Oral Answers to Questions
Grahame Morris Excerpts(7 years, 10 months ago)
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Stella Creasy (Walthamstow) (Lab/Co-op)
Grahame Morris (Easington) (Lab)
The Minister for Health (Stephen Barclay)
Nursing remains a strong career choice, with more than 22,500 students placed during the 2017 UCAS application cycle. Demand for nursing places continues to outstrip the available training places.
Stephen Barclay
It is not a false economy to increase the supply of nurses, which is what the changes have done. Indeed, they form part of a wider package of measures, including “Agenda for Change”, pay rises and the return to practice scheme, which has seen 4,355 starters returning to the profession. More and more nurses are being trained, which is why we now have over 13,000 more nurses than in 2010.
Grahame Morris
I respectfully remind the Minister that this is about recruitment and retention. The RCN says that we can train a postgraduate nurse within 18 months, which is a significant untapped resource, so why are the Government planning to withdraw support from postgraduate nurses training, too?
Stephen Barclay
We have a debate involving postgraduate nursing tomorrow, but the intention is to increase the number of such nurses by removing the current cap, which means that many who want to apply for postgraduate courses cannot find the clinical places to do so. That is the nature of tomorrow’s debate, and I look forward to seeing the hon. Gentleman in the Chamber.
Cancer Strategy
Grahame Morris Excerpts(8 years, 1 month ago)
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Grahame Morris (Easington) (Lab)
I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for opening this debate on behalf of the hon. Member for Basildon and Billericay (Mr Baron), and I pay tribute to his excellent work over many years as chair of the all-party group on cancer. I am delighted to support this debate, and as someone who has always taken a key interest in cancer strategy, I wish to highlight three issues. Pancreatic cancer has been well covered by my hon. Friend the Member for Scunthorpe (Nic Dakin), so I will refer to it only briefly. I also want to mention transformation funding and make a plea to the Minister, and I will say something about advance radiotherapy—a hobbyhorse of mine.
As hon. Members may be aware, I have recently recovered from a reoccurrence of lymphatic cancer, so I have first-hand knowledge of the importance of getting the cancer strategy right, not least in terms of early diagnosis and appropriate treatment. Delivering the recommendations set out in the cancer strategy is crucial to improving care and support for thousands of people affected by cancer. I do not seek to make a party political point about the nature of that policy, but essentially it requires resources, a plan, a strategy and commitment.
Sadly, pancreatic cancer has taken friends of mine, and it is particularly nasty. It has the worst five-year survival rate of the 20 most common cancers at less than 7% across the UK—a figure that has hardly changed over the past 40 years. In most other types of cancer, survivability has gone up. For pancreatic cancer, however, it has remained fairly flat. We urgently need investment and action, because pancreatic cancer is set, on current trajectory, to become the fourth biggest cancer killer by 2026. Currently, 80% of pancreatic cancer patients are diagnosed at the stage where the disease is advanced. Surgery is the only potential curative treatment, but sadly it is not an option when the disease is at an advanced stage. As far as I am aware, pancreas transplants are not an option. Early diagnosis is therefore absolutely key to improving the appalling survival rates and ensuring that patients are able to live longer following diagnosis.
I looked up the figures for my own area. Between 2010 and 2014, pancreatic cancer took the lives of 188 people in the Easington, Durham dales and Sedgefield clinical commissioning group area. It is clear that much more work is needed to deliver the kind of change we must see for the people affected, and their families, so we can achieve the improvements in survival rates that are so desperately needed.
Not long ago, I had the pleasure of visiting a local National Citizen Service group of young volunteers in my constituency—I think many Members have taken similar opportunities. The House might be interested to note that one group of young people were raising money for a chemotherapy ward because of their personal and family experiences. They thought that the facilities available were inadequate. This was because the ward, although filled with excellent and committed staff, was grappling with an increase in demand and a lack of funds. These young people raised enough money to buy an assortment of things, including floor fans to keep the patients cool. It is an indictment that, when we are putting additional money into the recovery fund and encouraging people to get through the treatment and to go on, we are relying on charitable donations.
At the Britain against Cancer conference 2016, the chief executive of NHS England announced £200 million of funding for treating cancer, along with improving early diagnosis and funding stratified pathways. The money was intended to support the roll-out of the recovery package. However, since this transformation funding was announced, there have been significant delays in its reaching cancer alliances, with only nine of 16 alliances having received funding. At the Britain against Cancer conference in December 2017, the Secretary of State for Health said that the release of funding to cancer alliances would be delayed in areas that were unable to demonstrate an improvement in their 62-day waiting time standard. That was an additional requirement that had not been included as part of the original criteria set during the bidding process.
Every person diagnosed with cancer—it does not matter where they live—should be able to rely on timely diagnosis and treatment when they are told they have cancer. However, as the final report from the all-party group on cancer’s inquiry concluded, the delayed release of funding to the cancer alliances has had a significant impact on their ability to make progress. I hope the Minister is paying attention, because I want to ask him a question.
Grahame Morris
I am very glad to hear it, because this is a serious point. The Department of Health and Social Care must decouple the release of transformation funding to cancer alliances from progress against the 62-day waiting time standard. I hope the Minister will address that point in his remarks. [Interruption.] I look forward with anticipation to his remarks.
It would not be a contribution on health from me if I did not mention advanced radiotherapy. I have raised regularly its benefits and advocated further investment in its research. Investment and research, given the cost, should be evidence-based, but there are some really quite exciting areas: in particular, proton beam therapy—I visited University College Hospital in London for part of my treatment and saw the installation of the proton beam therapy bunker and equipment there; stereotactic ablative body radiotherapy; adaptive radiotherapy based on advanced imaging—a kind of magnetic resonance linear accelerator; combinations of radiotherapy and novel drugs; biomarkers with selections for altered radiotherapy strategies so that radiotherapy can precisely target the cancer cells; and molecular radiotherapy. It is necessary that we evaluate the use of these new radiotherapy techniques and compare them with conventional radiotherapy and some surgical techniques, as radiotherapy is sometimes more effective than surgery and pharmaceutical products. I am advocating that they be used not instead of, but alongside other treatments and following considerable evaluation. This could result in better outcomes and reduced treatment costs.
Finally, I would like to thank all my colleagues on the all-party group on cancer, the cancer charities that continue to do excellent work and all those in our national health service working in cancer prevention and treatment.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for leading the debate and for her excellent speech, and I thank the hon. Member for Basildon and Billericay (Mr Baron) for securing the debate. He is not in the Chamber, but I also want to thank him for the excellent contribution that he has made to the work of the all-party parliamentary group on cancer for many years. His expertise and passion about this matter are what has made the APPG so successful.
I also thank the other Members who have made excellent speeches about this important issue. I thank the hon. Members for Bosworth (David Tredinnick), the hon. Member for North Warwickshire (Craig Tracey), with whom I co-chaired the all-party parliamentary group on breast cancer—he raised the important issue of breast density, which, as he said, is an issue on which we really do need to make progress—the hon. Members for Dumfries and Galloway (Mr Jack) for Chippenham (Michelle Donelan), for Strangford (Jim Shannon), and for Inverclyde (Ronnie Cowan), the Scottish National party spokesman. I thank my hon. Friends the Members for Coventry North East (Colleen Fletcher), for Scunthorpe (Nic Dakin), and for Bristol West (Thangam Debbonaire), and my hon. Friend the Member for Lincoln (Karen Lee). She is no longer in the Chamber, but she made a powerful and emotional speech about her daughter, who would be so proud of her bravery today—as, I am sure, her grandchildren will be. I hope that the whole family were watching the debate today. I also pay tribute to my hon. Friend the Member for Easington (Grahame Morris), who, I think, has fought cancer twice.
Mrs Hodgson
It is an absolute pleasure to see my hon. Friend in his place. Long may he stay there.
Cancer is, understandably, a very emotional topic. One in two people in the UK will be affected by cancer in their lifetimes, and, as we have heard from almost everyone who has spoken today, we have all been affected in some way ourselves. When my children were very small, I lost my mother-in-law to breast cancer. That is one of the reasons why I joined the all-party parliamentary group on breast cancer, and I am vice-chair of the group to this day. It is this emotion that encourages us and gets us all to come together to tackle cancer.
Over the years, there has been a steady improvement in cancer survival rates in England. However, we still lag behind the improvements of our European counterparts, and the number of new cancer cases continues to rise year on year. If these trends continue, it is estimated that by 2020 some 2.4 million people in England will have had a cancer diagnosis at some point in their life. That is why the Government must take urgent steps so that cancer diagnosis care and outcomes in England can be improved.
The cancer strategy was a welcome step forward to achieving the best cancer care and outcomes in the world, and Labour is fully committed to delivering, and helping to deliver, that strategy in full. However, as has been mentioned, there are some concerns across the House about the progress of the strategy. I am pleased that some of the targets have already been met, but I am under no illusions—many are no closer to being reached than they were almost three years ago. Will the Minister today commit to publishing a detailed progress update on each of the 97 cancer strategy recommendations by the end of this financial year, so we are all able to celebrate success but also focus our attention on more pressing challenges where needed? There are many challenges that the Government must face before achieving world-class cancer outcomes, but I will touch on only a few today: early diagnosis; waiting times; the workforce; and prevention.
On early diagnosis, we know that if a cancer is diagnosed early, treatment is more likely to be successful, but for cancers such as ovarian cancer and lung cancer it is often too late. The National Cancer Registration and Analysis Service found that over a quarter of women with ovarian cancer are diagnosed through an emergency presentation. Of those women, just 45% survive a year or more, compared with over 80% of women diagnosed following a referral by their GP. I should state at this point that I am chair of the all-party group on ovarian cancer. Similarly, research by the British Lung Foundation found that more than a third of lung cancer cases in England are diagnosed after presenting as an emergency. As a result, the Roy Castle Lung Cancer Foundation found that, if caught early, a person has up to a 73% chance of surviving five years or more. However, the current five-year survival rate for lung cancer is just 10% and, sadly, one in 20 lung cancer sufferers was not diagnosed until they had died. Cancer survival rates have doubled over the last 40 years, but those are shocking statistics. I therefore ask the Minister what his Department will be doing to ensure that cancers are detected even earlier, so that patients are no longer pushed from pillar to post trying to find a diagnosis.
Unfortunately, we know that once a patient has been diagnosed, they then have an agonising wait for treatment. Even if it was a wait of just a week, it would be agonising, but the 62-day target between urgent GP referral and treatment has not been met now for two years, meaning that patients are having to wait much longer than they should for treatment. Since the target was first breached in January 2014, over 95,000 people have waited for more than two months for treatment to start. Cancer patients should not be expected to wait so long. I therefore ask the Minister what his Department is doing to address this issue.
It is no secret that the NHS and the NHS workforce are under extreme pressure due to underfunding and understaffing by this Government. I want to place on record the fact that Labour Members do not take the NHS workforce for granted. We are incredibly grateful to them for their hard work, support and kindness to patients and their families. They are doing an incredible job despite the circumstances we currently find ourselves in, and we should never stop thanking them for the work they do to diagnose, treat and care for patients. The cancer workforce really are the backbone of the cancer strategy.
The improvement of early diagnosis and waiting times relies on an efficient cancer workforce, so the Minister must make these concerns a top priority if the targets in the cancer strategy are to be fulfilled. A report by Macmillan Cancer Support found that more than half the GPs and nurses surveyed in the UK say that, given current pressures on the NHS workforce, they are not confident that the workforce are able to provide adequate care to cancer patients. That is deeply worrying. The NHS workforce should be suitably equipped to diagnose, support and care for cancer patients, during and beyond cancer.
Through my work with the all-party parliamentary group on breast cancer, I have heard—as I am sure the Minister did during his time as the group’s co-chair—of the overwhelming support that a cancer nurse specialist can bring to breast cancer patients and their families. As we have heard, however, patients with secondary breast cancer are unlikely to have access to a cancer nurse specialist. Research from Breast Cancer Care shows that 42% of hospital trusts and health boards in England, Scotland and Wales do not provide dedicated, specialist nursing care for people with secondary breast cancer, even though they often have complex emotional and supportive care needs. Patients with secondary breast cancer are subject to a postcode lottery when it comes to having a cancer nurse specialist. What steps is the Minister taking to ensure that every cancer patient has access to a clinical nurse specialist?
There is no doubt that, if the cancer workforce had the time, resources and support they so desperately need, the recommendations in the cancer strategy would be achieved. I know that that is something the cancer workforce plan, published in December last year, aimed to address. Will the Minister update the House on the progress of the plan and outline how much funding the Government will be granting to ensure that the proposals in the plan soon become a reality? The NHS cancer workforce care for and support their patients every day, and we really need the Government to support the workforce, too.
Finally, I move on to the first issue raised in the cancer strategy: prevention. The World Health Organisation estimates that a third of deaths due to a cancer are the result of the five leading behavioural and dietary risks: high body mass index; low fruit and vegetable intake; lack of physical activity; tobacco; and alcohol. The subject of alcohol was raised by my amazing hon. Friend the Member for Bristol West. Tobacco was identified as the most important risk factor, responsible for approximately 22% of cancer deaths. Taking all five risk factors into account, it is estimated that between 30% and 50% of cancers could be prevented.
The Government’s tobacco control plan—which the Minister thankfully pushed to be published in his first weeks in the job—and the childhood obesity plan are welcome steps towards reducing the high rate of preventable cancers, but they will not go far enough if the Government continue to slash public health budgets. Will the Minister therefore commit to strengthening public health budgets, so that fit and healthy lifestyles can be encouraged across all our communities and help to contribute to cancer prevention? I know that, like me, he is passionate about making sure that England is one of the world leaders when it comes to cancer outcomes, but we are currently lagging behind. However, with the right funding and support from the Government, the cancer strategy has the potential to achieve that. I hope that he will take on board all that we have heard today and go back to his Department with an action plan of how best to move forward, so that we can really achieve world-class cancer outcomes in 2020.
The Parliamentary Under-Secretary of State for Health (Steve Brine)
I should like to thank my friend the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), for her remarks. I congratulate the members of the all-party parliamentary group on cancer on securing the debate, in particular the hon. Members for Scunthorpe (Nic Dakin) and for East Kilbride (Dr Cameron)—I shall leave it at that in describing the hon. Lady’s constituency, lest I make a total fool of myself. As the cancer Minister—Members will know that that is the job I always wanted to do—I thank them for the constant work they do on the all-party group and on the Britain Against Cancer conference. Linked to that, I want to extend my appreciation to the Members on both sides of the House who chair the all-party parliamentary groups on different kinds of cancer for the work they do. Some of them are here today. As has been mentioned, I was a co-chair alongside the shadow Minister and the previous Member for Mid Dorset and North Poole and we were quite a team. We were often referred to as Steve and the girls—I found my inner girl. We chaired the group together for five years and I was so proud to do that. We met some amazing people and I think we did some good.
With the shadow Minister, I was also vice-chair of the all-party parliamentary group on ovarian cancer—she still chairs that group—so I know how important it is that Parliament allocates time for this subject, both upstairs in the APPGs and here in the Chamber. Looking at how many people are in the Public Gallery and around the Chamber, this is about quality more than quantity. I say to those watching today who may say, “This is a debate on the cancer strategy. This is so important. Why isn’t the House as full as it is for PMQs?”—this is not all about what goes on in here. This is about what goes on in government, what goes on upstairs in the APPGs and Select Committees and, for so many Members, what goes on within ourselves. I did not know the shadow Minister’s motivation for chairing the APPG. I have never said my motivation—I will one day—but I realise now why she was so passionate.
The hon. Member for East Kilbride pretty much summed things up in the first line of the first speech of this debate when she said that we are all “on the same side” when it comes to cancer—what a brilliant way of putting it. The hon. Member for Coventry North East (Colleen Fletcher) talked about her husband, who lives with cancer. Macmillan has been brilliant with some of its communications, and we have all seen the television adverts saying that a mum with cancer is still a mum. There are so many people who are living with and beyond cancer—they call it “survivorship” in America—and we should always remember that.
Let me start by reassuring the House, if I need to, that cancer is a huge priority for me, for the Secretary of State and for this Government. As several Members have said, cancer survival rates have never been higher, and the latest survival figures show an estimated 7,000 more people surviving cancer after successful NHS cancer treatment compared with three years prior. Our aim is to save 30,000 more lives by 2020 through the cancer strategy that we are debating.
However, I know more than anybody that there is still so much more to do and so much potential, which is why we accepted all 96 recommendations in the cancer strategy. We have backed that commitment with over £600 million of additional funding up to 2021. We are now just two years into the implementation of the strategy, and the fantastic NHS cancer doctors and nurses supporting us to achieve our vision have made tremendous progress in many areas. I echo what many Members have said in their support.
The shadow Minister and others asked whether I will report back on how we are doing on all this. In October, NHS England published its “two years on” report on the day that I gave evidence to the all-party parliamentary group on cancer’s inquiry, which led to its report and to this debate. That was our latest progress report, and I hope that we will be doing something again later this year. NHS England’s national cancer director, Cally Palmer, who is based at the Royal Marsden Hospital and is an incredible lady with whom I enjoy working, is leading the implementation of the strategy. She agrees with me that there are many areas where we agree with the APPG’s report. We do not shy away from scrutiny, which is exactly why we are here. However, progress in many areas was not given sufficient prominence in the APPG’s analysis of progress. We said that at the inquiry. It is important that I put that on the record.
The measure of the strategy’s success will of course be about significant improvements in early diagnosis, which I will come on to, and obviously treatment and research. However, I am increasingly aware in this job that we need to make cancer services even better beyond 2020 and that there needs to be a greater focus on a fourth pillar—the “fourth Beatle”, if you like—which is prevention. Of course, we want to be the best in the world at delivering positive outcomes for patients after a diagnosis, but we have to understand the position. Earlier this week, I responded to a Westminster Hall debate attended by Members from Oxfordshire. There has been a 120% increase in the number of people presenting with cancer in Oxfordshire alone in recent years.
The number of people presenting with cancer continues to rise. We can do very well on the first three pillars, and we are, but prevention is where we will really move the dial. That is why my whole mission as the Minister for primary care and public health, a role created by this Health Secretary, has been to put in place a comprehensive system of measures to reduce the risk of cancer, as well as to treat cancer when it occurs.
As my hon. Friend the Member for Chippenham (Michelle Donelan) and the shadow Minister mentioned, one of my first acts as Minister was to launch the tobacco control plan. Why was I so keen to get it out there? Because we promised we would, but also because tobacco is the biggest preventable killer in our country today. The previous Labour Government and this Government have done well with the legislative framework. It is now about supporting local areas to continue bringing down the number of people who smoke from what are already record lows and to ensure that people do not start smoking in the first place.
Last year, we also launched a cross-Government air quality plan, which has been in the news and in the House this week. That plan is important, too, because it will significantly reduce the carcinogens in the air we breathe, which we know has a big impact on the development of disease. Furthermore, in 2016 we published our child obesity strategy, which was just the start of a conversation about how we will reduce child obesity over the next decade. Our overarching focus in all that work is to ensure that our children are supported to live healthy, active and happy lives, so that they grow into healthy, active adults who are less likely to develop cancer. We have always said that the child obesity strategy is constantly under review—it is part one—and we will go further, if needed, to build on that.
As has been mentioned a few times in this debate, perhaps the biggest game changer in preventing cancer is the world-leading work on genomics happening in our country. The chief medical officer’s 2016 annual report, “Generation Genome,” which was published the year before I was appointed, set out the huge potential for genomics in helping us to understand the inherited and acquired genomic causes of cancer and in shaping future research and future personalised cancer treatment, which is so important—it is something we should talk more about, as we should the whole prevention agenda.
Many subjects have been raised today and I am grateful to you, Madame Deputy Speaker, and to Members for giving me time to respond to them. As I suspect she would like me to do, I will give a couple of minutes to the hon. Member for East Kilbride, who opened the debate.
As I have already said, the workforce is key to our strategy. We have already committed to investing in and expanding our diagnostic workforce to improve survival rates by diagnosing cancer earlier. The first ever cancer workforce plan, which Health Education England published in December, set out how we will expand our workforce, how we will continue to invest in the skills of the staff we have, and how we will use their time and expertise where it is most needed.
HEE has already committed to training 746 more cancer consultants and 1,890 more diagnostic and therapeutic radiographers, which we know are in short supply, by 2021. The plan further commits to the expansion of capacity and skills, including 200 additional clinical endoscopists and 300 reporting radiographers by 2021. HEE will also expand the number of clinical nurse specialists, as the shadow Minister rightly mentioned, and develop common and consistent CNS competences, with a clear route into training, to ensure that every cancer patient has access to a CNS or other support worker by 2021—that subject was constantly raised when I chaired the all-party group. HEE will follow the plan later this year with a longer-term strategy looking at the workforce needs beyond 2021.
The hon. Member for East Kilbride and others, including the hon. Member for Easington (Grahame Morris), talked about the link between the 62-day standard and the performance and phasing in of transformation funding. Cancer alliances, as the House knows, are an important mechanism for improving performance on the 62-day standard from urgent referral through to treatment. They bring together clinicians from primary and secondary care, as is right—one NHS. They ensure collective responsibility for the cancer services they provide, and they provide the necessary leadership for the transformation of services. So £76 million of funding has already been allocated to the cancer alliances.
It is imperative that the alliances have the operational rigour and readiness to achieve the transformation that we need. After all, our constituents’ money is being allocated. So it is only right and proper, as the Secretary of State made clear in the question and answer session at Britain against Cancer, that the alliances demonstrate their preparedness for this funding. That is not to say that the 62-day standard is a requirement, but it does give a basis on which NHS England and NHS Improvement, along with other senior clinical advisers, can assess an alliance’s readiness to transform services. Transforming services is what we want to do.
Grahame Morris
What happens when cancer alliances do not achieve the 62-day target? It seems completely perverse that individuals suffering from cancer in those areas are penalised by lack of funds from the transformation fund. Is the Minister saying that those cancer alliances can still apply for that funding and measures will be put in place to ensure that they do reach that target?
Steve Brine
Yes, this is not hard and fast. I noted that NHS England has written to me as a constituency MP and to all other MPs today with details of the cancer alliances that they have in their individual areas. I bang on about this every time, as the shadow Minister knows, but I implore Members to engage with their local cancer alliances. I suspect that the people in this debate do that, but I would hazard a guess that many other Members do not. Members should know who the cancer alliances are in their areas and should have a relationship with them.
Let me now discuss CPES, which the hon. Member for Strangford (Jim Shannon) mentioned, as did the hon. Member for Lincoln (Karen Lee). On her speech, let me just say, wow. I said to my officials before this debate that there is always one speech in these debates—the shadow Minister was that person a few weeks ago—who leaves not a dry eye in the House, and today it was the hon. Member for Lincoln. I know she is not in her place now and I do not blame her for that. I think the whole House wanted to run over to give her a hug—many Labour Members did, and bless them for doing that. I think that the House, in its own way, gave her a collective hug, and I say well done to her for an amazing speech.
We totally recognise how important CPES is in our continued drive to improve cancer treatment and care, and to monitor that progress. I have always been clear that I want any future survey to continue to deliver the high-quality data that CPES does. I can tell the House that CPES will continue in its current form in 2018-19. We will engage with the cancer community to ensure that any decisions about future delivery and the model to be adopted, should the commissioning arrangements be revised, are informed by all parties and ultimately protect the integrity of the survey and quality of the data. I saw Dame Fiona Caldicott last week in Oxford and discussed the subject with her. Obviously, her work as the patient data guardian led to the challenge we now have—it was necessary work, but it certainly left us with a challenge. Cally Palmer, the national cancer director, and I will meet all the major cancer charities next week at my second roundtable, and this is on the agenda and we will be discussing it with them. I hope Members know that CPES remains very much at the top of my agenda.
Let me touch on early diagnosis, because everybody else has and because it is one of the most important shows in town. In every conversation I have ever had about how we can beat cancer, I have been told, “Early diagnosis”. Historically, our cancer survival rates have lagged behind the best-performing countries in Europe and around the world. The primary reason for that is, without question, late diagnosis. Sir Harpal Kumar will stand down as chief executive officer at Cancer Research UK shortly, but I had the privilege of having lunch with him a few weeks ago, when I asked him what we should think about in terms of the next cancer strategy. He said, “The rock upon which you build your church is early diagnosis.” I will not forget that, which is why one of the key priorities of the strategy is to diagnose cancer earlier, when the disease is more treatable.
How are we doing that? As part of our drive to ensure early diagnosis, we are also introducing the new 28-day faster diagnostic standard from GP referral to diagnosis or the all-clear. I have often said, and I repeat now, that 28 days is not a target; it is a maximum. I well know that when people have a cancer worry, 28 minutes seems like a lifetime, let alone 28 days. However, the 28-day standard is really important. It will be introduced from April 2020. Five pilot sites have started testing the new clinical pathways to ensure that patients find out within 28 days whether they have cancer or the all-clear.
Today, Public Health England, for which I have ministerial responsibility, has launched its 14th “Be Clear on Cancer” campaign, which focuses on breast cancer in women aged over 70, something monitored by my hon. Friend the Member for North Warwickshire (Craig Tracey)—my excellent successor chair of the all-party group on breast cancer—mentioned. That campaign will run until the end of March. It focuses on age-related risk, encouraging older women to be breast aware, and particularly to be aware of non-lump symptoms, which, understandably, have lower levels of awareness.
The other point I want to make on early diagnosis is that we know that the hardest cancers to detect are those where early symptoms can be vague and often symptomatic of less serious illnesses. Patients often see their GP multiple times before that all-important referral. That is why we are piloting 10 multidisciplinary diagnostic centres as part of wave 2 of what we call the ACE— accelerate, co-ordinate and evaluate—programme. Patients presenting to their GP with vague symptoms can be referred to an ACE centre for multiple tests, one after the other, and receive a diagnosis or the all-clear on the same day. The initial findings are incredibly exciting; I do not get easily excited, but I am excited about this. I had the pleasure of visiting one of the ACE pilots at the Churchill Hospital in Oxford last Tuesday, during recess, and I have to say that the enthusiasm and feedback I got from clinicians and patients about the potential of the ACE centres were really quite incredible. I look forward to seeing the analysis on that work in the coming months.
The shadow Minister talked about emergency room presentations, which are something I was quite shocked by as a Back Bencher when I went to all-party group meetings. It is true that emergency room presentations for cancer are horrible, but that is why the 28-day standard and the ACE centres are so important. When I talk to GPs, they tell me that they will refer and that there will then be a wait. Patients who are, understandably, worried and terrified may then present themselves at an A&E, at which point they may be diagnosed with a primary cancer. That then hits the stats around emergency room presentations for cancer. It does not mean that those people have been carried in; they have often walked in. That all explains why we need to grip early diagnosis better than ever.
My hon. Friend the Member for Bosworth (David Tredinnick) talked about Baroness Jowell’s speech in the other place last month. The Secretary of State was there to listen to the speech, and it was incredibly powerful. Baroness Jowell met the Secretary of State and the Prime Minister this morning. Investment in brain cancer research has been limited by a pretty low volume of research proposals focused on the topic in recent years, and we have been working with charities, academics and the pharmaceutical industry to address that over the last 12 months.
To accelerate our efforts in brain tumour research, the Secretary of State has today announced, alongside Cancer Research UK and Brain Tumour Research, a package to boost research and investment into this most harrowing form of cancer. We have announced £20 million through the National Institute for Health Research over the next five years, with the aim of doubling this amount once new high-quality research proposals become available. CRUK has confirmed it will provide £25 million of its money over five years in major research centres and programmes dedicated to brain tumours. Today’s announcement is incredibly positive.
Oral Answers to Questions
Grahame Morris Excerpts(8 years, 5 months ago)
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Steve Brine
I thank the co-chair of the all-party group on breast cancer in what is BCAM—Breast Cancer Awareness Month. We must never forget the treatment and support we give to those living with and beyond the cancer diagnosis. We must always remember those living with secondary breast cancer and the work of the third sector—brilliant charities such as Breast Cancer Haven and Breast Cancer Care—so that we can focus on access to a specialist nurse. As my hon. Friend says, the collection of data is critical, and I will be discussing that at my roundtable with some of the main players in the cancer community later this week.
Grahame Morris (Easington) (Lab)
Will the Minister abolish the patient penalty and scrap hospital car parking charges, which punish both the sick and hard-working NHS staff, as well as causing problems for residents living adjacent to NHS hospitals, such as Peterlee Community Hospital in my constituency?
Junior Doctors’ Contracts
Grahame Morris Excerpts(10 years, 5 months ago)
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Dr Whitford
I agree.
Since coming here, I have heard stories of people unable to access diagnostic imaging or to work up patients, but there is no argument about that from the profession. That is what we need to focus on, yet a lot of this seems to be about routine. There are fewer doctors at weekends because we do not do routine work. We have teams of people doing toenail and blood pressure clinics in the week. Professor Jane Dacre estimates that doing those at weekends would require 40% more doctors. We cannot do that. We need to make sure that hospitals at weekends have enough people and the right people to be secure, but junior doctors are already there—it is not they who are missing—and emergency services already have a consultant on call. We might need more discussion about their being physically in, but that is a discussion to have with the profession, whereas what we heard on 16 July, which gave the public the impression that senior doctors only worked 9 to 5, Monday to Friday, was very hurtful to the entire profession.
Grahame M. Morris (Easington) (Lab)
The hon. Lady is making some extremely powerful and relevant arguments. I wish to make a point about the importance of junior doctors in my region, having spoken to some of them at the demonstration on Saturday. They are essential to the functioning of the service. They have the option of going not only to the Antipodes but to Scotland, where these contracts do not apply. If we lose these valued staff, it could hurt my region more.
Dr Whitford
We will roll out a red carpet somewhere on the M74 and welcome them with open arms. The progression and migration in Scotland towards robust seven-day emergency care has been happening through a dialogue, not through a threat to impose a contract.
There are other things in this, such as the plan to change pay progression, which is currently on an annual basis, to recognise experience. That will be replaced with just six pay grades. Such a move will affect women in particular, because they tend to take a career break and they tend to work part-time, so they will get stuck at a frozen level for much longer. It may also be a disincentive to people to go into research, because they will be stuck on the same rung of the ladder for longer. We do not want that disincentive. We need to make sure that we are valuing how people develop and the experience they accrue along the way.
Grahame M. Morris (Easington) (Lab)
I would like to relay some comments made to me when I participated with other colleagues in a demonstration in Newcastle attended by about 5,000 junior doctors. I had the great honour to be in the company of Dr Rachel King, a dedicated professional from South Tyneside district general named “doctor of the year” for her outstanding contribution in the field of care of the elderly, and some of her colleagues. I was struck by their commitment. They love the service, they want to protect it and they want to see their profession valued, and to that end they asked me to make a few points today.
For them, this debate is not about money, although I take issue with the claim from some Members that the reforms are cost-neutral and that doctors will not lose out. That might be the case overall, but the hon. Member for Finchley and Golders Green (Mike Freer) made a really good point: some individuals might lose out. They pointed out that junior doctors, en masse, do not support the reforms. These are clever people—the cream of the crop—and we should listen to them. They know how the service works and how it should be reformed.
They also pointed out that the reforms could increase the danger to patient safety because they might well not solve the problem of junior doctors working longer hours. As colleagues have pointed out, including the hon. Member for Central Ayrshire (Dr Whitford), the protections currently in place are to be removed, yet we have not had an assurance that something else will be put in their place. As we all know, tired doctors make mistakes. We need to address this issue about discouraging career breaks. Many junior doctors are women who leave to have children. Having spent a great deal of money on training them—the Secretary of State may be able to tell us the figure, but I believe it is in the order of £200,000 or £250,000—we want to encourage them to come back into the profession. There are concerns about not having enough people going into specialist areas.
We need to address the issue about recruitment and retention. Members representing constituencies in the north of England have touched on the issue of how attractive it would be for people to go to Scotland where the new contract does not apply. Over a period of two or three days, about 1,300 GPs made an application for the certification to practise abroad. That should be a real concern when we are having difficulty recruiting and retaining GPs. There is also a knock-on effect in general practice, but I will leave it there, given the shortage of time.
Health and Social Care
Grahame Morris Excerpts(10 years, 9 months ago)
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Andy Burnham
I remember visiting with my hon. Friend. Let us put the facts on the record. The Secretary of State said a moment ago that privatisation was not happening, but it is happening. It is affecting my hon. Friend’s constituents, where cancer scanning has now been privatised. What happened? The contract was, I believe, given to Alliance at £87 million, whereas the NHS had bid £80 million. It was given to the private sector, however, which has now subcontracted the NHS at the same price of £80 million, creaming off £7 million. That is a scandalous waste of NHS resources when the NHS is facing a £2 billion deficit this year.
Grahame M. Morris (Easington) (Lab)
Does my right hon. Friend think it is a matter of concern that a significant report by Lord Stuart Rose, a Conservative peer, was suppressed by the Secretary of State? It would have given an indication of failings in NHS management and allowed us to correct some of the problems identified.
Andy Burnham
My hon. Friend raises an important point. Again, the Secretary of State is quick to lecture about openness and transparency, but a report compiled at huge cost to the public purse by Lord Rose, former chief executive of Marks & Spencer, was not published in the last Parliament even though it was submitted to the Department months before. What possible justification can there be for that? The Secretary of State is avoiding my gaze right now. I would be very interested to hear his answer on why that report was not published, and if he wants to take to his feet now—[Interruption.] He says from a sedentary position that it was not finished. Well, if you believe that, Mr Speaker, you will believe anything. Even though Lord Rose says it was finished, the Secretary of State sent Lord Rose’s homework back and said it was not good enough. People will draw their own conclusions from what we have just heard.
We have seen a staggering deterioration in the NHS finances on the Secretary of State’s watch and a loss of financial grip across the whole system. If we are to see the finances brought under control, it means we will see more of the cuts mentioned a few moments ago.
The warning lurking behind the front page of The Daily Telegraph will not be lost on NHS staff today. The Secretary of State knows the NHS is facing very difficult times and this is an early attempt to shift the blame on to NHS staff. Basically, he is saying, “If things go wrong it’s not my fault, it’s yours because I gave you enough money.” It is the classic style of this Government and this Secretary of State in particular: “Get your blame in on somebody else first.”
Grahame M. Morris (Easington) (Lab)
I am grateful for the opportunity to participate in this debate on the Queen’s Speech and on such an important subject. It is an absolute honour to follow so many excellent maiden speeches, not least that of my very good friend my hon. Friend the Member for York Central (Rachael Maskell) and some excellent contributions from all around the Chamber.
In the time available, I want to say a few things about health inequalities, cancer treatment and cancer outcomes. In my usual, inimitable style, Minister, and in the vein of the hon. Member for South Cambridgeshire (Heidi Allen), I shall endeavour to be helpful. I have some specific suggestions to put to the Minister in the context of the Government’s commitments outlined in the Gracious Speech.
I pay tribute to the excellent work done in the campaign headed up by Lawrence Dallaglio. We can now look forward to hundreds of newly diagnosed cancer patients with some of the most complex cancers being treated with advanced stereotactic ablative radiotherapy—SABR, as it is commonly known. Although SABR is widely used in the rest of Europe and, indeed, the United States, it will be the first time that patients with cancer other than lung cancers will receive treatment here in the UK. Not only does SABR treat cancers that conventional radiotherapy cannot, but the advanced nature of the treatment is such that patients have to be irradiated four or five times, rather than 25 times with conventional radiotherapy. SABR is not only more effective and will save our cancer centres money, but, more important, it can dramatically reduce the number of times patients are exposed to radiation while still destroying the cancer.
I pay tribute to the work done by Tessa Munt, who previously represented the constituency of Wells. She was a real champion and I think it was she who initially got Lawrence Dallaglio involved. It is good news for many cancer patients—and I emphasise “many”, because those of us who live north of Birmingham would have had no chance of finding one cancer centre that could treat all the cancers that the Dallaglio campaign opened the door to. Patients in my Easington constituency in the north-east of England with a cancer that had spread to secondary sites in the body—not an uncommon condition, of course—would find themselves being treated with SABR for one cancer in one hospital, and for the secondary cancer in a hospital over 100 miles away.
For the past five years, NHS policy on purchasing advanced radiotherapy machines has been to buy the cheapest conventional machines that can do a little bit of advanced work, and as a consequence we have cancer centres dotted around the country that can treat one cancer but not another, or that, because of their limited technology, treat fewer than the minimum number of 25 SABR patients required to maintain their accreditation. With the growth of SABR treatment, that approach to SABR technology is plainly a false economy. In the long run, it costs the NHS more and means that patients receive much more radiation than is needed, which is clearly not good for them.
While SABR is used to treat cancers outside the brain, stereotactic radiosurgery—SRS—is the global standard when it comes to treating brain tumours with radiotherapy. The use of the technique was increasing year on year up to 2013, but that was brought to a crashing halt when the health reforms were brought in and NHS England came into being. To justify the suppression of SRS treatment two years ago, NHS England ordered an SRS review. I remind the Minister that that review has yet to be completed; it is turning into the longest radiotherapy review in history. Meanwhile, patients are being denied treatment with the most modern SRS machines at the hospitals of their choice—for example, University College London hospitals—and are being sent elsewhere.
I do not wish to be too parochial, but the lack of provision of SABR and SRS in the north of England is a scandal. Outside Leeds and Sheffield, the north is something of a wasteland. According to NHS England’s own figures, there is no provision at all in the north-east—my region. The suppression of SRS is yet another false economy by NHS England. The most obvious reason why it is a false economy is that a non-invasive treatment, overwhelmingly given on an out-patient basis—patients come in for the day, get treated and go home—is hugely advantageous.
Five years ago the national radiotherapy implementation group said that what was needed were centres of excellence around the country to provide advanced stereotactic radiotherapy to our cancer patients. Detailed work has been carried out, and, as has been proven in other countries, it is improving the way we treat cancer patients with radiation, and we have finally started to make some progress with this next generation treatment in the UK. With the right equipment in the right place, we could do so much better, so will the Secretary of State order an independent assessment of the benefits of having one designated stereotactic centre of excellence in each English region, and of what would be the most appropriate technology to equip them with in order to treat the greatest number of patients and the greatest number of cancers?
Jane Ellison
The issue of people surviving cancer and getting proper treatment at the right time is something that we all feel passionately about. We inherited some of the worst cancer survival rates in the world, and the previous Government did a great deal to address that, but of course there is more to do. We have always acknowledged that there is more to do to help our health system respond to issues such as cancer. That is exactly why we are looking forward to the report in the summer from the independent cancer taskforce, which will challenge us all to go further and faster on early diagnosis and treatment.
Grahame M. Morris
Will the Minister address the issue that I raised in my contribution and the advice from Lawrence Dallaglio and the experts who believe that part of the solution to the point highlighted by my right hon. Friend the Member for Slough (Fiona Mactaggart) are regional cancer centres with advanced SABR technology, which is not available in many parts of the country, including my region?
Jane Ellison
I am sure we will return to debating SABR and other cancer treatments, as we did often in the previous Parliament. The hon. Gentleman acknowledged in his speech the progress that has been made on radiotherapy, and we want to build on that.
Nurses and Midwives: Fees
Grahame Morris Excerpts(11 years ago)
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Mr Anderson
That is absolutely what the debate is about. I will point out some glaring worries that have been described to me about the capability and the effectiveness of the NMC. It is not that people do not want to pay a subscription fee; people are forced to pay a fee to be registered, and if they do not pay it, they cannot work. If they cannot work, obviously, they will not make money. The question is whether they get value for money. I am pleased that my hon. Friend the Member for Easington (Grahame M. Morris) is here, and I hope that he will talk about the findings of the Select Committee on Health, which published a report a couple of years ago that was—to put it mildly—quite critical of the NMC.
I will provide some background about what the NMC stands for, what its objectives are and why it proposed a fee increase. I will explain why the NMC fee increase was so strongly opposed by the overwhelming majority of nurses and midwives. The reasons for that opposition included the NMC’s historically poor financial oversight and management, which was highlighted in a damning report by the Council for Healthcare Regulatory Excellence in July 2012. The council criticised the NMC’s lack of focus on preventive measures to reduce fitness-to-practise referrals, the real-terms pay cut imposed by the coalition Government on hard-working nurses and midwives and the catastrophic impact that a fee increase would have on workplace planning. Finally, I will talk about the impact of future fee increases on nurses and midwives and on the care that patients will receive.
Despite heavy opposition from professional bodies and trade unions representing registrants’ views, the NMC chose to increase fees, effective from the end of last month. I want to talk about how fees could be reduced, which comes back to the point made by the hon. Member for South Down (Ms Ritchie).
Grahame M. Morris (Easington) (Lab)
I congratulate my hon. Friend on securing the debate, and I congratulate those who supported the petition. Does he agree that one of the fundamental problems is that the Nursing and Midwifery Council is spending a disproportionate amount of its budget—about 75%—on 1% of the register through the fitness-to-practise cases? There must be a more cost-effective way for it to carry out its obligations.
Mr Anderson
That is the core of the debate. I am concerned about the fact that more and more cases are being referred. It appears that there has been a failure on the part of hospital management or health management in general, who are, in some cases, referring nurses and midwives to the NMC instead of using their own disciplinary procedures. They are giving away their responsibilities, and in doing so they are adding to the cost and the work load of the NMC, which should be dealing with other issues of equal importance.
Believe it or not, the NMC is the world’s largest regulator, with 670,000 nurses and midwives on its register. It is in the unique position of having a guaranteed income of £71 million a year. What other business or organisation has such a luxury nowadays? The NMC’s primary purpose is to protect patients and the public in the UK through effective and proportionate regulation of nurses and midwives. It is required to set and promote standards of education and practice, maintain a register of people who meet those standards, and take action when a nurse or midwife’s fitness to practise is called into question. By doing so, the NMC seeks to promote public confidence in nurses and midwives, and in the regulation thereof. However, the fee rise has done little or nothing to raise the confidence of the nurses and midwives whom the NMC regulates. Many, including some in my own constituency, feel that when they voiced their opposition to the fee increase, they were opposed or—even more worryingly—completely ignored.
For a nurse or midwife to practise in the UK, they must be on the register. They have no choice. It is illegal to work as a nurse or a midwife in the UK without being on the NMC’s register. To join and to stay on the NMC’s register, all nurses and midwives must pay the annual registration fee.
Mr Anderson
The fee increase is disproportionate, but the numbers of disciplinary and fitness-to-practise cases are also disproportionate. As we will hear, the number of nurses facing fitness-to-practise issues is grossly more than the number of doctors facing such cases. That means there is less money to spend on education and training to increase registration standards for nurses, which is what we all want.
Nurses lose at every level through the way in which the system is run. The review was not just about people saying, “Please don’t make me pay more money”; it was about, “Can we have a root and branch investigation into how this organisation is run? Can we make it run better? Can we make it run in everyone’s interest?”
Grahame M. Morris
There is a valid point about nurses and midwives who are returners and working part time. This burden is falling on the profession at a time when wages have been cut in real terms by between 8% and 10% over the past five years because of the Government’s failure to implement the recommendations of the pay review body. This is a double travesty.
Mr Anderson
My hon. Friend is right. He will not be surprised to learn that I share his view. The Government are treating nurses and other public sector workers appallingly. At the same time as saying, “We will give you no pay rise,” the Government are saying, “We want 60% more off you, and if you don’t pay it, you won’t be able to work.” As my hon. Friend the Member for Mansfield (Sir Alan Meale) said, these people are being pole-axed.
To join and stay on the register, all nurses and midwives must pay the annual registration fee. The fee is tied to their employment contract, which often stipulates that anyone who fails to pay the fee will face disciplinary action by their employer and a temporary lapse from the register. Since the NMC was established under the Nursing and Midwifery Order 2001 on 1 April 2002, there have been a number of increases in the annual registration fee. Historically, nurses joined the register for life and there was no annual fee increase. The order changed that, however. In 2004 the NMC annual registration fee was £43, which increased to £76 in August 2007.
In 2011, the Council for Healthcare Regulatory Excellence was tasked with investigating the NMC. It published a damning report that criticised the NMC’s lack of leadership, poor communication, inadequate governance and poor financial management. A new chairman and chief executive were appointed and, critically, the NMC accepted the report’s findings in full—the NMC accepted that it was not doing what it was supposed to have been doing as well as it should have been doing it.
In May 2012, the NMC indicated its intent to consult on a 58% fee rise from £76 to £120 a year. Following pressure from Unison, the Royal College of Midwives and the Royal College of Nursing, the Government offered a £20 million grant to the NMC. The Secretary of State for Health agreed to the grant because he was also appalled by the regulator’s poor financial management—and he would know about poor financial management, given the state into which he has got the health service in general. The result of that grant was that the registration fee was kept down to £100 a year, although we should remember that it had gone up to £76 only a few years earlier, so there was a big increase at a time when people were not receiving pay rises.
Grahame M. Morris
Is there not an argument for placing a moral obligation on the Government to make a contribution in the wake of the Francis report, which identified failings in a number of organisations, including the Nursing and Midwifery Council? Surely the Government have an obligation to help to meet the costs in order to put things right.
Mr Anderson
I am happy to say that, although I do not completely agree with my hon. Friend. A review would allow us to have a discussion and get people involved. If the Government are too involved, some people will worry whether the NMC will lose the independence of which it should be proud, if it is running properly. I have no problem in principle with the Government helping out in any way they can, because that is part and parcel of ensuring that nurses are able to do the job that we and the public want.
The fee increase was significant because nurses and midwives have been subjected to a Government-imposed pay freeze while, outside in the real world, everyday items and household bills are increasing dramatically. As we know, figures from the Labour party and others show that people are £1,600 a year worse off than they were five years ago. It is a double whammy, to put it mildly, for hard-working nurses and midwives to be told, “You are going to be worse off—and by the way, why don’t you pay more for your registration?”
In May 2014, the NMC consulted again on increasing the fee from £100 to £120, an increase of almost 60% in two years. The Government could have offered another bail-out to allow the NMC more time to address the challenges it faces from fitness-to-practise cases, but they chose not to. The proposed annual registration fee increase was heavily opposed by all the professional bodies and trade unions that represent the views of registrants. Ninety-nine per cent. of respondents to the Unison survey opposed the proposed increase to £120 a year. In the RCN survey, the same proportion of respondents disagreed with the proposed fee rise. The anger felt by registrants is demonstrated by the e-petition condemning the proposed fee increase, which was signed by almost 114,000 people. Their feelings are reasonable and understandable.
I will now address the NMC’s poor financial management, which was highlighted in the 2011 report. The fee increase was felt to be inappropriate because it placed too big a burden on individual nurses and midwives to make up for the NMC’s poor management. The £20 million grant from the Department of Health was meant to contribute to the cost of clearing the backlog of historical fitness-to-practise cases. Despite that help, some 50 cases have been outstanding for three years or longer. The issue was reinforced by the report, and 50 cases have been on the books for the three or four years since then. In 2009, the NMC had a relatively small number of such cases, and had it taken appropriate action at that stage, there would never have been the need to increase the registration fee to such a level.
The NMC’s consultation paper on registration fees recognised that the key driver of increasing costs is the massive increase in fitness-to-practise referrals. Since 2008, the number of fitness-to-practise referrals has increased by 133%. The NMC holds two and a half times as many hearings as all the other regulators combined. Last year, the NMC spent £55 million of its £71 million budget on fitness-to-practise issues, which means that 77% of its budget is spent on fewer than 1% of registrants. In comparison, the General Medical Council, which my hon. Friend the Member for Mansfield mentioned, spent only 56% of its resources on fitness-to-practise cases involving registered doctors in 2013-14. The people who helped me to secure this debate support my contention that the NMC model is unsustainable and detrimental to the majority of registrants.
Employers are the largest group making fitness-to-practise referrals. In 2012-13, however, 40% of fitness-to-practise referrals were closed during the initial assessment. Employers were making referrals that were not fit to be heard but that had to be heard, and the cost of those hearings comes directly out of the purses and wallets of nurses and midwives. It has been suggested to me that, following the Mid Staffordshire NHS Foundation Trust public inquiry, employers have become increasingly risk- averse and are using the fitness-to-practise referral process instead of internal processes and procedures to address performance and disciplinary issues. Instead of taking cases on themselves, employers are referring them to the NMC at unsustainable cost.
Inappropriate referrals block the system and add to costs, which is why it is important that the NMC assesses whether it is appropriate for employers to refer so many cases. The NMC could do that by including employers in reviewing the reasons for the dramatic increase in referrals since 2008. Is there a crisis? Is there a problem? Is there something wrong with the practice? If employers sit around the table with the NMC, perhaps they will get to the bottom of the situation.
The NMC should also take a more proactive approach to the promotion of education and standards as part of a preventive measure that could contribute to reducing the number of fitness-to-practise cases referred to the regulator. There should be an equally strong commitment to public protection, because that will prevent harm in the first place.
I have a quote from a full-time officer from Unison about his experience in dealing with NMC cases:
“The NMC pursue allegations against registrants that have little or nothing to do with patient safety and could not be said to have a public interest element. Despite the recommendations of the Law Commission review and its apparent endorsement by the NMC and the Department of Health, the NMC continues to bring cases relating solely to inter-employee and other issues wholly unrelated to their nursing practice. In addition the NMC insists on taking any cases with an apparent ‘public interest’ to a full hearing or meeting even where the registrant wishes to be voluntarily removed from the register. The lack of any clear definition of what is meant by the public interest makes the issue wholly subjective.
At a recent NMC hearing an NMC panel decided that a registrant’s apparent failure to approve staff applications for flexible working amounted to serious professional misconduct and was a public interest issue! This hearing lasted 10 days and probably cost well in excess of £30,000. It is absurd that nurses and midwives should be asked to foot the bill for such folly with ever increasing registration fees.”
That is the experience on the front line—that is what people are paying £120 a year for.
In an attempt to convey the affordability of the proposed fee increases, the NMC consultation paper compared subscription fees for professional bodies and those of trade unions with the NMC. However, that is not valid comparison. Unlike the NMC, trade unions and professional bodies are organisations that nurses and midwives can join voluntarily.
I would be delighted if the Government said that we could have a closed shop for trade unions and professional bodies. I am sure that you would agree, Mr Havard, but I have got a feeling that they may not be keen. Come 8 May, the next Government will be led by that wonderful gentleman, my right hon. Friend the Member for Doncaster North (Edward Miliband), but I have a feeling that he also might not be too keen on closed shops in the health service or anywhere else. However, that is what we have got with the NMC.
I understand why that is the way it is, but for the NMC to pretend that, somehow, a comparison can be made with joining trade unions is completely unfair. It would be much more suitable to compare the NMC’s registration fees with Health and Care Professions Council registration fees. Under “Agenda for Change”, both regulate professionals in similar pay bands, but when we compare a nurse at the top of band 5 with an occupational therapist on the same band, we see that the nurse would pay £120 a year in registration fees while the OT would spend £80. That goes back to the point raised earlier about why on earth part-time workers and those on different bands should pay the same subscriptions.
Although the NMC recognised the economic difficulties nurses and midwives face in its consultation paper, it proposed the fee increase regardless. Effectively, it ignored the reality of how those people are struggling.
Mr Anderson
Absolutely. I will come on to discuss the PSA before I sit down, which my hon. Friend will be glad to hear will not be long now.
Professional bodies and trade unions are working hard with the NMC to ensure that the development and introduction of the new process is as successful as possible and that lessons are learnt from the pilot sites. That process will be extensive and require significant efforts from registrants, but it surely cannot lead to further unjustifiable fee increases for hard-working midwives and nurses.
The NMC could take measures to prevent future fee rises for registrants, but it is not the only one that should beheld responsible. The Government could have taken measures to reduce further fee increases, but they chose not to.
First, the NMC has the most unwieldy legislation of all regulators despite being the largest. By contrast, the General Medical Council and the Health and Care Professions Council have more flexible legislation, which allows them to be more efficient and cost-effective. That prompts the question: why should midwives and nurses be treated differently from doctors and occupational therapists?
In April 2014, the Law Commission published a draft regulation of health and social care professionals Bill, which included reforms that would have helped the NMC keep costs down. If implemented, the draft Bill would offer the NMC the opportunity to speed its processes up and give it flexibility to amend rules without having to seek Parliament’s permission.
The Mid Staffordshire NHS Foundation Trust public inquiry called for regulators to focus on promoting safe, compassionate care, rather than intervening only after patients have suffered harm. The draft Bill would have allowed the NMC to focus more resources on education, effective registration and promoting professional standards, which would have done exactly what the inquiry called for. Currently, it is impossible for the nine health regulators to work together: there are nine different pieces of legislation, nine different codes of conduct and nine different fitness-to-practise procedures. It is not clear to me why we are treating health workers differently when the main objective of all health regulators is surely the same—public protection.
The draft Bill would enable and require regulators to co-operate more closely with each other, which would ensure consistency. It would help the NMC and all the regulators to keep their costs down collectively. However, this Government failed to include it in the Queen’s Speech, which meant it could not be debated or passed into law. It would be interesting to hear from the Minister what he thinks of that decision.
Registrants should not be punished for the Government’s failure in that respect. Likewise, the NMC should not use it to justify or push through any future fee increases. The NMC has joined representatives of patients’ groups, nursing and midwifery professional bodies, and trade unions to call on politicians, such as us here today, to commit to introducing the draft Bill to reform health care and its professional regulation.
In addition, following a review in 2010, the Government decided that the Professional Standards Authority, the body responsible for the oversight of the health professions’ regulators, would no longer continue to be funded by the Government and the devolved Administrations. Instead, the review recommended that the PSA should be funded through a compulsory levy or fee on the regulatory bodies that it oversees. So, rather than consult on whether there should be a levy or on who should pay it, the Government decided to consult on how the PSA levy on the regulatory bodies should be calculated. Rather than saying, “Should we do it?” they said, “How will we pay for it?”
Professional bodies and trade unions quite rightly argued against this levy; it is another hammer blow for the people working in the service. However, their concerns were ignored by the Government who, in their response to the consultation, decided to determine the fee based on the number of registrants that a regulator has. Again, this unduly disadvantages the NMC, which will bear a disproportionate amount of the cost because, as I said earlier, it is the largest regulator in the world. Based on the current size of the NMC’s register, the first £1.7 million levy to the PSA equates to £2.50 per registrant. The upcoming fee rise has already resulted in 12.5% of this additional sum effectively going straight to fund an external organisation, which is doing nothing to protect the public or to help to educate or protect the staff working in the service.
Because the NMC has no other source of income, these costs will almost inevitably be passed on to registrants, who include some of the lowest-paid professionals regulated by the health regulators. As I said before, approximately 90% of the NMC’s registrants are women, so the PSA levy will have an adverse impact on equality, as the hon. Member for South Down said. Also, many NMC registrants work in part-time roles, and so frequently they are not high-income earners. If the NMC is forced to increase the annual registration fee in order to pay the PSA, which in some respects it already has, that will have an impact on equality, as those in this group will be financially worse off. The poorest will pay the most, which is not unusual under this Government.
Over the years, all the NMC’s efforts have been directed at dealing with fitness-to-practise cases. This has had a detrimental impact on the level of service provided by the NMC to its registrants. For example, the NMC has failed to provide effective and up-to-date guidance on key issues, and there has been a lack of professional advice to registrants who have queries or concerns about how to interpret the requirements of or guidance on the code of conduct. Given the overwhelming, and appropriate, focus of professional regulation on public protection, and the diminution in professional advice, it could be argued that it is unfair to expect registrants to continue to bear the sole financial burden of the NMC’s professional regulation activities.
Furthermore, if the body overseeing the regulators is funded by the regulators, the public will lack confidence. Consequently, the funding arrangement for the PSA, which is based entirely on registrant funding, is flawed. At a time of ongoing financial austerity, the additional bureaucracy is undesirable, particularly when there are already existing mechanisms to scrutinise and hold regulators to account, for example, the annual accountability hearing by the Health Committee, which enables the people in this building to scrutinise what the regulators are getting up to.
For these reasons, I urge the Government not to implement the levy on the nine health regulators, and for the Government and the devolved Administrations to continue to fund the PSA until it is included in the draft Law Commission Bill.
It is appalling that the NMC decided to increase its fees despite the heavy opposition from hard-working nurses and midwives. It is tough enough to be a nurse or midwife without having to be penalised for coming to work. They are working in an increasingly difficult environment, which has been made worse by public sector cuts, chronic understaffing and continued pay restraint that means their pay is lagging well behind cost of living increases. If the NMC’s fees continue to increase, it will result in nurses leaving the profession, exacerbating existing problems in the health system, which is already struggling to cope.
To ensure that future fee increases are not made, it is essential that the following steps are taken. First, the NMC should undertake a full review of all fitness-to-practise referrals that do not proceed to a full hearing, and use that information to sit down with the employers and trade unions to ensure that all referrals to the NMC are in the interest of patient safety and public protection, and not just an excuse for employers to carry out internal disciplinary procedures. That would have a positive impact by reducing the number of referrals and the overall cost thereof.
Secondly, the NMC should shift resources into promoting awareness and the development of guidance that would help registrants to understand better how to act within the NMC’s code of conduct in their practice. That would help to reduce the number of fitness-to-practise referrals, which would be a win-win for everybody concerned.
Thirdly, the NMC should consider a reduced fee for new registrants, part-time workers and those nearing retirement age, to reflect better registrants’ income throughout their careers. There should be a phased fee for all concerned.
Fourthly, the Government should not implement the PSA levy on regulators and should continue to fund it centrally, at least until it is included in the draft Law Commission Bill.
Finally, the draft Law Commission Bill must be given adequate parliamentary time by the next Government to be debated and passed, to enable the NMC and other health regulators to reduce costs, in the interests of all concerned.
We count on nurses and midwives every day.
Grahame M. Morris
I wonder if we can get clarification on that last point; perhaps the Minister can provide it. Given the dearth of legislation, especially in the last Session, why was not parliamentary time found for something on which there could have been cross-party consensus, such as a draft Bill based on the Law Commission’s report?
Mr Anderson
My hon. Friend makes a very good point, and I am very interested to hear whether the Minister will respond to it when he sums up and say exactly why we have not been discussing this issue during the past two or three years, when we have been going home at ludicrous times, such as 5.20 pm on a Monday, week after week during the past few months.
We count on nurses and midwives every day. Our families count on them; the people of this country count on them. I have heard loud and clear from my constituents that the fee increases are unaffordable and my fear is that people will start to vote with their feet.
The NMC is subject to parliamentary scrutiny by ourselves and the Health Committee, but we have little opportunity to comment on fee rises such as this one. We need to get the NMC to work together with the employers, the trade unions and the representative bodies, to review what it is doing and to provide a better service for all concerned.
Grahame M. Morris (Easington) (Lab)
It is a pleasure to serve under your chairmanship, Mr Havard; regrettably, it may well be for the last time in this Parliament.
I congratulate my hon. Friend the Member for Blaydon (Mr Anderson) on securing this debate and the Backbench Business Committee on allocating the time. It is on an important issue, and the reason I wish to participate in it is because I serve on the Health Committee and we have looked at this issue on a number of occasions as part of our annual accountability hearings. Indeed, we produced a report, which my hon. Friend referred to; it was the fifth report of Session 2013-14, and the reference is HC 699. It is an excellent piece of work. The Committee went into some detail, covering many issues mentioned by my hon. Friend the Member for Blaydon and making recommendations about how best to proceed.
I do not want to repeat the arguments, but it might be useful to put into context the report and the concerns that have been raised. Constituents of mine who are nurses and midwives have written to me individually, quite apart from the petition. I think many hon. Members throughout the country have had similar representations.
There is an issue about fairness in respect of this considerable increase in fees, and about how the increases have come about. There is also an issue about whether those who are required, by the nature of their employment, to be registered should be placed into financial hardship, as has happened in some cases, particularly with women returners who are working limited, part-time hours. We all agree with registration, to maintain public confidence and trust in the nursing profession. However, there is an issue about whether some allowance should be made for them, in terms of a reduction in their fees.
As my hon. Friend indicated, the nursing and midwifery professions are among the oldest established and longest regulated professions in the United Kingdom, with regulation taking many forms over the last century. The current regulator, the Nursing and Midwifery Council, which has given evidence to the Health Committee, has been in operation since 2002. As we have heard, it is the statutory regulator for more than 670,000 nurses and midwives. The £67 million figure relating to its income is an old one, because it now receives more than £70 million.
In 2011, the Health Committee began holding annual accountability hearings in relation to the Nursing and Midwifery Council. Prior to that, our concentration was essentially on the regulation of the medical profession, with the General Medical Council. We have since widened the scope of the annual accountability hearings. In its report on the first annual accountability hearing with the Nursing and Midwifery Council, the Committee expressed concerns
“about the affordability of the registration fee”.
This has not just popped up: we have identified it as a trend since 2011. In that report, the Committee urged the Nursing and Midwifery Council
“to avoid further fee rises and to consider fee reductions for new entrants to the register”.
However, there have been fee rises since then. When I was first elected, the fees were £76 and they increased to £100 in February 2013. The further rise to £120 a year—that would probably account for the increase in revenue—would mean a 52% fee increase, at a time when nurses and midwives are experiencing severe and unsustainable pay restraint. These problems are further compounded by the decision of the Government and the Secretary of State for Health to veto the 1% NHS pay rise, denying a pay increase to 70% of nursing staff and ignoring the view of the independent pay review body. I want to place on record that the incredible work and effort of our nurses and midwives is of great value, and I want to say how much that is appreciated throughout the country.
Ms Ritchie
My hon. Friend is making a compelling case for the career position of nurses and midwives. Does he agree that the Nursing and Midwifery Council, as well as the Government, should be encouraging people into the profession, rather than providing disincentives, discouraging them from joining it and from training for such vital roles that will benefit all within the wider community?
Grahame M. Morris
I agree wholeheartedly. All across the country—certainly in my area—efforts are made, and have been made consistently, to recruit good quality staff. Often recruitment is done overseas, with adverts being placed in newspapers in countries that train good quality nurses and midwives, but have a surplus. It often strikes me as bizarre that although we have a reservoir of women returners, we not making it as easy as possible for them to return. Doing that would be in the interests of the service and of the country. It would be a false economy to continue doing what we are doing.
Sir Alan Meale
I am here today because my sister is a midwife and has been a nurse all her adult life. This is not just about times of restraint and restrictions on pay; there has also been a thorough re-grading of the whole nursing and midwifery system throughout the UK, which has already re-graded many nurses to lower grades than previously. They are experiencing a double whammy, and this is the third time they have been hit with a fee rise. We should not approve it.
Grahame M. Morris
I am grateful for my hon. Friend’s intervention. That is another excellent point, well made. Pressures are being placed on the NMC, including increases in its costs, that are placing a greater strain and burden on nurses and midwives. The Government have to recognise that. I know that my hon. Friend the Member for Blaydon has reservations about whether the Government supporting the NMC with one-off grants would impact on its impartiality. I do not think that should necessarily follow. We should recognise the considerable pressures being placed on it financially, not least those arising out of public concerns and the recommendations of the Francis report. We want the public to be confident that the profession is properly regulated and that the fitness-to-practise procedures are operating properly and effectively. However, I agree with my hon. Friend. There was a ministerial statement last Thursday regarding untoward practices highlighted in a report, including bullying of staff and so on, in a hospital in east London—I think it was the Barts Health Trust. If fitness-to-practise referrals are being used by employers in that way, it is reprehensible and is adding to the strains and pressures on the NMC.
The latest fee increases are being imposed on nurses and midwives who were extensively consulted about them. My hon. Friend mentioned the overwhelming numbers: 96%—many of us would be over the moon to have that as a vote of confidence in the general election—voted against those recommendations. However, it seems that the consultation served little purpose, other than to antagonise nurses and midwives, because the Nursing and Midwifery Council has, apparently, taken little or no regard of the views of NHS staff and has pressed ahead with the fee increase.
The Nursing and Midwifery Council has also failed to provide any assurances that the latest increase will not be followed up by further increases in coming years. As my hon. Friend the Member for Mansfield (Sir Alan Meale) mentioned earlier, if we are to encourage people to come back into the profession, they have to know that the regulator has a reasonable, cost-effective process in place. The Nursing and Midwifery Council stated in evidence to the Health Committee last year that it had introduced an
“annual formal review of the fee level”,
so it is not necessarily an ongoing commitment. However, we have to ask: why has there been such a huge increase, of more than 50%, in a relatively short period?
Clearly the Nursing and Midwifery Council must meet its statutory obligations. We would expect that as Members of Parliament—and the public would certainly expect that—for maintaining professional standards. Certainly more needs to be done to remove the constraints it faces through the fitness-to-practise process—a number of hon. Members have highlighted that—which is too costly. Seventy-seven per cent of the Nursing and Midwifery Council’s income of more than £70 million is being spent investigating less than 1% of the nurses and midwives on the register. That is an incredible sum of money, and I find it difficult to comprehend how that can be an efficient use of resources.
The Nursing and Midwifery Council is making progress—I recognise that, and certainly the Committee recognised it, although it said it thought the progress was “fragile”. The NMC recognises past failures—not least in IT systems—and is seeking to overcome some of them, but it is clear that further improvement is required. An assessment by the Professional Standards Authority for Health and Social Care—the organisation that oversees all the professional regulators—has found that the Nursing and Midwifery Council is failing to meet seven of the 24 standards of good regulation. By any measure, I would suggest that there is still a long way to go in bringing it up to standard. Of those seven failures, two relate to fitness to practise.
While it is important that improvements continue to be made, it is wrong to expect nurses and midwives to bear the burden of the costs by themselves, particularly when we have seen the value of their pay fall in real terms over the life of this Parliament. The Government cannot sit idly by and allow continual increases in fees without taking action or giving some guidance. We hear Ministers time and again praising the hard work and dedication of nurses, and I hope the Minister will do that at the conclusion of the debate. Nurses do an amazing job in the most difficult circumstances, but when it comes to pay, pensions or professional fees, the kind words of Ministers seem to be rarely followed up by practical action that would help NHS staff.
In conclusion, I hope the Minister will say what steps he is taking to support the Nursing and Midwifery Council to ensure that it can continue to drive through the improvements we all want to see without having to increase the fees and the cost of employment for nurses and midwives. I also hope that he will address the points made by my hon. and right hon. Friends on the need to speedily bring forward the law commissioners’ sensible and well thought out proposals on the NMC. I would be interested if he could explain why they have not been brought forward before now.
The Parliamentary Under-Secretary of State for Health (George Freeman)
It is a great pleasure to serve under your chairmanship, Mr Havard, for what will be the last time in this Parliament.
I thank the hon. Member for Blaydon (Mr Anderson) for the opportunity to speak in this debate and for raising issues that many nurses and midwives want to have addressed. I congratulate them on securing the debate through the e-petition mechanism. I pay tribute to all nurses and midwives, who do such great work in our health service, alongside all the others who keep the system going on our behalf 24/7. I also thank the Backbench Business Committee for selecting the debate, in the light of the petition on the Government’s e-petition website asking the Government
“to review the Nursing and Midwifery Council…with regard to the fees…and the processes through which those fees are decided.”
As Members from across the House have pointed out, many nurses and midwives are concerned about the way in which the Nursing and Midwifery Council has proposed to handle the costs of registration and of fitness-to-practise inquiries. Hon. Members have done a great service in raising the issue and allowing both me and the shadow Minister to respond.
The hon. Member for Blaydon will be aware that the NMC is an independent statutory body and is therefore responsible for determining the level of its annual registration fee. Under statute, it is responsible to Parliament rather than to Ministers. However, as the Minister responsible for professional regulation, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), in whose place I am standing today, takes a keen interest in the performance of the professional regulators, not least because he is an NHS clinical professional himself. He has regular contact with regulators, including the NMC, on this and a whole range of other issues.
It may be helpful to set the scene by providing some background about the professional regulatory bodies and how they are structured. They are independent statutory bodies whose statutory purpose is to protect, promote and maintain the health and safety of the public by setting robust standards for their health care professionals across the United Kingdom. For the NMC, the health care professionals concerned are nurses and midwives.
Professional regulatory bodies are held to account by the Professional Standards Authority for Health and Social Care, or PSA—an arm’s length body currently funded by the Government. Hon. Members will be aware that, following the 2010 review of arm’s length bodies, the Government have taken the decision to make the PSA self-funding and independent from Government, part of a broader change to the way in which health care and clinical professionals are regulated, given the growing sophistication and expertise of the various disciplines. The powers to facilitate that change were brought into effect by the Health and Social Care Act 2012. At its heart, the change reflects the long-standing principle that the system of professional regulation in health care is funded by the professionals themselves.
Grahame M. Morris
I cannot argue with the Minister’s quoted definition of the terms of reference of the professional regulators, and we would all agree that that is completely appropriate; there is no disagreement on party lines about that. However, does he accept that, as a result of recent events—most notably the specific recommendations of the Francis report—we are placing additional burdens and responsibilities on the regulators? Is it not beholden on the Government to recognise that and give due consideration as to where those burdens should fall?
George Freeman
The hon. Gentleman makes an interesting point. As the challenges for the NMC’s members and for it as a professional body change, adapt and evolve in the new landscape of greater transparency and accountability in the public interest, one issue for the NMC as a professional body is how it deals with that internally. Members across the House have raised a number of concerns about that, and I will touch on some of those later.
The intention is that in future the PSA will be funded by a fee raised on the nine professional regulators that it, in turn, serves. It is important to note that the fee is raised on the professional regulators—the regulatory bodies—not on registrants. The formula for calculating what contribution each of the nine regulatory bodies should pay was subject to consultation. It has been based on the number of registrants, simply because it was judged that that would most fairly equate the fee to the amount of service that the PSA provides to each regulator.
The NMC has nearly 50% of the total number of registrants so its contribution to the fee equates to nearly 50% of the overall costs of the PSA. However, it is important to remember that the fee per registrant is likely to be in the region of £3, which represents only 2.5% of the NMC’s overall registrant fee of £120 a year.
George Freeman
My point is that it is important to understand that the reforms mean that the PSA is funded by the nine regulatory bodies. How the bodies seek to cover that cost is up to them. In this case, the NMC has decided to apply it equally across all its members.[Official Report, 25 March 2015, Vol. 594, c. 3MC.] A number of hon. Members have raised a number of issues connected to that; the point about part-time nurses and midwives was an interesting one. There are issues with how the NMC chooses to allocate the cost internally. However, I repeat the key point that the fee increase is likely to be in the region of £3 per registrant. That represents 2.5% of the NMC’s overall registrant fee, which covers a whole range of other services.
It may be helpful to the House if I set out some details about the services that the NMC provides. It is the independent regulator for nurses and midwives in the UK. Its primary purpose is to protect patients and the public through effective and proportionate regulation of nurses and midwives. It is accountable to Parliament—not Ministers—through the Privy Council for the way in which it carries out its responsibilities. It sets and promotes standards of education and practice, maintains a register of those who meet those standards and takes action when the fitness to practise of a nurse or midwife is called into question. It also has a role in promoting public confidence in nurses and midwives and in regulation.
Members from all parties would agree that we welcome the growing sophistication of the role of nurses and midwives and the extra responsibilities reflected in salaries and professional standards. That is part of the evolution of the professionalisation of standards that we all welcome.
Grahame M. Morris
The Minister is setting out an explanation of transparency and accountability that I do not disagree with, but if we follow the line of his logic, he is saying that the NMC is responsible not to Ministers but to Parliament in the round. My assumption—perhaps he will correct me if I am labouring under a misapprehension—was that the Health Committee performed the role of holding the NMC to account. Given that the Committee takes the trouble to hold interviews and evidence sessions, and to make specific recommendations, is it not beholden on the Minister and Government to act on those recommendations, not least in relation to the Law Commission?
George Freeman
The Government take recommendations from the Health Committee very seriously—we have done so on a number of issues. It is interesting to quote what the Committee has said on this matter:
“We would urge the NMC to avoid further fee rises and to consider fee reductions for new entrants to the register.”
My point is that it is the NMC’s responsibility to deal with the issue. It is accountable to Parliament, and the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, observes its recommendations closely. However, its internal organisation is a matter for itself.
[Mr Philip Hollobone in the Chair]
George Freeman
I will happily make those data available to the hon. Gentleman and put them in the Library. They are from the NHS staff earnings survey’s provisional statistics by staff group in England.
It is worth noting that UK taxpayers can claim tax relief via Her Majesty’s Revenue and Customs on professional subscriptions or fees that they must pay to carry out a job. That includes the registration fee paid to the NMC. Nurses and midwives on a salary of £30,000, confronted with a fee increase of £3, can therefore claim tax relief on it. A basic rate taxpayer would be eligible for £24 tax relief on the £120 fee.
Grahame M. Morris
Could I press the Minister? He suggested that things are tight. We have just had the Budget statement from the Chancellor. We had a list of give-aways in Tory marginals—£2.5 million for the RAF museum in Hendon, moneys for projects in Blackpool and a new theatre in Pendle—but would that money not have been better spent helping to subsidise the registration fees of nurses working part time and of women returners, who earn considerably less than the average figure the Minister cited?
George Freeman
I note with relish and interest what I assume is official Opposition policy—that they do not support the Chancellor’s announcement about funding for the RAF museum. The point that I am trying to make is that he already set out in the autumn statement a serious pay commitment to the lowest-paid staff in the NHS, which I was summarising.
I am glad that the hon. Member for Easington (Grahame M. Morris) has raised the issue of the Budget. The reporting on it has made it clear that for a pre-election Budget it was, far from making give-aways, surprisingly light on them, and was very much “steady as she goes”, continuing to pare down the deficit with fair tax reform. The truth is that we have cut income tax for 27 million people, and particularly for the lowest-paid nurses and midwives. The impact of that is nearly £900 a year from changes to the personal allowance. That is not fashionable stuff that captures the top line in red-top newspapers, but nurses and midwives do not exist in isolation. They have the NHS pay deal but also the important tax allowance changes introduced by the Chancellor. The Government are taking pressure off the lowest-paid workers in the NHS and elsewhere. Viewed in the round, those changes give us a record that we can be proud of, albeit within a difficult set of funding requirements.
George Freeman
I am delighted to confirm that the Government remain committed to introducing primary legislation to address those wider reforms to the system of professional regulation; and it sounds as though, if the hon. Gentleman and I are in our posts then, that may well have cross-party support. That would be an important measure, and our inability to pass it before the end of this Parliament is not a sign of its importance; it is merely a function of the challenge of the availability of parliamentary time.
It is worth pointing out that the performance of the NMC has been challenged and highlighted by a number of bodies, including the Select Committee, but also by some of its members—nurses and midwives. It has had a troubled past with its performance, which is why Ministers commissioned the predecessor body of the Professional Standards Authority, the Council for Healthcare Regulatory Excellence, to undertake a full strategic review in 2012. That review put forward 15 high- level recommendations for improvement in the delivery of the NMC’s regulatory functions, and set an expectation that demonstrable improvements should happen within two years.
In 2014, the NMC commissioned KPMG to undertake an independent review to assess its progress, and KPMG concluded that the NMC had made a substantial number of improvements, which cumulatively placed it in a much stronger position than in 2012. That improvement was recently recognised by the Secretary of State for Health in his oral statement to the House about the Morecambe bay investigation. However, the NMC itself recognises that there is still much more to be done, and so the processes of improvement continue. Ministers have made it clear that we expect the NMC to work towards and ensure compliance with the standards of good regulation, and to continue looking for more efficient ways to work.
Hon. Members on both sides have raised points that I want to deal with. Several mentioned how the fees of part-time nurses are dealt with by the NMC, which is an interesting point. It is not for me to tell the NMC how to deal with it. That is for the NMC to decide, as an independent body, but I should have thought that, on the basis of pure justice and equity, members who do not work full time and therefore do not earn the same as those who do, and who do not generate, even on a pari passu basis, the same level of exposure to the costs or their organisation, would not have to pay the same costs. However, that is of course a matter for the NMC.
The hon. Member for Blaydon raised several questions, including whether the NMC will review its guidelines on fitness to practise, and provide guidance on fitness to practise cases. Those are all matters for the NMC as an independent body, but new legislation means that nurses can pay fees in instalments, and that fees can reflect part-time work.[Official Report, 25 March 2015, Vol. 594, c. 4MC.] The hon. Gentleman made an important point in his speech about part-time nurses.
The hon. Gentleman also spoke about revalidation. The truth is that the majority of the cost of nurse revalidation will fall on the employers that will be responsible for supporting their staff through revalidation. The revalidation drive is an important means of raising professional standards, and it will ensure that the public have faith and confidence that we are raising standards for nurses and midwives.
Grahame M. Morris
The NMC sometimes takes two years to complete some fitness-to-practise cases. The Select Committee recommended that it should aim to complete them all within nine months, which is not an unreasonable request. That is an incredible amount of time and resource to spend on those cases.
George Freeman
The hon. Gentleman makes a really good point; I was trying to make a similar point myself. We have encouraged the NMC and made it easier to speed up its processes. Anecdotally, I know from speaking to nurses and midwives that there is a lot of frustration about the slow pace of basic procedures, such as getting registration and coming back to the profession.
My hon. Friend the Member for Congleton (Fiona Bruce) cogently and clearly told the story of one of her constituents, a nurse, and spoke about the bureaucratic and clumsy registration processes. There is a common message for the NMC: it has a £70 million budget, so it ought to be able to run a less inefficient, quicker organisation and direct resources away from bureaucracy and towards dealing with fitness to practise, in which there is likely to be a growing public interest. It is good that the public want to drive up standards and be clear about patient safety across the professions.
On the issue of revalidation, we believe that nurses and midwives have some of the most important jobs in the NHS. They care for patients every day, so it is crucial to ensure that they are up to speed with the standards that the public and patients expect. We support the NMC in its drive to introduce revalidation, which will improve safety and the quality of care. It will reassure patients that nurses remain fit to carry out their vital work.
The challenges of the serious debt and structural deficit inheritance that we as a society are confronting mean that everyone in our public services has to deliver more for less within the current financial constraints and to ensure that standards continue to improve. Across our public services—indeed, across our general economy—there are extraordinary levels of productivity gain day in, day out. The general economy runs at 2% to 3% productivity growth every year with its eyes shut. The challenge is to create in the public sector the right climate and leadership conditions so that our great public servants can deliver similar productivity.
That said, we recognise the importance of the level of the NMC registration fee to all its registrants, which is why the Government have assisted the NMC to introduce rules that will allow registrants to pay their registration fee in instalments. Those rules came into effect on 9 March, and they enable the front-line nurses and midwives who have to pay the £3 extra fee to schedule payment of the total £120 annual fee across the whole year.
To maintain the NMC’s independence from the Government, its registration fee must cover the full costs of its regulatory activity. I am sure that nobody in any corner of the House believes that we should downscale or curtail the quality of that regulatory work merely on the basis of members’ unwillingness to pay. The principle is that health care professionals should fund the regulation of their profession to maintain the confidence of the public and patients. However, it is for the NMC to decide how to meet its statutory functions and protect patients and the public, which is our paramount consideration. The NMC recognises that it needs to do more to maintain the confidence of registrants, patients and the public in its performance, and to continue to improve its operation, effectiveness and efficiency.
I am grateful for the chance to correct the record and clarify that the Government are prioritising the lowest-paid workers in the NHS; we applaud and support their commitment. I want to take this opportunity to reaffirm the Government’s gratitude, thanks and support for their work. Despite the difficult funding constraints, in this Parliament we have consistently supported the lowest-paid workers in the NHS, rather than the best-paid, and we have reflected that in the latest pay settlement.
At the heart of this measure are some important points that need to be reiterated. There is a long-standing convention that health care professionals pay their own professional registration fees. The reform will increase the registration fee paid by nurses and midwives, whose average salary is £31,000, by £3, against their annual registration fee of £120. The Government have given the NMC a £20 million grant to help to offset those costs. The NMC has made it clear that it is able to pay for a substantial element of the increases through its ongoing efficiency programmes. The principal driver of cost is the growing public interest in fitness to practise and the cost of handling such cases. We are helping the NMC, not least by helping it to deal with those cases much more quickly, as the hon. Member for Easington highlighted.
We should not hold back the public’s interest in fitness to practise. It is part of a new culture of transparency and accountability across the system, post the Francis report, and the Secretary of State and many others want to encourage it in the modern NHS. The NMC is an independent statutory body that is accountable to Parliament, not Ministers.
I welcome the chance to inform the debate, particularly for NMC workers and for the many nurses and midwives who have taken the time to sign the Government’s e-petition form and, through the Backbench Business Committee and Members in the Chamber, to bring this issue to the Floor of the House. We as Ministers are very aware of the needs of the lowest-paid NHS workers, who do an extraordinary job for us. That is why, in the latest pay deal, we reflected that, with a 5.6% increase for the lowest earners and a 1% pay rise, which equates to £300 in the pockets of the nurses and midwives we are talking about.
The measures in the Budget and the Chancellor’s wider tax reforms, such as raising the tax threshold for the lowest-paid workers, will take more than 4 million of the lowest-paid workers out of tax altogether. The lowest-paid nurses and midwives are now £900 a year better off as a result of the increase of the personal allowance to £11,000. That is a substantial sum, compared with the £3 fee increment. The hon. Members for Denton and Reddish (Andrew Gwynne) and for Blaydon are eloquent and persuasive men, but even they cannot suggest that a £3 fee on health care professionals earning £31,000 represents a crisis in the NHS. They rightly said that it is important that the NMC quickly develops its efficiency and upgrades its internal mechanisms, and they made a number of interesting points about how that can be done to maximise fairness for the lowest-paid workers. I want to take the opportunity to repeat that the Government are absolutely on the side of those workers.
Barts Health NHS Trust
Grahame Morris Excerpts(11 years ago)
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Mr Speaker
It is good to know that in his capacity as a distinguished ornament of the Health Committee, the hon. Member for Easington (Grahame M. Morris) takes a keen interest in matters appertaining to east London.
Grahame M. Morris (Easington) (Lab)
Absolutely, and not least because we warned of these dangers during the passage of the Health and Social Care Bill, which later became an Act. With all due respect, I should point out to the Minister, on her references to openness and transparency, that this failing has happened as a direct result of mergers introduced by this Government. May I respectfully point out that when this merger was approved by the Secretary of State three years ago, Labour MPs, including my hon. Friend the Member for Leyton and Wanstead (John Cryer), did point out that such a change would be a disaster, and that has come to pass? The Secretary of State pressed ahead. May I point out the bullying issues that the report throws up? The chairman of the Unison branch was sacked on trumped-up charges. Will the Minister issue instructions to have those individuals reinstated?
Jane Ellison
The bullying of NHS staff who are trying to draw attention to poor care is never acceptable, and this Government have taken a lot of measures to make sure that NHS staff are protected. The trust’s chief executive has said the following about the report:
“We are very sorry for the failings identified by the CQC in some of our services at Whipps Cross and we know the Trust has a big challenge ahead.”
Part of that big challenge will be in restoring staff morale, and making sure that that culture of openness and support for staff is in place.
Maternity Services (Morecambe Bay)
Grahame Morris Excerpts(11 years ago)
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Mr Hunt
I think this is a time when the whole House needs to unite behind the staff in that trust, who are working very hard to turn the situation around; indeed, they have made great progress. I had to call Nicola Adam of The Visitor to reaffirm the point that there are absolutely no plans to close the hospital. I hope the whole House will recognise that statement for what it is and that hon. Members will reiterate it in all their communications with their constituents.
Grahame M. Morris (Easington) (Lab)
I thank the Secretary of State and my right hon. Friend the Member for Leigh (Andy Burnham) for the tone of the statement and the Opposition’s response. I want to ask the Secretary of State about the point he made in his statement about the relationship between clinicians and midwives, which Dr Kirkup identified as having deteriorated over the last two or three years. He said that there was evidence of untoward incidents, with worryingly similar features to those that had previously occurred, as recently as last year. The Secretary of State mentioned extra numbers, but is he confident that the relationship between midwives and doctors is now resolved and that we have safe care at that hospital and elsewhere?
Mr Hunt
I think we can trust the CQC’s view that the care in the maternity unit is safe, but the hon. Gentleman is absolutely right to draw attention to the issue of the barriers between doctors and midwives, which is striking. That goes back a very long time: there seemed to be a kind of macho culture among the midwives to do with not letting the doctors in, which probably led to babies needlessly dying, which is the great tragedy. Making sure that that culture is changed, so that the patient’s needs are always put first, is obviously a massive priority. I know that the trust has made great strides in that area, but we all understand too that it takes time to change culture, and we need to support it as it goes on that journey.
Child and Adolescent Mental Health Services
Grahame Morris Excerpts(11 years ago)
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Paul Blomfield
My hon. Friend makes a very important point. Such a matter is close to my heart in Sheffield, where funding from central Government will halve over the lifetime of this Parliament. That is putting an enormous strain on all the related services and support for young people that can play a broader role in alleviating some of the difficulties. In Sheffield, we are very conscious that our position is in sharp contrast to that in wealthier parts of the country.
The first point is about cuts at a time of increasing need. We know that budget cuts to front-line services are difficult and can be devastating at any time, but cuts to child and adolescent mental health services are being made at a time of increasing need. From 2011-12 to 2013-14, Sheffield CAMHS saw a 36% increase in referrals, and a 57% increase in initial appointments. If we are serious about reducing stigma, talking openly about mental health problems—we have made enormous advances in doing that—and having parity of esteem, we should welcome those referrals. However, that demand comes against the background of what has effectively been a 4% budget cut, disguised as a requirement to drive efficiency savings. That has had severe consequences for the level of support that young people are receiving. There has been a stark increase in waiting times.
Grahame M. Morris (Easington) (Lab)
It is certainly true that councils are faced with really tough decisions, given the 40% cuts to local government budgets. My understanding is that within the overall mental health budget of £14 billion, only £0.8 billion goes on child and adolescent mental health services. That seems to be a disproportionately small sum of money, given the scale of the problem.
Paul Blomfield
My hon. Friend makes a powerful point. It is a relatively small sum of money. Perhaps that indicates that a relatively small level of resource intervention could make a significant difference.
As I was saying, the consequence of the rising demand and falling resource in Sheffield is that some 18% of young people—almost one in five—wait over 13 weeks for treatment. The cuts not only impact on young people up to the age of 17, but have a knock-on effect on adult mental health services and on acute and emergency provision.
Sir Oliver Heald (North East Hertfordshire) (Con)
In listening to the hon. Member for Stoke-on-Trent South (Robert Flello), I recognised some important themes that were also evident in the speech of the Select Committee Chairman, my hon. Friend the Member for Totnes (Dr Wollaston). Both touched on what we can do to help people with mental health problems through volunteering, mentoring and bringing services together so that we have a more substantial whole that will help to tackle the fragmentation between different services and make something more rational and more joined up.
I was a governor of a residential school for young people with emotional and behavioural difficulties in the 1980s—Shaftesbury House in Royston. It was an Inner London education authority school, which did extremely good work with some very troubled young people. At that time, however, there was a different understanding of mental health issues from what we saw a few years later in 2001 when I was my party’s spokesman on mental health. By that time, there was much greater recognition that deep-seated mental health problems start at ages much younger than adulthood. Previously, there was a feeling that some of these issues were emotional, behavioural and developmental, but they were not seen in their true context.
I thus slightly disagree with the hon. Member for Stoke-on-Trent South. I think our understanding of mental health issues and what they mean for children and adolescents has changed over the period that he spoke about—and certainly since 2001, we know far more about the onset of these illnesses and about how they should be treated. I agree with him, however, that we are seeing a great number of young people affected by these issues. The hon. Member for Southport (John Pugh) talked about the ups and downs of adolescence and whether there was such a thing as a normal period of adolescence.
I believe that issues such as family breakdown, drugs, social media, and domestic violence put considerable pressure on young people, and it gets to the point where some adolescents have a series of crises. They can be intermittent, but there is often a recognisable crisis for which help is needed. It is more than just highs and lows; it is something more serious. In those circumstances, the delays about which we have heard can be particularly acute.
Two young people contacted me recently to raise issues about how child and adolescent mental health is dealt with. They were both very unhappy with the current situation. I thank the Minister for meeting one of them—a young lady who has been through CAMHS —to talk through the issues. She was very appreciative of hearing about the taskforce that has been set up, and it does the Minister great credit that he was prepared to meet her and that he has accepted that there are problems in the system that need tackling. Delay is certainly one of them. Another is the amount of help available, and particularly whether there are sufficient numbers of trained staff—psychiatrists, community psychiatric nurses, therapists and so forth. We have never had the numbers we need, and I hope the taskforce will consider that issue.
The Hertfordshire Partnership Foundation Trust has a youth panel that is deliberately aimed at revealing concerns. The young lady who came to see the Minister had been on that youth panel. She had suffered from anxiety, bulimia and depression; she had been bullied, but got no proper response from her school. She waited nine months for CAMHS, and had still not been given an appointment when she attempted suicide. Even after she had been in hospital, she had to wait for six weeks. She had only five sessions of therapy in 20 months at a time when she was experiencing serious crises. Another young lady who has been in touch with me was taken into an in-care unit, and it was three weeks before she saw a psychiatrist, although she too had experienced a bad crisis.
Grahame M. Morris
I cannot disagree with what the hon. and learned Gentleman is saying or the examples that he is giving, but does he accept the general point that one of the problems when it comes to planning effective interventions is the lack of current and accurate prevalence data that would enable the relevant agencies to plan and commission services that meet local requirements?
Sir Oliver Heald
I agree. I am sorry that action to deal with that problem was cancelled some years ago, because such action is definitely needed.
I was talking about the young woman who was taken to an in-care unit. She said that the staff always seemed to be overworked, and she was given no opportunity to exercise. She felt that, although she had been placed in the unit, nothing was being done to address her condition. I think that a great deal needs to be done to improve child and adolescent mental health services.
On page 76 of its excellent report, the Select Committee refers to the Minister’s taskforce, and says that the “current fragmented commissioning arrangements” must change
“to allow rational and effective use of resources in this area, which incentivises early intervention.”
That is an extremely important point. On page 77, the Committee deals with education and GP services and makes another important point, namely that this is not just about specialist CAMHS, but about school-based counselling. It quotes Mick Cooper, professor of counselling psychology at the university of Roehampton, as saying:
“Due to its short waiting times, convenient location, and broad intake criteria, school-based counselling is perceived by many stakeholder groups as a highly accessible intervention. It is able to offer a wide range of young people professional therapeutic support in a direct and immediate way.”
I think it is time that we joined up those services, using schools as a platform. In my constituency, there is an initiative called the North Herts Emotional Health Support Service, which aims to make a start with that. It has estimated that one in 10 young people aged between five and 16 is likely to be affected by a
“clinically significant mental health problem”
at some point, and has calculated on that basis that 18,000 school-aged children in north Hertfordshire are affected, including about 6,000 with emotional disorders. It has looked at the schools in question, and says:
“Evidence suggests that vulnerable children, young people and their families find it easier to access services”
at a school. It has trained a team of mentors consisting of teaching assistants, teachers and volunteers, and has identified a
“bank of quality-assured local counsellors and…therapists”
who can provide the sort of art and drama therapy that was described by the hon. Member for Stoke-on-Trent South. It has two local lead therapists whose job is to oversee the training and supervising of the mentors. It speaks of the importance of “offering consultancy and training” and “co-ordinating”, and hopes to engage a “part-time administrator”. It has made considerable progress with that model, and, although it will need to be evaluated, I think that we should do something similar.
The service is harnessing the good will of people who volunteer, and there are people who will do that—when I was a mental health spokesman, I met people who volunteered to work for Rethink and MIND—but it also uses the skills of professionals to train the individuals concerned, under supervision. It is giving us a lot of coverage and an ability to help young people relatively cheaply. That is a consideration in these times. I therefore suggest to the Minister that looking at such initiatives and those described on that page of the report is a possible way forward.
Many young people spend a lot of their time using social media of course—thumbs clicking at great speed. This is not necessarily a bad thing. People with anxiety or depression or another mental health condition could find online services that could help them and they could reinforce the coping techniques that they have been taught. I hope the taskforce will look at that. I think it might be fruitful.
Mr Robinson
Yes, I do indeed. The pressure in the education system to achieve results at any cost simply adds to the problem, as do the deprivation and poverty to which other Members have referred. All those factors have resulted in a situation in which incidents of self-harm are increasing at the rate of 20% a year. Referrals in Coventry are going up, and that constitutes a crisis, given that our accident and emergency services are already overcrowded and hard pressed.
Let me explain what that crisis means in regard to the number of weeks involved. Normally, effective substantive intervention would be expected within 18 weeks, but in Coventry the average wait for a substantive intervention has been 44 weeks. That is in a sector in which early intervention is clearly the most effective route to the successful management and eventual elimination of a mental health condition. That simply is not good enough, and I put that to the Minister for consideration by his taskforce.
We have asked the local council what can be done. As my hon. Friend the Member for Coventry South (Mr Cunningham) has said, budgets have been heavily cut. According to current Government plans to reduce public expenditure to 1930s levels—from which I know the Minister of State, Department of Health, the right hon. Member for North Norfolk (Norman Lamb) has dissociated himself—Coventry would experience a further 50% cut over the next five years. There would be nothing left. Fortunately, however, that is unlikely to happen, as I am sure that there will be changes of one kind or another to those plans, or to those making the plans, in the very near future.
It is impossible for the councils to find more funds, because they are under tremendous pressure, but there has already been a £50 million cut in the budget for CAMHS. It has been cut from £766 million. I think that that relates to the £800 million figure quoted by my hon. Friend for Eastleigh—
Mr Robinson
Easington. I beg my hon. Friend’s pardon. The CAMHS budget has been cut to £716 million, which is a cut of £50 million. That is an enormous cut.
Grahame M. Morris (Easington) (Lab)
I congratulate the hon. Member for Brigg and Goole (Andrew Percy), with whom I serve on the Health Committee, and the hon. Member for Totnes (Dr Wollaston), who so ably chairs the Committee. Although this report is the third report of the 2014-15 Session, I think it was the first report produced under the hon. Lady’s chairmanship, so it is quite an historic document. It is an important piece of work on a subject that has been neglected.
As time is short, I shall try to stick to a particular structure. I thank the Royal College of Paediatrics and Child Health for providing a briefing and for asking us to highlight some of its concerns about variations in services and funding for transition services and mental health care provision for prevention and early intervention. A number of right hon. and hon. Members have referred to those issues. I also want to make a few points from the perspective of local government. As we have heard and as the hon. Member for Brigg and Goole observed, this is an area of joint responsibility where local government, given the correct support and resourcing, can make a significant difference.
On the scale of the problem, it is a shocking statistic that 50% of mental illness in adult life, excluding dementia, starts before the age of 15, and 75% of mental illness starts before the age of 18. Apart from the mental health manifestations, there are often increased physical health problems associated with the deterioration in mental health. Disturbingly, since 1980, as others have mentioned, there has been no decline in the number of deaths caused by self-harm, suicide or assault, with more than 1,000 10 to 18-year-olds dying this way every year in the United Kingdom. The problem is particularly prevalent among boys.
An hon. Member spoke about the value of prevention and early intervention and alluded to a cost-benefit analysis, and he was absolutely right. Quite apart from the fact that it is the right thing to do, if we look at it purely in terms of the opportunity cost, we see that mental health problems that start in childhood and adolescence result in increased costs of between £11,000 and £59,000 per child annually, according to figures provided by the Royal College of Paediatrics and Child Health. Those are huge additional costs. With upstream interventions of the kind other Members have argued for, early identification of mental health difficulties should be established as a core capacity of all health, social care and educational professionals who work with children and young people, because the benefits would be considerable.
Another issue that has been talked about, and which I feel I must mention, is the provision of an evidence base on which to plan interventions. Indeed, the chief medical officer highlighted the lack of accurate prevalence data in evidence to the Committee. I fully understand that the Minister is carrying the can and making the arguments, but that survey had not been carried out for quite a few years. Although it has now been commissioned, my understanding is that the data will not be available for use until 2017. If we are to have a scientific or empirical basis on which to plan commissioning and resources, either in early years or in whichever tier is thought appropriate, we need an up-to-date and relevant evidence base of data.
Sir Oliver Heald
On the hon. Gentleman’s point about prevalence data, with which I agree, is not the real point that many of the contracts in mental health are block contracts, whereby a fixed amount of activity is purchased? If we do not know exactly what the prevalence really is, that is a bit of a shot in the dark.
Grahame M. Morris
I cannot disagree with that. I come from the perspective that we need to plan interventions on the basis of evidence, but how can we do that without current and relevant data on child and adolescent mental health? We certainly need that data. On the structure of the contracts, I am a firm believer in integration. There may well be issues with block contracts. The Health Committee received evidence from the south-west indicating that there are vast areas of the country where there is very little access to certain types of in-patient mental health provision, which is clearly unacceptable. One might have thought that a large block contract would make that less likely, but apparently that is not so. However, I am not an expert in commissioning; I am simply trying to identify the policy areas.
Having spent a number of years in local government, I have no doubt that local authorities wish to tackle some of the barriers that young people face in accessing mental health services. It is a complicated area, and we need to enable local areas—the hon. and learned Member for North East Hertfordshire (Sir Oliver Heald) just referred to larger block contracts—to commission better services, and perhaps that is better done on a more local level.
Mr Kevan Jones (North Durham) (Lab)
Does my hon. Friend realise that one of the problems with block contracts is that, because of their size, they freeze out small voluntary organisations that could deliver services on a local basis?
Grahame M. Morris
That is true. Some of the organisations that submitted evidence to the Health Committee and subsequently provided briefings made that point.
Another issue of concern is the complex commissioning landscape for CAMHS, which can result in poorly co-ordinated services and a lack of clarity about roles and responsibilities, leading to gaps in provision and poor transitions from child to adolescent and from adolescent to adult. The service is certainly underfunded. We often talk in this place about parity of esteem. As other Members have reported, CAMHS nationally is receiving about £1.8 billion of the £14 billion that is spent on mental health. Local authority-provided services, which are often having to bridge the gap, are facing huge financial challenges. My local authority, which I share with my hon. Friend the Member for North Durham (Mr Jones), has had to cope with cuts of £250 million over the lifetime of this Parliament. That is forcing councils to make extremely difficult decisions about which services are funded.
I fully understand the point made by the hon. Member for Brigg and Goole, but I also fully understand the difficult decisions faced particularly by authorities in the north that seem to be suffering disproportionate cuts. Councils are embracing their new public health responsibilities—
Andrew Percy
I hope the hon. Gentleman understands that both my local authorities are in the north of England; I would not want him to get his geography wrong.
Grahame M. Morris
I am certainly aware that some authorities are facing higher cuts than others. My area is one of relatively high deprivation, but we seem to be in a far worse position than some in the south that are more affluent and do not have the same kinds of pressures.
In rural areas, in particular, people face problems with travelling long distances, a lack of accessibility to specialist services, and long waits. One issue is the 12-week target for referral to CAMHS in cases where children and adolescents are referred out of their local areas. Transition between services varies from one area to another. In some areas it happens at 16, in some at 18, and in some at a point in between. These issues all need to be addressed.
Fundamentally, this issue comes down to funding. I welcome the establishment of the taskforce and the provision of £30 million over the next five years to improve services for young people with mental health problems. However, we must recognise that councils play a vital role in working with health services to target support and co-ordinate services, and they should play a key role in directing the funding.
Epilepsy
Grahame Morris Excerpts(11 years, 1 month ago)
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Grahame M. Morris (Easington) (Lab)
I, too, congratulate the hon. Member for South Thanet (Laura Sandys) and the right hon. Member for Chesham and Amersham (Mrs Gillan) on securing this important debate. In common with many other Members, I would like personally to thank the hon. Member for South Thanet for the excellent work she has done. She might not thank me for a glowing tribute, given that I am on the left of the party, but I think that she is a thoroughly decent MP who does an excellent job. She will be sadly missed. I am perhaps a less active member of the all-party group on epilepsy, but I am a member of many other all-party groups, particularly those on health and cancer. This is a very timely debate. It is thanks once again to the Backbench Business Committee that we have been afforded this opportunity to raise awareness of this important and often misunderstood condition.
In a previous role—I was not double-jobbing, I might add—I worked in the national health service in an analytical chemistry lab where I used to do tests on anti-epileptic drugs using gas chromatography techniques, so I know a little bit about the chemistry but not so much about the clinical manifestations and symptoms. I pay tribute to the tremendous and powerful speech by the hon. Member for Wycombe (Steve Baker), which really brought home the potential risks of this condition if left unregulated. It is one of the most common neurological conditions in the United Kingdom. As the hon. Member for South Thanet said, 500,000 people in the UK, or one in 100, have the condition. That is a considerable number of people. As I think we are all aware by now, epilepsy is not one condition but a composite. Other Members have mentioned the suspected link with autism. There are about 40 different types of seizure and perhaps as many as 50 different syndromes with various degrees of severity and complexity. However, with the right treatment, the right medication and the right support, there is no reason why someone suffering from epilepsy cannot lead a full and active life, as the hon. Lady so ably explained.
Many Members have talked about access to medical care and stigma, but I want to stress another aspect—the discrimination that can be faced by those with epilepsy, creating barriers to education, and, more particularly, to employment. A report published by Young Epilepsy found that three quarters of people with epilepsy have experienced discrimination due to their condition. This situation was reaffirmed by work commissioned by the disabilities charity, Quarriers, which found that more than two thirds of people with epilepsy admit that they worry what members of the public would say or do if they had a seizure, with over a third expressing concern that having a seizure in public has led to anxiety about whether to leave the house, even, let alone take up employment. In relation to employment, more than seven in 10—72%—stated that their condition had an impact on their career progression and choice, with more than two fifths avoiding even telling people about their epilepsy.
There are protections in place for those looking for work and for those who are in work, but I am concerned that these duties and obligations are not being met by employers. Equality laws make it illegal for employers to treat people with epilepsy unfairly, and protection must be provided against bullying and harassment due to their condition. Employers also have a duty to make reasonable adjustments to help people with epilepsy to get into work, or stay there, and to prevent them from being at a substantial disadvantage. However, we have found that people with epilepsy have been shown to be twice as likely to be at risk of unemployment as those without the condition.
The case of Karen Guyott, which was mentioned by my hon. Friend the Member for Vauxhall (Kate Hoey), has been drawn to my attention before. To comply with the instructions from yesterday, I am, as it says in my entry on page 205 of the Register of Members’ Financial Interests, a member of the RMT parliamentary group, although it is unremunerated and the RMT is not affiliated to my party. It is important that we speak in this House on behalf of working people, and charities, and raise legitimate concerns. That example of someone losing her job is an important test case because, as my hon. Friend said, London Underground did not provide the training or support required.
I only have a little time left, so I want to put this to the Minister, who I know is a decent and reasonable man: at the conclusion of the debate, I hope that he will make it clear that it is unacceptable to discriminate against someone due to their having epilepsy. I hope that he will support people, such as Karen, who are fighting blatant discrimination. Will he agree to raise her case with the Mayor, because Transport for London comes under the Mayor’s auspices? TfL is a significant public sector employer, and we want it to be an example of best practice. Will the Minister meet a delegation of interested MPs to discuss discrimination and epilepsy at work?