Oral Answers to Questions

James Gray Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

I take responsibility for everything that happens on my watch. [Interruption.] I think it is a little early to ask the Secretary of State to resign—but maybe not. The ambulance service is under great pressure, but across the country we have 2,000 more paramedics than five years ago, we are recruiting an additional 1,700 over the next few years, and from March this year, compared with March the previous year, the most urgent calls—the category A red 1 calls—went up by 24% and the ambulance service answered nearly 2,000 more calls within the eight-minute period. There is a lot of pressure, we have a plan to deal with it, but we need to give credit to the ambulance service for its hard work.

[Mr James Gray (North Wiltshire) (Con)]

I stood against Charles Kennedy in 1992 in Ross, Cromarty and Skye and will take the opportunity tomorrow of remembering what a very happy occasion it was and how very glad I was to lose to Charles at that election.

I strongly opposed the creation of the South Western Ambulance Service because I believed the Wiltshire Ambulance Service did a better job on its own. I know the Secretary of State has been monitoring the calls received by the South Western Ambulance Service—one of the two trial areas. Will he tell the House whether response times in the south-west have improved or got worse in recent years?

[Mr Hunt]

NHS England will be updating the House on the results of that trial. It was a very important trial because it was designed to stop the dispatch of ambulances to people who did not need one within eight minutes, in order to make sure ambulances were available for people who did need one. South Western was very helpful in taking part in that trial and we will update the House shortly on the results of it.

Local Suicide Prevention Plans

James Gray Excerpts

Wednesday 4th March 2015 Westminster Hall

[Mrs Moon]

I thank my hon. Friend for her question. We are both Welsh MPs, and we know how dire the situation is in Wales. The suicide rate in Wales is 15.6 deaths per 100,000—the highest in the UK. That is perhaps part of what drives me. I know that we have our own problems in Wales, but the matter is devolved to the Welsh Assembly. The all-party group’s work helps to highlight the problems here in England. After Wales, Scotland has the next highest rate, followed by Northern Ireland and the north-east of England. There is a serious problem in Wales that we must tackle as well.

People cannot be complacent if their area has a low level of suicide, because facts change, deaths change, and the figures change. At one point, the Isle of Wight had a very low suicide rate, but now it is higher, and it is considered to have an average rate. It has gone from low to average—that is a rise. We cannot assume that because the suicide rate is currently low it will remain that way.

The report highlighted particular concerns about London. It shows poor levels of suicide prevention planning, but also low levels of deaths. That does not make sense: not only the lack of action planning, but everything about the demographic profile of London and some of its regions would suggest that normally there would be a higher level of deaths in certain local authorities. Something must be done to examine what is happening, because either the data are wrong, and what is really happening is being hidden, or something very special is happening in London that provides some sort of insulation against suicide. We need to understand that. The age-standardised rate of death in London is 7.9 per 100,000, compared with Wales’s rate of 15.6. The gap is huge and must be addressed.

The most active local authorities and those with the highest rates of death from suicide in England are in the north-east, the south-west and the north-west, areas of social deprivation and high unemployment, and where the so-called economic recovery is not being felt. In those areas, the all-persons rates of death are 13.8, 12.5 and 12.3 respectively. On the whole, local authorities in those parts of the country are active, and the report commended their work. However, that raises new questions. We must look at what those active local authorities are actually doing and how they are spending their time and effort. The importance of local initiatives, local focus and local understanding in suicide prevention is recognised—we need to know the terrain, the population and where the pressure points are—but we must also examine the variation in what is being done across England without apparent consistent reasons for the strategic choices that are made.

For example, in some areas, funding is put into helplines, such as the Samaritans and the Campaign Against Living Miserably—CALM. In others, it is put into training, such as applied suicide intervention skills training—ASIST—and in some into better data collection, such as on self-harm, which the Minister and I have discussed often. Other activities will have gone unreported. With wide variability and without clear indication of the evidence on which the various initiatives are based, however, there are questions about which of those initiatives are more effective and why. We need to be able to understand how our suicide prevention work is working and the best way for local authorities to focus their attentions.

The all-party group concluded that both Public Health England and the national suicide prevention strategy advisory group should examine ways in which local authorities can share information about suicide prevention initiatives that have worked, in order to develop best practice. In addition, central funding of research and evaluation studies into the methodologies used is necessary, so that we can drill down to what is effective and why. In that way we can realistically make a difference with any necessary changes even at a time of economic austerity.

The Minister and I have talked about the importance of suicide audits and of timely information, so that people are not waiting for retrospective information to see if a problem is developing locally. Some authorities have a complete lack of clarity about audit work and that needs to be tackled. Much can be dealt with through better co-ordination with coroners and the provision of timely information by them, but I appreciate that the Minister might have difficulties with that, because coroners fall within the purview of the Ministry of Justice, which is perhaps less focused on the timeliness of information from coroners to help suicide prevention work. That is something that I hope the all-party group will come back to in the next Parliament, because the situation cannot be allowed to continue.

The rate of suicide in this country has generally been on the rise since 2008. Last year the number of people taking their own life increased by 4%. Suicide remains the leading cause of death for men aged between 20 and 34. Last year, 6,233 people in England and Wales died by suicide, which you could describe as a small number—

[Mr James Gray (in the Chair)]

indicated dissent.

[Mrs Moon]

You would not—I am glad to hear that, Mr Gray, thank you.

Each death by suicide is estimated to have an economic impact of around £l million. The reverberations across communities, families and workplaces are devastating. The suicide rate is a key indicator for the health and well-being of our country, our communities and our way of life. Suicide is not some niche issue that can be ignored by a local authority in its public health role because the numbers are too small. The issue is critical and indicates how healthy and how vibrant our communities and our society are.

The debate is probably the last about suicide in this Parliament, so I want to take the opportunity to make a few final remarks. The Minister and his predecessor, the right hon. Member for Sutton and Cheam (Paul Burstow), have been active in support of the all-party group and in suicide prevention work. I thank them for their support and acknowledge their work. Despite the failure of local authorities, active third-sector groups such as the Samaritans and individuals touched by suicide have offered support to those struggling to cope with life and to bereaved families. Sports figures and other celebrities have stepped forward to talk about their personal struggles and things that have changed their lives.

The police and other front-line workers are trying to save lives and responding to desperate people on a daily basis. During this Parliament, the role of the police in particular in tackling mental health problems, suicide, missing children and a whole range of other social problems outside their normal crime reduction role has shown their leadership and initiative. The work that the police are now undertaking to draw up a national process for responding to suicide is particularly welcome.

Suicide has not been illegal in this country since 1961, but it continues to carry a stigma, which we need to tackle. We also need to give support to bereaved families; to provide access to services that offer hope and a future for the suicidal; research in order to identify risks, best practice and awareness training that can prevent needless deaths; and local authorities to accept their responsibilities to support the dedicated individuals who already work across the four nations to prevent suicide. Without such individuals, the figures from two weeks ago would have been so much worse. It is time for us to take suicide seriously.

Late Stage Hepatitis C

James Gray Excerpts

Tuesday 6th January 2015 Westminster Hall

[Grahame M. Morris (Easington) (Lab)]

I congratulate my hon. Friend on securing an important debate. Does he agree that one problem that we face in tackling hepatitis C—he has outlined the scale of the problem; more than 200,000 people suffer from it—is the mixed messages coming from the Department of Health and, in particular, the information provided in an earlier debate in this Chamber by the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who said that hepatitis C is not curable when in fact, with appropriate treatments, the cure rates are between 80% and 95%?

[Mr James Gray (in the Chair)]

Order. One must be brief in a half-hour debate.

[Stephen Pound]

One would almost think that my hon. Friend the Member for Easington (Grahame M. Morris) had had sight of my notes, because there will be, in a few moments, a section on that. The bullet point, my aide-mémoire, my prompt, is simply the two words “Good news”, because there is good news. One reason why we are having this debate is to tell people that there is a cure—a very successful rate of cure—but also to say that we need people to be able to access that and we need, above all, to have a plan.

Let me explain why I called for this debate. Many years ago, I had a private Member’s Bill on presumed consent for organ transplants. At that time, the then Secretary of State for Health, rather aggressively, said that it was not the business of the state to decide what happens to a person’s body after they have died. Lord Reid, as he now is, apologised to me afterwards for being quite aggressive, but one thing that it brought home to me was the difficulty of finding livers for transplant. Hepatitis C leads to cirrhosis of the liver in virtually every case, and in some cases that can then become acute liver failure, in which case one of the treatments would be a liver transplant. People think that is an easy solution when in fact it is not. As I discovered, livers for transplant are very difficult to get hold of—very hard to access.

Modern medical advances have opened up a completely new world. I will say more about that, and particularly the new therapies, in a moment, but there is still massive and widespread ignorance, and what I am asking the Minister for today is to have a plan for addressing that. I am reluctant, as is anybody, to give over-much credit to the Scottish Parliament, but on this occasion I have to say that the Scottish plan, the “Hepatitis C Action Plan for Scotland”, which is now six years old, does, if I may say so gently, represent a far more comprehensive and overarching strategy than we currently have in England.

Oral Answers to Questions

James Gray Excerpts

Tuesday 16th April 2013 Commons Chamber

[Anna Soubry]

What I do know, having had a long meeting with my officials only this morning, is that the evidence, as they have explained it to me, is clear: SABR is effective only in a small number of people who have, unfortunately, a certain small tumour in their lungs, and it is not suitable for other treatments of cancers. However, if the hon. Gentleman wants to discuss the matter further, my door is always open.

[Mr James Gray (North Wiltshire) (Con)]

The trouble with all these things is that medical science moves faster than the targets set by the Government. Does the Minister agree with me that proton beam therapy is now almost as important as radiotherapy? How much have the Government spent on this therapy, and how many patients have been helped by it?

[Anna Soubry]

We are building two new machines specifically to deliver that treatment. I accept that these things often take a long time, but those machines are planned. In the meantime, NHS England has made it clear that people who need this specific type of treatment can receive it overseas and it will be funded accordingly.

Oral Answers to Questions

James Gray Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Hunt]

The hon. Gentleman speaks as though the problem of ambulance waits never happened for 13 years under Labour, but he knows that we actually had some appalling problems, with ambulances circling hospitals because hospitals did not want to breach their four-hour A and E wait targets. We are tackling the problem, and as I mentioned, if he looks at the figures published last week he will see that we are meeting the standards for ambulance waits that his party’s Government put in place. However, we are not complacent, and we are monitoring the figures closely. Particularly with the winter coming up, we want to ensure that the ambulance service performs exactly as the British public would want.

[Mr James Gray (North Wiltshire) (Con)]

Many ambulance trusts are indeed doing extremely well, as the Secretary of State indicated. Does he agree that that is at least partly due to localism in the ambulance service, which may be undermined if, for example, the Great Western ambulance service becomes an amalgamated regional service? Now it has been announced that the call centre in Devizes will be closed in favour of one in Bristol. Does he agree that there is at least a risk that the local service for people in Wiltshire will be reduced if such regionalisation is allowed?

[Mr Hunt]

I agree with my hon. Friend that the purpose of the changes that the coalition Government have brought to the NHS is to tap into local innovation, ideas and ambitions to transform services, and it is important that no changes undermine that. He should take comfort from the fact that my predecessor introduced clear tests for any major reconfigurations, including that they should be strongly supported by local doctors, that the public should be involved in any consultation, that the changes should improve patient choice and that there should be clear evidence of benefits to patients. I hope that that gives him and his constituents some reassurance.

Hospital Services (West London)

James Gray Excerpts

Wednesday 11th July 2012 Westminster Hall

[Mr Slaughter]

Apart from the bit of fun that I had at the beginning of the debate, I am going to stay off party politics. I think the hon. Lady knows that the NHS was rescued under a Labour Government, and knows about the increase in funding then. She will also know from articles in the press this week and last that in fact, the promise made by the Prime Minister before the election to increase funding for the health service is not being kept. [Interruption.] I therefore think that that was a bad point to make. [Interruption.]

[Mr James Gray (in the Chair)]

Order.

[Mr Slaughter]

There has already been significant change in hospital services in north-west London. That has been for clinical and financial reasons. It has involved within Imperial the centralising of services, including renal, paediatric, oncology and vascular specialisms. More of that was anticipated. Other proposals for savings have been leaking out of Imperial for the past six months. Further moves away from hospital to community or GP services were expected—but nothing on the current scale.

This review is driven by the need to cut costs and is unrestrained because the chaotic reorganisation in the NHS, for which the Minister must answer, means that there is no accountability on the part of those who are making decisions. The Joint Committee of Primary Care Trusts, itself a body artificially created to make these cuts, is neither their author, nor will it survive to see their execution.

I would like to say a little about the history of hospital services in my part of west London, the scale of the changes proposed and the flawed process under which they are being made. I would then like to summarise the emerging public and professional views on the proposals, before finally asking the Minister for his response. Given that many in the NHS see the north-west London proposals as a prototype for what will happen elsewhere, it is not satisfactory for him to disown interest. He must either justify or be prepared to criticise the loss of front-line hospital services.

Each of the hospitals now under threat has a long and distinguished history. I am afraid I am old enough to remember when Charing Cross was Fulham hospital and when Chelsea and Westminster was St Stephen’s. Hospitals have stood on the Hammersmith campus since 1905 and at Charing Cross since 1884. Originally, these were workhouse infirmaries, fever hospitals or military hospitals. They have evolved into the world-class treatment centres that they are today. I do not want to take up a great deal of time with the history, but while preparing for the debate, I did come across this interesting paragraph on the opening of Hammersmith hospital:

“Immediately on opening, there was an outcry about the cost of the…building…£261,000…and its lavishness. The vestibule was paved with mosaic and was surrounded with a dado of the most expensive encaustic tiles. The dining hall was ‘of baronial splendour’. The press dubbed it the ‘Paupers’ Paradise’ and the ‘Palace on the Scrubs’.”

I did not know the Daily Express was going in 1905, but clearly it was. I am not sure that that was a completely accurate representation of the hospital, because its annual report for 1957 illustrated a granite block—part of the last consignment to the workhouse for breaking up by the inmates of the casual ward. I do not want to give the Minister any ideas about reintroducing rock breaking for out-patients, but that does show that we have come a long way over that time.

The Minister may say that I am being nostalgic in looking at the history of Hammersmith’s hospitals or that it is evidence that change in the health service is nothing new, but that misses the point. These hospitals have grown up on their current sites and changed in response to local need. These are some of the most densely populated parts of the UK. There is intensive residential development in the area: tens of thousands of new homes are planned for the next decade. This is a population with complex health needs and high turnover. This is an area with major transport infrastructure—air, road and rail—and with risks ranging from major trauma accidents to tropical and infectious diseases.

The accident and emergency departments under threat are always busy. They are trusted by my constituents. They have evolved to work side by side with GP practices, walk-in clinics and urgent care centres. However, they work, because the level of clinical expertise available can be adapted to cases ranging from the relatively minor to the very serious. I understand the debate about having fewer major trauma centres—the trade-off between travelling further and losing critical treatment time against the quality of care on arrival. I do not think that that argument is settled, not least because of the unpredictable and congested road system in west London, but also because of the conflicting opinions as to how crucial minutes can be in reaching specialist care in different trauma cases. What is unarguable is that the vast majority of patients currently attending A and E will potentially receive a worse service. They will not be sure whether their condition merits a longer trip to a hospital that still has A and E services, or whether seeing a GP at an urgent care centre will suffice. There will certainly be confusion and delay, and overall standards in quality of care will fall.

--- Later in debate ---

[Several hon. Members]

rose—

[Mr James Gray (in the Chair)]

Order. There are no formal time limits, but I intend to call the Opposition Front-Bench spokesman at 10.39, unusually, which gives us exactly half an hour to accommodate the five remaining hon. Members who want to catch my eye. If my arithmetic serves me right, that works out at about six or seven minutes a head. As a courtesy to each other it might be nice to attempt to achieve that.

Veterans (Mental Health)

James Gray Excerpts

Wednesday 7th March 2012 Westminster Hall

[Julian Sturdy (York Outer) (Con)]

Given the nature of this afternoon’s debate, I should like to pay tribute to the soldiers missing and believed killed in Afghanistan. Our thoughts and prayers are with their families at what must be an incredibly difficult time.

It is always a privilege to serve under your chairmanship, Mr Dobbin, and indeed to initiate a debate in this Chamber. I feel, however, an even greater sense of privilege due to the special nature of this debate. Like many Members on both sides of the House, I am a great supporter of our armed forces family. From serving personnel to veterans, those brave men and women have served our country with dedication, and they deserve admiration, respect and parliamentary attention.

I should like to discuss veterans’ mental health, which is one of the few subjects that quite rightly commands political unity on both sides. The work of successive Governments over recent years has given the issue great momentum, and early in the debate I should like to commend the previous Government on the work that they did on behalf of veterans. I also congratulate the Minister on the way that the current Government have championed this worthy issue.

My interest in the mental health of veterans comes from my frequent correspondence and discussions with one of my constituents who is the mother of a veteran. Her dedication to improving the provision and information provided to veterans is inspiring, and I hope that she will take heart from today’s debate.

In recent years, efforts to tackle the cruel stigma that is related to mental health issues more generally across society have begun to make a difference to many of those who suffer from what is often an invisible illness. Indeed, it has been estimated that one in four people in the country suffer from some form of mental health issue each year. The Mental Health Network, which is part of the NHS Confederation, has carried out excellent work, and over the past few years, it has been heartening to see the Ministry of Defence and the Department of Health working closely with the Royal British Legion, Combat Stress and others in the voluntary sector to provide a range of improved services for veterans who suffer from mental health problems.

Let me take the opportunity to praise the work of all charities up and down the country that work day in, day out with members of our armed forces family. In particular, I should like to champion the Royal British Legion and Combat Stress—two charities that play a vital role in delivering key services to veterans and serving armed forces personnel. Together, those charities offer vast experience, unquestionable compassion and unwavering dedication. With approximately 22,000 armed forces personnel leaving the service and returning to civilian life each year, we must appreciate the wide-ranging mental health issues that can be provoked by experiences in war-torn countries and dangerous conflicts around the world.

Over the past 10 years, British troops have been involved in a range of conflicts from Iraq and Afghanistan to Bosnia and Sierra Leone, and the bloody experiences of those wars cannot fail to leave a mark on those who confront them. When we think of the sacrifices made by armed forces personnel, it is right to consider not only the often terrifying physical risks undertaken, but the mental strains that are placed on our brave servicemen and women.

It has been estimated that more than 27% of veterans suffer from a common mental disorder. For those armed forces personnel who leave the service each year having experienced direct action in recent operations, the transition from service life to civilian life is often traumatic. For many, the future is uncertain, and owing to the stigma that surrounds mental health issues, many sufferers fail to seek help on leaving the services. If they do seek help, it is often at a dangerously late stage. A Mental Health Network briefing last year suggested that, on average, veterans do not come forward for mental health support until 14 years after their discharge. Sadly, homelessness and alcohol or substance abuse is more prevalent among veterans when compared with others of similar age or social background.

I have three main objectives in this debate: first, to commend the superb work that has been carried out on behalf of veterans who have suffered from mental health problems in recent years; secondly, to seek assurances about the continuation of parliamentary support for such work to be maintained on a more permanent basis; and thirdly, to ensure that our provision for veterans is coherently delivered in the best possible manner.

The previous Government’s “New Horizons” strategy document bound the NHS and the MOD to improve access and support for the early treatment and prevention of mental health illness among servicemen and veterans. The current Government, led admirably by the Prime Minister, launched the military covenant, which enshrines into law the Government’s duty to support the entire armed forces family. The covenant makes a new commitment to provide

“extra support for veteran mental health needs.”

Soon after taking office in 2010, the coalition Government asked my hon. Friend the Member for South West Wiltshire (Dr Murrison) to produce a report on veterans’ mental health. He should be congratulated on his truly outstanding work and recommendations, and I encourage any hon. Member who has not yet read the report to request a copy from the Library.

My hon. Friend’s “Fighting Fit” report received favourable backing from the Government, and rightly so because it includes a raft of measures to ensure better provision for veterans and their families. Among 13 action points and four principal recommendations, the report specifically calls for

“An uplift in the number of mental health professionals conducting veterans outreach work… A Veterans Information Service (VIS) to be deployed 12 months after a person leaves the Armed Forces… trial of an online early intervention service for serving personnel and veterans.”

As part of the Government’s initial response, a dedicated 24-hour mental health support line for veterans was launched in March 2011, operated by the charity Rethink on behalf of Combat Stress and funded by the Department of Health. In addition, the number of mental health professionals was doubled from 15 to 30.

With the “Fighting Fit” report, the Government’s military covenant and the previous Government’s valuable work, much effort has been made to deal with this issue. The objective now, however, is to ensure that that wide-ranging support, financial assistance, e-learning provision and information literature continues and is focused in the most effective way possible.

I have a number of questions for the Minister to which I hope he will respond, although I accept that some information might require communication with his colleagues in the Ministry of Defence. First, will funding for the dedicated 24-hour support telephone line continue after the one-year trial, which I believe is soon coming to an end? I believe that having someone on the end of a telephone at any hour of any day who is willing to listen, able to support and trained to understand must be of tremendous reassurance and assistance to affected veterans. The continuation of funding for that telephone service would indicate a clear commitment to veterans, and I urge the Minister to push for that support to continue.

With an eye on the future, I ask the Minister to outline the time scales involved in implementing the new veterans service to which the Government have made a commitment. A key issue as we discuss the future of such support is the difficulty of keeping in touch with veterans. As discussed earlier, many leave the service and move on to temporary accommodation or work. It is impossible to provide meaningful support if we do not know where veterans now live or work. Will the Government do more to track and store information about veterans, and will that information be shared with key partners?

[Mr James Gray (North Wiltshire) (Con)]

I congratulate my hon. Friend on securing the debate. Does he agree that there is a particular problem with regard to the Territorial Army and reserve forces? Many of them are spread out across the nation, and we do not know where they are. At least, regulars have the regimental family around them, even after they become veterans. People from the TA are often out in the wide world without anyone to provide such support.

[Julian Sturdy]

I agree. It is also worth noting that reservists tend to suffer more from mental illness, if they have experienced conflict, than regular soldiers, so it is probably even more important that we understand where the reservists are and can monitor that and target help towards them.

--- Later in debate ---

[Guy Opperman]

It is interesting, is it not, that today is 7 March and on 7 March 1982, exactly 30 years ago, about three and a half weeks prior to the Argentine invasion of the Falklands, which happened on 2 April 1982, the British ambassador in Argentina wrote a cable from Buenos Aires to the then British Prime Minister, saying that matters were escalating. It is very well known, and it was reported in the Franks report that assessed the Falklands war, that “contingency plans” needed to be made. That was not enough and a war began, then escalated. I certainly will not go down the route taken by the hon. Member for Newport West (Paul Flynn) by digressing further. However, the point is that the treatment of the veterans of the Falklands war was not as good as the treatment of veterans now, partly because there were difficulties at that time in understanding what post-traumatic stress disorder was.

From a health standpoint, PTSD is not confined to victims of conflict. There are also plenty of victims of PTSD who were involved in normal, day-to-day accidents and disasters, whether it is industrial health accidents or factory accidents; people can have PTSD arising from those things. We need to change the way that PTSD and other aspects of the mental health of veterans are visualised, because it needs to be recognised that PTSD and other mental health conditions are just as much a disease or condition as breaking an arm or suffering from cancer, and it is just as difficult to solve or treat.

I move on. I endorse entirely what was said about the current situation, and I will abbreviate my comments to making an assessment of the current situation. Various studies have shown that a very large proportion of our veterans are suffering from PSTD. At present, approximately 24,000 veterans are in jail, on parole or serving community punishment orders. That is the astonishing number that emerges if we assess how many veterans are going through our criminal justice system. It manifestly shows that, for whatever reason, we have not done enough.

Let us also bear in mind that American studies have shown that approximately 30% of the US troops who were in Vietnam suffered from PSTD, or about one in three. That is an absolutely staggering number. Therefore, although we might look at the respective troops coming home from Afghanistan, and at those who fought in Iraq and other conflict zones, and think that they are all right, three out of 10 soldiers will genuinely suffer PTSD. They may suffer it in year one after their return. Year 14 is the average length of time that it takes, but it can take as long as 25 or 30 years, and throughout all of that time, their individual families are suffering and going through particular difficulties.

I applaud the “Fighting Fit” report and the work that is being done. However, I regret to say that that is not enough. Personally, I do not consider that it is enough. I accept entirely that we are in straitened times and that, with every budget, we have to consider the way in which things are dealt with. Nevertheless, I very much hope the Minister will give the sort of assurances that charities and individual soldiers’ organisations seek about their future, and that there are commitments on an ongoing basis to the matters outlined in “Fighting Fit”, so that those charities and organisations have the reassurance that genuine efforts will be made to ensure that their funding is sustained; that mental health systems are structured properly; that the recommendations of the inquiry into medical examinations while soldiers are still serving are properly implemented; and, given that we are introducing all these ideas from “Fighting Fit”, that there will be proper assessment of those ideas after they are introduced. I agree that organisations such as the Big White Wall are not necessarily being utilised in the way that was envisaged; they are being utilised, but not necessarily in the way that was envisaged.

I would very much like to see an overarching body for veterans. I would like a veterans agency to be considered by the Government, and the Government to consider whether there is a possibility of bringing together certain parts of the NHS, the Ministry of Defence and social services and housing elements, which make up so much of all the difficulties that our servicemen suffer, and dovetailing that with the health services that are provided in prisons.

We can look at the way that people are dealt with in terms of health services in prisons. I have extensive experience of going to see clients who are former servicemen and who have received a custodial sentence or who are held on remand. There was absolutely no doubt that they were hopelessly unable to deal with the difficulties of a custodial sentence, or the difficulties of being detained, at that particular time, in circumstances that they would normally have been perfectly able to deal with.

[Mr Gray]

I have agreed with much of what my hon. Friend has had to say, but I have some difficulties with the notion of the establishment of a new agency to carry out the functions that existing Government bodies are required to carry out at the moment. If there were a veterans agency, would there not be a risk that people at the Department of Health or the Ministry of Defence would shrug their shoulders and say, “Someone else is doing this for us, leave it to them”, and that the services received by veterans would be significantly worse than they are at the moment?

[Guy Opperman]

I accept there is always a risk that, if we create some new body, we will be in a position whereby everybody passes the buck and says, “Well, they’re sorting it out”. However, I am clear that every single MP could come to this House and say, “I have individual examples of people in my constituency, or stories that I have heard of former servicemen.” Those servicemen are continuing to slip through the net—they are unaware of the individual aspects of the services that are available to them—and the Government are not necessarily acting as an overarching body to ensure that they are aware of those services.

Let me give some examples. There is very good evidence from the “Fighting Fit” report and other studies that follow it up that there should be a leavers pack for soldiers and, for example, an ability for veterans to be monitored after they have been discharged. All those services are good, but they stop after a certain period and the Government do not go back to those individuals to ask, “Are you actually all right? Are you in a position to cope with the vicissitudes of your life and your existence on an ongoing basis?” That is the sort of thing that I would like done. I concede that it may be possible to do such things in the present Departments, but there must be more joined-up thinking, because the problem is ongoing, and there are examples.

I am conscious that other Members wish to get into the debate, so I will abbreviate my comments. I want to talk about the work of Veterans in Action, a classic charity, which is run by individual veterans. For a number of years, they have been providing in-depth support, which they have found is, sadly, lacking in the system. They tell me that there is no generic way to collect veterans’ information and that it is collected very much on a local, case-by-case basis. Similarly, they say it is extremely difficult to get organisations to work together. They also tell me that the Big White Wall is not being used as it was intended to be and that people are using the Combat Stress helpline as a first point of contact.

A great many smaller, third sector organisations and charities set up by veterans are having similar problems. With no national directory or local directories of such organisations, it is immensely difficult for individual veterans who are constantly moving around—who have problems with housing and with all the dislocation that goes with that—to harness the efforts of such organisations. Therefore, just as successive Governments have done amazing work looking after individual veterans’ health in conflict zones, we should do more to look after their mental health after they have left those conflict zones.

Oral Answers to Questions

James Gray Excerpts

Tuesday 10th January 2012 Commons Chamber

[Paul Burstow]

The hon. Lady chairs the all-party group on suicide and self-harm prevention. She does a lot of important work in this House in that regard, and I would be only too happy to talk to her about research priorities in this area. The Government are examining the research priorities to support the new strategy, which we plan to publish in the near future.

[Mr James Gray (North Wiltshire) (Con)]

I pay tribute to the hon. Member for Bridgend (Mrs Moon), who has done fantastic work on the prevention of suicide. It is not the Department of Health’s job to regulate the worldwide web, but what work has the Department done on examining the link between the watching of violent websites—and, indeed, looking at websites that promote or facilitate suicide—and the actual carrying out of suicide?

[Paul Burstow]

My hon. Friend makes a very important point, which has been raised by a number of charities, including Papyrus, during the consultation on the draft strategy. It is important to stress that the internet industry has been willing to engage in positive initiatives, not the least of which is Facebook and Google’s work with the Samaritans to make sure that whenever anyone types in “suicide” a link to the Samaritans always appears first. However, more needs to be done and we need the industry to tackle those darker sides of the internet to make sure that they do not prey on vulnerable people and do not peddle suicide.

Oral Answers to Questions

James Gray Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Burns]

Nothing has changed. As the hon. Gentleman will know, the NHS budget is a protected budget, and during the lifetime of the present Parliament it will receive real-terms increases. What the hon. Gentleman may not know is that the number of full-time equivalent clinical staff working in the NHS today is higher than it was in May 2010 and September 2009.

[Mr James Gray (North Wiltshire) (Con)]

Over the weekend, the Minister will have seen a number of reports in the press that tens of thousands of NHS jobs were to go. Is he aware of any evidence that that is the case, or is it pure trade union scaremongering?

Candour in Health Care

James Gray Excerpts

Wednesday 1st December 2010 Westminster Hall

[Tom Brake (Carshalton and Wallington) (LD)]

It is a pleasure to serve under your chairmanship this morning, Mr Gray. I congratulate my hon. Friend the Member for Poole (Mr Syms) on securing the debate and on lucidly and concisely setting out precisely why the Government should look carefully at a statutory duty of candour. I have not heard any effective arguments against it, but I will come on to some arguments from opponents. My hon. Friend set out why the duty would boost public confidence and he rightly pointed out that an apology—as we have probably all experienced—often, first, helps to secure closure for a family if a loved one has been involved in a tragic accident, and, secondly, can defuse a difficult situation that could end up in the courts for years afterwards. He has rightly set out the reasons why a duty of candour is a necessity.

My hon. Friend started by quoting from the Liberal Democrat manifesto, and I would expect nothing less in the coalition, so there is no need for me, as a Liberal Democrat, to do so. He also mentioned that the proposal has been carried through to the coalition agreement and, subsequently, into the NHS White Paper, which—although it perhaps does not contain a proposal as specific as a duty of candour—certainly makes it clear that hospitals need to be open about mistakes and always tell patients if something has gone wrong. One development to which he did not refer was the fact that legal aid will no longer be available in cases of clinical negligence, which I hope the Minister will pick up on in her response. I wonder whether that will have an impact and whether that strengthens the case for a duty of candour.

As I said in my opening remarks, there are opponents of a duty of candour. A briefing has been sent to Members by the Medical Protection Society, which is a

“leading provider of comprehensive professional indemnity and expert advice to…health professionals around the world.”

The briefing states that the society is committed to promoting openness in health care and supports the principle in the NHS White Paper that hospitals should be open about mistakes and always tell patients if something has gone wrong. However, it goes on to say that the MPS strongly believes that a change in culture would be more effective than a statutory duty. However, I agree with Action against Medical Accidents, which also briefed me for the debate. It said that perhaps the MPS is missing the point: it is not a question of a duty of candour or a change in culture, as it is perfectly possible to have both. Indeed, the duty of candour is one way of supporting and underpinning a change of culture, so that health care organisations are always open and honest with patients when things go wrong. The MPS says that it has been advocating that change in culture, and it is true that a number of organisations have been advocating it for the past 50 years or so, but the desired change has not happened. I am not sure how much longer one can wait for it.

There is an issue about guidance and about how seriously organisations take guidance when they are statutorily required to do other things. There is always a risk that guidance gets left aside while organisations focus on statutory duties. As the MPS said, it is correct that there is a professional duty for doctors and nurses to be open with patients in the event of a mistake, but there is a wider issue about there being no statutory duty on all health care organisations to promote and support that practice in their organisations. As my hon. Friend the Member for Poole said, the medical professionals may want to be open but, unfortunately, they are being advised by managers, who are not subject to the same professional codes and perhaps believe that less openness is the best course of action. My hon. Friend referred to the Stafford case, and, as I understand it, it was a legal officer who sought to suppress the doctor’s report in that case. When the General Medical Council was asked to confirm how many cases it had brought against a doctor specifically for a breach of this part of its code, it confirmed that it has not brought a case against a single one.

My hon. Friend also referred to the very sad case of Robbie Powell and the sterling efforts that the family have made. I am pleased to see that Mr Powell has joined us here today.

[Mr James Gray (in the Chair)]

Order.

[Tom Brake]

I am sure that Mr Powell will be listening carefully to what is said and reading the remarks in Hansard later. That family have played a major role in bringing this issue to our attention and are working with AvMA to promote what they hope will become Robbie’s law.

The MPS has provided information that I think works against its case. Its research shows that, at the moment, a third of doctors are not prepared to be open and honest when an accident occurs. If so many doctors feel constrained from or concerned about being open when an accident has occurred, it supports the case for a culture of candour. The MPS also refers to states in the United States where there is a duty of candour and where it perceives that there may be a difficulty in enforcing the duty. In his remarks, my hon. Friend the Member for Poole made it clear that the Care Quality Commission has confirmed that it could and would enforce a statutory duty, and would be in a position to do so, if that were part of its regulations.

Another issue that the MPS raised, which we need to respond to, is that the proposed duty would not include near misses. It is arguing against the duty of candour, but at the same time saying that it would be a problem if near misses were not included. I understand that there is a general agreement that, although it might the norm for near misses to be reported to the patient, there would be discretion in cases in which reporting a near miss might cause unnecessary harm. There is recognition that the near miss issue needs to be addressed carefully.

One important fact is that, whether it is a duty or a requirement, it must apply to all health care organisations. If there was one thing in the coalition agreement that was slightly remiss, it was the fact that it referred only to hospitals, but there is a wider health body that we need to include. I am sure that the Minister will clarify in her response that the duty of candour, or the requirement, would need to apply not only to the patient but, sadly, if the patient has died as a result of the accident, more widely to include family members. It should not be strictly restricted to the person who had the misfortune of suffering the accident.