International Health Regulations 2005

Preet Kaur Gill Excerpts

Monday 18th December 2023 Westminster Hall

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to serve under your chairship, Sir George, on this debate responding to the e-petition 635904, which relates to the International Health Regulations 2005. It is wonderful to see so many of the public in attendance.

I thank my hon. Friend the Member for Lancaster and Fleetwood (Cat Smith), who is Chair of the Petitions Committee, for opening the debate. I also thank the right hon. Members for Wokingham (John Redwood) and for Rayleigh and Wickford (Mr Francois) and the hon. Members for Shipley (Philip Davies), for North West Leicestershire (Andrew Bridgen), for Devizes (Danny Kruger) and for Christchurch (Sir Christopher Chope) for their contributions. I was in the debate responding to a similar petition regarding the draft treaty on pandemic prevention, preparedness and response in April; I hope hon. Members who were also in that debate will forgive me for retreading some similar ground.

The covid pandemic was one of the most surreal and seismic events of our lifetimes. Hundreds of thousands of people died here in the United Kingdom and millions more were extremely ill. There are perhaps two million people still living restricted lives, who are now in their fourth year of shielding because they are clinically vulnerable to the virus—we should not forget them. As our economy and public services still recover, it is vital that we learn lessons and take steps to strengthen our resilience for the future, and I hope that the inquiry taking place at the moment will be a valuable resource in that respect. Our NHS was badly prepared, the Government’s handling of public health measures was chaotic, and we jumped in and out of lockdowns. Some measures, such as guidance issued to care homes and eat out to help out, were raised as concerns by Members of this House, including myself.

As we discuss the petition, we must recognise the international dimension of the pandemic, too. Deadly infectious diseases do not respect borders. It is therefore squarely in our interests to co-operate with other nations and support efforts to co-ordinate the global public health response. The lesson of the pandemic was that no one is safe until everyone is safe, so it is clear that global co-operation on pandemics and biological threats needs to be strengthened. Labour absolutely supports the principle of legally binding international health regulations that define the obligations of countries in handling pandemic-level threats. That is critical to our national health security.

The international health regulations under discussion have of course existed in various forms since the 1960s. The latest iteration came into force in 2007. As they stand, the regulations obligate the 196 state parties to develop national core public health capacities for the detection, assessment, control and reporting of public health events. At some international ports, airports and ground crossings, they require parties to notify the WHO of serious diseases with risk of international spread. They set some of the human rights and other protections for any of us travelling abroad—protection of personal health data, for example. Those requirements are hardly controversial, apart from the fact that they were not on their own sufficient to prevent the spread of covid-19 around the world. That is why we think they must be strengthened. Climate change and globalisation mean that biological threats are only becoming more common, and future pandemics could be deadlier than covid-19. If another epidemic strikes with that same infectious potential, we must ensure that we are better prepared.

The subject of debate today is how amendments to the international health regulations and the pandemic accord under negotiation at the World Health Organisation might actually impact the United Kingdom’s public health policy in the future. Earlier I mentioned some of the measures taken by the UK Government during the pandemic, ranging from interventions like eat out to help out to the three national lockdowns. The variety of those policies and how they compare with some of the other 195 countries who are also signed up to the international health regulations shows that the UK and other countries were able to exercise considerable discretion in their domestic responses to the pandemic.

It is important to emphasise this fact: the e-petition we are discussing asks for Parliament to vote on amendments to the IHR, which are being negotiated alongside the draft text of the pandemic accord that we debated here in April. It raises concern that Parliament has not voted on an amendment to which the UK Government agreed and that was adopted at the World Health Assembly last year. That is a process-related amendment under article 59 of the international health regulations, which reduces the time for future amendments to come into force to 12 months. Of course, until any such future amendments are agreed, it will have no impact on the United Kingdom.

In any case, the principles that protect our national sovereignty will remain. The democratically elected Government are responsible for negotiating, signing, ratifying, amending and withdrawing from international treaties under their prerogative powers. Any legislation, if necessary to implement the regulations, would have to go through the proper parliamentary process. No international treaty can, by itself, change United Kingdom law. As for the future amendment, it makes sense that, as the only international treaty on infectious diseases, changes to the IHR are considered alongside the draft text for the pandemic accord. Of course, as negotiations are still under way, nothing is agreed until everything is agreed.

[Mr Francois]

If what the hon. Lady says is true, why has Parliament just spent two weeks arguing about Rwanda? Can I ask her a direct question? She has heard many concerns expressed from the Conservative Benches about these proposed amendments. With the exception of the hon. Member for Lancaster and Fleetwood (Cat Smith), who introduced the debate, not a single Labour Back Bencher has even been present, let alone contributed. Here is the question: would a future Labour Government be minded to accept the spirit of those amendments to the WHO treaty or to oppose them? Our position is very clear. What is the hon. Lady’s?

[Sir George Howarth (in the Chair)]

Order. I understand that feelings are running high and people have areas that they want to explore, but I hope that any further interventions are brief.

[Preet Kaur Gill]

We all know that Rwanda is just a gimmick by this Government, and I think that I have already set out my position very clearly. I will continue to make my remarks so that the Government are absolutely clear as to where we stand on this issue.

I am pleased that the zero draft highlighted that states must retain sovereignty, and that the implementation of the regulations

“shall be with the full respect for the dignity, human rights and fundamental freedoms of persons”.

I ask the Minister to take this opportunity to update us on the progress being made in negotiations over the amendments and the draft text. Can he reassure our constituents that the Government would not sign up to anything that would compromise the UK’s ability to take domestic decisions on national public health measures?

[John Redwood]

I do not understand the hon. Lady’s argument. This amendment to the regulations would mean that the WHO could decide that there was a health crisis in our country, whether we thought there was or not. It could then tell us how we had to handle it in far more detail than its advisory work during the covid crisis—it would be mandatory. What does she not understand about that and why does she not disagree with it? [Interruption.]

--- Later in debate ---

[Sir George Howarth (in the Chair)]

Order. I say to those in the Public Gallery that I know that there are strong feelings and that they have come here with a great deal of interest in the subject, but they need to be quiet. It is not an occasion for applause or shouting out. I would be grateful if people respected that. Thank you.

[Preet Kaur Gill]

I think that I have made my position really clear, hence my question to the Minister. Our constituents want reassurance that the Government would not sign up to anything that would compromise our ability to take domestic decisions on national public health measures. Nothing has been agreed. Today is an opportunity to hear from the Minister about how those negotiations are going forward and what amendments have been accepted. I also want to hear from the Minister.

[Mr Francois]

On that point, will the hon. Lady give way?

[Preet Kaur Gill]

I am not taking any more interventions. The reality is that although the pandemic is over now, the threat is not over. We must never leave our country with such a soft underbelly again. We strongly support efforts to strengthen the international legal framework to prevent, protect against, control and respond to cross-border health threats. It is squarely in our interests and integral to our security to encourage other countries to commit to do the same.

Draft Health Care Services (Provider Selection Regime) Regulations 2023

Preet Kaur Gill Excerpts

Tuesday 28th November 2023 General Committees

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to serve under your chairship, Mr. Efford. I begin by reflecting on the story of these regulations. That goes back to the David Cameron era of reforms that came into force with the Health and Social Care Act 2012. Those flagship Conservative reforms turned the concept of competition into the organising principle in our NHS. They turned competition from one of the ways that the NHS was meant to operate into pretty much the only way to run the NHS. As that Bill went through Parliament, Labour argued that relevant authorities should have the flexibility to award contracts. We warned against excessive private involvement in the NHS and said that the marketisation of the NHS would act as a barrier to integration—which is crucial for our ageing population, who often have multiple conditions—and would ultimately lead to a worse service for patients. We were vindicated.

The NHS that the Government inherited from Labour in 2010 was judged by the Commonwealth Fund as the best and—crucially, when we consider the regulations—one of the most efficient healthcare systems in the world. A decade on, the NHS is in the middle of the worst crisis in its history, with the highest waiting times and lowest patient satisfaction. It has been left without the staff, equipment or modern technology needed to ensure that patients can be treated on time, and it has slid down the international rankings to the middle of the pack. Competition may have been the watchword of the Government’s NHS reforms, but in reality, the only competition it meant was a race to the bottom. Even the current Chancellor admitted that the reforms led to ridiculous fragmentation, wasteful bureaucracy and a worse service for patients.

The new provider selection regime is an opportunity to correct a decade-long mistake, and to move the NHS away from competitive retendering by default and towards the emphasis on collaboration and integration that Labour called for all along. I will not go so far as to call this another case of the Government pinching our ideas, given what a long struggle it has been to get to this point, but it is a chance to draw a line under a failed Conservative experiment. That is why I and the Opposition will support the new regime today.

The new regulations are an extension of the Health and Care Act 2022. As the Minister outlined, they are intended to provide relevant authorities with greater flexibility to award contracts, and they set out the key criteria that they must take into account when choosing the process to follow. More people now live with multiple long-term conditions and need support from several different services at the same time, so it is vital that services have the flexibility to work together more effectively and provide joined-up, co-ordinated care that meets their needs.

The Government were previously wedded to outsourcing services to private companies and to the flawed notion that financial competition drives up clinical quality, when in reality it has been a barrier to integration. That undermined the NHS in the years before the pandemic, but then we saw a new scandal emerge and staggering levels of waste and cronyism, represented most potently by the infamous VIP lane for covid contracts. A recent report by Transparency International UK stated that a fifth of covid contracts awarded by the Government contained red flags indicating possible corruption. An analysis by The New York Times found that roughly half of the 1,200 contracts it analysed, worth some £17 billion, went to companies run by friends and associates of Conservative party politicians.

I raise that issue because it highlights just how important it is that we get these regulations right. The rampant reliance on outsourcing and the waste and cronyism we have seen under this Government need to come to an end. Labour is clear that every penny of the public’s money should be spent wisely. That does not mean endless financial competition, and certainly not any more opaque backroom deals. We recognise that the independent sector has a role to play in the NHS if a service cannot be provided by a public body, because the capability or capacity is not there. Labour will always put patients first, which is why in the short term we will use spare capacity in the independent sector to treat NHS patients and bring waiting lists down as we reform and strengthen NHS-delivered services and capacity for the future.

I turn to the specifics of the regulations. I welcome the increased emphasis on provider quality and patient outcomes in the new provider selection regime. It is right that providers will be evaluated not only on their capacity to deliver services, but on their track record of achieving positive results for patients. That change should foster a culture of continuous improvement among healthcare providers. Does the Minister agree that authorities should engage with service users to accurately assess and develop services to meet their communities’ needs? Will he say why no such stipulation is included in the regulations?

The emphasis on quality and outcomes, and the inclusion of transparent performance metrics and patient feedback, are also welcome. Transparency is key to avoiding the cronyism that we saw during the pandemic. Will the Minister address the concern raised by the NHS Support Federation and others that prior notice of how commissioners plan to award a contract is reduced under the new regulations? Only in the most suitable provider process and the competitive process will the public know of the commissioner’s intentions to begin the decision-making process, meaning that many decisions will take place with no notice to the public. Does that not risk disempowering patients?

The Opposition also support the recognition of the value of providing continuity of care, allowing commissioners to prioritise providers providing good quality care over time instead of having to resort to competitive retendering by default. I know that that flexibility will be welcomed by commissioners right across the NHS, which is reflected in the 70% support among respondents to the consultation. Does the Minister agree that with this flexibility must come greater accountability, and that quality data will be critical to that?

My hon. Friend the Member for Ilford North (Wes Streeting) recently set out Labour’s plans to make sure that people can see how their local providers are performing and the progress being made towards our targets to empower patients and put their experience at the centre of the service. Does the Minister not agree that the NHS should be accountable to the many, not just the well-informed few, and that this is a critical aspect of the culture shift we need to drive innovation and continuous improvement?

The aspect of the new regulations with perhaps the greatest potential is the flexibility to innovate that they provide to commissioners. Last week, I had the pleasure of meeting Professor Sam Everington, the former chair of the Tower Hamlets clinical commissioning group and a GP at the Bromley by Bow Centre, which has been doing groundbreaking work with its multidisciplinary team providing community-based care. Professor Everington told me, for example, how one local doctor, sick of seeing young boys turning up on his operating table with stab wounds, set up a charity to follow up those admissions and help those boys to prevent further knife crime. They reduced repeat hospital admissions from 30% to 1%.

These partnerships are game-changing, but they do not happen enough and they have not been consistently incentivised by the current model. Can the Minister say how the new regulations will encourage integrated care systems to consider a diversity of providers, including voluntary and community sector organisations, to play a role in delivering innovative health and care services? Where is the Government strategy to ensure that, where innovation is working at a local level, the right incentives and resources are there to ensure that it is adopted elsewhere, bringing the best of the NHS to the rest of the NHS?

Can the Minister explain why it has taken so long to bring these regulations forward? The Health and Care Act received Royal Assent 19 months ago. In the meantime, these regulations have suffered several disruptive delays, leaving commissioners and providers alike in limbo, creating uncertainty and undoubtedly increasing costs for the taxpayer. What support are the DHSC and NHSE providing to commissioners in integrated care boards, trusts and other relevant authorities to ensure that these regulations are implemented quickly and smoothly? Can the Minister say how his Department will ensure that the regulations are monitored and reviewed, especially so that commissioners are supported in knowing which procurement process to follow, and when? Does he know what progress NHSE has made to establish the independent oversight panel to resolve complaints on choice and procurement issues? That will be critical to managing disputes and reducing the cost to the taxpayer from cases going to judicial review.

I note that a job advert for the role of chair of the provider selection regime review panel has just closed. Part of their role will be to recruit and review panel members and to establish and maintain its process. Can the Minister confirm that this will be ready for when the regulations come into force? Can he assure me that there will be no risk of corporate capture of this panel leading to conflict of interest?

The Opposition support the new provider selection regime as a break from the failed reforms of the last decade. As more people are living with multiple long-term conditions and need support from several different services at the same time, it is vital that services have the flexibility to work together and provide joined-up, co-ordinated care. If implemented successfully, we hope that the new regime will simplify health procurement, saving time and money. I look forward to the Minister’s response.

Future of the NHS

Preet Kaur Gill Excerpts

Tuesday 24th October 2023 Westminster Hall

[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

Thursday 14th September 2023 Westminster Hall

[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

Tuesday 10th March 2020 Commons Chamber

[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)]

T6. In response to an urgent questions from the shadow Health Secretary yesterday, the Secretary of State confirmed that emergency legislation being introduced to tackle coronavirus would include changes to statutory sick pay. Can he confirm to the House that the emergency legislation will include specific proposals to remove the lower earnings limit of £118 per week in order to provide access to statutory sick pay for 1.8 million low-paid workers?

[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

Thursday 6th February 2020 Commons Chamber

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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 Excerpts

Legislative Grand Committee & 3rd reading: House of Commons & Legislative Grand Committee: House of Commons & Programme motion: House of Commons & 3rd reading & Programme motion
Tuesday 4th February 2020 Commons Chamber

[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

Thursday 16th January 2020 Commons Chamber

[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?

The National Health Service

Preet Kaur Gill Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is an honour to follow the hon. Member for Glasgow South West (Chris Stephens), who made a passionate speech, especially in respect of the women born in the 1950s who have been denied their pension rights.

I was disappointed to see only one reference to mental health in the Queen’s Speech, and even then it was a reference only to the Mental Health Act. I was disappointed to see in the attached background briefing that the Government’s much vaunted parity of esteem does not stretch to any new funding for mental health services. One in 10 children and young people in the UK suffers at some point with mental ill health. In Birmingham, nearly 40% of the population are under 25. Mr Deputy Speaker, I am sure that you will be horrified to learn that, despite that, for the whole of Birmingham, there is only one early intervention counselling service for young people.

The most recent count of the counselling service waiting list saw 400 young people waiting for a service—that is 400 young people in desperate need of support who require treatment urgently; that is 400 young people who will have to wait months to see someone; and that is 400 young people and families who, in most cases, have nowhere else to turn. This unwillingness to recognise or properly fund vital prevention is yet another example of the Conservative Government failing our children and young people.

Is the Secretary of State surprised that more and more young people are ending up in A&E when we neglect early intervention care? We need to listen to young people themselves about the growing needs that they have. The Government are not doing that, which is why I have launched a young people’s mental health working group, supported by Open Door, which is a local counselling charity in my constituency, and the Centre for Mental Health. This group will use its unique perspective to help to shape the services that young people use for the better.

Young people have a voice that we need to listen to, so what steps are the Government taking to ensure that they work closely with young people with lived experience of mental health when developing legislative and non-legislative actions related to mental health? Cuts have consequences. Slashing budgets removes safety nets for the most vulnerable in our society and has knock-on effects. I am sure that the Secretary of State knows that excluded students are 10 times more likely to suffer from mental health problems. What steps is he taking alongside his colleague in the Department for Education to support those students, rather than just hanging them out to dry?

An inquiry by Birmingham and Solihull Mental Health NHS Foundation Trust into 11 deaths found that they were probably avoidable. That is unacceptable, and it is vital that lessons are learnt. With one of the highest levels of beds occupied by patients with complex needs and one of the lowest numbers of beds per 100,000—coupled with cuts and underinvestment under the Conservatives—what steps is the Secretary of State taking to ensure that my constituents will be properly looked after, and that no more families will be forced to go through the pain and heartbreak of being told that a loved one’s death was probably avoidable?

I will touch briefly on the Secretary of State’s favourite private healthcare company—or at least the one he talks about the most and publicly endorses while simultaneously insisting that there will be no more privatisation of the NHS under him. The Secretary of State is not alone in his support for Babylon and, as I am sure the House is well aware, the most senior member of the Prime Minister’s team advised Babylon as recently as last year. The reason that hospitals such as the Queen Elizabeth in my constituency are being forced to take risks in using totally unproven private technical solutions is that they are not receiving sufficient support from this Government. Over the past nine years, the Tories have stripped the NHS and made it about profit, rather than patients.

My constituents are rightly worried about the continued growth of companies such as Babylon, as its tentacles in Birmingham reach out beyond the GP at hand. The Secretary of State holds this company up as a beacon of light for replacing face-to-face services, but 94% of enrolled patients are under the age of 45 and two thirds live in more affluent areas. Can he tell me how it will work for my more vulnerable constituents, and will he give us answers to the myriad other justified concerns of GPs, CCGs and professional bodies?

I conclude by paying tribute to the magnificent practitioners and staff who work day in, day out across our various health services. I thank those who come from around the world to support us when we need it—due to mental health problems, physical ailments, old age or any other issue. These people deserve to be supported, properly resourced and treated with respect, and they deserve a Government who give them more than empty rhetoric. I am sorry that, over the last nine years, under the coalition and then the Conservative Government, they have not been treated in the way in which they deserve.

Health

Preet Kaur Gill Excerpts

Tuesday 14th May 2019 Commons Chamber

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

This week is Mental Health Awareness Week, and I fully support the need to break the stigma and talk about our own and others’ mental health. Public health has an integral role to play in improving young people’s mental health, but we live in a country where, because of the actions of the Conservative party, the funding and the ability to access care from trained professionals are being decimated. What happens when we realise that we need support? How long do we have to wait for help? What are we doing to provide support for people who are struggling and their families, who are left to cope without sufficient support? How do the Government expect to provide support when they have cut £700 million in cash terms of the public health grant to local government between 2015-16 and 2019-20, according to the Local Government Association, of which I am a vice-president?

Today I want to speak specifically about children and young people’s mental health. NHS figures show that one in eight people under the age of 19 in England have a mental health disorder, and half of all mental health problems start before the age of 14. I recently conducted a survey of schools in my constituency. In 10 of the 11 schools that have responded to the survey so far, the number of pupils suffering with mental health problems has increased over the last five years. One saw a 15% increase in the last 12 months alone, and all but one have seen these cases becoming more severe.

I want to place on record my thanks to my hon. Friend the Member for Ogmore (Chris Elmore) for his chairing of the all-party parliamentary group on social media and young people’s mental health and wellbeing. The group’s recent inquiry found that 27% of children who are on social network sites for three or more hours a day have symptoms of mental ill health. That stands against 12% of children who spend no time on such sites. The Government’s online harms White Paper concurs with research by the Royal College of Paediatrics and Child Health, which reported that there was

“moderately-strong evidence for an association between screen time and depressive symptoms.”

The Government need to take real responsibility for the children in this country and their wellbeing. Instead, we have heard that they will support further research without saying what that will be, and that they welcome industry efforts. What parent would feel reassured by that? The industry has taken some steps to regulate itself, but it is obvious that it is not doing enough. Public health cannot be left to businesses, and with the mental health of children and young people at stake, we need to look at the various contributing factors. It is not enough simply to acknowledge the problem and not to address what is seen to be one of the growing risks to our children’s mental health and wellbeing.

Let us take the next step of the process: when a child has mental health problems, how are they identified? Teachers are often the individuals on the frontline most likely to spot this need, but they are working with larger classes and increased pressures, without teaching assistants or additional support. Schools in my constituency and many across the country are doing an amazing job in trying to make appropriate provision for their pupils to deal with mental health problems—from developing their own wellbeing support to check-in sessions and peer mentors—but this is not sustainable. Schools in my constituency have told me that immediate support is usually unavailable to vulnerable children and parents; response times from overburdened mental health agencies are poor; there are long waiting lists; and early help support is limited. Because of the fall in the ability to access core public health services, schools are forced to pick up the slack despite often not having had the appropriate training or resources to do so. A quarter of 11 to 16-year-olds with a mental health disorder have self-harmed or attempted suicide, and that figure rises to as high as 46% among teenage girls with a disorder.

The Children’s Commissioner has said:

“There is a danger that we continue to have a system that fails to help children until they are so unwell that they need specialist intervention.”

Funding pressures mean many councils are being forced to cut early intervention services that support children with low-level mental health issues and avoid more serious problems in later life, which cost far more over the coming decades. If we are to improve provision of preventive and early intervention services, it is vital that the Government adequately fund public health in the forthcoming spending review, as reducing spending on public health is short-sighted and irresponsible at the best of times.