Contaminated Blood

Oliver Heald Excerpts

Tuesday 11th July 2017 Commons Chamber

[Diana Johnson]

Just like every other Member, I have only seen what is out in the media, and I understand that there will be a consultation on the form of the inquiry. I am sure that the Minister will be able to help us in his contribution.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

I join in the tributes to the hon. Lady and the all-party group, of which I have been a member, because this is an example of how Parliament can work well. There is a family in Letchworth who said to me:

“As a family, we have suffered years of misery because of this scandal.”

Does the hon. Lady agree that it is right to consult the victims and their families on the form of the inquiry?

Junior Doctors Contract

Oliver Heald Excerpts

Wednesday 6th July 2016 Commons Chamber

[Mr Hunt]

There is one very good doctor in the Hull A&E department, and that is Dr Ellen McCourt, who has taken over as leader of the junior doctors committee—at least, I imagine she is very good; I have been very impressed every time I have met her. There are particular pressures at Hull, and as the hon. Lady knows we have had management changes. So far we have not seen the improvement in performance that we would like. I am aware that there are big issues with the infrastructure— the physical buildings. We will continue to work with the NHS locally and with the trust to try to improve the situation. She is right to bring it to my attention.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

I join my right hon. Friend in expressing sadness at the decision of the vote. He will remember that on previous occasions I have raised with him some family-friendly aspects of the lives of junior doctors. Does he agree that it is important to look at the training situation, where a couple can be sent to different towns many miles apart; the rostering, which can make family life difficult; and some of the problems of returners to work, whose training perhaps needs to be properly considered? Will he confirm that he will continue to look at these issues and that, as the monitoring and phasing goes ahead, he will try to address them?

[Mr Hunt]

My hon. and learned Friend is correct to have raised that before and I can reassure him that we have subsequently started a very big piece of work to look at those exact issues. The difficulty is that throughout their training junior doctors are rotated every six months. That is particularly disruptive to family life or, for example, if they have a partner and one is sent to Sheffield and the other to Bristol. We are seeing what we can do to deal with that. The other issue that we are looking at is that of people who for family reasons discover that they have a caring responsibility, maybe for children or for a parent with dementia, and want to switch to a specialty that may not have quite so many unsocial hours, and whether it is possible to novate their training across from one specialty to another, which does not happen at present.

Junior Doctors Contract

Oliver Heald Excerpts

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

The cross-party initiative was not to have a new contract, but to abandon plans for a new contract and to have pilots in a few limited places. If we had followed that advice, we would not now have agreed with the BMA the biggest changes in the junior doctors contract for 17 years. Our goal was to get the agreement that we secured yesterday—safer care for the NHS and a better deal for doctors. That was what we achieved, and we would not have got there if we had listened to that advice.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

May I join the welcome for the agreement and the persistence and patience that eventually paid off? In previous statements, I have raised with the Secretary of State the problem involving married couples who are both doctors. There are difficulties with training when they are sent to different areas and with rosters that clash. Will he say a word about the progress that has been made in this important area of making work a bit more family-friendly?

Junior Doctors Contracts

Oliver Heald Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Speaker]

May I say, on behalf of Members on both sides of the House, how good it is to see the hon. Member for Bristol West (Thangam Debbonaire) back in her seat and, I hope, now in very good health?

[Sir Oliver Heald (North East Hertfordshire) (Con)]

Many Members are as concerned as the Secretary of State is about the prospect of emergency care not being provided. Does he agree that junior doctors seem to have concerns about the rota and shift patterns, particularly where they are married to another doctor? Is he able to give any assurance that this issue will be looked at carefully as things are rolled out and that the NHS will help couples in that situation by making sure the rotas are more reasonable?

Cancer Drugs

Oliver Heald Excerpts

Tuesday 19th January 2016 Westminster Hall

[Pauline Latham]

I accept what the hon. Member for Torfaen (Nick Thomas-Symonds) says. I have also campaigned for Abraxane to continue because, very sadly, a former Member of this House died from pancreatic cancer in the last Parliament. He had very few weeks to live once he was diagnosed, so it is a particularly unpleasant disease.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

On Abraxane, does my hon. Friend agree that if a cancer is fast-acting and the gap between diagnosis and death can be as little as six months, getting an extra month or two means that a person can settle their affairs and get peace of mind? That is very important time.

[Pauline Latham]

It is incredibly important time. Any extra few weeks in such a situation is so valuable to those patients.

In answer to a written question submitted by my hon. Friend the Member for Crawley (Henry Smith) on 10 December 2015, the Minister said:

“NHS England has advised that a draft treatment pathway for patients with multiple myeloma, which takes into account the…impact of treatments removed from the Cancer Drugs Fund (CDF), is currently being finalised.”

I hope he is able to update us today on when those proposals might be published. My constituent and his family would like to know what options, if any, he has.

It is not only drugs for rarer cancers that have been hit. Drugs to treat breast cancer, bowel cancer, prostate cancer, leukaemia and other blood cancers, some gynaecological cancers and cancers that affect the central nervous system have all been removed, which probably amounts to thousands of patients who are now unable to receive treatment. That is absolutely devastating for patients and their families, as the chance to prolong life for a few more months or years has been diminished.

--- Later in debate ---

[Marion Fellows (Motherwell and Wishaw) (SNP)]

It is a privilege to serve under your chairmanship, Mr Streeter. I thank the hon. Member for Mid Derbyshire (Pauline Latham) for securing this important debate. I will give the debate a more Scottish context.

For patients with a life-threatening or highly symptomatic illness, getting access to the best treatment is crucial. Living with a condition that has no cure or treatment is difficult, but knowing that you or your loved one is denied access to an available treatment is intolerable. Our biggest problem is accessing new drugs, which are often very expensive and above the limit set for NHS access by the National Institute for Health and Care Excellence—NICE—or its Scottish equivalent, the Scottish Medicines Consortium, the SMC. That results in delayed access to new treatments and, as has been mentioned, it appears to contribute to the UK’s poor cancer outcomes by comparison with other countries. The issue is even worse for those with rare diseases, because the commercial imperative to develop a drug in the first place is weaker, due to low patient numbers.

There is also frustration for clinical researchers who enter patients into trials that lead to a drug’s development in the first place. The UK, and particularly Scotland, punch above their weight in the active recruitment of patients into drug trials for diseases such as cancer. Patients may benefit from gaining access to the new treatment during the trial but, once the trial has been successfully completed, new patients do not get that opportunity, which is demoralising and could undermine research efforts in the future. Some of the drugs that have been researched over the years are now being removed from the list in England.

Once a new drug has gained a licence, NICE and the SMC carry out their assessments. In Scotland, however, the SMC utilises the evidence gathered to carry out just a brief review, with the emphasis being more on the drug’s effectiveness. Cost comes after that.

There are three major differences in the access systems north and south of the border. While both have drug access funds, in England the fund is only for cancer whereas in Scotland it is for any new drugs and rare diseases.

The Cancer Drugs Fund in England, which was meant to be temporary, has enabled patients to access new cancer drugs that would otherwise have been unobtainable. It has now been running for five years and some drugs are being excluded on cost grounds. In Scotland, after a review in 2014, the SMC established the patient and clinician evaluation, which allows reconsideration of a drug while taking into account the wider experience of it and capturing input from patients and clinicians. That gives patients a voice.

[Sir Oliver Heald]

Abraxane fails the test of three months’ effectiveness, but it is useful in producing two. Why is it that the Scottish system allows Abraxane? Will the hon. Lady give us a bit more of an understanding of that? I would like to see the drug back on the list, and if the Scottish system is a way of doing that, it might be worth looking at.

[Marion Fellows]

I thank the hon. and learned Gentleman for his intervention. He has asked me something that I cannot answer definitively at the moment, because I am not a clinician. I am, however, more than happy to come back to him on that. I know that PACE—the patient and clinician engagement group—has done some development on it, but I would like to give the hon. and learned Gentleman a fuller answer and I can do that later, if he agrees.

[Sir Oliver Heald]

indicated assent.

[Marion Fellows]

Where cost is a factor in prescribing drugs it is important that we consider ways of lowering it. The pharmaceutical price regulation scheme could be used. When a drug’s spending threshold is reached, a rebate is paid. In England, it goes back to the Treasury but in Scotland it goes on to further new drugs.

The delisting of cancer drugs because of cost causes untold heartbreak to patients and families—the very people we all represent—and the time has come to find a way of making new drugs accessible to, and affordable for, the NHS by considering arrangements such as multi-year budgeting, which would allow for a lower initial price. Pharmaceutical companies would hopefully be open to that in exchange for getting their drug into use at an earlier stage.

It is important to understand that drug companies fund drug development research for years before they even know if the drug is worth licensing. Many potential drugs fall by the wayside and, as the public purse would never be able to fund such a level of risk, it is necessary that pharmaceutical firms see a return on their investment, to secure ongoing research. That goes back to why some drugs are delisted because of their cost. However, there must also be recognition of the support provided by universities in Northern Ireland and Scotland, and in England, which get Government funding to help towards researching new drugs.

Off-patent drugs can also be used in cancer treatments, usually through repurposing. It is important that we consider that, as it could also lead to a cost—[Interruption.] I am sorry, I will just wind-up my speech. Some of the barriers to treatment can, however, be broken down through negotiation between all interested parties. The aim would be a system that worked equitably for all stakeholders, from patients, doctors and the NHS to Governments and the pharmaceutical industry.

--- Later in debate ---

[George Freeman]

The answer is yes. That is why I have set up the accelerated access review, which is doing precisely that. NICE is heavily involved in contributing to setting up the reforms, giving it new flexibilities and changing the way we adopt, assess and reimburse new medicines. I meant that NICE is recognised internationally. Indeed, other countries follow its health technology assessments, and its methodology and protocols. The challenge now is to update them for a world of genomics and informatics, with a much more targeted and precision medicine landscape. I accept that in that context we are not yet world class—we have more to do—but NICE is a world class organisation. Given the chance to update its systems, I believe it will lead the world in that field.

In the autumn statement we fully funded the NHS’s five-year forward view, including its cancer strategy, with a commitment to £10 billion extra per year by 2020. We frontloaded that with £6 billion, as was asked for, to allow it to make the investments necessary to modernise. That is a half-trillion pound commitment to spending on the NHS over this Parliament, so I gently point out to the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), that to describe that as a cut is testing the admirable elasticity of the English language.

On the importance of NICE and independent, clinically led decision making, much as at times like this I yearn to reach for a big lever, pull it, make a decision and send hon. Members out dancing and cheering and send patients home happy, I think we all understand that it is right that such decisions are not taken by MPs or Ministers; they must be taken by clinicians, based on the very best evidence from the very best independent advice. That is how this system works: NICE makes an independent judgment using the very best systems available to it. I take the point made by my hon. Friend the Member for Warrington South (David Mowat) that that needs to be, and it is being, updated to give NICE more flexibility to reflect the challenges of precision medicine—treatments that have a very definable, predictable response in a very small number of patients. NICE’s advice goes to NHS England, which makes the clinical judgment about treatment protocols. It is right that the Cancer Drugs Fund is based on that clinical decision making.

Nevertheless, there is an anomaly. Although we expect NHS England to be guided by NICE, in one therapeutic area, with the best of intentions, we have created a fund that sits at the end of the process, so that NHS England has a fund to buy drugs that NICE has said no to. That is an anomaly in the system. The point of the review is to take the CDF commitment to fund earlier, so that NICE can use it as an assessment fund to enable it to look earlier in the process at new drugs that are coming on stream and then give NHS England advice. That is in keeping with our general policy of opening up a space between research and medical practice in which we use data from the front-line treatment of patients and from the system to inform our procurement and reimbursement system.

Rather than “finger in the air” theoretical models of health-economic benefits, we are within touching distance of a system that is able to use real data in realtime from real patients with real diseases to drive real models of cost-benefit and health economics, and we are trying to wire the system in order to deliver that exciting prize. Members will understand that, where funding is finite—£1.3 billion is a big commitment, but it is finite—the system must re-prioritise which drugs it purchases. That is difficult for those who are in the process of getting a diagnosis and expecting a treatment that is then withdrawn, but I stress that no patient who is in receipt of a treatment that is withdrawn has that treatment withdrawn from them specifically. If they are getting a drug, they continue to get it.

My hon. Friend the Member for Mid Derbyshire mentioned pomalidomide, a drug used to treat relapsed myeloma. The CDF clinical panel looked at it, reviewed it, and, based on its independent, best-in-class assessment, the score was too low so the panel recommended that it not be approved. As I understand it, NICE is currently looking at other treatments for multiple myeloma, including panobinostat. I checked with NICE before the debate, and can say that final guidance on that treatment for that condition is imminent.

I remind Members that any patients receiving drugs continue to be treated, and that no drug will be removed if it is the only proven therapy available on the NHS. Sometimes in debates such as this we give the impression that we are taking away a drug, patients will stop getting it, and patients who have no other treatment will be left without treatment. That is not what happens. We should remember that there is an individual funding request mechanism—the IFR—for patients with exceptional conditions that are not met by other drugs. That is there specifically so that if any constituents have a unique claim on clinical exceptionality, their clinicians can make that case.

I should highlight the fact that two new drugs were approved in the previous CDF round. We sometimes forget that new drugs are being approved. We do not get requests for debates in Westminster Hall to congratulate the system on their approval, but it is worth mentioning them. The system approved panitumumab for bowel cancer and ibrutinib for cell lymphoma. Those approvals have been widely welcomed by patients and charities in the relevant sectors. I am delighted that, through the early access to medicine scheme that we introduced last year, which, with patient consent and their clinician’s approval, enables unlicensed drugs to be fast-tracked, we have now got pembrolizumab through, tested, into patients and purchased by NHS England several years earlier than would have been the case. That is a precursor of what we want to do much more widely through the accelerated access review.

It is no coincidence that one reason for the delay that was referred to earlier is that I am very keen for the CDF review to be done at the same time as the accelerated access review. Had we not done that, colleagues would have been saying to me, “How ridiculous, Minister, that you have reviewed the Cancer Drugs Fund and closed it before you have received the recommendations of the accelerated access review this spring.” I wanted to ensure that we are building a landscape that is logical and fit.

[Sir Oliver Heald]

Does my hon. Friend the Minister accept that it is worth while to look at the difference between a condition that goes from diagnosis to death over, say, 18 months, where an extra two months of life is proportionately quite small, and one of these very fast-acting cancers, such as pancreatic, where a person gets only six months and giving them an extra two would be very important in allowing them to settle their affairs and come to terms with the world?

[George Freeman]

My hon. and learned Friend makes an important point. I urge colleagues, as elected representatives, to make such points to NHS England through the CDF review, which closes on 11 February. We represent 70,000 or 80,000-odd people, so it is appropriate to make the point that for different diseases there is a big difference between the benefits of extra time for patients.

In the limited time I have left, I want to touch on some of the questions that came up. Colleagues asked about performance measures for data. It is important that we use the data from the CDF better. We are introducing measures to ensure that the contracts for 2016-17 specify that trusts that do not submit complete datasets will be penalised. One hundred per cent. of trusts are now submitting data, so we have closed that door. Some of the horses may have bolted, but we are getting properly on top of the data.

My hon. Friend the Member for Mid Derbyshire asked first about a draft treatment pathway for multiple myeloma. NHS England advises that that is currently in the process of being finalised. It has been the subject of public consultation and is being revised to take account of the comments received and the potential impact of treatments that have been removed from the CDF. The treatment pathway is due to be published in 2016. Secondly, on individual funding requests, NHS England does publish data on its website, including the number of individual funding requests for each drug on the national CDF list. Thirdly, on the issue of penalties for failing to produce data, we have built specific performance measures into the systemic anti-cancer therapy database.

My hon. Friend also mentioned multi-drug treatment cost reductions. It would not be appropriate for me to comment on NHS England’s individual commercial discussions with companies, but I can say that I am actively looking at ways to integrate better the Department of Health negotiators with NHS England commissioners through the accelerated access programme, so that we can get the benefit of time, cost and risk reductions in the pathway in more enterprising pricing mechanisms. I am confident that there is interesting progress to be made in that space.

I am aware that it is traditional for the Minister to leave a little time for the Member who secured the debate to wind up. I have around 15 questions that I have not had the chance to answer, so with your permission, Mr Streeter, I will write to the Members who contributed to the debate. I close by reiterating our commitment, as a Government, to get on top of the issues that have been raised. I hope that Members can see that, as the first Minister for Life Sciences, I am making progress in the direction that has been highlighted.

Cambridgeshire CCG and UnitingCare Partnership

Oliver Heald Excerpts

Monday 18th January 2016 Commons Chamber

[George Freeman]

My hon. and learned Friend makes an excellent point. The service is currently being continued, albeit by the CCG rather than through the company that was created for the purpose. As she says, the reforms that were put in place were the right reforms. Indeed, they were led by local clinicians and designed with that in mind.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

In Royston we have the Royston NHS and social care hub, which will include beds as well as other services. Does my hon. Friend agree that there is no reason at this stage for people to become anxious that the difficulty with the contract will lead to any change in the quality of services that are planned for the future?

[George Freeman]

That is right. As both questions have highlighted, the change in the care pathway is being pursued by the CCG and there is no reason for patients—the users of the system—to fear any dramatic change to the service. The remaining issue is the residual issue of how the contract came to be put in place. The dispute between the parties is about their different conceptions of the financial and contractual situation. I do not want to prejudge the investigations, but the service reforms will continue.

The final decision to terminate was taken after extensive discussions between the CCG, UnitingCare, Cambridge University Hospitals NHS Foundation Trust, Cambridge and Peterborough NHS Foundation Trust, NHS England and Monitor. Prior to escalation to NHS England and Monitor, the CCG, CUH and CPFT worked hard to try to reach a resolution locally.

Cancer Drugs

Oliver Heald Excerpts

Tuesday 20th October 2015 Westminster Hall

[Jim Shannon]

The hon. Gentleman must have helped me put my notes together because I have written that one down. It was one of my next points. Yes, we are concerned about that. I look forward to the Minister’s response on that point because, quite clearly, it is hard to understand why Abraxane should be removed given that it at least extends the life of many people.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

On that point, a very small number of conditions are very fast-acting. Pancreatic cancer is one of them—six months, on average, between diagnosis and passing away. Does he agree with me that NICE needs to find some way to capture the importance of an extra two months? An extra two months to somebody who only has six is time to settle their circumstances and come to terms with the situation. It is a very important two months and somehow that needs to be captured.

[Jim Shannon]

I could not have said it better. That is exactly the issue for many in the House and for those outside who have to deal directly with these issues.

Moves such as the removal of the drugs prevent thousands of cancer sufferers across England and Wales from being able to access the quality treatment they deserve. Thousands of people are disadvantaged, thousands of families are losing out and thousands of normal people are in despair. Today, we need to give them hope, an advantage and life itself.

The Government have said that the manufacturers of drugs recommended for removal from the Cancer Drugs Fund will have an opportunity to reduce their costs. Negotiations are under way. I am keen to hear the Minister’s response on that. I would like confirmation that patients already receiving a drug that will be removed from the Cancer Drugs Fund will continue to be treated with that drug. Clinicians certainly indicate that they consider it appropriate to continue treatment. The patient needs to be assured that the system is such that those who are on the drugs will continue to be. I had written down the point about pancreatic cancer. The hon. and learned Member for North East Hertfordshire (Sir Oliver Heald) is absolutely right. I thank him for his intervention.

We are living in times when we are all being asked to tighten our belts but when it comes to issues like this, we simply cannot put a price on doing what is right. Given the consequences for patients, it is imperative that we act sooner rather than later. A long-term and sustainable system for cancer drugs is essential and, while we build that, we have to keep doing what we can to improve the lives of those suffering right now. That starts today with this debate. The debate has been happening outside the Chamber and today is an opportunity to highlight to issue in the Chamber.

I am particularly looking forward to hearing the Scottish National party spokesperson today because I was talking to the hon. Member for Central Ayrshire (Dr Whitford) last night at a different debate. She was unable to attend today. The Scottish National party, Scotland and its Parliament have led the way in how cancer drugs can be allocated. There are lessons to be learned from Scotland so the SNP’s comments will be particularly pertinent.

We have an opportunity to do what is right. Today we have an opportunity to make a difference and to affect normal, everyday people’s lives in a positive way. We need to seize that opportunity. Let us use this House for what it was designed for—to help the people we represent. Cancer can strike anyone. It is indiscriminate and that is why we should be doing our best to get what is best for our constituents.

With the working group on the Cancer Drugs Fund currently suspended, it is important to remember that each minute we fail to make progress on the issue we are failing a British citizen suffering from cancer. I need not remind the Chamber of the ultimate consequences of patients being denied access to life-extending treatments. The longer we delay consultation on the new system, the more lives we are failing. Having said that, it is important that we consider the outcome and results rather than just the intention of the actions we take. The Cancer Drugs Fund did great work when it started and the intention of the fund was most honourable. However, we all know of the budgetary constraints that made the Cancer Drugs Fund sustainable, which is why we need to have an open and rational discussion about how to progress.

I should have said this at the beginning, but I will do so now: I thank the hon. Member for Scunthorpe (Nic Dakin), who attended the Backbench Business Committee on my behalf on a Monday about two months ago. I was unable to be over here on that Monday but he did it for me so I thank him publicly for that opportunity.

I welcome the fact that the Cancer Drugs Fund will become operational once again from April 2016, as I welcome any provision of care for cancer sufferers, but it is imperative that we develop a long-term solution that commits us to those who depend on cancer drugs for the extension of their life and for their families. Very often—I see this in my constituency office and I know that other Members do—we see the impact on the families. There are enormous financial, emotional and physical pressures.

Contaminated Blood Products

Oliver Heald Excerpts

Wednesday 9th September 2015 Westminster Hall

[Ms Ritchie]

I am grateful for that helpful intervention, which characterises the real emotional trauma and pain that people who have been given contaminated blood products have had to endure for many years. The uncertainty needs to be addressed as well. The only body and the only people who can address the problems endured by those affected are the Government.

There is concern that the compensation resulting from the consultation could come directly out of Department of Health funds. Nobody who is suffering as a result of contaminated blood products wants anyone else with any other type of illness to suffer because of a lack of resources. Dedicated funding should come out of the Government’s contingency funds for people who suffer from this ailment, because these are special circumstances.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

One of the families from my constituency who are affected are present in the Public Gallery. Does the hon. Lady agree that in framing compensation it is important to look not only at the pain, suffering and misery that has already occurred, but at the future needs of those concerned?

[Ms Ritchie]

The hon. and learned Gentleman is absolutely right. People’s future lives have to be taken into account, and we must also think of those who will contract these viruses at a later stage. The Government must consider the planning of resources and the availability and approval of medicine.

A&E Services

Oliver Heald Excerpts

Wednesday 24th June 2015 Commons Chamber

[Ben Howlett (Bath) (Con)]

I, too, congratulate the two new Members, for Dewsbury (Paula Sherriff) and for Salford and Eccles (Rebecca Long Bailey), who have spoken. I made my maiden speech a couple of weeks ago and know what a terrifying experience it is.

As Members from all parts of the House may already know, I have watched the NHS provide first-class healthcare to my mother, who has had a debilitating long-term musculoskeletal condition for the past 20 years. I am absolutely certain that without the support of the NHS her pain and suffering would have been an awful lot worse. Having said that, I should note that on a number of occasions she has needed to visit A&E to make her condition a little better, and, although improvements have been seen, her experiences have been mixed. I appreciate that my family’s case is just one example of this care. Improvements have been seen but people from around the UK are facing a mixed picture on care received at A&Es.

From the outset, I wish to stress, in agreement with my hon. Friend the Member for Totnes (Dr Wollaston) and the hon. Member for Central Ayrshire (Dr Whitford), that turning this issue into a political football is not helpful and that this is not a new issue. I have worked alongside the NHS for seven years and have given advice and support to four Health Secretaries, both Labour and Conservative, with each saying that they would do all they could to improve A&Es across the UK and more than their predecessor to cut unnecessary bureaucracy for medical professionals. As I said, this issue is not a new one. Emergency medical professionals have been warning that a hiatus has been on the horizon for a decade or more. I am therefore pleased that this Secretary of State has recognised the need to look at the issue much more seriously and holistically.

I would like to spend some time correcting a number of myths that have been espoused by the Opposition. First, and most importantly, I should say that the increase in A&E attendance is not because funding has been cut. The better care programme, designed to integrate health and social care services between national Government and local authorities, is predicted to reduce A&E admissions by 3%. The 111 service launched in 2013 directs 8% of callers to A&E departments, whereas 30% of these people would have gone to A&E if the service were not available. In addition, £150 million has been provided to fund evening and weekend GP appointments, through the Prime Minister’s challenge fund, meaning that people can access care through GPs instead of having to go to A&E.

Given that picture, we are clearly not going to be able to provide the high-quality care that is needed without proper investment. I am pleased that this Government have decided to take on board the recommendations of Simon Stevens and invest a further £8 billion in the NHS. That, of course, will have a significant positive effect on A&Es. Last year, the Government invested a record total of £700 million, ensuring local services had the certainty of additional money and time to plan how best to use it. As the Royal College of Emergency Medicine said:

“This represents the largest annual additional funding yet seen.”

I know from speaking to people at the Royal United hospital in my constituency that this additional investment has really helped.

The Opposition spend most of their time trying to do down our achievements, which the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), espoused in his opening remarks, but the protection of the NHS budget and the additional funding since 2010 has enabled A&E departments’ capacity to increase significantly since 2010. That additional funding has paid for 2,500 beds in both acute and community treatment, and the equivalent of 1,000 new doctors. We have now added almost 1,200 additional A&E doctors, including an additional 400 A&E consultants, and 1,700 additional paramedics since 2010. The additional £2 billion being invested in front-line care in 2015-16 will go a long way to supporting the NHS into the next winter.

My next point relates to weekly reporting of A&E data. The Opposition will be very much aware that the best healthcare decisions are clinically led, although it seemed as though they disagreed with that earlier on. As Sir Bruce Keogh rightly explained in his recent letter to the chief executive of NHS England:

“There is concern that, in a small number of instances, some targets are provoking perverse behaviours and the complexity of others is obscuring their purpose and meaning.”

I agree with him that the A&E standard has been an important means of ensuring that people who need to get rapid access to urgent and emergency care do so, and we must not lose that focus. I also agree with him that we do not need to review the four-hour standard at this time and that we need to look at a wider range of measures if we are to drive improved outcomes across the entire system.

I totally agree with the suggestion that we standardise reporting arrangements so that performance statistics for A&E, referral-to-treatment times, cancer, diagnostics, ambulances, 111 and delayed transfers of care are all published on one day each month. That fits very nicely with the calls from medical practitioners across the UK for a reduction in the burdens of bureaucracy that have been crippling productivity at the heart of our NHS. One key reason for my brother and his wife leaving this country to practise medicine in New Zealand was this overarching issue of bureaucracy. I very much hope this plan will show medical professionals and patients that we all look to improve the quality of data collection.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

I do not know whether my hon. Friend had this experience, but during the election campaign a number of constituents told me how excellent the services were in A&E. Of course we have a brand new unit at the Lister hospital, but did he have the same experience?

[Ben Howlett]

Yes, absolutely, I did. When I was speaking to countless residents on the doorsteps across Bath, I found that the quality of provision of the Royal United hospital and other hospitals around the rest of the UK was tremendous. I spend a lot more time than Opposition Members do in thanking NHS professionals for the work they are doing in my constituency and elsewhere.

Child and Adolescent Mental Health Services

Oliver Heald Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Dr Wollaston]

I absolutely agree. The other problem is that sometimes those larger national charities may have no local presence or understanding.

We need greater flexibility so that commissioners within health and local authorities are able to provide stable, long-term funding and to set the priorities for these new pots of money. It is always easy to announce new projects, but we must allow funding to be directed at existing services that have a fantastic proven track record. The value for money that we get from these services is extraordinary, as is the value that young people place on them. Young people have told me—this applies particularly to a rural constituency such as mine—that it is no good having a CAMHS service in a neighbouring town if they cannot get to it because there is no transport. That is why voluntary services are so particularly valued.

I was going to discuss our comments on schools, but my hon. Friend the Member for Brigg and Goole (Andrew Percy), as a former teacher, is far better placed to talk about that, so I will leave it to him to elaborate. I just want to touch on the new challenges that young people face with cyber-bullying, sexting, and image sharing. This is a 24-hour pressure; there is no safe haven for them in these circumstances. I welcome the fact that the taskforce will comment on not only the challenges but the opportunities that the internet may give us to assist young people.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

My hon. Friend is making some important remarks, as has her Committee. Somebody who suffers from a condition such as depression or anxiety, and has already been taught coping techniques, often finds it helpful to have a mentor. Perhaps apps, mobile phones or the like could reinforce those coping techniques at times when life seems difficult. That is an important part of the picture.

[Dr Wollaston]

I thank my hon. and learned Friend.

In using the internet, one of the challenges is how to know which of the sometimes thousands of resources that will pop up as a result of a search are valuable and to be trusted. It would be useful to have a mechanism for directing people to those that have the best evidence base behind them, and have been rated by young people as being the most helpful. While these kinds of resources may be welcomed by some people, they will not be the most appropriate for everybody. We need to have choice and a range of resources. That also applies to IAPT—improving access to psychological therapies. Cognitive behavioural therapy has an evidence base behind it, but it does not necessarily work for everybody. Those who do not find CBT helpful must have other avenues they can go down, including longer-term support where that is appropriate.

In closing, I draw the Minister’s attention to another area of early intervention—perhaps the earliest of all. Does he have any encouraging points to make on the provision of perinatal mental health services? I look forward to his response.

--- Later in debate ---

[Sir Oliver Heald (North East Hertfordshire) (Con)]

In listening to the hon. Member for Stoke-on-Trent South (Robert Flello), I recognised some important themes that were also evident in the speech of the Select Committee Chairman, my hon. Friend the Member for Totnes (Dr Wollaston). Both touched on what we can do to help people with mental health problems through volunteering, mentoring and bringing services together so that we have a more substantial whole that will help to tackle the fragmentation between different services and make something more rational and more joined up.

I was a governor of a residential school for young people with emotional and behavioural difficulties in the 1980s—Shaftesbury House in Royston. It was an Inner London education authority school, which did extremely good work with some very troubled young people. At that time, however, there was a different understanding of mental health issues from what we saw a few years later in 2001 when I was my party’s spokesman on mental health. By that time, there was much greater recognition that deep-seated mental health problems start at ages much younger than adulthood. Previously, there was a feeling that some of these issues were emotional, behavioural and developmental, but they were not seen in their true context.

I thus slightly disagree with the hon. Member for Stoke-on-Trent South. I think our understanding of mental health issues and what they mean for children and adolescents has changed over the period that he spoke about—and certainly since 2001, we know far more about the onset of these illnesses and about how they should be treated. I agree with him, however, that we are seeing a great number of young people affected by these issues. The hon. Member for Southport (John Pugh) talked about the ups and downs of adolescence and whether there was such a thing as a normal period of adolescence.

I believe that issues such as family breakdown, drugs, social media, and domestic violence put considerable pressure on young people, and it gets to the point where some adolescents have a series of crises. They can be intermittent, but there is often a recognisable crisis for which help is needed. It is more than just highs and lows; it is something more serious. In those circumstances, the delays about which we have heard can be particularly acute.

Two young people contacted me recently to raise issues about how child and adolescent mental health is dealt with. They were both very unhappy with the current situation. I thank the Minister for meeting one of them—a young lady who has been through CAMHS —to talk through the issues. She was very appreciative of hearing about the taskforce that has been set up, and it does the Minister great credit that he was prepared to meet her and that he has accepted that there are problems in the system that need tackling. Delay is certainly one of them. Another is the amount of help available, and particularly whether there are sufficient numbers of trained staff—psychiatrists, community psychiatric nurses, therapists and so forth. We have never had the numbers we need, and I hope the taskforce will consider that issue.

The Hertfordshire Partnership Foundation Trust has a youth panel that is deliberately aimed at revealing concerns. The young lady who came to see the Minister had been on that youth panel. She had suffered from anxiety, bulimia and depression; she had been bullied, but got no proper response from her school. She waited nine months for CAMHS, and had still not been given an appointment when she attempted suicide. Even after she had been in hospital, she had to wait for six weeks. She had only five sessions of therapy in 20 months at a time when she was experiencing serious crises. Another young lady who has been in touch with me was taken into an in-care unit, and it was three weeks before she saw a psychiatrist, although she too had experienced a bad crisis.

[Grahame M. Morris]

I cannot disagree with what the hon. and learned Gentleman is saying or the examples that he is giving, but does he accept the general point that one of the problems when it comes to planning effective interventions is the lack of current and accurate prevalence data that would enable the relevant agencies to plan and commission services that meet local requirements?

[Sir Oliver Heald]

I agree. I am sorry that action to deal with that problem was cancelled some years ago, because such action is definitely needed.

I was talking about the young woman who was taken to an in-care unit. She said that the staff always seemed to be overworked, and she was given no opportunity to exercise. She felt that, although she had been placed in the unit, nothing was being done to address her condition. I think that a great deal needs to be done to improve child and adolescent mental health services.

On page 76 of its excellent report, the Select Committee refers to the Minister’s taskforce, and says that the “current fragmented commissioning arrangements” must change

“to allow rational and effective use of resources in this area, which incentivises early intervention.”

That is an extremely important point. On page 77, the Committee deals with education and GP services and makes another important point, namely that this is not just about specialist CAMHS, but about school-based counselling. It quotes Mick Cooper, professor of counselling psychology at the university of Roehampton, as saying:

“Due to its short waiting times, convenient location, and broad intake criteria, school-based counselling is perceived by many stakeholder groups as a highly accessible intervention. It is able to offer a wide range of young people professional therapeutic support in a direct and immediate way.”

I think it is time that we joined up those services, using schools as a platform. In my constituency, there is an initiative called the North Herts Emotional Health Support Service, which aims to make a start with that. It has estimated that one in 10 young people aged between five and 16 is likely to be affected by a

“clinically significant mental health problem”

at some point, and has calculated on that basis that 18,000 school-aged children in north Hertfordshire are affected, including about 6,000 with emotional disorders. It has looked at the schools in question, and says:

“Evidence suggests that vulnerable children, young people and their families find it easier to access services”

at a school. It has trained a team of mentors consisting of teaching assistants, teachers and volunteers, and has identified a

“bank of quality-assured local counsellors and…therapists”

who can provide the sort of art and drama therapy that was described by the hon. Member for Stoke-on-Trent South. It has two local lead therapists whose job is to oversee the training and supervising of the mentors. It speaks of the importance of “offering consultancy and training” and “co-ordinating”, and hopes to engage a “part-time administrator”. It has made considerable progress with that model, and, although it will need to be evaluated, I think that we should do something similar.

The service is harnessing the good will of people who volunteer, and there are people who will do that—when I was a mental health spokesman, I met people who volunteered to work for Rethink and MIND—but it also uses the skills of professionals to train the individuals concerned, under supervision. It is giving us a lot of coverage and an ability to help young people relatively cheaply. That is a consideration in these times. I therefore suggest to the Minister that looking at such initiatives and those described on that page of the report is a possible way forward.

Many young people spend a lot of their time using social media of course—thumbs clicking at great speed. This is not necessarily a bad thing. People with anxiety or depression or another mental health condition could find online services that could help them and they could reinforce the coping techniques that they have been taught. I hope the taskforce will look at that. I think it might be fruitful.

--- Later in debate ---

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

I congratulate the hon. Member for Brigg and Goole (Andrew Percy), with whom I serve on the Health Committee, and the hon. Member for Totnes (Dr Wollaston), who so ably chairs the Committee. Although this report is the third report of the 2014-15 Session, I think it was the first report produced under the hon. Lady’s chairmanship, so it is quite an historic document. It is an important piece of work on a subject that has been neglected.

As time is short, I shall try to stick to a particular structure. I thank the Royal College of Paediatrics and Child Health for providing a briefing and for asking us to highlight some of its concerns about variations in services and funding for transition services and mental health care provision for prevention and early intervention. A number of right hon. and hon. Members have referred to those issues. I also want to make a few points from the perspective of local government. As we have heard and as the hon. Member for Brigg and Goole observed, this is an area of joint responsibility where local government, given the correct support and resourcing, can make a significant difference.

On the scale of the problem, it is a shocking statistic that 50% of mental illness in adult life, excluding dementia, starts before the age of 15, and 75% of mental illness starts before the age of 18. Apart from the mental health manifestations, there are often increased physical health problems associated with the deterioration in mental health. Disturbingly, since 1980, as others have mentioned, there has been no decline in the number of deaths caused by self-harm, suicide or assault, with more than 1,000 10 to 18-year-olds dying this way every year in the United Kingdom. The problem is particularly prevalent among boys.

An hon. Member spoke about the value of prevention and early intervention and alluded to a cost-benefit analysis, and he was absolutely right. Quite apart from the fact that it is the right thing to do, if we look at it purely in terms of the opportunity cost, we see that mental health problems that start in childhood and adolescence result in increased costs of between £11,000 and £59,000 per child annually, according to figures provided by the Royal College of Paediatrics and Child Health. Those are huge additional costs. With upstream interventions of the kind other Members have argued for, early identification of mental health difficulties should be established as a core capacity of all health, social care and educational professionals who work with children and young people, because the benefits would be considerable.

Another issue that has been talked about, and which I feel I must mention, is the provision of an evidence base on which to plan interventions. Indeed, the chief medical officer highlighted the lack of accurate prevalence data in evidence to the Committee. I fully understand that the Minister is carrying the can and making the arguments, but that survey had not been carried out for quite a few years. Although it has now been commissioned, my understanding is that the data will not be available for use until 2017. If we are to have a scientific or empirical basis on which to plan commissioning and resources, either in early years or in whichever tier is thought appropriate, we need an up-to-date and relevant evidence base of data.

[Sir Oliver Heald]

On the hon. Gentleman’s point about prevalence data, with which I agree, is not the real point that many of the contracts in mental health are block contracts, whereby a fixed amount of activity is purchased? If we do not know exactly what the prevalence really is, that is a bit of a shot in the dark.

[Grahame M. Morris]

I cannot disagree with that. I come from the perspective that we need to plan interventions on the basis of evidence, but how can we do that without current and relevant data on child and adolescent mental health? We certainly need that data. On the structure of the contracts, I am a firm believer in integration. There may well be issues with block contracts. The Health Committee received evidence from the south-west indicating that there are vast areas of the country where there is very little access to certain types of in-patient mental health provision, which is clearly unacceptable. One might have thought that a large block contract would make that less likely, but apparently that is not so. However, I am not an expert in commissioning; I am simply trying to identify the policy areas.

Having spent a number of years in local government, I have no doubt that local authorities wish to tackle some of the barriers that young people face in accessing mental health services. It is a complicated area, and we need to enable local areas—the hon. and learned Member for North East Hertfordshire (Sir Oliver Heald) just referred to larger block contracts—to commission better services, and perhaps that is better done on a more local level.