Health Inequalities

Debate between Dan Poulter and Lucy Allan

Wednesday 20th March 2019 Westminster Hall

[Lucy Allan]

I thank my hon. Friend for his intervention, and I am aware of the position he sets out. He is absolutely right; these problems are happening elsewhere with the combination of CCGs coming together and not being able to meet the needs of the individual areas that are receiving the funding.

In Telford, the local hospital trust serving both Telford and Shropshire announced in January, after five years of bizarrely convoluted and contorted deliberation, that it was pleased to announce its investment of a total pot of £312 million in a state-of-the-art critical care unit in the leafy, affluent shire town of Shrewsbury in Shropshire, 19 miles from Telford. In addition, the trust announced that it was pleased to say it would transfer Telford’s women and children’s unit and emergency care from Telford to Shropshire.

I have repeatedly asked the revolving door of hospital management over the past five years to explain how that proposal narrows health inequalities, how that decision improves the health outcomes of the most disadvantaged groups in the area they serve and how it improves health access for the most disadvantaged group if it is moving their provision 19 miles from its current location.

The response to my questions over a significant period has been to take no notice whatever. As an MP I have found, and I know from talking to them that many colleagues have also found, that local hospital trusts and CCGs feel no obligation whatever to respond to or even take notice of elected representatives. Indeed, my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) noted in this place just last week, in an excellent debate on his local trust, that he had “absolutely no influence” on any decisions made by the CCG in his area.

As the Shrewsbury and Telford trust felt no obligation to respond to questions on this incredibly important issue, I asked the then Secretary of State if he could seek a response on my behalf. However, even that did not bring so much as an acknowledgement that reducing health inequalities is an important issue for the hospital trust or the CCG when making spending decisions.

The trust seems to feel entirely unaccountable to anyone. The Department of Health and Social Care says that it is accountable to NHS England, and NHS England says that the trust board is accountable to the trust chairman. In reality, there is no accountability. This subject has been raised with me over and over again by local residents who strongly oppose this reallocation of funding from a disadvantaged area to a more advantaged area.

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

My hon. Friend will be aware that there are health and wellbeing boards at play in local authorities. How effective has her local health and wellbeing board been at holding the CCG and other parts of the NHS to account, not only for their spending decisions but for how those decisions impact on frontline patient care?

[Lucy Allan]

I thank my hon. Friend for sharing his expertise in this area. My local council and health and wellbeing board have equally not been listened to on this issue. It is a Labour council, but it has tried extremely hard; if there was an opportunity to suggest otherwise, I would perhaps take it, but that is not the case. Both tried hard and have not been listened to. Most frustrating has been that the voice of local people has not been heard. Who do we expect to enforce this statutory duty? We cannot expect constituents to crowdfund a legal process because we want to hold CCGs to account.

Prevent Strategy

Debate between Dan Poulter and Lucy Allan

Wednesday 1st February 2017 Westminster Hall

[Lucy Allan]

I completely agree with the right hon. Gentleman. I am delighted that he made that point, and that he made it so eloquently, because he has helped to articulate my argument.

Under the Counter-Terrorism and Security Act 2015, Prevent moved from being a co-operative and voluntary action by the community to being a statutory duty, and therein lies the problem. A failure to meet a statutory duty can have negative consequences, for example for teachers in schools. Ofsted assesses whether the duty has been met and delivers a grading for the achievement of compliance with it. The grading will be reduced if a school has not complied with the duty. As a school governor, I have seen the incentive to make referrals under Prevent. If we do not make them, we might feel that we will get into trouble, or that there will be a negative impact on the school or a teacher’s career.

That approach has led to an exponential increase in the number of referrals since Prevent became a statutory duty. One child a week under the age of 10 is being reported to Prevent—I use the word “reported”, but perhaps I should use “referred” instead.

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

My hon. Friend is making some good points about concerns in certain communities, particularly the Muslim community. Does she accept that one issue is that of miscommunication? My understanding is that Prevent is not only about the Muslim community, which seems to be the focus for a lot of the discussion; it is also about the real danger from right-wing extremist groups. Prevent is focused on training people to understand that as well.

[Lucy Allan]

My hon. Friend is absolutely right. I have not so far mentioned, and I think I will not mention at any point, the Muslim community specifically. However, I will mention some use of Prevent to tackle the far right, which is a good point and one we should all take on board.

--- Later in debate ---

[Lucy Allan]

I thank the Minister for his intervention. What is important about what he said is that although the incident was not referred under the Prevent mechanism, the same actions were taken. The teachers concerned would have been trained in Prevent and alert to this whole issue. Although they did not formally trigger the Prevent mechanism, they still called the police about an issue that might otherwise have been to do with extremism. It is important to bear that in mind.

From what I have seen, when schools look for signs of extremism, they do not really know what they are looking for. They often come up with suggestions for things that might be grounds for referral that have no possible connection at all to extremism. I have sat in governors’ meetings where teachers who want to comply have openly discussed scenarios such as a child coming into school and saying that he has been on a Fathers 4 Justice march or a march to protest against badger culls. To me, Prevent is certainly not intended to tackle that. There is no indication that that type of activity would lead to extremist or terrorist behaviour. It is greatly concerning that people are sitting around in schools thinking, “What possible scenarios can we come up with?”

More and more public sector workers are being trained in how to report under the Prevent duty, but that does not make me feel any more comfortable. I believe that some 600,000 people are now trained to refer people under Prevent for the purposes of re-education and religious guidance. That does not give me confidence at all; it actually makes me feel more concerned. We should not, as a matter of course, have people sitting and waiting to spot signs when, if there had been grounds to report them, their own good judgment may have kicked in and enabled some less intrusive, less authoritarian approach to be taken to deal with the issue.

[Dr Poulter]

My hon. Friend might be aware that I am one of those public sector workers when I am not working as an MP. May I reassure her that a lot of work on Prevent goes on, particularly in psychiatry, and we use clinical judgment in exercising our duties? Referrals are rarely made to Prevent through mental health services unless there is a reason for doing so. Referrals are usually made due to the exploitation of an individual by other people, and it is those people who end up being referred and engaged in the Prevent process, not the individual themselves.

[Lucy Allan]

My hon. Friend makes a good point.

Children and young people will always test boundaries, and playground banter and bragging must not be seen as potentially sinister things where children must be watched. That breeds fear, suspicion and mistrust, which concerns me.

My hon. Friend the Member for Banbury (Victoria Prentis) raised safeguarding. I want to challenge the way that Prevent is packaged as a safeguarding measure. In effect, we are told, “Prevent must be a good thing, because it is intended to keep us safe.” It is depicted as offering support and advice to ensure that susceptibility to radicalisation is diminished. It is a real concern that that is how the Government perceive Prevent, because that perception is out of step with how Prevent is interpreted and perceived by those affected by it. In the context of Prevent, safeguarding is often about forcible state intervention in the private life of an individual when no crime has been committed, and that is inevitably experienced in a negative way.

It is important to understand that families subjected to safeguarding measures will, in any event, experience them as frightening, shaming and stigmatising. Someone in a position of trust—whether a teacher or a doctor—is used to gather and share data, often about young children, without consent, investigations are conducted and the police are involved. That process is anything but supportive and helpful; it destroys trust. A less heavy-handed approach would be far more constructive. Calling that approach safeguarding, and conflating counter-extremism measures and safeguarding, is quite dangerous.