Health and Social Care

Baroness Laing of Elderslie Excerpts

Thursday 16th January 2020 Commons Chamber

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

First, may I draw your attention, Mr Deputy Speaker, and that of all Members to my declaration in the Register of Members’ Financial Interests as a practising NHS psychiatrist?

Before I address the motion and speak in support of the Queen’s Speech and its focus on health and social care, I pay tribute to the hon. Member for Ealing North (James Murray). I have no doubt that he will have the eloquence of his predecessor—somebody we in the House knew for his many jovial speeches. I also have no doubt that he will match the diligence that his predecessor showed as a constituency MP in fighting for the needs of his local residents, not least by standing up for his local NHS and maintaining a health service locally that meets the needs of people in Ealing. I wish the hon. Gentleman very well in all that he does in this place.

Many commendable and positive things can be recognised in the contribution by my right hon. Friend the Secretary of State. He rightly talked about the need for increased investment in the health service and about the need to support the staff who work on the frontline. He rightly identified the need to improve mental health provision and talked about the need to find political consensus on social care.

I intend to talk briefly about a couple of those issues, but before I do so it is worth observing that we now have a new Prime Minister and the Government have a strong mandate. That is an opportunity to reflect on what we could do as a Government to improve the legislation that we ourselves have passed and that has perhaps had unintended consequences. There is a particular concern among patients and people who work in the NHS about the fragmentation of services, which has been the result of the sometimes market-driven approach to the delivery of healthcare and the encroachment of the private sector on the delivery of traditional NHS services.

As a clinician, what matters most to me is that we deliver the right services for patients. We need to recognise that the involvement of private sector provision has sometimes led to greater fragmentation and a lack of joined-up care for patients. In particular, if we look at how addiction services are commissioned, we see the impacts of that on increasing homelessness and people not getting treatment in a timely manner, or on the joined-up care with the NHS afterwards. If we look at how some sexual health services are now commissioned, we see that it is done in a fragmented way that often lets patients fall through the cracks. With a fresh mandate and a new Prime Minister, I hope we have an opportunity to look at that and be honest that the answer is not always in the market—that the answer is in well-funded, properly delivered public services that are free at the point of need and often run by the state. We have to be honest about that and recognise where we could do things better in future.

The second point I wish to make is on the need to value our staff. NHS staff have had a difficult period, with wage restraint and morale issues—for example, as a result of the junior doctor dispute. We also need to recognise the challenges relating to the NHS workforce which Brexit has brought into focus. We are very reliant, and have been historically, on the contributions made by members of the NHS who come from all over the world, from within the EU and from throughout the country, and frankly our NHS could not work without them. We are very grateful for those contributions and it is right that we support those people in our NHS.

Of course we need to focus on improving the number of British-trained graduates across the health service, but we also need to recognise that the staffing crisis is the biggest issue that we now face. If we want to realise the ambition to increase nursing numbers and GP appointments, we have to recognise that across the piece there is a need to take staff training, recruitment and retention seriously. We need to look at the fact that in different parts of the United Kingdom—for example, the north-west or the north-east—there are fundamental staffing challenges and a difficulty in recruiting and retaining staff that is much more acute than it may well be in the south of England. I know the Government want to look at that, but we need to come up with meaningful answers.

We need to look overseas at examples in Australia, where they have to cover a very large land mass. They have had challenges attracting staff to work in parts of rural Queensland and the Northern Territory; we need to take lessons from those healthcare systems and apply them here so that we can address workforce shortages on the frontline. Without the staff, we cannot deliver the care. It is all very well to talk about improvements in patient safety and other things, but unless we have the staff to do it, we cannot deliver it. I hope that there is now an opportunity for the Government to grip these issues. Staff planning takes more than just one parliamentary cycle until the next general election; it is a five or 10-year mission, but it is one that we need to grip now if we do not want to have lasting workforce shortages in many regions of this country.

In particular, I draw the attention of those on the Treasury Bench to the challenges that we face in mental health. It is absolutely right and commendable that we have focused on destigmatising mental health and on the importance of mental health liaison services. Professor Simon Wessely did a welcome review of the Mental Health Act 1983 that was long overdue. I am sure we will address those issues.

We have to recognise that community mental health services have been substantially the Cinderella of mental health services for far too long. If we want to improve care and prevent people with mental ill health from getting so unwell that they need to turn up at hospital, we need to recognise that the primary focus of investment in mental health services—indeed, one of the issues we face is a staffing crisis in mental health, with falling numbers of frontline mental health nurses in the community —must be in community services. They have been hollowed out for too long and now need investment.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. I hesitate to interrupt the hon. Gentleman, but he has now spoken for seven minutes and we are on a six-minute time limit, so I know that he will finish soon.

[Dr Poulter]

Thank you, Madam Deputy Speaker. I am sure that Members on the Treasury Bench will take away and look at the issue I just outlined.

The Government are rightly looking for political consensus on social care and on finding a sustainable funding formula. However, as part of that, they should also consider how social care services need to look. It is no good bringing in money when the mode of delivery is wrong. I hope that, as part of the consensual approach, there will be a renewed focus on delivering care in the community in an integrated way, thus joining up the health and social care systems. I hope that that will be part of the important review and the approach to political consensus that the Government are trying to deliver.

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. The reason why we do not have a formal time limit is to try to help people who are making maiden speeches. It is difficult to make your maiden speech against the clock. It should not be difficult for people who have spoken in the Chamber many times to speak for six minutes, so when we get to six minutes, I will call “Order.” I call Julie Elliott.

[Julie Elliott (Sunderland Central) (Lab)]

Thank you, Madam Deputy Speaker, and I will take that amount of time.

I want to speak today on eating disorders, an issue that is important to me and many of my constituents and friends who have approached me about the subject. Awareness of mental health issues has been on the rise, with recent examples such as the Football Association’s Heads Up campaign encouraging people to take a minute out of their lives to think about their mental health. The ongoing work of organisations such as Mind and Beat has meant good progress on combating the stigma of mental health issues and informing the public about the importance of taking care of mental health.

There is undoubtedly still a lot of work to do on eating disorders. It is such an incredibly important and pressing issue, and at the same time so preventable with proper support, funding and attention, that I am disappointed that it was not named in the Gracious Speech as a subject on its own. The only mention of mental health is:

“My Ministers will continue work to reform the Mental Health Act.”

I very much hope that eating disorders will be part of the reform.

There is a major problem with the way eating disorders are dealt with in this country. From poor staffing levels to the way disorders are diagnosed and the wait to be treated, too many people who need treatment urgently do not get it. More than 1 million people in the UK suffer from an eating disorder and it is about time they got the services they deserve.

As Hope Virgo has shown in her excellent Dump The Scales campaign about the diagnosis of eating disorders, multitudes of people around the country are being turned away by their GPs as a result of their body mass index not being low enough. They are being refused treatment, not because of any psychological assessment, but because their weight is not low enough. Although National Institute for Health and Care Excellence guidelines advise against the use of single measures such as BMI to determine whether to offer treatment, that does not mean it does not happen. As much as I would like to present case study after case study of young people being turned away from treatment because they were not considered ill enough, only to go on to do more damage to their bodies in the hope of actually receiving treatment, time does not allow it. But it happens, and that has to change. It is shocking that it has happened once, but we are talking about hundreds of people being turned away from services they desperately need.

Those first connections with medical professionals are so important, not least because of the bravery shown by sufferers in seeking help and talking about their illness, but also because the earlier the treatment is administered, the more effective it can be. Identifying problems as early as possible does not just allow people to be treated quickly and more efficiently, but can mitigate the long-term effects of illness and decrease the chances of relapse. Early intervention is the key to proper treatment for those suffering from eating disorders. It might mean that the person seeking help no longer needs a hospital stay, or that they recover quicker, or that they feel stronger fighting their illness knowing they have the support behind them that they need. That is why the Government need to do a full review of treatment and care pathways for people who suffer from eating disorders and ensure that there are services that people can approach, and that they can be treated quickly and effectively.

However, there is also a big variety in quality and speed of treatment depending on where people live in the country. We need to see the end of the postcode lottery, which means that the quality and speed of care is based on where people live and what age they are, and sometimes ends in those lucky enough to be referred being sent to hospitals more than 200 miles from where they live. Only yesterday, I saw a letter to a young woman who, after an urgent referral, has been told she should expect an 18-month wait to be seen by a psychological therapist. That is truly shocking. I therefore fully agree with the calls on the Government by leading eating disorder charity Beat to hold the NHS to account for comprehensive implementation of the access and waiting time standard for children and young people in every region and community.

There is desperate need for direct investment in a fully supported NHS that does not need to divert the funds assigned to mental health to other areas to plug massive funding deficits in an attempt to continue to provide basic care.

We also need to ensure that our medical professionals understand the signs of eating disorders and the pathways available. Trainee doctors can receive as little as two hours’ training on eating disorders throughout their several years of training. We need to invest in services to get parity of esteem for mental and physical health, and there are simply not enough beds to deal with the growing demand from those suffering from eating disorders and those who need mental health treatment more generally.

We need more staff. Those who work for the NHS are stretched as it is, and we need more staff in frontline services to help ease the pressure and ensure that treatment is effective and quick. We need more and proper support in our schools. I implore the Government to act on those measures.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I am delighted to call Laura Trott to make her maiden speech.

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[Madam Deputy Speaker (Dame Eleanor Laing)]

I am pleased to call Feryal Clark to make her maiden speech.

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[Jackie Doyle-Price (Thurrock) (Con)]

It is a pleasure to follow the maiden speech of the hon. Member for Enfield North (Feryal Clark). She has just proved that what she lacks in height she makes up for in her energetic performance, and I have no doubt that she will give the Treasury Bench considerable challenge in the future. So many firsts, but I must congratulate her specifically on being the first refugee Member of Parliament. Does that not show that this country is open and liberal, and welcomes those from all parts of the world, whatever their circumstances, who want to make a contribution and do the right thing? I congratulate the hon. Lady. When I go around schools, I give the message to everyone that if they work hard and take advantage of every opportunity that comes to them, they will get on in life. I now have a new poster girl, and I look forward to hearing more contributions from her.

I was struck by the opening speeches, because it is getting a bit boring that all we hear is, “We’re spending this much money” and “Well, it’s not enough and we would spend more than you.” That will not get the best for our NHS. The truth is that whichever side of the House we sit on, we all want our NHS to be the best it can be. Every Government, of whatever colour, will always make the NHS a priority when it comes to the Budget. Let us not make this debate all about money. When we do, we let those areas in which we are not doing as well as we should off the hook. Getting the best out of the NHS is not just about money; it is about leadership and about behaviour—on the part not just of medical professionals, but of patients too. We need to make sure that we have honest discussions about outcomes, what we need to do better, what we expect from everyone and what patients can legitimately expect from the NHS.

That was very much part of the discussion during the general election. I remember knocking on doors and being asked, “But can we trust you on the NHS?” I would reply, “Conservatives are not aliens from the planet Zog who never get ill. We depend on the NHS as much as anyone else. Why would we ever engage in an act of self-harm by not doing our best for it?” We can be clear that under this Government the NHS will have the investment that the country can best afford, and we will focus on making sure that it delivers the best service possible.

The biggest challenge facing the NHS is not money. The workforce remains a considerable challenge. While we carry on talking about imports and the need for more doctors and nurses, we will continue to feed perverse behaviours and make the labour market in the NHS dysfunctional. Medical staff know that they can earn more as locums, so we have a massive vacancy rate and sky-rocketing salary bills, because of the choices people make. We need to do more to address that issue.

Much healthcare can be delivered by those who are not medical professionals. We need to look at where the NHS can commission services from the voluntary sector and how that could work. It is not just about doctors and nurses: it is about a more holistic approach to wellbeing. I would really welcome it if we could move the political debate away from pounds towards patients.

My right hon. Friend the Member for South West Surrey (Jeremy Hunt) spoke passionately about patient safety. Again, we need to focus on outcomes, and no one did more than he did to meet that challenge. When he became Secretary of State for Health, my constituency had a failing hospital, but thanks to the measures that he put in to improve performance, we now have a hospital that provides the service that we deserve. We should not be shy about challenging poor performance. The excellent doctors, nurses and others delivering medical services know when things are failing and would welcome the challenge to the leadership of their institutions to make them better.

We need to do more to help more vulnerable patients. The public services do very well for the pointy-elbowed middle classes who are able to fight for what they want, but the test of a society is how we treat the most vulnerable. In that regard, I welcome the commitment to reform the Mental Health Act 1983. That Act was a product of an era in which people with mental ill-health were an inconvenience to be managed. I am pleased to say that we have moved on very far from that, and we will introduce reforms that will empower patients to look after their own recovery. We should be grateful to people who have been through detention and shared their distressing experiences to make things better.

I can see that you are rightly looking at the clock, Madam Deputy Speaker, but I want to mention one final challenge in an area where, as a Minister, I was disappointed not to be able to do more—the issue of people with autism and learning disabilities being detained in institutions that, frankly, are doing them harm. I was horrified to see a report on “Sky News” only this week that showed that we have lost 10 people in the past year in those institutions. That is a mark of failure of the state: families entrusted their loved ones to that care and then lost them. I hope very much that we will redouble our efforts to make sure that we are not putting people into inappropriate care settings and are giving them the tools to be able to live outside those institutions.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I am delighted to call Florence Eshalomi to make her maiden speech.

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[Marion Fellows (Motherwell and Wishaw) (SNP)]

It will come as no surprise to you, Madam Deputy Speaker, that I intend to dwell on health and social care issues as they relate to my constituents in my own country of Scotland.

Before I do so, however, I should like to remind the House that just because edicts and statements are issued from the Government Benches, it does not mean that they are factually correct. Indeed, I must say that the pejorative language used by Conservative Members, including those representing Scottish seats, when discussing Scotland and its SNP Government, is unjust, mostly fallacious and paints a picture of healthcare in Scotland that neither I, my family nor my constituents recognise. In Scotland, the SNP Government are carrying on with the day job and have abolished prescription charges, which helps many folk in Scotland. To know that they can have the medication they need without worry is a fine thing, and it can save precious NHS resources further down the line.

Satisfaction with the NHS in Scotland remains high. In 2018, 95% of patients rated their overall experience of cancer care positively. [Interruption.] The hon. Member on the Government Front Bench may shake his head, but I can vouch for that, as my husband had cancer treatment in Scotland. Some 86% of patients rated their full in-patient experience positively, and 83% rated the overall care provided by their GP surgery as good or excellent. Scotland’s patient safety record is among the best in the world. Over the past five years there has been a decreasing year-on-year trend in the rate of MRSA and C. diff infection.

Scotland led the UK by introducing a mental health waiting times target. In the Scottish Government’s 2019-20 programme, the budget for mental health increased by £15.3 million, up by nearly 22%. This is the first Government in Scotland to have a ministerial post dedicated to mental health. The SNP is always looking to improve services for all Scots, which is why the Government are undertaking a review of mental health legislation in Scotland. The review aims to improve the rights and protections of persons who may be subject to existing legislation, and to remove barriers to those caring for their health and welfare.

This Tory Government aim to emulate Scotland by abolishing parking charges at hospitals. Since 2008, when the SNP Government abolished charges in NHS car parks, patients, visitors and staff have saved over £39 million.

The Nuffield Trust, an independent health think-tank, has said that although the 3.2% increase in NHS England’s budget is welcome, it must not detract from the reality that the English health service cannot adequately function or improve without significant investment in NHS capital and the workforce. Perhaps NHS England, through adequate Government funding, could emulate NHS Scotland and offer the same bursary to student nurses as we do in Scotland, where from next September nursing students will benefit from a £10,000 bursary, which is double the proposal for nurses training in England.

Of course, nursing students receive free tuition in Scotland. The benefits of this policy are easy to see, with nursing student numbers in Scotland increasing for seven years in a row. Compare that with a 30% drop in applications in England. How difficult will it be for this Government to achieve their promise of 50,000 extra nurses, or is it actually 19,000 fewer nurses? I am not sure; I am a bit confused about that figure. Perhaps I am not the only one.

On the question of social care, in 2011 the Scottish Government became the first in the UK to pay the real living wage to staff, including all NHS workers. In 2002, free personal care for the elderly was introduced by the Labour-Lib Dem Executive, and I give them credit for that, but that was against the wishes of the Westminster parties, which used it to cut social security funding for older people in Scotland—as ever, Westminster never misses an opportunity to cut Scotland’s budget. [Interruption.] Now the SNP, in government, has extended free personal care to all those under 65 who need it, and from the next Parliament the Scottish Government will work to abolish social care charges. [Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. The hon. Lady must be heard. There are indeed a lot of Members here this afternoon, but we will have no noise.

[Marion Fellows]

Thank you, Madam Deputy Speaker.

The Westminster Government would do well to look at and emulate many of the forward-looking, fair, equitable and progressive policies that originate in Scotland. One example is that, through the Social Care (Self-directed Support) (Scotland) Act 2013, everyone who uses social care services can now control their individual care budget.

The Prime Minister promised to

“fix the crisis in social care once and for all … with a clear plan we have prepared”.

The UK Government have failed to propose a Bill, a clear timetable or costings in their manifesto to address the social care crisis in England. The Tories have been in government for a decade and overseen the social care crisis. According to Age UK, there has been a £160 million cut in public spending on older people’s care in the last five years, despite rapidly rising demand. About 1.2 million people over the age of 65 did not receive the care support that they needed, and cuts have increased the pressure on unpaid carers.

I encourage the Secretary of State to look to and adopt the innovative measures that the Scottish Government have introduced in Scotland, to benefit those who live in England and use its NHS and social care provision.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I am delighted to call Dehenna Davison to make her maiden speech.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. It gives me great pleasure to call Dean Russell to make his maiden speech.

[Dean Russell (Watford) (Con)]

Thank you, Madam Deputy Speaker. It is wonderful to see you in the Chair. I am incredibly humbled to be here. As a working-class lad, to be sitting on these Benches is an enormous honour, but to be sitting among so many other working-class Conservatives is just as fabulous. I must thank the people of Watford for putting me in this wonderful place and for giving me the honour and the opportunity to hopefully make a change in this country.

First, however, I want to pay tribute to my predecessor. Everyone who knows him will know that he works tirelessly and is a true gentleman: Mr Richard Harrington. When I first became a candidate, people would say to me, “Dean, you’ve got big shoes to fill.” At first I thought it was a dig at my height, but I soon found it was because of Richard’s amazing legacy and the work he has done for the people of Watford. Today’s debate focuses on health, and there are so many things I could talk about—from his jobs fairs to the work he has done on social housing and tenancies—but I will specifically pay tribute to his work to ensure that Watford General Hospital and the local NHS got additional funding. I am proud that Watford will get one of the six new hospitals in the coming months and years, as was alluded to in a previous speech. Richard was a true champion for Watford, and I hope I can fill his shoes in the coming years. I will work tirelessly to do so, although my height may not change.

As you know, Madam Deputy Speaker, Watford General is on Vicarage Road, right next to the legendary, most fabulous Watford football club, which famously once had Elton John as its chairman. I would like to steal one of his song titles and say that I would like to be the first rocket man of Watford as we soar to the stars.

Sadly, to be totally honest, Elton John was not actually born in Watford—I cannot do anything about that—but we do have an incredible wealth of world-famous Watfordians. We have our very own Spice Girl in Geri Halliwell. [Hon. Members: “Hear, hear!”] You have to give a whoop for that. We have our own boxing heavyweight champion of the world in Anthony Joshua. We have our own political heavyweight, too, in the dearly departed Mo Mowlam. And we have the England football manager with the best waistcoats in the world, Mr Gareth Southgate.

As a science fiction fan myself, it is particularly exciting that we have our very own member of Doctor Who’s time-travelling Tardis team in Mr Bradley Walsh. Many Members will know that Bradley Walsh hosts a famous game show called “The Chase”, in which he battles with “The Beast” Mark Labbett. As a Conservative, I feel that in this election we battled our own “Chase” and our own beast—the beast of socialism—and we won. We defeated that beast.

One of the most world-famous parts of Watford is a magical place, and it was mentioned earlier in a brilliant maiden speech: Warner Brothers studio and the Harry Potter tour. Given his love of buses, I would like to invite the Prime Minister to visit the studio, because we have neither a boring single-decker bus nor a boring double-decker bus; we have the world-famous Harry Potter triple-decker “Knight Bus.” Who can beat that?

Watford is not just a hub for entertainment. We are also a massive magnet for investment and business. We have several UK headquarters. We have Hilton hotels, so people have somewhere to sleep. We have TJX, the home of TK Maxx—looking around the Chamber, I am sure everyone has recently bought their clothes from there. We have a place to drink in JD Wetherspoon, and we have a place to win millions and to help millions more in Camelot and the lottery. We also have our very own pharmacy, a fabulous business called Sigma Pharma. Of course, every Member will want to visit our incredible market, our high street and the Intu centre for a most delectable day out.

Madam Speaker—sorry, Madam Deputy Speaker; I promoted you—at heart I am really just a family man, and it is my family who inspire me. My working-class roots may have defined who I am, but my family are the ones who drive me forward. I give credit to my parents and my sister for all the work they have done over the years and for the support they have given me. I am sure it is the same for many Members. Our families make such a difference to our lives and keep us grounded. In that sense, my wife and my daughter truly are my beating heart and soul.

However, not everyone in society has a family or even friends to support them, and, through no fault of their own, they may feel that they are on their own. That is where community comes into play. Let us all be role models to support people who feel as though they have no one. That is the role of a Member of Parliament: not just to make laws, but to help those around us. We must let everyone know that opportunity has no gender. Opportunity should have no race and it should have no age. Whoever someone is, wherever they are, they should be able to be the best version of themselves. I believe that my party is helping to represent that.

Community is very important to me, which is why I worry about modern times. Mental health has been a big issue today, but so, too, is loneliness. We used to talk about being lonely in a crowd, but today there are so many who are lonely in the cloud. The digital world, modern life and social media mean that probably more people are aware of the names of the Kardashian family than they are of those of the neighbours on their own street.

For many years, I have felt that we need to bring the world back together, to be less divisive and to try to tie those threads together. I have had a daily philosophy for many years, and it goes like this: HOPE is an acronym and it stands for Help One Person Everyday. If we all do that in our own lives, in a way that changes people’s lives, we will have a better world. I feel honoured to be in this place as a Conservative, to enable that on a much bigger scale. We may be able to effect laws and change legislation, but changing people’s lives is surely why we are here.

In the past few years, we have seen lots of divisiveness, but let us have an age of decisiveness. Let’s not just get Brexit done—let’s get stuff done, to make people’s lives better. I believe that our manifesto and the Queen’s Speech have shown that that is our goal. As we enter 2020, let us lead the world in relentless positivity, optimism and can-do-ism, and turn this into the soaring 20s. As I complete my speech—I may be going over time; I apologise—I just want to thank people for electing me to be on this Bench and tell them that I will work tirelessly for the people of Watford, and with all Members here, to make the world a better place.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I thank everyone who is speaking today but not making a maiden speech for their kindness towards the maiden speech makers, who are being given a lot more leeway. That means that we will now have to impose a time limit of four minutes on people who are not making maiden speeches and still one of six minutes or so for maiden speeches. There is no point in people looking shocked; there are only so many hours in a day and that is where we are.