Oral Answers to Questions

Seema Malhotra Excerpts

Tuesday 13th January 2015 Commons Chamber

[Dr Poulter]

My right hon. Friend is absolutely right. A lot of work is going on with the Royal College of General Practitioners and the Royal College of Psychiatrists to improve GP training and skills in mental health more generally. The specific key to this is providing the right early years work force, which is why it is so important that this Government have invested in additional health visitors to give each and every child the best start in life. The latest figures from NHS England show that the number of health visitors has increased by more than 3,000 under this Government.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

What steps is the Minister taking to make sure that awareness of domestic violence is incorporated in guidance for mental health care? We know that pregnancy can sometimes be the first time there is violence in the home, and we obviously need a strategy to address that.

[Dr Poulter]

The hon. Lady makes very important points. I have certainly seen in my clinical practice that some women present when there are domestic violence issues or other issues in the home, and such issues can be heightened and exacerbated during pregnancy. A lot of work is now going on to improve the awareness of all NHS staff of domestic violence and, more broadly across training, of mental health issues.

A and E (Major Incidents)

Seema Malhotra Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

My hon. Friend is right. It is important to say that lots of people in the NHS have been asked in the past few days on the media what the issues are, and they have not been saying that it is about money. They have been saying that it is about reforming the structures. That is why, as well as the money that is available for this winter, we need to look at the plans that we can put in place to improve access to GPs, to improve the co-ordination between the health and the social care systems, to deal with issues that prevent people from going to hospital in the first place. That is what this Government want to do.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

Many of my constituents in Feltham and Heston have raised with me their concerns about being able to access GP services, some having to wait weeks and in the mean time having to seek emergency help. Does the Secretary of State now regret the Government’s decision to axe Labour’s guarantee of a GP appointment within 48 hours?

[Mr Hunt]

If the hon. Lady regrets that, she might want to ask her Labour colleagues in Wales why they also axed the 48-hour target. We do need better access to GPs. That is why we are funding the training of 5,000 more GPs over the next five years. With targets, we must be careful of unintended consequences. When we had that target in place, a quarter of people who asked for an appointment in more than two days were told that that would not be possible, because we found that people played the target. That is why we do not want to go back to that system.

National Health Service (Amended Duties and Powers) Bill

Seema Malhotra Excerpts

Friday 21st November 2014 Commons Chamber

[David Tredinnick (Bosworth) (Con)]

I am grateful to be called to speak in the debate, Madam Deputy Speaker, and I apologise to my Front-Bench colleagues that I might not be here for the wind-ups because I have to be in Hinckley for the switching on of the Christmas lights, which is something I always look forward to.

I should like to follow a long tradition in the House in which the speaker who follows a Member making their maiden speech—even though I am told that, technically, it was not one—says something nice about them. I congratulate the hon. Member for Rochester and Strood (Mark Reckless) on winning his by-election last night, and I further congratulate him on getting to the House this morning. I imagine that he has been up all night. I simply offer him this warning. I was thinking of Dave Nellist, a former Member for Coventry, who defected to another party and then disappeared. I have to warn the hon. Gentleman—my former hon. Friend—that the history of those who defect in this place shows that they do not remain here for very long after they come back. We expect to regain his seat at the next general election, but well done to him in the meantime.

I should also like to congratulate the hon. Member for Eltham (Clive Efford) on introducing his Bill. I once had the honour to stand for the Greater London council in the constituency adjacent to his. It was then known as Woolwich East, so I know his area and his hospitals a little. He has certainly done well to get his Bill to the House, and I note from the Division this morning that he has 100 additional Members here today, so he is no doubt hoping for a closure motion at some point. If his Bill progresses, I would be happy to serve on its Committee. I have a long-standing interest in health matters and I have been a member of the Health Select Committee since it was set up in this Parliament, as well as of the Science and Technology Committee in this Parliament. I am also the chair of the all-party parliamentary group on integrated health care.

This is a wide-ranging Bill. I hope to address some of the things that are not in it, although I will not talk about all the things that are in it as time is short and I do not want to occupy the stage for too long. I want to look at three areas. The first is the hon. Gentleman’s proposal to change the arrangements that allow trusts to generate half their income from private sources. Secondly, I want to look at whether mergers should be dealt with by Monitor or whether that area should be reclaimed. I want to focus on mergers and integration, because the integration of services in the NHS is of fundamental importance. He might be able to improve his Bill in that respect. Thirdly, if time allows, I want to talk about the proposal to exempt the NHS from the transatlantic trade and investment partnership.

I have been listening to the right hon. Member for Wentworth and Dearne (John Healey), and I believe that Labour’s whole strategy is based on something that is fundamentally untrue. It is based on trying to persuade the electorate that we are setting out to privatise the health service and thereby reduce the health care available. It is regrettable that Labour is taking the Goebbels-esque approach of saying something that is fundamentally untrue and then repeating it and repeating it in the hope that the electorate will buy into it. I put it to Labour Members that that might be a populist approach, but it could be hard for them to defend as we get nearer the election.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

The hon. Gentleman says that he does not believe creeping privatisation is taking place as a result of the changes that the Government have introduced, but does he not see it as an inevitable consequence, even if it is not the Government’s stated intention?

[David Tredinnick]

I thank the hon. Lady for her intervention. The Government have made it possible for trusts to generate half their income from private sources, but it is not true to make out that we are in some way privatising the health service in a way that is detrimental to patients. We have made it possible for trusts to generate more income. In an ideal world, it would be wonderful if we could pay for all health care through general taxation. However, the Health Committee has examined the Nicholson challenge and seen the tremendous demand on resources. We have managed to maintain a flat-line budget in this Parliament, but demand is such that it is difficult to pay for everything through general taxation. One way to do it is by getting the private sector to contribute to the health service. The original arrangements were increased to this figure of nearly half. The thing to remember is that all the money generated from these sources is reinvested in patient care.

I had some freedom of information requests made, and wish to refer to the effect of these arrangements on four NHS foundation trusts in the midlands. They are not from Leicestershire, because those figures did not come through, but I do represent a midlands constituency. The Dudley Group NHS Foundation Trust received £68,000 in 2010-11, £50,000 in 2011-12 and another £80,000 in 2012-13 in funds that can go directly into patient care. The figures for the Heart of England NHS Foundation Trust are £559,000 in 2009-10, another half a million in 2010-11, a bit more in 2011-12 and nearly £532,000 in 2012-13, and there has been an increase to £628,000 in 2013-14.

My FOI request to the Shrewsbury and Telford Hospital NHS Trust elicited the following response—it is a short paragraph, so if I may, I will read it out:

“The Shrewsbury and Telford Hospital NHS Trust gains substantial income from Apley Ward and Clinic. Where private patient work is carried out in an NHS hospital, it is carried out in addition to and not in place of regular NHS treatment. Profits from this private facility make a considerable contribution to the running costs of the hospital for the benefit of all patients and staff.”

The hon. Member for Eltham made a passionate speech, but this point goes to the heart of the issue: privatisation is not about reducing resources, but increasing them. I gave notice to the hon. Member for Walsall South (Valerie Vaz) that I was going to mention the other figures I received, which are from the Walsall Healthcare NHS Trust and which show that over the past four years it has gained between £14,000 and £50,000 a year. The figures illustrate clearly that this approach is helping, and that is very welcome.

Oral Answers to Questions

Seema Malhotra Excerpts

Tuesday 21st October 2014 Commons Chamber

[Norman Lamb]

I would be very happy to write to the hon. Gentleman. I am sure that he welcomes the fact that, for the first time, we are introducing access and waiting time standards in mental health, including in children’s mental health. Until now, there has been discrimination at the heart of the NHS. Labour introduced waiting time and access standards, but it left out mental health. That was completely unjustifiable and I am proud that the coalition is correcting it.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

The cost of living crisis has had a huge impact on children’s well-being across Britain as families struggle. That issue has been raised with me by support workers in my constituency who have seen young people come forward with depression. That is compounded by the lack of mental health support services. Does the Minister recognise those issues? Is he happy with the data that he has available on the prevalence of young people’s mental health problems?

[Norman Lamb]

I absolutely recognise the problem. I have commissioned an up-to-date prevalence survey so that we have evidence that can help services around the country. If the hon. Lady wants to talk with me further about the problems in her area, I would be happy to do so.

Psychological Therapies

Seema Malhotra Excerpts

Wednesday 16th October 2013 Westminster Hall

[Mike Thornton (Eastleigh) (LD)]

I am glad to follow my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) and the hon. Member for Strangford (Jim Shannon), whose points were particularly relevant. I shall try not to repeat them too often in my speech—that might mean reducing its length slightly, people will be pleased to hear.

When I was first elected, a new aspect of my life was the size and complexity of the casework that came my way. Much of it I expected and was familiar with, having been a councillor, but the one facet that surprised—no, shocked—me was the obvious failure in our duty to those with mental health issues. The next surprise was to discover that, in fact, the situation has improved over the past few years, and for that I pay tribute to the Minister, my hon. Friend the Member for North Norfolk (Norman Lamb), and his predecessor, my right hon. Friend the Member for Sutton and Cheam (Paul Burstow).

Today, we have the news that Dr Martin Baggaley, commenting on the results of a BBC freedom of information request, said that we are in “a real crisis” regarding the provision of mental health beds in England. My hon. Friend the Member for North Norfolk, the Minister, is reported by the BBC to agree that that is unacceptable.

At least, however, the BBC was able to obtain figures for the number of beds that have been lost. What would the response have been had the local trusts said, “Sorry, we don’t keep such figures. We have no idea of the number of beds available”? In another possible scenario, one of us asks the Secretary of State for Health, “What is the waiting time for the treatment of breast cancer or leukaemia?”, but the answer is, “I don’t know and I can’t find out.” Would not the whole House erupt in outraged uproar? Would not the press ask how proper provision for those patients can be provided in such circumstances?

Without adequate data and reporting, the needs of millions of ill people cannot be addressed—people with mental health issues. Without decent information, resources cannot be allocated correctly, results properly analysed or effective treatment provided. Yet for much of mental health provision, there is insufficient knowledge of whom we are treating, how we are treating them and how long they are waiting for treatment. As my hon. Friend the Member for Halesowen and Rowley Regis mentioned, we do not have minimum waiting times for much psychological therapy.

Few data are collated for the national policy framework. The data that we have focus on IAPT services and the rates for early mortality. My hon. Friend mentioned how early treatment of mental health problems can stop far worse developments, but without proper data we cannot understand that.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

The hon. Gentleman is making an important point about early intervention in mental health conditions. Does he agree that early intervention does not just stop an individual from cascading to the point at which their life becomes dysfunctional, but has a tremendous economic impact in preventing time off work and the difficulties that that causes for employers?

--- Later in debate ---

[Andrew Selous]

As colleagues have already stated, data on the type of therapies available under IAPT show that couple therapy is available in less than a quarter of cases. The data came from the “National Audit of Psychological Therapies for Anxiety and Depression, National Report 2011”, so they are official. The figure for couple therapy is only 24.6%, while interpersonal therapy is available in under half, or 48.3%, of the settings in which provision is made. For psychodynamic and psychoanalytic therapy, the figure is under 40%, at 39.8%, whereas cognitive behavioural therapy is available in 94.9%—just under 95%—of cases.

Those figures demonstrate the significance of CBT, which for some people with mental health issues is absolutely the right treatment, but it is important to realise that CBT is clearly not the appropriate treatment for all those with mental health conditions. We should also remember that all those therapies are approved and recommended by NICE, and the evidence shows that all such treatments are effective for the right patients.

I am particularly concerned that the benefits of a relational approach to the treatment of depression are not being realised and that, in many cases, individual CBT counselling is given where it is not appropriate. I want to tell a true story of one young couple’s experience of interacting with the IAPT programme. Figures and sums of money give the broad picture—they are our stock in trade as Members of Parliament—but they are a bit high-level and do not capture the essence of mental health provision on the front line.

Let me tell the story of Polly and Mark—to protect their anonymity, those are not their real names—who experienced considerable challenges in having two children, with several miscarriages and a stillbirth. Polly became very low and left her successful career. The hon. Member for Feltham and Heston (Seema Malhotra) has already pointed out the cost to the economy when people have mental health issues. Polly’s husband, Mark, had a very difficult childhood, and he was badly affected by his parents’ violent and stormy relationship.

When Polly and Mark’s youngest child was two, Polly confessed that she had had an affair seven years earlier, which left her feeling guilt and shame long after it ended. On learning that, Mark was utterly devastated by the revelation and fell into a deep depression, with unmanageable rages during which he threatened to kill the other man. Polly developed severe headaches, so she went to her GP and was sent for tests. On finding nothing wrong, the GP recommended that Polly have individual counselling focusing on the stillbirth four years previously. After being unable to work and having three weeks of sleepless nights, Mark also visited his GP. Mark was referred to a psychiatrist, who diagnosed him as suffering from acute depression and prescribed him antidepressants.

The couple were acutely conscious that their relationship was about to break down. Not having been offered any form of couple therapy by IAPT, they approached a voluntary sector service, and for six months, they went to weekly couple therapy. At the same time, they were offered cognitive behavioural therapy through IAPT. They believed that the problem was their relationship, but health professionals clearly thought that the depression needed treatment. In couple therapy, Polly was able to share her anxieties about her parents’ divorce and about how she did not want her children to suffer as she had. As the couple therapy progressed, Mark and Polly became more open with each other and began to understand how their relationship problems were a product of both recent and past difficulties.

An important point is that that couple therapy—it was not provided through IAPT; Mark and Polly had to go to the voluntary sector for it, because IAPT had offered them CBT that they did not need—was voluntary help that lasted for six months. My concern is that IAPT provision, whether of CBT or other measures, is often given for only a short period, which is not always appropriate or likely to be successful in such cases.

That true story illustrates powerfully why we need to look again at the IAPT programme, excellent though much of it is, and to take a relational approach to many of the issues where appropriate. I hope that it has been helpful to Members to put that real-life case study on the record.

Academic studies show why what I have said is important and matters. Evidence reveals links between relationship quality, depression and re-employability. For example, a meta-analysis conducted by McKee in 2005 concluded that lack of social support by partners in a relationship has negative impacts on the physical and psychological health of the unemployed person and is especially associated with more frequent development of psychosomatic symptoms, stress and depression.

The all-party parliamentary group on strengthening couple relationships, which I chair, and the newly formed Relationships Alliance published only last week a report that said that relationships were the missing link in public health. That report showed that relationship quality is often a key determinant of health and well-being, and that it has strong links with the ability to deal well with cardiovascular disease, obesity, alcohol misuse and mental health issues. All those issues link up, and strengthening the health of couple relationships is often right at the heart of them.

If we look at what has happened since the IAPT programme began—I understand that it receives funding of about £400 million a year—we can see that the investment has been very much towards cognitive behavioural therapy, with interpersonal psychotherapy, counselling for depression, brief dynamic therapy and couple therapy the poor relations in the area.

In a written parliamentary question, answered on 8 January 2013 and printed in volume 556, column 258, of the Official Report, we learn that of 1,225 sessions in 2012-13 only 99 were for couple therapy, whereas 459 were for CBT low-intensity therapy and 322 for CBT high-intensity therapy. If we look at the period from 2008-09 all the way through to the projections for 2013-14, we will see that of nearly 8,000 different sessions—7,958 to be precise—only 297 were for couple therapy. The story that I have just given of Polly and Mark shows that such sessions are needed up and down are country and can indeed make a significant difference.

[Seema Malhotra]

The hon. Gentleman is making a powerful speech on the importance of having a relational base to services. In my own constituency of Feltham and Heston, I visited a service that was started a year ago by the National Society for the Prevention of Cruelty to Children. It works with children who have parents with drug and alcohol problems. I am struck by what the hon. Gentleman is saying. Is he able to talk a bit more about, or perhaps give a comment on, how having such a focus in a service can help children who are the victim of the illness of their parents?

[Andrew Selous]

I am grateful to the hon. Lady for her comments. May I extend to her a very warm invitation to come to the next meeting of the all-party parliamentary group on 6 November when we will consider such issues further? She is absolutely right that these issues are intergenerational. If she was following the example of Mark and Polly, she would have learned that it was their own parents’ stormy relationships that had affected them. Of course their children were suffering deeply from the problems that they were having in their own relationship or marriage. Such issues are deeply related, and she is completely right to say that the children suffer hugely when there are relationship problems between the parents. It is vital that we get this matter right for the children, and I would welcome her support on a cross-party basis on these important issues; they are just too important to be bipartisan about. I would love to have cross-party agreement on the importance of relational issues in public health, because I feel so passionately about the matter.

Another concern is the geographic differences in the ability to get couple therapy through IAPT at the moment. Ruth Sutherland, the chief executive officer of Relate, told me only yesterday that the programme is very geographically bound. Provision is better in the north of England—I note that there are not many colleagues from the north of England in the Chamber today—than in the south, so there is an inequality of access geographically, as well as there being fewer of these sessions available across the UK as a whole.

Let me make one further point to the Minister about why one part of IAPT provision is an incredibly serious matter for the whole NHS. As a clinician, he will know about the huge importance of long-term conditions, which are faced by so many of our constituents. He will be well aware of the significant demands that they will make on the NHS in years to come. I am talking about strokes and dementia and all sorts of other long-term ailments that many of our constituents will live with for a very long time.

I heard a moving story a couple of weeks ago from a gentleman who was visiting his elderly parents in Manchester. He said that between them as a couple they could function. Between the two of them, they had one pair of eyes, ears and legs that worked. They were both sick in different ways. They could cope and look after each other, but what would have happened if they had split in younger years? They might have been like Polly and Mark and had difficulties and not been able to receive the type of help that I have outlined. Let us say that they did sadly split up, like so many couples do today. They would be in two different flats in different parts of Manchester needing far more help from their GP and far more adult care, and that would fall on the clinicians for whom the Minister is responsible and on adult social services. Yes, it would have an impact on their families, and we would all be paying more through our taxes and there would greater burdens on business as well from having to look after that couple in two different settings. The importance of strong couple relationships in older age, in later life, is critical not least to deal with the increase in long-term conditions, which are becoming more and more prevalent and which many of our constituents will be coping with for many years to come. That is my final pitch to the Minister.

We are talking specifically about mental health and IAPT. I understand that a lot of good work is being done under IAPT and that it is an excellent programme, but I ask the Minister, when he goes back to his Department and talks to his colleagues and the Secretary of State, to take back with him the absolute centrality of strong relational health up and down are country as far as public health, the burdens on the NHS and his Department are concerned.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Sir Edward, it is a pleasure to serve under your chairmanship this morning.

This has been a thoughtful and important debate on a subject that is not talked about nearly enough. Every day in Britain, people of all ages and backgrounds, and from all communities, have their lives blighted by the spectre of mental illness. Theirs are some of the great untold stories of our society. As many hon. Members have already said, the issue of mental health has been swept under the carpet for too long. One in six people are afflicted by mental illness, but all too often they are scared into silence. That is why this discussion is so important.

I also congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) on securing this debate and on the campaigning that he has done on this issue. In addition, I thank him for giving me the opportunity to talk about mental health in my first debate as Labour’s newly appointed shadow Minister with responsibility for public health.

This debate is even more timely because of the news that we have heard on the BBC this morning, to which a number of hon. Members have already referred. Dr Baggaley, the director of medicine at South London and Maudsley NHS Foundation Trust, has said that our mental health services are in “crisis”, following the news—after the BBC made freedom of information requests—that in a little more than two years we have seen the loss of 1,700 mental health beds. I note that the Minister of State, Department of Health, who is the Minister with responsibility for care, said this morning that the situation is “unacceptable” and that the provision must improve. I hope that the Minister who is here in Westminster Hall today will refer to that when he responds to the debate.

We have heard a number of valuable contributions this morning. In responding to the excellent points that have been made, I will cover three broad themes: first, I will reiterate the importance of early intervention; secondly, I will talk about the improving access to psychological therapies programme, including some specific issues about how IAPT needs to work better; and thirdly, I will talk about what we need to do beyond IAPT.

Let me begin with early intervention. As hon. Members have already said, the long-term consequences are clear if we do not tackle mental illness early; indeed, we can already see those consequences right across our society today. We can see them in the workplace, where mental illness is the largest single cause of long-term sick leave; we can see them in our criminal justice system, where 70% of those in our prisons have a mental illness; and we can see them in our economy, where mental ill health costs Britain’s businesses £26 billion every year, or £71 million every day. Also, in our health service, according to the London School of Economics the physical health care necessitated by mental illness costs the NHS an extra £10 billion each year. All those points show why the case for action could not be any clearer.

I am sure that, like myself, many hon. Members will have had experience of constituents coming to them for assistance; indeed, several hon. Members have referred to those experiences in their contributions to the debate. Constituents come to us in deep distress and dire circumstances. However, many of those situations could have been avoided if those people had received specialist treatment for mental illnesses at a much earlier stage. I echo the hon. Member for Halesowen and Rowley Regis, who said that it is absolutely crucial that we look at this issue of early intervention.

That was why in 2007 the last Labour Government launched the IAPT programme, which helped to make respected and evidence-based therapies available to more people than ever before. As we heard in the hon. Gentleman’s opening speech, thousands of people have been helped on that programme so far. Since then, the current Government have continued the programme and extended it to cover more people, which is a welcome step. However, as this debate has made clear, IAPT is still a developing scheme, with areas that are in need of much improvement. So, my second theme is to focus on those areas that require attention, and I would be grateful if the Minister could address them in his closing remarks.

There are three areas in particular that require attention. The first is funding. Spending on IAPT has increased from zero in 2008-09, when the programme was first launched, to £214 million in 2011-12. The Department of Health has also allocated £54 million to improve access to therapies for children and young people, which is a good step. However, it must be noted that Ministers always pledged that IAPT funding would be additional funding and would not replace existing psychotherapy services. Despite those assurances, non-IAPT therapy services have been cut by more than 5%. Funding has fallen from £185 million in 2009-09 to £172 million in 2011-12. What makes that even more worrying is that overall mental health spending has been cut in real terms for the second year in a row.

That real-terms cut has particular resonance when it comes to the second area that requires attention, which is waiting times; again, waiting times have already been mentioned by hon. Members during this debate. NICE’s aim is that patients receive access to evidence-based therapies within 28 days of referral. It is regrettable that this debate falls the day before the latest programme statistics are published. According to the latest figures, however, which are for 2012-13, more people are having to wait longer to start receiving treatment for anxiety or depression.

[Seema Malhotra]

My hon. Friend makes very important points about waiting times and how they have continued, and also about the cuts to services. Given that the number of university students seeking counselling has risen by a third in the last four years, does she agree that it is important to recognise the impact that the drop in funding could be having on vulnerable students, sometimes forcing them to leave university, which can affect the rest of their life? With the number of students in that situation increasing and without data for average waiting times, we must recognise the importance of early intervention and very fast response.

[Luciana Berger]

I thank my hon. Friend for that intervention, and she raises an important issue. There are lots of different groups of people who do not have access to these sorts of services or who have to wait a disproportionate amount of time to access them. We have already heard hon. Members talking about older people who might not be able to access the IAPT programme, and my hon. Friend refers to university students, who do not necessarily fall into the category of children and young people, but who, as young adults, are struggling with leaving home and with financial pressures.

I have not seen any direct research about what effect the current cost of living crisis is having on our population—I hope that there will be some research into that issue—but my experience from my case load as a constituency MP indicates that we have a problem in our society regarding the pressures of life. More people are having to access these services and therefore the services should be available, which makes the issues of waiting times even more relevant.

More than 115,000 people had to wait more than 28 days from referral until their first treatment or therapy session, which was a 19% increase from the previous year. The hon. Member for South West Bedfordshire (Andrew Selous) made the point that this issue is not only about the statistics but the people behind the statistics, who have to go through the trauma of waiting for treatment and suffering the uncertainty of not knowing when it will come.

On Monday, someone contacted me to say that they had been waiting for a year and a half for cognitive behavioural therapy in the Wirral, on Merseyside, and just this morning on BBC “Breakfast”: there was a woman who was interviewed who had had to wait 17 months for talking therapies treatment. Eventually, she had to be sectioned as her condition deteriorated while she waited for treatment. These cases are not unusual— there are too many cases like them—and it pains me to learn of them. According to a report produced by the We Need to Talk coalition of mental health charities and royal colleges, one in five people have been waiting for more than a year to receive treatment. However, the same report found that people who receive treatment within three months are almost five times more likely to be helped back into work by therapy than others who have to wait for one or two years. As another person wrote to me this week, even a six-week wait can seem a whole lot longer if someone is clinically depressed. Just as we focus on waiting times for cancer treatment and other examples of physical care, we must do the same for mental health therapies.

I will repeat the commitment, which my right hon. Friend the Leader of the Opposition made a year ago, that the next Labour Government will rewrite the NHS constitution; that we will strengthen the rights that it grants to patients; that we will create a genuine parity between mental and physical health care; and that we will set down a new right of access to the therapies that we have been talking about this morning. That will mean that mental health patients will be entitled not only to drugs and other medical treatments but to psychological therapies, and they will have the same guarantees on waiting times, professional advice and patient experience.

However, in addition to how long it takes to receive treatment, we need to examine the range of therapies that are available in the first place, which brings me to my third broad theme; again, it is a theme that has been already been referred to by other hon. Members, but it is important to reinforce it and to ask the Minister to respond to it. Different people are affected by different mental health conditions for all sorts of different reasons. That is why we need diverse mental health provision, with a range of therapies, to cater for people with different needs, preferences and personalities. As the hon. Member for Halesowen and Rowley Regis said, only five types of therapy are currently available via IAPT. Moreover, 90% of IAPT funding has gone towards cognitive behaviour therapies, with limited support for other modes of therapy. The United Kingdom Council for Psychotherapy has described this as an

“overwhelmingly manualised and brief approach to therapy that sits at odds with the professional practice of the majority of leading psychotherapists and counsellors.”

We need to look at going beyond basic therapies that help people go about their day-to-day lives more adequately. There needs to be appropriate room for more intense and longer term psychological treatments, so that the underlying causes do not go unaddressed.

The hon. Member for South West Bedfordshire mentioned the need for couples therapies. The hon. Member for Halesowen and Rowley Regis also talked about older peoples’ problems with accessing treatment.

There is a patient choice issue, too. According to a survey of 500 service users by Mind, only 8% of people had a full choice about which therapy they received and just 13% had a choice about where they received therapy. The 8% who had full choice of therapies—a very small number—were, on average, three times happier with their treatment and five times more likely to say that therapy had helped them back into work. As the programme develops, we need to do all we can to ensure that it caters to people’s individual needs.

What needs to be done beyond IAPT? As welcome as IAPT is, we have to remember that the programme currently only aspires to be available to 15% of the population. The programme’s three-year report, published last November, shows that it is currently delivering 45% recovery rates and aims to reach 50% by March 2015. The big question this raises is, what about the other 50% to 55%—the 50% who continue to suffer from conditions, having gone through the IAPT process, but are not eligible for more intensive psychotherapy services under the stepped care model? That question, and this debate, requires an answer that goes far beyond the IAPT programme. It requires ending the artificial dividing lines in our NHS and pursuing a whole person, fully integrated approach to mental, physical, social and care issues, as Labour has indicated, and it demands a complete revaluation of how we, as a country, think about and approach mental health. That is what Labour’s mental health taskforce is looking at, under the expert leadership of Stephen O’Brien, the chair of Barts Health NHS Trust.

General mental health support should not start in hospital or the treatment room. It needs to start in our workplaces, our schools and our communities, even across our kitchen tables and in the conversations we have with one another. There is no reason why we should not be able to talk about mental health and psychological therapies in the same way we do about access to sexual health services, vaccinations or cancer treatment, but we have a long way to go.

I look forward to the Minister’s response. I hope that he will respond to my questions and issues raised by other hon. Members. Returning to my opening comments on today’s news about the crisis in mental health provision and the reduction in the number of beds, the point of our debate is access to services that would prevent people from going into those beds in the first place. However, we hear today that bed capacity is at 100%. I hope that the Minister will mention those issues as well, because they are interlinked.

A and E Departments

Seema Malhotra Excerpts

Tuesday 21st May 2013 Commons Chamber

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

I recently visited the London ambulance service. When ambulance staff cannot hand over a patient to A and E, the patient is kept waiting in the ambulance. Will the Secretary of State confirm that the number of handover delays lasting more than 30 minutes has doubled to 200,000 in the past three years? Will he also update the House on when he expects that trend to be reversed?

[Mr Hunt]

Handover delays are unacceptable, and the short-term and longer-term measures that I am putting in place will, I hope, help to reduce them. The hon. Lady might want to talk to her own Front Benchers about this, however, because they seem to be setting their face against improving primary care as a way of reducing the pressures on A and E departments, even though that goes against the grain of what the public and the NHS want.

Induced Abortion

Seema Malhotra Excerpts

Wednesday 31st October 2012 Westminster Hall

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

I have listened with great interest to the debate and the points made by hon. Members from all parties. I recognise, as I am sure all hon. Members do, the difficulty and sensitivity of this debate. I am sure we would all prefer a world in which there are fewer abortions; in which men and women have access to sex education, support and advice to make the right decisions for themselves; in which, should partners choose to engage in sexual relations, there is safe and confidential access to contraceptives; in which there is no rape or incest; and in which, if a woman becomes pregnant, she is not so afraid of family and community that she is unable to seek early advice and support. But we do not live in such a world. In making judgments as politicians and as a society, we must use the best available evidence and the right balance of arguments and interests. At the heart of our debate, there must be evidence and facts.

Recent debates in the House have ruled out lowering the time limit, and for good reasons. First, there has been no new medical evidence to suggest any scientific or medical reason for a reduction in the abortion time limit since the subject was last debated in the House of Commons in 2008, during the passage of the Human Fertilisation and Embryology Bill. Amendments to lower the time limit to 22, 20, 16 or 12 weeks were voted on, and all were rejected by MPs. The major professional medical bodies in the UK support the 24-week abortion time limit, including the British Medical Association, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the British Association of Perinatal Medicine.

There has been no significant change in survival rates. Many of those who currently advocate a reduction in the time limit argue that there have been major clinical developments in the care of pre-term infants which have led to a reduction in the gestational age at which a foetus can survive and that, therefore, the 24-week limit should be reduced. That is not the view of the main medical bodies, and there are no calls from them to reduce abortion time limits. For example, the BMA debated the issue at its annual representatives meeting—the ARM—in 2005 and in 2001. On both occasions it rejected a call for any reduction in the 24-week time limit.

It is important to keep a focus on the facts. No statistics make the case for reducing the limit. The majority of abortions in the UK take place at an early stage of pregnancy: 91% are carried out before 12 weeks of gestation; and only 1% of abortions take place after 20 weeks—that number has continued to fall year on year. We have heard some survival rates of zero at 20 weeks, 1% at 22 weeks and about 10% at 23 weeks, but the viability in terms of quality of life remains a great concern.

There is no support for reducing the limit among health groups. Indeed, following the call by the Secretary of State for Culture, Media and Sport, in early October, for the abortion limit to be reduced to 20 weeks, the BMA said:

“The BMA does not believe there is any scientific justification to reduce the abortion limit from 24 to 20 weeks. We will not be lobbying for any reduction.”

When the Secretary of State for Health later offered his support for a reduction to 12 weeks, the Royal College of Obstetricians and Gynaecologists called the suggestion “insulting to women”, stating that his comments

“politicise the debate around the abortion time limit and do not put women at the centre of their care.”

Different arguments are made, on the right of life of the baby and on the question of the woman’s well-being and her right to choose. Furthermore, the right to choose is related to a woman’s well-being, given that she has to carry a baby to term and does so knowing that she will have the responsibility afterwards—

[Mr David Crausby (in the Chair)]

Order. The hon. Lady’s speaking time is up.

Social Care (Local Sufficiency) and Identification of Carers Bill

Seema Malhotra Excerpts

Friday 7th September 2012 Commons Chamber

[Barbara Keeley]

Absolutely; I thank my hon. Friend for that point.

The Bill is also supported by British Gas, BT, Bright Horizons and PricewaterhouseCoopers because they believe that its measures are important. Caroline Waters OBE, the director of people and policy at BT and the chair of Employers for Carers, says:

“We are seeing the mounting costs, not just to families but to business of a care system that often cannot support carers trying to juggle work with care. Stimulating the care market can deliver an economic triple win—better services for families, the infrastructure to help employers retain skilled staff and a real boost to economic growth. The debate started 20 years ago with childcare and there is now a pressing need to bring the same focus and progress to care for older and disabled people. This Bill would start this important process by placing a duty on local authorities to ensure a supply of care as is already the case for childcare.”

Members of the Employers for Carers forum increasingly report staff leaving work at short notice to take on caring responsibilities. The peak age for caring is between 45 and 65, and that age frequently coincides with the peak of an employee’s skills, knowledge and experience. Losing such employees can lead to large retraining costs on top of recruitment costs.

A recent report by Dr Linda Pickard of the London School of Economics shows that carers giving up work to care costs about £1.3 billion a year in lost tax revenue and benefits. Also on costs to the economy, a recent report by Carers UK suggests that the failure to address the funding of adequate care provision, as other countries have done, means that we are missing out on jobs and growth.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

Does my hon. Friend agree that it is vital that we support carers of working age who are reducing their work hours and days because of the disproportionate impact it has on their pension savings and entitlements? The prospect of becoming a poor pensioner is not the right reward for those who give so much to families and our communities.

[Barbara Keeley]

Sadly, that is the case. We know that the care sector is underpaid, but that is nothing compared with the financial impact of giving up work to take on a caring commitment.

Hospital Services (West London)

Seema Malhotra Excerpts

Wednesday 11th July 2012 Westminster Hall

[Angie Bray]

Of course, we all want better clinical outcomes for all our constituents. The question is how to get to that result, and how to provide services for residents. An unfortunate aspect of the way things have been done is the pitching of one hospital against another, with everyone being asked to decide on one or another. That has been a divisive process.

My constituents face the real possibility of Ealing, Central Middlesex, Hammersmith and Charing Cross hospitals all having their A and E departments downgraded —a result that would surely be disproportionately negative for them and that threatens to destabilise health care provision across my constituency. In making its three key recommendations for the current consultation, NHS North West London seems to have completely overlooked their needs. While the consultation document does at least mention the full list of eight possible options, the pressure on people to support one of its three main recommendations leaves the impression that minds have already been made up. Minds should not be made up when my constituents in Acton—a place with a rapidly expanding population—look set to be left without any local emergency cover.

The consultation and pre-consultation business case documents make bold predictions when calculating travel times to justify recommendations. One document even states that the

“geographic distribution is proposed to apply to the remaining sites to minimise the impact of changes on local residents”.

Tell that to the people of Acton, as they battle their way through traffic to Chelsea and Westminster hospital, or the people on the western edge of my patch doing the same to get to Hillingdon hospital, in the event of downgraded services at Ealing hospital. With London’s transport infrastructure as it is, I remain unconvinced that those bold predictions stack up.

The current recommendations take all my constituents further away from access to emergency health. That is why I am encouraging all constituents who get in touch with me on this issue to contribute to the ongoing consultation, regardless of my concerns. That seems to be the best way forward. After all, we all know that, for many people, their local hospital is more than just a physical structure. Attachments to hospitals are often incredibly emotional. Quite naturally, people want to know, when or if they or their loved ones fall ill, that they can access the care that they need in good time. It is all very well presenting a case for change based on facts, figures and statistics in a hefty document, but it is clearly important that local people—the people who use these hospitals—are given a proper chance to have a proper say on their future.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

Does the hon. Lady agree that it is very important that the many people in our constituencies who do not have a car are able to get to a hospital quickly? Relatives also need to travel to hospital in a way that has a minimal impact on their families, particularly those with caring responsibilities.

[Angie Bray]

I agree. It is always important to bear in mind the impact on families who want to visit, because that is all part of the healing process. That is an important consideration.

The consultation is not made easy when the options to choose from are buried in such a heavy document. I have concerns about how that will affect the consultation process. The consultation document is itself a barrier to participation, as it is so huge and bulky as to be virtually impenetrable.

It would be helpful if NHS North West London were to encourage the GPs that it says support its proposals to actually speak out in support of them. The public are much more inclined to listen to their doctors than their politicians—we all know that, unfortunately—and I have urged those behind “Shaping a healthier future” on numerous occasions to do exactly that. So far, however, there has been a deafening silence. If the case for change is so strong, why are we not hearing more local GPs coming out publicly in support of the recommended options?

It is, of course, important to acknowledge that the NHS is set to undergo a series of improvements. The health reforms will fully kick in in April next year, crucially putting GPs in charge of decision making. It therefore seems extraordinary that, after the lengthy process of getting legislation through Parliament, we are now seeing a last-minute, top-down reorganisation of local health care pushed through by NHS North West London, instead of waiting for the GPs to take charge.

The “Shaping a healthier future” programme is a bureaucratically-led initiative by NHS North West London. As such, I urge my neighbouring MPs to accept that this is not about Government cuts. In fact, the Government are putting extra funding into the NHS in real terms year on year, and the Conservatives were the only party to pledge to do so in their 2010 election manifesto.

--- Later in debate ---

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

Thank you for allowing me to speak in this important debate, Mr Gray. It is important to my local constituents and to me personally. I congratulate my hon. Friend the Member for Hammersmith (Mr Slaughter) on securing the debate and thank him for allowing me to join him and speak in it. I agree with everything that my hon. Friends have said. As hon. Members have repeatedly said, this is not a scaremongering debate and we are not taking a party political line—these are the genuine concerns expressed by constituents and health professionals.

I will not repeat my colleagues’ arguments on whether the consultation is fair and transparent, but I hope that the Minister will take this one point on board about the way that people are being asked to access the document—by making a request, downloading and then responding online. I do not know about other areas, but in my constituency the people who are going to respond are those who are very keenly concerned because they have used the services before and they have lived in the area for many years. Many of my constituents will not have access to the documents and will not be able to respond.

I hope the Minister will take that point on board and understand the reasons for it. There are old people who do not have access to computers. Ethnic minority communities, whose first language may not be English, will not have the access to do that, either. It is not easy. There is always the response that they could ask friends, relatives and others, but it is not that simple to respond to the fear that the hospital services are going to close. Those people should be taken into account as well.

The future of all the hospitals in north-west London lies in the balance. I am particularly concerned about Ealing hospital, which is very close to my heart. My two grandchildren were born in Ealing hospital, my daughter worked there and I live just a short walk away. Many of my constituents depend on Ealing hospital for life-saving treatments.

It is therefore with shock and anger that I speak about the current proposals to close Ealing’s accident and emergency unit, maternity unit, paediatric services, intensive care unit and other acute services. If the proposals go through, they will mean the effective closure of Ealing hospital. It will cease to be a district general hospital and be little more than a glorified polyclinic, with the surplus land sold off for luxury flats. I am deeply concerned about the proposals, and fear that they will have a significant detrimental impact on the health care that my constituents receive. It is being said that the proposals are clinically led, but the House should be aware that Ealing hospital consultants and local GPs almost universally oppose them. It is clear to me that the proposals are financially driven and that clinical care for my constituents will suffer.

I have been warning for some time about the significant threat to Ealing hospital. I have had numerous exchanges on the subject with the Prime Minister at Question Time. In October 2010, in answer to my specific question about whether there were any plans to close Ealing hospital, the Prime Minister gave a broad answer. He stated that the purpose of the health reforms was to put decisions about A and Es in the hands of patients and doctors, and that decisions to close A and Es that did not do so were often wrong. I agree.

[Seema Malhotra]

My hon. Friend rightly raises the particular circumstances of Southall and the surrounding areas, where there is a distinct community that operates in a particular way. Decisions about health care must take into account not just clinical issues but how a community behaves and how its members access health care.

[Mr Sharma]

I am sure that the Minister will take note of that and will respond.

Ealing is a case in point, as the decision is being made by the unaccountable north-west London primary care trusts in their dying days before they are abolished, and not by patients and doctors. Patients and doctors are firmly against the proposals. I ask the Minister to listen to them and abandon the proposals.

After the Prime Minister visited Ealing hospital in May 2011 to deliver his keynote speech on the Government’s health reforms, I again asked him specifically at Prime Minister’s Question Time whether there were any plans to close Ealing hospital. In his answer to me on 8 June 2011, he said that he was impressed by what he saw, stated twice that there were no plans to close Ealing hospital and said that the maternity service was undergoing phased redevelopment. Those assurances and answers now seem hollow and almost worthless unless the Prime Minister intervenes to stop the closure of Ealing hospital.

The Secretary of State for Health has also said on the record that there were no plans to close Ealing hospital’s A and E, and asked where all the people would go who use it. My hon. Friend the Member for Hayes and Harlington (John McDonnell) has given the figures on how many people use the services, and I am sure that the Minister will have taken note.

My constituents, local GPs and hospital consultants, local Members of Parliament and councillors of all political parties are totally opposed to the proposals, and there is a massive campaign against them. I ask the Prime Minister and the Secretary of State to listen to local people and intervene to safeguard our health services at Ealing hospital and other hospitals in west London. Lives are at risk and the future of the health service is at stake. With the support of Ealing Hospital SOS, Ealing trades council, Ealing council and West London Citizens, I will not stop campaigning, and neither will my hon. Friends and constituents, until the proposals are stopped dead in their tracks.

NHS Annual Report and Care Objectives

Seema Malhotra Excerpts

Wednesday 4th July 2012 Commons Chamber

[Mr Lansley]

My hon. Friend is absolutely right. The Labour party completely ignores the fact that one of the central points is that the creation of health and wellbeing boards—I pay credit to my Liberal Democrat friends in the coalition for that—the involvement of democratic accountability and the opportunity to create joint strategies that integrate public health, social care and the NHS and impact additionally on the wider and social determinants of health will be absolutely instrumental in the improvement of services and health in future.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

Will the Secretary of State confirm that shortly after taking office he downgraded the standard that the NHS should see A and E patients within four hours from 98% to 95% and that many A and E units are now failing to meet even that relaxed target? Does he believe that that was the right move, and does he have any other plans to change it again?

[Mr Lansley]

I did indeed reduce the standard to 95%, on clinical advice, and currently the NHS is achieving 96.5%.