Child and Adolescent Mental Health Services

Jim Cunningham Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Paul Blomfield (Sheffield Central) (Lab)]

It is a pleasure to follow the hon. Member for Totnes (Dr Wollaston), whose very thoughtful and incisive speech drew on both her own rich experience and the Select Committee’s excellent report.

In the September recess each year, I organise a series of consultation meetings across my constituency. The one I enjoy most is that with young people. It is organised with a range of youth groups, such as Members of the Youth Parliament, and brings together a good number of young people aged from 18 to their early 20s. It is really sparky and lively, and they pull no punches in raising issues. When I ask them what are the top priorities that I, as their Member of Parliament, ought to take up on their behalf, it has been very striking just how high mental provision has come in the past couple of years. That would not have been the case when I was young.

The fact that young people themselves put such a high priority on mental health as an issue should send us a very clear warning signal. That does not only apply in Sheffield. Following ballots of tens of thousands of young people across the country, the Youth Parliament has made mental health one of its two priority campaigns this year. If it is so important for young people and they are pressing us on the issue, we should be deeply concerned.

In advance of today’s debate, I have been in contact with three of the groups I work with in Sheffield: CHILYPEP —the Children and Young People’s Empowerment Project; Young Healthwatch; and STAMP—Support, Think, Act, Motivate, Participate—which is a group of 14 to 25-year-olds who have come together with the specific objective of improving mental health support for other young people. They are concerned about the current state of provision, or what they would describe as the lack of provision, and they fear for the future and the impact of cuts on an already desperately inadequate service.

The groups have identified three key problems. The first is that reductions in funding are taking place at a time of increasing need. The second, which very much echoes the points made by the hon. Lady and the report, is about the lack of early intervention. The STAMP young people’s manifesto states:

“Act now, tomorrow could be too late!”

That indicates the severity of what we are talking about. The third is that young people are abandoned at 16.

[Mr Jim Cunningham (Coventry South) (Lab)]

On the issue of resources, budget cuts have been inflicted on local authorities, such as Coventry. Some of them have had to find about £3 million or £4 million, which is an extra burden. The Government hope that local authorities can somehow resolve that situation, and then they wonder why they have problems with young people.

[Paul Blomfield]

My hon. Friend makes a very important point. Such a matter is close to my heart in Sheffield, where funding from central Government will halve over the lifetime of this Parliament. That is putting an enormous strain on all the related services and support for young people that can play a broader role in alleviating some of the difficulties. In Sheffield, we are very conscious that our position is in sharp contrast to that in wealthier parts of the country.

The first point is about cuts at a time of increasing need. We know that budget cuts to front-line services are difficult and can be devastating at any time, but cuts to child and adolescent mental health services are being made at a time of increasing need. From 2011-12 to 2013-14, Sheffield CAMHS saw a 36% increase in referrals, and a 57% increase in initial appointments. If we are serious about reducing stigma, talking openly about mental health problems—we have made enormous advances in doing that—and having parity of esteem, we should welcome those referrals. However, that demand comes against the background of what has effectively been a 4% budget cut, disguised as a requirement to drive efficiency savings. That has had severe consequences for the level of support that young people are receiving. There has been a stark increase in waiting times.

--- Later in debate ---

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

I am grateful to be called to speak in this debate after the hon. and learned Member for North East Hertfordshire (Sir Oliver Heald), who has ministerial experience in this sphere. I do not, but I have some experience in other spheres of finding money for it and I know how difficult that can be. I therefore congratulate the hon. Member for Totnes (Dr Wollaston), Chair of the Select Committee, on her report. We in Coventry find it very timely, and we look forward in due course to the Minister’s taskforce and its report, leading, we hope, to what the hon. Lady very precisely referred to in terms of improvements to services—better services for children and adults on the ground, which is where it matters. She also said she found having to grapple with out-of-date figures—it is rather surprising that we should have them—frustrating. I therefore thought I would take part in the debate in order to bring up one or two up-to-date figures on a particular aspect of young persons’ and adolescents’ mental health that is becoming more and more prevalent, and disconcertingly and alarmingly so in Coventry: self-harm.

We have seen a terrible and frightening increase in self-harm over the past five years. The first figures we had were back in 2010 and the figures for 2014 have just come out. They show an alarming increase from 50 referrals in 2010 to over 300 in 2014. That is a terrifying rate of increase. It has been going pretty steadily at over 20% year in, year out, and, as my hon. Friend the Member for Stoke-on-Trent South (Robert Flello) pointed out so tellingly, it points to the impact deprivation and poverty can have on children, as there is a fairly well-established causal link between pockets and areas of deprivation and poverty and the tendency among adolescents to self-harm and referrals.

Those referrals come on top of what we already know is a crisis in A and E. They are only exacerbating that, and leading to youngsters with terrible mental health problems being turned away—doors closed in their face. It is a situation that in Coventry has led to a clear and recognisable crisis, and to an emergency meeting of the scrutiny board to examine exactly what the situation is, to report on it, and to see what measures can be taken to deal with it.

It is often all too easy to blame lack of resources and the Government, but, as the Chair of the Select Committee said, there clearly is a lack of resources. Towards the end of my brief remarks, I will discuss the fact that mental health services have always been the Cinderella services of the health service. I think that is fairly well accepted both outside and within the NHS. If we are to embark on yet another reorganisation and integration of health services as a whole, I hope that the underfunding and the lack of past attention that has affected and led to the present situation in mental health services will not be overlooked. It is not as though all the services can be integrated equally or proportionately, but if certain services are not to be further damaged, they will need to receive particular recognition and get preferential priority in the integration—I do not like the word “reorganisation”—which all the parties agree needs to be done carefully. This should not be rushed. We do not want another reorganisation forced on the health service. It should be done sensibly and gradually, and with sensitivity to the individual needs of the services that are being integrated.

[Mr Jim Cunningham]

Does my hon. Friend agree that the Caludon health centre at the University hospital Coventry does a very good job in very difficult circumstances? Yesterday, I met some young people from Coventry college who told me about the pressures that they were under. They are worried about exams and about whether they will be able to get a job after their exams, because the number of young people out of work in the west midlands is extremely high. Does my hon. Friend agree that we need to consider all the pressures that young people face these days?

[Mr Robinson]

Yes, I do indeed. The pressure in the education system to achieve results at any cost simply adds to the problem, as do the deprivation and poverty to which other Members have referred. All those factors have resulted in a situation in which incidents of self-harm are increasing at the rate of 20% a year. Referrals in Coventry are going up, and that constitutes a crisis, given that our accident and emergency services are already overcrowded and hard pressed.

Let me explain what that crisis means in regard to the number of weeks involved. Normally, effective substantive intervention would be expected within 18 weeks, but in Coventry the average wait for a substantive intervention has been 44 weeks. That is in a sector in which early intervention is clearly the most effective route to the successful management and eventual elimination of a mental health condition. That simply is not good enough, and I put that to the Minister for consideration by his taskforce.

We have asked the local council what can be done. As my hon. Friend the Member for Coventry South (Mr Cunningham) has said, budgets have been heavily cut. According to current Government plans to reduce public expenditure to 1930s levels—from which I know the Minister of State, Department of Health, the right hon. Member for North Norfolk (Norman Lamb) has dissociated himself—Coventry would experience a further 50% cut over the next five years. There would be nothing left. Fortunately, however, that is unlikely to happen, as I am sure that there will be changes of one kind or another to those plans, or to those making the plans, in the very near future.

It is impossible for the councils to find more funds, because they are under tremendous pressure, but there has already been a £50 million cut in the budget for CAMHS. It has been cut from £766 million. I think that that relates to the £800 million figure quoted by my hon. Friend for Eastleigh—

NHS (Government Spending)

Jim Cunningham Excerpts

Wednesday 28th January 2015 Commons Chamber

[Chris Leslie (Nottingham East) (Lab/Co-op)]

I beg to move,

That this House notes comments from leading doctors and nurses that the NHS is in crisis under this Government, which has wasted £3 billion on a reckless reorganisation; believes an extra £2.5 billion a year should be invested in the health service, including to fund an additional 20,000 nurses and 8,000 GPs, by raising additional revenue from closing tax loopholes, a levy on tobacco companies and a tax on properties worth over £2 million; further notes that the Office for Budget Responsibility has said that the Government’s spending plans in the Autumn Statement would return public spending to a share of national income last seen in the late 1930s, before there was an NHS, and a level which is incompatible with the Government’s claims to be able to protect the NHS; recognises that only four OECD countries have total government expenditure at 35 per cent or less of GDP and that all of these countries have significantly higher charging as a share of overall national health spending than in the UK; and calls on the Government to reconsider the plans set out in the Autumn Statement for even deeper spending cuts, which the head of the Institute for Fiscal Studies has said could involve a fundamental reimagining of the role of the state.

We have discussed already today some of the issues facing the NHS, but when will the Government realise that our health service faces such unprecedented pressures that it is in intensive care and in need of urgent attention if we are to avoid reaching the point of no return?

I want at the outset to set the context for this debate, because it is important that we look at this Administration’s record so far. We know that the numbers of people waiting for more than four hours in the accident and emergency departments of our hospitals throughout the country have grown and grown, but in 2014 almost 1.25 million people waited for longer than four hours. It is true that the number of people going to A and E has been increasing: in the last four years of the last Government, it was rising by about 60,000 a year, but in the last four years it has gone up by 600,000 a year. This is a rapid escalation in the level of strain on our NHS infrastructure, which has a series of causes that fall at the Government’s door.

[Mr Jim Cunningham (Coventry South) (Lab)]

It gets worse. At University hospital in Coventry, we are now back to the bed-blocking of previous Tory Governments as a result of cuts to local government funding for social workers, which means that people cannot be discharged. That is back to the future, as it were.

[Chris Leslie]

The accident and emergency situation is a barometer of a series of failures across the health and social care infrastructure. I shall certainly deal with some of those questions, as will my hon. Friends.

National Health Service

Jim Cunningham Excerpts

Wednesday 21st January 2015 Commons Chamber

[Mr Stephen Hepburn (Jarrow) (Lab)]

If anybody wants to see the direction in which this Government are going with the NHS and what impact their policies are having on it, they should come up to my constituency.

Let us think back to the Prime Minister’s weasel words before the last general election—that the NHS was “safe” in his hands and that he wanted the initials NHS to be synonymous with and to define his name. Then let us look at what is happening today. It is a wonder he can lie in bed straight at night, as we see the NHS in crisis—the only thing it is doing is crying out SOS. He promised that there would be no reorganisation, but what do we get? We get the biggest reorganisation since the NHS was formed, and one set up for one thing and one thing only: to privatise the NHS. Some £3 billion has been spent on that reorganisation and the bill is going up—£3 billion that should have been spent on the sick instead of on P45s going out to thousands of nurses when cuts are implemented. It is disgraceful.

Ministers have only to come to Jarrow to see what is happening. In my local hospital three elderly patients wards have closed, a minor injuries unit has closed and now, to make matters worse, a popular walk-in centre, which sees over 27,000 patients a year, is to close. The closure is opposed by everybody in the area—the council, the trade unions, the patients and the staff.

[Mr Jim Cunningham (Coventry South) (Lab)]

Has my hon. Friend noticed that the Government are running true to form, like the previous Conservative Government, when we had bed blocking and people sleeping on trolleys because they could not get a bed in hospital? Has he noticed particularly that local authority budgets could have provided for the elderly and prevented bed blocking?

[Mr Hepburn]

That is exactly the point that the shadow Secretary of State made in his opening speech.

As we heard earlier, local managers are not listening. They are stooges of the Government and they are carrying out the cuts without listening to local people. It is disgraceful. They are not incompetent, and nor are the Government—they know exactly what they are doing. There is a deliberate effort to sabotage the NHS by piling those 27,000 patients a year on to the local doctors.

Adult Social Care

Jim Cunningham Excerpts

Wednesday 21st January 2015 Westminster Hall

[Mr Mudie]

The hon. Gentleman is quite right. I will touch on the sheer lack of connected thinking in the Treasury—I do not think that the Department of Health has much to do with that.

The National Audit Office, which is usually pragmatic and non-political and accepted as objective, pointed out in its review of the service that total spending on adult social care—covering the whole gamut of, I suppose, 18 to death—fell 8% in real terms between 2010-11 and 2012-13. Older adults experienced the greatest spending reduction at 12% in real terms. Interestingly, the NAO stated:

“Rising needs, reducing local authority spending, and reductions in benefits may be putting unsustainable pressure on informal carers and acute health services.”

Chillingly, it went on to say:

“National and local government do not know whether the care and health systems can continue to absorb these cumulative pressures, and how long they can carry on doing so.”

That is from its review last year, yet the cuts have continued.

[Mr Jim Cunningham (Coventry South) (Lab)]

To substantiate the point that my hon. Friend has just made, I can tell him that about a fortnight before Christmas we met local GPs who were voicing concerns about bed blocking in particular, caused by cuts in local government expenditure for social care. That is reminiscent of what happened under the previous Conservative Government.

The other affected area is meals on wheels. When a visitor goes to an old person’s house, they see what condition they are in and often they are able to help but get only 15 minutes to do so.

[Mr Mudie]

My hon. Friend is quite right. When I was a trade union official, I looked after what were termed home helps and I always appreciated that point—as I did as a councillor, just like him. They were invaluable people who went into old people’s homes, met them and formed relationships, and if they were handled and trained properly, they would report back on any change in condition they saw. That was often valuable for the old people.

If the Minister read the excellent newspaper The Independent this morning, he will no doubt have seen the article reporting the comments of the chief executive of Age UK, Caroline Abrahams. The article states:

“Care of the elderly is in a state of ‘calamitous, quite rapid decline’…with…thousands fewer people receiving care than five years ago.”

She spelled out the fact that the number of people receiving home care has fallen by a third since 2010.

Places in day centres, where lonely, vulnerable adults could find warmth and companionship and escape cold, empty homes are down 66%. Incredibly, in the area that my hon. Friend just mentioned—equipment and adaptations such as rails and stair lifts—40% fewer people now receive help. I say that is incredible because everyone accepts that such adaptations and aids help old people stay in their homes. Often, they save their lives, but they are certainly a method of preventing them going prematurely into residential homes or hospital beds, yet the money has been cut and 40% fewer are being helped.

The article continues:

“Ms Abrahams said that hundreds of thousands of older people were being left ‘high and dry’.”

It goes on:

“‘The lucky ones have sufficient funds to buy in some support, or can rely on the good will of family, neighbours and friends. But there are many who are left to struggle on entirely alone,’ she said.”

I remind the House that that is the chief executive of Age UK, the leading charity for old people.

The Care and Support Alliance pointed out that population changes mean that more people need care, but, as we know, fewer people receive it. There have been further cuts to adult social care budgets in recent years, and a 26% reduction in the number of older people receiving state-funded services, despite the Personal Social Services Research Unit having predicted that demand would increase by 17% between 2000 and 2020.

The picture is the same among working-age disabled people, 90,000 of whom lost access to state support for their care needs between 2008 and 2013. The alliance says that there is a “chronic underfunding” of care. With local authorities having had to find significant savings owing to reductions in Government grants, there have been further cuts to social care budgets in recent years. The Association of Directors of Adult Social Services and the Local Government Association estimate that about £3.53 billion has been taken from adult social care budgets during the past four years. In the last year alone, 40% of the total savings made by local authorities were achieved through reducing adult social care services. That is quite an alarming figure, but perhaps understandable. That has resulted in a tightening of eligibility for care at local level and of the size of care packages for those who remain eligible. When discussing the Barker commission’s recommendations for more funds and the options that had been set out, the CSA commented:

“What is no longer an option is to continue the current chronic underfunding of care.”

I hope that in the short time available to me, I have allowed the voice of representatives to be heard and put on the record—not partisan politicians but those working in the service full time, who know the people, the finances and the difficulties. What it all adds up to is something that has been known in this place for some considerable time—the service is underfunded, at a time when it is recognised that there are additional pressures and that there is a need for more money, not less. We all know that. It has been known in this building for at least 10 years, covering two Governments. People told us until they were blue in the face that more money was needed, because there were more older people who were living longer and had greater needs. Yet because of elections, I presume, everybody dodges the column and no one has made the difficult decision about how we put money into the service. There should have been a public debate along those lines, to show people the quiet neglect of vulnerable people that is happening every day, in almost every street in our communities.

[Mr Cunningham]

The situation is a little worse than that. We are really going back to about 30 years ago, when local authorities were forced into doing deals with the private sector for old people’s care homes. Recently, we have witnessed some of those care homes going bankrupt, which means closure and a lack of places for people.

[Mr Mudie]

It is clear that my hon. Friend has read my speech; I was just coming on to the privatisation of adult care services.

I hope that I have highlighted in my remarks the important role of local authorities in the sector. As an ex-councillor, I instinctively have much sympathy with the difficulty they face in having to take some very difficult decisions about priorities in the face of the Government onslaught on their budgets. Leeds, my home authority, has faced a tremendous task in running a city when it has had to find £250 million in cuts during the period of the first spending review. Having achieved that, it is now dismayed to hear the Chancellor threaten—indeed, promise—further cuts until 2018, if he gets back in office. In fact, Leeds has been told that it will face a budget cut of £46 million in 2015-16. Other councils face similar problems, and I simply do not know how the Chancellor feels he can order those huge cuts and still have our major cities being run and our elderly and disadvantaged being properly cared for.

I was alarmed when I was informed that a dementia residential and daycare home in my constituency, The Green, was being closed, and that many hundreds of home care workers were also losing their jobs. When I looked into things, I discovered that, chiefly as a measure to keep the city intact financially, the council had had to act in line with other big cities and had taken two unfortunate steps.

The first, which has been mentioned in passing, was to raise the criteria level at which help should be given. This meant that new applicants would have to meet higher eligibility thresholds than before. Parkinson’s UK and the National Autistic Society are two organisations that have pointed out how the new criteria put their members at a disadvantage when it comes to receiving help. The Government have legislated on that point in the Care Act 2014, and although that meets the Government objective of ending postcode unfairness, it also legitimises local authorities, or rather strengthens them, when they have to turn people down because they have needs that are lower than the criteria require. Those organisations have given evidence on how the quality of life of individuals with either Parkinson’s or autism has been diminished. I hope that the Government’s decisions will be reviewed in happier times.

What is more difficult to review is the point that my hon. Friend the Member for Coventry South (Mr Cunningham) touched upon—the decision to outsource adult care services. That has been done to help meet the shortfall in Government grant. Perhaps I am paranoiac—I probably am, because I think paranoia keeps us safe—but I wonder whether that is what the Government intended. Many people have been outraged by the Government’s propensity to privatise much of the NHS, but thanks to the love that the British public quite rightly have for that unique and wonderful organisation, the Government have backed off from adopting a full-frontal approach and are now taking a more subtle, if not devious, approach.

So quiet has the handing over of care homes and home care staff been that it has rarely been picked up by the general public, except by the clients of those homes and the ex-local government staff themselves. There is a growing awareness of 10-minute visits and the failure to provide elderly people with the same carer; providing the same carer is an important part of home care, so that people can build a relationship with them and trust can develop. The former staff are aware of the loss of local government wages, the use of zero-hours contracts and the loss of payment for travelling time, which accounts for those 10-minute visits.

I will just depart from my script to say that that situation is not surprising. If a council outsources contracts and there is a duty to save money, given that those contracts primarily involve labour, the only way in which money can be saved is to hand them over to a private company. That company would have no compunction in offering lower wages, no travelling time, worse holidays and worse sickness schemes. That is what has happened in the majority of cases.

Contaminated Blood

Jim Cunningham Excerpts

Thursday 15th January 2015 Commons Chamber

[Alistair Burt]

My latest understanding is that the Penrose inquiry has said that later this month it will announce when it will report so I think that by the end of January the leader of the inquiry will have announced when publication will take place. I will touch on that later; the non-reporting so far is one problem that we have had to deal with.

Let me give one further brief story as part of the background to the statistics. I have been privileged to work with one family where three brothers died. To give an indication of what that meant, the sister wrote to me:

“the story of my three brothers, all dead, as a direct result of the treatment given to them by the NHS. The impact on the family? A devastation that time has not and never will heal, owing to the lack of acknowledgement over these deaths by both the Government and the medical profession…Family life is never the same with any bereavement, and we can only cherish their memories and their offspring, but there are still so many un-answered questions as to the decisions made”.

Each of us has a number of stories that we could raise, and I apologise for not being able to read out more.

Why now? The answer is that there has been a lot going on in recent times. This Parliament began with the very first Back-Bench debate, initiated by the hon. Member for Coventry North West (Mr Robinson), who I am pleased to see in his place. I am sure that that helped lead to an announcement in January 2011 by the then Secretary of State of further changes to the funds providing payments, but underlying issues remained outstanding. We were all approached.

On 18 October 2013, I asked the Prime Minister a question on the issue. I will not repeat the detail, but it got a warm response from the Prime Minister who understood the problem and promised that he would put support into it, meet the gentleman that I wanted him to see, and take it up. To put this in historical context, the reason for approaching him was that the scale of the tragedy is certainly on a par with those issues for which the Prime Minister has apologised in this Parliament—Hillsborough and Bloody Sunday—having the bravery to recognise what had been done in the past, with the authority that only a Prime Minister could have.

We took the Prime Minister at his word. I was proud to take my friend, my constituent and his colleague to that meeting. We said we needed No. 10 to offer to work on what more might be done to close off the issue, and since then the Prime Minister has indeed put members of his policy team to work, together with my hon. Friend the Minister. I am grateful for the Prime Minister’s engagement and I am, of course, hopeful. I hope that my hon. Friend the Minister will say more about that work.

My question was followed up infinitely more powerfully by a debate on 29 October led by Paul Goggins, in which he outlined some of the issues that we agree are still to be settled. He spoke principally about the funds and people’s finances, the bureaucracy and inconsistency of the funds, the discrimination suffered by those who did not fit certain categories, the crude distinction between stage 1 and stage 2 hepatitis C sufferers, the inadequacy of funds for making discretionary payments, and the absence of transparency and accountability over the years. He suggested that if the Government were to continue to reject a public inquiry, there should be an alternative process, including:

“In addition to fair financial support, those who have suffered so much are still owed a full explanation and a sincere, profound apology.”—[Official Report, 29 October 2013; Vol. 569, c. 201WH.]

Hovering in the background of all our deliberations were a Government who were prepared to take on a public inquiry. In 2008, the then Health Minister for Scotland, now the First Minister, announced to her great credit the sort of judicial investigative inquiry on the transmission of infectious disease via transfusions in Scotland that has not been held for the UK as a whole. It covers effectively all the major issues dealt with by Archer, and will very likely have comments to make that will have a bearing on UK-wide policy. It may well have implications for financial considerations in respect of responsibility for what happens and what needs to be done.

As I told the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke), we do not yet have that report, but while MPs have waited for it we have not been idle. In April the all-party group and additional colleagues working with me, held two public meetings at Westminster. We wanted to keep the community informed of what was happening, discuss expectations and hear from them. As MPs attacked the issue yet again, we were asking the Government to focus on the key issues. Those meetings helped to reinforce our sense that we were talking about the right themes—the changes that life had brought for people who had not expected to live, and the financial considerations that that now brought them. There is the problem of leaving anything; the problem of mortgage and insurance; and the problem of the bereaved and the dependants, which we all know very well. They all have to be in the front of the Government’s mind as they approach this.

[Mr Jim Cunningham (Coventry South) (Lab)]

I thank the right hon. Gentleman for giving way and pay tribute to him for the tremendous amount of work he has done on the issue. It would be fair to say that since he has been involved there has been a degree of progress, although not total progress, because we will not have that until we get some action. Does he agree that many of the families feel very strongly about this and often feel frustrated by the lack of progress?

[Alistair Burt]

I am grateful to the hon. Gentleman for his kind remarks and I appreciate them very much. Yes, one thing we were told in our meetings in April was that people are sick of coming to Parliament. They have been coming for many years and many of them will feel that even today, but this is the best we can do as Members of Parliament. We know that those on both Front Benches are listening.

Oral Answers to Questions

Jim Cunningham Excerpts

Tuesday 13th January 2015 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I have been in contact with the NHS Trust Development Authority. I have been reassured that the safety of patients in Stafford is the primary concern and that the transfer of services should help to ease pressure on local services and improve patient care.

[Mr Jim Cunningham (Coventry South) (Lab)]

T7. Government-inflicted cuts on local government funding and subsequent reductions in adult social care services have increased the pressures of bed-blocking at University hospital Coventry, with a number of patients unable to be discharged as they wait for a nursing home place or a package of care in their own home. Does the Minister agree that this is a problem, and what steps has his Department taken to remedy it? Will he not do the Pontius Pilate act but take responsibility for his actions?

[The Minister of State, Department of Health (Norman Lamb)]

The hon. Gentleman is absolutely right that what happens in social care has an impact on the health service, and the answer has to be to stop seeing them as two separate systems and to look at the whole health and care system. That is why the better care fund is such an incredibly important initiative, pooling a substantial sum of health and care funds, and it must go further so that we end up pooling the entire resource.

NHS (Five Year Forward View)

Jim Cunningham Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

I assure my hon. Friend, who has campaigned very hard to improve standards at Medway hospital, that, first, we want to support its doctors and nurses, who are more passionate than anyone about putting this difficult period behind them; and that secondly, I have no greater focus than on making sure that we do turn around these hospitals in difficulty. It is a challenging process, but the extra funds that I have announced today will benefit all hospitals, including Medway.

[Mr Jim Cunningham (Coventry South) (Lab)]

The Secretary of State has boasted about the numbers of doctors and nurses coming through on his watch, but that actually started on Labour’s watch because, as he has said, the process takes seven years. What proportion of this new investment in the national health service is to be invested in Coventry, particularly given the disparity regarding doctors’ surgeries and the loss of doctors?

[Mr Hunt]

The training may have started under Labour, but if we do not have enough money in the NHS budget, we cannot pay for these doctors and nurses. We can do that because we took a decision, bitterly opposed by Labour, to disband the primary care trusts and the strategic health authorities and to lose 21,000 administrators so that we could pay for 10,000 extra doctors and nurses, including in Coventry.

National Health Service (Amended Duties and Powers) Bill

Jim Cunningham Excerpts

Friday 21st November 2014 Commons Chamber

[Clive Efford]

There are a number of provisions relating to the Secretary of State which state that everything that is decided has to put patients first, rather than competition. That is the key difference in this Bill. The Secretary of State will have to be satisfied that every penny raised from private income serves the needs of patients. The Secretary of State will set the limit, which can be variable, but it will have to come down because this House will demand that.

[Mr Jim Cunningham (Coventry South) (Lab)]

Is it not true that, under this Government’s reorganisation, between £3 billion and £5 billion has been wasted as a result of tendering exercises?

--- Later in debate ---

[Andy Burnham]

I appreciate what the hon. Gentleman says—it would be churlish for me to say otherwise—and I am grateful for the way he said it. The things Opposition Members were saying back then have happened, and we can see the effects of the Government’s reorganisation in the NHS. With the new figures that came out this morning, we see that A and E has missed the Government’s target for 70 weeks in a row. The A and E figures are the barometer of the health and care system. They are the best place to look if we want to see whether there are problems in the health and care system. The fact that the target has been missed for 70 weeks in a row tells us that severe storms are building over the NHS.

[Mr Jim Cunningham]

I am glad my right hon. Friend raised that. It takes us back to pre-1997, when people who could not get beds were lying on trolleys. I am sure he remembers that. I can remember a hospital in Coventry that was falling down. As a result of the Labour Government, we got a new hospital.

[Andy Burnham]

My hon. Friend is right. The Labour Government inherited a situation where almost three quarters of the NHS estate was built before 1948. We transformed that, as well as bringing those waiting lists down. He is right to remind us.

I cannot believe that Government Members have not had the guts to be here today to argue for their own policy on the NHS. Or is it that under the shambolic regime of their new Chief Whip, who is now inflicting the same chaos on the parliamentary Conservative party as he did on England’s schools, the Government did not think they could win the vote today, so they did not dare to bring their troops here to hold it? I do not know what the reason is, but they clearly do not believe in their own legislation and the catastrophic reorganisation that followed. An unnamed senior Cabinet Minister has been quoted in The Times as admitting that it was their single biggest mistake.

General Practices (Coventry)

Jim Cunningham Excerpts

Thursday 30th October 2014 Commons Chamber

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

This debate might not be as lively as the debate on post offices in May, when we also had the pleasure and privilege to have you presiding over us, Madam Deputy Speaker. Nevertheless, we have an important topic to debate and I am pleased that the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) is ready to respond, because we have one or two questions for him. I thank Mr Speaker for granting the debate. My hon. Friend the Member for Coventry South (Mr Cunningham) would like to take part and he has my willing acquiescence. I do not intend to detain the Minister or the House for long this evening, but I wish to put to him a point that was made to me in a precise and graphic way by the local medical committee for Coventry—it is also for Rugby, but in this debate I am principally speaking as the Member of Parliament for Coventry North West.

The situation has been described as a “crisis”. A letter, almost a cri de coeur, went out from the local medical committee on behalf of GPs, issued in the name of the chairman of Coventry local medical committee, Dr Peter Whidborne. He said that,

“due to increasing workload, and decreasing resources, general practice has now reached crisis point.”

That is what triggered my interest in this matter and my concern as the local MP, and it was reinforced by many anecdotal and personal encounters with residents in my constituency—I am sure my hon. Friend will confirm the same thing for Coventry South—who said that they cannot get appointments with GPs. Patients are finding the situation increasingly frustrating, and an assiduous campaign has been waged by certain elements of the popular press against the 2004 GPs contract and all the weaknesses that we know it contained, yet there is also the reality of the pressures under which GPs operate.

The public’s general impression is that the previous Government granted GPs all too easy a deal but that GPs have not responded in kind, and that despite the general improvement in their terms and conditions, rather than improving services they have in fact responded with a decrease in the level of service provided. Many would agree that there has been such a decrease, but they would disagree that that is due entirely, or even mainly, to the 2004 contract changes. In fact, it is a reflection of the general unease throughout the whole health care service. Such unease is reflected in, among other things, reliable figures produced by the Deloitte Centre for Health Solutions, which I will refer to in a moment. On access to GPs, as with other areas of the health service such as A and E departments in the acute hospitals or services for elderly people who suffer from a chronic condition, people are finding it increasingly difficult to get the level of care required, and the resources needed to provide it, because of the stretching of health service provision at a time when resources are relatively stagnant.

Let me cite some figures that I think graphically illustrate the situation we are facing. In Coventry, the number of people emigrating from other countries is increasing and the number of GPs is decreasing—the figure from the Deloitte study is something like a 2.5% decrease in the total number of GPs over the last five years, at a time of increasing demands on them in terms of visits and patients to be seen. Let us remember that 90% of all patients are first seen in a primary practice by GPs before they access any other services offered by the NHS, including the general hospital, and that figure is increasing every year. For the first time in the NHS’s history, however, the number of GPs is shrinking. We must deal with that basic fact at a time when numbers should be increasing.

I am pleased that the Labour party has pledged—this is not a party political point—to increase the number of GPs by 8,000, and to raise the money for that and for wider £2.5 billion spending on the health service through a mansion tax and a tax on tobacco companies. I am sure that in so far as such measures have success—I have some experience of that with the windfall tax that some Members may remember—the latter idea will find widespread support throughout the House. If at the end of the day the mansion tax does not prove successful for whatever reason, the Government will have to look elsewhere, but the need for additional resources can no longer be denied.

Shortly before coming to the Chamber for the debate, I heard on the news that the Secretary of State has said that the reconfiguration involves not only integration of care for the elderly and social care with the mainstream health care services. That is important, but it also involves dealing with the divisions between the acute hospitals, which take the bulk of the spend, and GPs. The reconfiguration must mean that more is done by GPs when services can be sensibly provided by them, and that less is done in hospitals. I believe I am correct that that idea was first mooted by Lord Darzi in around 2008-09. The word used at the time was “polyclinics”, which require a lot of investment. In the interview on television news, the Secretary of State said words to the effect that we need more GPs and 15,000 more community workers in GP practice to make it a success, both of which clearly require more money.

Somehow or other, the Government must face up to the fact that, when it comes to claims for money, services to patients in Coventry and cities throughout the country must be increased. Otherwise, we will have more closures of local management committees and GP practices. Some 518 UK practices have closed in the past five years. Others have expanded, but in Coventry alone, eight major practices have closed. We have shrinkage of capacity and an increase in demand. By the definition of those two statements, we have a crisis, which is the subject of our debate.

Will the Minister tell us how far the Government have got with the pilot scheme under the clinical commissioning group in north Lancashire? The pilot intends to find out how the additional resources—£1 million has been put up—can be fed in without taking away from other parts of the health service, which it is important to emphasise. How is that working out?

That point came to my attention with the letter and prompted me to apply for the debate. The situation was highlighted in an early-day motion back in June. I did not sign it at the time but have rectified that. It was tabled by a Member who speaks for the Liberal party and seconded by two distinguished Labour Members, a former Chairman of the Select Committee on Health and my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson), a previous Labour Secretary of State for Health—he was Secretary of State in one of the earlier Labour Administrations. An amendment that I would be interested in supporting was tabled by a Government Member. He said that money was available for that pilot study. I would like to hear how it is making services more effective and providing more resources effectively for the delivery of GP services.

There is a conundrum. Why are GP practices not as attractive as they ought to be to new entrants? Fewer of those qualifying in the medical profession want to go into general practice, hence we have a net decline in the total numbers at the very time when, for all the reasons I have given, we should be increasing those numbers. Why is it so difficult? When one gets into a practice, and before becoming a partner, one gets more than £50,000 a year. Beyond that, when people become partners, they get approaching £100,000 and sometimes more, even in the initial stages. The average pay for GPs in Coventry is more than £100,000 a year.

[Mr Jim Cunningham (Coventry South) (Lab)]

Some months ago, I visited one or two different general practices in Coventry. The disparity in medical technology was startling. I have raised that in the House before, but I hope the Minister will touch on the reasons why we get such disparities.

[Mr Robinson]

I am very grateful to my hon. Friend for his intervention.

Some 10,000 GPs—I am sure these figures are well researched by Deloitte—have expressed an intention to retire in the next five years. That is 2,000 a year, and Labour is promising to increase the number of GPs by 8,000. We will therefore need considerably more than that just to remain where we are now. What are the projections for doctor qualifications and the division between secondary and primary care? Are we catering for enough or will we have a continuing crisis with people blaming the previous contract, as they do in the press all the time, when in fact there are simply not enough doctors or resources to go around?

I do not want to say that all doctors are perfect. They are no more perfect than the rest of the human race. The simple fact is that they are under strain. I could cite many instances, but I would like to mention one in particular. Dr Jamie Mcpherson, the secretary of the local medical committee in Coventry, is a very fine and dedicated GP whom I have known for years—he was one of the first people to come and see me when I was first elected—through the troubled years when Lady Thatcher’s Governments were first introducing tremendous cost pressures. When there was the idea that GPs would be budget holders of practices, he came to see me and said, “We don’t want that. We are aware we have to improve, but we want to be doctors serving the community.” That was his view. There is always a tension between the pressure to make GPs into budget holders who look at costs and the need for them to be committed to what they are really there for: serving the community as doctors.

I said I would give plenty of time for my hon. Friend the Member for Coventry South to speak and I intend to do so. Before I sit down, however, I would like to raise a few more points. What are the Government’s plans to ensure that there are more GPs, not five years out but in the next year or two? Can we expect any net increase in resources and in the number of GPs? Do we have any plans to have 15,000 extra community care health workers? It seems to me that we have an undue concentration on the reorganisation of the secondary sector. We have always had, in this House and outside, a top-down preoccupation with the secondary sector, the acute hospital, as if we solve everything by a concentration on it.

When I received the letter from the Coventry GPs, I realised that an increasing problem relates to the place that GPs occupy within the health community. What progress is being made in north Lancashire? What are the Government’s plans in the next year or two—they must have them, because they budget over three years—for the number of GPs, increasing resources and the establishment of new buildings?

I would like to mention another point that has been brought to my attention. There has been some investment in new buildings for GP practices. Has that investment been made with a view to them becoming polyclinics and taking on more of the “routine” jobs, if we can call them that? They are still very specialist and require trained nurses, which is why Labour has plans for 20,000 more nurses—not all, perhaps, for GP surgeries—and 8,000 more doctors. They are very skilled jobs, even though they are more routine. How much of the investment in new buildings for GPs has been devoted to the provision of a wider range of care? I ask that because it is clear that the capital cost of investing in providing new premises for practices is one of the stumbling blocks to getting new entrants into GP practices.

The other point I want to draw attention to when it comes to the Government’s plans, in addition to whether there is a problem with the practices and the capital costs of buildings, relates to women GPs. Nearly half of all GPs are now women—I think it is roughly 50%—and they need to be able to work part time. We therefore need a flexible contract. Is it flexible and is flexibility encouraged? They have a tremendous and increasing role to play.

Those are the questions I wanted to put to the Minister. We are very pleased to see him in his place and I am very pleased that we are having this debate.

[Mr Jim Cunningham (Coventry South) (Lab)]

I thank my hon. Friend the Member for Coventry North West (Mr Robinson) for the invitation to contribute to this evening’s Adjournment debate. I am told—I hope I have got this right—that it is the Minister’s birthday today, so may I get off on the right footing by wishing him a happy birthday? [Interruption.] He is looking rather puzzled about how I might have found out, but I think we should wish him a happy birthday anyway, even if he disagrees with what we say in this debate.

I support my hon. Friend the Member for Coventry North West, because family doctors in Coventry have warned that local GP surgeries are at breaking point. The Coventry local medical committee has written to the Government to highlight just how much GPs are struggling. The letter was sent on behalf of 198 GPs, nurses, managers and other staff. I am concerned that the life of a GP is becoming increasingly unattractive. We are seeing earlier retirement and emigration to other countries. We do not want a shortage of experienced GPs because we are driving them away. We are all aware of the demographic changes that are putting increased pressure on GPs, but we can try not to exacerbate them. I have written to the Health Secretary on this matter and I look forward to the reply.

I want to raise a few areas of concern about the ways in which GPs are put under pressure. I have heard from GPs on the ground that the level of paperwork required is ever increasing. Targets for GPs can be useful, but GPs feel that they are continually trying to satisfy changing requirements in order to receive the required funding. When that is combined with the climbing numbers of appointments, GPs are hard pushed to tick all the boxes needed to ensure that they are not financially penalised. I am concerned that GPs are being forced to spend far too much time doing administrative and managerial work, which is simply not practical when patient numbers are soaring and GP numbers are dropping. That has been made far worse as a result of the Government’s top-down reorganisation of the national health service, with the introduction of GP-led commissioning. We ought to be asking our GPs to do what they should be doing: treating patients, rather than being swamped in paperwork.

I am concerned that, as a result, GPs are unable to meet the expectations of patients. GPs routinely work between 10 and 12 hours a day and offer appointments at 10-minute intervals. That is extremely demanding, but it also means that they are unable to give patients the care they would wish to. For example, 10-minute slots do not allow time to discuss more than a few medical issues, and certainly not in any depth. Doctors want to help their patients, but the vast numbers of patients, combined with the paperwork and administrative work demanded of them, make that difficult. Patients deserve doctors who have the resources and the time to provide the best care they can.

Last year, a survey of GPs by the British Medical Association showed those points clearly. Almost all the doctors responding to the survey said that bureaucracy and quality and outcomes framework box-ticking had increased in the past year, 94% said that their workload had increased, 82% felt that some of the new targets were reducing the number of appointments available to the majority of patients, 90% said that their practice’s resources were likely to fall in the next year, and 45% said they were less engaged with the new clinical commissioning groups because of the increased workload. Perhaps most significantly, 86% of GPs said that morale had fallen in the past year.

I know that GP surgeries are working hard to keep things going, but we cannot replace resources. Will the Minister make a commitment to Labour’s £2.5 billion Time to Care fund? The Time to Care fund will support 20,000 more nurses, 8,000 more GPs, 5,000 more care workers and 3,000 more midwives. Nothing speaks like adequate funding. The extra funding will help to reduce the pressure. I want to know what the Government are doing to alleviate the pressure on GPs, to ensure they have the adequate resources to do the job and to improve morale. Finally, will the Minister make a commitment to Labour’s plans to spend more on the NHS?

--- Later in debate ---

[Mr Jim Cunningham]

I thank the Minister for his announcement about a new practice in Prior Deram Walk, which is badly needed and which we would welcome.

[Dr Poulter]

I am pleased to have brought some good news about future planning to the debate. As I will be writing to the hon. Member for Coventry North West in detail about some of the initiatives with medical students, I am happy to outline further the future plans for that practice in the letter.

GP patient survey results from 2014 indicate that 85% of people who responded in the Coventry and Rugby clinical commissioning group area rated their GP surgery as “very good” or “fairly good”. Although this is a high proportion, it could of course be improved further. The figure is, however, testament to the work of local GPs and the quality of care they provide, alongside everybody who works in those practices. I am also aware that Coventry local medical committee had concerns that Coventry and Rugby CCG was not following NHS England planning guidance and investing more in general practice to support it in transforming the care of patients aged 75 and older. I understand the LMC has now reached agreement with the CCG on that, which is good progress. Our plans for personalised care for the most vulnerable patients included NHS England asking CCGs to set aside £250 million from existing funds. However, as has always been the case, CCGs are not restricted to using this funding on general practice only. For example, in some areas, CCGs have used the funding to employ extra district nurses for local practices.

On the important point about the wider community work force, it is increasingly the case that although a nurse may be counted as a member of hospital staff, their role goes across not just the hospital, but the community. That is particularly the case for nurses who support patients with long-term conditions such as multiple sclerosis and diabetes. Although that nurse is officially counted as a hospital employee, they play an increasingly important role in supporting the patient in the community. Having visited the local hospital in Coventry, I know that there is a great emphasis on the hospital working much more collaboratively with the community. The role of the hospital is about not just picking up the pieces when things go wrong but proactively supporting patients, especially those with long-term conditions, when they are at home.

Oral Answers to Questions

Jim Cunningham Excerpts

Tuesday 21st October 2014 Commons Chamber

[Dr Poulter]

The Health and Social Care Act 2012 ensures that commissioners must also have regard to delivering integrated health care services. I reassure my hon. Friend that the West Sussex CCG has clearly stated:

“The…CCG will continue to commission MSK related trauma from the current providers and the intention is for this to continue for the duration of this MSK…contract”.

[Mr Jim Cunningham (Coventry South) (Lab)]

23. What is the Minister doing to retain GPs as there is considerable concern in Coventry about the number who are leaving practice?

[Dr Poulter]

I hope that I can reassure the hon. Gentleman that there are now 1,000 more GPs in training and working in the NHS under this Government than when we came to power in 2010. We are committed to training even more GPs to ensure that we can widen access to general practice services.