Eating Disorders Awareness Week

Paul Farrelly Excerpts

Wednesday 27th February 2019 Westminster Hall

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

Thank you, Mr Bailey. I congratulate the hon. Member for Angus (Kirstene Hair) on her success in securing this debate during Eating Disorders Awareness Week. I thank Beat, the eating disorders campaign group, for its unstinting efforts on behalf of the more than 1 million sufferers across the UK. After this debate, from 11 o’clock to 3 pm, during the lobby of Parliament, I am hosting a drop-in event with my good friend, the hon. Member for Stafford (Jeremy Lefroy), in room R of Portcullis House; colleagues here and those listening can go there to find out more about Beat’s work.

This debate follows that secured last October by the hon. Member for Bath (Wera Hobhouse), which shows that support for this cause is truly cross-party. We also had a debate on the subject in September with the children’s Minister, the hon. Member for Stratford-on-Avon (Nadhim Zahawi), highlighting the issues for vulnerable children going into adulthood. In that debate, I focused on concerns that regularly pop up in my area of north Staffordshire for young adults suffering from anorexia, bulimia and other eating disorders, which have such devastating effects on them and their families.

The impact on young adults is one example of a core concern of the Parliamentary and Health Service Ombudsman’s groundbreaking 2017 report, which I will focus on again today. This suffering and vulnerability does not stop when children reach the age of 18. However, in my immediate locality—Newcastle-under-Lyme, Stoke-on-Trent and Staffordshire Moorlands, which have a population of well over 600,000 people—the commissioning of specialist support and treatment does stop at the age of 18.

Staffordshire is served by six clinical commissioning groups, with one common accountable officer. The budget for specialist, post-18 eating disorder services in the four CCGs serving the centre, east and south of the county is £428,000 a year, but for the North Staffordshire and Stoke-on-Trent CCGs, it is exactly zero. Sufferers who, up to the age of 18, had been used to specialist support in the community or at in-patient facilities have to rely thereafter on the hard-pressed, overstretched and generalist child and adult mental health teams. It is a postcode lottery—an “unwarranted variation”, in the NHS jargon—that has persisted for far too long, is patently unfair and lets local families down badly.

Of course, the last thing those families and their children want is the publicity that would bring pressure to bear on the CCGs to change course and give them the specialist support that is available just a few miles down the road. Last September, however, after our debate here, one of my constituents, Sarah Pustkowski, was brave enough to speak out publicly about the effects on her.

Sarah is 25 and developed anorexia nervosa when she was 16. She is slowly recovering—touch wood—but her father says that she is not out of the woods yet. Her case shows how long the anomaly in our area has persisted, because her dad first approached me in 2014 when she was 20 to relate what a cliff edge they had fallen off, in terms of specialist support.

Until then, Sarah had access to the excellent Kinver Centre, a hospital in Stafford just down the A34. When discharged, however, all the expert support that the family was used to stopped, because our CCGs failed to commission it. The Kinver Centre can admit people from all over the country, not just the county, but not from north Staffordshire, Stoke-on-Trent or Staffordshire Moorlands, because our CCGs provide no funding. Sarah and her family are not alone.

Since the autumn, we have been working with sufferers, concerned local health professionals and providers, and Beat to resolve the situation. A business case has been drawn up for the two CCGs as part of their annual prioritisation process, which aims at consistent commissioning across the county. The professionals involved are more hopeful than before but, with intense financial pressures on our NHS, I pray that the dawn does not again prove false in the coming weeks.

Something that should help to make the case and, one would hope, to inform and form Government policy, is information as to what happens across the country as a whole. Last October, after our debate here, we asked the new Secretary of State which of the 190-plus CCGs in England also did not provide specialist 18-plus eating disorder services. His written reply stated:

“This information is not held centrally…NHS England does not hold information about all of the specific services commissioned by individual CCGs.”

But specialist in-patient units are commissioned by NHS England, so the response could have been more helpful.

The Secretary of State’s reply went on to say that the Government were investing £150 million in community-based care for eating disorders, which will mean that

“70…new or extended…services are now either open or in development”,

which will benefit

“at least 3,350 children and young people a year”.

We are still, however, at a loss to know precisely where. Perhaps the Minister could write to us with some more details after the debate.

In December, we served freedom of information requests on all 190-plus of England’s CCGs about the full extent of their services and funding. As hon. Members who have done that before know, it is a mammoth exercise that takes quite some following up. Thankfully, only a handful of CCGs did not respond and are being chased, and about 25 swerved the questions and gave little meaningful information, but the overall picture for adults and young adults is certainly better than the situation in North Staffordshire, and no doubt in the areas of many hon. Members present.The majority do provide specialist 18-plus services—in the community, at least.

There is still a glaring hole in the picture of specialist adult in-patient provision, however. Most CCGs defaulted on that question and referred it to our old friends at NHS England. Coming full circle, we formally FOI-ed it, too, in the new year. Under the statutory limits, a reply was due by last Thursday, but despite chasing, none has yet come. It would have been good to have had it by the end of last week to inform our local business case, and it would have been respectful to the families and sufferers for NHS England to have responded before this awareness week.

I am sorry to speak at length about our travails, but the saga demonstrates only too clearly how difficult it is for conscientious campaigners such as Beat, the families and the MPs who support them to lay their hands on the information they need. If it is difficult for us, it is fair to ask how Ministers can draw up effective and informed policy, and make sure that recommendations for improvement, such as those in the Parliamentary and Health Service Ombudsman’s report, are put into practice.

One of the five core recommendations in that report was that

“The Department of Health and NHS England should review the existing quality and availability of adult eating disorder services to achieve parity with child and adolescent services.”

It is that lack of parity, and the progress in reducing it, that we have been so frustratingly trying to get to the bottom of in the last six months. If the Minister has more information, I hope that she will share it with us and, importantly, ensure that NHS England does, too.

[Several hon. Members rose—]

--- Later in debate ---

[Paula Sherriff]

I thank the hon. Gentleman for his intervention. Frankly, a debate would not be complete without an intervention from him. I absolutely agree. When I was speaking to the professional at the Mirfield Free Grammar, she told me that much of what comes through her door relates to eating disorders, crucially in boys as well as girls. Sometimes we continue to stereotype that eating disorders affect only women. The reality is quite different.

As a number of Members have suggested, social media can be a double-edged sword. I will talk about Beat in a moment. Beat does excellent work and has fantastic online resources, as do a number of other mental health charities. However, other sites that we have heard about that encourage people with regard to suicide and their eating disorders can be problematic to say the least.

The Government have made a commitment that, by 2020, 95% of children and young people who are referred with an eating disorder will be seen within one month, or one week if it is considered urgent. That is obviously very welcome, but with 2020 just around the corner I am concerned that, given current workforce and funding pressures, that will be difficult to achieve, or will possibly result in manipulation of waiting time figures. A patient will get a first appointment within the timescale, but any follow-up or effective treatment will still come many months, or even years, after referral. I would be grateful if the Minister would say how it will work in practice.

Although that is all well and good for children and young people, there are still no clear plans for adults with eating disorders. I recently visited a NAViGO service in Grimsby that supports people with eating disorders, and I was struck by how many people who were older than me were experiencing in-patient treatment.

My hon. Friend the Member for Newcastle-under-Lyme (Paul Farrelly) talked about his constituent Sarah. I have a constituent who was diagnosed with an eating disorder at 16. Owing to the severity of her illness, she was sadly admitted to hospital for a lengthy stretch. On her release, she attended fortnightly appointments with an eating disorder specialist. As her recovery was going well, my constituent decided that she would like to take up an offer of a university place in Manchester, because despite her very difficult illness she had achieved the most fantastic A-level results. She saw going to university as a positive step in her healing and as a way of getting on with her life. The local NHS trust that delivers mental health services in my area informed her that she would have to transfer over to mental health services in Manchester.

Neither my constituent nor her family thought too much about that, as it was not raised in such a way that allowed them to foresee any issues. However, five months on, my constituent is still waiting for the handover to be completed and, sadly, during that time she has suffered a serious relapse and is once again looking at in-patient care. I recently attended the all-party parliamentary university group, and we talked about transition when people go to university, and about mental health in general. We need to look at that in some detail.

[Paul Farrelly]

Clearly, the administration in the health services that led to that outcome is of grave concern. It is also concerning when specialist services in a particular area stop for young people when they turn 18. Only those people going away to university or college in areas that provide such services, or those people whose families have a lot of money and can fund treatment privately, have the prospect of change. The people who are left are effectively discriminated against.

[Paula Sherriff]

I thank my hon. Friend for that intervention. I absolutely agree. We had a very interesting discussion at the APPG about whether we could do more pre-screening when people go to university. We must also remember those in further education, not just those in higher education.

I ask the Minister whether what happened to my constituent would have happened had she been suffering from a serious physical condition. Earlier, a colleague made an analogy with cancer—“Your cancer is only at stage 1; we’re not going to treat you until it becomes more advanced.” As we all know, eating disorders carry the highest mortality rate of any mental illness; yet this young lady has been left to suffer, in a new city, away from family and friends and without any support network. We all have to ask ourselves how on earth that was allowed to happen.

I commend the fantastic work being done to raise awareness of eating disorders and to support sufferers, and crucially their carers and families, by the charity Beat, some of whose representatives are in the Gallery. They work relentlessly to battle against the stigma of this dreadful disease, and to push for better access to services and treatments. When my office spoke to them about the case of my constituent, they said that sadly it was very typical of the stories that they hear every day on their helpline. How many families are going through the same mental torture day after day while waiting for that elusive appointment confirmation to drop through their letter box?

With no specific waiting time targets for adults with eating disorders and poorly funded mental health services, many overstretched mental health trusts are unable to put the necessary resources into those vital services, and treatment availability has become a hideous postcode lottery, as my hon. Friend the Member for Newcastle-under-Lyme highlighted. Service access and levels of funding vary widely from one area to the next.

Furthermore, there is a huge disparity between access to adult services and to those for children and young people, with adults on average waiting twice as long. The eating disorder charity Beat has had a huge rise in calls to its helpline over the last year. In 2017-18, Beat staff helped 17,000 people, and they estimate that by the end of 2018-19 they will have helped more than 30,000. It is commendable that they managed that increase in demand so well, and I know that with more funding they could help even more people.

In October 2018, following an eating disorder storyline, which Beat had been very involved in helping with, on the popular teenage soap “Hollyoaks”, calls to Beat’s helpline spiked to more than double those in any previous month. That highlights the need to raise awareness about eating disorders and, crucially, to quash the stereotypes and stigmas so that more people know that they can seek help earlier. Reportedly, it could take an adult with an eating disorder more than two years before they realise that they have an issue, and up to another two years to seek help. More needs to be done to increase awareness and access to treatments.

Beat recently undertook some research into eating disorder stereotypes. When people think of eating disorders they often think of young, white women, but that is a popular misconception. The reality is much more complex. More adults suffer from eating disorders than young people, and the number of male sufferers increases year on year, with people who identify as LGBT+ at significantly higher risk. Stereotypes prevent people from seeking and receiving medical treatment in the earlier stages, which, in turn, makes it harder for people to recover.

I am grateful that the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) raised over-eating. When we think of eating disorders, we often think of anorexia or bulimia. It is important that we consider the full spectrum of disorders. Beat’s research also found that people from black, Asian and minority ethnic and less affluent backgrounds would feel less confident in seeking help from a health professional for an eating disorder. That stigmatisation and fear of speaking out can have far reaching and dangerous consequences.

We also need to work to ensure better training for those on the frontline. The hon. Member for Westmorland and Lonsdale (Tim Farron) made an important point about training for those in health professions so that they can better recognise and support those who present with eating disorders.

Another constituent of mine waited more than two years to be seen by a psychiatrist for depression and anxiety. During that time, sadly, she also developed an eating disorder. She was consuming less than 700 calories a day and avoiding any foods with even a trace of fat, and her weight had plummeted over a period of six months, but at her first psychiatric appointment she was told that she was not underweight enough to be considered to have a serious eating disorder. At her second appointment, the psychiatrist weighed her and congratulated her on her increased weight and body mass index. As hon. Members can imagine, that was the last thing that she wanted to hear. The psychological effect set her recovery back by weeks.

Sadly, that was not an isolated incident. There are many fantastic people working on the frontline of our health services, but there is also a minority who would hugely benefit from extra awareness training in what an eating disorder looks like, how best to treat it and where to refer patients for treatment.

I know the Minister well and am satisfied that she has huge compassion in the area, but equally I hope that she has listened to the points raised in this debate and will press the Government to put eating disorders higher up the agenda, make promises and set targets that will ultimately save the lives of sufferers. She will have my full support in doing so.

NHS Long-term Plan

Paul Farrelly Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

Supporting children with mental ill health is an incredibly important part of the plan, from early intervention on anxiety and depression through to support for those with more serious mental health conditions. It means that there will be dedicated support that can link with schools’ mental health services and help signpost in what is often a complicated system. The Mental Health Minister, my hon. Friend the Member for Thurrock, has already agreed to meet my hon. Friend to discuss this further. It is an important and welcome intervention.

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

When our local sustainability and transformation plan was submitted in October 2017, it projected an annual deficit in health and social care in Staffordshire and Stoke-on-Trent of £542 million by 2020-21, which is more than double the £250 million projected at the time of the 2015 general election. That shows the scale of the problem, because there are more than 40 STPs across England. Will the Secretary of State write to me with some numbers to show how this long-term plan will help our local STP with the extra revenue and investment needed to transform services so that we do not face a litany of unsustainable cuts, notwithstanding those in the years immediately to come?

[Matt Hancock]

Of course we are putting more money in, and in the coming days we will announce the local provision increases for the first year—there is a £6 billion cash uplift in year 1. We will be working with local areas in the months ahead on the plans for years 2 to 5.

Points of Order

Paul Farrelly Excerpts

Wednesday 7th March 2018 Commons Chamber

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

rose—

[Mr Speaker]

I will come to the hon. Gentleman, but I have another point of order first.

--- Later in debate ---

[Mr Speaker]

Not at this time. I say to the hon. Member for Worsley and Eccles South (Barbara Keeley), who is an experienced denizen of the House, that there will be opportunities through the business question and subsequently for her to draw the attention of the House again, and perhaps in more detail, to her concerns and to elicit a ministerial reply.

[Paul Farrelly]

On a point of order, Mr Speaker. I ask your advice on how the House can put on the record its concern that the Conservative manifesto in 2017, with its promise to scrap Leveson 2 and section 40, pre-empted the results of a consultation that the Department for Culture, Media and Sport was carrying out. How can we be sure, particularly given the comments of Sir Brian Leveson, that that decision was reached fairly and reasonably and will not be subject to judicial review?

[Mr Speaker]

I will say two things in response to the hon. Gentleman. First, he seeks and perhaps over-generously expects from me a degree of reassurance and even of wisdom that it is not within the capacity of the Chair to provide. Secondly, in asking how we—meaning the House as a whole—can be sure, I simply say that the hon. Gentleman, who is no stranger to these matters, raises something of a philosophical question. Whether, when and to what degree Members can be confident of certainty are not matters that can be broached now from the Chair. However, in so far as he was seeking—as the puckish grin on his face suggests—to register his own concerns, he has found his own salvation.

NHS Winter Crisis

Paul Farrelly Excerpts

Wednesday 10th January 2018 Commons Chamber

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

I want to talk about the situation at my local hospital, the Royal Stoke University Hospital. Winter crises there are hardly new, but they have escalated year on year, and our hospital features luridly in the national press each winter. It is often the most affected, and it is no coincidence that its funding deficit is England’s worst. This winter, however, is the first time that Royal Stoke consultants have taken to social media to apologise for 36-hour A&E waits, for corridors yet again jammed with the frail elderly on trolleys, and for what they now describe as third-world conditions.

The background is that of all the areas subject to the so-called sustainability and transformation plans, Staffordshire is the worst performing in the country. Before the 2015 general election, we exposed locally a funding deficit, prior to the STP, that would have reached £250 million a year by 2020. Since then, the issues have been exactly the same, but the figure for health and social care has now more than doubled. The Royal Stoke now accounts for over £100 million of it, having taken over the crisis-ridden Stafford Hospital, for which extra Government funding has now ended. The response so far has not been to invest in change, but to launch a scorched-earth policy. Community Hospitals have been closed, rehabilitation wards shut, drug and alcohol services axed, and lip service paid to the prioritising of mental health. The effect is most acutely felt at A&E and in admissions to Royal Stoke University Hospital, which is already brimming to capacity and struggling to discharge hundreds of patients because social services are also in crisis.

On 23 November, I attended a clinical commissioning group “Designing Your Future Local Health Services” consultation at Bradwell Hospital in Newcastle-under-Lyme. It is a hospital close to my heart. At the turn of the millennium, before I became an MP, I chaired our local “NHS Care for All” campaign, which saved Bradwell Hospital as a facility precisely to take pressure off the Royal Stoke. My father passed away there in 1997 and my mother, a former nurse, passed away there after a catastrophic stroke three years ago.

At the end of March last year, our local CCGs closed Bradwell Hospital, with Longton and Cheadle community hospitals have gone beforehand, and wards at Leek Moorlands Hospital have closed since then. I was not the only person at the November meeting to label the consultation a sham. I also said that I wished the meeting could have happened at the end of February this year instead, after the winter crisis, the flu and the norovirus had bitten, as they are doing now. The CCGs had tried to pull the plug on Bradwell in the autumn of 2016, but they had to keep it open for another six months to cope with last year’s winter crisis. As late as November, they were saying they had no plans to reopen the hospital, but there was an inevitable volte-face in December.

Lurching from crisis to crisis is no way to run and plan a health system, and it is not only MPs, campaigners, patients and their families who are saying that. Last year, working with local councillors, including Charlotte Atkins at Staffordshire County Council and the indefatigable Joan Bell at Stoke-on-Trent City Council, the reformed local “NHS Care for All” campaign, which is chaired by the energetic Councillor Allison Gardner from Newcastle-under-Lyme, succeeded in getting our hospital closures referred to the Secretary of State. The advice of his independent reconfiguration panel was published just before Christmas, and it was damning of the CCGs. The verdict was delivered to him on 18 October—well before the winter crisis—and we would have thought that he would have reacted, but just one week later the chief executive of two of our local CCGs was appointed to run all six Staffordshire CCGs. That is a reward for failure in our area. Things have to change. The Royal Stoke University Hospital has to be given more investment, because more cuts will simply mean that next winter’s crisis will be even worse.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

Happy new year to you, Madam Deputy Speaker.

We have had a good debate this afternoon with some well-informed—as the hon. Member for Bristol South (Karin Smyth) put it—contributions from both sides.

The NHS is a service that we are all immensely proud of; we can agree on that. Even during the challenging winter period it continues to deliver overwhelmingly safe and effective care to thousands of our constituents, and we should never lose sight of that. We have heard examples of that today, including from my right hon. Friend the Member for Meriden (Dame Caroline Spelman), who spoke with her usual calm about the triage model she saw working well in her area when she had to go to hospital over the holiday period. My hon. Friend the Member for Stafford (Jeremy Lefroy) was among many Members who visited the NHS over the recess period and he spoke, as well he might, and as well as he usually does, about the safe care he saw being delivered.

As my right hon. Friend the Secretary of State, and before him the Prime Minister, said earlier, we have done more preparation for winter this year than ever before, planning earlier to make sure the NHS is better prepared. More than that, we have put in the money, in the form of an additional £337 million for winter pressures and an additional £1 billion for the social care system this year. As the Public Health Minister, I am proud of our flu vaccination programme, already the most comprehensive in Europe, which has been extended even further. This was planning ahead.

We have also allocated £100 million of capital funding to help hospitals set up GP streaming systems at their A&Es, reaching 91% coverage by the end of November. This, too, was planning ahead; they did not just appear overnight. And for the first time ever, people were able to access GPs nationally for urgent appointments from 8 am to 8 pm seven days a week over the holiday period.

Of course, there were additional pressures this year: very cold spells in December, a sharp uptick in flu and respiratory conditions, and higher hospitalisations from confirmed cases of flu than in the peak of winter last year.

[Paul Farrelly]

There are also questions about NHS leadership. As the Minister is aware, Staffordshire is under great pressure. The Secretary of State received reports about the closure, with lack of consultation, of community hospitals in our area on 18 October, which slated two local CCGs. Yet a week later the NHS appointed the chief operating officer of those two CCGs to oversee four more in Staffordshire. Will the Minister ask his right hon. Friend the Secretary of State to explain that decision?

[Steve Brine]

The sustainability and transformation partnerships have been established across England—I am sure that the hon. Gentleman will have engaged with the one in his area—and they take local decisions about how services are organised in local areas. I implore him to engage with his STP; indeed, I know that he is already doing so. If he wishes to talk to me about this, he can of course do so.

Let me respond to some more of our contributors. The hon. Member for Bristol South always speaks sensibly. She spoke about the public representation and involvement in STPs. I agree that we could do more in that area, and as the Minister responsible for STPs, I want to see that we do so. Her point was well made. The hon. Member for Crewe and Nantwich (Laura Smith) spoke about her constituent, Elle, who lost her battle with cystic fibrosis. She speaks up for her constituents well, and very emotionally, and if she continues to do that, she will do extremely well in this House.

The hon. Member for Stockton South (Dr Williams) is a new Member, and I already have a lot of respect for him. In his typically sensible contribution, he made some sensible suggestions for improvement in the NHS. He went on to talk about how we could do better on prevention, and he was absolutely spot on. We all agree that prevention is part of our one NHS. He said that this was not all about money, and I agree. Money is a key part of this, however, and that is why we spend 9.9% of our GDP on healthcare, which is above the EU average.

The hon. Member for Leicester West (Liz Kendall) said that this is not what happens every year, but the NHS is under great pressure at this time every year. A headline from The Guardian newspaper on 27 October 2001 stated “NHS faces another winter of crisis”. The NHS is often under pressure at this time of year, and the important thing is how we prepare for that. As I have said, we are better prepared than ever. It is a shame that the hon. Lady is not listening to my response. [Interruption.]

National Health Service Funding

Paul Farrelly Excerpts

Tuesday 22nd November 2016 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

I beg to move an amendment, to leave out from “House” to the end of the Question and add

“welcomes the Government’s investment, on the back of a strong economy, of significant additional funding and resources each year for the NHS during the 2015 Parliament; notes that this settlement was frontloaded at the specific request of the NHS in NHS England’s own plan to deliver an improved and more sustainable service, the Five Year Forward View; and further notes that the NHS will receive a real terms increase in funding in each year of the Spending Review period, while the Labour Party’s Manifesto at the last election committed to only an extra £2.5 billion a year by 2020, far less than the NHS requested.”.

As I did in last week’s debate on social care, I start by recognising the fantastic work done by NHS staff up and down the country. This autumn, I met a mental health nurse who told me how she had had to cope with the pressure of one of her patients throwing himself off a bridge the day after a consultation. I am sure that all Members have stories of the incredible dedication of NHS staff—not just people doing their jobs, but people putting their heart and soul into their work, staying late, going the extra mile, and sacrificing home time and holidays to be there for patients. As I did last week, I also recognise the 50,000 NHS staff from EU countries, including 26,000 low-paid staff, who do a brilliant job. Today we have heard concerns about funding, A&E—

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

Will the Secretary of State give way?

[Mr Hunt]

I will give way in a moment, but I just want to finish this sentence, if I may.

We have heard concerns about funding, A&E performance, waiting times and morale, and I want to answer them all. There are many pressures in the NHS, but I also want to recognise some successes, because one of the things that is most damaging to morale is not giving credit where it is due.

[Paul Farrelly]

Can the Secretary of State explain why he has made scores of redundancies in north Staffordshire? In my 15 years as an MP, I have never seen the local NHS in such a meltdown, with a scorched-earth policy of cuts and closures, and more to come with next year’s still-secret STP. When will the Government realise that pressures on social care and the NHS are such that those services are unsustainable without decent further funding and investment?

[Mr Hunt]

As the hon. Gentleman knows, those things would certainly be unsustainable if we had followed the Labour party’s investment plans at the time of the previous general election. If he wants to know what is happening to staff, let me tell him that in the period I have been Health Secretary, we have got 5,000 more doctors and 10,000 more nurses. That is what happens when we have a Government who are prepared to invest in the NHS.

The shadow Health Secretary talked about A&E—he is right to say that we are not hitting the target, and we are doing something about that—but he did not tell the House that, since Labour left office, we have recruited 1,200 more doctors for A&E departments, which is a 25% increase, including a more than 50% increase for consultants. Every day, we are seeing 2,500 more people within four hours.

Social Care

Paul Farrelly Excerpts

Wednesday 16th November 2016 Commons Chamber

[Teresa Pearce (Erith and Thamesmead) (Lab)]

I welcome the contributions made by Members on both sides of the House. They have highlighted the scale of the crisis we face in adult social care. My right hon. Friend the Member for Leigh (Andy Burnham) set out passionately the long-standing need for integration. We had informative and knowledgeable contributions from my hon. Friends the Members for Halton (Derek Twigg), for Tooting (Dr Allin-Khan), for Halifax (Holly Lynch), for Wirral West (Margaret Greenwood), for Dulwich and West Norwood (Helen Hayes), for Heywood and Middleton (Liz McInnes) and for Great Grimsby (Melanie Onn). On the Government side, we also heard thoughtful contributions from the right hon. Member for North East Bedfordshire (Alistair Burt) and the hon. Members for Central Suffolk and North Ipswich (Dr Poulter), for South Cambridgeshire (Heidi Allen) and for Bexhill and Battle (Huw Merriman).

It seems we all agree that there is a crisis. I believe that 2017 will be a make-or-break year for our social care system. That system is currently teetering on the edge of a precipice. More and more, we find that local authorities can no longer afford to fulfil their statutory obligations regarding the social care of elderly and disabled people. Social care providers are handing contracts back to councils because they are no longer financially viable. Beds in hospitals are occupied for weeks—sometimes even months—by people who are well enough to leave but cannot because there is no social care available for them once they do.

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

In a matter of months, within the still secret Staffordshire STP, the projected 2021 deficit for social care has jumped from just over £100 million to £256 million. With the NHS deficit, that makes more than half a billion pounds now, excluding anything from Stoke-on-Trent. Without further funding and investment, that gap is simply unbridgeable, so it is hardly surprising that in the past few days both the STP chair and its programme director have tendered their resignations.

[Teresa Pearce]

I am glad my hon. Friend has had the chance to raise that very important point.

The crisis is affecting elderly people across the country, as we have heard eloquently expressed by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley). More than a million elderly people in this country who need social care are getting no support. Half of older people who have difficulty bathing or getting dressed receive no support. One third of all older people who have difficulty going to the toilet on their own are receiving no support. An estimated 1.1 million are chronically lonely. Is it any wonder that almost 4 million older people in this country now say that television is their only source of company? That is happening on our watch, and we should all be both saddened and shamed by it.

The rise in demand for social care does not come as a surprise to any of us, however. We live in a society with an ageing population. We must concentrate on building a sustainable social care system to meet that rising demand. Members across the House know from their own constituencies, as I do from mine, that the spending cuts have already hit vulnerable people. One in 10 care homes has closed since 2010, and 400,000 fewer people accessed care in the last Parliament because of funding reductions. According to Learning Disability Voices, a shocking three quarters of all people who apply for social care support from their local council are now turned away.

For those who can access care, the bar for what can be described as care gets lower and lower. Staffing levels have been so severely reduced that workers have barely any time to actually look after people. As we have heard, some visits have been cut from 30 to 15 minutes. That is 15 minutes to make someone dinner, to bathe them, to give them medication, to change their sheets and to give them any other help they might need. It is barely time to take your coat off and say hello. In fact, 15 minutes is about the time we take in this place to divide. I hope Members will bear that in mind when they pass through the Lobby shortly.

The King’s Fund has described the care system as a

“threadbare local authority safety net.”

Although the majority of those receiving care are elderly people, roughly a third are younger people who have a physical disability, learning disability or mental health problem. These people are far less likely to have income to support them and far less likely to have children who can care for them as they get older. In fact, they are more likely to have elderly relatives who live in dread of what will happen when they are gone.

When disabled people are looked after in the community, with a local authority-provided care package, their needs are reduced by up to 50%. We often hear about needing to reduce the dependency culture, and the provision of social care, including day centres, does just that: it allows people with disabilities to live an independent and healthy life. Rather than allowing this sector to crumble, we should be looking at how to invest in and expand it. It has been said here today that the mark of a civilised society is how we treat the disabled, the elderly and the vulnerable. We are failing that test miserably.

Let us be clear about one thing: this crisis is not the fault of those working in the social care sector. In fact, they are among the most undervalued and underpaid workers in the country. Neither is this crisis the fault of local government. Nobody goes into local government and public service to cut care and support for the vulnerable. Local authorities are trying to plug the gap. In 2014 alone, councils diverted £900 million from other budgets to maintain the current level of social care, despite making efficiency savings. Local councils are on the frontline of government, providing the integral services that our communities rely on. It is simply impossible for them to plug the momentous funding gap in adult social care that they face. Let us make no mistake about the root of this crisis: it is the stark result of the austerity policies pursued by the previous Chancellor. It is his six years of brutal and devastating cuts to local government that have brought us here.

If we let our elderly and disabled people languish in loneliness and frustration in unhygienic and inadequate conditions, it will be a stain on our collective conscience. What kind of country would we be? When the new Prime Minister took up her position, she stood on the steps of No. 10 and said she wanted

“a country that works for everyone.”

Today, the Government have an opportunity to prove that the Prime Minister meant what she said. I would like the Minister to consider three questions when he responds to the debate. Will he confirm that the better care funding is not additional money, but has in fact been taken from the existing NHS budget? What assessment has he made of the effect of the living wage on care contracts, and does he have an estimate of how many contracts will be exited in the next 12 months by providers? Will he let me know what steps and checks he is making to ensure that local authorities are not commissioning 15-minute care visits, as recommended in their own guidelines? If the Minister cannot answer those questions today, I hope he will write to me in the coming weeks.

We are all hopeful that the autumn statement will bring forward urgent funding to stem an impending crisis in social care, but there must also be a strategy to put social care on a sustainable, long-term footing so that people can grow old in this country without fear, and disabled people can live with dignity and safety. The Government must recognise that by stripping local government of its funding to the point that even statutory requirements are difficult to meet, we will not benefit the economy or productivity of this country, or the wellbeing of our society. As the sixth-richest economy in the world, this country can, and must, provide this vital assistance to the most vulnerable people in society.

NHS Sustainability and Transformation Plans

Paul Farrelly Excerpts

Wednesday 14th September 2016 Commons Chamber

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

This so-called transformation process has been going on in fits and starts in Staffordshire since 2014. By 2020-21, the deficit will be £347 million, including social care, according to the draft STP presented behind closed doors in Whitehall in July. The Secretary of State has refused to publish that plan, of course, but what is important is that the menu being cooked up behind the scenes is already being dished out in practice, with no meaningful public consultation, playing fast and loose with NHS guidelines. It is being driven by cost-cutting, bullied through by NHS England, not rational planning for better integrated care in the future, even if that means that, in the short term, the pressure on patients is increased, particularly at our local Royal Stoke University hospital, where the wretched sight of trollies queuing up in A&E corridors is now commonplace.

Before the summer, the closure of ward 4 at the local Harplands hospital took away a safe place of discharge for patients with mental health problems. Cuts to the county’s better care fund threaten the viability of drug, alcohol and other services, as well as respite and rehab facilities such as those at Brighton House in Newcastle. Last month, we learned that both wards at Cheadle community hospital will close, further affecting discharges, while social services struggle to cope. Children’s A&E at Stafford has shut, and last week staff at Newcastle’s community hospital, Bradwell, learned that three of its wards are to close this winter or next spring. As a result of all that, the pressures on our local acute hospital will simply continue to multiply.

As a county, Staffordshire does not fit together as a healthcare whole. While the north and west look to Stoke, the south engages with Birmingham, Wolverhampton and even Worcester, and the east with Derby. Rather than plan integrated care along those pathways, I understand that a county-wide merger of everything is now on the cards. That monolith has been called, with no sense of irony, an accountable care organisation, yet the health and care transformation board has been anything but accountable so far, not least in relation to the pay that senior executives are raking off from this process.

The parachuted-in programme director, Penny Harris, is being paid a salary of £168,000 a year for a four-day week, and her deputy, Sarah Carter, is on £172,000 for a five-day week. The lead finance officer, Neil Chapman, is on £244,000 a year. Add in two other people on the Staffordshire board who are on £131,000 and the annual bill for just five of them comes to £846,000. Another £675,000 is going to KPMG, which means that more than £1.5 million is being paid by the local NHS. These people, quite simply, are devouring what is left in the pot for transformation.

Draft Pharmacy (Premises Standards, Information Obligations, etc.) Order 2016

Paul Farrelly Excerpts

Tuesday 1st March 2016 General Committees

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

Following my hon. Friend’s contribution, I also want to put something on the record. I have had representations from pharmacists in Newcastle-under-Lyme in north Staffordshire who face funding cuts. They are, quite frankly, baffled, because they are also expected to do more on the frontline to help patients and relieve pressure on GP surgeries, which, like much of our health service, are embattled at the moment.

Oral Answers to Questions

Paul Farrelly Excerpts

Tuesday 5th January 2016 Commons Chamber

[Ben Gummer]

My hon. Friend is entirely right, and we are already having an impact. We had to bring in the requirement for safer staffing rotas because of the catastrophe at Mid Staffs and the need to try to staff hospitals better, and that had an immediate consequence which called for agency workers. Unfortunately, some companies have taken advantage of that situation, but we have introduced measures to stop that and are already having an impact across the service.

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

The University Hospitals of North Midlands NHS Trust faces a deficit of £19 million for 2015-16, but until the NHS’s Staffordshire review is completed it faces uncertain prospects further out, not least as it has taken over Stafford county hospital recently. The hospital wrote to the Minister before Christmas, so will he meet hospital management and local MPs as soon as possible this new year to discuss this uncertain situation and the progress on the whole Staffordshire review?

[Ben Gummer]

I would be happy to meet them, I will meet them and I congratulate them on eliminating 12-hour trolley waits for the first time this year. They are doing a great job in difficult circumstances, as are many hospitals across the country. I am confident that they, too, will be able to get their deficit under control next year, with the help of the transformation fund, which is available for high-performing trusts.

Health and Social Care

Paul Farrelly Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

Let me make some more progress, and I shall give way later.

The Queen’s Speech also talked about a seven-day NHS as part of our determination to make the NHS the safest healthcare in the world. When the right hon. Member for Leigh was Health Secretary, things were different, and he knows that we had a culture of targets at any cost and a blind pursuit of foundation trust status, which led to many tragedies. I hope he will today accept that if we are to make the NHS the safest and most caring system in the world, we must support staff who speak out about poor care, and stop the bullying and intimidation of whistleblowers that happened all too often before.

Finally, I hope we can agree on something else today—namely, that with the election behind us, we all use more temperate language in our health debates. There are many pressures on the NHS from an ageing population, tight public finances and rising consumer expectations, but the one pressure people in the service can do without is constantly being told by politicians that their organisation will not exist in 24 hours, 48 hours, one week, one month or whatever. It is a toxic mix of scaremongering and weaponising that is totally demoralising for front-line staff.

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

The Secretary of State has said that privatisation is not happening, but in Staffordshire the £1 billion end-of-life cancer care contract is up for tender, threatening the hospital finances at Royal Stoke even further. Before the election, my right hon. Friend the Member for Leigh (Andy Burnham) gave a commitment to the Royal Stoke University Hospital that it would be the preferred provider for this contract. Will the Secretary of State give that commitment today?

[Mr Hunt]

As I said earlier, I do not think these decisions should be made by politicians; I think they should be made by GPs on the ground, on the basis of what is best for the hon. Gentleman’s constituents. That is a dividing line between me and the shadow Health Secretary, if not the shadow Health Minister, because I think there is a role for the independent sector when it can provide better or more cost-effective services to patients. It appears that the Labour party, under the leadership of the right hon. Member for Leigh, would rule that out in all circumstances.

--- Later in debate ---

[Andy Burnham]

I am grateful that the Secretary of State has intervened because yet again he has got his facts wrong. Am I not correct in saying that in the first two years of the last Parliament the Government cut staffing further from the levels I left by 6,000? [Interruption.] No, he and his predecessor cut nurse places by 6,000 in the first two years of the last Parliament. Separately, they cut nurse training places, leading to a shortfall in nurse recruitment of around 8,000 in the last Parliament. When the Francis report was published, the NHS had fewer staff than it had in 2010 and fewer nurses coming through training.

The Secretary of State likes to blame everybody else, but how about taking a bit of blame himself for once? He left the NHS in the grip of private staffing agencies, and since the Francis report a small fortune has had to be spent on private staffing agencies. The figures have gone through the roof on his watch and he has failed to do anything about it. That is why people will not believe that the NHS is safe in his hands.

[Paul Farrelly]

Would my right hon. Friend care to remind the Secretary of State of a privatisation that has increased the NHS deficit and not improved efficiency? After the proposed transfer of a scanning contract from the Royal Stoke university hospital there was rightly a public outcry. The scanner remains there, but none the less the private company, Alliance Medical, is staying in there, taking its cut and the cost to the taxpayer has increased.

[Andy Burnham]

I remember visiting with my hon. Friend. Let us put the facts on the record. The Secretary of State said a moment ago that privatisation was not happening, but it is happening. It is affecting my hon. Friend’s constituents, where cancer scanning has now been privatised. What happened? The contract was, I believe, given to Alliance at £87 million, whereas the NHS had bid £80 million. It was given to the private sector, however, which has now subcontracted the NHS at the same price of £80 million, creaming off £7 million. That is a scandalous waste of NHS resources when the NHS is facing a £2 billion deficit this year.

--- Later in debate ---

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

I want to talk about what the Government call the distressed health economy of Staffordshire—north Staffordshire, in particular—and some worrying recent developments while we were preoccupied with May’s elections.

In February, I was leaked a copy of a report on Staffordshire’s so-called challenged local health economy prepared by accountants KPMG. It was completed last August and was one of 11 commissioned by the Secretary of State on areas of England with NHS deficits. As far as I am aware, though, following the leak, Staffordshire’s is the only one to see the full light of day. It painted a picture of a local health system “in perpetual crisis mode” which suffered from a “generally oppressive culture” and had no “clear long term strategy”. The report was also scathing about the effects of the Government’s top-down reorganisation of the NHS after 2010. There was conflict at the top of many of the bodies and a lack of collaboration between the new clinical commissioning groups. That led to waste, duplication, and, frankly, letting patients down, not least the frail elderly who turned up too often at A&E, were all too often readmitted, and spent too long in hospitals rather than at home. In conclusion, the report said that if nothing changed Staffordshire’s health economy would be £217 million in the red in barely four years’ time.

The KPMG report was full of questionable assumptions and glaring omissions. These included the impacts on our local Royal Stoke University hospital of taking over troubled Stafford hospital at a cost of an extra £250 million while itself struggling with a £30 million deficit and coping with a crisis in admissions and A&E. Profoundly, the report failed to estimate the investment needed in primary, home and social care to make the planned savings possible without patients in the NHS across the county suffering as a result.

The report’s prescriptions were clearly fundamental to the future of local healthcare and certainly deserve debate, but funnily enough, before the election the Government were not only keen to suppress all 11 reports but even to deny their existence. In early February I tabled written parliamentary questions asking the Government to publish the reports; they declined to do so. I then asked simply when each was started, when completed, and by which consultancy firm. These simple factual questions first gained a holding reply. Then, a fortnight later, in March, the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), who is in her seat in the Chamber, gave this remarkably considered reply:

“Consultancy firms were not commissioned to produce reports on the local health economies, as described in the question”.

By that stage, I had the “non-existent” “Final Report for Staffordshire” in my hand, as I do now. The Government have therefore hardly been a paragon of truth and transparency in this regard. I hope that now they have conjured £8 billion of NHS investment out of the election air they will mend their ways in future—likewise the NHS itself, not least NHS England, which is, certainly in my view, the least accountable public body that I came across in the previous Parliament.

The conclusions of all that work on distressed health economies are now dribbling out in board papers of the hospitals and the patchwork of CCGs and NHS trusts created by the Government’s reforms. If Staffordshire is anything to go by, however, there is no joined-up information for the public, let alone consultation. Last week, following KPMG’s recommendations, the local CCGs in my area and the newly created Staffordshire and Stoke-on-Trent Partnership NHS Trust announced, from this autumn, the closure of Longton community hospital in Stoke-on-Trent South, as well as cuts in my constituency of Newcastle-under-Lyme to Cheadle hospital, Leek Moorlands hospital and Bradwell hospital, which cared for both my father and my mother until they passed away—my mum, sadly, only before Christmas just gone. The two CCGs, to quote The Sentinel, a local newspaper, last week,

“say they have already done enough ‘pre-engagement’ on the plans to render further consultation redundant.”

Well, they certainly have not. In fact, there has been no engagement at all, neither pre nor post.

Recent NHS figures show that in January and February, 613 of the total of 912 cases of patients waiting on trolleys at A&E for a bed to be found for over 12 hours —two thirds of all cases—happened at our local Royal Stoke University hospital. Yet another of the KPMG proposals is the removal of 63 beds at the hospital to save £20 million. Currently we do not know where that recommendation stands, but the cumulative effect of the cuts could simply make the situation for patients and the NHS at our hospital far worse.

That is why today I have asked all the local NHS bodies to meet local MPs on a cross-party basis and to make plans to engage and consult properly with the public. I hope that the Secretary of State and Health Ministers will not only encourage that, but join in and explain how these cuts and changes fit into the NHS plan and how much of the £8 billion they have conjured up will go into helping the local health economies not only in Staffordshire, but in the 10 other areas around the country facing major challenges and cuts.