Mental Health Taskforce

Helen Whately Excerpts

Tuesday 23rd February 2016 Commons Chamber

[Alistair Burt]

I understand the right hon. Lady’s point. I know that such issues are being considered extremely carefully by those who are responsible for developing the policy, but I will ensure that her further concerns are noted and that the Departments recognise them.

[Helen Whately (Faversham and Mid Kent) (Con)]

There is so much good stuff in this report that I must congratulate the authors on their work and my right hon. Friend the Minister on his interest. I particularly welcome the recognition in the report of the gap in the provision of psychiatric liaison services, and the commitment to have such services at the core 24/7 level in at least half of all hospitals by 2020. Will my right hon. Friend advise me on whether such provision is fully funded? Given the difficulties of getting such services in place at the moment, will he take a close interest in the plan to make it happen in practice?

[Alistair Burt]

I thank my hon. Friend for her interest in this subject, which she had expressed to me previously, and her work on it. Yes, our determination is that the extra £1 billion a year that will be spent on mental health services will cover the training and the commitment that we have made to 24/7 cover. It is very important that such cover is there. The issue was identified when the Care Quality Commission looked at the work of the mental health crisis care concordat, which has been so successful in its first 12 or 18 months. I can assure her that I am determined to ensure that we provide these facilities.

Junior Doctors’ Contract Negotiations

Helen Whately Excerpts

Monday 8th February 2016 Commons Chamber

[Ben Gummer]

The hon. Lady speaks from experience, and rightly points to the fact that avoidable mortality that is attributable to weekends is different from mortality at weekends—the Secretary of State has been clear about that in his public statements. However that gap does exist, as the hon. Lady knows, and Professor Sir Bruce Keogh was clear in his statements that there is an avoidable rate of mortality. He stated:

“There is an avoidable ‘weekend effect’ which if addressed could save lives. This is something that we as clinicians should collectively seek to solve. It also strengthens the moral and professional case for concerted action.”

The way in which the hon. Lady characterised the discussions in September, October and November is not quite right. We implored the BMA to come and talk; I personally had those discussions with leaders of the BMA, and they refused to do so. It was only when they came and talked to us that we made substantive progress.

The hon. Lady is right to raise these issues, and we wanted to discuss such matters with the BMA. One issue was protection against excess hours, but we had no counterparty with whom to negotiate. Since we have had that counterparty, we have made good moments of progress, and the result is the guardian position, which she welcomed in another place. The guardian will be able to levy fines, and those fines will be remitted to the guardian. I hope—and indeed expect—that process to reduce the excess hours that we still see in a small minority of positions. We must get away from the perverse incentives for trusts and a small minority of doctors that mean that unsafe working hours are perpetuated.

Of course we all regret the course that this dispute has taken, but it would not have done so had the BMA taken a responsible position from the beginning. If people lie to their members and say that they will have their pay cut and their hours raised, of course doctors will be angry—all of us would be. The fact is that that was never true, but it has inflamed the situation. We could have had the kind of productive talks that we have had over the past three or four weeks back in August, September and October had we not had all the mess beforehand because of untruthful statements issued by the BMA.

[Helen Whately (Faversham and Mid Kent) (Con)]

The level of support among junior doctors for this pay dispute is at least in part because of longstanding dissatisfaction with the experience of being a junior doctor. Sir David Dalton recommended a review of those longstanding concerns in his recent letter. Do the Government intend to commission such a review?

[Ben Gummer]

The Government will be looking at Sir David Dalton’s recommendation and acting on it. He is right to point to the fact that the 1999 contract is imperfect—it was agreed back in 2008 that it had many failings, and that something needed to be done to fix it. That contract in its generality has helped to contribute to the lowering of morale in the junior doctor workforce, which Sir David Dalton has recognised, as has the Secretary of State. It is not just the way in which training placements are made and a whole series of other problems with the contract; it is also the fact that people have to work for long periods of consecutive nights and days, all of which is reduced in the latest proposed contract.

NHS Trusts: Finances

Helen Whately Excerpts

Monday 1st February 2016 Commons Chamber

[Ben Gummer]

To ask about PFIs signed by the previous Government is a brave line of attack. I have held a number of meetings about Barts with the hon. Lady’s colleagues, and I completely understand the difficulty that she and they—and, indeed, the trust—find themselves in. I had a meeting about Barts this morning. I also had two last week, and I shall be having a further two this week and next week, precisely because I want to see the transformation she needs in her area. I am very happy to discuss that in greater detail with her. In fact, I will convene a meeting of local MPs in the near future.

[Helen Whately (Faversham and Mid Kent) (Con)]

The Government rightly front-loaded the extra money that the NHS called for in the “Five Year Forward View”, but it is vital that that money is used to drive transformation, such as the productivity improvement that is needed and the shift of care out of hospitals. Will my hon. Friend assure me that the money will go not just to plug deficits, but to change the way in which services are delivered?

[Ben Gummer]

My hon. Friend is entirely right and speaks from experience. That is why, as part of the spending review settlement, £1.8 billion was set aside as a transformation fund. The principle behind the transformation fund is that the money will go to those trusts that are beginning to show transformation in the way they are running not only their finances, but their whole operations. That is for the betterment of patients as a whole. We have to see transformation; otherwise money will be wasted, as it has been in years previously.

NHS and Social Care Commission

Helen Whately Excerpts

Thursday 28th January 2016 Commons Chamber

[Norman Lamb]

I am grateful to the right hon. Gentleman for that intervention; he absolutely makes the case. Incidentally, I think that it is massively in the Government’s interests to respond positively, because any solution has to carry public support and support across the political spectrum.

Consider these points. Does it still make sense to maintain the divide that was originally put in place in 1948 between the NHS and the social care system? Is that serving patients effectively, particularly given that the big challenge of this century will be people living with long-term, chronic conditions, often multiple conditions, and often a mix of mental and physical health conditions? For those people, a divide between different organisations with different pools of money and different commissioning arrangements does not seem to make much sense. I think that that needs to be looked at.

Too often, the system gives the impression of being rather dysfunctional. For example, last October there were 160,000 bed days resulting from people whose discharges were delayed. These are predominantly older people, often with dementia, who remain stuck in hospital long after they are ready to go home or somewhere closer to home. This is not good care. We are letting people down by keeping them in hospital for longer than they need to be, which also makes it harder for them to become independent again. The figure went down a little in November, but it is still the second highest since the data on delayed discharges started to be recorded.

[Helen Whately (Faversham and Mid Kent) (Con)]

The right hon. Gentleman mentions the relationship between the NHS and social care and the problem with their being separate. Does he acknowledge that the “Five Year Forward View” contains several approaches to bringing them together, and that parts of the country are already working on further integrating them? Is it not important to press on with those approaches so that we can see how they work and move as quickly as possible on this?

[Norman Lamb]

I totally agree with the hon. Lady. I have always been a strong supporter of the forward view. Simon Stevens is a good leader of the NHS. He has a vision, and he recognises that the solutions to this challenge often lie beyond the NHS. Some of the models that are being trialled across the country are very interesting. I do not want what I am saying to be seen in any way as undermining the very good work that is under way in the so-called vanguards around the country.

--- Later in debate ---

[Norman Lamb]

My right hon. Friend comes to the central point. As someone once said, the NHS has the status of a national religion. In this partisan atmosphere in which we all work, there is a danger that anyone who proposes a change to the NHS will get condemned from on high, because of the political points that can be scored in so doing. If we are to think about what we need from a modern health and care system that focuses on prevention, and to make changes in a rational way, we must give Government the space to think afresh about how we can sustain the system and guarantee care for those who need it. We have a choice now: we continue to drift until, ultimately, the system crashes, or we grasp the nettle and come up with a long-term solution.

All parties should commit to the proposal. If we want a good example, we should look at the commission of Adair Turner, which was established by the Labour Government to look at the long-term sustainability of pensions in this country. He managed to secure cross-party buy-in. He came up with proposals that led to change and reform. It was a process that gave people the space to look at a very difficult challenge and to come up with solutions. That is one model we could follow. It should be strictly time-limited. Somebody made the point that we are talking about not a royal commission, which goes into the long grass for three or four years, but a time-limited commission of up to one year with the aim of coming up with solutions that are then implemented. It should engage with the public, with patient groups and, critically, with staff, who, as the right hon. Member for Sutton Coldfield (Mr Mitchell) said, often feel that they are under intense pressure and that they are not listened to by Governments of all political persuasions. They, together with unions and civic society, should be centrally engaged with this commission. At the end of the process, we should seek to come up with recommendations that can then be implemented and can give everyone in this country the assurance that there is a long-term settlement for the NHS and for care.

Finally, let me raise one or two things that the commission needs to consider. It needs to look at the divide between the NHS and social care and at the adequacy of funding. How much as a society are we prepared to pay to ensure that we have a good, well-functioning health and care system? At the moment, funding for our health and care system comes through three different channels: the NHS, local authorities and the benefit system. Does that make sense? Should we look again at that system?

We also need to look at how we, as a country, are spending money on our older people. Are we spending it effectively enough? Are we targeting it at those older people who most need Government help? We need to look at intergenerational fairness and at where the money comes from—a point very well made in a recent book by the respected former Cabinet Minister, David Willetts. We also need to consider how we can give power to people to help them to self-care. David Wanless, when he reported for the Labour Government, made the point that his projections about how much extra money the system would need was based on people being engaged in their health—I am talking about self-caring more effectively. That has not happened in the way that he proposed.

We also need to consider the case for a dedicated health and care tax, which can be varied locally. Even protecting NHS spending results in disproportionate cuts in other areas of Government spending, distorting sensible, rational decisions. As this is an area on which spending inexorably rises, there is a case for carving out such a tax.

[Helen Whately]

rose—

[Norman Lamb]

I am sorry, but I want to conclude my remarks now to give other Members a chance to speak.

This proposal has had very significant support. NHS Survival, which now encompasses 8,000 members—junior doctors, patient groups and so on—has strongly argued for such a tax. Forty chief executives of care organisations wrote to the Prime Minister to support the case. The chief executive of the King’s Fund, Chris Ham, has written a very helpful blog, making the case. Royal colleges of surgeons, pathologists and anaesthetists have all supported the call. I urge the Government to respond positively. They should stop and think for a moment before rejecting our proposal, because it might be an enormous help to the Government in resolving an intractable problem. This is the time for a 21st-century Beveridge report to come up with a long-term settlement for the NHS and for social care.

--- Later in debate ---

[Dr Wollaston]

Indeed; I remember that too. I agree that unless we up our game and redouble our efforts on prevention, we will not achieve the savings that are required to close the gap in the “Five Year Forward View”. That is why I wanted to touch on prevention first.

There is another area that we need to do much more on here and now. We need to have a relentless focus on variation across the NHS. We hear examples of local systems that are making things work, but the NHS has a long history of failing to roll out best practice. The “Growing old together” report, which was published today by a commission set up by the NHS Confederation, gives examples of good practice across the NHS and social care in which integrated practice is not only delivering better care for individuals, but saving money. The only depressing aspect of that is that one has to ask why it is not happening everywhere. Rather than endlessly focusing on the negatives in the NHS, let us focus more on the positives and on facilitating their roll-out.

[Helen Whately]

My hon. Friend is talking about work that is being done on the problems in the health service and about approaches that can improve it. Does she share my concern that although there are big challenges, there is a risk that a commission such as the one proposed could prove a distraction from getting on with the many things that we know need to happen and the very good proposals in the “Five Year Forward View”? It could therefore be unhelpful, rather than helpful, despite its objective.

[Dr Wollaston]

If that were the case, it would be a problem. I think that the two things could happen in parallel. We could work towards a consensus about future funding at the same time as focusing relentlessly on what needs to be done in the here and now. However, I agree that if it were a distraction, it would be a problem.

As well as continuing to have a relentless focus on tackling variation, we need to follow the evidence in healthcare. When money is stretched, we must be sure not only that we spend it in a way that follows the evidence, but that we do not waste money in the system. I caution the Minister on the issue of seven-day services, which we have discussed at the Health Committee. If there is evidence that GP surgeries are empty on a Sunday afternoon because there is no demand, and in parallel with that we are being told that out-of-hours services are in danger of collapse because, in a financially stretched system, there are not the resources or manpower to offer both, we must be led by the evidence and be prepared to change what we are doing.

When money is tight, we owe it to our patients to focus on the things that really will improve their care. There must be no delay in making changes when we know that something that has been put in place with the best possible intentions may be having unintended consequences. We must be clear that we will follow the evidence on best practice and value for money, so that patients get the best outcomes in a financially stretched system.

--- Later in debate ---

[Helen Whately (Faversham and Mid Kent) (Con)]

It is an honour to follow my hon. Friend the Member for Stafford (Jeremy Lefroy), who made some very good points and helpfully referred to the Barker report, which deserves to be debated. We must take a grip of some of its proposals. Although I am sure we do not all agree with everything in the report, it is a good thing to talk about.

It is also an honour to follow the hon. Member for Walsall South (Valerie Vaz). I am now a member of the Health Committee, so it is good to hear about her experiences on the Committee and to reflect on what I might do with my fellow Committee members to make sure that we are effective in driving forward the agenda of the integration of health and social care, about which she spoke so powerfully.

I thank the right hon. Member for North Norfolk (Norman Lamb), the hon. Member for Leicester West (Liz Kendall) and my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) for calling for this debate. It has been a good, wide-ranging and productive conversation about the future of the health service and social care. There have been extremely interesting contributions from my hon. Friends the Members for Totnes (Dr Wollaston) and for South West Wiltshire (Dr Murrison), the right hon. Member for Sheffield, Hallam (Mr Clegg) and my hon. Friend the Member for Lewes (Maria Caulfield), among others.

I share the desire and aspiration of the right hon. Member for North Norfolk to take the politics out of the NHS and discussions about the health service and social care. There are certainly situations, particularly in the run-up to elections, when there is very unhelpful scaremongering from all sides about what is going on.

[Mark Tami (Alyn and Deeside) (Lab)]

I agree with the hon. Lady. We need to look at this matter for the long term. Whoever makes such statements during election campaigns—whether it is us or the Government—the talk of death taxes and such things is not particularly helpful, because we need to form a cross-party view, given that we require long-term measures that will cost money. There is no way of getting out of that.

[Helen Whately]

The hon. Gentleman might want to hear what else I have to say before he agrees entirely with what I am saying, but we share the view that scaremongering is unhelpful.

In a health system that spends £135 billion of taxpayers’ money every year, that employs 1.3 million staff and that has over 60 million users in the British population, there is no way in which this issue cannot be political, as the hon. Member for Leicester West said. It just is political. It is no bad thing that it is political, because it means that there is a debate about it and, out of debate, we get better answers. It also means that the public are given a choice.

One concern I have about the proposed commission is that there appears not to be a consensus on what it should be about among those who support it. I have heard this afternoon that it should be about the future funding settlement for health and social care, but also that it should be about public health, the structure and configuration of the NHS—the estate solutions—the future role of mental health in the health service, prevention, and the integration of health and social care. To me, that is a problem. If the commission is to be effective and short—a period of one year is proposed—and if it is to lead to something concrete, it cannot possibly be that wide-ranging. I worry that those involved in the commission will spend a huge amount of time working out, and disagreeing among themselves about, what the commission is looking into. That process would be an enormous waste of time, money and attention—there is a limited amount of attention, brain power and resources to put into such a discussion about the future of health and social care, which is an opportunity cost.

To the extent that the commission might focus on future funding for the long term of health and social care, that is important and should be given a huge amount of attention. We need to look further out, but if anything is political, it is that question. Questions such as how much as a society we should spend on health and social care, what proportion of GDP or what amount per person we should spend, and how it should be funded—should it be taxes, charges or co-payments—are important, but they are very political. They are questions of value. It would be incredibly difficult to take the politics out of them.

In fact, it would be wrong to come to a consensus. We need a debate and we need to disagree. We need to give the public a choice. Just as the current funding settlement through to 2020—the £8 billion or £10 billion in this Parliament—was put to the public last year at the general election as part of an overall package of Government spending, taxation, debt and deficit proposals, future funding for the health and social care system should be put to the public at a future election. It is not something that should be agreed by insiders in a commission between now and the next election—the suggestion is that it should move quickly. That is a worrying proposal if I have understood it right. The public should decide that and it should be debated in the run-up to an election.

[Mark Durkan (Foyle) (SDLP)]

Does the hon. Lady really believe that the public would be happier with a confused and disagreed choice that has been argued over between parties rather than an agreed and long-term choice that puts real priorities and undertakings in front of them?

[Helen Whately]

The public would rather be given a choice. We will have a debate about Europe in the run-up to the forthcoming referendum, which voters voted for in the election. We should respect voters and put choices to them on which they can take a view.

[Caroline Flint]

I understand some of the hon. Lady’s points and have heard contributions about all aspects of health this afternoon. The central point of the motion is funding. The truth is that no political party in the past 40 or 50 years has put before the electorate a clear framework of what the state will pay out of the pooled funding we get from national insurance and income tax, and what people will add on top based on their income or assets to fund the future of social care. We have never had that proposition because it is not within the mix of a general election. In the bustle and the back and forth, a debate on that has not been allowed to happen. We, as politicians, are to blame.

[Helen Whately]

I agree with the right hon. Lady that it is difficult in our election cycle to think further ahead, but it is not impossible. During the last Parliament, the NHS came up with the “Five Year Forward View”, which at the time was supported by all major political parties. With that experience behind us, it is possible to go ahead and come up with further long-term views. As I said, a debate, rather than aiming for a consensus, would be helpful. That is exactly the sort of thing that think-tanks, researchers and all sorts of organisations can, are and should look into.

I want to highlight the fact that this issue is political. The right hon. Member for North Norfolk mentioned an organisation called NHS Survival. I saw on its website that lots of clinicians are involved with it. It is fabulous that clinicians are involved in this discussion about the future of the NHS. That said, the founder of the organisation was also, according to its website, the person who initiated a petition calling on the Secretary of State for Health to resign. The right hon. Gentleman called on NHS Survival as an example of a body lobbying for a commission, but it is clearly very political. There is no way of taking the politics out of this.

[Norman Lamb]

I totally share the hon. Lady’s view that the politics should not be taken out of health. As others have said, we spend such a substantial amount of public money on the NHS and social care that it is absolutely right it should be subject to political debate. However, as others have said, in particular the hon. Member for Leicester West (Liz Kendall) and the right hon. Member for Don Valley (Caroline Flint), we do not ultimately, in the partisan environment we work in, confront the really difficult issues. They keep being put off. This is the whole problem. However much in theory she describes a perfect democratic situation in which these issues are debated and resolved, they are not resolved. We remain drifting into crisis because we are not confronting it.

[Helen Whately]

The right hon. Gentleman makes an important point about the need to look at and confront the long-term future funding settlement. I just do not think a commission is necessarily the right way to do it. The fact that we are having a conversation about it now, here in this House, is in its own right a good thing.

[Maria Caulfield]

Does my hon. Friend agree that NHS England is non-partisan and that the “Five Year Forward View” is non-partisan? It has considered all the aspects, and the role of a political party is to decide whether to support that or not. Too often, it is the politicians making the suggestions, not the NHS.

[Helen Whately]

I agree with my hon. Friend that the “Five Year Forward View” was a landmark document in that it set out the NHS’s own plan for its own future, supported by political parties. The more it can be encouraged and enabled to have that autonomy—and for organisations within the NHS to have that autonomy —to determine its own future, the better.

Another proposal is that the commission should focus on the integration of health and social care. In many ways that is already in progress, with many different models being pursued—it is one of the important features of the “Five Year Forward View”. One thing I am wary of is that the commission might come up with a one-size-fits-all model for integrated health and social care. If we have seen anything in recent years, it is that one-size-fits-all is not a good idea. One of the good things going on at the moment is the development of different models, whether in Manchester or in a local vanguard area such as down the road in Whitstable, looking at different ways of doing things. That is healthy. Each area could and should work out for itself the way to bring health and social care together. What we, and Government, should do is enable, support and encourage areas to move forwards and be bolder, and not necessarily impose a single template of how it should be done.

I am very mindful of the problems and outcomes challenges the NHS has on a national level, but in my constituency I have two trusts in special measures. My 100-year-old grandmother is, right now, in an acute hospital. If the system was working better, she would not be there. The health service has many problems, as well as many strengths. We should focus on how the NHS can get on with things that are in the pipeline. There have been many allusions to recent reports and evidence of best practice that is not being replicated enough across the system. There is a lot going on: the development of the vanguards, devolution, integrated care organisations and so on. All that good stuff is happening and we just need to get on with it.

We need to shift care, especially primary care, out of hospitals and, as people who can hold the Government to account, we need to make sure that the funding follows that shift. That is something that concerns me, and let us keep an eye on it. We also need to shift towards, and provide the funding for, parity of esteem for mental health and to improve the quality of care through transparency, technology and developing a learning culture in the NHS, with a greater focus on outcomes. This is happening, but we need more of it.

I am particularly concerned about the terrible morale among the NHS workforce. About 80% of junior doctors have said that they do not feel valued by the organisations they work in, and the figure is similar for other members of the healthcare workforce. That is an enormous problem. If I was to call for a commission on anything, I would call for one to look into why the workforce is so downbeat and demoralised. That is a fundamental but specific issue about which something could be done.

Overall, the NHS needs to get on with achieving the productivity opportunity that it identified and committed itself to in the “Five Year Forward View”. Many people are sceptical about the NHS’s ability to make £20 billion of efficiency improvements in the coming years. To do that, it needs to be bold and make the most of technology to reduce the enormous wastage in the NHS. It needs to solve the problem of patients not being discharged or coming to hospital unnecessarily. It needs to join up with the social care system around the NHS and address the shortage of nursing beds, for instance, which is an acute problem in my constituency and one of the major reasons patients are in hospital unnecessarily. I want all these things happening more quickly, on a larger scale and with greater boldness. The NHS and the social care system need to direct their energies at doing that, instead of being distracted by a commission covering the wide range of subjects mentioned today.

To conclude, I welcome our having a conversation that feels a lot less party political than many conversations about the NHS and which looks to the long term, as well as the near future, but I do not support the commission proposed by the right hon. Member for North Norfolk.

Childhood Obesity Strategy

Helen Whately Excerpts

Thursday 21st January 2016 Commons Chamber

[Mrs Hodgson]

Yes, that private Member’s Bill is an excellent initiative, and should be adopted by the Government and local authorities. It is very simple to share the data that we already have on families who are entitled to benefits, to ensure that the entitlement of their children to the pupil premium is not lost when universal free school meals are rolled out. That is a very important point.

Although we do not always think about obesity in this way, it is a form of malnourishment. What we are seeing today is very similar to what we saw more than 100 years ago, with children lacking the right nutrients to see them living a healthy childhood and growing into healthy adults. That is especially concerning given that today more than one third of children are leaving school overweight or obese.

The school setting is one of the most important interventions in a child’s life; it is where we nurture and educate future generations. Why should we not feed these children so that they are fuelled to receive the best education and life chances possible? That notion was strongly supported by the previous Labour Government, who introduced a raft of measures that addressed the food eaten by children in our schools. They included nutrition-based school food standards that provide children with the proper nutrition to learn, fully costed plans to extend our universal free school meal pilots, and the introduction of healthy, practical cooking on the national curriculum.

Although much, or all, of those measures were scrapped when the coalition Government were formed in 2010, it was very welcome when, in 2013, the school food plan was published, calling for the reinstatement of lots of those measures as well as new and improved measures in our schools to address the health of our children. Those included introducing food-based standards for all schools, training head teachers in the benefits of food and nutrition, improving Ofsted inspections on school food, and the roll-out of universal free school meals for primary school children, when funding was found.

As we know, that funding was found, thanks to David Laws and the right hon. Member for Sheffield, Hallam (Mr Clegg). Fortunately, universal infant free school meals were secured by the Chancellor in the comprehensive spending review. All those measures came out of concerns for the health of our children and the growing obesity crisis, especially given that 57% of children were not eating school lunches. Some were opting to take in packed lunches, only 1% of which met the nutritional standards of a hot lunch, while others were opting to go off site to eat junk food at local takeaways.

As research has found, health problems associated with being overweight or obese cost the NHS more than £5 billion a year, and, with obesity rates continuing to rise for 11 to 15-year-olds, especially in deprived areas, it is now clearer than ever that we need seriously to address childhood obesity.

Giving children a healthy and balanced diet during the school day can only be a positive intervention in helping to address obesity. I cannot stress how strongly I believe that one of the most important interventions to help address health issues in childhood is universal free school meals.

[Helen Whately (Faversham and Mid Kent) (Con)]

The hon. Lady mentioned that children are consuming junk food from outlets near schools. Does she believe that councils should have powers, as part of planning guidance, to take action on junk food outlets being so close to schools?

[Mrs Hodgson]

Yes, I do. I really welcome that intervention, because it not only makes the point, but stresses it very strongly. Some councils are very good and introduce byelaws to ensure that burger vans cannot pull up outside a school, and that, if there is already a number of takeaway shops nearby, no more can open. Matters such as that need to be addressed by councils.

The pilots introduced by the previous Labour Government in Durham and Newham to look into the benefits of universal free school meals found many benefits to a child’s health, and research continues now that we have universal infant school meals. The pilots in Durham and Newham found a 23% uptake in vegetable consumption at lunchtime and a steep decline in the typical unhealthy packed lunch foods. For example, there was a 16% decline in soft drinks and an 18% decline in crisps. Those are all-important figures that the Government should remember, and both the Department of Health and Department for Education should look further into how best they can use the vehicle of universal free school meals to help improve children’s health.

Although universal free school meals are protected in the Government’s comprehensive spending review—this followed a concerted campaign by school food campaigners, myself and others in the House—there is another area that the Government must consider when looking to improve the health of our children: holiday hunger. Children are in school for just 190 days of the year, and the rest—a total of 170 days—is totally down to their parents. Some may say that that is how it should be and that when we lock the school gates for the holidays it is none of our business what children eat, whether they eat or what they get up to. None the less, with the growing use of food banks in school holidays and the reports that children return from the longer school holidays noticeably thinner and unhealthier, the issue is one that we can no longer ignore.

If there is a push for better food provision in our schools, then we need to be doing much more during the holidays so as not to undo the hard work that goes into improving the life chances of children during term time. That is why the school food all-party group, which I chair, has established a holiday hunger task group, which last year launched its “Filling the Holiday Gap” guidelines to provide organisations and local authorities wishing to provide food during holidays with the resources to offer healthy and nutritious food. Late last year, it published its update report, which called for action to be taken by the Government.

When the Government’s childhood obesity strategy is published, I hope that there will be significant mention of the benefits that school food, especially universal free school meals, can have on a child’s health, and of how it can be used to address the growing childhood obesity crisis. There is evidence out there to support using universal free school meal provision to its fullest, instead of squandering its potential, to improve the health of our children.

This is a moment when the Government can really make a difference to children’s lives and I hope that all options and avenues will be pursued so that children are given the healthy food that they need to fuel their education and to make them as healthy a version of themselves as possible so that they grow into fit and healthy adults.

--- Later in debate ---

[Nigel Huddleston (Mid Worcestershire) (Con)]

I, too, pay tribute to the Health Committee for its great work. I pay tribute particularly to the Chairman of that Committee, my hon. Friend the Member for Totnes (Dr Wollaston), and to my hon. Friend the Member for Erewash (Maggie Throup) for her work in the all-party obesity group.

This is a very important topic. It is also a very emotive one, as we have heard, especially for those of us who are generally instinctively against Government interference and taxation, and want small government. I have wrestled with that, like my hon. Friend the Member for St Austell and Newquay (Steve Double), but I have come round to the idea that when it is necessary to interfere, and when we have to balance out these freedoms with doing the right thing by our children, then we do need to consider all options. I have been slowly persuaded, but am now comfortably persuaded, on issues such as the sugar tax. So unfortunately, probably for the first time ever, I disagree with my hon. Friend the Member for Colchester (Will Quince). However, I am sure that it will be the first of many such times over coming years.

The evidence is overwhelming. Like the hon. Member for Strangford (Jim Shannon), in researching this topic I found that the numbers are astounding. The figures are overwhelming, and very alarming. I will not repeat them, but the report contains many such figures, and it is well worth a read.

One of the issues that comes up again and again is food marketing. Research tells us that children as young as 18 months can be influenced and are capable of recognising brands, which is a truly astounding fact. The House will be aware that current regulations on TV advertising mean that foods high in fat, saturated fat, salt and sugar are banned from being advertised during children’s programming, but many organisations, as well as the report, have suggested that that should extend up to the 9 pm watershed, and with considerable reason, given the evidence. The latest Ofcom figures show that two thirds of children watch television during what is considered adult airtime, with peak viewing for children between 7 pm and 8 pm. The British Heart Foundation found last year that during just one episode of “The X Factor”, a programme that is quite popular with children, there were no fewer than 13 junk food adverts. The issue is even more acute with online advertising, where adverts are often attached to videos, including music videos. That is probably worthy of a debate in itself.

Let me turn to food standards in schools, where there has been a tremendous breakthrough over the past few years. Those of us who visit schools look on with envy at the school meals now compared with the ones that many of us had to suffer years ago. Yet in many schools up and down the country, we have the farcical situation where lunches provided by schools are generally very healthy, but the food children themselves bring into schools, or is provided by their parents, is often not healthy. We can only imagine how frustrating it is for teachers, and indeed everybody who works in schools, including my wife, to see children filling themselves up with junk food at school and knowing there is little they can do about it. We need more co-operation between schools, and between parents and teachers. I back the Committee’s proposal that nutritional guidelines should be published for packed lunches and that, where necessary, teachers should be able to have, perhaps robust, conversations with parents so that these guidelines are followed.

Of course, diet is very important, but so is physical activity, as has been mentioned many times. I back up the supportive comments about the DCMS’s sports strategy. In The Times on Monday we saw a snack guide that included information on how long it would take to burn off the calories of various foods. It is easy to laugh at things like this, but it showed that a chocolate bar, bag of crisps and a bottle of Coke would require almost one hour of running or more than two hours of walking to burn off. How many children, or indeed parents, know that? Given that a child could consume all those things on top of, or instead of, a healthy meal, while doing no exercise, it is a really alarming picture. We must do more to encourage and enable exercise.

I am blessed to represent a primarily rural constituency. It is very easy for me and my family to get outdoors, to go on bike rides, and to go on public pathways. I am well aware that not everybody in the country has those privileges. Councils and local government need to do much more to enable access to healthy outdoor living and sports facilities. Planning plays a part in this too. When I see planning proposals for housing developments, I find it remarkable how little provision there is for recreational facilities, or indeed access to countryside. Cities fare far worse than the countryside in this regard.

[Helen Whately]

My hon. Friend is making an important speech covering a wide range of actions that need to be taken to tackle the obesity problem. Does he agree that this is not just about the sugar tax or product placement? The scale of the problem is such that we need a whole range of steps where the Government take a lead in showing how serious the problem is, and a whole range of actions to make sure that a difference is made quickly.

[Nigel Huddleston]

I thank my hon. Friend for that intervention; I could not agree more. Indeed, she has stolen my conclusion. It is absolutely the case that this is a very complex matter that covers so many areas that it is difficult to fine tune it. I hope that we can avoid focusing purely on the sugar tax, as important as it is.

We must recognise and praise the fact that up and down the country there are some great experiments going on, with schools practising innovative ways to encourage physical activity. For example, Commando Joe’s goes into schools and encourages team building and physical activity. I give credit to Bengeworth academy in Evesham in my constituency where we have our own Commando Joe—a gentleman called Chris Parry who works alongside staff and children having previously done four tours of Afghanistan with the Marines. He is doing great work, and long may that continue.

As my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) said, this is not just about healthy eating. It is also about planning, education, labelling, and information, and the cost in healthcare if we do not do anything—we need to cover so many areas. If the aim of this debate was to give the Government ideas about what they could do to help in this area, then I am sure that by the end of it that will have been achieved.

Oral Answers to Questions

Helen Whately Excerpts

Tuesday 5th January 2016 Commons Chamber

[Ben Gummer]

I thank the hon. Lady for bringing that issue to the notice of the House. The reconfiguration she mentions is the responsibility of local commissioners, but I am very happy to meet her, and anyone she wishes to bring with her, to discuss the planned changes.

[Helen Whately (Faversham and Mid Kent) (Con)]

My local mental health trust recently reduced its psychiatric liaison cover in A&E and is now considering the level for the coming year. Will my right hon. Friend provide an update on what the Government plan to do to ensure specialist mental health care in A&E?

[Alistair Burt]

The mental health taskforce will shortly bring forward its recommendations. It will be looking very carefully at what is provided in A&E. It was the subject of the crisis care concordat review by CQC earlier last year. I am looking specifically at psychiatric liaison, because I saw my hon. Friend’s written question very recently.

Mental Health

Helen Whately Excerpts

Wednesday 9th December 2015 Commons Chamber

[Luciana Berger]

I will make a little progress, because I have my speech to get through and I am conscious that many Members on both sides of the House want to contribute to this debate.

We are calling for three things that we believe will make a difference. First and foremost—several interventions have referred to this—we are asking the Government to restore transparency to address the murky picture of mental health funding. Secondly, we are asking Ministers to address the fundamental inequality that currently exists in our NHS constitution. Finally, we are asking the Government to prioritise prevention and to implement a fully cross-departmental plan to prevent mental health problems from developing in the first place.

[Helen Whately (Faversham and Mid Kent) (Con)]

Does the hon. Lady agree that transparency is known to be a very effective lever for the Government to use to improve quality? Does she welcome the steps taken by the Government to increase transparency in the performance of mental health services?

[Luciana Berger]

I do not share the hon. Lady’s view. Just in the last week, I have written down a list of 10 things about which I have asked the Government for figures, but about which I have been told that they do not hold information centrally. Many of the statistics that were available previously are no longer available. The central request we are making today is to restore the transparency, particularly on how much is spent on mental health, which the Government took away in 2011-12. Many Members on both sides of the House would like to know those figures.

--- Later in debate ---

[Helen Whately]

My hon. Friend mentions psychiatric liaison in A&E. Does he agree that it is incredibly important for hospitals to have a comprehensive psychiatric liaison service, so that when people go to A&E, there is a specialist capable of giving them the right help?

[Mr Walker]

I wholeheartedly agree with my hon. Friend. The provision of specialist care in those situations is vital.

The Minister replied to my written question in July, saying that the Government’s mandate to NHS England states that access to crisis services for an individual must be

“at all times as accessible, responsive and high quality as other health emergency services.”

Does this mean that he has the power to mandate that mental health support to A&E services be provided by practitioners, rather than merely through phone support? I urge Ministers to consider the case for all emergency departments, especially those as busy as the one at the Worcester Royal hospital, having 24-hour access to mental health experts.

I draw the Minister’s attention to the case of a constituent who, as a result of the absence of this support early in 2014, went through an acute episode, having left A&E without receiving the help she needed. This involved the calling of multiple police cars and ambulances. That use of the emergency services incurred far greater cost than simply having the support in place would have done. Any savings made from the failure to commission overnight cover would, in my view, be a case of being penny wise and pound foolish. As the Secretary of State said, not investing in mental health can sometimes be a false economy.

Overall, however, I welcome the progress made. I welcome the additional investment, including in my constituency. I hope that the Minister can respond to my concerns.

Junior Doctors Contract

Helen Whately Excerpts

Monday 30th November 2015 Commons Chamber

[Mr Speaker]

I call Helen Whately—[Interruption.] Order. May I gently remind Members that it is a good idea to continue to stand? One should not stand once and assume thereafter that the Chair is psychic. I had a hunch that the hon. Lady wished to contribute, but keep standing—it helps the Chair and it is also helpful exercise.

[Helen Whately (Faversham and Mid Kent) (Con)]

Thank you, Mr Speaker.

I welcome the fact that the BMA is returning to talks and that there is a potential agreement on the table. The dispute has focused on pay and hours, but I think that its roots might go deeper. For instance, juniors often do not feel valued or part of the team. Does my right hon. Friend agree that the best way to improve the situation for juniors is for them to engage in talking, rather than striking, and that talking, which they are doing, is the right choice by juniors, who are the future leaders of the NHS?

[Mr Hunt]

I agree with my hon. Friend, who has great knowledge of NHS matters. I simply say to junior doctors that this is not just about contracts and pay; it is also about training. Having consultants more available at weekends will help improve training for junior doctors. We will also need to look at continuity of training, which I think has been undermined in recent decades. If junior doctors are looking for a visible reflection of this Government’s commitment to the NHS, they should look at last week’s spending review statement and the extra resources we are putting into the NHS in very tight circumstances. This Government are backing the NHS, and we are doing everything we can to back junior doctors as part of that.

Male Suicide and International Men’s Day

Helen Whately Excerpts

Thursday 19th November 2015 Westminster Hall

[Philip Davies]

I very much agree with my hon. Friend. Increasingly, working-class boys are some of those who are doing the worst at school and need the most help. I certainly agree with him about political representation. I have often said that replacing Rupert from Kensington and Chelsea with Jemima from Kensington and Chelsea does not do much for diversity in the House of Commons, but that is perhaps a debate for another day.

Of course, some people believe that only men can be sexist. Frances Crook of the Howard League for Penal Reform, for example, tweeted the following a few years ago:

“Sexism is not about choosing between two genders, it’s about historic & current oppression by men. Only men can be sexist.”

That view is not uncommon, but it is, I believe, misguided. If it is not okay for a man to be sexist, it cannot be okay for a woman to be sexist. A good example of that is positive discrimination, which is portrayed as a great thing that can rebalance things for oppressed females, yet it is just discrimination. Whether we put the word “positive” in front of it or not, it is still discrimination. In my opinion, there is absolutely nothing positive about positive discrimination, and it certainly has nothing to do with equality.

Just a few months ago, a publishing house declared that it would not accept any male authors for a year to redress some perceived discrimination against female authors. I never quite understood that, because as far as I can see, there are plenty of published female authors, but leaving that aside, people commended the publishers for their stance. Imagine if another publisher had said that it was not going to publish female authors—there would have been an outcry. Thankfully, when I put a complaint to the Equality and Human Rights Commission about that, it agreed with me that it would be unlawful. However, it is interesting to note the number of people whose minds that clearly did not cross; because it was in favour of women, they thought it was fine.

[Helen Whately (Faversham and Mid Kent) (Con)]

I was very grateful to see the motion on the Order Paper to do with male suicide and male mental health, which is why I and some of my colleagues came along today. I disagree with some of the points that my hon. Friend has been making about the broader equality agenda, but could we perhaps move on to the conversation about male mental health, on which there are important things to be said?

[Philip Davies]

I am grateful to my hon. Friend for that intervention. If she had been a little more patient, I was just coming on to male suicide. I was setting the context for the debate, which, as she will see if she looks at the Order Paper, is also about International Men’s Day and is not just limited to male suicide. I am now coming on to the issue of male suicide, but I am glad to have been able to set the scene, and I am sorry that pointing out that men are sometimes badly treated in the world is so discomforting for her to have to listen to. However, that is part of the problem we have in this House.

--- Later in debate ---

[Philip Davies]

I am sure that my hon. Friend is right and that most people would agree with him. In fact, in the time allocated to this debate, statistically at least one man will have taken his own life, which means that yet another life will have been ended prematurely and another family will have been left devastated.

According to the Campaign Against Living Miserably, which is supported by many individual charities and which I would like to thank for its help with today’s debate, a YouGov poll this month that surveyed 2,000 men found that

“42 per cent…had considered suicide, with…41 per cent…never talking to anyone about their problems.”

In addition:

“49 per cent…of those who didn’t seek help ‘didn’t want people to worry about me’. A third…felt ashamed, nearly four in 10…did not want to make a fuss and…43 per cent…didn’t want to talk about their feelings.”

According to various sources, including the Government’s suicide prevention strategy for England, the suicide rate is highest among males aged 30 to 59. It has fluctuated in recent years between 30 and 44, but it is currently those who are aged 45 to 59 who have the highest suicide rate.

We might ask why these men feel that they have to end their lives in such numbers. There is the obvious issue of mental health problems; not wanting to ask for help could mean that those go untreated in some men. I was sent a briefing by the Royal College of Psychiatrists, which said:

“Three quarters of all people who end their own life are not in contact with mental health services and men who are suffering from depression are much less likely than women to look for formal help from mental health professionals.”

There are also clearly other things that are likely to affect men more than women—for example, being in debt or being a war veteran. The Samaritans point to evidence that suicidal behaviour comes about as a result of a complex interaction of a number of factors. In the case of men, financial worries play a big part—so unemployment and redundancy can be a trigger—and also the influence of a historical culture of masculinity.

In some cases, men might feel—usually mistakenly—that they are a burden on others or that people would be better off if they were dead. The fact that men still see themselves as the providers in many cases means that financial hardship is very significant, and in their mind reduces their contribution to the family unit. Someone in debt might think that their family would be better off if they were not there. Even putting aside the enormous emotional loss to those left behind, the financial gain may not be as the person intended, as taking their life could invalidate their life insurance.

[Helen Whately]

A minute ago, my hon. Friend mentioned the importance of mental health care for men and of men accessing it. It is well known that men may well go to an accident and emergency department to seek care when they have mental health needs and often A & E is the only place that is available in the middle of the night, but although some hospitals have good care in the form of psychiatric liaison teams, many hospitals do not have good psychiatric liaison services. Those services are known to be very helpful. I know that my right hon. Friend the Minister supports such services and that some funding is going towards them, but can we make certain that that funding ensures that there are good psychiatric liaison services in all hospitals and transparency about the level of those services, so that we can ensure that they are effective?

[Philip Davies]

I am very grateful to my hon. Friend for that intervention. I am sure that we all hope that my right hon. Friend the Minister will deal with that point when he makes his contribution to the debate.

Shockingly, 56.1% of men who commit suicide do so by hanging themselves. I cannot imagine the horror of finding someone who has hanged themselves. Add to that the fact that that person is a loved one and it is even more tragic. Then, there are all the questions that inevitably arise following a suicide from the person’s loved ones. Why? Why did I not know there was something wrong? Why did they not talk to me? Why did they leave me? What could I have done to prevent this from happening? The guilt and sense of loss that those left behind must feel after someone has killed themselves should be reason enough to want to do something, never mind the absolute waste of life of the individual concerned. Suicides account for more deaths than road traffic accidents, so one would expect the Government to be trying to tackle this issue.

Sometimes this place is also about sending out signals or messages, and the message that I want to go out loud and clear today to anyone contemplating suicide is: you are not alone. There is nothing whatever weak or wrong in seeking help, and there are plenty of people out there who can help you, so please talk to someone—confidentially and anonymously if you prefer, but please talk to someone. Suicide is never the right option.

The Royal College of Psychiatrists says:

“We also need to work towards building a society where people should not be afraid to seek help for fear of being stigmatised and where the media agree to responsible reporting of suicide.”

I could not agree more. It says that it is also important that information on depression and how men can get support is available in what might be traditionally considered male settings, such as football stadiums, barbers or pubs. Again, that seems like a very good idea.

Suicide, especially in the numbers that we see for men, is a huge, tragic problem, and we need to work together to achieve change. One thing that leads men to contemplate suicide is the breakdown of a relationship, especially if children are involved. It is clear that the courts are more likely to place children with the mother than with the father. This is a massive area where men face very different treatment from women. We underestimate the effect on fathers of having to battle to see their children and facing the inevitable likelihood that they will come off worse simply because of their gender.

I am certainly not saying that all cases are like that. Many, many reasonable mothers allow the father as much access to the children as possible, and we should always recognise that, but life is not always that simple in every relationship. Some women do use their children as a stick to beat the father with—perhaps because they are bitter about the failed relationship, because of financial reasons, or because they have moved on and it is easier for them if their new partner takes on the role of father to their children. Women can fail to put the father on the birth certificate, limiting his rights, or lie to him about whether he is even the father. Short of a child-swapping disaster in hospital, women know for sure that their babies are their own, but fathers can never know 100% that that is the case without a formal DNA test. Many are sure because of their trust in their partner, but plenty will be unsure because of their partner’s behaviour, or because they have been deliberately tricked.

I have received numerous messages on the subject of fathers and their children. Unfortunately, we do not have time to go through them all, but I will read out one or two that contain the points that many people have made and that link the serious issues of fathers not having access to their children to the issue of suicide. One person said:

“Dear Mr Davies,

A number of local fathers have been in touch with…our MP, as I have over the years, about the way fathers are routinely excluded from their children’s lives or treated very differently from mothers.”

This was from a constituent of my hon. Friend the Member for Kettering (Mr Hollobone), and the person said that they were delighted that my hon. Friend had helped us to secure this debate. They continued:

“It’s been proved time and again that children benefit from parenting by both their parents after separation but it is all too easy for false allegations to be made in an attempt to exclude fathers. There are rarely any repercussions and it can be many months before broken relationships with children can be mended—if ever.

Sadly, I know a number of men who have been driven to suicide as a result of their experience. Many fathers I meet at the local meeting I chair have mental health problems associated with separation and the difficulties they have experienced. And that’s aside from other members of their families including of course grandfathers, of whom my husband is one.

I do hope something positive comes from the debate on Thursday”.

That is from Jenny Cuttriss, chair of the Families Need Fathers branch in Kettering.

Messages from other people on the subject include one saying:

“I have spent the last 4 years going through the Family Courts trying to maintain a decent relationship with my children. Over and over again my ex has been emotionally abusing my daughter and alienating me from her life… She has also maliciously claimed DV”—

domestic violence—

“and taken out a Non-Molestation order against me to try and stop me…having contact or being involved in my daughter’s life in retaliation to me getting my ex’s mother arrested for assault as she attacked me inside a court building.”

I had been aware of the stories about men’s chances when it comes to custody of their children for some time, so last February I asked the Ministry of Justice

“in what proportion of all cases heard in family courts where both the mother and father sought custody of their children the residence order was awarded to (a) the mother, (b) the father and (c) jointly”.

The answer from the then Minister was:

“The information…does not record details of the orders…such as which…parties were awarded the order. The information requested can only be obtained…at disproportionate cost.”—[Official Report, 24 February 2014; Vol. 576, c. 261W.]

However, from everything that I have heard, including from those who actually do the adjudicating in family courts, it seems that it takes something out of the ordinary for men to be awarded custody of their children, and it seems that the Ministry of Justice cannot say otherwise. The Equality Act 2010 does not seem to apply in this area.

If people think men have life easy, they need to think again when it comes to families. Women have an awful lot of control, and there is an inbuilt bias towards them when it comes to the very important job of raising children. It does not look as though that is going to change anytime soon, yet as someone wrote in a message to me,

“I really believe that if this system worked against women the way it works against men there would be hell on about it! Whenever there is any discussion of gender inequality the focus is solely on women being disadvantaged…and never about these inequities or those that you yourself raise or the many other areas where men are disadvantaged.

The fact that women usually take responsibility for childcare is often cited as an obstacle to women’s progression in their careers and…under representation in senior roles and I believe society’s perceptions and family law appear to be perpetuating this issue. Perhaps more equality in family law and wider society could prove a win-win for both sexes?”

That seemed to me a very good point.

Oral Answers to Questions

Helen Whately Excerpts

Tuesday 17th November 2015 Commons Chamber

[Helen Whately (Faversham and Mid Kent) (Con)]

6. What steps his Department is taking to improve clinical outcomes for people treated by the NHS.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

On a number of fronts, the Department is looking at how it can improve clinical outcomes. Indeed, that is the entire focus of the Department. With reference to hospitals, we can improve clinical outcomes across the service through introducing a seven-day NHS, by increasing transparency and by looking at the cover provided by consultants and doctors.

[Helen Whately]

I welcome the Government’s commitments to improving outcomes for patients admitted at weekends, but seven-day services are needed not just in hospitals but in primary care, community care, social care and mental health services. What steps are the Government taking to make sure that seven-day services are available in all settings where patients need care urgently?

[Ben Gummer]

My hon. Friend makes her point extremely well. A seven-day NHS will operate only if it works across all areas of care. That is why the local integration of care and health services is part of our wider vision for the NHS. I urge her to look, when it is published, at Professor Sir Bruce Keogh’s report on urgent and emergency care, which envisages precisely the sort of joined-up care that will ensure people receive the correct attention at the correct level and do not therefore go to hospital when they can be dealt with in primary care settings.