Hospital Parking Charges (Exemption for Carers) Bill

Baroness Laing of Elderslie Excerpts

Friday 30th October 2015 Commons Chamber

[Mr Nuttall]

The Bill is silent on that point. It might well be that, in the mind of the hon. Member for Burnley, some mechanism would be put in place to reimburse the trusts, depending on the number of carers registered with them. Or perhaps she would simply say to them, “Sorry, if you’ve got a lot of carers in your area, you’ll just have to suffer the consequences.” It is not clear what would happen.

I want to turn to a drafting matter that has not been touched on. Clause 1 is entitled “Duty to exempt qualifying carers from hospital car parking charges”, and subsection (1)

states:

“Health Care providing bodies shall make arrangements to exempt qualifying carers engaged in any of the qualifying activities listed in section 2(2) from charges for parking their cars”.

The question that arises is how wide the scope of healthcare facilities actually is. Clause 1(2)(b) states that the duty in that previous subsection is the responsibility of “any private hospital”. I personally believe it would be a step too far if we were to legislate on what private companies were allowed to charge for and to whom they should give exemptions.

Clause 1 provides for “arrangements” to be made for “qualifying carers”, while clause 4 provides for a “scheme” for “eligible carers”. Why does there have to be a difference? Why does one set of carers get arrangements while another get a scheme? It appears that schemes are more complicated than arrangements. Clause 1(4) requires the arrangements for qualifying carers to be in place within 12 months, whereas in the case of eligible carers, 12 months are allowed for a scheme to be submitted to the Secretary of State, and it does not have to be implemented until a year and a half after the Bill becomes law. If the matter is so urgent, why will it take a year and a half for carers to become entitled to the exemption?

It is a pleasure to welcome you to the Chair, Madam Deputy Speaker. I think there has been an error in the printed version of the Bill. In the printed copy that I have, clause 4(1) states:

“Health Care providing bodies shall establish schemes to exempt eligible carers engaged in any of the qualifying activities listed in section 2(1)(b) from hospital car park charges and submit such schemes to the Secretary of State within 12 months of this Act coming into force.”

However, clause 2(1)(b) states:

“A qualifying carer under section 1(1) is a person who…has an underlying entitlement to the Carer’s Allowance.”

The provision in clause 4(1) has been amended online to refer to section 2(2), which is the correct subsection. Section 2(2) is indeed the subsection that sets out what a qualifying activity is. It states:

“A qualifying activity under section 1(1) is transporting, visiting or otherwise accompanying or facilitating”—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. As the hon. Gentleman has drawn my attention to a matter concerning the activities of the House—namely, the printing of the Bill—I will for the sake of clarity make it clear that the Bill that I have, and that I assume other people have, clearly refers to section 2(2) and not section 2(1). I am happy to clarify that point as the hon. Gentleman made his point directly to me.

[Mr Nuttall]

rose—

--- Later in debate ---

[Mr Nuttall]

Madam Deputy Speaker, I think we have a solution. It does not say that on my copy. I must have a first edition, and it might be more valuable! It is priced at £3, but now we have discovered that it is a rare first edition, it might be worth a lot more. I am willing to raffle it and donate the proceeds to Carers UK. I am glad that the matter has been corrected, Madam Deputy Speaker, and I am sorry if I inadvertently addressed my comments to you personally. I was not trying to suggest that you had had any involvement in the preparation of the Bill.

[Madam Deputy Speaker]

For clarification, the hon. Gentleman has done nothing wrong. The printing of material such as this is a matter for the House and a matter for the Chair.

[Mr Nuttall]

I shall bring my comments to a conclusion. Given the real likelihood that the effect of the Bill will be to reduce the income from car parking, it must be a possibility that the legislation would increase the cost of the NHS to the public purse. In the first year of the abolition of parking charges in Scotland, the sum of £1.4 million was given to Scottish health boards by the Scottish Government, so I wonder whether the Bill might require a money resolution in due course, as my hon. Friend the Member for Shipley has suggested.

It is a worthy aim to try to help carers with their hospital car parking charges. In reality, however, there are a number of problems. Fundamentally, we are faced with this question: what should £200 million be spent on—healthcare or free parking? The answer might be to say that we will exempt only one group, but if we exempt carers, should we not exempt staff, for example, or armed forces personnel? The list soon expands. However well-intentioned the Bill is, we have to look at the problem in the round. No one likes paying parking charges, but the fact is that, alongside general taxation, income from car parking ultimately supports front-line services.

I commend the hon. Member for Burnley for her work on the Bill but, for the reasons I have outlined, I cannot support it today.

--- Later in debate ---

[Julian Knight (Solihull) (Con)]

I also congratulate the hon. Member for Burnley (Julie Cooper) on securing the debate and drawing up the Bill. It seems many hours since you spoke, but I remember that you spoke powerfully and are clearly a strong advocate for carers and for your local NHS. I also think that Government Members will be grateful for the fact that you also paid tribute to the actions of—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I always let Members get away with this mistake once, and sometimes twice, but the hon. Gentleman has used the word “you” three times. “You” refers to the Chair, and the hon. Lady is the hon. Lady. I am having to say this every day and it is a long time since the general election, so people really ought to be able to take it on board by now. The hon. Gentleman is not the only person making this mistake, so he should not feel bad about it.

[Julian Knight]

Thank you, Madam Deputy Speaker. I will now address only the Chair using that particular word.

I congratulate the hon. Member for Burnley, but unfortunately I cannot support the Bill. However, like my hon. Friend the Member for Shipley (Philip Davies) and many other Members who have spoken, I support the fairer hospital parking that she is trying to achieve. I want to share my experience in Solihull as a campaigner for fairer hospital parking, as it has direct relevance to how we approach the issue as a country and to the Bill.

Many hon. Members have mentioned their hospitals and the experience they had when parking charges were introduced. For my constituents in Solihull, parking charges were introduced not only to bring extra revenue into the NHS and front-line services but to ensure that hospital car parks were free for the use for which they are intended. We have had many difficulties in Solihull because the hospital is located near the town centre and, as that is a popular area, people have used the car park all day while they have been shopping. Many people who needed to use the facility at the hospital were therefore unable to do so and might have parked illegally, receiving fines at a later date. Hospital parking charges, although very unpleasant, are in many cases necessary, particularly at sites close to town centres. As we live in a very densely populated country, there are not many hospitals that are so far from town centres that it would be an easy win not to have any charges whatsoever. The car parks might still be misused in the way that I have explained.

Over time, hospital parking charges have grown exponentially. At the moment, in the three hospitals that make up the Heart of England NHS Foundation Trust—Solihull, Good Hope and the Heartlands—charges can be up to £5.75, but for just one hour they can be £2.75. Again, people have to guess how long they will stay, which is unfortunate. I have looked at the contracts that our local hospitals have signed and in my view there is an excessive charge on the provider from the private companies involved. I am not happy with many aspects of these contracts.

Junior Doctors’ Contracts

Baroness Laing of Elderslie Excerpts

Wednesday 28th October 2015 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

It is obvious that there are too many people who wish to speak and not enough time left. We have only 40 minutes of Back-Bench time remaining. There is no point in people looking disappointed; there are only 24 hours in a day and this is how it is. We can debate all sorts of things but there is only so much time. I have to reduce the time limit to three minutes, and I trust that colleagues will be decent and considerate to each other and not take too many interventions. If they do take interventions, could they not take the extra minute that is added on? I call Norman Lamb.

Mental Health (Armed Forces Veterans)

Baroness Laing of Elderslie Excerpts

Wednesday 14th October 2015 Commons Chamber

[Dr Cameron]

I do indeed support awareness month, and I very much like the hon. Gentleman’s wee badge.

To conclude, veterans are individuals who would have put their lives on the line for their country. The least we can do is prioritise their care and treatment to support them in their recovery. I welcome the Prime Minister’s comments today regarding prioritisation of this issue, and I welcome the Minister’s reply.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I call the Minister, Alistair Burt.

[The Minister for Community and Social Care (Alistair Burt)]

I think, Madam Deputy Speaker, there is another colleague who is going to intervene.

[Johnny Mercer (Plymouth, Moor View) (Con)]

Madam Deputy Speaker, I was going to share the time with the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron).

[Madam Deputy Speaker]

In order to do so, the hon. Gentleman must have the permission of the person whose debate it is, the Minister and the occupant of the Chair. He clearly has the agreement of the Minister and of Dr Cameron. He has my agreement, too.

[Johnny Mercer]

Thank you, Madam Deputy Speaker. I apologise—I spoke to Mr Speaker before you took the Chair.

I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow for giving me a few minutes of her allocated time, and offer my sincere thanks to her for bringing what the Prime Minister rightly described today as “this very important issue” before the House. He correctly identified the strategic defence and security review as an opportunity to get our approach right in the future, and I fully support him in that intention.

The subject before us this evening refers to that great stain on this nation of ours, which I mentioned when I first spoke in this House. I regret to say that, aside from some excellent individual practice and charitable work, the way we look after our veterans’ mental health in this country remains poor. Many of our young men and women, who by good training and fortune walked away from battle without any physical scars, have been stricken in later years by an underlying sickness that can tear at the very core of the strongest and most enduring individual. I speak as a Conservative Member of Parliament. I work hard to support all the efforts of Government to produce and implement the exciting and progressive agenda so clearly laid out by the Prime Minister a week ago, but on this issue, while it remains in its current state, I am afraid I will not be silenced.

I have no personal agenda to drive here. I have never had the misfortune to need to use one of our tremendous military charities. I will forever be the soldiers’ voice in this debate, crafted from much time spent on operations with our young men and women, and now in my privileged position as a Member of this House and attracting a great deal of correspondence on this issue it is incumbent upon me to speak out and I will do so. I feel embarrassed at my fellow man sometimes as we stand here again tonight in 2015 in the seat of the world’s most advanced democracy and talk yet again about the stigma of mental health.

The stigma results from a basic lack of education and understanding about a human condition that affects one in four of us—a condition as medically valid as a broken leg or a fractured arm, but because it occurs in our heads, its treatment has historically been subjected to unacceptable social, political and financial disadvantage. That stigma ends in this Parliament, and I will not rest until it has.

A&E Services

Baroness Laing of Elderslie Excerpts

Wednesday 24th June 2015 Commons Chamber

[James Cleverly]

I am not taking interventions.

The fact that the ability to discharge patients back into the community is dependent on the ability to care for them while they are in the community means that adult social care must be considered an essential and integral part of the A&E mix. If general wards are not able to discharge into the community, they are not able to make bed spaces available and, in turn, A&E departments are not able to transfer to other wards within the hospital.

I therefore pay tribute to the excellent work done on the Manchester model, putting together NHS provision and adult social care, so that the obvious inter-relationship between the two could be looked at holistically. I am happy that some Opposition Members—perhaps only some of them—welcomed the introduction of the Manchester model. Again, if we could work in a cross-party, collegiate way to learn the lessons from that integrated service model in Manchester and roll it out nationally, I think we would be in a much better place for looking at and subsequently dealing with the problem of A&E waiting times.

It has been alleged—I am sure Opposition Members will all leap to their feet to deny it—that Labour Members were keen during the last general election to weaponise the NHS. [Interruption.] Those were not my words. This is too important an issue to turn into a party political football. I will make this commitment—[Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order.

[James Cleverly]

I am obliged, Madam Deputy Speaker.

Let me make this commitment: if I perceive that my own Front Benchers are trying to turn the issue into a political football, I will be as critical of them as I am of Opposition Members.

Money is a very important part of the NHS mix, and I welcome the fact that my party has committed itself to funding the NHS to the levels recommended by experts in the field, but money alone is not enough. More money has been given to GPs’ surgeries, but the St Lawrence medical practice in my constituency is still struggling, which is forcing a number of people to use local A&E services.

This is an important issue; let us discuss it with decorum. I commend the Government’s actions.

--- Later in debate ---

[Richard Arkless (Dumfries and Galloway) (SNP)]

It is indeed a huge honour, Madam Deputy Speaker, to be called by you today to make my maiden speech in this very important debate on A&E services in the NHS. As an introduction, I can report with a small measure of glee that the NHS in Dumfries and Galloway has treated 96.8% of all A&E out-patients within the Scottish Government’s target of four hours. The NHS remains safe in public hands north of the border.

As is customary, I wish to pay tribute to my predecessor, Mr Russell Brown, who was elected to this House in 1997 on a tidal wave of Blairite euphoria, ousting the seemingly immoveable Sir Hector Monro. My election to this House has absolutely nothing to do with Russell Brown as a person or as a constituency MP. He was merely a victim of the political reawakening that has occurred all over Scotland, and the resultant Scottish National party tsunami, and he was let down badly by his party. My message to Russell is simple: thank you, Russell, for your tireless dedication to the people of Dumfries and Galloway.

The Labour party has left the people of Dumfries and Galloway and of Scotland; it is not the other way round. My message to those on the Labour Benches is simple: can they please get their act together? We had an opportunity to defeat this Tory Government last week to create a referendum fairness board, and they blew it. They would rather sit on their hands or vote with the Tories than support an SNP proposal. They should ditch the tribal opposition and work with us so that we can put this wafer-thin majority to its full test.

This SNP group is determined to dismantle the myths that surround our brand of nationalism. Perhaps I am in the best position to dispel those particular myths, because I am not from a traditional SNP nationalist household. Independence is not an argument that I used to subscribe to; I actually voted no to devolution in 1997, and I only joined the SNP four days after the independence referendum. My conversion has been protracted, evidence-based and not led by blind patriotism. As a dual qualified lawyer and businessman, I was invited to speak at a town hall debate, a mere 15 months ago, during the referendum, alongside my hon. Friend the Member for Ochil and South Perthshire (Ms Ahmed-Sheikh). I kept getting invited back—almost 50 times in fact. Here I am, 15 months later, in this world famous Chamber representing the people of my home region. What a privilege it is. A special mention goes to my wonderful wife, Anne, whose dedication to our two young children allows me to take up the privilege in this House.

Dumfries and Galloway, or the Scottish Riviera as I prefer to call it, is a constituency of serene beauty, abundant wildlife, vast forestry, rolling hills and a coastline that stretches almost 200 miles. It runs from my home town of Stranraer in the west to Wigtown, Newton Stewart and Whithorn in the Machars, to Gatehouse of Fleet, Kirkcudbright, Castle Douglas in the Stewartry, all the way across to Dalbeattie and Dumfries in the east. There is something for everyone. It is a place that I love dearly, and we are indeed a resilient bunch. It is, and should be even more, a tourist mecca. There are so many festivals and community initiatives—simply too many to mention in total. Members should visit the book town of Wigtown, the artists’ town of Kirkcudbright, and the Wickerman festival. They should watch out for the UK’s finest oyster festival in Stranraer, coming soon. We are a region of entrepreneurs, innovators and inventors. We invented the pedal bicycle and discovered electro-magnetism, and we gave Christianity to Scotland in the fifth century through St Ninian of Whithorn.

In my view, Dumfries and Galloway is dynamic and growing, with more small businesses employing fewer than 10 people per head of population than any other constituency in Scotland—a remarkable statistic, given the rural economic disadvantages that we suffer. Small businesses are our largest employers, the lifeblood of our community and the lifeblood of our economy, but they need serious help to fulfil their potential. Throughout my constituency, 3G networks are very rare and 4G virtually non-existent; fibre-optic cables do not reach the outlying areas. That is simply not good enough. Would it not be fantastic if 5G was rolled out with 100% geographical coverage in the rural areas of the UK that need the help the most—places like Dumfries and Galloway? That is the real way we can rebalance our economy and it is something I pledge to fight extremely hard for in the coming years.

No maiden speech by an MP for Dumfries and Galloway would be complete without reference to our national treasure, Robert Burns. Although he was born in Ayrshire, we in Dumfries and Galloway claim Scotland’s national bard as our very own. Burns wrote of the River Nith, which runs through the heart of Dumfries,

“The banks of the Nith are as sweet poetic ground as any I ever saw”.

It is hard to disagree. Dumfries was inspirational to Burns, who was at his most productive when living there, composing classics such as “Auld Lang Syne” and the masterpiece “Tam o’ Shanter”. However, poverty and hunger were ever present in Robert Burns’ life. We have food banks in Dumfries and Galloway, frequented not only by the poor and the disadvantaged, but by victims of draconian benefits sanctions and, more important, the working poor—people who work full time but still find themselves living in poverty. In 2015 in my constituency, children are going to school hungry. Austerity policies are literally starving our children not just of a happy childhood, but of a successful future. Burns’ gratitude for good nourishment was clear when he wrote:

“Some hae meat and canna eat,

And some wad eat that want it,

But we hae meat and we can eat,

Sae let the Lord be thankit.”

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I call Andrea Jenkyns. The time limit is now four minutes.

Social Care and Military Compensation

Baroness Laing of Elderslie Excerpts

Wednesday 25th March 2015 Commons Chamber

[Jane Ellison]

I will come to that, and will try to give the hon. Gentleman a bit of reassurance about the advanced and ongoing work that is taking place.

Social care is a priority for the Government, and, in the context of difficult spending decisions, we have taken steps to protect care and support services. For example, we have allocated extra funds for those services during the current Parliament. We have created a better care fund, which, next month, will introduce a £5.3 billion pooled budget for health and care that will provide much needed funding for care and support, and will break new ground in driving closer integration of services.

Although spending on care and support is ultimately a decision for local government, we must be mindful of the overall fiscal position. I think that Members on both sides of the House agree on that. We must ensure that if we change the charging rules nationally, the cost will be met. To that end, my officials are continuing to work with their counterparts at the Ministry of Defence—I hope that that gives the hon. Gentleman some sense of momentum, and deals with his concern about “silo” working—and with the Royal British Legion, with a view to considering the issue during the spending review that will take place after the election.

I hope that the hon. Gentleman—and, indeed, all hon. Members—will welcome the historic reforms that will come into force in just one week’s time. They are very significant in the context of the broader issue of care. This Government have been the first to prioritise care and support. I hope that Members in all parts of the House will feel able to welcome the clear plans that I have set out for the future. As for the specific issue that the hon. Gentleman has raised, I hope he recognises that this is ongoing work which is taken very seriously. His securing of what has turned out to be the last Adjournment debate of this Parliament has underlined the importance of the issue that he has raised. I think that, throughout the purdah period and beyond, the debate will give added momentum to the work that is being done.

Given that this has been the last Adjournment debate of the current Parliament, Madam Deputy Speaker—and you and I have shared a number Adjournment debates—let me take this opportunity to thank you and, through you, Mr Speaker and the other Deputy Speakers. I also thank all the staff of the House, and, in particular, those who have sat through some of our late-night health debates, of which there have been many. However, I especially thank the Chair, and all those who have supported the Chair during these important Adjournment debates, which give us a chance—as tonight’s debate has—to explore important issues in some detail, outside the heated atmosphere that the Chamber attracts on other occasions. I also thank Members in all parts of the House, some of whom are very regular attenders at these debates, for their attendance tonight, and for the interest that they have taken in these important matters.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I thank the hon. Lady for the gracious way she has thanked Officers of the House in respect of Adjournment debates. These debates are extremely important and she has taken part in many of them, as have I and the other Deputy Speakers and Mr Speaker, and we all appreciate how important they are. I also thank the hon. Member for Blackpool South (Mr Marsden) for introducing the final Adjournment debate of this Parliament.

Question put and agreed to.

Mental Health and Well-being of Londoners

Baroness Laing of Elderslie Excerpts

Thursday 12th February 2015 Commons Chamber

[Ms Abbott]

I very much agree with my hon. Friend. As he says, there are cost of living issues. Then there are spiralling housing costs. Health care in London has some of the biggest turnover and some of the highest vacancy levels of any health care provision in the country. The pressures of the cost of living crisis and the housing crisis are making it increasingly difficult to provide permanent staff to meet the health care needs in general and the mental health needs of Londoners.

I shall focus in my speech on the cost to London of the mental health crisis and the importance of parity of esteem between mental and physical health, about which Members on both sides of the House have spoken. It is important to stress it, because we are nowhere near parity of esteem when it comes to the questions of finance and resources. I also want to talk about the mental health and well-being of London’s lesbian, gay, bisexual and transgender community, and about the growing crisis of mental illness among our children, adolescents and young adults. I shall also deal with something not often spoken about—mental health issues in our black and minority ethnic communities in London.

It is important, because mental health is sometimes a marginalised issue, to talk about the huge cost of the mental health challenges to London. Recent figures indicate that almost a million adults of working age in London—15.8% of the adult population—are affected by common mental disorders such as anxiety and depression. I was in the House about 18 months ago when Members of all parties bravely talked about their own experience of depression and how they felt a stigma and found it very difficult to get treatment.

It is estimated that 7% of London’s population have an eating disorder, that one in 20 adults has a personality disorder; that 1% of Londoners are registered with their GP as having a psychotic disorder such as schizophrenia, bipolar and other psychoses; and that nearly half of Londoners are anxious. London has the UK’s highest proportion of people with high levels of anxiety. In addition, almost a third of Londoners report low levels of happiness, which must clearly be exacerbated by the cost of living issues we have mentioned. The number of Londoners reporting low levels of happiness is well over 2.5 million. We London MPs see many of them in our surgeries week after week.

In basic economic terms, almost £7.5 billion is spent each year addressing mental health issues in London, while according to the Greater London Authority, the wider health, social and economic impact of mental illness costs the capital an estimated £26 billion. In social care costs alone, London boroughs spend around £550 million a year treating mental disorder, and another £960 million each year on benefits to support people with mental ill health. There are some concerns about the changes in welfare and the—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I fully appreciate that the hon. Lady is a parliamentarian of great experience, and I am not making this point for the sake of it, but she is not addressing the Chair. She is speaking to somebody over there on the Government Benches, but while somebody over there might be able to hear what she is saying, the Chair cannot. I am sure she is speaking of matters of great interest. It would be appreciated by the rest of the Chamber if she addressed the whole Chamber.

[Ms Abbott]

I am grateful to you, Madam Deputy Speaker. As ever, you are punctilious about matters of order.

London boroughs spend about £550 million a year on just the social care costs of treating mental disorders. Another £960 million is spent each year on benefits to support people with mental ill health. Across the population, the net effect of those wider impacts substantially affects London’s economy, infrastructure and population. Mental health is not simply an issue for health and social care; it is an issue for everyone. Mental health conditions debilitate London businesses each year by limiting employee productivity and reducing the potential work force. Every year £920 million is lost owing to sickness absences, and a further £1.9 billion is lost in reduced productivity. Moreover, the costs extend more widely: the staggering sum of £10.4 billion is lost each year to London business and industry as a result of mental health issues.

The London criminal justice system spends approximately £220 million a year on services related to mental ill health, and other losses such as property damage, loss of stolen goods and the lost output of victims cost London a further £870 million. Those costs are already too high, but treatment costs are expected to grow over the next two decades. Mental health issues also prevent physical health conditions from being addressed properly. However, mental ill health remains one of the least understood of all health problems. The problem is exacerbated by the existence of an obstinate and persistent stigma that prevents people from talking about mental health or paying attention to the debate about it, and therefore prevents us as a society from addressing it properly.

I want to say a little about the issue of parity of esteem between mental and physical health. The continuing lack of parity of esteem, in terms of both funding and attitudes, underlies some of the mental health problems not just in London, but throughout the country. As the daughter of a mental health nurse, I am very clear about the fact that there is no parity of esteem between mental and physical health. My mother came here as a pupil nurse in the 1960s, and was part of the generation of West Indian women who helped to build our NHS. She took time off work to bring up a family, but she returned to nursing in the 1980s, and her subsequent career in mental health exemplified the issues involved in the lack of parity of esteem.

The first thing that I want to say about parity of esteem is that those who might be described as the high fliers in health do not necessarily go into mental health. That has always tended to be the case. I shall never forget something that happened in 1987, when I was a brand-new MP. The then chief nurse at City and Hackney told me that I must visit the hospitals in the area. She said that I should meet her at 10 pm, and she would take me to the three major hospitals in hospital: Bart’s, Homerton, and Hackney mental hospital. I met her, and we went around Bart’s. She did not think it in any way remarkable that in Bart’s, even at the dead of night, we did not see a single black nurse. Then we went to Homerton, where there were quite a few black nurses doing the night shift. The chief nurse said to me innocently, “You know, they”—meaning nurses of colour, I assume—“seem to prefer the night shift; our day shift is quite different.”

Then I went to Hackney mental hospital. Although this happened in 1987, I have never forgotten it. The mental hospital was, literally, an old workhouse. It was as grim as anyone could possibly imagine—and, of course, all the nurses there, day and night, were BME. I am afraid that that pointed to a lack of parity of esteem, in the context of the way in which nurses were allocated and the direction in which their careers were leading. I am not in any way detracting from the specialists in mental health, but in respect of nurses there has long been a stratification when it comes to who should work in mental as opposed to physical health.

My mother was a devoted mental health nurse who dealt with geriatric patients with dementia. When my brother and I were older and she went back to nursing, she worked in a hospital outside Huddersfield called Storthes Hall. Thankfully, it has now been closed. It was another former Victorian workhouse, and it looked exactly like a Victorian workhouse. One had only to visit that hospital, see the conditions there and then visit the new Huddersfield royal infirmary in the centre of Huddersfield to see physically demonstrated the complete inequality in services offered to people with physical illness as opposed to people with mental illness.

For a number of years, there has been more focus on mental health in all parties, which is to be welcomed, and more focus on the importance of parity of esteem. However, the financial issues are a challenge. For many years, mental health has been chronically underfunded and it has the reputation of being a Cinderella service. At national level, mental health accounts for 28% of the pressure in the NHS, yet on average clinical commissioning groups spent just 10% of their budget on mental health in 2013. Separate investigations by Community Care and the BBC showed that mental health trusts had their budgets cut by 2.3% in real terms between 2011-12 and 2013-14. The effects of some of those cuts have been felt throughout the system. There have been difficulties in accessing talking therapies. Service provision is creaking at the seams. Over 2,000 mental health beds have been closed since 2011, leading to several trusts with sky-high bed occupancy rates.

There is no question—perhaps Ministers will query this—but that austerity and issues with welfare, access to housing and unemployment have put some of London’s most deprived communities under pressure. Welfare cuts, the lack of stable tenancies and improperly enforced employment regulations must have an effect on the incidence of mental health-related illness. Therefore, on the one hand we have cuts to funding and on the other a rise in the conditions that affect people’s well-being and ultimately their mental health. That is a double-edged sword that spells disaster for the well-being of Londoners.

The specific mental health needs of LGBT Londoners are not discussed often. For a long time, London has been a city where young people come to find themselves. It is an inclusive environment where LGBT people are welcome. London boasts a dynamic gay scene and has successfully hosted World Pride. LGBT Londoners are now able to get married, to raise families and are equal before the law. We must safeguard those achievements by ensuring that they have access to appropriate health care and mental health provision.

It is time to change the stereotype that LGBT people are busy partying and having a good time. Unfortunately, it is not a wholly accurate depiction of the community. There are various estimates about the incidence of mental health problems in LGBT groups, but research I have seen says that sexual minorities are two or three times more likely to report having a long-standing psychological or emotional problem than their heterosexual counterparts; and that two out of five LGBT people will experience a mental health problem at some point in their lives, which is quite a high proportion. In 2014, Stonewall said:

“Compared to the general population, lesbian, gay and bisexual people have higher rates of mental ill health as well as alcohol and drug consumption. Lesbians are also more likely to have never had a cervical smear test, while gay and bisexual men are more likely to experience domestic violence.”

Particularly among young LGBT people, we see rising levels of self-harm. Homophobic behaviour is going unchallenged in the workplace and on London’s public transport system, and hate crimes against LGBT people remain stubbornly high. There are also issues about access to mental health services for LGBT groups.

The situation is even worse for black and minority Londoners who identify as lesbian, gay or bisexual, among whom rates of suicide and self-harm are higher than among than the population generally. Some 5% of black and minority ethnic lesbian and bisexual women have attempted to take their own life in the last year, compared with just 0.4% of men over the same period, and one in 12 have harmed themselves in the last year compared with one in 33 in the general population. What are the Government doing to improve the training of NHS staff on the specific health needs of LGBT people and black and minority ethnic LGBT people, because at present they are both challenged with higher levels of mental health issues but have difficulties accessing services?

There are particular challenges in London associated with the recent reorganisation of the NHS, moving responsibility for public health to local authorities. In principle that move makes it much easier to address the social determinants of ill health, including mental health, but the concern is that because of pressures on local authorities funding for mental health will drop and the ability to provide London-wide services for groups, such as the LGBT community, will weaken.

The House will know that my party is not proposing to put the NHS through a further reorganisation when we return to office in a few months’ time. However, it would make sense for existing structures in London to monitor outcomes for LGBT people throughout the capital, and given the complexity and size of London we cannot simply take a one-size-fits-all approach to LGBT issues.

Young people today are living in a time of unprecedented pressures, with smartphones, the internet, a world of 24-hour communication, new avenues for bullying, new fears and new concerns. The issues are plain to see in the growing demand for services for young people across London, with London hospital admissions for self-harm rising from 1,715 in 2011-12 to 2,046 in the last year. At least one in 10 children in the UK is thought to have a clinically significant mental health problem, which amounts to 111,000 young people in London. The impact of childhood psychiatric disorders costs London’s education system approximately £200 million a year, and in 2013 the Children and Young People’s Mental Health Coalition found that 28% of joint health and wellbeing strategies in London did not prioritise children and young people’s mental health.

What are the Government doing to ensure that joint strategic needs assessments look at, and include information about, the size, impact and cost of local children’s mental health needs, to ensure that sufficient services are being commissioned? Will the Minister ensure that data about BME young people and children will be comprehensively included in the new national prevalence survey of child and adolescent mental health being commissioned by the Department of Health? Concerns have been raised in this House previously about the funding of services for children and adolescents, but it is clear in London in particular that there is an unravelling crisis in relation to young people and mental health.

As I said at the outset, London’s youth, and youth nationally, live in an era of unprecedented pressure. Data obtained from a freedom of information request of top-tier local authorities in England by the mental health charity Young Minds revealed that in 2010-13 local authorities in London cut their children and adolescent mental health service budgets by 5%, at a time of increasing pressure on young people. The latest data show that Southwark cut its budget by 50%, as did Lambeth and Hounslow. Tower Hamlets cut its budget by 30%, and Haringey cut its budget by 10%. Those are some of the most deprived boroughs in London, and if they are really cutting their expenditure on young people’s mental health care to that extent, it is very serious.

[Ms Abbott]

My hon. Friend is right to say that the cuts are arbitrary, and they certainly do not account for unmet need. In my time as a Member of Parliament—my hon. Friend must have had similar experiences—I have met many mothers and other people who are unable to access the mental health care that they need, particularly talking therapies. Cutting provision at a time when we do not even know the size of unmet need is very dangerous.

I want to turn now to mental health care provision for the black and minority ethnic community. I have looked at this issue over many years, and I believe that the manner in which the mental health system fails people of colour is a tragedy that has been consigned to the shadows for too long. As well as talking about parity of esteem between mental health and physical health, we need to talk about a parity of care between all sections of the community, and at this point that is not happening. I hope to set out briefly some of the findings of the research that has been carried out over the decades on black people and mental health, but my central point is that black and minority ethnic people are not getting parity of care and service. This is a long-standing issue that goes back decades, and I call on the Government to do what they can. I shall also call on the incoming Labour Government to pay attention to this issue in a way that has not happened in the past. Governments genuinely need to understand and address these needs.

Black and minority ethnic mental health is a particular issue for London because half Britain’s black and ethnic minority community is inside the M25. Sometimes it is hard to get the data we need, but we know, for instance, that in Lambeth—less than a mile from this Chamber—more than half the people admitted to acute psychiatric wards, and more than 65% of the people in secure wards, are from the Caribbean and African communities. I know from regularly visiting Hackney’s psychiatric wards, and the Hackney forensic unit, that the proportion in Hackney is as at least as high, if not higher, than that. We have accurate statistics for Lambeth, but we only have to walk into psychiatric wards across London to see that the majority of beds in the big mental health institutions such as the Maudsley are occupied by people of colour.

I remember, as a new MP in 1988, raising the disproportionate number of black people on wards with the head of psychiatric services in City and Hackney. I asked, “Why are so many people on your wards black and minority ethnic? It’s way out of proportion even with the population of City and Hackney.” City and Hackney produced three very senior psychiatric doctors to talk to me about this. They turned to each other, paused, muttered, and one suggested that it might have something to do with “ganja psychosis”. Another then ventured the opinion that perhaps more mad people were migrating from the Caribbean. I had to say to him, “It’s hard enough to get into this country if you’re sane; it is to the highest degree unlikely that the authorities are allowing all these mad people to come into the country.” But the striking thing about that conversation was that it was not some casual conversation on a ward; the head of psychiatric services had marshalled the three most senior psychiatric doctors in City and Hackney, and the only explanation they could offer for their wards being full of black people was “ganja psychosis”. I was struck by how low the level of knowledge was and how low the level of interest was.

I also know from my years as a Member of Parliament how many black families are struggling with the consequences of the mental health system’s failure to offer the right support at the right time, and the help and services to which they are entitled. One of the saddest things I see in my work as a Member of Parliament is black mothers, single heads of household, struggling with black males in their household who clearly have chronic mental health problems. I have had women come to see me who have been assaulted by their own son. When they are told that they should go to a GP and that perhaps their son needs to be sectioned, they say,” No, no, no.” That is because there is a terrible fear in the black community of the mental health system. Some women would rather risk assault by their own son and live in fear than consign their son to the mental health system, because their understanding is that once that system gets their child, the child is pumped full of drugs and never comes out again or, if they do, they are not the same. So it is time this Government and any incoming Government give more attention to issues relating to black people and mental health.

Those issues have not altered in decades: there are disproportionate numbers of black people, particularly men, in the system; we are more likely to be labelled “schizophrenic”; we present later to the system, which makes matters worse; we are more likely to come to the mental health system through the criminal justice system, particularly by being picked up by the police on the street and finding ourselves sectioned; and we are less likely to be offered talking therapy. I remember going in the ’90s to a mental health therapy centre in west London that specialised in talking therapy and did excellent work. I noticed that there were no black and minority ethnic people there and when I asked about this I was told, “Oh, we find that black and minority ethnic people don’t benefit from talking therapy.” That is an extraordinary attitude. We need to do more to make talking therapy available across communities, including BME communities. Black people are also statistically more likely to be offered electroconvulsive therapy—in other words, they are more likely to be plugged into the mains. There is also a terrible history of deaths in mental health custody, which are often to do with the type of restraint used and a fear of a violent black male. There is a whole string of such cases, of which Sean Rigg’s is one of the most recent.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I appreciate that the hon. Lady is developing some very important points, but I should draw to her attention the fact that the allotted time for an introductory speech in a Backbench Business Committee debate is 20 minutes. I have allowed her well over half an hour, as I appreciate that not many people are making demands on the time in the House this afternoon and that she is addressing important issues. Even given all that, I trust that in the very near future she is likely to come to a conclusion.

[Ms Abbott]

I am grateful to you, Madam Deputy Speaker, as you are so precise about order. I would not want to think that the length of my speech will prevent anyone else who wishes to speak from entering into the debate.

In conclusion, let me say that the issues I am raising about mental health in London—the cost of mental health to Londoners, and the effect of the under-provision of mental health services in London, not only to the individuals and families who suffer, but to London as a whole—are vital ones. I am glad I was able to bring them to the House and I am sorry if you feel I have gone on at too great a length, Madam Deputy Speaker. The issues associated with what is happening to black people and mental health include the lack of provision, the over-representation in the system and the fear that black families have of the mental health system. So this is a huge issue, and it is one that is not debated enough in this House. I am sorry that you felt I spent too long on the issue of black people in London and mental health. What is happening to our young people and children is a new crisis, which is definitely not being debated in this House, and I am glad to be able to draw it to the attention of the House.

Absolutely in conclusion, may I say that these are vital issues for Londoners. In the end, addressing health care is about addressing all the social determinants—the welfare system, housing, employment or education. I am glad to have had the opportunity to draw the House’s attention to how serious the crisis is, particularly in relation to our young people. I wait with interest to hear what the Minister has to say.

Improving Cancer Outcomes

Baroness Laing of Elderslie Excerpts

Thursday 5th February 2015 Commons Chamber

[Bob Stewart]

I will finish for my hon. Friend. This is a very brave man, because he wants to join the Royal Air Force. He is fully fit, he does marathons—he is a lunatic of course—and he wants to join the Royal Auxiliary Air Force, whose tie I am wearing in support of his bid.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I am sure I should reprimand the hon. Gentleman for suggesting that the hon. Member for Filton and Bradley Stoke (Jack Lopresti) is a lunatic. That is not parliamentary language, although I am sure it was meant in a kindly fashion. He was, however, absolutely right to commend the hon. Member for Filton and Bradley Stoke for the very brave speech that he has just made, which the House seriously appreciates.

National Health Service

Baroness Laing of Elderslie Excerpts

Wednesday 21st January 2015 Commons Chamber

[Several hon. Members]

rose—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I am afraid that I shall have to reduce the time limit to seven minutes and that it will have to be further reduced if people take more than just over six and a half minutes.

--- Later in debate ---

[Several hon. Members]

rose—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I must reduce the time limit to five minutes if everyone who wants to speak is to have an opportunity so to do.

Standardised Packaging (Tobacco Products)

Baroness Laing of Elderslie Excerpts

Wednesday 21st January 2015 Commons Chamber

[Dame Angela Watkinson (Hornchurch and Upminster) (Con)]

I draw Members’ attention to my entry in the Register of Members’ Financial Interests. I thank the hon. Member for Glasgow North (Ann McKechin) for allowing me to make a brief contribution during her debate—doubly so, because she did not withdraw her permission when I told her that I was going to disagree with her. Similarly, I thank the Minister.

I speak as a lifelong non-smoker. That is my choice, and it is a choice open to everybody. Nobody is forced to smoke. The Government have already invested heavily in existing strategies: television adverts, which were extremely effective—particularly the one about not smoking in front of children in one’s car—street hoardings, newspapers and magazines, smoking cessation treatment free of charge in GP surgeries and pharmacies, and anti-smoking advice in schools. My own schools are very effective in giving citizenship classes warning about the health risks of smoking. There cannot be anyone in this country, young or old, who does not know about the health risks of tobacco. Nobody smokes in ignorance.

Plain packaging has the laudable purpose of deterring children from starting smoking and helping smokers who wish to quit, but there is no reliable evidence that plain packaging will influence smokers in general or children in particular. In Australia, where plain packaging was introduced in 2012, both youth smoking and sales of illicit tobacco increased in the following year. There are many complex social reasons that lead to youth smoking, but packaging is not one of those factors. Currently 3% of under-15s smoke in the United Kingdom—the lowest percentage in a generation. I have asked people who were buying cigarettes in my local newsagent whether plain packaging would influence their tobacco purchasing habits, and they find the idea laughable.

Standardised packaging would be bad for exports, bad for retailers, particularly small shops, bad for jobs in warehousing, distribution, marketing, design and packaging, and bad for the Treasury, but very good for criminals, making the illicit trade much easier. What would follow—bottles of wine with plain labels, or bars of chocolate in plain packages as we are controlled and someone else makes our decisions for us?

Let us try to be positive and sensible. Let us clamp down on illicit sales of smuggled cigarettes in our neighbourhoods, and enforce a new ban on purchasing tobacco for under-18s, as with alcohol. Let us support shopkeepers in their role as gatekeepers to age-restricted products, encourage “No ID, no sale” signs in shop windows, and enforce stiff penalties against retailers—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I hesitate to interrupt the hon. Lady, but time is very short. I hope she will draw her remarks to a close because the Minister has a speech to make.

[Dame Angela Watkinson]

I am very aware of that, Madam Deputy Speaker.

Let us enforce stiff penalties against retailers caught selling cigarettes knowingly to children and let us not forget the responsibility of parents to know how much pocket money their children have to spend and what they spend it on. In short, the policy of plain packaging is well intentioned but misguided. It will do more harm than good. It will not work and I oppose it.

Health and Social Care (Safety and Quality) Bill

Baroness Laing of Elderslie Excerpts

Friday 9th January 2015 Commons Chamber

[Sir William Cash (Stone) (Con)]

I beg to move, That the clause be read a Second time.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

With this it will be convenient to consider:

New clause 3—Care and Quality Commission annual State of Care Report—

‘(1) Section 83 of the Health and Social Care Act 2008 (health and adult social services: reports for each financial year etc.) is amended as follows.

(2) After subsection (2) insert—

“(2AA) The reports under subsection 1(b), (c), and (d) must, in particular, cover the safety of health and adult social care services in England.”’

[Sir William Cash]

Before I make my remarks on the proposals, I pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), my neighbour, with whom I have worked for the past five years with great enthusiasm, because he has dedicated himself to all matters in his constituency, but specifically to dealing with the problems that came out of the Mid Staffordshire public inquiry—I campaigned vigorously to get that public inquiry. I also pay tribute to Ken Lownds, whom I regard as a hero of that inquiry in many respects. I pay tribute to his work on zero harm and the Bill. I do not in any way want to leave the Minister out of the tributes because he has done a great job, as has the Secretary of State for Health. I wanted to put that on the record. We are reaching the climax of the Bill and this is the moment to pay tribute to those who so richly deserve it.

The object of new clause 2 is to amend section 46 of the Health and Social Care Act 2008. The section deals with health and adult social care services reviews and performance assessments. It comes under the rubric of reviews and investigations under chapter 3 of the Act on health care standards.

Section 46, “Periodic reviews”, provides that:

“In respect of each Primary Care Trust the Commission”—

the Care Quality Commission—

“must…conduct reviews of the provision of health care provided or commissioned by the Trust…assess the Trust’s performance following each such review, and…publish a report of its assessment.”

It also makes special provision with respect to each English national health service provider. Subsection (3) states:

“In respect of each English local authority the Commission must…conduct reviews of the provision of adult social services provided or commissioned by the authority…assess the authority’s performance following each such review, and…publish a report of its assessment.”

In the light of experience, and to improve the 2008 Act, particularly section 46, the new clause would substitute for subsection (3) the following:

“The assessment of the performance of a registered service provider is to be by reference to whatever indicators of quality the Commission devises, but must include indicators of the safety of health and social care services.”

The purpose of that is to require the CQC to ensure that the indicators used to assess ratings cover the safety of care, which goes back to the question of harm-free provision. Basically, the argument goes like this: the object is to stress that the CQC can be an effective regulator only if it is free of undue influence from Ministers. The measure is a good indicator of whether the Government are prepared to say that they want the CQC to be able to exert influence and carry out its functions irrespective of undue influence from Ministers. In other words, are they prepared to step back and allow the CQC to do its job properly?

The CQC has decided to make safety one of the key indicators for the assessment of provider ratings. As a result, safety is a critical component of the CQC’s new inspection regime. On many occasions, I have discussed with Ken Lownds over dinner and otherwise the origins of much of his thinking on the subject, some of which I had difficulty understanding—apparently some of it comes from aviation safety, but I will leave that to the experts.

Under the leadership of the three chief inspectors, the CQC has put in place specialist inspection teams able to scrutinise the quality and safety of care more rigorously. Inspections no longer simply consider whether providers are meeting the registration requirements, but provide a judgment about the quality of care on a scale running from outstanding to inadequate, offering providers, commissioners and local people fuller information about the quality of care.

The CQC’s tougher, people-centred, expert-led and more rigorous inspections are seeing some outstanding care, and the CQC has already rated many good services. That new approach has also exposed poor care and variations in care, making the level of quality transparent in a way it has never been before.

I have to say that my experience of what happened after Mid Staffordshire—this was before my hon. Friend the Member for Stafford came into the House, and I pay tribute to what he has done to help me since—was itself a matter of the gravest concern. Having witnessed what went on there, I then had to engage in a campaign, and I tried, unsuccessfully, to push the Government of the time into having a public inquiry, but Ministers, including two Secretaries of State, refused point-blank to hold one.

Furthermore, I had to nudge—if I can use that word—those on my own party’s Front Bench quite vigorously. I think that would be the appropriate description. That included our then shadow Secretary of State and the now Prime Minister, who responded magnificently, making an inquiry a manifesto commitment. One of the very first things the Government did when they came into power under the present Prime Minister was to say, “We will have this Mid Staffordshire public inquiry under the Inquiries Act 2005.” As a result of that and of the work of Ken Lownds, my hon. Friend and others of us who have been involved in this issue, including the sponsors of the Bill—I should also refer to them—we now have this new Bill in my hon. Friend’s name, which will make quality transparent in a way it never has been.

We are already confident of the great strides the CQC is making to be an effective regulator of health and social care providers. I hope that the Minister will accept that new clause 2 is exploratory, but I tabled it in the fervent belief that he will respond satisfactorily to my request, because this is a matter of grave concern.

If it is convenient, Madam Deputy Speaker, I will move on to the next new clause, unless my hon. Friend the Member for Stafford would like to respond to my points now. Would that be appropriate?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

At this point, we are considering new clause 2 and new clause 3, so it would be appropriate for the hon. Gentleman to address new clause 3, if he so wishes.

[Sir William Cash]

That is very good. I just wondered whether my hon. Friend wanted to respond on new clause 2 before I move on to new clause 3.

New clause 3 proposes to amend section 83 of the 2008 Act, which deals with health and adult social services and with reports for each financial year. The new clause would insert proposed new subsection (2AA), which says:

“The reports under subsection 1(b), (c), and (d) must, in particular, cover the safety of health and adult social care services in England.”

To put that into ordinary language, the purpose is to require the Care Quality Commission to cover safety of care in the annual state of care report. That is hugely important, because it is the narrative to which people will be able to refer in identifying progress on these incredibly important provisions.