Managing Risk in the NHS

Valerie Vaz Excerpts

Wednesday 17th July 2013 Commons Chamber

[Valerie Vaz (Walsall South) (Lab)]

It is always a pleasure to follow the hon. Member for Bracknell (Dr Lee). I do not think that hon. Members have had a chance properly to mention that the NHS is 65 years old.

We now have two figureheads atop the NHS: the Secretary of State and the chief executive of NHS England. Hon. Members might have missed the change of name from the NHS Commissioning Board to NHS England. Such is the power of the chief executive that he neither had to come to Parliament nor to deal with elected representatives to achieve that. The two of them sit there like Laurel and Hardy, whose catchphrase was, “Here’s another fine mess you’ve gotten me into.” We know there is a mess, as there is a host of ongoing reviews.

Let me start by referring to the Francis report, which was produced by a leading QC who started his work in 2009 after being picked by my right hon. Friend the Member for Leigh (Andy Burnham), so that was something he got right. Some £10 million later, after sifting the evidence and hearing bereaved people give their testimony, Robert Francis produced a report with 290 recommendations. At the time, it appeared that they had been accepted in full, but all is not as it seems, because apparently there needs to be a review on its implementation.

Yesterday, we received Sir Bruce Keogh’s thoughtful review. It is actually a model report, as it gives clarity on what needs to be done. The Secretary of State mentioned Don Berwick’s report on the Francis review, which is due in the autumn. Camilla Cavendish has reported on health care and social care assistants. My right hon. Friend the Member for Cynon Valley (Ann Clwyd) and Tricia Hart will review how patients make complaints, although no date has been given for when that will report. Sir Bruce Keogh is busy again, as he is producing a further report on a plan for vulnerable older people, which I think is also due in the autumn.

You would be forgiven for thinking that that was the end of it, Mr Speaker, but that is not quite the case. The chief executive of NHS England announced to the Health Service Journal—not to the Secretary of State nor to Parliament—that he would do some work to determine what NHS England’s strategic direction might be. One would have thought that he would already know, and the process seems somewhat late given when the body was set up. He told me that the cost would be £3 million over three years, but how many doctors and nurses would that buy?

What has been the response of the Secretary of State to date? Urgent care boards and chief inspectors—PR and an extra layer of bureaucracy. The Health Committee heard evidence that urgent care boards were the management that was removed by what happened to the strategic health authorities. What are the costs? The Treasury has already clawed back £3 billion from the NHS. According to the National Audit Office, the efficiency gains of £5.8 billion that were made in the first year were a result of reducing the tariff to providers and the public sector pay freeze, but how long can that carry on?

The NAO has published interesting statistics following the passage of the Health and Social Care Act 2012. The reported cost of the reforms was £1.1 billion. The Secretary of State told the Health Committee that he had seen—he did not know—a figure of between £1.5 billion and £1.6 billion. Professor Kieran Walshe has put the figure at £3 billion.

The NAO said that of the 170 organisations closed down, 240 have been opened, and 10,094 full-time equivalent staff have been made redundant. It is a shame, when there is an underspend of £3 billion, that the College of Emergency Medicine is crying out for extra emergency doctors and consultants, and at least half a million pounds is spent on locums in A and E, and all before we have even looked at integration.

Many have endorsed what is rapidly becoming known as the Burnham plan, including the right hon. Member for Charnwood (Mr Dorrell). The Health Committee has seen the work at Torbay, which was piloted in 2004-05—by the previous Government, incidentally—but we were told that the Health and Social Care Act could affect the way it works.

I want to ask the Secretary of State to do something fairly useful: ask someone at the Department of Health to pull together and publicise best practice from across the country. The Health Committee heard evidence that some of the A and E hospitals had got it right by moving elderly people directly to consultant geriatricians.

Finally, it is very easy for those of us who are exposed to the world of NHS structures to say how we can fix it, but Robert Francis took evidence from those who use the service directly on how they came across the inaction and indifference of a large institution. Sir Bruce Keogh has done the same with his report. They talked directly to those on the front line and those who use the service, not just those in the boardroom. They are the ones who should be listened to—all those who work in the NHS and have to provide a service when their pay is frozen. The people who use our NHS want professional people who are competent at their job caring for them when they are at their most vulnerable. Only if we listen to them will we be able to wish the NHS many happy returns in future.

Oral Answers to Questions

Valerie Vaz Excerpts

Tuesday 16th July 2013 Commons Chamber

[Anna Soubry]

Of course, the overall health budget will be rising by some £12 billion by 2015, and in relation to mental health, I have to say that I am exceptionally proud of this Government for making mental health such a priority, notably through the mandate. I think we are to be congratulated on at last recognising how important mental health is. In our view, it underpins almost all public health matters and so many of the troubles and conditions that people present to GP surgeries. Therefore, I think we are doing an extremely good job on this subject.

[Valerie Vaz (Walsall South) (Lab)]

4. What plans he has to implement the recommendation of the Francis report on safe staffing levels.

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

We agree with Robert Francis that there is a need for evidence-based guidance and tools to inform appropriate staffing levels. We have set out a number of recommended actions to support appropriate staffing levels in “Compassion in Practice”—the nursing, midwifery and care staff vision and strategy for England.

[Valerie Vaz]

I thank the Secretary of State for his answer, but Robert Francis said in his report that minimum safe staffing levels lead to helping patient safety. If the Secretary of State agrees with Robert Francis, why does he not implement that recommendation now?

Tobacco Packaging

Valerie Vaz Excerpts

Friday 12th July 2013 Commons Chamber

[Anna Soubry]

I could speak for a very long time about illegal drugs and how we make them less attractive to young people. We know, for sure, that we need a subtle mixture of different measures that persuade young people not to take substances that are harmful to them. I am more than happy to have that conversation with my hon. Friend.

[Valerie Vaz (Walsall South) (Lab)]

Apart from vending machines, what public health initiatives is the Minister going to undertake immediately to stop 570 children a day taking up smoking?

[Anna Soubry]

We have a number of measures. For example, we have some of the toughest tax and duty measures in relation to tobacco. The “Stoptober” campaign was phenomenally successful last year. We have a TV campaign that is encouraging people not to smoke in cars, for example, as well as our other continuing work. With public health being devolved back to where it always should have been—to local authorities—a number of authorities, notably up in north-east England, have taken grave measures to tackle smoking by educating young people, in particular. This is all good work that will continue through Public Health England.

A and E Departments

Valerie Vaz Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

My hon. Friend rightly draws attention to the importance of the ambulance service, which is also feeling the pressure on A and E departments. We need to help the ambulance service to do its job better too. One thing that it always strikes me would make a huge difference to ambulance services is if staff could access the GP records of someone they were picking up on a 999 call, so that they would know that the patient was a diabetic with mild dementia and a heart condition, for instance. That kind of information can be incredibly helpful. I hope that by sorting out the IT issues with which the last Government struggled, we can help ambulance services to do that.

[Valerie Vaz (Walsall South) (Lab)]

The Select Committee on Health heard evidence today from the College of Emergency Medicine about a 50% shortfall in trainee doctors and consultants. On average, trusts—I was going to say PCTs—spend £500,000 on locums. What does the Secretary of State intend to do about that?

[Mr Hunt]

We certainly intend to address A and E departments’ recruitment issues, which I recognise are one of the causes of the pressure. Over-reliance on locum doctors is not a long-term solution to improving the performance of A and E departments either, so those are both areas that we will be looking at.

Health and Social Care

Valerie Vaz Excerpts

Monday 13th May 2013 Commons Chamber

[Valerie Vaz (Walsall South) (Lab)]

It is a pleasure to follow the hon. Member for Gainsborough (Mr Leigh) and to speak in the debate on the Gracious Speech to both Houses of Parliament.

I do not know about you, Madam Deputy Speaker, but I sense some confusion or dysfunction in the air—it started with the weather: first, we thought it was spring, and then found that it was not—which seems to have got down to the Government. Let me provide some examples. The Government want us to build more conservatories, but at the same time they are asking people to downsize to other properties. Over lunches, they are giving the benefit of the doubt to some companies minimising their tax bills, yet are not giving the benefit of the doubt to those who have to turn up to Atos assessments—even though they are in a wheelchair or have other long-term conditions. That is very dysfunctional.

Mr Qatada has been given £500,000 in legal aid, when he could have fought his appeal from abroad, but, with the cuts in legal aid, my constituent, Mrs Pressdee, cannot find a legal aid lawyer to help her from losing her home. What about the statement that Eton produces people who dominate Government because of their commitment to public service? I always thought there was a link between Eton and the Labour party, the Woodcraft Folk, the girl guides and the boy scouts, which are all committed to public service. Curiously, however, the number of public sector workers, who have a commitment to public service, has been decreasing over the last 13 quarters.

Let us deal with the commitment in the Gracious Speech to the reform of long-term care. This can be achieved only on the back of moving money from the health budget to social care, which the previous Secretary of State for Health had already started to do. This commitment in the Gracious Speech has been made against the backdrop of nurses and junior doctors saying they need more staff and that they are overstretched, but there is no commitment to staffing ratios.

About £10 million was spent on the Francis report, but its recommendations on the health service they have been practically discarded by this Government. Instead, the Secretary of State for Health is suggesting what can be described only as a vanity policy—he wants a chief inspector of hospitals. He was unable to tell me how much the chief inspector would earn, where the budget was coming from, whether this counted as committed spending, whether the Treasury knew about it, or whether it was to be taken out of the Care Quality Commission budget. This was not a recommendation that either Robert Francis or the Health Select Committee made. The Health Service Journal surveyed senior people in the hospital sector, 73% of whom said they did not believe hospital inspectors would be effective. This is a headline vanity policy.

The Francis report was not about sticks or the smack of firm government, but about a change in culture. Francis said that there should be one organisation undertaking the monitoring of organisations’ ability to deliver compliance of fundamental standards. At the moment, we have the CQC, Monitor and now the chief inspector who will apparently have the power to close hospitals. The Secretary of State made a comparison with Ofsted earlier, so let us remember Helen Mann, a head teacher who was so terrified of an Ofsted inspection downgrading her school from outstanding that she hanged herself. Is this what we want our public servants to do? In any case, it was not Ofsted, but the hard work of teachers and pupils that drove up standards. Here is the chaotic part: for a top-performing hospital, there will be lower regulation. How can that be fair? The Secretary of State was unable to tell the Select Committee how long these top-performing hospitals would be able to keep their top rating. That is a recipe for chaos. And what will be monitored? Again, the Secretary of State was unable to say. Will it be mortality rates, success in surgery or what?

I would like draw hon. Members’ attention to an article by Professor Nick Black in The Lancet in March 2012, in which he discusses the myth that grew up—that productivity in the NHS was falling—and warned of the dangers of using one set of indicators. That is exactly what happened at the Leeds hospital. The Secretary of State has conceded that the data were not verified when Sir Bruce Keogh made the decision to close children’s heart surgery, leaving parents and professionals confused and anxious. Whoever has the ear of the chief inspector and has their own data could therefore damage a hospital.

Let me deal now with the Gracious Speech’s reference to improving the water industry. Members may like to know that Thames Water, which is controlled by an Australian bank, now proposes to recycle sewage water for drinking, yet fails to mention investment in infrastructure or the leaking pipes that caused the shortage in the first place. All that was despite the fact that the company had made £552 million in profit by the end of March 2013. I ask the Government to look further into that.

This Gracious Speech should be based on justice, tolerance and the rule of law, yet all that is being undermined. The gracious people of this country, on whose behalf the Gracious Speech was made, deserve better.

Oral Answers to Questions

Valerie Vaz Excerpts

Tuesday 16th April 2013 Commons Chamber

[Anna Soubry]

We have invested £450 million in improving exactly the matter that the right hon. Gentleman raises, and I do not share his analysis one bit.

[Valerie Vaz (Walsall South) (Lab)]

As well as raising awareness of cancer, will the Minister clarify whether this new list of 28 prescribed drugs produced by the NHS Commissioning Board will increase access to the cancer drugs fund?

[Anna Soubry]

What I know is that the cancer drugs fund is delivering in a way that, if I may say so, was not delivered under the last Administration.

Mid Staffordshire NHS Foundation Trust

Valerie Vaz Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

First, I thank my hon. Friend for his extraordinarily tireless work and for the extremely measured and mature attitude he has taken to the problems in the hospital, which is on his patch. Hon. Members on both sides of the House welcome that. He is right about the role of the royal colleges. There are some challenging suggestions in the Francis report for some of those colleges, but when we are seeking to raise standards, it is important that setting up that scorecard for the new chief inspector happens with the help of the royal colleges, whose business it is to raise standards in the NHS.

[Valerie Vaz (Walsall South) (Lab)]

I thank the Secretary of State for his statement, and we welcome the continuation of this discussion at the Health Committee. One of the recommendations of Francis was for the Secretary of State to look at the overlap between the CQC and Monitor, both of which were involved and have accepted they were part of the failings. Under the new inspection regime, will the chief inspector report to the Secretary of State or to the NHS Commissioning Board?

[Mr Hunt]

Neither. The chief inspector will report to the CQC. The hon. Lady is right that one of the problems is the overlapping roles and the confusion of roles. What we are announcing today is a significant change in the responsibilities of the CQC. It will no longer be involved in putting right problems in hospitals: its job will simply be to identify problems, so it is not compromised in its ability to be the nation’s whistleblower-in-chief. The responsibility for putting right problems will lie with Monitor, the NHS Trust Development Authority, the NHS Commissioning Board and the wider NHS system. We want to make sure that the chief inspector is unconstrained and unconflicted, when his or her team goes into hospitals, from shouting loudly if there is a problem and continuing to shout loudly until it is solved.

Accountability and Transparency in the NHS

Valerie Vaz Excerpts

Thursday 14th March 2013 Commons Chamber

[Valerie Vaz (Walsall South) (Lab)]

It is a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy) and to pay tribute to him for the dignified way in which he has represented his constituency during the Francis report.

I begin by thanking the Backbench Business Committee for securing this important debate. The NHS in England has a budget of £108 billion and employs 1.35 million people, with just under half of them clinically qualified, so it is right that accountability is at the centre of the NHS, for the people who work there, those who use it and those who fund it. I am sure that all my hon. Friends who have spoken and will be speaking in this debate do not see it as a chance to score political points or as background noise to denigrate an institution that was set up with the simple promise that is delivered every single day—that health care is free to everyone, irrespective of their ability to pay or of pre-existing conditions. It still operates as a service in which people are not judged on their illness but provided with a service.

I know that the debate is taking place against the background of the Francis report, but I wish to point hon. Members to a book that is about to come out—it is by Roger Taylor and called “God bless the NHS”. It was serialised in The Guardian last weekend. Roger Taylor says in the book:

“Paul Woodmansey was a senior doctor at Stafford throughout the period that things went wrong; He is mentioned by a number of patients for whom his department provided a haven of professional high quality care while standards in other wards collapsed.”

Let us not forget then that, even when a light is shone in a corner of the NHS where it is found to have failed the very people it was meant to help, there are areas of good practice.

Let us look at the background of this debate on accountability.

[Jeremy Lefroy]

I am sorry to interrupt the hon. Lady, but I would like to point out that the same Dr Woodmansey has been appointed as the new medical director of the Mid Staffs trust Stafford hospital. I welcome that, for the reasons that she has articulated.

--- Later in debate ---

[Valerie Vaz]

Let us look at what is going to happen in 18 days’ time when the Health And Social Care Act 2012 comes into force. I do not want to rerun the arguments about the Act, but let us look at what is to come. Let us look at the accountability of the structures under the Act. The NHS Commissioning Board becomes the conduit for everything, including the flow of money, and all the strategic decisions filter down. If anyone cares to look at the Department of Health website and the new structure, they will see a series of concentric circles. Parliament, the Department and the Secretary of State all appear to be in the outer circle, running round in circles. Where is the accountability in that?

I have to tell the Secretary of State—although I am pleased to see him here, this is a Back-Bench business debate—that section 75 regulations were signed off, under a negative resolution, by a Minister who is not accountable to the House. Section 75 says that everything has to be tendered except for technical reasons, or reasons of extreme urgency. That had to be changed to state that contracts can be tendered if the relevant body is satisfied that the services to which the contract related are capable of being provided only by that provider.

Regulation 10 previously said that commissioners may not engage in anti-competitive behaviour; otherwise, Monitor will be after them. Sorry, those are my words. That was changed to say that commissioners must not be anti-competitive unless it is in the interests of patients.

What of the future? I pay tribute to the right hon. Member for Charnwood (Mr Dorrell), who made an excellent speech. I want to draw attention to a report that our Select Committee produced on complaints and litigation in June 2011. I urge the Secretary of State, if he cares to listen, to read that report and consider all the recommendations. Even then, we called for all providers to have a duty of candour to patients. We also said that we found it striking that the Government did not mention complaints in the information revolution consultation and were surprised that they did not see how complaints information could help people see what is going on. My hon. Friend the Member for West Lancashire (Rosie Cooper), who is no longer in her place, was right to say that complaints can provide information about what needs to be put right.

Mr Deputy Speaker, I am not sure whether you are aware that the NHS litigation bill has now reached £1.3 billion. I urge the Secretary of State to look into the reasons why that is happening. We have to redress negligence, but there are other reasons why that bill is rising. There are remedies that do not involve money or changes in structures or reorganisations.

[John Pugh]

Does the hon. Lady acknowledge that that is what the NHS Redress Act 2006 was supposed to do? I am genuinely puzzled, and I hope that the Minister will resolve this puzzle for me, about how much of that Act has been formally enacted.

[Valerie Vaz]

I cannot answer that; I am not on the Front Bench.

We all agree that there is no place for gagging clauses if lessons are to be learned about patient care. I agree that the Government have made an important announcement today, but let me remind the Secretary of State that the NHS issued management directions in 1999 and 2004. I am concerned that the NHS still needs reminding about these gagging clauses. We must get away from a system in which whistleblowers are driven out of their jobs on spurious disciplinary issues. At Mid Staffs, doctors and nurses are under disciplinary reviews, but as yet I have not heard anything about whether managers will also be held to account.

Action plans that arise from complaints are a vital part of organisational learning, but they are only of value if they are followed through to implementation, and it was clear from evidence to us in the Select Committee that that did not happen at Mid Staffs.

Publication of complaints data must be obligatory for all care providers, including foundation trusts and private providers with NHS contracts. We must move away, as the hon. Member for Southport (John Pugh) said, from the blame and victim culture and reduce the emphasis on disciplinary procedures. We must put more emphasis on retraining and risk management.

We should enshrine accountability for patients at board level, making boards more diverse, not just comprising the usual suspects. Private providers, as my right hon. Friend the Member for Leigh (Andy Burnham) said, are not subject to FOI; they must be. The register of GPs’ interests must be open to clinical commissioning groups. It should not be up to the public to ask whether GPs have declared their interests. Every decision must be associated with a list of GPs’ interests.

I have spoken to the chief executive of the Royal Orthopaedic hospital, who said that he ensures that doctors, nurses and managers are all on an equal footing, which is an example of good practice. His phrase is that there should be “no gap between board and ward”. He puts his patient groups on the board, every ward gets rolling visits and board members even feed the patients.

In my own way, I have also been accountable and I have published on my website a table of all the complaints my constituents have come to me about so that they can see what sort of things are going on at the Manor hospital. The chief executive of the hospital is undertaking a patient survey and ensures that he looks at all the responses.

I hope that I have outlined some positive aspects as a way of moving forward and that we will continue to have an accountable, transparent and unique NHS that is the best in the world.

NHS Commissioning Board

Valerie Vaz Excerpts

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

This Government will ensure that there is no unfair competition, such as existed under the previous Government, whereby private providers got handed guaranteed income on a plate, irrespective of whether or not they did the work. I am clear that nothing in our legislation will prevent a real drive towards integrated care, to which the hon. Lady and I share a commitment.

[Valerie Vaz (Walsall South) (Lab)]

Will the Minister say whether there was a mistake in the instructions given to parliamentary counsel in drafting these regulations? Will he also tell us which Minister signed them off?

[Norman Lamb]

This comes down to a question of the legal drafting and a legitimate concern that the regulations did not meet the policy objectives set out clearly in the Health and Social Care Act and during the course of the debates on it in Parliament. We simply want to ensure that that objective is faithfully met.

Backbench business

Valerie Vaz Excerpts

Thursday 14th February 2013 Westminster Hall

[Norman Lamb]

I am nervous about treading on other ministerial toes, but I am sure that in one way or another we can get the issue addressed properly. I am grateful to the right hon. Gentleman for informing me so well.

The hon. Member for South Derbyshire (Heather Wheeler) made a helpful contribution and discussed the need to raise awareness of eating disorders. She mentioned personal, social, health and economic education in schools. All schools are encouraged to provide young people with good, age-appropriate education about sex and relationships, but we are reviewing PSHE to establish how teaching can be improved. There is clearly a need to improve the teaching in many schools.

The hon. Member for North Tyneside (Mrs Glindon) mentioned her local service, NIWE, and the important work that it is doing. She spoke about the number of people who are not diagnosed but who none the less suffer from eating disorders, and about the fact that they have the highest mortality rate of any mental illness. She said that early intervention was important.

I was struck by what the hon. Lady said about recovery groups. This morning I spoke at a conference on mental health. I spoke specifically about recovery and a new way of looking at mental health. We must move from trying simply to treat the condition to working collaboratively with professionals and people experiencing the condition, and we must focus on recovery. Fantastic results are being demonstrated from that shift in approach. It is frustrating that in some parts of the country, great things are happening, but it is patchy, as many hon. Members have said, and improvement is needed. She also made the point that mental health is the poor relation, as I have acknowledged. That must change.

I pay tribute to the hon. Member for Enfield, Southgate (Mr Burrowes), who has had to leave, for the work that he has done on addictions, focusing on treatment and recovery. He has been committed to improving the experience of people suffering from a range of addictions. He, like other Members, discussed the growing prevalence of the condition among teenage boys, which should worry us all. My hon. Friend the Member for Wells (Tessa Munt) spoke movingly. She mentioned the cult of celebrity, pressure on youngsters, variability of services around the country and access to those, the quality of care being variable and the need for much improved training and for multidisciplinary teams.

Interestingly, my hon. Friend mentioned issues of consent, a difficult area about which there are strong views on both sides. I am acutely aware of the horrible position of a parent wanting to help, but being unable to because of the legal constraints that prevent them from making an effective intervention. We need to think more about that, and the Children’s Minister is also involved in the discussion.

My hon. Friend the Member for South Basildon and East Thurrock got it right. Fascinatingly, he talked about his discussion with his children last night. I am so pleased that his television is broken, because it has led to our being given a valuable insight that we might otherwise not have had. He mentioned the increasing prevalence among males, including among gay men, which is a real concern. He also talked about the need for help for parents in understanding the condition much better.

The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), was right to talk about holistic care and the need to look at the whole individual. I will mention other things that he said as I go through my speech. I wish his son a happy birthday today, as he enters his teenage years.

The hon. Gentleman asked a couple of questions. On collating national statistics, we have a long way to go on the collection and interpretation of data relating to mental health. I have a fortnightly meeting on mental health in my office, so that we maintain an absolute focus on achieving tangible improvements. We talked specifically about data yesterday. The Health and Social Care Information Centre is getting more data but is not yet able, with the resources available, to interpret those. I want the same resources applied to mental health as to physical health. That is a challenge that I have made to the system.

The hon. Gentleman mentioned National Institute for Health and Clinical Excellence guidance. NICE is independent. I do not know whether there is a need for a review—a renewal—of the advice. I am happy to talk further to him about that.

This is an occasion on which we should not just raise awareness of the issue as part of eating disorders awareness week, but send a clear message to people with eating disorders, their loved ones and families: we hear you when you talk about your concerns. I am determined, as the Minister responsible for mental health, to do what I can to help.

I pay tribute to the work of Beat, based in Norwich in my county of Norfolk, which does brilliant work. Hon. Members have also mentioned Anorexia and Bulimia Care and the fantastic work that it does.

Eating disorders can be tremendously dangerous and damaging conditions. The UK has the highest rates of eating disorders in Europe. But it is a disease that is often hidden, as hon. Members have said. Sufferers are often unwilling to seek help or to recognise they have a problem. Reported cases are the tip of the iceberg. It is a disease that often strikes at the young. In 2009, the adult psychiatric morbidity survey showed that 20% of 16 to 25-year-olds admitted to having “a problem with food”. That is a significant percentage.

According to the Health and Social Care Information Centre, in 2011-12 the biggest increase in hospital admissions for eating disorders was among girls aged 10 to 15. The shadow Minister, the hon. Member for Denton and Reddish, mentioned admissions of those under 10, as well—shockingly, more than 50 children under 10 were also admitted.

[Valerie Vaz (Walsall South) (Lab)]

I apologise for not attending earlier, Mr Walker; I was in another debate in the main Chamber. I congratulate the hon. Member for Romsey and Southampton North (Caroline Nokes) on securing this debate.

The Minister mentioned young people. Will he say what services are available for 17-year-olds in terms of continuity of care, as they move to adult services?

[Norman Lamb]

I will talk about that later. In so many respects, we have problems with people falling through the gap between children and adolescent mental health services and adult services, and that is matched in other areas, as well. There is a need to deal with this. The draft Care and Support Bill deals with the transition from teenage to adult services. I will return to that matter. I thank the hon. Lady for her intervention.

A generation of young people is growing up depressed and unhappy with their relationship with food. I want to tell hon. Members about a case in my constituency. Charlotte Robinson was a bright, outgoing young woman who was about to secure straight As at A-level and had dreams of going to Cambridge—between Duke of Edinburgh’s awards and learning to fly helicopters—but tragically, Charlotte was a victim of anorexia, stolen from her family in her prime, with her whole life ahead of her. That is what I meant when I said that for some, thankfully, there is life after anorexia—but not for everyone.

Charlotte’s parents, Christopher and Pauline, who are remarkable people, have campaigned tirelessly to help others. Pauline even ran the London marathon in pink wellies, such is her commitment. They are fantastic people and their attitude was that they did not want other families to experience the same horror that they have gone through, so they have been determined to change things in their county of Norfolk. They discovered that there was no specialist commissioned service at all in their own county. This is what we find. Hon. Members have talked about the enormous gaps in services around the country.

As a result of Christopher’s and Pauline’s fantastic determination, there is now a specialist commissioned service, but it took their efforts to achieve it. Their efforts have helped to fund local centres and a helpline in Norfolk, working with NHS Norfolk and the charity Beat, which I have mentioned. Their focus is on early intervention, helping people like Charlotte—helping children, young people and adults as soon as they need help. Charlotte’s decline was dramatic and rapid and the wait, although nothing like the nine months that we have heard about, still was too long for her.

Speedy access and early intervention are critical. That is why our mental health strategy prioritises early intervention and demonstrates how timely action can help.

In many cases, eating disorders stem from low self-esteem or are linked to stress and emotional problems. That is why our support for local organisations in improving mental health services locally is so important. Our mental health and suicide-prevention strategies both include actions that local organisations can take to improve mental health in their areas: ensuring that children and parents get mental health support from birth; that schools and colleges promote good mental health, alongside targeted support for those at risk of mental health problems; that public services recognise people, of all ages, at risk of mental health problems and take appropriate, timely action; and that health services step in early if there is psychosis or a crisis, to stop more serious problems occurring.

The right hon. Member for Knowsley and my hon. Friend the Member for Romsey and Southampton North raised the problem of transition—moving from being a young teenager at home to a young adult. Often the problem is exacerbated by moving to university, where people suddenly lose contact with services that might have been available to them at home. As my hon. Friend mentioned specifically, that is where things can break down. Away from friends and family, in a new and often stressful environment and, crucially, registering with a new GP, young people can often enter a spiral of decline. The problem must be addressed.

I will now outline some of our ambitions for services. From this April, the NHS Commissioning Board will commission specialist services for eating disorders for adults and children. Having one specialist group to ensure that specialist services are commissioned everywhere has the potential to improve the position in many parts of the country where such services are inadequate or missing. The Commissioning Board will develop a national service specification and encourage better planning, access and outcomes, helping to bridge the gap when someone moves and raising the level of care throughout the country.

We want clinical commissioning groups to commission services with early intervention in mind. We also expect adult social services to work alongside CCGs to focus existing support on early intervention, integration, personalisation and recovery. Social services have a role to play, involving service users as equal partners in commissioning and monitoring services, ensuring that services are designed for the people who use them.

Public health services can articulate the many benefits of good mental health and, because of their pivotal role in the new system, they can talk about mental health directly with members of the public. The transfer of public health to local government, alongside children’s services, social care and other services, with a seat on the health and wellbeing board, potentially gives it a prominence that it has not had in the past. The funding settlement for public health has also surprised many people, with significant real-terms increases this year and next. There is great potential for a focus on public mental health in a way that we have not had in the past, so I hope that we can take advantage in the best possible way of that opportunity.

Of course, the problem cannot be fixed by tweaking the system. A huge stigma remains around mental health, which means that in too many cases children and young people are not getting the support that they need. That is particularly the case with eating disorders, and people affected often feel marginalised and excluded, unable to talk about their suffering. The problems can be compounded if the sufferer is a man or suffering from a less stereotypical but no less serious eating disorder, such as atypical anorexia or a binge-eating disorder. Personal testimony and the courage of individuals in speaking out send a powerful message, and challenge that stigma.

The Department of Health is therefore funding Time to Change, a brilliant campaign that was started under the previous Government but continues now. We are providing £16 million between 2011-12 and 2014-15, the first time that Time to Change has had central Government funding. It will also get a further £4 million from Comic Relief, the second time that that charity has awarded its largest UK grant to Time to Change. Run by the charities Mind and Rethink Mental Illness, Time to Change is England’s most ambitious programme to end the stigma and the discrimination against mental health through activities ranging from education to publicity. It aims to reach 29 million members of the public, explaining mental health and helping them to understand conditions, including eating disorders, that might at first seem alien or scary.

I was delighted that two young women from Time to Change came into the Department of Health recently to speak about their own experiences of mental health. They spoke about how talking about their own mental health had empowered them. One said that it had, “given me my life back”. Their stories were both moving and inspiring and I pay tribute to all those who find the courage to open up and to talk to others. Time to Change aims to increase the confidence of 100,000 people with mental health problems, helping to give them the self-belief that they need to recover.

The Time to Change campaign also works with schools to support children and young people facing problems of integration and bullying that can be caused by mental health issues. I have not only signed up to committing the Department of Health to be an exemplar employer on mental health, but made the commitment to try to get every other Department to sign up as well. We cannot encourage others to behave in the right way unless we practise what we preach. That is a challenge for Government, and I have not yet achieved that aim, but I am determined to pursue it.

The reasons for eating disorders are complex, as has been made clear in the debate this afternoon. Biology and genetics play their part, but so too does the pressure from our celebrity culture and the media. A recent controversy ignited by stick-thin La Perla lingerie models erupted only last week, and it is important to send out the message that organisations that do this sort of advertising have a responsibility; they cannot opt out. Government cannot do everything on its own. Everyone in society has a responsibility to get the right messages out. I was pleased to hear the shadow Minister’s reference to Vogue, which has made a good commitment to avoid getting out the wrong images.