HIV Prevention

Ben Bradshaw Excerpts

Thursday 12th March 2015 Commons Chamber

[Mr Ben Bradshaw (Exeter) (Lab)]

Is not the hon. Gentleman making a strong argument for mandatory personal sex and relationship education in schools, which is something the Opposition now support? Sadly, his party has not quite got there yet.

[Mike Freer]

The right hon. Gentleman makes a good point. If he bears with me for just a minute, he might find that I am in agreement.

We have to accept that many teenagers will become sexually active, yet sex and relationship education—SRE—remains poor. The National Aids Trust recently published a report showing that in SRE there is little teaching about, among other things, same-sex awareness or HIV transmission. Teachers can be nervous of sex education full stop, let alone same-sex issues, sexual health or, in particular, HIV. That is compounded when schools struggle with homophobic bullying, which can contribute to teenagers feeling uncomfortable about seeking advice or information about their attractions or about having a safe sexual relationship when the time comes.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate my hon. Friend the Member for Finchley and Golders Green (Mike Freer)—my friend in every sense—on securing this debate on a very important subject. As he said, it is one that we perhaps do not discuss enough. I am delighted to have the opportunity to respond. I pay tribute to him for his long and distinguished record of campaigning in this area, and for the important work he has done in our party on equalities and in this Parliament in championing HIV prevention and other important matters.

Other distinguished colleagues are in the Chamber this evening. The right hon. Member for Exeter (Mr Bradshaw), a former Health Minister, has done long and distinguished service in this field, and it is good to see him in his place. It is also good to see my hon. Friend the Member for Ribble Valley (Mr Evans) in his place, and he highlighted the important issue of homophobic bullying in a telling intervention. I also wish to place on record my thanks to my hon. Friend the Member for Brighton, Kemptown (Simon Kirby), who has done great work, with others, in lobbying Ministers extensively on the subject of HIV prevention.

Many good points have been made, and I will pass on the passionate views on sex and relationship education to my right hon. Friend the Secretary of State for Education. I am sure that she will want to be aware of those comments, but I shall not attempt to respond to them myself.

I am proud of the Government’s record on tackling HIV, including on prevention. In 2012-13, the Government spent an estimated £630 million on HIV treatment and care, which has been key in enabling people with HIV to live long and healthy lives. The success of that treatment is shown by that fact that 90% of those on treatment are virally suppressed, substantially increasing their lifespan and significantly reducing their risk of passing HIV to others. However, as my hon. Friend the Member for Finchley and Golders Green said, we need to do far more to stop people getting HIV in the first place.

On top of the money I have just mentioned, we have given local authorities a ring- fenced public health grant of £8.2 billion over three years and mandated the provision of sexual health services as part of that. We welcome the fact that new HIV diagnoses have fallen from 6,333 in 2010 to 6,000 in 2013, and the proportion of late diagnoses continues to decline—down to 42% in 2013 from 50% in 2010—but we have a lot more to do, and my hon. Friend outlined some of the concerns in his speech.

The Government have taken action beyond awareness-raising and testing, for example through lifting the ban on the sale of home testing kits. Reducing the number of HIV infections, especially in men who have sex with men—MSM—is important because we have seen a worrying trend in new infections. In 2013, there were an estimated 3,250 new diagnoses, the highest number ever reported. That really is a cause for concern and one of the reasons why it is good that we are debating the subject this evening. We also know that transmission is continuing among black African men and women who are acquiring their infection within the UK.

It is estimated that one in eight gay men in London are HIV positive, and while that might sound alarming, it also reflects the success of treatment and that more and more people are now living into old age with HIV. My hon. Friend rightly put a focus on being more innovative, and the importance of preventing the spread of HIV is one of the reasons why the Government have committed to protecting the HIV prevention budget—but I am clear that we need to be more ambitious and innovative. That is why we are redesigning our HIV prevention programme for England in 2015-16. I see this as a transitional year towards the updated long-term strategy for HIV prevention and sexual health promotion more widely. In future, this work will be led and managed by Public Health England, which is consistent with its wider work on health promotion and social marketing. I expect PHE to work closely with local authorities to promote the health of their populations.

One of the most exciting innovations to promote HIV testing is postal home sampling kits. Public Health England and local authorities will establish, for the first time, a national home sampling service. Through this, we will be able to deliver up to 50,000 home sampling kits in 2015-16, around three times as many as last year. That will augment the continued growth in HIV tests performed in genito-urinary medicine clinics—more than 1 million tests in 2013, which was 100,000 more than in 2010. People knowing their HIV status is important not only in getting treatment and allowing them to live a long and healthy life, but, critically, in preventing HIV from being passed to others. We now know that being on treatment substantially reduces the risk of passing on HIV. That testing is critical and a key component of our public health response to HIV.

We will continue to contract with the Terrence Higgins Trust in running public awareness campaigns. Changes to that contract have been made for 2015-16, but it is a respected charity in the field and its work remains an important strand of our HIV prevention programme. THT will have an increasing focus on digital platforms to meet the needs of the 21st century, including using Facebook and Twitter. The potential is huge. A single push on a phone app has consistently generated more than 1,000 postal test orders. In addition, those contacted through Facebook have turned out to be three times more likely to return a postal test than those contacted through any other route. Facebook is used by all age groups. It is therefore an important access point, particularly given the middle and older age profile of many of those diagnosed HIV positive.

THT will also continue to work with local partner organisations to talk to those at highest risk face to face, particularly those without access to the internet or to more traditional media. Those conversations include encouraging tests in GUM clinics, use of postal test kits and offering point of care tests in a diverse range of settings, including in churches and shops. That work is particularly important in reaching black African populations who are less likely to attend GUM clinics, but more likely to be diagnosed late.

[Mr Bradshaw]

I thank the Minister for her kind comments about the Terrence Higgins Trust. I refer hon. Members to my declaration in the Register of Members’ Financial Interests—I am a trustee. Can she clarify whether she has announced specifically how the Government’s public health HIV prevention budget will be spent? If not, will she tell us when she expects to make that detailed announcement?

NHS Services (Devon)

Ben Bradshaw Excerpts

Thursday 11th December 2014 Commons Chamber

[Mr Ben Bradshaw (Exeter) (Lab)]

Last week, on 3 December, the Northern, Eastern and Western clinical commissioning group, responsible for commissioning health care on behalf of the population of Devon, excluding Torbay and south Devon, announced a package of cuts, restrictions and the ending of some treatments and operations altogether. The decisions included denying all planned operations to smokers and people with a body mass index of more than 35, the issuing of hearing aids to be restricted to one ear, and cataract operations to be restricted to one eye. Some treatments and operations were to be stopped completely, including certain varicose vein treatment, shoulder surgery and earwax removal.

In her letter to me, the chief officer of NEW Devon CCG, Rebecca Harriott, indicated that this was just the start. She wrote:

“Other measures are still being considered. Some will be for the longer term, but some will be announced in the coming months. We anticipate that there will be further measures for a full or partial suspension identified during December and for implementation from January.”

This constitutes the wholesale rationing of health care in Devon—rationing in the NHS on an unprecedented scale, as well as a return to the worst ever postcode lottery. It means that people in Devon—or most of Devon—who have paid and still pay their taxes in exactly the same way as everyone else in England will not be able to get the operations and treatment they need because of where they live. People over the border in Somerset, Dorset and Cornwall still will, as will those in Devon who are registered with a GP in Torbay or south Devon.

This is how the Royal College of Surgeons, the professional body that represents hospital doctors, reacted to Devon’s announcement:

“Access to routine surgery should always be based on an individual’s clinical need. The Government has been clear that restricting clinically necessary treatment on the basis of financial considerations is unacceptable. We urge the Department of Health and NHS England to review the situation in Devon.”

So my first question to the Minister when she responds is: will she review what is happening in Devon, as the Royal College has requested?

The professional bodies and charities representing the hard of hearing and partially sighted have also responded with outrage. Britain’s main deaf charity, Action on Hearing Loss, said that it is appalled by what is happening, pointing out that the decisions were made without any consultation with local people, health care professionals or the wider hearing loss sector. Paul Brecknell, its chief executive, said:

“This is a service that’s been available since the birth of the NHS. Hearing loss is a serious health issue, which, if unmanaged can lead to isolation, dementia and mental health problems”.

My constituent, Mark Worsfold, was born profoundly deaf and works as a radar scientist at the Met Office in Exeter. He e-mailed me describing the new policy as

“morally, legally and financially indefensible”

and he went on:

“I rely entirely on lip reading for communication. What many people don’t realise is how much of lip reading is guess work. Hearing aids can make the difference between highly educated guesswork and incomprehension. Having just one hearing aid doesn’t mean your lip reading ability is halved, it can destroy it completely.”

The National Deaf Children’s Society told me that the decisions made are “unthinkable and entirely unethical”, and called for their immediate reversal and the publication of the evidence on which the decisions were based. That leads me to my second question to the Minister. Will she publish, or will she require the CCG to publish, all the clinical evidence on which these decisions have been based?

The Royal College of Ophthalmologists condemned the decision to ration cataract operations to just one eye. A senior consultant told me that it is likely to cause people who are losing their sight to fall, particularly on stairs, and will lead to a big increase in hip fractures, one of the main reasons for pressure on hospitals, again costing the NHS more in the end.

On the proposed weight restriction, I was contacted by a constituent, Kate Bolsover, a former NHS nurse and care assistant, who said the following:

“I’m overweight due to having arthritis and severe issues with my spine that require heavy medication that increases weight gain. I’m doubly incontinent because of abuse from my ex-partner and I need an operation to fix that, but because of these cuts I won’t be able to have my operation, and without it I won’t be able to go out. I feel doubly discriminated against by an NHS I worked so many hours for with passion.”

Medical experts and health care professionals have told me that they believe the cuts and rationing announced in Devon breach the NHS constitution and Devon’s own CCG guidelines. These state that access to services should be governed by the principle of equal access for equal clinical need. They also believe that the cuts and rationing breach the clauses on discrimination in the NHS constitution, and the duty contained in it and the CCG’s own local framework to reduce health inequalities.

A number of people have told me that they are preparing legal challenges. The weight restriction alone, according to figures provided by the CCG, could affect as many as 11,000 people a year, and the smokers’ restriction even more than that. One smoker from Exeter e-mailed me this morning to say:

“I am a smoker yet I could be denied an operation here in Devon if I don’t give up. As a taxpayer, surely this must be illegal. I can’t refuse to pay my taxes, yet I can be refused to use a service I help fund. This is so wrong.”

Even the Minister’s own Conservative colleague, the Secretary of State for Communities and Local Government, stung perhaps by suggestions that he might fail Devon’s new weight criteria, has told my local newspaper, the Express and Echo, that he believes that what is happening in Devon is “anathema and un British”. Simon Stevens, head of NHS England, told the Health Committee this week that he had “reservations” about what is happening in Devon. He said that all health organisations need to abide by the NHS constitution, and that the Government could step in if they do not.

So my next question to the Minister, which I have repeatedly asked in letters to Ministers and NHS England but to which I have had no reply is this: what assessment has she made of the compliance of what is happening in Devon with the NHS constitution? It requires equal access based on clinical need, it forbids discrimination and it requires health inequalities to be addressed. If when she studies what is happening in Devon in full she or Mr Stevens agrees with me that it does breach the NHS constitution, will she or NHS England intervene? Perhaps she already has, because less than an hour before this debate was due to start, a letter pinged into my computer inbox from Devon CCG announcing that it was dropping the weight and smoking proposals. That is right, Madam Deputy Speaker. Who says Parliament counts for nothing? However, this is no way to run our precious NHS.

I pay tribute to all those who have helped me and others with the campaign against this rationing, although the battle is not over yet. The rest of the rationing proposals remain in place, and that brings me to the underlying financial crisis facing the NHS in Devon.

In February, NHS England, Monitor and the NHS Trust Development Authority jointly announced they were sending in consultants to examine and analyse the mounting financial crisis facing Devon NHS. Devon was one of 11 so-called “financially challenged” NHS organisations to be investigated in this way. The work was supposed to find out the underlying reasons for the particularly serious problem that we have in Devon. Was there something that the Devon NHS was doing wrongly? Were there areas where it could work better or more efficiently? Were there other underlying factors, such as the cost of caring for Devon’s disproportionately large and growing elderly population, which meant that Devon was underfunded in comparison with other parts of the country?

In spite of asking for months now for details of that investigation, Ministers and NHS England have failed to provide it. They still have not done so. Instead, the Minister’s fellow Minister, the Liberal Democrat right hon. Member for North Norfolk (Norman Lamb), had the gall to go on BBC Radio Devon this morning and blame the £430 million deficit and resulting cuts and rationing on our local NHS spending money unwisely. When the Minister replies, will she explain what he meant by that? Where has Devon been spending money unwisely? Is she really saying that unwise spending decisions have caused a deficit this huge? This is exactly what the consultants’ investigation into Devon and the other financially challenged trusts was supposed to tell us. Will she now publish the detailed findings of that investigation so that we can know the truth?

As well as the cuts and rationing to treatment and operations that I have already outlined, Devon faces the closure of community hospitals and the highly successful and extremely well used walk-in centre in Exeter is threatened with closure. The Prime Minister and the Health Secretary keep claiming that they want better access to GPs, but things are getting worse. The Sidwell street walk-in centre in Exeter is a fantastic and vital resource for hard-pressed patients who find it difficult or impossible to see a GP at a time that suits them. Its loss would simply add to the pressure on already overstretched local GPs and my local A and E department.

That leads me to the impact of the NHS funding crisis in Devon on the acute sector. My excellent local hospital, the Royal Devon and Exeter, has during the last 15 years or so been one of the best managed and best performing hospitals in England. It recently and unusually missed the Government’s own watered down maximum waiting time for accident and emergency. It is also running a large deficit for the first time ever. When announcing the hospital’s intention to go into the red, its first-class chief executive, Angela Pedder, implied that if it did not, she would not be able to guarantee safe care.

We cannot debate the current situation in the NHS in Devon without mentioning mental health. The problem of inordinately long waits and the shortage of beds for young people has been raised by me and others in this place for the past three years. It was highlighted again recently when the deputy chief constable of Devon and Cornwall police tweeted his frustration at having to accommodate a young girl with mental illness in a police cell for two nights. When I asked the Health Secretary about that last week, he blamed poor communication. He was wrong. The girl was taken into police custody from a general hospital paediatric ward, where she should never have been in the first place, because there was no appropriate children’s mental health bed available for her. The reason it took several days to find her a bed is that she had been turned down for one by private sector providers who, under their contract, do not have to accept patients.

That case is not an isolated example. In the last year alone for which figures are available, 30 children with mental health problems in Devon were taken into police custody while suffering a crisis because there were no beds available. When beds have been found, young people have been sent as far away as Newcastle because there are none closer to Devon. I would be grateful if the Minister could outline in full exactly what the Government are doing—not in the future, but now—to address the scandal of mental health provision for children in Devon. In researching for this speech, I learnt that at any one time there are between two and five children with mental health problems on the paediatric ward of the Royal Devon and Exeter hospital in my constituency because there is nowhere else for them to go. That is totally unacceptable.

I would also like to ask the Minister about concerns I have picked up about how well the various NHS bodies in Devon are working together. There seem to be particular concerns about the relationship between Northern Devon Healthcare NHS Trust and other NHS organisations in Devon. That was illustrated recently when Northern Devon decided to centralise stroke services in the rural market town of Ottery St Mary, rather than near the acute provision in Exeter, which is what the clinicians and all of the other organisations involved wanted.

Until a few moments before this debate, I had not received a reply to any of my letters, but several came pinging into my inbox just before. It is simply not good enough for MPs to have to go through the lottery of securing an Adjournment debate before they can get reasonable responses from health organisations and Ministers. I have now received a response to my letter to the head of the Trust Development Authority, David Flory, but it not particularly reassuring. He states:

“The relationship between Northern Devon Healthcare NHS Trust and North, East and West Devon Clinical Commissioning Group has been strained over the last two years. In 2013, arbitration was required to agree the 2013/14 contract and both parties needed mediation to address in-year issues.”—

it sounds like a divorce—

“The need for formal dispute resolution is often a symptom of deeper issues with local relationships.”

I have been raising concerns about that for months. What have the Government being doing about it?

I asked for this debate because of my growing frustration about the fact that the people of Devon, other Members of Parliament and I were not getting answers to the basic questions we were asking. As I have said, my computer has been pinging all afternoon with sudden responses to letters I sent weeks or even months ago, for which I am grateful. Of course, the most dramatic of them has been the climbdown by NEW Devon CCG with regard to banning operations for people who are obese or who smoke. The Minister, when she replies, might like to tell the House what role, if any, she has played in helping it to reach that climbdown.

However, the underlying financial crisis that I have spoken about today has not been addressed. If the CCG is now not going to do the things that it had already announced it would do, what is it going to do instead? It has already said that this is just the beginning and that more proposals for rationing and stopping treatment will be set out this month and next. Until the underlying financial problem is addressed and we know why there is a particular problem in Devon, it will not be resolved to the satisfaction of my constituents. I hope that the Minister can give answers to me and to the people of Devon now.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate the right hon. Member for Exeter (Mr Bradshaw) on securing this debate. He is right to say that Parliament is intended to bring these very important topics to the fore. In securing this debate, he rightly brings a very important subject to the Floor of the House, and I welcome the opportunity to respond. It is a matter of great importance to him and his constituents, but also to other Members in the area. My right hon. Friend the Member for East Devon (Mr Swire), as a Minister in the Foreign Office, and my hon. Friend the Member for Central Devon (Mel Stride), as a Government Whip, are unable to speak in the debate, but let it be noted for the record that they are here in attendance, representing their constituents, and have shown a keen interest in the matter and discussed it with me, as has the right hon. Gentleman.

I start by commending the work carried out every day by those working in our NHS, particularly in the area of Devon that we are discussing. At every opportunity in this House, we should, particularly as we approach the Christmas season, pay tribute to the fantastic work of our front-line NHS workers.

I turn to the service changes to Northern, Eastern and Western Devon—NEW Devon—clinical commissioning group. As the right hon. Gentleman set out, the CCG is facing significant financial pressures, with an end-of-year deficit of £14.5 million for 2013-14 and a similar deficit predicted for this financial year. To address these pressures, the CCG proposed some changes, which it described as “temporary”, to some of the services it commissions in the area. On 3 December, as he said, it announced that it was taking urgent measures to prioritise essential services and the requirements laid out in the NHS constitution.

We recognise that CCGs have to take resourcing decisions based on the needs of their local community, but blanket restrictions on procedures that do not take account of the individual health care needs of patients are unacceptable. Decisions on treatments, including suitability for surgery, should be made by clinicians, based on the individual clinical needs of patients. The Deputy Prime Minister made that point in response to the right hon. Gentleman at Prime Minister’s questions, and I reiterate it now. The right hon. Gentleman has given some very serious and moving examples of patients who would be affected by such blanket restrictions. National Institute for Health and Care Excellence guidelines represent best practice, and we expect NHS organisations to take them fully into account as they design services for their local populations and work towards full implementation over time.

With regard to the latest position, things have moved quite rapidly in the past 24 hours, as the right hon. Gentleman outlined. NEW Devon CCG announced today that it will no longer compel patients to undergo weight loss or stop smoking ahead of routine surgery. It confirmed that patients will instead be offered evidence-based guidance, as we would expect, on the benefits of weight loss and smoking cessation as part of their health care. As a former Health Minister, he would, like me, draw attention to the fact that both those things are generally desirable in terms of good health and the efficacy of treatment. The CCG also confirmed that it would not be restricting in vitro fertilisation treatment or caesarean sections on non-medical grounds.

In announcing its decision on weight loss and stopping smoking, the CCG confirmed that it will continue with a series of other measures that have already been announced, but those will be subject to public consultation in the new year, where appropriate. Discussions are under way to confirm the extent of that consultation. Today I had a telephone discussion with some of the key people involved, including the chief officer of the CCG and the NHS area lead. I know that the right hon. Gentleman and my right hon. and hon. Friends will want to take a full part in that consultation. Indeed, the right hon. Gentleman indicated some of the areas that he will wish to explore in that consultation process.

NHS England has confirmed that it is currently scrutinising the CCG’s proposals and is in close dialogue with it. That has been confirmed to the right hon. Gentleman, with a good level of detail, in a letter to him from the chief executive of NHS England, which I have had sight of. I hope that he has had that letter; I think he has.

[Mr Bradshaw]

indicated dissent.

[Jane Ellison]

If not, I apologise on behalf of NHS England. I was informed that the letter had been sent to him. I very much hope that it has pinged into his inbox by the time he returns to his office. If, by some chance, it has not reached him, I will certainly make sure that my office passes him a copy. I will also make sure that other right hon. and hon. Members who would want to have sight of the sentiments in the letter have sight of them.

NHS England has confirmed that it is currently scrutinising the CCG’s proposals. They are in close dialogue and I confirmed that myself in my conference call today. NHS England is seeking assurance that the proposals are in the best interest of patients, which we would all echo; that they are based on sound evidence, to which the right hon. Gentleman alluded; and that they are subject to a well-planned process, including, if appropriate, public consultation.

On the next steps on financial issues—the right hon. Gentleman put this in the context of a longer-term concern—the CCG has stated that its financial projections are being updated in the light of the current pressures and the five-year system-wide assessment of a potential finance gap between resources and the cost of health demand, which the CCG considers will be £430 million, which is a considerable sum.

Devon was one of the 11 financially challenged health economies to be provided with intensive support by NHS England. I understand that the report of that work is due to be published shortly, along with planning guidance, which will be a joint publication with the NHS Trust Development Authority, Monitor and NHS England. The right hon. Gentleman does not have long to wait to see that detailed piece of work on the broader, long-term picture.

[Mr Bradshaw]

Does the Minister have any idea why it has taken quite so long? Did the CCG drop its smoking and obesity proposals before or after her telephone conversation with it?

[Jane Ellison]

I will write to the right hon. Gentleman with a response to his first question, as I am not abreast of the detail. The letter to him from the chief executive of NHS England is dated the 10th, so I think that answers his second question. I apologise that he has not received notice, but discussions were under way prior to my phone call with the local NHS leads, during which we touched on the issue.

As part of the work I was just referring to, an extensive, detailed analysis of services and costs in the NEW Devon health economy was undertaken. The NHS England area team director of finance has given significant support and challenge to the CCG to understand its financial position and to support the development of a financial recovery plan. The area team has also been engaged with the CCG through the quarterly assurance process and agreed a set of actions with time scales to improve the financial position.

I stressed in my conversation today the urgency of the matter and the clearly enormous public and parliamentary interest in it. Parliamentarians have a very important role to play in being a bridge between health officials and the public and the constituents they represent, as reflected by the interest shown in this debate by Devon MPs. The CCG and NHS England will meet next week to consider the CCG’s medium to long-term financial plans. It is an important meeting and I have asked to be kept abreast of those developments.

I will ask the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb), to write to the right hon. Gentleman with more detail on the mental health issues he has raised.

The right hon. Gentleman has also raised concerns in the House and elsewhere about the walk-in centre. That is dealt with in some detail in Simon Stevens’s letter to him—I repeat my regret that he has not had sight of it—so if he has further concerns after reading it, he might want to raise them with the chief executive. However, he is, of course, always welcome to raise them with Ministers.

To return to the central part of this debate, I reiterate that policies providing for blanket restrictions on treatments for particular classes of patients based on lifestyle characteristics are unacceptable, and various Ministers—including, as I have said, the Deputy Prime Minister at PMQs this week—have made that clear. Any general policy on prioritisation of services must be robust, evidence-based and justifiable. In addition, any general policy must take account and make provision for an individual’s clinical situation, an example of which was given by the right hon. Gentleman.

CCGs have statutory duties to consult, inform or otherwise engage with the public about commissioning decisions, and duties to promote the involvement of individual patients in decisions about their care and treatment. We fully expect that the CCG will be mindful of those obligations when making any decisions. As I have said, I have stressed the importance of good communication, which is absolutely vital. I have had personal experience as a constituency MP, as well as a Health Minister, of communication not reaching the right people at the right time, resulting in confusion and sometimes distress for constituents and patients. It is therefore very important to get such things right, and I expect all local health economy leads to be extremely mindful of the need to involve local parliamentarians and other democratically elected people.

[Mr Bradshaw]

Does the Minister accept the importance not only of good communication, but of functional relationships? The letter from David Flory about the dysfunctionality of the relationship between Northern Devon and the rest of the heath economy in Devon is very worrying.

[Jane Ellison]

Functioning relationships are absolutely key to long-term planning. We have all recently seen the “Five Year Forward View” from NHS England, and the Government have expressed their support for the plans and intentions in that document. Co-operation and close working are at its heart, as they are at the heart of any local plans for the short, the medium and particularly the medium to long term. Functioning relationships between different parts of the health economy, as well as between the elected Members in the area, are therefore vital.

I feel confident that the right hon. Gentleman will continue to draw attention to that need. Indeed, throughout the debate my hon. Friend the Member for Central Devon and my right hon. Friend the Member for East Devon have nodded in assent in relation to the importance of good communication.

Important meetings are coming up imminently, and I expect there to be good communication on their outcomes. I have asked to be kept abreast of them. Engagement with the public and others, including MPs, will take place next year on the issues that have to be consulted on.

--- Later in debate ---

[Mr Bradshaw]

I want to put it on the record that the obviously very important and long-awaited reply from NHS England is not one of the many e-mails that have pinged into my inbox today, so I would be grateful if the Minister ensured that I get it as soon as possible.

[Jane Ellison]

I feel sure that someone is already working on that, but as I say, we will try to get it to the right hon. Gentleman as soon as possible, and to let other interested colleagues have sight of its sentiments.

I urge all right hon. and hon. Members to engage with the consultation process, and to bring all their constituents’ communications to bear by feeding them into the consultation. I have asked to be kept abreast of those matters. As the right hon. Gentleman will see from the chief executive of NHS England’s response, this important matter is being taken extremely seriously both by Ministers and at the very top of NHS England, as well as by local health leaders.

I hope that the outcome of the discussions and consultations will be a good one—as we require it to be—for the right hon. Gentleman’s constituents and other members of the public in the area. We look forward to seeing how matters progress, and I again congratulate him on bringing this important matter to the Floor of the House.

Question put and agreed to.

NHS (Five Year Forward View)

Ben Bradshaw Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

I thank my right hon. Friend for his comment, because the use of police cells is not an issue with which we should be playing party political games. As it happens, their use was much higher under the last Labour Government. We are starting to address that issue, and he is right: even one person spending a night inappropriately in a police cell is one person too many. That is why we are making good progress, but in the end it will require people who purchase health care in local areas to look at people with mental health needs in a holistic way—not just trying to solve issues problem by problem, but looking at and addressing the whole problem and making sure they get the treatment they need.

[Mr Ben Bradshaw (Exeter) (Lab)]

The Secretary of State should not be at all surprised by this terrible case of the young girl kept in a police cell in Devon over the weekend, because I and other Members have been raising this personally with him for at least the last three years. What has he been doing over that period to address the scandal of young people’s mental health services in Devon and nationally?

[Mr Hunt]

I will tell the right hon. Gentleman what I have been doing: I have been putting in place a strategy that will see over the next few months a reduction of 51% in the number of mental health patients who use police cells. That is progress. It still means that there are too many people in police cells, but I would just gently urge him not to try to make party political capital out of this, because a higher number of them were used under the last Labour Government. We are addressing a long-standing problem in a responsible way, and are determined to go further.

Oral Answers to Questions

Ben Bradshaw Excerpts

Tuesday 25th November 2014 Commons Chamber

[Dr Poulter]

It is particularly important in rural areas that patients with complex medical needs who have difficulties mobilising or who perhaps do not have access to a car are supported by the local NHS to access the services they need. There is provision for local hospitals, as well as for CCGs, to give financial assistance to support patients in accessing services and to give them lifts to hospitals, as appropriate.

[Mr Ben Bradshaw (Exeter) (Lab)]

T10. When I asked the Prime Minister two weeks ago about the financial crisis facing Devon NHS, he seemed completely unaware of it, so could the Health Secretary please explain why Devon NHS faces an unprecedented £430 million deficit and what he is doing to stop the rationing, cuts and total withdrawal of some services that is now being proposed?

[Mr Hunt]

We are not rationing services. In fact, we are doing 1 million more operations every year than were done under the previous Government. I will tell the right hon. Gentleman why that financial pressure exists: we have an ageing population, with nearly 1 million more over-65s than four years ago, and huge pressure to deliver good care in the wake of the Francis report. The NHS will be supported if we have a strong economy that can fund real-terms increases in health spending—something that never happens if the deficit is forgotten.

Patient Safety

Ben Bradshaw Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

I would like to thank my hon. Friend for the support that she has given to her constituent, whom I think I have also met. My hon. Friend is absolutely right: we have to stop this system of consequences for people who do the right thing and speak out. It is not right for me to comment on an individual case, because legal proceedings are often involved, but one hears of situations where people have spoken out and then been victimised by a trust, and that is wrong. We need to be better at looking after whistleblowers, but we need to go further and eliminate the need for whistleblowing by creating a culture where trusts are hungry to hear from their own staff about safety concerns because they want to put them right.

[Mr Ben Bradshaw (Exeter) (Lab)]

An Exeter psychiatric nurse of more than 20 years’ standing wrote to me in despair this week saying that

“mental health services are in collapse”,

and that patients are regularly placed in “life threatening” situations or sent as far away as Bradford because there are no beds locally. Vulnerable people are waiting a shocking three months for the co-ordination of their care. How dare the Secretary of State come to the House today and claim that our mental health services are not in crisis?

[Mr Hunt]

There are real pressures in our mental health services, but the right hon. Gentleman should recognise the progress that the Government have made. That includes doubling the money going into talking therapies, having global summits on dementia and putting a massive amount of money towards raising the profile of dementia in this country and across the globe, and legislating for parity of esteem as between mental and physical health—something that never happened under the previous Government. There is a lot of work to do, but I think he should give credit where it is due.

Care Homes

Ben Bradshaw Excerpts

Thursday 1st May 2014 Commons Chamber

[Norman Lamb]

I thank my right hon. Friend for that question and I very much share his view. In my own county of Norfolk, a brilliant third sector organisation is doing precisely that. It is arranging for ordinary people to go into care homes, judge the sense of kindness of compassion there and give a much richer view than statutory agencies might be able to provide. I would also point to the role of Healthwatch England, which has been established through the health reforms. Those organisations have the power in every local area to go into care homes—they cannot be blocked from going into them or any other health or care setting—to make their own judgments on where things are going wrong. Through that much greater transparency and openness, we will not only expose poor care but drive up standards.

[Mr Ben Bradshaw (Exeter) (Lab)]

Do not terrible events such as those revealed by the brilliant “Panorama” team show that the Government were wrong to reject one of the central recommendations of the Francis report, namely that care assistants should be regulated?

[Norman Lamb]

First, I share the right hon. Gentleman’s recognition of the work that “Panorama” has done. It is interesting that two examples of appalling abuse—namely this case and that at Winterbourne View—have been exposed as a result of hidden cameras. We must acknowledge that and recognise that there might be a role for the use of hidden cameras in the CQC’s work where there is potential evidence of abuse and where we need to establish that evidence in order to take effective action.



On the right hon. Gentleman’s question about registration, my concern is that the registration of nurses did not stop awful things happening at Mid Staffordshire. It is not in itself a panacea that ensures good-quality care. For me, the most important element is proper training to ensure that everyone is trained to an acceptable standard before undertaking unsupervised care work. If we can establish that standard across the country, we can drive up standards.

Oral Answers to Questions

Ben Bradshaw Excerpts

Tuesday 1st April 2014 Commons Chamber

[Jane Ellison]

My understanding is that the consumption of sugary drinks is banned in schools. I have discussed that with the Department for Education, but I am happy to take up the point.

I must correct the hon. Gentleman on his point about childhood obesity. Let us give credit where it is due. Childhood obesity levels are for the first time levelling off and we are beginning to see some progress, although there is much further to go. We have a straightforward disagreement. The Government believe we need to give people information. The Opposition believe in a top-down, state-driven approach.

[Mr Ben Bradshaw (Exeter) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

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

Last week, I launched a campaign to save up to 6,000 lives by halving avoidable harm and avoidable death in the NHS. I am inviting all NHS trusts to sign up to safety, by putting together their own plans, with support provided by NHS England, Monitor, the NHS Trust Development Authority and the NHS Litigation Authority. Learning from hospitals with the best safety records anywhere in the world, such as Virginia Mason in Seattle and Salford Royal here in England, we have a once-in-a-generation opportunity to put behind us the tragedy of Mid Staffs and make the NHS the safest health care system in the world.

[Mr Bradshaw]

People in Exeter and Devon with mental illness are now waiting more than two years for treatment. This is totally unacceptable and will, if it has not already, lead to the loss of lives. The Minister has repeated today his criticism of NHS England’s decision to cut funding for mental health, but as the shadow Minister reminded him, he is not a passive observer; he is the Minister responsible. What will he do about it?

[Mr Hunt]

The reason we are not passive observers is that we have made some substantial improvements in mental health provision since coming to office, including legislating for parity of esteem, which is precisely why the right hon. Gentleman feels able to ask that question. There are 55,000 more people every year getting a dementia diagnosis and nearly 80,000 people going on to psychological therapies. Lots has been done, but there is lots more to do, and we will continue to do everything we need to until we get that parity of esteem.

Urgent and Emergency Care Review

Ben Bradshaw Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Ben Bradshaw (Exeter) (Lab)]

May I assure the Secretary of State that the people of Exeter are not confused about their walk-in centres, but appreciate them and have been using them in ever-increasing numbers? These centres are now under threat, so will he at least admit that closing NHS walk-in centres and scrapping Labour’s GP access targets has been a dreadful mistake?

[Mr Hunt]

Perhaps the right hon. Gentleman might like to hear what the British Medical Association said yesterday about walk-in centres. The BMA is not known for its support of Government policies, but it said that urgent care centres

“were often opened in places with little patient demand…The result has been a lot of money being spent on these facilities with some now closing because commissioners have found there is not sufficient demand”.

That is the problem we are sorting out.

In-patient Mental Health Services (Children and Adolescents)

Ben Bradshaw Excerpts

Wednesday 23rd October 2013 Commons Chamber

[Alan Johnson]

This debate is about services in England, but I confirm that part of the problem is the fact that there is a rising need for adolescent and child mental health services and a decreasing capacity to deal with that need.

I asked the Minister in a parliamentary question which other areas had been affected and which units had ceased to operate. I was told by the Minister that no units had ceased to operate as a result of this change and nor were any closures expected when the change was introduced on 1 October. As I said, the unit in Hull closed in March. The change had already happened. Will the Minister take this opportunity to correct that answer?

Not only did West End close in March, but we are beginning to hear of closures across the country, including in Devon and Somerset, where my right hon. Friend the Member for Exeter (Mr Bradshaw) has been pursuing this issue vigorously with the chief executive of NHS England, who confirmed in a letter to him that other units had closed as a result of the change to tier 4 specification well before the spurious 1 October date.

[Mr Ben Bradshaw (Exeter) (Lab)]

Is my right hon. Friend, a former Health Secretary, aware that, in Devon, that has led to young people being admitted to adult mental health residential units, in clear breach of the Mental Health Act 2007—a scandalous position? I hope that the Minister will have something to say about that when he responds.

[Alan Johnson]

I am aware that that has happened. I feel sure that, as the debate gathers momentum, Members from other parts of the country will have similar experiences.

Let me be clear. I fully accept that for the majority of young people, a community-based approach to mental health problems will give them the best treatment, but for a number of children and their families, intensive in-patient care is necessary. Those children need an approach that spans the whole network of provision, not just health, but education and social care, which cannot be replicated in a child’s home—if they have a home; many of the children affected are in care.

West End provided such services. Its in-patient facility was judged inadequate because it was available for only five nights a week. But combined with weekends at home, this provided an excellent service, which the parents who experienced it fully supported. Their preference was to extend the unit to a seven-day service, if that was what was necessary to meet the new specification, but that alternative was never offered or discussed.

--- Later in debate ---

[Norman Lamb]

. The right hon. Gentleman raises the tariff, and that is what I want to get to the bottom of. I genuinely want to understand the issue and reach a conclusion on it, and I hope that by meeting we will be able to do that.

We want to ensure excellent child and adolescent mental health services facilities across the country. That is why we are investing £54 million over four years in the children’s and young people’s IAPT—improving access to psychological therapies—programme. That will drive service transformation in CAMHS, giving children and young people improved access to the best mental health care by embedding evidence-based practice which has been absent in these services until now and making sure that they use session-by-session outcome monitoring. The IAPT programme is fundamental to the success of our mental health programme. Our children’s IAPT programme is ambitious in its objectives. Its aim is service transformation with an emphasis on evidence-based practice and a rigorous focus on frequent session-by-session outcome monitoring. It differs from the adult IAPT programme in working across existing community-based CAMHS rather than creating new services.

[Mr Bradshaw]

I am sorry to have to say this, but the Minister’s speech is just waffle. Will he accept that the Government’s reorganisation of the national health service has led to confusion as to who is responsible for the interface between tier 3 and tier 4 mental health services for young people? Will he look at the cases I have raised with the Secretary of State of young people from my constituency being sent to Newcastle—the north-east of England—and all over the country, and being sent to adult wards, in breach of the law?

[Norman Lamb]

I do not think it has been waffle at all. I have tried to answer very directly the concerns that have been expressed. I will absolutely look into the cases that the right hon. Gentleman raises. When I hear reference to children being placed in adult services, I find that as unacceptable as he does. I want to understand how it has happened and bring it to an end. NHS England is carrying out a review over a three-month period to assess the facilities for tier 4 services to ensure that sufficient services are available in all parts of the country. Because of the nature of the specialism, they cannot be in every town and city, but they must be within reasonable reach. That is exactly what the review is seeking to undertake.

Oral Answers to Questions

Ben Bradshaw Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Mr Ben Bradshaw (Exeter) (Lab)]

Why do the Government continue to set their face against the essential recommendation of the Francis inquiry on minimum staffing levels?

[Dr Poulter]

The simple reason, as the right hon. Gentleman will be aware from his time at the Department of Health, is that ticking boxes on minimum staffing levels does not equate to good care. It can sometimes lead to a drive to the bottom, rather than to addressing the needs of the patients whom the front-line staff are looking after. The Berwick review has borne that out clearly. It is important to consider the patients and the skills mix on the ward, and to ensure that we get things right on the day for the individual needs of the patients.