Social Care Reform

Munira Wilson Excerpts

Wednesday 23rd June 2021 Commons Chamber

[Helen Whately]

My right hon. Friend makes an important point about the breadth of the reform that is needed. I can confirm that we are looking at how we can support the workforce further, including by raising skills and improving training opportunities and career progression, and how technology can be used to support better care and more independence as well as providing more time for the workforce to do personal care rather than administration. On housing, most people want to live behind their own front door for as long as possible, surrounded by their own things and in their own communities, so that is also absolutely part of our reform.

[Munira Wilson (Twickenham) (LD) [V]]

New analysis for the Care and Support Alliance found that since the Prime Minister stood on the steps of Downing Street some two years ago and promised to

“fix…social care once and for all”,

2 million requests for formal care and support from adults over 18 have been turned down by their local council; that is the equivalent of 3,000 requests being turned down every day, putting immense pressure on unpaid carers as well as the NHS. This shows the human cost of dither and delay, so will Ministers stop their internal spats and off-the-record briefings and commence cross-party talks immediately with the sector so that we can fix this issue?

[Helen Whately]

We have of course had to focus on the pandemic over the last 18 months, but we are already working on reform. We are already consulting widely with the sector; I and the Department have together met and spoken to more than 70 different organisations and representatives of the care sector, from care providers to local authorities, and including care users and carers themselves. We will be working with this broad range of people, including parliamentarians; we need to build a consensus not only across Parliament but in society as a whole for our social care reforms.

Children and Young People’s Mental Health

Munira Wilson Excerpts

Wednesday 16th June 2021 Westminster Hall

[Munira Wilson (Twickenham) (LD)]

I beg to move,

That this House has considered children and young people’s mental health.

It is a pleasure to serve under your chairmanship, Sir Gary. I am very grateful to be given the opportunity to lead a debate on this critical issue. Eighteen months ago in my maiden speech, I pledged that children and young people’s mental health would be an issue that I champion in this place. It is a cause for which I will fight relentlessly, because children and young people are our future. Their hopes and dreams depend upon us doing the right thing by them.

Those who are struggling with their mental health and wellbeing, whether those suffering mild anxiety to those young people attempting to take their own life, deserve the very best care and support. Yet children and young people do not have a voice in the political system and are too often overlooked. In fact, the former Children’s Commissioner, Anne Longfield, said in her final speech earlier this year that in Government there was an “institutional bias against children”—never more so than during the pandemic when, frankly, they have been an afterthought at every turn. From new born babies to schoolchildren to university students, the Government have let them down in planning and providing for their social and educational needs, and again in their announcements about children’s recovery.

Teenagers and young people in my constituency who are ambassadors for the fantastic local charity Off The Record tell me that uncertainty over exams, combined with the social isolation of being stuck at home away from their peers, worries about loved ones and now concerns about their future job prospects have all taken their toll. But this crisis in children and young people’s mental health started long before the pandemic. One reason why I made it my priority at the start of last year was because following my election, I was astounded week in, week out by the emails from parents or conversations at my surgeries, of stories of battles with child and adolescent mental health services to access treatment for children who are considering suicide, self-harming or withdrawing themselves from school. Yet they were having to wait six months or sometimes a year for treatment.

At a lower level, support in schools is patchy, with only some having access to a counsellor or mental health support team. Community-based support to intervene early can be dependent on voluntary sector provision in any given area. The pandemic has only served to highlight and exacerbate the existing lack of access and inequalities within children and young people’s mental health. In 2017, one in nine children had a diagnosable mental health condition. That rose to one in six at the height of the pandemic. The Government need to use this moment to renew their focus on mental health and overhaul the support available.

I want to focus on three elements within the system and what needs to be done: CAMHS, schools and community services. Turning first to CAMHS, referrals are at their highest ever level, with over 65,500 referrals for 0 to 18-year-olds received in March 2021. That is more than double the number in March 2020 and almost 70% higher than in March 2019. Behind the staggering numbers is a child or a younger person in turmoil, often left in limbo waiting for treatment, and a carer beside themselves with worry. From talking to NHS leaders in my area, I know that unplanned admissions for children suffering a mental health crisis are at extremely high levels with services struggling to cope.

While it must be acknowledged that the Government have increased spending in this area, resulting in the NHS slightly exceeding its 2019-20 target of community mental health support for 34% of children needing support, there is still a long way to go. Last week, a local GP said she is increasingly finding that children she refers to CAMHS are being knocked back, and she is routinely requesting schools make a supporting referral to secure therapy. When referrals succeed, the wait can seem interminable. I heard from the adoptive father of a seven-year-old who suffered significant trauma and abuse within her birth family. She was referred to treatment, the initial assessment took several months to secure, and then the family were told that there would be a year’s wait—yes, a year’s wait for a seven-year-old for an eight-session course of treatment, only if deemed necessary.

There is a postcode lottery of spending across the country. Eight local areas spend less than £40 per child on mental health services, while 21 areas spend more than £100 per child. That brings me to an important point about data and reporting, which is so important for accountability. Inconsistencies in financial reporting across clinical commission groups makes it difficult to interrogate the data to check they are meeting NHS England guidance to increase year-on-year the proportion of spending on children and young people’s mental health. This measure should be included in the mental health investment standard.

The other issue with data collection and publication is that it is impossible to judge whether different areas are meeting access targets, as the percentage of young people with a diagnosable mental health condition is only available nationally, not on a local basis. The Children’s Commissioner should not have to request this comprehensive data on waiting times and referrals every year. The Minister will know that I tabled an amendment during the passage of the NHS Funding Act 2020 to improve transparency in operational expenditure and performance at a local level. I discussed this with her ministerial colleague, the hon. Member for Charnwood (Edward Argar), a few months ago. He assured me that the Minister is taking this forward, and I hope she can update us on when this local data might be routinely available.

However much money is pumped into CAMHS, improving access to it is contingent on plugging big holes in the workforce. The Royal College of Psychiatrists’ 2019 workforce census found that the rate of unfilled NHS consultant psychiatrist posts in England has doubled in the last six years, with one in eight CAMHS psychiatrist posts vacant. We urgently need a proper long-term work- force strategy, adequately resourced and with an annual report to Parliament. The forthcoming heath and care Bill is the ideal opportunity to hardwire this provision.

Turning to the role of schools in tackling mental health concerns, they are key to early intervention, and step in where children do not meet the CAMHS threshold. Provision of counselling and other mental health support services in schools can be variable and dependent on already massively overstretched school budgets. Mental health support teams can fill the gap. However, the current roll-out rate is very slow. The Government are aiming to reach a fifth to a quarter of the country by 2022-23, and have recently provided more funding to accelerate the roll-out, but I urge the Minster to be more ambitious.

On children’s recovery from the pandemic, most of the education catch-up funding announced by the Government has been largely focused on academic catch-up, with little focus on emotional wellbeing and mental health support. All the research shows that it is difficult for children to learn if they are struggling with their mental wellbeing. Liberal Democrats supported YoungMinds’ call for a £178 million ring-fenced resilience fund to allow schools to provide bespoke mental health and wellbeing support packages, as appropriate to their pupils and context. So far the Government have committed just £17 million of dedicated mental health support for schools as part of the recovery. A recent Ipsos MORI poll showed that parents put increased wellbeing support at the top of their priority list as part of any education recovery plan.

Finally, I will touch on the importance of community support services. We know that half of all mental health conditions present themselves by the age of 14 and three quarters by the age of 24. That is why prevention and early intervention are so critical. We know that some children and young people do not want, or are unable, to access mental health support in schools, but community-based services can be a lifeline.

Waiting until children reach crisis point is far too late. For younger children, family-based interventions, such as those offered by Kids Matter, are an effective approach. The Purple Elephant Project in Twickenham, founded by the inspirational Jenny Haylock, who has built a team of art and play therapists, works with children and their families from a very young age. Coram is also doing some incredibly important work on boosting children’s self-esteem and resilience.

For teenagers and young adults, I warmly welcome the campaign launched by a range of children’s and young people’s mental health charities, called “Fund the Hubs”. It calls for early-support hubs, offering easy-access, drop-in support on a self-referral basis for young people up to the age of 25, who do not meet the threshold of CAMHS.

The hubs would offer a mix of clinical staff, counsellors, young workers and volunteers, providing a range of support services. Additional services could be co-located under one roof, such as sexual health services or employment advice. The hubs could be delivered in partnership with the NHS, through local authorities or working with the voluntary sector, depending on the local area. Such an approach has already been tried in Manchester, Ireland and Australia, and has been shown to relieve pressure on and deliver cost savings to the health service. I hope the Minister will look at that innovative model.

In conclusion, we owe it to our children and young people to offer them the very best start in life. As a Liberal, I am passionate that every child gets the maximum opportunity to reach their full potential. With spiralling figures of children suffering anxiety, who are self-harming or struggling with eating disorders, as well as many more who are grappling with low confidence and self-esteem, we need to use this moment as we emerge from the pandemic to hit the reset button.

I urge the Minister, who I know shares my passion on this issue, to develop a proper cross-departmental strategy to tackle this growing crisis. Let us re-envision what support looks like for children and young people. Let us break down the silos between schools, local authorities and the NHS. Let us make sure that we prevent and intervene early to stem the tide, while also investing in training the mental health workforce.

I have heard too many times, from too many parents sick with worry, that CAMHS is simply not fit for purpose. I have yet to see much evidence to disagree with them. I hope the Minister will make it her mission to fix it, and work cross-party, if she is willing. I stand ready to do so for the sake of our children and their future, and I hope my Labour counterpart will, too. Not only is it morally the right thing to do, but our country’s recovery depends on their success.

[Sir Gary Streeter (in the Chair)]

Colleagues, we have 45 minutes and nine Back-Bench speeches to fit in, so that is exactly five minutes each. Please try to keep to time, so that I will not need to impose any restrictions.

--- Later in debate ---

[Munira Wilson]

I thank all hon. Members who contributed in such a knowledgeable and passionate way to this debate. I hope the Minister has seen that there is cross-party support for greater support for and investment in mental health services. I recognise that the Government have put more money in, but one of the themes has been whether it is getting through to the local level and the frontline. That is why my hon. Friend the Member for Bath (Wera Hobhouse) and I keep picking up the point about data, and the hon. Member for Newton Abbot (Anne Marie Morris) did the same. I am grateful to hon. Members for picking up points that I was not able to cover, such as the baby blind spot, eating disorders and disabled children. There are so many issues; this is multifaceted.

The Minister talked about definitions and said that we are conflating mental health and wellbeing, but it is all part of a continuum. That is why it is so important, as part of the prevention agenda, to focus on wellbeing as much as the serious mental health concerns. That is why I was trying to cover that vast spectrum in my speech. I reiterate that I stand ready to work with the Minister.

The hon. Member for Strangford (Jim Shannon) quoted JFK. Well, I will quote Mandela back at him:

“There can be no keener revelation of a society’s soul than the way it treats its children.”

Motion lapsed (Standing Order No. 10(6)).

Coronavirus

Munira Wilson Excerpts

Wednesday 16th June 2021 Commons Chamber

[Munira Wilson (Twickenham) (LD)]

It feels a little like groundhog day—another month, another debate on covid regulations—yet we really should not be here having this debate today. For people and businesses up and down the country, this four-week delay to fully restoring our freedoms is a huge and very costly blow, yet the sacrifices that continue to be demanded of the British people are not being coupled with the support that they need to do the right thing. That is why Liberal Democrats will not be voting with the Government tonight on the public health provisions. While we support the motion on continuing the hybrid proceedings in this place, I gently ask the Minister why the Government think we as Parliament need to continue meeting in a hybrid way whereas councils up and down the country have been forced to meet in person, often at great cost when they are already under huge pressure.

As my Liberal Democrat colleagues and I have been saying for the past six months, the way to restore our freedoms must be three-pronged: vaccination; test, trace and isolate; and robust border controls. The point has already been made countless times that the reason we are here is that Ministers undoubtedly failed completely on the last of those three points by putting India on the red list far too late, for political reasons, allowing the delta variant to be seeded into the community. Even once the Secretary of State recognised it as a variant of concern, we know there was a 17-day delay in designating it as such, which meant that surge testing commenced far too late. That cannot happen again.

The situation we find ourselves in was avoidable. Ministers must take full responsibility for having to delay the lifting of restrictions next week, and part of that responsibility is to support people to do the right thing. With businesses on their knees, jobs are at risk and many of the self-employed have yet to get a penny of support. The hospitality, events, weddings, culture, tourism and travel industries are on their knees. Even after domestic restrictions are lifted, we know that the travel sector will have to continue to bear the brunt of restrictions, given that the biggest threat to our full reopening in the UK will be variants brought back in through international travel, so the complete lack of a bespoke package of support for those industries beggars belief.

If we want to restore our freedoms fully next month, as the Prime Minister has promised us, and allow our economy to thrive again, it will be critical to test every potential case, trace every contact and support self-isolation. Experts have been calling for better financial and practical support for the past year, and finally the penny dropped earlier this month for the former head of Test and Trace that supported self-isolation was the missing piece. Even so, there has still been no comprehensive package announced to pay people their wages to self-isolate, provide accommodation if necessary and support those with caring responsibilities. That is the way to break chains of transmission and stop new outbreaks in their tracks, and it is an awful lot cheaper than blanket restrictions.

Learning to live with this virus, as I believe we absolutely must, requires a proper strategy and an action plan—not hoping for a fair wind. It means bringing together the UK’s world-leading genomic sequencing capability with traditional public health test and trace at a local level, coupled with the right support. Our public health directors up and down the country are crying out for that. They will continue to be our frontline in managing this virus as we learn to live with covid. Let us give them the tools they need and not be back here again in a month’s time asking for a further delay—or, worse still, be asked to reintroduce restrictions months down the line.

[Mr Deputy Speaker (Mr Nigel Evans)]

I call Dame Andrea Leadsom—congratulations on your well-deserved recognition in the Queen’s birthday honours list.

Covid-19 Update

Munira Wilson Excerpts

Monday 14th June 2021 Commons Chamber

[Matt Hancock]

Our goal is that, by 19 July, two thirds of adults—around two thirds—will be double vaccinated. The data published today shows that the protection from transmission of this disease from a single jab is quite a lot lower for the delta variant, but the protection from hospitalisation from both jabs is that bit higher. That means that we do have to take a bit more time to get the protection from the double dose, whereas previously the single dose got a very significant proportion of the protection, but it does mean that once we get there, we have confidence in the effectiveness of the jab at keeping this virus at bay.

[Munira Wilson (Twickenham) (LD)]

Professor Chris Whitty’s slide earlier this evening was very clear: we were on track to ease all restrictions next week until the delta variant hit our shores and took off in the UK. Apart from the late decision to red list India, could the Secretary of State explain why it was that, on 19 April, he told this House that the delta variant was a variant of concern and there would be surge testing, yet it was not officially designated a variant of concern until 6 May? This is important because that is what unlocked the surge testing. Why was there a delay of 17 days, and what impact does he think this delay has had on the spread and therefore on today’s announcement?

[Matt Hancock]

I took action to tackle this variant before it was designated even as a variant under investigation, because I was worried about what was happening in India, so in a way the hon. Lady makes my point for me. On the delta variant, we acted before it was recommended as a variant of concern by the scientific process. In fact, I have kicked off a review of that process, because I think it is the process and the scientific advice that should advise me that a variant is of concern. But having looked at and seen the data in India, we took action even before it was recommended.

Covid-19 Update

Munira Wilson Excerpts

Monday 7th June 2021 Commons Chamber

[Matt Hancock]

My hon. Friend rightly asks these important questions about the decisions we had to take on Portugal. The truth is that we acted, yes, on the scientific advice: the advice of the joint biosecurity centre, based on the best information we had about this new variant—so-called delta AW, because it is a variant on the delta variant itself. We took that advice.

Restoring international travel in the medium term is an incredibly important goal that we need to work to. It is going to be challenging and hard because of the risk of new variants, and variants popping up in places such as Portugal that otherwise have a relatively low case rate. But the biggest challenge and the reason this is so difficult is that a variant that undermines the vaccine effort would undermine the return to domestic freedom, and that must be protected at all costs.

Thankfully, the delta variant itself, after two doses, gets effectively the same coverage as the old alpha variant or indeed the original variant, so the fact that that is now dominant in the UK does not put our strategy at risk. It makes it more of a challenge of getting from here to there, but that is a challenge for the decision this week and how we handle things in the short term; it does not put the strategy at risk. A variant that undermined the vaccine fundamentally would put us in a much more difficult place as a country, and that is why we are being as cautious as we are.

[Munira Wilson (Twickenham) (LD)]

As the Secretary of State has pointed out himself, data has been key in the pandemic. I agree with him, having previously worked briefly for NHS Digital, that data saves lives. I also agree with him that patient data belongs to the patient, and one of the things I learned during my time working in data is that public trust is key. So why will the Secretary of State not pause this data collection programme, which patients must opt out of by 23 June, to mount a full public information and communication campaign and be explicit about how people’s sensitive data might be used and by whom?

[Matt Hancock]

We are explicit about that. I appreciate what the hon. Lady said about the importance of data and data saving lives, and I agree with her about the importance of trust and bringing people with you. In fact, a large majority of those in the NHS are now actively enthusiastic about using data better. I very much hope we can keep it that way, not least because everybody has now seen the importance of using data to manage a crisis. One of the reasons for the vaccine success—why it has been rolled out so effectively—is that the data architecture that underpins the vaccine roll-out is extremely effective, and I pay tribute to the people who built it.

Covid-19: Government Handling and Preparedness

Munira Wilson Excerpts

Thursday 27th May 2021 Commons Chamber

[Matt Hancock]

Absolutely I am. GP access, in particular, is very important. This morning, I met the British Medical Association and the BMA GP leadership to talk about what more we can do to strengthen access to GPs. These are the sorts of things that matter to our constituents, as does the new hospital that we are going to build in my hon. Friend’s constituency. It was a wonderful visit to Devon on Tuesday, and it has been great going around the country to look at what we can do to invest further in the NHS, strengthen it and support it to deliver better care. North Devon does not have a better champion than my hon. Friend. As for what she said about the Opposition, all I can say is that sometimes the right hon. Member for Leicester South (Jonathan Ashworth) offers constructive criticism, he has generally had a good crisis and perhaps he will return to that approach soon.

[Munira Wilson (Twickenham) (LD) [V]]

In the words of the Prime Minister’s former chief adviser:

“Quite the opposite of putting a shield around them, we sent people with covid back to the care homes.”

If that is true, this is one of the biggest scandals and tragedies of the pandemic. Can the Secretary of State please confirm when testing on discharge from hospitals into care homes was routinely offered? Will he apologise to the tens of thousands of bereaved family members whose relatives died in care homes?

[Matt Hancock]

It has been an incredibly difficult time for those who have worked in and lived in care homes throughout this pandemic. That has been true across the world, and I pay tribute to the staff in social care who have done so much. It was, of course, a difficult challenge, especially at the start when many characteristics of this virus were unknown. As I have answered many times in this House, we have published full details of the approach that we are taking and that we have taken. We have worked with the care home sector as much as possible to keep people safe and followed the clinical advice on the appropriate way forward.

Covid-19

Munira Wilson Excerpts

Tuesday 25th May 2021 Commons Chamber

[Nadhim Zahawi]

I will absolutely look at what the issue is. The good news we have had recently from our regulator, the Medicines and Healthcare products Regulatory Agency, is that the Pfizer-BioNTech vaccine can now be stored for up to a month—it used to be only five days from once it was thawed from minus 70° C—which means it is much more versatile and less challenging than it used to be. So I will absolutely look at that and contact my hon. Friend.

[Munira Wilson (Twickenham) (LD)]

One area of concern for which new restrictions have been published but no advice has been communicated is the London Borough of Hounslow, which shares a boundary with Whitton, Hampton and St Margarets in my constituency. Hundreds, if not thousands, of people go back and forth every day, for school, for work, to get food and other essential supplies and for medical appointments. So, first, could the Minister advise my constituents whether they should be getting on buses and trains that cross the borough boundary and whether they should be going to supermarkets and accessing medical services over the borough boundary? Secondly, will he consider vaccinating, as a priority, people, such as teachers, key workers and airport staff, who have to go to work in Hounslow but live outside the borough?

[Nadhim Zahawi]

I am grateful for the hon. Lady’s question and I discussed this with the Mayor of London this morning. Of course Hounslow is on the list of affected areas and we are turbocharging the vaccination programme, as well as doing the surge testing and the sequencing and isolation. But as I have outlined in response to others, people need to exercise caution and common sense, and travel outside of the area only if it is essential. That is important. The right thing to do is for us to work together to make sure we deliver that message, as I did this morning with the Mayor of London.

A Plan for the NHS and Social Care

Munira Wilson Excerpts

Wednesday 19th May 2021 Commons Chamber

[Munira Wilson (Twickenham) (LD)]

This Government, with their 80-seat majority, are in an enviable position. They could put forward an ambitious and visionary plan to improve the country’s health and wellbeing and put social care at the forefront of their agenda. Yet here we are, following the biggest health crisis in 100 years, at a watershed moment, and the Queen’s Speech presents us with a Government who prioritise unnecessary and discriminatory legislation to introduce voter ID over ensuring that people can get the care that they need and over ensuring that we have a plan to train the next generation of doctors and nurses whom we will all rely on. What a waste of a precious opportunity of a mandate to bring about transformational change to the quality of British citizens’ lives.

Just nine words in the Queen’s Speech were devoted to social care, despite the Prime Minister’s promise on the steps of Downing Street 22 months ago to

“fix the crisis in social care once and for all”,

and there is still nothing on unpaid carers. Instead, reform keeps being kicked into the long grass for this overlooked and critically important sector. Although it is welcome that the health and care Bill seeks to improve integration between health and social care, it does not address the fundamental issues facing our care system in terms of structure, workforce and funding—problems that were highlighted so tragically through the pandemic. Ministers need urgently to commit to cross-party talks. They have a clear choice: to leave a lasting legacy or be responsible for an abject moral and political failure on one of the biggest public policy challenges that this country faces.

If the Prime Minister really wants us to believe that the NHS is safe in Conservative hands and that he genuinely cares about social care, then we need urgent action to ensure that we have enough doctors, nurses, carers, physios and other healthcare professionals both in the short and the long term. In 2019, there were about 100,000 full-time-equivalent vacancies in the NHS, and after a gruelling year, as we saw only yesterday with the nurse who treated the Prime Minister when he was in intensive care, many are needed. They are burnt-out, stressed and fed up of their good will being taken for granted.

With record waiting lists for both physical and mental health treatment, we clearly need some short-term solutions, but we must not shirk the long-term challenges. These shortages predate the pandemic. The Liberal Democrats support calls from the Health and Social Care Committee for a transparent and independent annual workforce report, with requirements for future staffing that cover the next five, 10 and 20 years and regular updates to Parliament on progress and resourcing. I implore the Minister to think big and not to squander this unique opportunity to bring about lasting, positive and long-term change in our health and care services and to improve the wellbeing of the British people.

Covid-19 Update

Munira Wilson Excerpts

Monday 17th May 2021 Commons Chamber

[Matt Hancock]

Typically my right hon. Friend asks the most pertinent question, to which we do not know the answer. The level of vaccination that we need in order to withstand the incursion of new variants, even those that the vaccine will work against, depends on their level of transmissibility, and we do not know the increased level of transmissibility over and above that of B117, the previous main variant here in the UK, which was first discovered in Kent. This is an absolutely critical question, but unfortunately we do not know the answer to it yet.

[Munira Wilson (Twickenham) (LD)]

Having reached this tremendous milestone today, and given the sacrifices that the British people have made through lockdown and the fantastic successes of the vaccination programme, will the Secretary of State listen to his own colleague, the Minister for Covid Vaccine Deployment, the hon. Member for Stratford-on-Avon (Nadhim Zahawi), who said last week that, with the new variant, we must “isolate, isolate, isolate” every single case and its contacts? Will he finally commit to paying people’s wages to stay at home to self-isolate, and provide practical support in terms of accommodation and support for dependants if necessary? Otherwise, we will only go backwards.

[Matt Hancock]

I am afraid I do not agree with the hon. Lady’s characterisation of the situation, not least because the approach we are taking in Bolton did work effectively in south London. We are piloting new approaches to ensuring that we can support people to isolate, and some of those pilots are taking place in areas where we can see cases of B1617.2. We keep this under close scrutiny and review to see what works effectively.

Elective Surgical Operations: Waiting Lists

Munira Wilson Excerpts

Tuesday 20th April 2021 Westminster Hall

[Munira Wilson (Twickenham) (LD)]

It is a pleasure to serve under your chairmanship, Ms McVey, and I congratulate the hon. Member for Bootle (Peter Dowd) on securing this very important debate. I fear many of us will end up repeating some of his points, but hopefully I shall be digging into one or two of those points in a bit more depth.

I start by paying tribute to and thanking our incredible NHS staff up and down the country—not least in my constituency—for their incredible commitment, resilience and hard work. Frankly, they have all gone well above and beyond what they are paid to do and what they signed up for throughout this pandemic, both in treating those with coronavirus and in rolling out the phenomenal vaccination programme. Also, despite what we are discussing today, we must not forget that urgent treatment, urgent surgery and A&E visits were still taking place throughout the pandemic. We must not forget that, so a heartfelt thanks to them.

We often hear that the NHS has coped throughout the pandemic. Indeed, we did not see those awful scenes that we saw in Italy of people being treated in corridors and makeshift tents. I would say, though, that the NHS has coped, but at what cost? We have heard the startling figures of 4.7 million people waiting for treatment. We know that about 2.3 million of those are for elective surgery, and there are all sorts of estimates, of anywhere between 4 million and 6 million or 7 million hidden patients, or those who have not yet necessarily presented. There is that pent-up demand for treatment. We know that two thirds of those waiting for treatment have been waiting for more than 18 weeks, and just shy of 400,000 have now been waiting for over a year. As has already been outlined, the impact on patients’ quality of life, in terms of mental health and excess deaths, cannot be overstated, but I would also like to touch on the workforce impact, before moving to solutions and finance.

As the hon. Member for Bootle has stated, it is estimated that approximately half of those with cancer did not contact their GP in the first wave. In fact, I heard a story the other day, via a friend of a friend, about somebody whose cervical smear test was cancelled last year. She was trying to contact her GP with symptoms earlier this year, and was fobbed off. She has now been discovered with stage 4 cervical cancer. I suspect that those stories will be replicated up and down the country. Macmillan Cancer Support has estimated that there are 15,000 missing diagnoses. We all know the importance of early diagnosis. I used to work for a cancer charity and in a pharmaceutical sector that had a big interest in oncology. We all know that surgery, often combined with early chemotherapy and radiotherapy, is absolutely critical in improving life chances and sometimes in being curative.

On the subject of hip and knee replacements, we know that the second and third most common operations are hip and knee replacements. The vast majority of patients needing that kind of surgery have osteoarthritis. Again, waiting lists in those areas have gone up exponentially. It is clear from talking to health service leaders on the ground that these cases are not necessarily in the priority category, which is understandably where cancer resides. As we have heard, though, there is an impact on quality of life, in terms of pain and reduced mobility. A survey by Versus Arthritis found that over 50% of those waiting had increased pain and reduced mobility, and more than three quarters experienced a deterioration in mental health and wellbeing. The longer-term impacts on the NHS and, critically, the social care sector, which was already struggling and on its knees, will be huge. The direct and indirect cost implications, therefore, will be huge, not to mention further complexity from late surgery.

Although this debate is about surgery, it would be remiss of me not to mention mental health. The Minister knows that I have a personal interest in and passion for mental health. We all know that mental health waiting times were pretty dire before the pandemic, particularly for children and young people. Now they are worse still. I am hearing from parents week in week out about not just children, but young people—often those who have crossed from the CAMHS age to being young adults—who cannot access services and are waiting a year or more for treatment. Again, without early intervention and action on these problems now, we are storing up problems further down the line. We know from the Royal College of Psychiatrists survey that two fifths of those waiting for treatment have ended up contacting crisis services. That is not the best way to treat people with mental health conditions. The hon. Member for Bootle mentioned excess deaths, and modelling from the Scientific Advisory Group for Emergencies suggests that we could have 18,200 or so excess deaths that are not covid-related. I implore the Minister to make sure that we start to count excess deaths that are not covid-related. At the moment they are hidden by the covid figures, but I suspect that these delays to treatment are causing a huge number of excess deaths.

The other big issue that I want to talk about is the workplace impact. We know that staff morale is through the floor at the moment. I recently had a meeting in south-west London with other south-west London MPs, organised by the local Royal College of Nursing branch, at which we talked to nurses. I heard from one after the other about how they are struggling in terms of their mental wellbeing and morale. We know from an RCN survey that a third of its members are considering leaving. We already had huge numbers of vacancies in nursing and other parts of the NHS before this pandemic, and the turnover will increase. I have made the case, as have many Opposition Members, for a better pay settlement for our NHS workers—1% is frankly an insult and a pay cut, as we keep hearing again and again. I implore the Minister once again: pay is important, but so is greater support for NHS workers’ mental health and wellbeing. I know that local NHS leaders are trying to do what they can, but further support and a commitment from the Minister would be welcome.

Finally on the impacts, I want to touch on health inequalities. Covid has massively exposed the health inequalities in our country. The thing that I fear most is that those who know how to shout the loudest and navigate the system, and have access to the sort of remote technology that is being increasingly used, will be able to access the treatment they need. I say that as the MP for a relatively affluent part of London, where I suspect a higher than average number of people have access to private healthcare and health insurance, and will be able to get treated through that route. Those who have been worst hit by covid will be worst hit by these waiting lists.

On solutions, I have touched on the need to treat our staff better in terms of pay and mental health support, and reduce the turnover. Importantly, we need to give staff time to recover. That is what I keep hearing from the chief executives of hospital trusts and community trusts on the ground: they need time to recover.

That leads me to my second point on the solutions. I would love to hear the Minister explain why the block contracts with the independent sector ended at the end of March. I would have thought that continuing to use independent sector capacity in the short term would help. A number of the stakeholders who briefed us for today’s debate have raised concerns about the fact that independent sector provision is largely concentrated in the south-east, London, the south-west and the east of England. That is not ideal and could exacerbate the inequalities that I have talked about, but something is better than nothing. If it helps to reduce the pressure on the NHS, it is important that it is looked at as a solution.

Thirdly, I would like to talk about transparency. We need an honest discussion with the public about these waiting lists, and clear reporting about the waiting times for the different waiting lists. We have talked about support for patients who are waiting for treatment, and good, clear, regular communication is an important part of that. I mentioned the need for transparency about excess deaths as a result of people waiting for treatment. The Government need to level with the public if there are tough choices to be made around the prioritisation of what treatment people will get within a certain period of time, or if they will have to travel for treatment. They need to be up front and honest with the public, because that is the only way we will maintain public trust.

That relates to a point that I want to make about communication. We must continue to communicate with the public about whether it is safe to go to hospital for treatment, and we must look at how we engage hard-to-reach groups that might not be embracing some of the digital technology that is increasingly being used to improve efficiency, not just because of infection control measures.

There must be better local collaboration. I want to thank the two acute hospitals that serve my constituency: Kingston Hospital and West Middlesex University Hospital, which are part of South West London and St George’s Mental Health NHS Trust, and London North West University Healthcare NHS Trust respectively. I know they are working incredibly hard on community diagnostic hubs and the surgical hubs that we have talked about, and they are ensuring we have covid-light sites, and so on, in line with the NHS operational guidance. That is to be welcomed, championed and supported. We have touched on having greater support for patients waiting for treatment.

NHS providers have said that we need a bold, transformative approach to tackle these waiting lists, and ultimately that will need to be supported by cash. I will pre-empt the Minister, who will stand up and say, “We have committed £4 billion”—I am sorry to steal his lines. Yes, that is fantastic and to be welcomed, but last autumn the Health Foundation estimated that we will need about £10 billion to deal with the backlog.

We saw in the late 1990s and the early 2000s that the way to bring down waiting lists is huge injections of cash. The Chancellor said he would give the NHS whatever is needed. We know that a lot of these problems come from an underlying lack of funding in the NHS over the long term and that, for four years, the NHS has not met the target in the NHS constitution that 92% of patients should wait no longer than 18 weeks to start elective treatment. That was an underlying problem pre-pandemic, but it has been exacerbated. That is why at the last general election the Liberal Democrats suggested that we should raise income tax by a penny in the pound specifically for the NHS and social care.

I am sure that the Minister has the Chancellor on speed dial, just like the former Prime Minister does, and I know that the Secretary of State has the Chancellor on speed dial. I implore him to make the case for the cash injection needed to tackle waiting times and improve the health of the nation. I am sure he does not need my help, but I and the Liberal Democrats stand ready to help him to make the case, just as the hon. Member for Bootle has already offered.