and targets are not a ceiling but a floor. It is about saying, “How do we set a target that is realistic?” Of course, we will aim to do better than that, but it is about setting something that the system feels is achievable, because that in turn gets much more buy-in.

On beds, we are increasing capacity, as my right hon. Friend the Member for Wokingham (John Redwood) alluded to. What it is really about is freeing up patients who are fit for discharge from hospital, who should not be there and would actually prefer to be getting care at home. It is about looking at the end-to-end bed capacity, not simply at beds within the acute sites.