Social Care and Military Compensation
Baroness Laing of Elderslie Excerpts(10 years, 10 months ago)
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Jane Ellison
I will come to that, and will try to give the hon. Gentleman a bit of reassurance about the advanced and ongoing work that is taking place.
Social care is a priority for the Government, and, in the context of difficult spending decisions, we have taken steps to protect care and support services. For example, we have allocated extra funds for those services during the current Parliament. We have created a better care fund, which, next month, will introduce a £5.3 billion pooled budget for health and care that will provide much needed funding for care and support, and will break new ground in driving closer integration of services.
Although spending on care and support is ultimately a decision for local government, we must be mindful of the overall fiscal position. I think that Members on both sides of the House agree on that. We must ensure that if we change the charging rules nationally, the cost will be met. To that end, my officials are continuing to work with their counterparts at the Ministry of Defence—I hope that that gives the hon. Gentleman some sense of momentum, and deals with his concern about “silo” working—and with the Royal British Legion, with a view to considering the issue during the spending review that will take place after the election.
I hope that the hon. Gentleman—and, indeed, all hon. Members—will welcome the historic reforms that will come into force in just one week’s time. They are very significant in the context of the broader issue of care. This Government have been the first to prioritise care and support. I hope that Members in all parts of the House will feel able to welcome the clear plans that I have set out for the future. As for the specific issue that the hon. Gentleman has raised, I hope he recognises that this is ongoing work which is taken very seriously. His securing of what has turned out to be the last Adjournment debate of this Parliament has underlined the importance of the issue that he has raised. I think that, throughout the purdah period and beyond, the debate will give added momentum to the work that is being done.
Given that this has been the last Adjournment debate of the current Parliament, Madam Deputy Speaker—and you and I have shared a number Adjournment debates—let me take this opportunity to thank you and, through you, Mr Speaker and the other Deputy Speakers. I also thank all the staff of the House, and, in particular, those who have sat through some of our late-night health debates, of which there have been many. However, I especially thank the Chair, and all those who have supported the Chair during these important Adjournment debates, which give us a chance—as tonight’s debate has—to explore important issues in some detail, outside the heated atmosphere that the Chamber attracts on other occasions. I also thank Members in all parts of the House, some of whom are very regular attenders at these debates, for their attendance tonight, and for the interest that they have taken in these important matters.
Madam Deputy Speaker (Mrs Eleanor Laing)
I thank the hon. Lady for the gracious way she has thanked Officers of the House in respect of Adjournment debates. These debates are extremely important and she has taken part in many of them, as have I and the other Deputy Speakers and Mr Speaker, and we all appreciate how important they are. I also thank the hon. Member for Blackpool South (Mr Marsden) for introducing the final Adjournment debate of this Parliament.
Question put and agreed to.
Mental Health and Well-being of Londoners
Baroness Laing of Elderslie Excerpts(11 years ago)
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Ms Abbott
I very much agree with my hon. Friend. As he says, there are cost of living issues. Then there are spiralling housing costs. Health care in London has some of the biggest turnover and some of the highest vacancy levels of any health care provision in the country. The pressures of the cost of living crisis and the housing crisis are making it increasingly difficult to provide permanent staff to meet the health care needs in general and the mental health needs of Londoners.
I shall focus in my speech on the cost to London of the mental health crisis and the importance of parity of esteem between mental and physical health, about which Members on both sides of the House have spoken. It is important to stress it, because we are nowhere near parity of esteem when it comes to the questions of finance and resources. I also want to talk about the mental health and well-being of London’s lesbian, gay, bisexual and transgender community, and about the growing crisis of mental illness among our children, adolescents and young adults. I shall also deal with something not often spoken about—mental health issues in our black and minority ethnic communities in London.
It is important, because mental health is sometimes a marginalised issue, to talk about the huge cost of the mental health challenges to London. Recent figures indicate that almost a million adults of working age in London—15.8% of the adult population—are affected by common mental disorders such as anxiety and depression. I was in the House about 18 months ago when Members of all parties bravely talked about their own experience of depression and how they felt a stigma and found it very difficult to get treatment.
It is estimated that 7% of London’s population have an eating disorder, that one in 20 adults has a personality disorder; that 1% of Londoners are registered with their GP as having a psychotic disorder such as schizophrenia, bipolar and other psychoses; and that nearly half of Londoners are anxious. London has the UK’s highest proportion of people with high levels of anxiety. In addition, almost a third of Londoners report low levels of happiness, which must clearly be exacerbated by the cost of living issues we have mentioned. The number of Londoners reporting low levels of happiness is well over 2.5 million. We London MPs see many of them in our surgeries week after week.
In basic economic terms, almost £7.5 billion is spent each year addressing mental health issues in London, while according to the Greater London Authority, the wider health, social and economic impact of mental illness costs the capital an estimated £26 billion. In social care costs alone, London boroughs spend around £550 million a year treating mental disorder, and another £960 million each year on benefits to support people with mental ill health. There are some concerns about the changes in welfare and the—
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I fully appreciate that the hon. Lady is a parliamentarian of great experience, and I am not making this point for the sake of it, but she is not addressing the Chair. She is speaking to somebody over there on the Government Benches, but while somebody over there might be able to hear what she is saying, the Chair cannot. I am sure she is speaking of matters of great interest. It would be appreciated by the rest of the Chamber if she addressed the whole Chamber.
Ms Abbott
I am grateful to you, Madam Deputy Speaker. As ever, you are punctilious about matters of order.
London boroughs spend about £550 million a year on just the social care costs of treating mental disorders. Another £960 million is spent each year on benefits to support people with mental ill health. Across the population, the net effect of those wider impacts substantially affects London’s economy, infrastructure and population. Mental health is not simply an issue for health and social care; it is an issue for everyone. Mental health conditions debilitate London businesses each year by limiting employee productivity and reducing the potential work force. Every year £920 million is lost owing to sickness absences, and a further £1.9 billion is lost in reduced productivity. Moreover, the costs extend more widely: the staggering sum of £10.4 billion is lost each year to London business and industry as a result of mental health issues.
The London criminal justice system spends approximately £220 million a year on services related to mental ill health, and other losses such as property damage, loss of stolen goods and the lost output of victims cost London a further £870 million. Those costs are already too high, but treatment costs are expected to grow over the next two decades. Mental health issues also prevent physical health conditions from being addressed properly. However, mental ill health remains one of the least understood of all health problems. The problem is exacerbated by the existence of an obstinate and persistent stigma that prevents people from talking about mental health or paying attention to the debate about it, and therefore prevents us as a society from addressing it properly.
I want to say a little about the issue of parity of esteem between mental and physical health. The continuing lack of parity of esteem, in terms of both funding and attitudes, underlies some of the mental health problems not just in London, but throughout the country. As the daughter of a mental health nurse, I am very clear about the fact that there is no parity of esteem between mental and physical health. My mother came here as a pupil nurse in the 1960s, and was part of the generation of West Indian women who helped to build our NHS. She took time off work to bring up a family, but she returned to nursing in the 1980s, and her subsequent career in mental health exemplified the issues involved in the lack of parity of esteem.
The first thing that I want to say about parity of esteem is that those who might be described as the high fliers in health do not necessarily go into mental health. That has always tended to be the case. I shall never forget something that happened in 1987, when I was a brand-new MP. The then chief nurse at City and Hackney told me that I must visit the hospitals in the area. She said that I should meet her at 10 pm, and she would take me to the three major hospitals in hospital: Bart’s, Homerton, and Hackney mental hospital. I met her, and we went around Bart’s. She did not think it in any way remarkable that in Bart’s, even at the dead of night, we did not see a single black nurse. Then we went to Homerton, where there were quite a few black nurses doing the night shift. The chief nurse said to me innocently, “You know, they”—meaning nurses of colour, I assume—“seem to prefer the night shift; our day shift is quite different.”
Then I went to Hackney mental hospital. Although this happened in 1987, I have never forgotten it. The mental hospital was, literally, an old workhouse. It was as grim as anyone could possibly imagine—and, of course, all the nurses there, day and night, were BME. I am afraid that that pointed to a lack of parity of esteem, in the context of the way in which nurses were allocated and the direction in which their careers were leading. I am not in any way detracting from the specialists in mental health, but in respect of nurses there has long been a stratification when it comes to who should work in mental as opposed to physical health.
My mother was a devoted mental health nurse who dealt with geriatric patients with dementia. When my brother and I were older and she went back to nursing, she worked in a hospital outside Huddersfield called Storthes Hall. Thankfully, it has now been closed. It was another former Victorian workhouse, and it looked exactly like a Victorian workhouse. One had only to visit that hospital, see the conditions there and then visit the new Huddersfield royal infirmary in the centre of Huddersfield to see physically demonstrated the complete inequality in services offered to people with physical illness as opposed to people with mental illness.
For a number of years, there has been more focus on mental health in all parties, which is to be welcomed, and more focus on the importance of parity of esteem. However, the financial issues are a challenge. For many years, mental health has been chronically underfunded and it has the reputation of being a Cinderella service. At national level, mental health accounts for 28% of the pressure in the NHS, yet on average clinical commissioning groups spent just 10% of their budget on mental health in 2013. Separate investigations by Community Care and the BBC showed that mental health trusts had their budgets cut by 2.3% in real terms between 2011-12 and 2013-14. The effects of some of those cuts have been felt throughout the system. There have been difficulties in accessing talking therapies. Service provision is creaking at the seams. Over 2,000 mental health beds have been closed since 2011, leading to several trusts with sky-high bed occupancy rates.
There is no question—perhaps Ministers will query this—but that austerity and issues with welfare, access to housing and unemployment have put some of London’s most deprived communities under pressure. Welfare cuts, the lack of stable tenancies and improperly enforced employment regulations must have an effect on the incidence of mental health-related illness. Therefore, on the one hand we have cuts to funding and on the other a rise in the conditions that affect people’s well-being and ultimately their mental health. That is a double-edged sword that spells disaster for the well-being of Londoners.
The specific mental health needs of LGBT Londoners are not discussed often. For a long time, London has been a city where young people come to find themselves. It is an inclusive environment where LGBT people are welcome. London boasts a dynamic gay scene and has successfully hosted World Pride. LGBT Londoners are now able to get married, to raise families and are equal before the law. We must safeguard those achievements by ensuring that they have access to appropriate health care and mental health provision.
It is time to change the stereotype that LGBT people are busy partying and having a good time. Unfortunately, it is not a wholly accurate depiction of the community. There are various estimates about the incidence of mental health problems in LGBT groups, but research I have seen says that sexual minorities are two or three times more likely to report having a long-standing psychological or emotional problem than their heterosexual counterparts; and that two out of five LGBT people will experience a mental health problem at some point in their lives, which is quite a high proportion. In 2014, Stonewall said:
“Compared to the general population, lesbian, gay and bisexual people have higher rates of mental ill health as well as alcohol and drug consumption. Lesbians are also more likely to have never had a cervical smear test, while gay and bisexual men are more likely to experience domestic violence.”
Particularly among young LGBT people, we see rising levels of self-harm. Homophobic behaviour is going unchallenged in the workplace and on London’s public transport system, and hate crimes against LGBT people remain stubbornly high. There are also issues about access to mental health services for LGBT groups.
The situation is even worse for black and minority Londoners who identify as lesbian, gay or bisexual, among whom rates of suicide and self-harm are higher than among than the population generally. Some 5% of black and minority ethnic lesbian and bisexual women have attempted to take their own life in the last year, compared with just 0.4% of men over the same period, and one in 12 have harmed themselves in the last year compared with one in 33 in the general population. What are the Government doing to improve the training of NHS staff on the specific health needs of LGBT people and black and minority ethnic LGBT people, because at present they are both challenged with higher levels of mental health issues but have difficulties accessing services?
There are particular challenges in London associated with the recent reorganisation of the NHS, moving responsibility for public health to local authorities. In principle that move makes it much easier to address the social determinants of ill health, including mental health, but the concern is that because of pressures on local authorities funding for mental health will drop and the ability to provide London-wide services for groups, such as the LGBT community, will weaken.
The House will know that my party is not proposing to put the NHS through a further reorganisation when we return to office in a few months’ time. However, it would make sense for existing structures in London to monitor outcomes for LGBT people throughout the capital, and given the complexity and size of London we cannot simply take a one-size-fits-all approach to LGBT issues.
Young people today are living in a time of unprecedented pressures, with smartphones, the internet, a world of 24-hour communication, new avenues for bullying, new fears and new concerns. The issues are plain to see in the growing demand for services for young people across London, with London hospital admissions for self-harm rising from 1,715 in 2011-12 to 2,046 in the last year. At least one in 10 children in the UK is thought to have a clinically significant mental health problem, which amounts to 111,000 young people in London. The impact of childhood psychiatric disorders costs London’s education system approximately £200 million a year, and in 2013 the Children and Young People’s Mental Health Coalition found that 28% of joint health and wellbeing strategies in London did not prioritise children and young people’s mental health.
What are the Government doing to ensure that joint strategic needs assessments look at, and include information about, the size, impact and cost of local children’s mental health needs, to ensure that sufficient services are being commissioned? Will the Minister ensure that data about BME young people and children will be comprehensively included in the new national prevalence survey of child and adolescent mental health being commissioned by the Department of Health? Concerns have been raised in this House previously about the funding of services for children and adolescents, but it is clear in London in particular that there is an unravelling crisis in relation to young people and mental health.
As I said at the outset, London’s youth, and youth nationally, live in an era of unprecedented pressure. Data obtained from a freedom of information request of top-tier local authorities in England by the mental health charity Young Minds revealed that in 2010-13 local authorities in London cut their children and adolescent mental health service budgets by 5%, at a time of increasing pressure on young people. The latest data show that Southwark cut its budget by 50%, as did Lambeth and Hounslow. Tower Hamlets cut its budget by 30%, and Haringey cut its budget by 10%. Those are some of the most deprived boroughs in London, and if they are really cutting their expenditure on young people’s mental health care to that extent, it is very serious.
Ms Abbott
My hon. Friend is right to say that the cuts are arbitrary, and they certainly do not account for unmet need. In my time as a Member of Parliament—my hon. Friend must have had similar experiences—I have met many mothers and other people who are unable to access the mental health care that they need, particularly talking therapies. Cutting provision at a time when we do not even know the size of unmet need is very dangerous.
I want to turn now to mental health care provision for the black and minority ethnic community. I have looked at this issue over many years, and I believe that the manner in which the mental health system fails people of colour is a tragedy that has been consigned to the shadows for too long. As well as talking about parity of esteem between mental health and physical health, we need to talk about a parity of care between all sections of the community, and at this point that is not happening. I hope to set out briefly some of the findings of the research that has been carried out over the decades on black people and mental health, but my central point is that black and minority ethnic people are not getting parity of care and service. This is a long-standing issue that goes back decades, and I call on the Government to do what they can. I shall also call on the incoming Labour Government to pay attention to this issue in a way that has not happened in the past. Governments genuinely need to understand and address these needs.
Black and minority ethnic mental health is a particular issue for London because half Britain’s black and ethnic minority community is inside the M25. Sometimes it is hard to get the data we need, but we know, for instance, that in Lambeth—less than a mile from this Chamber—more than half the people admitted to acute psychiatric wards, and more than 65% of the people in secure wards, are from the Caribbean and African communities. I know from regularly visiting Hackney’s psychiatric wards, and the Hackney forensic unit, that the proportion in Hackney is as at least as high, if not higher, than that. We have accurate statistics for Lambeth, but we only have to walk into psychiatric wards across London to see that the majority of beds in the big mental health institutions such as the Maudsley are occupied by people of colour.
I remember, as a new MP in 1988, raising the disproportionate number of black people on wards with the head of psychiatric services in City and Hackney. I asked, “Why are so many people on your wards black and minority ethnic? It’s way out of proportion even with the population of City and Hackney.” City and Hackney produced three very senior psychiatric doctors to talk to me about this. They turned to each other, paused, muttered, and one suggested that it might have something to do with “ganja psychosis”. Another then ventured the opinion that perhaps more mad people were migrating from the Caribbean. I had to say to him, “It’s hard enough to get into this country if you’re sane; it is to the highest degree unlikely that the authorities are allowing all these mad people to come into the country.” But the striking thing about that conversation was that it was not some casual conversation on a ward; the head of psychiatric services had marshalled the three most senior psychiatric doctors in City and Hackney, and the only explanation they could offer for their wards being full of black people was “ganja psychosis”. I was struck by how low the level of knowledge was and how low the level of interest was.
I also know from my years as a Member of Parliament how many black families are struggling with the consequences of the mental health system’s failure to offer the right support at the right time, and the help and services to which they are entitled. One of the saddest things I see in my work as a Member of Parliament is black mothers, single heads of household, struggling with black males in their household who clearly have chronic mental health problems. I have had women come to see me who have been assaulted by their own son. When they are told that they should go to a GP and that perhaps their son needs to be sectioned, they say,” No, no, no.” That is because there is a terrible fear in the black community of the mental health system. Some women would rather risk assault by their own son and live in fear than consign their son to the mental health system, because their understanding is that once that system gets their child, the child is pumped full of drugs and never comes out again or, if they do, they are not the same. So it is time this Government and any incoming Government give more attention to issues relating to black people and mental health.
Those issues have not altered in decades: there are disproportionate numbers of black people, particularly men, in the system; we are more likely to be labelled “schizophrenic”; we present later to the system, which makes matters worse; we are more likely to come to the mental health system through the criminal justice system, particularly by being picked up by the police on the street and finding ourselves sectioned; and we are less likely to be offered talking therapy. I remember going in the ’90s to a mental health therapy centre in west London that specialised in talking therapy and did excellent work. I noticed that there were no black and minority ethnic people there and when I asked about this I was told, “Oh, we find that black and minority ethnic people don’t benefit from talking therapy.” That is an extraordinary attitude. We need to do more to make talking therapy available across communities, including BME communities. Black people are also statistically more likely to be offered electroconvulsive therapy—in other words, they are more likely to be plugged into the mains. There is also a terrible history of deaths in mental health custody, which are often to do with the type of restraint used and a fear of a violent black male. There is a whole string of such cases, of which Sean Rigg’s is one of the most recent.
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I appreciate that the hon. Lady is developing some very important points, but I should draw to her attention the fact that the allotted time for an introductory speech in a Backbench Business Committee debate is 20 minutes. I have allowed her well over half an hour, as I appreciate that not many people are making demands on the time in the House this afternoon and that she is addressing important issues. Even given all that, I trust that in the very near future she is likely to come to a conclusion.
Ms Abbott
I am grateful to you, Madam Deputy Speaker, as you are so precise about order. I would not want to think that the length of my speech will prevent anyone else who wishes to speak from entering into the debate.
In conclusion, let me say that the issues I am raising about mental health in London—the cost of mental health to Londoners, and the effect of the under-provision of mental health services in London, not only to the individuals and families who suffer, but to London as a whole—are vital ones. I am glad I was able to bring them to the House and I am sorry if you feel I have gone on at too great a length, Madam Deputy Speaker. The issues associated with what is happening to black people and mental health include the lack of provision, the over-representation in the system and the fear that black families have of the mental health system. So this is a huge issue, and it is one that is not debated enough in this House. I am sorry that you felt I spent too long on the issue of black people in London and mental health. What is happening to our young people and children is a new crisis, which is definitely not being debated in this House, and I am glad to be able to draw it to the attention of the House.
Absolutely in conclusion, may I say that these are vital issues for Londoners. In the end, addressing health care is about addressing all the social determinants—the welfare system, housing, employment or education. I am glad to have had the opportunity to draw the House’s attention to how serious the crisis is, particularly in relation to our young people. I wait with interest to hear what the Minister has to say.
Improving Cancer Outcomes
Baroness Laing of Elderslie Excerpts(11 years ago)
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Bob Stewart
I will finish for my hon. Friend. This is a very brave man, because he wants to join the Royal Air Force. He is fully fit, he does marathons—he is a lunatic of course—and he wants to join the Royal Auxiliary Air Force, whose tie I am wearing in support of his bid.
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I am sure I should reprimand the hon. Gentleman for suggesting that the hon. Member for Filton and Bradley Stoke (Jack Lopresti) is a lunatic. That is not parliamentary language, although I am sure it was meant in a kindly fashion. He was, however, absolutely right to commend the hon. Member for Filton and Bradley Stoke for the very brave speech that he has just made, which the House seriously appreciates.
Standardised Packaging (Tobacco Products)
Baroness Laing of Elderslie Excerpts(11 years ago)
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Dame Angela Watkinson (Hornchurch and Upminster) (Con)
I draw Members’ attention to my entry in the Register of Members’ Financial Interests. I thank the hon. Member for Glasgow North (Ann McKechin) for allowing me to make a brief contribution during her debate—doubly so, because she did not withdraw her permission when I told her that I was going to disagree with her. Similarly, I thank the Minister.
I speak as a lifelong non-smoker. That is my choice, and it is a choice open to everybody. Nobody is forced to smoke. The Government have already invested heavily in existing strategies: television adverts, which were extremely effective—particularly the one about not smoking in front of children in one’s car—street hoardings, newspapers and magazines, smoking cessation treatment free of charge in GP surgeries and pharmacies, and anti-smoking advice in schools. My own schools are very effective in giving citizenship classes warning about the health risks of smoking. There cannot be anyone in this country, young or old, who does not know about the health risks of tobacco. Nobody smokes in ignorance.
Plain packaging has the laudable purpose of deterring children from starting smoking and helping smokers who wish to quit, but there is no reliable evidence that plain packaging will influence smokers in general or children in particular. In Australia, where plain packaging was introduced in 2012, both youth smoking and sales of illicit tobacco increased in the following year. There are many complex social reasons that lead to youth smoking, but packaging is not one of those factors. Currently 3% of under-15s smoke in the United Kingdom—the lowest percentage in a generation. I have asked people who were buying cigarettes in my local newsagent whether plain packaging would influence their tobacco purchasing habits, and they find the idea laughable.
Standardised packaging would be bad for exports, bad for retailers, particularly small shops, bad for jobs in warehousing, distribution, marketing, design and packaging, and bad for the Treasury, but very good for criminals, making the illicit trade much easier. What would follow—bottles of wine with plain labels, or bars of chocolate in plain packages as we are controlled and someone else makes our decisions for us?
Let us try to be positive and sensible. Let us clamp down on illicit sales of smuggled cigarettes in our neighbourhoods, and enforce a new ban on purchasing tobacco for under-18s, as with alcohol. Let us support shopkeepers in their role as gatekeepers to age-restricted products, encourage “No ID, no sale” signs in shop windows, and enforce stiff penalties against retailers—
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I hesitate to interrupt the hon. Lady, but time is very short. I hope she will draw her remarks to a close because the Minister has a speech to make.
Dame Angela Watkinson
I am very aware of that, Madam Deputy Speaker.
Let us enforce stiff penalties against retailers caught selling cigarettes knowingly to children and let us not forget the responsibility of parents to know how much pocket money their children have to spend and what they spend it on. In short, the policy of plain packaging is well intentioned but misguided. It will do more harm than good. It will not work and I oppose it.
National Health Service
Baroness Laing of Elderslie Excerpts(11 years ago)
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Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I am afraid that I shall have to reduce the time limit to seven minutes and that it will have to be further reduced if people take more than just over six and a half minutes.
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I must reduce the time limit to five minutes if everyone who wants to speak is to have an opportunity so to do.
Health and Social Care (Safety and Quality) Bill
Baroness Laing of Elderslie Excerpts(11 years, 1 month ago)
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Sir William Cash (Stone) (Con)
I beg to move, That the clause be read a Second time.
Madam Deputy Speaker (Mrs Eleanor Laing)
With this it will be convenient to consider:
New clause 3—Care and Quality Commission annual State of Care Report—
‘(1) Section 83 of the Health and Social Care Act 2008 (health and adult social services: reports for each financial year etc.) is amended as follows.
(2) After subsection (2) insert—
“(2AA) The reports under subsection 1(b), (c), and (d) must, in particular, cover the safety of health and adult social care services in England.”’
Sir William Cash
Before I make my remarks on the proposals, I pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), my neighbour, with whom I have worked for the past five years with great enthusiasm, because he has dedicated himself to all matters in his constituency, but specifically to dealing with the problems that came out of the Mid Staffordshire public inquiry—I campaigned vigorously to get that public inquiry. I also pay tribute to Ken Lownds, whom I regard as a hero of that inquiry in many respects. I pay tribute to his work on zero harm and the Bill. I do not in any way want to leave the Minister out of the tributes because he has done a great job, as has the Secretary of State for Health. I wanted to put that on the record. We are reaching the climax of the Bill and this is the moment to pay tribute to those who so richly deserve it.
The object of new clause 2 is to amend section 46 of the Health and Social Care Act 2008. The section deals with health and adult social care services reviews and performance assessments. It comes under the rubric of reviews and investigations under chapter 3 of the Act on health care standards.
Section 46, “Periodic reviews”, provides that:
“In respect of each Primary Care Trust the Commission”—
the Care Quality Commission—
“must…conduct reviews of the provision of health care provided or commissioned by the Trust…assess the Trust’s performance following each such review, and…publish a report of its assessment.”
It also makes special provision with respect to each English national health service provider. Subsection (3) states:
“In respect of each English local authority the Commission must…conduct reviews of the provision of adult social services provided or commissioned by the authority…assess the authority’s performance following each such review, and…publish a report of its assessment.”
In the light of experience, and to improve the 2008 Act, particularly section 46, the new clause would substitute for subsection (3) the following:
“The assessment of the performance of a registered service provider is to be by reference to whatever indicators of quality the Commission devises, but must include indicators of the safety of health and social care services.”
The purpose of that is to require the CQC to ensure that the indicators used to assess ratings cover the safety of care, which goes back to the question of harm-free provision. Basically, the argument goes like this: the object is to stress that the CQC can be an effective regulator only if it is free of undue influence from Ministers. The measure is a good indicator of whether the Government are prepared to say that they want the CQC to be able to exert influence and carry out its functions irrespective of undue influence from Ministers. In other words, are they prepared to step back and allow the CQC to do its job properly?
The CQC has decided to make safety one of the key indicators for the assessment of provider ratings. As a result, safety is a critical component of the CQC’s new inspection regime. On many occasions, I have discussed with Ken Lownds over dinner and otherwise the origins of much of his thinking on the subject, some of which I had difficulty understanding—apparently some of it comes from aviation safety, but I will leave that to the experts.
Under the leadership of the three chief inspectors, the CQC has put in place specialist inspection teams able to scrutinise the quality and safety of care more rigorously. Inspections no longer simply consider whether providers are meeting the registration requirements, but provide a judgment about the quality of care on a scale running from outstanding to inadequate, offering providers, commissioners and local people fuller information about the quality of care.
The CQC’s tougher, people-centred, expert-led and more rigorous inspections are seeing some outstanding care, and the CQC has already rated many good services. That new approach has also exposed poor care and variations in care, making the level of quality transparent in a way it has never been before.
I have to say that my experience of what happened after Mid Staffordshire—this was before my hon. Friend the Member for Stafford came into the House, and I pay tribute to what he has done to help me since—was itself a matter of the gravest concern. Having witnessed what went on there, I then had to engage in a campaign, and I tried, unsuccessfully, to push the Government of the time into having a public inquiry, but Ministers, including two Secretaries of State, refused point-blank to hold one.
Furthermore, I had to nudge—if I can use that word—those on my own party’s Front Bench quite vigorously. I think that would be the appropriate description. That included our then shadow Secretary of State and the now Prime Minister, who responded magnificently, making an inquiry a manifesto commitment. One of the very first things the Government did when they came into power under the present Prime Minister was to say, “We will have this Mid Staffordshire public inquiry under the Inquiries Act 2005.” As a result of that and of the work of Ken Lownds, my hon. Friend and others of us who have been involved in this issue, including the sponsors of the Bill—I should also refer to them—we now have this new Bill in my hon. Friend’s name, which will make quality transparent in a way it never has been.
We are already confident of the great strides the CQC is making to be an effective regulator of health and social care providers. I hope that the Minister will accept that new clause 2 is exploratory, but I tabled it in the fervent belief that he will respond satisfactorily to my request, because this is a matter of grave concern.
If it is convenient, Madam Deputy Speaker, I will move on to the next new clause, unless my hon. Friend the Member for Stafford would like to respond to my points now. Would that be appropriate?
Madam Deputy Speaker (Mrs Eleanor Laing)
At this point, we are considering new clause 2 and new clause 3, so it would be appropriate for the hon. Gentleman to address new clause 3, if he so wishes.
Sir William Cash
That is very good. I just wondered whether my hon. Friend wanted to respond on new clause 2 before I move on to new clause 3.
New clause 3 proposes to amend section 83 of the 2008 Act, which deals with health and adult social services and with reports for each financial year. The new clause would insert proposed new subsection (2AA), which says:
“The reports under subsection 1(b), (c), and (d) must, in particular, cover the safety of health and adult social care services in England.”
To put that into ordinary language, the purpose is to require the Care Quality Commission to cover safety of care in the annual state of care report. That is hugely important, because it is the narrative to which people will be able to refer in identifying progress on these incredibly important provisions.
National Health Service (Amended Duties and Powers) Bill
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Sir Tony Baldry
I have given way to the hon. Gentleman once, and as the hon. Member for Easington (Grahame M. Morris) accused me, ungallantly and unfairly, of filibustering—even though everything I have said is relevant and to the point—I would like now to make a little more progress and come to my final point, or almost my final point.
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. It is not possible for the right hon. Gentleman to filibuster, because if he was not in order, I would not allow him to continue speaking.
Sir Tony Baldry
I know that; you know that, Madam Deputy Speaker; I just wanted to make quite sure that the hon. Gentlemen below the Gangway knew that I was speaking relevantly.
I want to say something about the transatlantic trade and investment partnership. This is another of those things that people run around saying will be the end of civilisation as we know it. The transatlantic trade and investment partnership will not change the fact that it is up to the UK Government alone to decide how UK public services, including the NHS, are run. Any assertion that TTIP will undermine the NHS is a complete red herring. The position has been confirmed by both the European and the US negotiators, and indeed the chair of the all-party group on European Union-United States trade and investment. Excluding health from the agreement would prevent our pharmaceutical and medical devices sectors from benefiting from TTIP.
As we approach the next general election, I hope the Labour party will not treat the NHS as a political football. I hope we will not see, as we have at every general election since I have been an adult, the Labour party running around saying that it has 24 hours to save the NHS or that the Conservative party is seeking to privatise it, which is completely and utterly untrue. We all have a collective interest in ensuring that our NHS continues to be the best health care service in the world. There are huge challenges ahead for health care in this country, with an ageing population and ever-increasing improvements in medical technology. We should be facing up to those changes in an adult and responsible way. The Labour party should not be reneging on the clear commitments it made in both legislation and policy when it was in government. This Bill is totally unnecessary and it should not pass.
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. The hon. Gentleman is aware that I am watching very carefully the matters that he is addressing in the House right now. He must speak to the Bill. We are discussing whether the Bill should have a Second Reading and go into Committee.
David Tredinnick
Madam Deputy Speaker, you are kind to draw that to my attention. I simply say this: there are different regulatory bodies—not just Monitor—that we should consider. We should be taking on board the fact that osteopaths, chiropractors and homeopathic doctors are regulated by separate Acts of Parliament, yet the Health and Care Professions Council regulates clinical scientists, paramedics, physiotherapists. The Professional Standards Authority, which is another regulatory body, provides oversight of nine statutory bodies. Then there is the umbrella body, the Complementary and Natural Healthcare Council. I will leave it at that, as I do not wish to stray. On the safety aspects of those bodies, I understand from Balens, which has been insuring support services for 10 years, that there has not been a claim against a herbalist for more than 10 years.
The Bill partly addresses the issue of the transatlantic trade and investment partnership. Across the world, there is a whole mass of new thinking that could be incorporated in our health service. I am nervous that if we take out TTIP—if an exemption for the NHS is proposed—it will not be in our interests. In America there are a lot of integrated practices, in which a range of different health disciplines are brought together to reduce costs.
Sir Oliver Heald
On a point of order, Madam Deputy Speaker. I may have inadvertently said that the contract was let, but I do not believe that I did. The true position is that it was the right hon. Gentleman who took the decision to privatise the services in that hospital, and it is wrong for him to seek to deny it. [Interruption.]
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I appreciate that the hon. and learned Gentleman wishes to ensure that the record is set straight. He has attempted so to do, but it is not a point of order for me to deal with.
Andy Burnham
“Attempted” is the operative word, Madam Deputy Speaker. The hon. and learned Gentleman says that it was my decision, but it was the decision of his right hon. Friend the Member for South Cambridgeshire (Mr Lansley). He did it when their Government came in, and the hon. and learned Gentleman should have the good grace to withdraw what he said.
I was in the middle of answering the intervention from the hon. Member for Cambridge (Dr Huppert)—the hon. and learned Gentleman should listen to this, because he will get his answer. I said that the process should go forward under the NHS preferred provider principle, which I introduced—he seems not to understand that. To correct him, when the previous Government left office there were three bidders, one of which was an NHS provider, so he really needs to get his facts straight—
Dr Huppert
On a point of order, Madam Deputy Speaker. The right hon. Gentleman claimed earlier that one of the bidders at Hinchingbrooke was an NHS provider, but according to the National Audit Office there was Circle, Serco and Ramsay. Can he now either correct the record for the House, or let us know which of those three he believes is an NHS provider?
Madam Deputy Speaker (Mrs Eleanor Laing)
The hon. Gentleman makes a perfectly good point of debate, but it is not a point of order.
Andy Burnham
We have spineless Government MPs who will not come here today to argue for the Act.
I congratulate the hon. Member for Rochester and Strood (Mark Reckless) on his victory and on being here today, despite being up all night—I cannot imagine that he managed to get any sleep. His party leader has said that when the hon. Gentleman is tired he says things that he does not mean—I think that he just nodded there. Given that he has been up all night, I can only conclude that he does not actually believe what he said in the speech we just heard. In three days he has gone from being in favour of the repatriation of European citizens to being against the privatisation of the NHS. That is a pretty big political distance to cover in just three days.
Sir Tony Baldry
On a point of order, Madam Deputy Speaker. There is so much noise coming from the Opposition Bench below the Gangway that it is impossible even for someone who is as near to the Minister as me to hear what he is saying. Given that Labour Members appear to support this Bill, it would be a courtesy for them at least to listen to the Minister with some attention.
Madam Deputy Speaker (Mrs Eleanor Laing)
The right hon. Gentleman knows very well that all Members exercise their right to speak loudly, quietly, in stage whispers and in other ways in this Chamber. I am listening very carefully to the level of noise, and if it reaches much higher than it already has, I will ask Members to be more courteous to the Minister. However, I am quite sure that the Members present will wish to be courteous to the Minister and to hear what he has to say.
Dr Poulter
Thank you, Madam Deputy Speaker. I am sure that Members in all parts of the House—although perhaps not the hon. Member for Rochester and Strood—would like to reaffirm their commitment to and the value they place on all NHS staff, no matter what background or culture they come from. We want those staff to continue to practise in and work for our NHS to the benefit of patients.
Dr Poulter
Thank you, Madam Deputy Speaker.
The point was articulated very well by my right hon. Friend the Member for Banbury (Sir Tony Baldry) in one of the best and most accurate speeches of this Parliament in an NHS debate.
Madam Deputy Speaker
There has been much discussion this morning about who has said what about what. My concern in the Chair is that the Bill should be discussed. That is the matter before the House, and we will discuss it.
Dr Poulter
Thank you, Madam Deputy Speaker. I think the tone of that point of order made my point for me better than I could have done.
As my right hon. Friend the Member for Banbury said in what was one of the best speeches on the NHS I have heard in this Parliament, the Health and Social Care Act 2012 did not introduce competition into our NHS. To say that it did is factually incorrect, scaremongering and distracts the NHS from addressing the key issues it faces. It was the creation of a mixed health economy, implemented by the previous Labour Government, that exposed our NHS to competition law, not the introduction of the Health and Social Care Act.
Off-patent Drugs Bill
Baroness Laing of Elderslie Excerpts(11 years, 3 months ago)
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Mr Jamie Reed
On a point of order, Madam Deputy Speaker. I seek your guidance on whether or not it is in order for Government Whips to instruct their own Members not to vote in order to ensure that the Division was not quorate.
Madam Deputy Speaker (Mrs Eleanor Laing)
I understand why the hon. Gentleman wishes to draw the House’s attention to what happened, but he knows as well as I do that the behaviour and actions of Government Whips is no business of the Chair.
General Practices (Coventry)
Baroness Laing of Elderslie Excerpts(11 years, 3 months ago)
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Madam Deputy Speaker (Mrs Eleanor Laing)
I call the Minister, and the House wishes him a happy birthday.
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. It being Five o’clock and there being a total lack of Whips in the Chamber—
Jim Fitzpatrick (Poplar and Limehouse) (Lab)
I beg to move that the House do now adjourn.
Madam Deputy Speaker
I am grateful to the hon. Gentleman for his attempt to be helpful, but I will invite the Minister to move that the House do now adjourn, after which he may recommence his speech.
Motion made, and Question proposed, That this House do now adjourn.—(Dr Poulter.)
Dr Poulter
Thank you, Madam Deputy Speaker. I apologise for the lack of the usual accompanying member of the Treasury Bench team to conclude proceedings, but I am pleased to continue the informative debate we have been having.
I was addressing the point about practice closures. The way the information is collected sometimes leads to a headline of “practice closures”, but it may well be that practices have merged, and it is important to recognise that when we have a debate, even an informed one such as this. When a number of practices have co-located locally to improve premises and there has been improved investment, that is an enhancement of services; it in no way diminishes the services available to patients. I do not know the details of each and every surgery in Coventry, but clearly collaboration has taken place, along the lines of the Darzi model outlined by the hon. Member for Coventry North West, whereby surgeries can pool their resources and work together. That can bring benefits to all their patients and mean an additional freeing up of money to invest in other community-based health services, for example, physiotherapy or speech and language therapy. That approach has worked well in many parts of the country, including in the examples I gave in Coventry.
I understand that NHS England has also given approval for new premises for the Prior Deram Walk practice in Canley, Coventry, with the new facility expected to be completed next summer. Ongoing investment is taking place locally. Practices in Coventry have a good provision of extended hours, through the enhanced service for extended hours, and have adopted online booking for appointments and repeat prescriptions. NHS England’s area team monitors complaints from patients and is currently receiving no complaints about access or difficulty in registering with a practice in the Coventry area, although if there are concerns, I would be happy to take an intervention.
Madam Deputy Speaker (Mrs Eleanor Laing)
I am grateful to the hon. Gentleman for his point of order. I recall the lively debate and the lively bit of road to which he refers. The House is grateful to him for coming forward with his usual courtesy and sense of duty in order to set the record straight.
Question put and agreed to.
NHS Services (Access)
Baroness Laing of Elderslie Excerpts(11 years, 4 months ago)
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Madam Deputy Speaker (Mrs Eleanor Laing)
Order. The right hon. Gentleman is not giving way. He must be allowed to speak.
Mr Hunt
The Government are proud of our record on the NHS in England: more operations for more people; three quarters of a million more people getting the cancer treatment they need; record numbers being seen promptly in A and E; record numbers getting treatment for dementia; and the first ever introduction of maximum waiting times for mental health conditions. It is an NHS under pressure, yes, but it is an NHS preparing for the future, with higher-quality care in hospitals, integrated health and social care, and personal care driven by a much bigger role for GPs.
Some of those changes need money, and we have delivered that, but some of them need a change in culture, different ways of working, more transparency and a more patient-centred approach. That can mean challenging the system, which the right hon. Member for Leigh has never been prepared to do, but which this Government will always do if it is right for patients. We want an NHS building for the long term and an NHS with the confidence of a strong economy behind it. Under this Government, the NHS is independently rated as the best in the world. I oppose the motion.
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. The House will be aware that a great many hon. Members have indicated they wish to speak and that there is limited time available for their speeches. With my apologies for my inability to articulate—I did not catch my sore throat from the Leader of the Opposition—I have to set a time limit of six minutes.