Obstructive Sleep Apnoea

Yasmin Qureshi Excerpts

Tuesday 2nd September 2014 Westminster Hall

[Julie Hilling]

I thank my hon. Friend for that intervention. It feels as though she has looked at my speech, because I am going to cover in detail a number of the aspects that she has raised.

OSA can reduce a person’s ability to work and impair the quality of life of the person and their family. The story of Steve, one of my constituents in Bolton West, shows only too well what can happen when OSA is not diagnosed. When Steve was 36, he started to get lots of daytime sleepiness; indeed, he was sleeping all the time. He became very aggressive and went to his doctor, who treated him for depression. The first medication did nothing, and the second medication made him even more aggressive. He managed to maintain his job, but with great difficulty, often having to slope off for a sleep, and he was being threatened with dismissal. He did not have a relationship with his young daughter; between the ages of four and six years old, she had no relationship with her dad at all. He could not play with her or interact with her, except to snarl at her. Indeed, he did not have a relationship with his wife or anyone else at that time. The family went on holiday, but his wife said that she would never go away with him again because he slept the whole time. Eventually, he had to take sick leave from work, and for five months he never left his bed. He was so bad that his wife had to change the bedclothes around him. He had a constant headache and felt worthless as he was not contributing anything to society or his family. He could not eat properly and just could not function. He attempted suicide twice.

Steve was referred to a mental health consultant at Royal Bolton infirmary who immediately asked whether he had been tested for sleep apnoea and he was referred to Wythenshawe sleep clinic. There are three stages of sleep: a top layer, a lower layer and deep sleep. The sleep clinic discovered that every minute and 43 seconds, Steve went back to the top of the sleep cycle and was never getting into a deep sleep. He was given a continuous positive airway pressure—CPAP—machine. He went home, slept for 11 hours and was back at work the next day. Eight years later, he still uses the machine every night and has never looked back. It does have its downsides. He will not go abroad because he has a great fear of electricity cuts and he cannot sleep in the same room as his wife because of the noise of the machine, but he believes that that is a small price to pay for getting his life back. Steve feels like he suffered two years of torture. Let us not forget that sleep deprivation is listed as a proscribed method of torture. However, with a very low cost treatment, he can now function and live life to the full.

My friend’s sister, 52-year-old Jean, also had difficulty in getting her GP to take her issue seriously. She went to him because she was very tired all the time and kept falling asleep in work and on the bus home. She would go to bed and sleep all night, but wake up feeling just as drained and tired. After three visits, her GP started to take her problem seriously and, after running a number of tests with no result, referred her to Wigan infirmary. She got an appointment within three weeks, had her sleep monitored and then got a CPAP machine. It has not solved her problem completely, but it has much reduced the number of times she wakes up and she is able to enjoy life again.

[Yasmin Qureshi (Bolton South East) (Lab)]

I congratulate my hon. Friend on securing this Adjournment debate. On the point that she raises about how long it takes for people to be diagnosed, is it not correct that about 1.5 million people in this country probably suffer from this condition, but only about 330,000 people are ever diagnosed? Presumably, therefore, one thing that we need to do is to make medical practitioners aware that this condition is perhaps a lot more prevalent than we think it is.

[Julie Hilling]

I thank my hon. Friend for that intervention. She is right. We need to make both the public and medical practitioners aware. Also, we need to ensure that the services are in the right place. I will talk more about that in a moment, but first let me tell hon. Members about one more person. My office manager, Noelene, also surprised me by saying that she suffers from OSA; I never had any inkling that she did. She has an underactive thyroid and was extremely tired and forgetful. She would have no recollection of doing something or no memory of how she had got somewhere. She just blamed her thyroid, but her endocrinologist told her that her thyroid levels were fine and that she could not keep blaming everything on her thyroid. He referred her to his friend the sleep specialist. She collected a monitor that afternoon and less than four weeks later was given a CPAP machine. As the specialist said, if the mask works, it is OSA, and if not, it is something else and they will have to continue to investigate. She had problems with the mask initially and found it very uncomfortable but persevered. She could not get on with the full mask, because, as she said, a full mask and hot flushes are not a great combination, so she tried two other masks and now has a nose mask. Occasionally she does not use it, but immediately feels bad. She is now four years on from diagnosis and treatment.

I guess I am not surprised that I did not know that people had the condition, because snoring and falling asleep all over the place are still treated as a great joke, and the first reaction of most of us when we are told that we snore is immediately to deny it. The cost of undiagnosed sleep apnoea is enormous, however. Up to 80% of cases of OSA remain undiagnosed. Awareness of the condition is poor, and the risks associated with it are underestimated even by doctors. The British Lung Foundation led a three-year project to raise awareness of the condition and to campaign for the setting of quality standards for the treatment and care that OSA patients can expect. The OSA patients’ charter, published in 2012, was designed to do that, and it calls on the Government to prioritise OSA by increasing awareness, ensuring adequate data are collected for good service planning and investing more research into the condition.

Progress has been slow, however. The British Lung Foundation commissioned a report on the health economics of OSA, which will be published later this week, to demonstrate the economic and social arguments for greater focus on, and treatment of, the condition. The report finds that treating OSA can generate direct health benefits to OSA patients, and reduce costs incurred by the NHS, in comparison with not treating the condition. Currently, only 22% of OSA patients are treated across the UK, but increasing diagnosis and treatment rates to just 45% could yield an annual saving of £28 million to the NHS, as well as 20,000 quality-adjusted life years. That includes savings that result from reductions in road traffic accidents, heart attacks and strokes, as well as the positive impact on patients’ quality of life and improved survival rates over time. Other sources suggest that NHS expenditure on undiagnosed patients is estimated to be approximately twice that of people of the same age and the same gender. It is estimated that if everyone in the UK with moderate to severe OSA was treated, approximately 40,000 road traffic accidents could be prevented—accidents that not only affect sufferers of OSA, but cause injury and death to so many others.

The main treatment for OSA, continuous positive airway pressure, is very cost-effective. NICE usually values a treatment as cost-effective if it costs £20,000 to £30,000 per quality-adjusted life year gained, but the main treatment used for OSA costs the NHS only £5,000 per quality-adjusted life year gained. Because OSA is associated with other conditions such as heart disease, stroke and diabetes, some savings may also be made in the reduction of medication for those conditions. A Canadian study found that 38% of patients being treated for OSA reported a reduction in their intake of medicines to manage their other conditions.

What do we need to do? In July 2012, the Department of Health set up a working group on OSA to look at areas for improvement in care and services for the condition. However, the group was disbanded early in 2013 during the NHS restructure, and no one is responsible for taking forward the recommendations from the group’s work. The Department of Health should appoint a body to take forward those recommendations. In 2012, NICE was asked to produce a quality standard on sleep-disordered breathing. That has not been developed, and it should be taken forward as an immediate priority so that those with OSA know what to expect from their care.

Everyone who has symptoms of OSA should be diagnosed quickly and accurately, and they should receive the highest standard of care. That will help to reduce NHS costs and improve patients’ quality of life, and it could reduce the number of road traffic accidents that are caused by sleepy drivers. The level of risk of OSA varies across the UK depending on the prevalence of risk factors, and there is a mismatch between the geographical distribution of need and the regional distribution of services. Local commissioners must ensure sufficient availability of services in areas such as Bolton West that have a high estimated OSA prevalence. OSA screening and specialist referral should be introduced into the quality outcomes framework. Doing so would allow for more accurate data on the number of referrals being made from primary care and provide an immediate financial incentive for early intervention that would reduce costs and improve outcomes in the long term.

Finally, let me return to where I started on my journey of interest in OSA. Those who drive for a living, frequently on monotonous roads and motorways, are at risk of falling asleep at the wheel. Their lifestyle also puts them at increased risk of developing sleep apnoea. Those who fear that they have the disorder are often worried about seeking treatment, because they are concerned about losing their livelihood. I hope that the Minister will support the call of the sleep apnoea partnership group to expedite the treatment of vocational drivers so that they can be driving again within four weeks of referral.

Hospital Car Parking Charges

Yasmin Qureshi Excerpts

Monday 1st September 2014 Commons Chamber

[Yasmin Qureshi (Bolton South East) (Lab)]

I congratulate the hon. Member for Thurrock (Jackie Doyle-Price) on securing this debate. I start with the point on which she finished, which is that the NHS is supposed to be free at the point of use. When we set sometimes exorbitant charges at different hospitals, we are effectively taxing the ill and their families.

Members have talked about the families of patients in hospital for the long term, with all the costs involved for relatives who visit them. This is honestly not a party political point, but in 2009, when my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown) was Prime Minister, the Labour party suggested that those who had family members in hospital for a long time should get special permits to enable them to visit without having to pay each time, but that was scrapped in 2010 when the current Government came in. I ask them to reconsider that proposal. One way in which they could act very positively would be to have a similar provision such that the family of those in hospital for the long term can get and use special permits. That would certainly deal with the problem of the long-term ill.

There is another group of people whom we have not mentioned. We now have an elderly population and most older people have not just one health issue, but several health complications, so they often end up having to go to hospital to see consultants and doctors for six, eight or nine different illnesses or health issues. Each time they go, they or the person accompanying them has to pay hospital parking charges.

I give the example of my mother, who is 82 years of age. She has several different health issues, and every time I take her to my local hospital—I am her carer—it costs £3, just for five or 10 minutes. I am in the privileged position of being able to afford that, but there are many people in my constituency, who have caring responsibilities for adult and often elderly family members, who may only be on the minimum wage.

[Lilian Greenwood (Nottingham South) (Lab)]

Does my hon. Friend agree that for the many elderly people who do not drive, public transport is a really important issue, just like parking charges? Is she aware that Queen’s medical centre in Nottingham is soon to have the first dedicated hospital tram stop, which will improve access for older and disabled people in particular?

[Yasmin Qureshi]

I did not know about the Nottingham tram, but I am pleased that people there will have a tram stop to deal with the problem. Something like that would be brilliant in my constituency. There is a bus that goes to my hospital, the Royal Bolton, but because of its location the service is not frequent, so getting there is quite difficult. Such public transport solutions can help people as well. My hon. Friend is absolutely right that many older people cannot drive, so they also have that challenge.

Perhaps we do not think enough about the number of appointments most older patients have, as do those who are generally ill and have to go in and out of hospital for appointments numerous times. The way forward may be to abolish car park charging full stop, so that a scheme can be applied nationally. The minute we have a discretionary system and leave each hospital trust to decide for itself, some—perhaps because where they are located means they have a large parking space—can charge a small amount, such as 50p, while other hospitals that lack space because of where they are must charge a bit more. Leaving things to discretion means having, as everyone says, a postcode lottery. A better solution might be to make special dispensation, across the whole country, for those going to hospital appointments or those who are in hospital for some days.

Although I have a legal background, I am not normally an advocate for a lot more law, because it is not always a good idea to have loads of legislation. In this case, however, it is worth thinking about having legislation or a directive with the even more novel approach of abolishing such charges altogether. At the end of the day, nobody goes to hospital for pleasure; they go out of necessity and because they are unwell. Therefore, a hospital that raises £500,000 or £1 million, with all the budget it has—

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order.

NHS

Yasmin Qureshi Excerpts

Wednesday 5th February 2014 Commons Chamber

[Margot James (Stourbridge) (Con)]

rose—

[Yasmin Qureshi (Bolton South East) (Lab)]

rose—

[Andy Burnham]

I will make a little progress and then I will give way.

There have been record levels of hypothermia this year and thousands of over-75s have been treated in hospital for respiratory or circulatory diseases. That brings me to the second underlying cause of the increase in attendances at A and E. The ageing society is not a distant prospect on the horizon. Demographic change is happening now and it is applying increasing pressure on the front line of the NHS.

We all need to face up to the uncomfortable fact that our hospitals are increasingly full of extremely frail elderly people. Too many older people are in hospital who ought not to have ended up there or who are trapped there because they cannot get the right support to go home. That situation is unacceptable and it has to be addressed.

[Andy Burnham]

The hon. Lady wants me to answer that question, but I direct her to her right hon. Friend, the Chairman of the Health Committee, who has dismissed the self-serving spin from the Government that says that these problem are all to do with a contract that was signed 10 years ago. I began my speech by citing figures that show an exponential rise in the number of people attending A and E since 2010. Many of those people are very frail older people. That is the issue before the House, so it does not help the debate for the hon. Lady to stand up and make a spurious political point.

[Yasmin Qureshi]

Is not one of the reasons why more elderly and frail people are going to hospital that there has been a £1.8 billion cut in adult social services and support? Those people are ending up in hospital because they are not receiving the care that they need at home.

[Andy Burnham]

My hon. Friend is absolutely right. I will come on to say that the single most important underlying cause of the A and E crisis is the severe cuts that we have seen to adult social care. That has created a situation in which older people are trapped on the ward and cannot go home because there is not adequate support at home. That means that A and E cannot admit to the ward because the beds are full. Hospitals are operating way beyond safe occupancy levels. Because of that, the whole hospital begins to jam up and the pressure backs up through A and E. When A and E cannot admit to the ward it becomes full, so ambulances queue up outside because they cannot hand people over to A and E.

That is exactly what is happening in our NHS at the moment. A and E is the barometer of the whole health and care system. If there is a problem anywhere in the system, it will be seen eventually as pressure in A and E. That is what is happening. The simplistic spin from the Conservative party, which says that it is all to do with a GP contract from 10 years ago, is discounted by expert after expert.

--- Later in debate ---

[Andy Burnham]

I agree with the hon. Gentleman. There are examples of good practice out there, but I suggest that he speaks to chief executives of clinical commissioning groups and trusts. They are telling me that the competition regime introduced by his Government is a barrier to that kind of sensible collaboration. The chief executive of a large NHS trust near here says that he tried to create a partnership with GP practices and social care, but was told by his lawyers that he could not because it was anti-competitive. Does the hon. Gentleman support that? Is that what he thought he was legislating for when he voted for the Health and Social Care Act? People are being held back from doing the right thing for fear of breaking this Government’s competition rules.

Recently, we heard of two CCGs in Blackpool that have been referred to Monitor for failing to send enough patients to a private hospital. The CCG says that there is a good reason for that: patients can be treated better in the community, avoiding costly unnecessary hospital visits. That is not good enough for the new NHS, however, so the CCG has had to hire an administrator to collect thousands of documents, tracking every referral from GPs and spending valuable resources that could have been spent on the front line.

[Yasmin Qureshi]

My right hon. Friend might be aware that recently the trust in Bournemouth wanted to merge with neighbouring Poole trust, but the competition rules stopped the merger taking place.

[Andy Burnham]

My hon. Friend is right. For the very first time in the history of the NHS, competition intervenes to block sensible collaboration between two hospitals seeking to improve care and make savings. Since when have we allowed competition lawyers to call the shots instead of clinicians? The Government said that they were going to put GPs in charge. Instead, they have put the market in charge of these decisions and that is completely unjustifiable. The chief executive of Poole hospital said that it cost it more than £6 million in lawyers and paperwork and that without the merger the trust will now have an £8 million deficit. That is what has happened. That is not just what I say; listen to what the chief executive of NHS England told the Health Committee about the market madness that we now have in the NHS:

“I think we’ve got a problem, we may need legislative change…What is happening at the moment…we are getting bogged down in a morass of competition law…causing significant cost and frustration for people in the service in making change happen. If that is the case, to make integration happen we will need to change it”—

that is, the law. That is from the chief executive of NHS England.

--- Later in debate ---

[Jeremy Lefroy (Stafford) (Con)]

First, I want to praise all those who work in accident and emergency departments up and down the country to provide a vital full-time 24/7 service locally and nationally. Many Members have already pointed out that it is almost a year since the Francis report was published. Its reception in the House demonstrated one of the best examples of cross-party respect from the Prime Minister and the Leader of the Opposition and, subsequently, from my right hon. Friend the Secretary of State and the shadow Secretary of State. I would like to see that cross-party support being built on.

I should also like to praise the Secretary of State for the work that he has done to take the recommendations forward. He has mentioned some of them today, including those relating to the chief inspector of hospitals, to social care and to general practice. Many more aspects of the report have already been mentioned, and there will no doubt be more to come. I must stress, however, that we need to have a proper debate on the Francis report now, one year on, in Government time in the House, to see where we have got to.

I also pay tribute to all those people who did the work that enabled the Francis report to come about. They include Julie Bailey, Helene Donnelly and the many others who worked with Cure the NHS, and all those in Stafford hospital who have subsequently responded to the report to make the hospital a place that I am proud to say now provides some of the best care in our region, including those in the A and E department. We have, however, lost our 24/7 A and E department; we now have a 14/7 A and E department. That is something that we are going to have to look at again; we need to look at how we are to cover the out-of-hours emergency care in our area. Nevertheless, we now have some of the best A and E care in the region, because it is consultant led. We now have sufficient consultants to cover that service.

I want to make four points that I believe need to be taken fully into account in this debate on A and E services. The first is about doctors. The Secretary of State has already mentioned the problem with recruiting people into emergency medicine. It is not seen as the most attractive career, perhaps because of the shift work involved. We need to look at the whole training structure. Perhaps it would be better for trainee doctors to spend more time in accident and emergency departments in their foundation years. Perhaps we should add a third foundation year in order to enable them to spend more time in A and E, because that is surely where they will learn most about this kind of medicine.

We also need to look carefully at the role of specialisms in the NHS. Although that would be the subject for a whole other debate, it is very important, because we have more than 60 specialisms in this country, compared with about 20 in Norway. Their increasing role means there is a need to maintain a full-time specialist rota of up to 10 consultants, which is placing increasing stress on the finances of the NHS. That is true in A and E, as elsewhere. That is a subject for another day, but it is a very important point.

Another area to mention is demographics, although I will not go on at length about it because the facts are known to us all. In Staffordshire, we are expecting the number of over-85s to double and the number of over-60s to go up by 50% in the next 25 years. There is no doubt that we have reached a tipping point, particularly as the baby boomers enter their retirement years, and that is not recognised. It is not just a straight line graph; there is a bit of exponential growth in the number of older people now coming in to our hospitals. That is to be expected.

[Yasmin Qureshi]

I agree with everything the hon. Gentleman has said so far. Will he also consider the fact that A and E waiting time rises have also been caused by: the effect of walk-in centres closing; the closure of NHS Direct and its replacement by the botched 111 system, which has not helped anyone; and a real cut in adult care, which has meant that a lot of elderly people have been taken to hospitals, instead of being cared for at home, and they cannot be released unless they have somewhere safe to go to?

Oral Answers to Questions

Yasmin Qureshi Excerpts

Tuesday 16th July 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

My hon. Friend is absolutely right to highlight such initiatives. That was why the Government, as part of the Health and Social Care Act 2012, set up health and wellbeing boards, which bring together housing providers, the NHS, the third sector and social care locally so that they can look at how to improve and better integrate personalised care, especially for the frail elderly.

[Yasmin Qureshi (Bolton South East) (Lab)]

T2. In the 1960s and 1970s, the drug Primodos was given to pregnant women, resulting in serious birth defects in thousands of babies, who are now adults in their 40s. The then Committee on the Safety of Medicines failed to act in time, the scientist at Schering, the drug manufacturing company, accepted subsequently that he had made up his research, and the solicitor Peter Todd has described the events as the biggest medical and legal cover-up of the 20th century. Will the Secretary of State meet me and the victims of Primodos so that we can present our evidence on what has happened?

[Dr Poulter]

The hon. Lady is right to highlight the fact that when we have scientific and clinical data, they must be used responsibly, as the MMR scandal also indicated. Of course I would be delighted to meet her to talk through this matter further.

Accident and Emergency Waiting Times

Yasmin Qureshi Excerpts

Wednesday 5th June 2013 Commons Chamber

[Mr Hunt]

The system is dysfunctional, and at the heart of the problem is Labour’s creation of a system in which GPs lost round-the-clock responsibility for the patients on their list. That is fundamentally wrong and we need to deal with it.

[Yasmin Qureshi (Bolton South East) (Lab)]

Today’s debate is about the increase in waiting times at accident and emergency departments. In 2010, when Labour left office, 98% of people were seen within four hours; three years later, after three years of Conservative Government, the number of people who have to wait more than four hours has trebled. What is the Secretary of State going to do about that?

Mental Health

Yasmin Qureshi Excerpts

Thursday 16th May 2013 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

I beg to move,

That this House has considered the matter of mental health.

There can be no health without mental health, and, above all else, I hope that today’s debate communicates that clearly and powerfully in the country and in this House. I start by thanking the Backbench Business Committee for recommending this most important of subjects for a debate, and the Government for finding the time to make it possible. Undoubtedly, there is a lot to debate on mental health, and I am grateful to my two colleagues—one on either side of the House—who have joined me in seeking this debate. I refer to the hon. Members for Bridgend (Mrs Moon) and for Broxbourne (Mr Walker), who hope to catch your eye, Mr Speaker, and contribute as we proceed.

Last year the House had a remarkable, moving debate on mental health, which was very personal for some hon. Members. It demonstrated that mental health is not an issue of “them and us”, but affects all of us. One in four of us may experience a mental health problem at some point.

[Yasmin Qureshi (Bolton South East) (Lab)]

I congratulate the right hon. Gentleman on securing the debate. Recent World Health Organisation figures predict that by 2030, depression will be the leading cause of diseases around the world, physical and mental. People can lose years of their life, as mental illness undermines their physical health too. Would the right hon. Gentleman agree, therefore, that mental health must be at the top of the Government’s agenda?

[Paul Burstow]

I certainly would. The fact that a large number of hon. Members are present, hoping to contribute to the debate, that the Backbench Business Committee advocated the debate, and that the Government have given the time suggests there is cross-party consensus that mental health has for far too long been hidden in the shadows and not awarded sufficient priority. The cost to our society of mental ill health across England, Scotland and Wales amounts to over £116 billion a year, but that does not adequately capture the human cost—the misery—that arises from it. Given that the burden of mental ill health is about 23% of the burden of all disease in our country, it is surprising that for so many years it has not been tackled with the necessary vigour. So I agree absolutely with the hon. Lady.

--- Later in debate ---

[Mr Jones]

That is our great challenge, and not just for the present Government. We did a lot in the last Government to recognise the problem. I pay particular tribute to my right hon. Friend the Member for Leigh (Andy Burnham), who championed IAPT—improving access to psychological therapies—services, for example, but part of the problem is cultural. We do not talk about these issues in this country. I think that is changing—I will come to the stigma in a minute—but for anyone who has suffered from a mental illness or who has a family member who has, there is a sense of shame. There should not be, but there is a sense in which talking about it means that those people are failures, when I would argue the opposite. In many cases it is a sign of strength. With the right support, people can function normally, work perfectly normally and have a perfectly happy and productive family life.

[Yasmin Qureshi]

I congratulate my hon. Friend on being brave and speaking about his situation—as I congratulate the hon. Member for Broxbourne (Mr Walker) on speaking about his—and on highlighting the issue. There is a stigma attached to it, and we should discuss it more. My hon. Friend said that the lady who approached him said that she was able to recover after she was given support. Does he agree that some mental health treatments are often quite costly? There is a funding issue, so should we not also encourage the Government to ensure proper funding for services across the country for everyone who may have problems?

[Mr Jones]

We need to explode the myth that the problem is funding. I do not think it is; I think it is where the funding is spent—a point raised earlier. Indeed, funding that is properly spent on early interventions for people with mental health issues will save the NHS money in the long term, not cost it.

--- Later in debate ---

[Yasmin Qureshi (Bolton South East) (Lab)]

I congratulate the right hon. Member for Sutton and Cheam (Paul Burstow) on securing the debate and thank the Backbench Business Committee for granting it. I also pay tribute to all hon. Members who have spoken today and in the previous debate. They have covered many aspects of mental health, many types of mental health illnesses and many groups of people affected by them.

When many normal members of the public think about people who suffer from mental health problems, they often think about those who go around killing or assaulting people or self-harming, but they are a small minority. The majority of people with mental health problems, as my hon. Friend the Member for North Durham (Mr Jones) said earlier, look very normal; it could be any one of us, or people who look similar to us. Mental health issues do not often result in people self-harming, but there can be problems with depression or with how to relate to families and friends or to the community at large.

Of course, sometimes those health issues are difficult to identify and assess, and as a result it is sometimes hard to prescribe the right treatment. However, I believe that if enough time and effort is taken to try to identify the problem and support the person fully, it is probably easier to find out what is going on and what the right treatment is.

Members have already touched on how people can be reluctant to talk about their mental health issues because there is still an element of stigma and shame. Although it is great that people are talking about it, we know that it is still not being talked about enough and that there is still stigma. Mental health issues can also affect employment and housing and can lead to rejection by family and friends.

Different communities and groups of people have been mentioned. My hon. Friend the Member for Bridgend (Mrs Moon) quite properly touched on mental health issues in the armed forces, and other hon. Members touched on mental health issues in black and minority ethnic communities. I will mention that as well because, in addition to a number of barriers, such as jobs, stigma and rejection by family and friends, they also face the barrier of accessing appropriate care and treatment that is also culturally sensitive.

Although it is accepted that there is nothing genetically that makes people from black and minority ethnic groups more vulnerable to mental health issues, often those issues are not diagnosed properly. Psychiatry in the United Kingdom, understandably, is based on the western understanding of mental illness and often medical models are used to treat it, but in fact mental health means different things to different people from different cultures and different communities, and they can be affected by many different issues, such as spiritual, religious and background issues. Those might relate, for example, to the countries they have come from. Therefore, a purely medical approach is not necessarily the right one for many people. A more holistic approach that looks at a person’s overall health should be considered.

Contrary to what was said earlier, there are of course problems with resources. We know that mental health issues can be very expensive to deal with, because often it is hard to identify what is happening and the treatment might take months or years and require one-to-one assessment. It is much easier when somebody has a damaged arm or a faulty kidney; such conditions can be expensive to treat, but at least they can be identified and treated. Once the treatment is done, the person recovers. But mental health is unique in that respect, because that does not happen.

We know that drug and alcohol addiction is often linked with mental health issues. In fact, units that deal with addiction are very expensive, so there are funding problems. I know that from my own practical knowledge and experience, having been a criminal law practitioner for 20 years before becoming a Member of Parliament. When clients were charged with various criminal offences, they often had psychiatric problems or problems with drug or alcohol addiction. When they were being sentenced, the pre-sentence report would often require us to look into drug or alcohol rehabilitation units. The first question we used to ask was whether the local authority or social services responsible for the person had the necessary funding. Weeks used to go by while everybody searched around to find the funding so that the person could go into the unit. That is why I raised funding for mental health issues earlier and questioned whether it is sufficient and appropriately applied to the whole country. In parts of the country, there are very good practices and systems, but in many others that is not the case. It is a question of ensuring that the same treatment, facilities and services are available across the whole country.

More treatment centres should be available in the criminal justice system. There should also be more psychologists and psychiatrists. The problem we had in criminal cases was that the person in question often needed to be assessed by a medical expert or psychologist, and it used to take weeks and weeks before that could be done, which then used to take time away from treatment. Six months can elapse between somebody being charged and getting treatment. That is if they even get the treatment, because sometimes the funding authority will not fund it, so they end up in the prison system, which does not help them. That is partly why a large number of people, in comparison with the rest of the population, commit suicide in prison.

Everybody here, including Ministers, I am sure, wants to deal with mental health on a humanitarian level, but there is also an economic and financial case for ensuring that the system is working properly. If we are able to help a person to recover from their mental health problems, it will be better for our country and for society generally. For example, if an adult who cares for children suffers mental health problems and is not treated properly, those children will often be taken away and put into care homes or with foster families. That is an incredibly expensive process. If we are able to support and help the parent, the thousands of pounds that it would cost to deal with the problem will be saved. Everyone talks about the humanitarian case, and we all agree with that, but it makes economic sense as well.

I pay tribute to hon. Members who have mentioned their mental health experiences; it is great that that has happened. I hope there is a debate about this issue in the rest of the country and it is appreciated that many people can experience mental health problems of differing natures. If we recognise that, then medical and social services professionals, and others, can intervene to help. I congratulate the hon. Member for Broxbourne (Mr Walker) and my hon. Friend the Member for North Durham on talking about their experiences. It takes a lot of courage for a public person to mention these issues, and I thank them for what they have said.

Mid Staffordshire NHS Foundation Trust

Yasmin Qureshi Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

I am sure that my hon. Friend’s sentiments are shared on both sides of the House. Indeed, I could have done with such a guide when I started this job last September. I am happy to do as he requests, but from today’s announcement the most important thing that the country should know is that when it comes to failures in care, the buck stops in one place. It will be the chief inspector’s job to identify such failures and shout publicly about them, and that will be an important clarification that the system needs.

[Yasmin Qureshi (Bolton South East) (Lab)]

This is not a debate about private or public, but will the Secretary of State ensure that the duty of candour is applied equally to private providers of NHS services?

[Mr Hunt]

Yes, it will be, as it will to providers in the social care sector.

Regional Pay (NHS)

Yasmin Qureshi Excerpts

Wednesday 7th November 2012 Commons Chamber

[Mr Hunt]

No. Let me just remind the right hon. Gentleman that the budget increase in the NHS that this Government committed to and that this Government announced was something that he said would be “irresponsible”. We have ignored that, and I have been completely clear that the NHS budget went up.

We support recruitment and retention pay—an amount that can be as much as 30% of a person’s salary, and which the Opposition, if they were consistent in their opposition to regional pay, would presumably wish to abolish. We support the London weighting, which is, again, a form of regional pay that we would be planning to abolish if we listened to the Opposition’s arguments today.

[Yasmin Qureshi (Bolton South East) (Lab)]

rose—

[Mr Hunt]

The hon. Lady might want to think about her own constituents before she jumps on that bandwagon. We also support high-cost area supplements. Why should trusts not be able to offer higher packages to lower-paid staff living in expensive areas beyond the capital so that they can live nearer to where they work? If we listened to the Opposition and their trade union sponsors, that, too, would be banned. This Government support the right of local trusts to determine how best to reward their own staff, so they can recruit, retain and motivate the people whom patients rely on every single day. That includes the right of each employer to choose their own terms and conditions or to use national terms and conditions, should they wish.

[Yasmin Qureshi]

I was not in this House when the earlier legislation and policies were being put through, but the question for today is: will someone working in London be paid the same as someone doing the same work in Bolton? Will the Secretary of State reassure us that the fundamental change to that arrangement will not take place?

[Mr Hunt]

May I gently remind the hon. Lady that she stood for election on a manifesto that did not include abolishing the 2003 Act or the Health Act 2006, which gave foundation trusts the freedom to set their own pay and conditions? [Interruption.] I ask Labour Members to let me answer the question. May I also remind her that the previous Government, whom she supported, introduced “Agenda for Change”, which does not pay the same amount throughout the country for the same work? It actually includes a lot of flexibility for regional pay.

--- Later in debate ---

[Kerry McCarthy]

I shall try to move on. When I wrote to the Health Secretary, the response I got back was very ambiguous. It referred mysteriously to when the document was first leaked to the public, rather than saying what the Government were aware of in relation to the consortium.

In the debate earlier today, the Minister definitely said the words, “Yes, we were.” The civil servant behind her was shaking his head and saying, “No, we weren’t. No, we weren’t,” so I hope that we get some clarity on the matter and a firm answer when the Government respond to this debate. To what extent did they know about and encourage the south-west consortium to start?

The consortium, as I indicated, was initially developed in secret but since NHS staff found out about it by accident, I have received hundreds of letters and e-mails from staff who are angry and anxious not just for their own futures, but for their patients. It is shocking that they found out about that only by accident and were not consulted by the consortium.

[Yasmin Qureshi]

Does my hon. Friend agree that we were a bit surprised to hear the Secretary of State say that Labour is asking for national pay and opposing regional pay because the unions are bankrolling us? My hon. Friend said that she had received many e-mails. I am sure that, like me, other Opposition Members have received hundreds of e-mails from people who work in the health service—ordinary people, working people—who say that they do not want regional pay. That has nothing to do with any union.

[Mr Speaker]

Order. Interventions on both sides should be brief, and rather briefer than that.

--- Later in debate ---

[Yasmin Qureshi]

The hon. Gentleman said that as somebody from the north of the country he accepts that there is already a north-south divide in pay. Does he agree that regional pay would make that even worse?

[John Pugh]

Absolutely.

I was enlarging on the fact that the Minister has to keep peace between sectors of the coalition, and I do not envy him that role. To be fair, many Members from the majority party are also finding this issue uncomfortably irrelevant.

So what can the Minister do, and what can we do? I have a suggestion. The south-west trust was set up by Labour as an independent providers foundation trust with, frankly, pathetic levels of public accountability. Trusts were set up to operate within a market competing with other NHS providers and private providers, and they do not in law have to consider themselves as part of the wider NHS—as part of national bargaining or “Agenda for Change”. Apparently the trusts in the consortium do not to want to so consider themselves and want to ignore national agreements. If they see themselves as independent free agents in competition with other free independent agents, then surely they cannot all form a cartel with a huge share of the health market and conspire collectively to keep wages, and so their costs, down. That is not a free market—it is market abuse. It is not even fair trading. It is the sort of thing that in the United States would lead to a class action as wage fixing.

That is why my colleagues and I are referring this issue to Monitor and the Office of Fair Trading for investigation. This misguided lot in the south-west cannot be allowed to be freebooters when it suits them and freeloaders on the NHS when asked to play by market rules. If the Government are a bit schizophrenic on this issue, the south-west consortium appears to be even more so.

Health and Social Care Bill

Yasmin Qureshi Excerpts

Tuesday 13th March 2012 Commons Chamber

[John Healey]

The hon. Gentleman is right. One of the great tragedies here is that the Government have squandered the good will and confidence of NHS staff that is necessary to make the changes to the NHS that it must make. This health Bill will make making those changes more difficult, not easier.

The Government could have built on the golden legacy and the great improvements that patients saw under 13 years of Labour investment and reform: hundreds of new hospitals and health centres; thousands more doctors, nurses and specialist staff; and millions of patients with the shortest ever waits for tests and treatments. Instead, we have a Tory-led Government, backed by its Lib Dem coalition partners, who have brought in the chaos of the biggest reorganisation in NHS history; wasted billions of pounds on new bureaucracy; and betrayed our NHS with a health Bill that will, in the long run, break up the NHS as a national health service and set it up as a full-blown market ruled, in time—for the first time—by the full force of competition law.

Everything about this NHS reorganisation has been rushed and reckless. This has been a master class in misjudged and mishandled reform—implementing before legislating, and legislating before being forced to call a pause to listen and consult on the plans already in hand. This health Bill was introduced last January. What was a very bad Bill is still a bad Bill. Make no mistake: this legislation will leave the NHS facing more complex bureaucracy and more confusion about who decides what and who accounts for what, and mired in more cuts and wasted costs for years to come.

Risk has been at the heart of the concern about these changes from the outset. There has been a lack of confidence and a lack of evidence, yet the Government are ready to manage the risks of introducing the biggest ever reorganisation in NHS history at the same time as the biggest financial squeeze since the 1950s. These risks were the reason for the growing alarm among the public, professionals and Parliament in the autumn of 2010, when I made my freedom of information request for the release of the transition risk register.

Last Friday the courts dismissed the Government’s efforts to keep secret the risks of their NHS reforms. Apocalyptic arguments were made in court, in defence of the Government, about how releasing the register would lead to the collapse of the Government’s system for managing risk. That did not happen when the Labour Government were forced to release the risk register for the third runway at Heathrow. Nor will it lead to the routine disclosure of Government risk registers, because the tribunal’s decision, like the Information Commissioner’s decision before it—both saw the transition risk register—was based on my argument that the scale and speed of these changes was unprecedented, and therefore that the public interest in their being disclosed was exceptional.

The Government have dragged out their refusal to release this information for 15 months. That is wrong. They have now lost in law twice. This is not a political argument but a legal and constitutional argument. It is about the public’s right to know the risk that the Government are running with our NHS, and about Parliament’s right to know, as we are asked to legislate for these changes.

[Yasmin Qureshi (Bolton South East) (Lab)]

Will my right hon. Friend give way?

[John Healey]

I will not, as I have less than a minute left.

Release of the transition risk register is now urgent, in the last week before the Bill passes through Parliament. It will also be important in the two or three years ahead, as this reorganisation is forced through the NHS. I say to Ministers this evening: do the right thing. Respect the law, accept the court’s judgment and release the register immediately and in full, so that people and Parliament can judge for themselves.

NHS Risk Register

Yasmin Qureshi Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Chris Skidmore]

Yes, the situation has moved on. We have had the listening exercise under Steve Field and various Select Committee on Health reports. The name of the commissioning bodies, which were called consortia, has changed. Nurses have been added and we have opened things up so it is not just about GP commissioning.

[Yasmin Qureshi (Bolton South East) (Lab)]

If the register is as irrelevant as the hon. Gentleman says, why not publish it?

[Chris Skidmore]

The Opposition are asking—[Interruption.] The shadow Secretary of State has already said that risk registers should not be published because they are confidential documents that must be used by policy makers. The Opposition are asking for a risk register that is out of date when what we should have been discussing today was reform of the NHS and how we can deal with an ageing population at the same time as dealing with a rise in chronic diseases.

I thought that it was striking that the shadow Secretary of State said at the end of his remarks that he would put the NHS first, without any mention of the patients. That is what these reforms are here for. They are allowing patients to be put in the driving seat and to sit down with their doctor, to understand what treatments they need and to have a choice of treatment through the opening up of providers. We could have had that debate—we could have spent six hours discussing that instead of this irrelevant document that you want to have a look at, which is out of date and from November 2010 when it is now February 2012. You are two years out of date, you are out of time and you are out of touch. I urge everyone to vote down the motion, simply because it falls outside the point.

--- Later in debate ---

[Charlotte Leslie (Bristol North West) (Con)]

Will the hon. Gentleman give way?

[Yasmin Qureshi]

Will my hon. Friend give way?

[Grahame M. Morris]

I am only going to give way twice, so I shall give way to the hon. Lady.