Oral Answers to Questions

Catherine West Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Dunne]

As my hon. Friend knows, we are launching a second wave of nursing associates at the beginning of April. I am pleased to be able to confirm that Southern Health NHS Foundation Trust, which manages Portsmouth Hospitals NHS Trust, is one of the trusts that will receive nursing associates, and that the system is partly designed to give social care workers opportunities to upskill.

[Catherine West (Hornsey and Wood Green) (Lab)]

The Secretary of State will be aware of a recent High Court case concerning a surrogacy issue that has led to legal limbo. Does he agree that the existing legislation has let children down, and that reform is urgently needed?

[Nicola Blackwood]

I can confirm that the High Court has made a judgment, that the current orders for parental orders are discriminatory, and that the Government will act within a reasonable timescale. We intend to lay an order before the summer recess in an attempt to address some of the challenges.

NHS and Social Care Funding

Catherine West Excerpts

Wednesday 11th January 2017 Commons Chamber

[Mr Hunt]

First, I would like to use this moment to congratulate the hon. Gentleman’s local trust on coming out of special measures last year and on the progress it is making. In a way, that is the answer to his point. His local trust was in special measures, and North Cumbria is still in special measures. We had some profound worries about patient care in both trusts, and we still do in the North Cumbria trust. That is why the status quo is not an option, but we understand the concerns of his constituents and many others about some of the proposals being made.

[Catherine West (Hornsey and Wood Green) (Lab)]

What does the Secretary of State make of the talk among professionals at the moment about the potential for a flu epidemic? What does he make of the comments by the doctor who wrote to me on Sunday saying that she is extremely concerned that staff are too busy to isolate patients who are coming in—who need oxygen—so that others do not potentially catch flu?

[Mr Hunt]

There is a concern at the moment about a growth in respiratory infections, and that is causing capacity constraints. We are watching what is happening on flu very carefully, but we have a record 13 million people vaccinated against flu, and I hope that that will put the NHS in a good position.

--- Later in debate ---

[Catherine West (Hornsey and Wood Green) (Lab)]

I do not know the collective noun for Government Chief Whips and Opposition Chief Whips, but I believe it is a crop of Whips. Anyway, it is an honour to follow two esteemed former Chief Whips.

I begin on a slightly less happy note by quoting from an educational psychologist who wrote to me this week:

“I and my colleagues are frequently overwhelmed, frustrated and in disbelief about the amount of work we need to manage, the difficulties in working across services because of cuts and changes to policy. Everyone is perpetually exhausted and burnt out. When we’re not at work because of training, illness or leave we feel simultaneously guilty and relieved.”

Her email went on to describe how she is the only clinical psychologist on duty in the whole of a very busy inner-London constituency.

I wish to comment briefly on the juncture between primary and secondary care, and on acute care. In the past 18 months, many of us have had the experience of fighting for a general practitioner’s service. The Westbury clinic, which lies just between my constituency and that of my right hon. Friend the Member for Tottenham (Mr Lammy), has been quite a battleground in the past 12 months. He and I have had to really fight for basic GP services for our constituents. I believe this situation is replicated across the country, and it is obviously what is leading to the build-up of individuals; as the Secretary of State has said, we have so many people turning up to A&E who probably could be seen by a GP but simply cannot get an appointment.

[Robert Flello]

One problem we face in Stoke-on-Trent is that we are about half a dozen GPs away from the whole GP system collapsing, because as GPs are retiring or leaving for other reasons, their patients are then going to the ever-smaller number of GPs that there are. Two GPs are due to retire shortly, but if we lose half a dozen the whole GP system in Stoke-on-Trent is liable to collapse completely. What will that do to A&E?

[Catherine West]

That leads to an individual patient waiting 35 hours on a trolley to be seen, as happened this weekend. I know that a number of Members have made this point, but it bears repeating: it is disgraceful that staff are blamed when this is going wrong, given that the responsibility clearly lies with politicians—with the Government. I was upset to see that today’s front page of The Times blames the senior civil servant at the heart of the NHS, as this is really down to poor Government planning.

[Stephen Pound (Ealing North) (Lab)]

On the subject of poor planning, I am sure that my hon. Friend will, like the rest of the House, have heard James O’Brien speaking on LBC yesterday describing his experience of having conjunctivitis over the Christmas holiday and having to go to a community pharmacist because he could not get a doctor’s appointment and did not want to go to A&E. Is this not the maddest time ever to be considering closing thousands of community pharmacies? Is this not the time when we should be supporting them, not closing them?

[Catherine West]

I do not know whether a Brexit-fever madness took over, but there was a moment when cutting community pharmacies seemed like the right thing to do. Clearly, it was the wrong thing to do at such a crucial time, particularly given the impact of the illnesses to which we all fall prey during the winter months.

In my earlier intervention, I asked the Secretary of State about the flu epidemic. He assured me on the number of vaccinations, and I am pleased that more people have been vaccinated against seasonal flu. However, let me return to the point I was making. I understand that there has been quite an increase in the number of young people getting the flu, so we are not talking about people in the herd group who would have been advised to be inoculated against it. When people, tragically, get the flu they suffer, and doctors do not have time to isolate those individual cases. That creates a real risk, given how busy staff are, that that flu could become an epidemic. Having given us assurances today, I hope the Secretary of State will take that point up further with chief executives of acute trusts.

I want to give colleagues an idea of what is happening on social care. In 2010, I was a council leader and we had a social care budget for children—this is nothing to do with schools, just children—of £102 million. The same local authority now, in a busy London area, has for 2017-18 got a budget of £46 million. If someone is really telling me that the needs are half as much as they were in 2010 or that somehow families need less help and support, which is what children’s social care provides, I would be very surprised. A cut from £102 million to £46 million in 2017-18 is deeply worrying for the children who are in desperate need of social care.

Adult social care is equally worrying. The Secretary of State told us on Monday that we should not worry because £600 million is going into social care. I would not worry, except that I happen to know that, between 2010 and 2015, £4.8 billion was taken out. Anyone who has even key stage 2 maths will know that that does not add up. If £4.8 billion is taken out over a five-year Parliament, putting in £600 million 18 months later is not going to help.

I feel sorry for councils. If they increase tax, that is quite unpopular, but if they do not the Government blame them for not wanting to sort out the social care crisis. Even where the precept does bring the local authority quite a lot of money, the amounts raised do not help in the longer term because they just go towards a short-term fix—we are not actually fixing the problem that we need to be looking at: we need more homes in which older people can live comfortably, have fewer falls and accidents, be warmer so that they are not suffering from fuel poverty, and stay out of A&Es.

It is all about long-term planning, but we have built hardly any new homes, even for older folk. If we did so we could start a chain and enable their families to move into their old homes, thereby solving another problem. We have reached a crisis in which older folk end up in A&E and, on occasion, have to wait on a trolley for 35 hours, which I still cannot quite believe. I am sure that the newspapers are telling the truth, but 35 hours is an awfully long time to be on a trolley and not be seen.

Last year, my right hon. Friend the Member for Tottenham and I had a debate on mental health in this very Chamber, which was followed by a meeting of Members of Parliament from the local sub-region. We were very worried about people suffering from mental health problems, for whom there is currently a perfect storm. First, there have been benefits cuts. We are now in our seventh year of austerity, and there is no doubt that people with mental health problems have been right at the bottom of the pile. Secondly, we have seen cuts to supported housing and all the programmes that helped people suffering with mental health problems to keep their tenancies. That is all being cut, so people have no one to support them, which is part of the reason they fall ill. Thirdly, we have seen cuts to the number of nurses. There are fewer mental health nurses in the system than there were two years ago and, of course, fewer beds.

A constituent came to see me at my surgery in November to say that he had fallen ill with a mental health problem. He was very surprised because he had never suffered in such a way before and was amazed by the poor care he received, in part because no one was available to diagnose him properly. He spent more than 24 hours in a padded cell, with no explanation and no indication of what sort of service he could expect. There were so few beds that he was sent about 20 miles away to be cared for at another hospital, leading to a great deal of stress and worry for his family.

The whole health system is in crisis and needs our urgent attention. Despite all the demands, political and otherwise, that the Brexit process is going to create, I hope we will not forget not only the most vulnerable—those with mental health problems or in social care and so on—but our basic, universal NHS for all.

Mental Health and NHS Performance

Catherine West Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I welcome my hon. Friend’s contribution as a practising nurse; it adds greatly to the House. I am more than happy to pay tribute to our brilliant mental health nurses. They have one of the most stressful jobs anyone can have, and I pay particular tribute to the ones in Sussex, which has those tragic suicide hotspots.

[Catherine West (Hornsey and Wood Green) (Lab)]

Given that the cold weather is coming, I want to return to the risk of a flu epidemic. A desperate doctor wrote to me last night to say:

“Sooner or later, there will be an epidemic and let me tell you: we cannot cope. Another shift, another full hospital. Another gridlocked A&E, more desperate but often implausibly understanding patients. Another 13 or 14 hour shift with one 10 or 15 minute break. Some patients and relatives get angry, some despair, most watch us and realise we can’t physically do anything more.”

Please help me, as her MP, to represent her, and please help us to have more staff.

[Mr Hunt]

That doctor speaks for many doctors who are working incredibly hard, particularly in our emergency departments. I would say to that doctor that we recognise the need for more doctors and we are recruiting more doctors, not just across the NHS but in emergency departments in particular. We also recognise that we need to find a different way to deal with some of the patients who come to the hospital front door, so that we can alleviate the pressure. That is what we are looking at.

Contaminated Blood and Blood Products

Catherine West Excerpts

Thursday 24th November 2016 Commons Chamber

[Diana Johnson]

I am very happy to agree with my hon. Friend. That should certainly be investigated.

I return to people’s concerns about the use of private companies. We know that, over the past six years, there has been a huge sense of mistrust of the disability assessment regime operated by Atos before it walked away from its contract with the Department for Work and Pensions. If there is one thing that could fatally undermine progress towards a better support scheme, it is the plan that the new scheme be administered by a private company. I strongly urge the Government to look again at that plan and show empathy for the people affected.

[Catherine West (Hornsey and Wood Green) (Lab)]

I congratulate my hon. Friend on her dogged and tireless work on this issue. Does she agree that there is a big issue of trust here, in relation not just to the potential new providers but to what happened previously? Some survivors and families who survive victims who have passed away believe that senior health professionals knew about the contamination but decided to continue with their interventions for cost reasons.

[Diana Johnson]

Yes. One point I will come to later is the need for some form of inquiry.

To continue my point about why who runs the scheme is so important, a big criticism of the new scheme is the continuation of discretionary payments. Department of Health officials are still not listening to the concerns raised about that. The APPG inquiry uncovered huge issues with the highly conditional and poorly managed discretionary support scheme. One respondent told us:

“The whole system seems designed to make you feel like a beggar”.

I also believe that the trust’s current administrators have not fought hard enough for their beneficiaries, which legally they could have done. Instead, they saw their role as dispassionate managers and conduits to the Department of Health. They left the affected community alone to fight for themselves. If the new support scheme ends up being managed by Atos or Capita it will do nothing to address those fundamental issues, and could even make the situation much worse, adding insult to injury. I call on the Minister to do the right thing and announce that she will scrap plans for a private profit-making scheme administrator, and will replace the current scheme with a more beneficiary run and focused organisation that has no profit motive.

Will the Minister set out exactly what kind of discretionary support the new scheme will provide? It remains unclear whether any or all of the current support will continue. That contrasts starkly with the Scottish scheme, where the financial review group agreed that no one should receive less financial support under the new scheme. Will the Government urgently provide the same guarantee and publish full details of any obligations that the new scheme administrators will be subject to?

There are also issues with the current welfare benefits reassessment regime that many people are having to go through—for example, moving from disability living allowance on to the personal independence payment. Those issues need to be addressed urgently, so that individuals can be passported straightaway on to new benefits. I hope the Minister will agree that that is a sensible way forward for the people affected.

My third concern relates to the families of those affected, who need better support under the scheme. Under the new English proposals, widows and widowers will continue to be eligible for discretionary support—whatever that means; I have raised my concerns about that already—on top of a new £10,000 lump sum, provided their loved ones died at least partially as a result of contracting HIV or hepatitis C. However, many clinicians have already told me that that could mean many people are excluded from assistance simply because their partner’s death certificate does not include mention of HIV or hepatitis C, sometimes at the family’s request. The new proposals could also still be considerably less generous than the support that some widows already receive, because there is a huge question mark hanging over what discretionary help they will get under the reformed scheme.

--- Later in debate ---

[Diana Johnson]

I agree with my right hon. Friend, who makes his point very well. We need to make sure that any new support scheme moves quickly. We need to get on with this. The previous Prime Minister, when he apologised on behalf of the nation 18 months ago, also allocated £25 million, but none of that has been spent yet, as I understand it. We need to make sure that a scheme is introduced as quickly as possible, although obviously with our concerns having being addressed. But absolutely the two things can run in parallel, and a Hillsborough-style panel inquiry would give people the opportunity of a truth and reconciliation inquiry. I still think it a key requirement if there is to be any real sense of justice and closure.

[Catherine West]

Families who have suffered a loss following this terrible scandal have expressed a desire to get hold of certain documents and to find out what happened and who knew what. They really just want a sense of justice.

[Diana Johnson]

I will now conclude. I know that in later speeches hon. Members will want to raise the deeply moving stories of their constituents. It is those stories that have led me to campaign on this issue over many years, and I am always mindful of the struggles faced by my constituent Glen Wilkinson. Glen was diagnosed with hepatitis C after a routine tooth operation in the 1980s, when he was just 19. He has had to live with the virus all his life and is still waiting for proper recognition of how it has affected him. I hope that the Minister and the Government will now work to ensure that Glen and others can live the rest of their lives in dignity.

--- Later in debate ---

[Catherine West (Hornsey and Wood Green) (Lab)]

I am pleased to speak in this debate on behalf of children who lost their father, a mother who lost her son, and a spouse who lost her husband, as well as the many people who still suffer an injustice.

I want to focus on transparency in the public sphere. As the right hon. Member for North East Bedfordshire (Alistair Burt) said, it has become obvious that there is evidence that there was knowledge long before there was action, as we saw, for example, from Lord Owen’s testimony to the Archer inquiry. It was stated that when he went to the Department of Health as a Minister and saw boxes of notes on the subject, that raised questions in his mind. He decided he needed a team to deal with the matter, but when he returned a week later, all the paperwork had been shredded. I therefore wonder whether, through this debate—perhaps the Minister will reply to us in writing—we could give permission to others who might know more to come forward. I agree with the right hon. Gentleman that it might not be right to hold a full-scale, lengthy inquiry, but there must be some way of holding to account the individuals who knew more.

That covers the justice point; the other linked point is the question of trust in health providers. Madam Deputy Speaker, as I am sure that you are aware from listening to this debate, there was wide knowledge at the time, even among health professionals. I therefore wonder whether health professionals who were working in the national health service at the time might be able to shed some light on how it could be that individuals knew about the contamination, yet decided to continue with the use of contaminated products, both for reasons of cost and because it was said that there was no alternative. Years later, we are in a position of trying to find the truth. Now is the time to look at these two questions of trust and justice.

I add my voice to those who have said that bringing in Atos and other private providers could redouble the sense of a lack of trust about resolving this matter. Could we not look at this as just an NHS-led process, which would underline honesty and a sense of communicating well with those who have suffered so many years of trauma due to this terrible situation?

I put on record my recognition of the excellent work of the all-party group and of members of the haemophilia community, who have helped MPs to research this matter so diligently and have called for a proper investigation for so many years. I thank my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) for bringing forward the debate.

Chronic Urinary Tract Infections

Catherine West Excerpts

Friday 28th October 2016 Commons Chamber

[Catherine West (Hornsey and Wood Green) (Lab)]

I am grateful for the opportunity to open this debate on the inadequacies of the current testing regime for people suffering from chronic urinary tract infections. I am happy to have been joined by other Members, and in particular by my right hon. Friend the Member for Islington North (Jeremy Corbyn), my neighbouring Member of Parliament, who has a long track record in defending services for patients with those conditions, and has worked closely with the Whittington hospital in that regard.

This subject has been neglected for too long, although it affects far too many people. Some 33% of women are expected to suffer from a urinary tract infection before the age of 24, and one in 10 girls and one in 30 boys have a UTI by the age of 16. The issue first came to my attention through the work of Professor Malone-Lee in his lower urinary tract symptoms clinic, which is run from the Hornsey central health centre in my constituency. Many of his patients are my constituents, but many others travel from all over the country and even from abroad to seek his expert help with complex, chronic bladder conditions that have made their lives a misery for many years. Some of them are in the Public Gallery today, including some who have travelled across the country to be here, so this is an important debate for all of us.

The devastation of those patients when Professor Malone-Lee’s clinic was closed temporarily last year and the ongoing concern that I and many others have over the clinic’s future have brought his unique methods into the spotlight. One patient told me that before she saw Professor Malone-Lee, she suffered every single day in pain, leaving her unable to function. Another told me that her life had not been worth living after 32 years of terrible pain and invasive treatments that failed to solve her bladder problems.

I am aware that the long-term future of Professor Malone-Lee’s clinic is the subject of a review by the Royal College of Physicians, so I do not intend to focus specifically on his work today. Instead, I will talk about the wider issue, which my contact with the professor and, more importantly, with so many of his current and past patients has highlighted: the inadequacies of the current testing regime to diagnose urinary tract infections.

The gold standard for diagnosing urinary tract infections over the past 60 years has been to culture a mid-stream urine specimen and identify a pure growth of a known urinary pathogen within a range. However, such dipstick tests have been known to be deficient for many years, with data as far back as 1983 casting considerable doubt on the veracity of their findings due to the lack of sensitivity. Such tests cannot exclude acute or chronic urinary tract infections and do not take into account differences in bacterial strain virulence, host genetic variability, intracellular bacterial reservoirs or even the dilution of the urine specimen due to high liquid intake before the test. The standard laboratory culture will miss 50% of infections. That matters, because these are real people with real symptoms.

Too many people have told me that they have spent years reporting horrendous symptoms and suffering terrible pain, but that they have been dismissed and told that they do not have an infection because the culture was negative. That is to confuse the absence of evidence of disease with evidence of the absence of disease, when those are two wholly different things. What happens to the poor people whose symptoms are dismissed based on a test that experts know to be inadequate? Some will recover and others will find that a short course of antibiotics cures their symptoms, but far too many others will enter a cycle of repeated acute infections, exacerbated by sex, exercise, alcohol, certain foods, stress and many other of life’s normal occurrences, causing devastation to their lives.

As many as 20% to 30% of patients fail to respond to the current recommended antibiotic treatment, whether it is prescribed for three or 14 days. That is not an insignificant number of people when one considers that the Cystitis and Overactive Bladder Foundation estimates that the condition affects about 400,000 people in the UK. Despite that, doctors are not being given the basic tools to inform them how to treat these symptoms differently, and they will not be until the health service revises the inadequate guidelines for testing and treatment. Professor Malone-Lee’s clinic has clearly shown that there are different and more effective ways of testing. Many patients who have not responded to conventional treatment have seen their lives transformed by antibiotic treatment over a prolonged period.

I am well aware of the understandable anxiety among many clinicians and inspectors about antibiotic resistance and the evolution of superbugs. That is clearly something that cannot and should not be ignored, but it is not a reason to fail to question the current guidelines for the treatment of chronic urinary tract infection or to ignore their clear inadequacies. Neither is it a reason to fail to manage the care of those who do not respond to so-called conventional treatment options and to leave them in distress for months and, all too often, years. What evidence is there about the consequences of partially treated urinary infection in the long term? Safe strategies should be developed for helping people who present with particular problems that do not respond to the so-called guidelines. Data show that the NHS spent £434 million on treating 184,000 patients in 2013-14 in unplanned admissions associated with urinary tract infections. Failing to adequately treat these patients is expensive for our NHS and devastating for the patients themselves. The testing and treatment methods employed through the lower urinary tract symptoms pathway under Professor Malone-Lee are estimated to cost approximately £409,000 for 1,000 patients compared with a cost of approximately £5.3 million for 1,000 patients using conventional methods.

I urge the Minister to give this neglected subject the attention it deserves, and I would be grateful for answers to the following questions. Why are people with symptoms and signs being told that they have no infection on the basis of discredited tests? Why are the existing guidelines and policies so didactic when the published evidence implies that there is considerable uncertainty about our knowledge of the condition? Why do these guidelines base their conclusions on the results of quantitative urinary culture which has been so discredited? What is the NHS provision for adults and children with long-term chronic urinary infections? Finally, why is there no tertiary care facility for recalcitrant cystitis in the NHS?

I ask the Minister to meet me and other MPs with constituents who have been affected by the inadequacies of the existing guidelines so that we can discuss this issue in more detail. This is a cause of immense suffering for many people across the country who struggle to be heard and to be taken seriously. I know that I also speak on behalf of MP colleagues who cannot be here today—many have sent apologies—when I say that many of those affected would be very keen to meet the Minister in person to share their experiences. Will she today agree to have a meeting with representatives from patient groups?

NHS Sustainability and Transformation Plans

Catherine West Excerpts

Wednesday 14th September 2016 Commons Chamber

[Sir Simon Burns]

Will my hon. Friend give way?

[Catherine West (Hornsey and Wood Green) (Lab)]

Will the Minister give way?

[Mr Dunne]

I give way to the hon. Lady.

[Catherine West]

I thank the Minister for giving way and hope he does well in his first performance here in the House. What percentage of acute trusts are in deficit, and what proportion of clinical commissioning groups are in special measures?

[Mr Dunne]

Many trusts were in deficit in the last financial year, and those deficits were funded by the Department of Health. Looking forward, we are using the financial discipline of control totals not to instigate cuts, as the hon. Member for Hackney North and Stoke Newington suggested, but to hold the accountable managers to account for delivering within the financial envelope that those control totals represent. That is what a responsible Government do—we give money to public services and expect them to live within those means. This year the NHS has received one of the largest cash settlements it has ever had, three times more than the rate of inflation.

North Middlesex University Hospital NHS Trust

Catherine West Excerpts

Tuesday 12th July 2016 Westminster Hall

[Catherine West (Hornsey and Wood Green) (Lab)]

It is an honour to serve under your chairmanship, Ms Vaz. I congratulate my right hon. Friend the Member for Enfield North (Joan Ryan) on securing the debate. It feels a bit like mark 2 for her, I think, given the earlier experiences with Chase Farm. I am pleased about the cross-party nature of the debate; it was interesting to hear the personal experience of the hon. Member for Enfield, Southgate (Mr Burrowes) of care at the hospital.

Like my right hon. Friend the Member for Tottenham (Mr Lammy), I am at a loss; I attended the annual general meeting a couple of weeks ago and have written letters to Ministers—indeed, the Minister present today has been kind enough to have a meeting with us. We have had press reports and urgent questions. We have asked questions at Prime Minister’s questions. We have had Adjournment debates, and the Mayor of London has raised the matter with NHS London. I am at a loss to know what we should do next, and which levers can be pulled.

I am pleased that management action has been taken, and that Mr Sloman has now taken an interest and is the accountable officer. I am equally pleased that Ms McManus has been brought in to take over on an emergency basis while the leadership of the hospital is being looked at. However, I have concerns for the long term about a situation in which decision makers in Hampstead would make decisions about a north London hospital whose area is Edmonton, Tottenham, Wood Green, Enfield and Haringey. I am concerned about how remote and out of touch they might be. I look forward to hearing in the spring what the management arrangements will be for the medium to long term. We must ensure that there is proper representation of local people at board level and a proper voice for our area in the hospital management and governance structure.

I will briefly raise two constituency cases. One is about medicines training, which was referred to in the Care Quality Commission’s report. I understand from a constituent that when her father was discharged from the hospital, somehow his name had got mixed up with another patient’s name, and when she got home she had the incorrect medicine for him. That is a basic error, and the wrong medicine could have been fatal for an elderly and frail man.

The second case arose after an anonymous phone call to my office reporting on the condition of an elderly patient. The caller was very distressed, as the patient was his elderly wife. He said, “I’m so worried to tell you, because I am afraid that they actually might kill her if I tell you her name.” There is a level of desperation, and that call was made not so long ago; it was within the last month.

There are some general lessons to be learned from this specific situation about the lack of leadership and lack of quality control in our public services. The first is about the recruitment and retention of properly qualified staff. We desperately need to tackle the low morale of staff, which has been exacerbated by the poor handling of the junior doctors dispute. Morale is low not only at senior level or consultant level but at the middle level, and even at the level of junior doctors. Once the hospital lost the contract for the training of junior doctors, everything went downhill from there. We need to get that training back, and we need to work very hard and very quickly to get back the doctors and experts who want to serve, learn and train in a university hospital.

The second lesson to learn is about the crucial issues in our health economy, one of which is the problems with primary care. I understand that there are immense problems with the current Enfield primary care arrangements. The clinical commissioning group is not in a good place. I would like to hear about any associated issues, and I would like to know what levers the Minister can pull to ensure that proper primary care arrangements are put in place for Enfield and that primary care in Haringey is strengthened.

I understand that Haringey has done some very good things, including putting some extra general practitioners into the accident and emergency department to educate people about where to go when they first come into hospital, and about how they can go and see their GP in the local community. I would be happy to hear about an evaluation of that programme and whether it has been helpful. Rather than rushing in with a band-aid solution, can we hear back about that programme? What has the evaluation been, and what do the experts think? Has that programme stopped the flow of people coming—perhaps incorrectly—to A&E, and has it helped the primary care health economy?

It is well known that Members including my right hon. Friend the Member for Tottenham secured a debate in the main Chamber on mental health in Haringey. At St Ann’s hospital in Haringey, the acute care places are really overloaded, which has led to greater demand for beds at North Middlesex hospital. Once the health economy becomes unbalanced, that can put more strain on A&E departments from general patients who do not have mental health problems.

Furthermore, there is an ambulance crisis. Police officers have told me that there are not enough ambulances and that they have to take patients to the North Middlesex hospital themselves because the ambulances cannot cope. Of course, we know that once the ambulances get to hospital, people are being treated inside the ambulances, which is completely unacceptable.

[Mr Lammy]

My hon. Friend will also appreciate that a major criticism in the CQC report was that after patients have left the ambulance, they are treated solely by nurses at grade 5, with no doctors in sight and no consultants available after 11 o’clock at night. How can there be an emergency department when there are no consultants available on a Friday or Saturday night?

[Catherine West]

My right hon. Friend makes an excellent point about an issue that must be monitored. I look forward to the Minister reporting back on the lack of the leadership and clinical excellence that we expect on behalf of our constituents.

The cuts to public health provision will have an extra impact. I will give just one example, which many Members here have pursued—basic HIV/AIDS care. We are not doing the preventive work, and we are unnecessarily cutting back the public health budget, which will eventually lead to more people turning up at A&E or acute care departments in crisis. These issues in the health economy are all linked, and we need to do much more about all of them.

We are all aware that litigation accounts for a quarter of NHS expenditure. Why do we not get better at doing the proper work first, so that the money we spend on lawyers and expensive court cases when we get things wrong does not add up to so much? The situation is absolutely desperate. We need more investment, and we need to stop making mistakes so that we do not have to pay for litigation and so that instead of litigation there can be front-loading of resources into prevention, mental health and good-quality primary care and basic services. People accessing the NHS could then have confidence that their local service is as good as we should expect it to be.

Finally, we know that in London, there are a number of issues with the cost of living, the cost of transport and the cost of childcare for medical practitioners and nursing staff. Those issues are linked to the others that I have mentioned, and I would like to see a more robust approach from the NHS around London to the needs of those working in our hospitals and our public services. London is not like other areas, where it is cheaper to rent homes and so on. We are unable to recruit the medical practitioners and nurses we need because they cannot afford to live in the area, and we should examine that issue more energetically and not just in a theoretical way.

Thank you very much, Ms Vaz, for calling me to speak. I look forward to hearing the Minister’s conclusions.

[Valerie Vaz (in the Chair)]

I point out to the Front-Bench spokespersons that the wind-ups are starting now, and we are expecting a Division in the House at around ten to 4.

NHS Spending

Catherine West Excerpts

Wednesday 6th July 2016 Commons Chamber

[Karin Smyth]

I agree with my hon. Friend. In fact, one of the reports I have with me is the one we published in December about the work of the Care Quality Commission and some of the concerns that have already been issued about the work it does to uncover issues such as the ones she has highlighted in her constituency.

[Catherine West (Hornsey and Wood Green) (Lab)]

Does my hon. Friend agree that a worrying number of trusts are now in deficit, whereas 10 years ago they were simply bubbling along well—in fact, they were getting more money for their budgets? Even for North Middlesex hospital, which we have heard about extensively tonight, the situation is increasingly worrying, as it is now in deficit for the first time in 10 years.

[Karin Smyth]

I agree and I will talk about some of the issues with trusts.

Hon. Members have provided examples that highlight our concerns about how the Department is managing to do what Parliament intended with the funds voted to it. They highlight the importance of giving the Public Accounts Committee and Parliament the opportunity to review the departmental accounts properly.

The Department of Health annual accounts cover more than 20 arm’s-length bodies and delivery partners, not only NHS England, but the Care Quality Commission, NHS Improvement, the National Institute for Health and Care Excellence, the Human Tissue Authority, Health Education England, the NHS Litigation Authority and—one of my and, I am sure, many hon. Members’ favourite organisations—NHS Property Services Ltd.

Within NHS England, NHS trusts reported a record deficit of £2.45 billion in 2015-16—almost £500 million worse than planned, and triple the size of the 2014-15 deficit. As my hon. Friend the Member for Hornsey and Wood Green (Catherine West) said, a record 121 out of 138 acute trusts ended 2015-16 in deficit. Analysis by the King’s Fund and the Health Foundation has challenged the Secretary of State’s claim that, in the 2016-17 Budget, the NHS will receive the sixth biggest funding increase in its history. The chief economist at the King’s Fund concluded that this year’s total real spend increase of 1.6% is the 28th largest increase since 1975-76.

The Health Foundation noted:

“The health budget has been protected from cuts but spending growth is substantially below the growing pressures on the service…In exchange for this protection, the NHS has been asked to absorb these pressures through improved efficiency. There are opportunities to improve the efficiency and effectiveness of the NHS but realising these savings is proving to be a huge challenge—particularly against a backdrop of staffing shortage.”

Given the size of the trust deficit and the implications for the budget of NHS England, which takes up by far the greatest part of the Department’s budget, there are widespread concerns about how the Department might stay within its departmental expenditure limit. Failure to do so would be an exceptional breach of control. As my friend, the hon. Member for Aberdeen North (Kirsty Blackman) said, there are issues about the way in which capital has been transferred to revenue and so on.

The Public Accounts Committee understands that the accounts will be available before the recess—perhaps next week, which would be very welcome. We need to look at not only NHS England’s spend, but that of the other 20 or so bodies that make up the Department of Health. I know that you, Madam Deputy Speaker, and Parliament will take a dim view if the Department’s accounts are not subject to proper scrutiny when the Committee, which had some additional training this year to review the accounts, is ready to undertake such scrutiny.

In addition to my concerns about last year’s accounts and this year’s departmental budget, I believe that Brexit now poses huge risks. My major concerns are about staffing, procurement and medicines, but there are many others. In my NHS career as a non-executive director on a trust board and as a manager, I read and indeed compiled many a risk register. It is truly a joyful task. The Department requires all its bodies to identify, assess and mitigate risks. As anyone in any business knows, risk registers are an essential part of the planning process. Few if any risks to business could be greater than Brexit. I would expect the Department to have a robust Department-wide risk assessment process, and I would expect it to include Brexit.

Yesterday at Health questions, I asked what was being done across the Department, including the NHS, to assess and mitigate the risks to its current year budget of Brexit’s huge impact on staffing, procurement and medicines. I received a far from satisfactory reply—although he tried to be helpful—from the Under-Secretary of State for Life Sciences. I therefore pose three key questions to Ministers: what are the risks of Brexit that the Department must surely have already identified through its risk register or by other means? How are they to be mitigated? When will they be debated and discussed in Parliament?

World Autism Awareness Week

Catherine West Excerpts

Thursday 28th April 2016 Commons Chamber

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

I beg to move,

That this House notes that World Autism Awareness Week was held from 2 to 8 April; believes that there is a lack of understanding of the needs of autistic people and their families; and calls on the Government to improve diagnosis waiting time and support a public awareness campaign so that people can make the changes that will help the UK become autism-friendly.

We were on recess during World Autism Awareness Week. I want to put on record my thanks to the Backbench Business Committee, which has granted this debate, and to you, Mr Speaker, for indicating that you may be willing to extend the debate because of the demand from people who want to speak in it. I know that there are conflicting Committees going on in other parts of the House, which will cause some problems for people who want to speak in the debate.

I also put on record my thanks, as chairman of the all-party group on autism, for the genuine cross-party view on the subject, and for the help and support I have received from Members of all parties. It is commendable that the House should work in such a way. It is nice to record that the all-party group on autism is, I think, one of the all-party groups that has the largest number of members. That shows the significance of this topic.

In 2015 the National Autistic Society carried out a YouGov poll and found that more than 99.5% of people in the UK had heard of autism. That means that, more or less, we are all aware of autism, which is a jolly good thing. However, just 16% of autistic people and their families whom the National Autistic Society spoke to as part of its recent research said that the public had a meaningful understanding of autism. Despite all the progress that has been made, there remains an enormous gulf between awareness and understanding. The key point here is that although more understanding may seem like a soft issue that everyone across the House can easily get behind without much thought, it is understanding that goes to the core of what people and families who live with autism every day have to deal with.

[Catherine West (Hornsey and Wood Green) (Lab)]

I congratulate the right hon. Lady on all the work that she has done over the years on this crucial subject. She mentioned the National Autistic Society, and I praise it for its wonderful work. Does she agree that stigma around autism among the general public, in educational institutions and among many employers still holds all of society back?

[Mrs Gillan]

That is true to an extent, but I want to balance that by saying that in some areas, many people who are on the autism spectrum are welcomed into the world of work, by GCHQ and other organisations that can take advantage of their unique capabilities. The hon. Lady is right in many areas, however, hence the debate.

Mental Health Services: Haringey

Catherine West Excerpts

Thursday 28th April 2016 Commons Chamber

[Catherine West (Hornsey and Wood Green) (Lab)]

I want to thank the Minister, who has had a busy afternoon, for his excellent winding-up speech on autism. I congratulate my right hon. Friend the Member for Tottenham (Mr Lammy) on the long-term interest he has had in mental health and on the way in which he has championed the issue.

Since I was elected nearly 12 months ago—it will be 12 months next week—my office has seen more than 40 individuals whose mental health problems are so serious that I would say that they, and indeed others around them, are at serious risk. Since last May, the number of mental health cases coming in to my surgery has increased, which is a real concern of mine.

I have three questions for the Minister. First, are the Government monitoring the suicide risk of those facing homelessness? Secondly, is the number of housing related suicides being recorded and documented during the inquest process? Thirdly, what support are the Government giving to local councils to ensure that vulnerable adults with complex mental health difficulties do not face street homelessness?

I just want to mention two cases. The first is that of a soldier in the Army—he was in the light infantry—who did five tours in Northern Ireland and served in Bosnia. He suffered from post-traumatic stress disorder, but on the same day that he was issued with a section 21 notice he attempted to take his own life. Luckily, he was unsuccessful. He wrote to me that

“facing homelessness was the catalyst to me taking the action that I did”.

The second case concerns a young woman constituent who was victim of child sexual abuse. She suffers from a dissociative disorder, and has spent three years battling the CCG to get the therapy that she needs to handle her complex mental health problems. Her battle continues, and she is still without the support that she desperately needs to deal with the trauma of her past.

Mr Deputy Speaker, you will be very impressed to know that the community is working very hard on this problem. That involves not only me, my right hon. Friend and local councillors, but Mind in Haringey and an individual by the name of David Mosse, who leads on the suicide prevention plan for Haringey. As I am sure the Minister knows, not one borough in London yet has a comprehensive suicide prevention plan that challenges all the agencies to take responsibility for trying to prevent suicide. As we speak, David, as a concerned resident, is leading a session to try to secure best practice in Haringey by bringing all the agencies together to prevent suicide. That is a very exciting development. I just wish we could match at the statutory level what the community, Mind, the suicide prevention team, parents and carers are doing.

A charter for better mental health services has been developed locally with some wonderful family carers and service users. Their demands are very clear, and I will send the Minister a copy of their charter. They want community mental health teams to be less overstretched, and they want effective early intervention. They recognise the desperate shortage of acute psychiatric beds—capacity is frequently 128%, which is overcapacity—and they basically want enough hospital beds to be available locally. As my right hon. Friend has said, we believe in community approaches to sorting out mental health problems, but we all accept that there are times when, even with the best will in the world, people need to be hospitalised for certain treatments. The idea of switching things into the community is laudable, but we need beds for the moments when acute care is necessary.

Another demand is for the crisis response service to be more fit for purpose, with an effective and accountable emergency crisis response. In the case mentioned by my right hon. Friend, the young man attempted to take his own life because of the domino effect: it was the emergency crisis response not being adequate, the ambulance service not being adequate and the fact that no bed was available that led to his attempt on his life.

Finally, the last three issues on the charter are that the route into admissions needs to be clearer for patients and carers, that there is a lack of suitable housing for vulnerable people after they have been in hospital and that carers feel that they are not listened to.

Will the Minister touch on preventing suicide through better homelessness options? Unfortunately, the moment when certain individuals receive their section 21 notice from a housing provider, meaning that they are going to be made homeless, often coincides with an attempt at suicide. I have quoted the cases of a man and a women from my constituency who have each been affected, but we know that, sadly, suicide is the biggest killer of men under the age of 45, across the country. That is a very sad note to end on, but I look forward to the Minister’s response.