Future of the NHS
Preet Kaur Gill Excerpts(6 months, 2 weeks ago)
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Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)
It is a pleasure to serve under your chairmanship, Mr Pritchard, and I add my thanks to my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing the debate. She is a committed campaigner for our national health service, and she set out clearly how the NHS faces an unprecedented challenge. We have heard powerful cases put forward about the need for reform, including from the hon. Member for Southend West (Anna Firth). My hon. Friend the Member for St Helens South and Whiston (Ms Rimmer) focused on the workforce strategy for the NHS. I also thank my hon. Friends the Members for Liverpool, Riverside (Kim Johnson) and for Lewisham East (Janet Daby), who talked about sickle cell disease and equality in the NHS, and the hon. Member for Strangford (Jim Shannon).
This debate on the future of the NHS is timely as it is our first opportunity to put to the test the Government’s new slogan, which was unveiled at their conference:
“Long-term decisions for a brighter future”.
Personally, I would say that 13 years is long enough. What has been the result of that? Where we once spoke of winter crises, we now face crisis in the NHS all year round. Patient outcomes are declining, public satisfaction is at a 40-year low and improvements in healthy life expectancy have stalled.
One in seven of us are now stuck on waiting lists. Some 2.6 million people of working age are out of work and long-term sick—a record high. Across swathes of the country, dental deserts mean that patients are pulling their own teeth out because they cannot get the care they need. This Government was the future once, and their record is historically bad.
As the CQC warned last week in its “State of Care” report, the risk is that healthcare in this country becomes a two-tier system, where those who can pay get treated and those who cannot have to wait. My party will never accept that. We will always defend the principle of an NHS that is there for everybody when they need it, free at the point of use.
As we have heard, we need a serious plan for investment and reform if the NHS is to realise that promise. If the Government cannot deliver, we will. We will train thousands more doctors and nurses so that the NHS has the staff it needs, armed with cutting-edge technology to treat patients sooner and faster. We will get doctors and nurses to help to address the backlogs and pull the NHS out of permacrisis. We will reform the system to shift more care to the community, fix the front door to the NHS, and deliver a prevention-first revolution to shift focus from the NHS as a sickness service to it being a genuine, holistic health and care service.
One thing that will define the future of the NHS is the disease burden of the country. Children in school today will live into the next century. Our NHS has been there for us for 75 years and will need to be there for 75 more, but it will not be there if we carry on as we are. The change we need to make is the shift to prevention. Right now the situation is scandalous, given the clinical time and need that is taken up with treating illnesses that could have been avoided in the first place. Many of the biggest killers, from cancer to heart disease, could be drastically reduced through healthier lifestyles and environments, yet as we saw with the latest child measurement programme statistics released last week, primary schoolchildren are some of the least healthy there have ever been. Nearly one in four children are now obese by the time they leave primary school, which is absolutely shocking. Some prevalence studies show that four in 10 obese children have evidence of fatty liver disease.
Yet more shocking is the fact that, while these children are bombarded with adverts for junk food, such as KitKat cereal, or are begging their parents to fork out more than £10 for a bottle of Prime energy drink, the Government have seemingly abandoned their plan to tackle junk food promotions and adverts targeting children. I ask the Minister: when will the Government publish the consultation into the pre-watershed junk food ads ban? Where is the secondary legislation that they promised? They said that the delay was to allow time to consult, yet the consultation has been done and is probably sitting in a drawer in Whitehall somewhere. What is the hold-up? Will the Minister back Labour’s plan to ban junk food ads before the watershed and to introduce free breakfast clubs serving healthy food at school, so that every child gets the best start?
The future of NHS dentistry is also hanging by a thread. Dentists are leaving the NHS every year. Huge parts of the country are dental deserts, where practices are not even taking on NHS patients. The No. 1 reason that children end up in hospital is to remove rotting teeth. It has been six months since the Government announced their dental recovery plan, but where is it? Their response to the excellent Health and Social Care Committee report into NHS dentistry is also overdue; when can we expect that?
In the meantime, Labour has set out our rescue plan. We will have 700,000 more urgent appointments a year to bring down the backlogs. We will target funding to train up dentists in left-behind areas, and, of course, we will have a national supervised toothbrushing scheme for schoolchildren, because we know that the cheapest intervention means not needing to see a dentist at all.
Securing the future of general practice is also integral to the future of the NHS as a whole. People trust their GPs, and the relationships that they build with their patients are irreplaceable, but despite the Government’s much-vaunted primary care recovery plan, record numbers of GPs are still leaving the profession. In 2019, the Government promised to deliver 6,000 extra NHS GPs. Will the Minister explain why that promise has been broken? How does he expect to move more care from acute settings to the community if general practice continues to decline at this rate? Where is his equivalent to Labour’s fully costed plan to recruit 8,500 mental health professionals, with support in every community and every school, to relieve the pressure on frontline GPs? And will the Minister say what proportion of the community diagnostic centres that have been set up in recent years are actually in the community, rather than in an existing healthcare site?
The Minister will surely acknowledge the point that there will be no sustainable future for the NHS without tackling the crisis in social care. Thousands of people are stuck in hospital beds who are medically fit to leave but are unable to do so, because the care that they need in the community is not there to support them. Can he explain how he expects to find a sustainable solution to that persistent problem without getting serious about pay and standards and addressing the chronic workforce shortage in the sector?
It is also a poor reflection of this Government’s long-term planning that the NHS is still stuck using creaking, outdated equipment, and has fewer scanners per person than Greece. Freedom of information responses from NHS trusts have revealed that half—48%—still have an MRI or CT scanner in operation past the recommended lifespan of 10 years. One in five trusts are using the same scanners that they had when the last Labour Government left office in 2010.
Does the Minister not agree that it is time for an upgrade? There are currently 1.6 million people waiting for diagnostic scans and tests in England—three times as many as when the last Labour Government left office in 2010. Slow, outdated equipment is part of the problem, so will the Minister follow Labour’s lead, with our “Fit for the Future” fund to double the number of CT and MRI scanners?
To really make the NHS fighting fit for the future, we should grasp the opportunities in the explosion of innovation in health technologies, too. Right now, a revolution is taking place in medical science, technology and data that has the potential to transform our healthcare. By using Britain’s strengths in life sciences and NHS data, we could transform the model of healthcare in this country using prediction, prevention and highly targeted precision medicine.
Today, genomic screening can spot predisposition to big killers such as cancer or heart disease. Let us imagine: if every family could choose to screen their baby’s genetic information, they would be empowered to give their child the healthiest start in life. Last month, I visited the Precision Health Technologies Accelerator at the University of Birmingham, part of the life sciences park that it is building there. Over time, it hopes that the campus will grow into a leading life sciences hub, bringing together the best of our university, business and the NHS, and creating more than 10,000 jobs in the process. That is really exciting.
The next Labour Government will build on the strength of our life sciences sector. The development of coronavirus vaccines shows us how industrial policy can work, with the state playing a crucial role in partnership with the private sector. Yet the Government scrapped the Industrial Strategy Council and, since 2019, the UK has dropped from second to ninth in global life sciences league tables for inward foreign direct investment. Where is the Government’s strategy to put the NHS at the front of the queue for cutting-edge innovations in the health sector and end the postcode lottery in the adoption of new treatments and diagnostics?
Daniel Kawczynski
Bearing in mind that the Shrewsbury and Telford Hospital NHS Trust is the worst-performing for A&E in the United Kingdom, will the hon. Lady commit, if there is a Labour Government, to backing the £312 million investment in our local trust—yes or no?
Preet Kaur Gill
I thank the hon. Gentleman for his question, but I do not have the level of detail to be able to make any such commitment. He needs to speak to the Minister to ensure that the valuable investment they have been able to obtain for people in Shrewsbury is actually realised. That is really a conversation for him to have with the Minister.
There is no doubt that the NHS needs serious reform if it is to serve for the next 75 years. Since the Prime Minister and Health Secretary made a pledge in January for 5,000 more beds in time for winter, the number of hospital beds in England has fallen by almost 3,000. After a promise to clear all patients waiting 78 weeks or more for treatment by April this year, which was a shockingly low bar, the number rose last month from 7,300 to 9,000 patients. Despite making it one of their flagship five pledges to cut waiting lists, the Government have again broken their own record this month, with the number of patients waiting now at 7.8 million.
This Government cannot be trusted with the future of the NHS. Whether it is the social care crisis or the RAAC—reinforced autoclaved aerated concrete—scandal, the Government have literally failed to fix the roof while the sun was shining. The NHS will not survive another five years of this. Labour’s 10-year plan of change and modernisation will build an NHS fit for the future, shifting the focus of healthcare from the acute sector into the community to boost prevention, diagnose conditions earlier and provide treatment closer to people’s homes.
In closing, I want to put on the record my deep thanks to all our NHS staff for going above and beyond for patients, and especially everyone at the University Hospitals Birmingham trust in my constituency, which is the largest trust in the country.
Mark Pritchard (in the Chair)
The Minister of State may speak for 10 minutes, but there are a couple of extra minutes as well. In addition, the convention is to allow the mover of the motion a couple of minutes to wind up, so he has a lot more latitude than usual.
Community Pharmacies
Preet Kaur Gill Excerpts(7 months, 3 weeks ago)
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Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)
It is a pleasure to serve under your chairmanship, Sir Mark. I thank the hon. Member for Waveney (Peter Aldous) for securing this important debate, and I congratulate him and Members on both sides of the Chamber on putting forward a compelling argument for supporting our community pharmacy sector and increasing its role in the provision of localised community healthcare. I thank my right hon. Friend the Member for Knowsley (Sir George Howarth); the hon. Member for Winchester (Steve Brine), who chairs the Health and Social Care Committee and who made some excellent contributions; my hon. Friend the Member for Bradford South (Judith Cummins), who has been campaigning on this issue; the right hon. Member for Tatton (Esther McVey); and my hon. Friend the Member for Coventry North West (Taiwo Owatemi), who is a pharmacist and who shared her first-hand experience of some of the challenges. We have heard some great contributions in this debate.
It is a great pleasure to take on this important portfolio covering primary care and public health. In this year—the NHS’s 75th—its founding mission, to deliver care to everyone who needs it, when they need it, free at the point of use, is clearly under threat. Thirteen years of Conservative Government have left the NHS flat on its back, and the rightful expectation of my constituents and people across the country of an NHS with time to care for them when they need it is being trampled. We see longer waiting times, a postcode lottery in care and, shamefully, for the first time in decades, healthy life expectancy falling in many regions across the United Kingdom, including the west midlands, which I represent. That is one of the starkest indicators of how this Government, far from levelling up the country, have let it down.
The NHS is Britain’s greatest institution and my party’s proudest achievement, and nothing gives me fire in my belly like the prospect of what a Labour Government will do to fix it. Community pharmacy is a huge part of that, relieving pressure on overstretched GPs and delivering first-class care and advice to patients. As many hon. Members have highlighted during the debate, it is high time we realised the potential of pharmacies; as with the vaccine roll-out during the pandemic, they have proven time and again that there is so much more they can deliver as part of the primary care mix.
Pharmacists are the third biggest profession in the NHS, with around 13,000 community pharmacists across the UK, and together they prescribe more than 1 billion medicines a year. Not only are pharmacists medicine experts within the NHS, but colleagues have acknowledged their wider skills and knowledge, which are under-utilised. It is estimated that pharmacists give around 58 million informal consultations to walk-in patients a year, saving 20 million GP appointments. We also know that drug-related problems, often resulting from poor medicine management, cause around 15% of hospital admissions and cost the NHS hundreds of pounds a night, so pharmacies have an enormous contribution to make to the wider system.
Chemists do far more than just dispense repeat prescriptions and sell shampoo. They provide a range of clinical services in prescribing for common ailments and have a key role to play in public health and preventive services. There are great examples of innovative public health work that pharmacists are doing, such as in Bradford, where the “Wise Up to Cancer” initiative promoted health literacy among south Asian women, or the Jaunty Springs Health Centre in Sheffield, where a shared care agreement between the pharmacy and GP surgery meant that a majority of health interventions could be delivered in the pharmacy consultation room, freeing up the GP and cutting waiting times.
There is good practice in pockets across the country that we should be building on. I know that Ministers have belatedly acknowledged that, and there has been some expansion of the clinical services that pharmacies offer in recent years. However, a few sticking-plaster proposals really miss the opportunities that are there. Will the Minister update us on how negotiations with the sector over the Pharmacy First launch are progressing, and can he promise that it will be operational in time for the flu season? What consideration has he given to expanding Pharmacy First to establish a community pharmacist prescribing service covering a broader range of common conditions?
The Minister will know that in some countries, which are way ahead of the Government on this, such as Canada, pharmacists can prescribe for dozens of common conditions, freeing up millions of appointments in general practice every year. What is his long-term strategy to equip pharmacies for a future where their talents, capacity and expertise can be fully utilised and to fix the front door of the NHS?
Hon. Members have also raised a number of concerns about the financial pressures facing pharmacies. I know that the sector appreciates the additional funding announced in May, but that is of course tied directly to its expanded responsibilities as part of the primary care recovery announcement and does not recognise how current cost pressures are impacting the sector. Since the community pharmacy contractual framework was signed in 2019, the cost of doing business has continued to rise—especially since the right hon. Member for South West Norfolk (Elizabeth Truss) crashed the economy.
The result has been many pharmacies closing their doors for good, disproportionately in the most deprived areas, as analysis from the Company Chemists’ Association has found. Last year alone, 110 pharmacies shut up shop, and many more have had to reduce opening hours, services and staffing. Will the Minister say what assessment he has made of the risk of more pharmacies closing down and reducing operations before the end of the current funding settlement in 2024 and what impact that will have on the NHS medicines supply, the knock-on pressures on other parts of primary care and the prospects for extended clinical services in the community setting?
As the Minister will know, the 2019 funding agreement was made on the promise that the Government would drive wider efficiency savings and regulatory changes across the system. For many community pharmacies, the roll-out of the hub-and-spoke model was an answer that would allow them to streamline their services. However, it has been 14 months since the Department of Health and Social Care’s consultation on hub-and-spoke dispensing closed, and we have still had no response from the Department, nor the secondary legislation that was promised. Can the Minister please give us answers today about the considerable delay in progressing with hub-and-spoke reform? What is the hold-up?
I would also like to raise the issue of staffing with the Minister. The community pharmacy workforce survey released last month revealed that, compared with 2021, there was a 6% reduction in the full-time equivalent workforce in 2022. The vacancy rate for pharmacy technicians was about 20%, whereas it was 16% for pharmacists and 9% for dispensing assistants. Two thirds of contractors said that they found it very difficult to fill pharmacist roles last year, and in turn, the bill for locum pharmacists rose by 80% last year alone. Many chemists are struggling to cope with those pressures, contributing to thousands of unplanned closures every month. That is bad for the taxpayer and bad for patients, so what assessment has the Minister made of the challenges faced by community pharmacies in hiring, training and retaining skilled pharmacy staff? Does he recognise that the Government’s workforce strategy has not kept pace with the scale of change in the sector? Does he share my concern that without a functioning community pharmacies network, the Government’s primary care recovery plan is built on very shaky foundations?
The next Labour Government have a plan to reform the NHS to shift care from acute settings to the community. As part of our plans to build a neighbourhood health service, we will realise the potential of community pharmacies, giving people services that they can rely on and access earlier on their doorstep. That will mean accelerating the roll-out of independent prescribing to establish a community pharmacist prescribing service that covers a broad range of common conditions. It will mean cutting unnecessary red tape to allow pharmacy technicians to step up, ensuring that pharmacists can work to the top of their licence and make more of their considerable expertise in prescribing and medicines management, rather than having repetitive dispensing processes. All of that will be supported by greater digital interoperability, allowing the profession to support GPs in the management of long-term conditions.
The Minister will have heard the broad support for the sector in today’s debate, as a trusted and cost-effective measure for addressing some of the chronic challenges we have come to expect under this Government. I look forward to his answers on what more he is doing to support this important sector and realise the potential of the pharmacy profession.
Oral Answers to Questions
Preet Kaur Gill Excerpts(4 years, 1 month ago)
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Edward Argar
My hon. Friend is right. I do not intend to prejudge the consultation, but I agree that his constituents should look very carefully at the evidence of what it will do to save lives and improve healthcare and respond accordingly.
Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)
Matt Hancock
I can confirm that we will ensure that whatever the status of people working across the economy, whether they are self-employed or employed but working fewer than the set number of hours a week, they will get the support that means they are not penalised for doing the right thing.
Children’s Mental Health Week
Preet Kaur Gill Excerpts(4 years, 3 months ago)
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Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)
I am sure that my esteemed colleagues, including the Minister, will have already read my article concerning this important debate on the PoliticsHome website today. But I do understand the competition for parliamentarians’ time, so I have brought with me a hard copy that I am happy to share if anyone would like to read it. Those more digitally minded can find it on the website.
The mental health of thousands of children and young people has reached crisis point. This week is Children’s Mental Health Week, intended to shine a spotlight on the importance of children and young people’s mental health. The Mental Health Foundation has found that childhood determinants are the primary factor in future mental wellbeing, with over three quarters of all mental health problems emerging by the age of 20. The Government set out their ambition in their mental health Green Paper in 2017. However, does the Minister agree with analysis by Barnardo’s stating that the plans let down children and young people in three quarters of England who will see no improvement by the end of 2022-23?
I hope that everyone in the Chamber will agree with me that no child should have to reach crisis point to get help—but far too often, as we all know, that is the case. A crisis can come in many forms. It can be seen in the criminal justice system, where a staggering 95% of 15 to 21-year-olds in custody have been found to suffer from a mental health disorder. It can be seen in the tripling in the number of young people under 18 with a recorded diagnosis attending A&E since 2010. It can be seen in the 74% increase in suicide rates for 10 to 19-year-olds since 2010. It can also be seen in Local Government Association findings that social services were seeing more than 560 cases of children with mental health disorders every single day—an increase of more than 50% in four years.
Dr Julian Lewis (New Forest East) (Con)
I hope that I am not pre-empting what the hon. Lady is about to say, but does she feel that the explosion in social media and addiction to it among young people plays any part in the terrible increases that she is describing?
Preet Kaur Gill
The right hon. Gentleman makes that point very well. A lot of research has been done on this by the Royal Society for Public Health. It is a contributing factor—one of which there are so many.
Looking after our children and young people requires children’s and young people’s mental health services to be properly resourced. At the moment, this is simply not happening. Almost a quarter of NHS child and adolescent mental health wards were rated as inadequate or requiring improvement by the Care Quality Commission in 2019. We also know that we have a huge shortage of mental health professionals, with a workforce that has hardly grown since 2010. According to the Royal College of Psychiatrists, we need an additional 4,370 consultant psychiatrists to meet current Government commitments. A recent British Medical Association survey revealed that almost two thirds of nurses said that on their last shift there was a shortage of one or more nursing staff. So can the Minister tell me how these shortages will be addressed?
Jim Shannon (Strangford) (DUP)
I thank the hon. Lady for this absolutely superb Adjournment debate on a very critical issue. While there is, as she says, an onus on Government to respond, does she recognise that, as the health charity Place2Be says in early-day motion 137, tabled only this week by me and others—it also says that the theme of this year’s week is Find Your Brave—schools, churches and voluntary sector youth organisations also provide help to children at a time when they need it?
Preet Kaur Gill
The hon. Gentleman makes a really important point. Far too often, we do not recognise the work that schools are doing, and the charity sector, especially, has contributed significantly. Importantly, the Green Paper does not recognise that.
Today I want to focus on the public health approach, utilising early intervention and prevention. This is far too often overlooked, but it is a vital part of any attempts to tackle the crisis we are facing. Furthermore, if we fail to support children at an early stage, we will inevitably feel the impact further down the line when emergency services will be forced to step in. That is what we are seeing at the moment, and change clearly needs to happen.
So what am I talking about and what does it look like in practice? Let us take local government. Because of huge cuts by national Government, 60% of local authority areas have seen a real-terms spending drop on mental health services for children that come under the “low level” bracket, which includes early intervention for things like eating disorders and depression. Or let us look at our creaking and failing criminal justice system. Research by Revolving Doors found that children of offenders are three times more likely to have mental health problems or to engage in antisocial behaviour than their peers—and, as I said, almost all 15 to 21-year-olds in custody suffer from a mental health disorder. Reducing reoffending and the number of parents experiencing incarceration is not just a good in itself but may prevent their children from having mental health problems and reduce the likelihood that the child is involved in offending in the future. Will the Minister explain why, in answer to my written question, the Department for Health and Social Care admitted last week that it had
“not made a formal assessment of the adequacy of mental health services or mental health assessment in Young Offender Institutions”?
Let us take community-based mental health services. The Care Quality Commission, in its review of healthcare and adult social care in England in 2018-19, found that 21% and 10% of community-based mental health services for children and young people are rated as “requires improvement” or “inadequate” for the responsive key question.
Take schools, which the hon. Member for Strangford (Jim Shannon) mentioned. Schools in Birmingham are facing a funding shortfall of more than £90 million in 2020, but they are still working hard to fund their own mental health support or arranging peer mentors. Why are they doing that? One reason is that waiting times for referrals—if the referral is even granted—are far too long. Last year, I conducted a survey of schools in my constituency of Birmingham, Edgbaston and discovered that 90% had seen an increase in staff and students suffering from mental health problems. That is not sustainable without a substantial increase in support for our schools. Take looked-after children. According to Government data, they are nearly five times more likely to have a mental health disorder than their peers.
Take poverty. The TUC found that poverty in working households has increased by 800,000 since 2010. Poverty contributes to mental wellbeing. The Centre for Mental Health’s Commission for Equality in Mental Health found that children from the poorest 20% of households are four times more likely to have serious mental health difficulties by the age of 11 than those from the wealthiest 20%.
Ms Lyn Brown (West Ham) (Lab)
My hon. Friend’s speech is resonating with me. In the conversations I have had with primary school teachers, they talk about the stress that children as young as six, seven and eight are under because their families are struggling to pay the rent, despite the fact that the parents are at work. Poverty is a major driver of this. We have to tackle both things—the mental health needs of our young people, but also the poverty in which they live.
Preet Kaur Gill
My hon. Friend is right; poverty has consequences.
Take social security. The Government’s flagship policy of universal credit is not only driving more households into poverty but is creating a climate of fear and threats. Those are all factors that lead to poor mental wellbeing.
No child should have to reach crisis point before they are able to get help with their mental health. We cannot pretend that the causes of mental health are simple or that they are not impacted and exacerbated by inequalities and injustice. The Centre for Mental Health has rightly raised the futility of funding mental health services that support symptoms if those resources are diverted from preventive measures to tackle poverty and inequality, including policies in the criminal justice system, education, public health, youth services, housing and social security.
Those sectors and services are all in vital need of long-term, sustainable support, and that is why I am calling on the Minister to ensure that a public health approach is introduced that promotes mental wellbeing, prevents future mental health problems and supports recovery from mental health issues. There are different ways to achieve that, but I would like to ask the Minister to take the first step and, with a reshuffle imminent, ask the Prime Minister to introduce a children’s wellbeing commissioner, or similar, with real teeth, powers and resources to work across Departments.
Ms Dorries
The hon. Member is absolutely right, and I will come on to the workforce in a moment.
Making sure that people recognise this issue was part of the Every Mind Matters campaign. I do not know if everybody saw that, but we had the royals and celebrities such as Davina McCall promoting the Every Mind Matters campaign. We did that to reduce the stigma and to show that it was okay, because really successful people—hugely high achievers in society—have mental health issues and are concerned about mental health. Part of the project was to break down the stigma associated with mental health, which is a bit of a barrier to people accessing mental health care, and to get over that stigma to begin with.
We know that an increasing proportion of young people are seeking mental health help from the NHS, and we are responding by already ramping up capacity. We are on track to meet our commitment to improving access. By next year, 70,000 more children and young people will be accessing specialist treatment each year, compared with 2014-15. That equates to 35% of children and young people with a mental health condition, and that is starting from zero.[Official Report, 12 February 2020, Vol. 671, c. 9MC.]
Preet Kaur Gill
Can the Minister expand a little on how those young people are going to access that specialist support, because an early years counselling service in my constituency has a waiting list of 500 young people? It really does concern me, because the only way they are going to get any support is when there is actually a crisis. She keeps referring to the money, but can she give a bit more detail about what people can expect on the ground?
Ms Dorries
Indeed; I will go on to address access and waiting times. The money that has been given to CCGs to spend on children and young people’s mental health is ring-fenced, and the hon. Lady might want to go back to her CCG and ask to see how much money it has been given by the Government and how it is being spent so that she can assure herself that the money we are providing to her CCG is being spent on children and young people’s mental health and is not being siphoned off somewhere else. Claire Murdoch and her team at NHS England have been looking at CCGs across the country where they think there are problems and mental health services are not being commissioned adequately, but the hon. Lady may want to go away and do that with her own CCG, and check that it is spending the money that has been given on children and young people’s mental health.
Preet Kaur Gill
I think what my CCG will say is that the money is just not adequate. Birmingham is one of the youngest cities in the country; there are so many issues across the city in terms of trying to access care and there just are not the resources and the services, and we are not doing enough to engage our charity sector or support schools. I know that the Government have made an announcement about providing counsellors in secondary schools, but what about early intervention—what about primary schools given that we understand those issues are manifesting themselves very early on? Why are we allowing things just to continue and therefore having to spend much more money later on? That does not seem to make any sense.
Ms Dorries
It would not be appropriate for me to respond to that because autism is not in my brief as a Minister. That comes under the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage), but I will make sure that the hon. Member gets a response to that question.
To turn to the children and young people’s mental health Green Paper, every school will be encouraged to have a senior lead for mental health as well as access to mental health support teams, which are the trailblazer schemes.
Preet Kaur Gill
Does the Minister think that it is right that we will be expecting teachers to take on another role? They are already leads for safeguarding, FGM and Prevent—a huge array of things. Does she really think that that is right and that it will address the issues?
Ms Dorries
As I explained, we have the trailblazer schemes—we are putting fully qualified, dedicated mental health workers into schools. I imagine that some of the schools in the hon. Member’s constituency will be beneficiaries of that, so the responsibility will not be with the teachers; it will be with the mental health workers. I absolutely take her point: teachers have a huge amount to do. I will check with my officers which schools in the Birmingham area have trailblazer schemes and whether they are due to go in to help her. She described her area as having 500 young people waiting, so I am sure that it is very much on the list. I will also check with Claire Murdoch at NHS England, which is responsible for delivery. It is quite interesting that whenever I say to constituents in my surgery, “The Government provide the money and the policy but NHS England is responsible for delivery,” they say to me, “Who are NHS England? I don’t know who they are. You are the Government.” However, it is responsible for delivery so I will check with Claire Murdoch what is happening in the hon. Member’s area and where the trailblazer schemes are going.
Mental health support teams will be rolled out to a fifth of schools. I am sure that the hon. Member will be pleased to know that the new schools-based service is in addition to existing provision for children and young people with mental health needs. It is in addition to the additional funding that has been given to the care commissioning groups. I will also touch base with her commissioning group. One of my concerns has been that the money that is ring-fenced for children and young people’s mental health is perhaps not always being spent on what it should be spent on, so I will touch base with it. That would also give us a better picture of what the care commissioning group is dealing with. These new plans will significantly increase the availability of mental health support to children and young people and build on existing provision.
On the workforce, to deliver and spend the money, most of which will go on salaries, we need the people to spend it on to deliver the mental healthcare. We are not complacent about the scale of the workforce challenges associated with achieving the very ambitious plans for mental health services, and making transformation a reality will require significant shifts and innovation in the way in which we deliver our services.
We have seen promising results from NHS Improvement’s work to improve retention among mental health trusts. I spoke to a group of students recently who were considering healthcare as a future career; they were considering midwifery. We need more midwives. We have a lovely, glamourised image of the role of midwives from the television, from “Call the Midwife” and “One Born Every Minute”. People who are considering going into NHS caring professions are looking at the more glamourised areas of care, and I am struggling to persuade people that mental health is a fantastic, rewarding career. We want more mental health nurses. In fact, two weeks ago, I announced that the grant for those who want to work in mental health nursing will be £8,000—they will get the upper tier.[Official Report, 12 February 2020, Vol. 671, c. 10MC.] They will also get assistance with childcare costs. So I ask people who are considering nursing overall as a career please to consider mental health nursing. I know how difficult it is. When I was training to be a nurse, we were offered 12-week placements in maternity or psychiatry, and my entire cohort chose maternity, so I know the challenge that I am up against. We need to increase the workforce, but we need to attract more people to that area.
Social media was mentioned earlier. In that regard, the NHS holds only part of the answer. We must do more across Government to protect the mental health of our children, and that includes protecting young people against harmful online content. We now know more about the impact of social media platforms on the health and wellbeing of our young people, and the need to manage the detrimental impacts. The scale of the challenge that we face in protecting children online is vast. That is why the chief medical officer commissioned an independent review of the evidence, and gave advice about setting boundaries for children and young people online. The Government’s “Online Harms” White Paper sets out a range of legislative and non-legislative measures detailing how we will tackle online harms, and also sets clear expectations for tech companies to keep children safe.
My right hon. Friend the Member for New Forest East (Dr Lewis) mentioned online harms earlier, and he was absolutely right. We face many challenges in our modern society, such as poverty—which was mentioned—as well as online social media and addictions, and many of those challenges filter down and have an impact on young children.
I am extremely proud of what has been achieved so far in relation to children’s and young people’s mental health. As I said earlier, we have achieved more than any previous Government, including those of my own party. We are increasing funding massively, and we are introducing a whole new service through mental health support teams so that more children and young people than ever before—345,000—will be able to access mental health support. We have made huge progress on putting mental health on the same footing as physical health.
Preet Kaur Gill
We know that the Care Quality Commission has raised numerous concerns about mental health provision and instances in which young people are not receiving the care that they need. The Minister says that it is the responsibility of NHS England to deliver on that, but what more does she think she can do to put pressure on NHS England? What can we do? I do not understand how it is possible for a care provider that has been rated inadequate to continue to provide care for other people. Who should intervene if the necessary changes have not been made, and the CQC has allowed a young person to continue to receive inadequate care?
Ms Dorries
I am not sure which service the hon. Lady is talking about. If she is talking about an in-patient unit, perhaps she would like to speak to me afterwards so that I can obtain some more information for her, rather than just guessing. As for how we can ensure that NHS England delivers, I have regular meetings—in fact, I had a meeting yesterday afternoon—with both Claire Murdoch and Tim Kendall to get updates. Just a couple of weeks ago, Claire announced the launch of the first ever gambling clinic. They are working very hard at NHS England to deliver the long-term plan. As I have said, however, it is a long-term plan. The bath was empty, but the plug is now in, the taps are on, and it is filling up. Claire is working her socks off, as is everyone else, to deliver as rapidly as possible, but the other side of the coin is the workforce—getting the mental health nurses in and trained, recruiting them through universities, which has been more successful, and finding people who want to attract others to work in mental health. Claire is delivering those services as fast as she can, but they do not deliver themselves. They need people to deliver them, and that is what we are working so hard on.
In the context of NHS England, the hon. Lady asked what we could do. It is my job to hold it to account, and I can assure her that I am doing that every step of the way. Most people who work in mental health know Claire Murdoch and her 45-year reputation of working in mental health. She is a formidable force, and I do not think that anyone is going to prevent her from delivering as fast as she can. She has said to me that we have never had it so good and that we are going to motor ahead with this. That is exactly what is happening.
The Prime Minister has announced his absolute commitment to mental health, and I am confident that by continuing with record levels of investment, improving access and waiting times and focusing on prevention as well as treatment, we will provide a brighter and healthier future for all our young children.
Question put and agreed to.
NHS Funding Bill
Preet Kaur Gill ExcerptsTuesday 4th February 2020
(4 years, 3 months ago)
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Anne Marie Morris
The hon. Lady is absolutely right. The challenge, as she recognises, is how we change the language in a way that is accepted and becomes the norm. Part of this is having a much greater focus, as I hope the Secretary of State and his team ultimately will, on wellness, because that is absolutely as important as dealing with the illness when it happens.
We need to remember that in terms of stages of intervention, the whole lifecycle is not just about birth, education and the workplace; it is also about the elderly and veterans, for whom there is often not as much done to identify need and provide support. An older person in a rural area will often have the need but because they are simply out of scope—under the radar—they will, for a very long time, suffer in silence to a point beyond which they cannot be helped. The challenge of mental wellness/illness for older people needs to be a specific focus.
For all that we say, and rightly, about the importance of ensuring that our veterans are properly diagnosed and properly supported, I am certainly conscious of veterans in my constituency who are struggling to get help and support, or even an initial diagnosis. Sometimes the support they need is so complex that they can only get it in London. For somebody who does not have good mental health, the journey from Devon right the way up to London is something they simply cannot conceive of and make a reality.
I am extremely grateful to the Minister for sitting and listening to my thoughts, and for understanding my approach in terms of looking at this in a much more holistic way and seeing how we might measure and report on it so that we can demonstrate to people that we are making progress on parity of esteem. We should look at inputs as well as outputs. I look forward with a great deal of interest to his reply on the points that have been made, particularly on outputs in mental health.
Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)
I rise to speak to the amendments in my name and the names of my colleagues.
As we have all heard, our NHS needs to be properly resourced in both physical and mental health, but far too often patients are losing out under this Government, with longer waiting times, a huge increase in cancelled operations, and crumbling hospitals. Colleagues have already raised these important issues. I urge the Government to accept the amendments in the name of the Leader of the Opposition as a real signal of their intent to reverse the damage that their party has done to our national health service over the past 10 years.
My amendments focus specifically on mental health. The Government have made much of the need to ensure parity of esteem. This would mean us valuing mental health equally with physical health and adopting an approach that tackles it using the same standards that we expect for physical health patient treatment as a template for treatment that we provide for mental health patients.
I have heard warm words from the Prime Minister, the Secretary of State and Ministers about the importance of mental health and the growing need to tackle mental ill health as an urgent priority, but I have not yet seen that wholehearted commitment manifest itself in actions to tackle the situation we are in. The British Medical Association found that the mental health workforce has had little growth over the last 10 years. The Royal College of Psychiatrists found that the rate of unfilled NHS consultant psychiatrist posts in England has doubled in the last six years. The first briefing paper from the Centre for Mental Health’s Commission for Equality in Mental Health found that mental health inequalities are closely linked to wider injustices in society. Far too many patients with a mental illness are still being sent hundreds of miles away from home.
By accepting the amendments in my name, the Government would show that they are willing to be transparent about the way they go about achieving their long-stated aim of parity of esteem. The Government have already shown, with the presentation of this Bill, that they think it is a good idea to commit, in law, to a minimum allotment that the Secretary of State will make to the health service in England in each financial year for the next four years. That is designed to show that their promise is legally binding and can be scrutinised by Parliament and the public if they do not reach those targets.
To ensure that our mental health services are properly resourced and truly responsive to the various complex conditions that people present with, the public need to know how much is being spent, including how much is being proposed, and what happens in practice. That is all my amendments seek to do—they would provide Parliament and the public with the opportunity to compare the proposed allotment with the final allotment across different years.
Of course, that is not enough, and it is clear that additional resources for mental health services are only one part of the answer to tackling the mental health problems in this country. We know that education and training services are essential to bring about the necessary increase in the workforce. We know that local government provides significant elements of mental health support through public health, youth services, housing and social care, and two thirds of schools fund their own mental health support. We also know that the Government’s roll-out of universal credit will exacerbate mental health inequalities, which all too often relate to people’s economic and social circumstances. This is not the time to go into those in detail, but I urge the Government to remember the need for those essential services to have a long-term funding settlement and, in the case of social care, an agreed basis for future financing. With ambitious targets to meet in the long-term plan, there is a risk that resources will be diverted from other areas of mental health support to achieve compliance.
I would like to invite colleagues across the House to join me on Thursday for my adjournment debate on Children’s Mental Health Week, which is this week, to discuss these issues further. I know what a commitment to transparency on mental health spending would mean for all those suffering mental ill health and those fighting for them. I hope that the Secretary of State will accept amendment 1 and new clause 1, to ensure that mental health services get a fair deal from the legislation and that pledges made by the Government and NHS England are realised in practice.
Bim Afolami (Hitchin and Harpenden) (Con)
It is a pleasure to speak in this debate, because it is a rare one in so far as there is quite a lot of agreement across the Committee on the substance of it. There appears to be agreement—I await an intervention if anybody disagrees with this—that increasing funding for the NHS is a good thing, that it is good that mental health is a Government priority and that it is very important to establish what parity of esteem means in practical terms.
I would like to take this opportunity to describe what I have seen in my constituency in terms of the importance of mental health and how the increased funding will make a practical difference. One way in which the funding will make a difference is with mental health support teams. There are mental health support teams in 25 areas in the country. Hertfordshire was picked as one of those 25 areas, and we have two teams—one in my constituency, and one just outside it—that effectively piloted a hub-and-spoke model. As the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) said, it is Children’s Mental Health Week, and the aim of that model is to ensure that young people get better mental health support in and around their school, working in conjunction with the NHS.
As I have seen in my constituency and everywhere I go, when I speak to young people, one of the first things they ask me is, “How can we improve mental health?” Whenever I have spoken to young people, their teachers or local NHS staff, they say this model has the potential, as it is rolled out and developed over the coming months and years, to make a real, fundamental difference. If people are looking for the practical impact of our increased funding for mental health, these teams are one way in which we are already starting to make a difference, not just in my constituency but across the country.
I would like to mention a couple of charities I am involved with that are starting to work in an integrated way with the NHS in improving young people’s mental health. There is a charity called GRIT—a word in politics that we should all remember—or Growing Resilience in Teens. It was set up by a fantastic doctor in Hitchin called Dr Louise Chapman, and it does what it says on the tin: it is about growing resilience in mental health.
As politicians, when it comes to legislation or speaking to each other in the Chamber or outside, we think often about pounds and pence and talk about structures such as hospitals and stuff that can be measured in a very easy way, or at least what we think is an easy way. However, growing resilience is one of the things we need to ensure the NHS does more effectively. Not just in mental health, but particularly in mental health, growing resilience in our young people is an integral part of prevention. The former Secretary of State, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), talked about that in his speech, saying that half of mental health problems are established before a young person is 14.
We need to grow resilience among young people to future-proof each and every one of us, and our communities and our society, against serious mental health problems in the future, at the same time as investing in mental health services such as CAMHS, which has already been mentioned several times in this debate. However, we need to do both: to grow resilience and to improve the institutional frameworks. Again, that is what the money this Bill is providing will go towards.
Another charity is called Tilehouse Counselling, which again is based in Hitchin. I do not mean to say that Hitchin has all the charities in my constituency, but in this area Hitchin is a real regional leader and, indeed, a national leader. Tilehouse Counselling provides counselling services to young people, and young people often find themselves at Tilehouse when CAMHS does not have the capacity.
I urge the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), who is on the Treasury Bench—she knows this because everybody knows how much she cares about the NHS, how much she knows about it and her own personal experience in it as a professional—to use the money provided by this Bill to increase the workforce and to improve the state of CAMHS so that it can treat more people. Again, that means helping the mental health hubs to work with young people and the education system to improve prevention and, when mental health intervention is needed later on if things have got more serious, making sure that CAMHS has more capacity. Again, the money in this Bill will help to provide that.
Another new organisation in my constituency is called GoVox. It has already been in discussions with NHS Digital, and NHSX, about online ways of improving mental health for young people. Increasing funding matters, and it is always worth stating and restating in the Bill that these are minimum numbers, not maximum numbers. This money is hugely needed, and it should make a big practical difference.
On the pleas from Opposition Members—in relation to new clauses 1, 2 and 9, and a few others, which say that the Government must report on this or must do that—I urge the Minister for Health to commit in his response to showing how he and the Government will improve the existing reporting procedures and mechanisms so that the House can be kept fully informed. My right hon. Friend the Member for Wokingham (John Redwood) spoke about how Members of Parliament often feel distant, not from information about funding, but from outcomes. Will the Minister explain how the Government could improve that delivery mechanism, as that would allay some concerns across the Committee?
Health and Social Care
Preet Kaur Gill Excerpts(4 years, 3 months ago)
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Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)
It is an honour to follow the hon. Member for North West Norfolk (James Wild) who, along with many hon. Members this afternoon, made an excellent maiden speech. I wish him well and look forward to working with him and all new Members.
Two months ago, I stood in this Chamber and spoke of my disappointment that the Queen’s Speech included only one reference to mental health, and even that was a reference to the Mental Health Act 1983, rather than a systematic programme to tackle mental health across all demographics. According to research by the Children’s Society, of the 22,365 children in Birmingham, Edgbaston, an estimated 2,733 five to 19-year-olds are struggling with mental ill-health. That is more than 10%. At the same time, the money available for local services for children and young people has fallen by 38%. Is it any wonder that just last week, research by the Education Policy Institute revealed that more than a quarter of child referrals for children and young people’s mental health services in England last year were rejected? Even when a referral was accepted, many children had to wait for an average of two months to begin treatment in 2019—double the Government’s four-week target. Birmingham Women’s and Children’s Hospital has a median wait time of 112 days. That is almost four months.
A decade of neglect in early intervention care, and an under-resourced mental health services sector, has meant that many more young people are turning up to A&E. I had hoped that the Government would have listened when I raised the issue in the debate on the previous Queen’s Speech, but given a second chance, the Prime Minister has failed once again to show that he is serious about tackling mental ill health. Yes, reform of the Mental Health Act 1983 is important and desperately needed, but the Government also need properly to fund vital preventive services.
For the many new Members of Parliament, I will repeat the shocking statistic that failed to elicit any action last time: for the whole of Birmingham there is only one early intervention counselling service for young people. The most recent waiting list has 400 young people and their families who are waiting desperately for treatment and support. The only conclusion I can draw is that the Conservative Government are knowingly and willingly failing our children and young people.
We know what we need. We need genuine parity of esteem. We must use the standards that we expect for physical health treatment as a template, and apply them to mental health patients. We need mental health services that are truly responsive to the complex conditions with which our young people frequently present. We must listen to young people when making decisions about the mental health services they use. I will ask the Minister once again: will he listen to those of us who are calling for the Government to do more for young people with mental ill-health, and deliver on the promises that his party has been making—promises that it has so far been breaking?
As a former social worker, I was surprised that the Queen’s Speech failed to commit to a review of children’s social care—the vital system that is designed to protect some of the most vulnerable in our society. That total and utter dereliction of duty follows cuts of almost a third in services for children and young people since the Conservatives came to power. Children’s social care is coming apart, despite the best efforts of hardworking councils around the country.
It should not be just about this; it should not just be firefighting. Social care should be about providing a system to support every child. We must give children the opportunity for the best start in life, whether that is in the form of late intervention such as safeguarding teams that step in in instances of abuse or neglect, or whether it is early intervention such as children’s centres and programmes that support parents and youth services. Children’s services are not only about looking after children in care; they provide effective family support services that help more children to stay in their homes if it is safe to do so. The Conservative party manifesto recognises the underfunding of children’s social care. Does the Minister agree that local authorities still do not have sufficient resources to address rising demand, even if his Government deliver on their manifesto commitment?