Health and Social Care

Debate between Baroness Laing of Elderslie and Dan Poulter

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—]

National Health Service (Amended Duties and Powers) Bill

Debate between Baroness Laing of Elderslie and Dan Poulter

Friday 21st November 2014 Commons Chamber

[Madam Deputy Speaker (Mrs Eleanor Laing)]

The right hon. Gentleman knows very well that all Members exercise their right to speak loudly, quietly, in stage whispers and in other ways in this Chamber. I am listening very carefully to the level of noise, and if it reaches much higher than it already has, I will ask Members to be more courteous to the Minister. However, I am quite sure that the Members present will wish to be courteous to the Minister and to hear what he has to say.

[Dr Poulter]

Thank you, Madam Deputy Speaker. I am sure that Members in all parts of the House—although perhaps not the hon. Member for Rochester and Strood—would like to reaffirm their commitment to and the value they place on all NHS staff, no matter what background or culture they come from. We want those staff to continue to practise in and work for our NHS to the benefit of patients.

--- Later in debate ---

[Madam Deputy Speaker]

Order. The Minister is not giving way.

[Dr Poulter]

Thank you, Madam Deputy Speaker.

The point was articulated very well by my right hon. Friend the Member for Banbury (Sir Tony Baldry) in one of the best and most accurate speeches of this Parliament in an NHS debate.

--- Later in debate ---

[Madam Deputy Speaker]

There has been much discussion this morning about who has said what about what. My concern in the Chair is that the Bill should be discussed. That is the matter before the House, and we will discuss it.

[Dr Poulter]

Thank you, Madam Deputy Speaker. I think the tone of that point of order made my point for me better than I could have done.

As my right hon. Friend the Member for Banbury said in what was one of the best speeches on the NHS I have heard in this Parliament, the Health and Social Care Act 2012 did not introduce competition into our NHS. To say that it did is factually incorrect, scaremongering and distracts the NHS from addressing the key issues it faces. It was the creation of a mixed health economy, implemented by the previous Labour Government, that exposed our NHS to competition law, not the introduction of the Health and Social Care Act.

General Practices (Coventry)

Debate between Baroness Laing of Elderslie and Dan Poulter

Thursday 30th October 2014 Commons Chamber

[Madam Deputy Speaker]

I am grateful to the hon. Gentleman for his attempt to be helpful, but I will invite the Minister to move that the House do now adjourn, after which he may recommence his speech.

Motion made, and Question proposed, That this House do now adjourn.—(Dr Poulter.)

[Dr Poulter]

Thank you, Madam Deputy Speaker. I apologise for the lack of the usual accompanying member of the Treasury Bench team to conclude proceedings, but I am pleased to continue the informative debate we have been having.

I was addressing the point about practice closures. The way the information is collected sometimes leads to a headline of “practice closures”, but it may well be that practices have merged, and it is important to recognise that when we have a debate, even an informed one such as this. When a number of practices have co-located locally to improve premises and there has been improved investment, that is an enhancement of services; it in no way diminishes the services available to patients. I do not know the details of each and every surgery in Coventry, but clearly collaboration has taken place, along the lines of the Darzi model outlined by the hon. Member for Coventry North West, whereby surgeries can pool their resources and work together. That can bring benefits to all their patients and mean an additional freeing up of money to invest in other community-based health services, for example, physiotherapy or speech and language therapy. That approach has worked well in many parts of the country, including in the examples I gave in Coventry.

I understand that NHS England has also given approval for new premises for the Prior Deram Walk practice in Canley, Coventry, with the new facility expected to be completed next summer. Ongoing investment is taking place locally. Practices in Coventry have a good provision of extended hours, through the enhanced service for extended hours, and have adopted online booking for appointments and repeat prescriptions. NHS England’s area team monitors complaints from patients and is currently receiving no complaints about access or difficulty in registering with a practice in the Coventry area, although if there are concerns, I would be happy to take an intervention.

Care Bill [Lords]

Debate between Baroness Laing of Elderslie and Dan Poulter

Tuesday 11th March 2014 Commons Chamber

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. The right hon. Gentleman was listened to with courtesy. The same courtesy must be shown to the Minister.

[Dr Poulter]

I have repeatedly read out supporting evidence from the previous Government and from the impact assessment that showed that they recognised that the regime had to take into account the wider health economy. It is not my fault or the fault of hon. Members on the Government Benches that Labour’s legislation was not properly drafted, and that it did not do what it intended—

--- Later in debate ---

[Madam Deputy Speaker]

Order. The Minister’s state of health is not a matter to be dealt with from a sedentary position. If he is not giving way, he is not giving way.

[Dr Poulter]

I must make progress. I want to address the points made by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow). I will not give way until I have made better progress. On the point made by the right hon. Gentleman—and this is important—when he put forward the legislation on the TSA, he envisaged potentially turning it into a hospital closure clause. In 2009, on Second Reading of the Health Bill, he said:

“We believe these measures will provide protection against the possibility of NHS providers continuing indefinitely.”—[Official Report, 8 June 2009; Vol. 493, c. 544.]

That would suggest that the right hon. Gentleman thought that whole organisations might be shut down or closed as a result of the TSA regime. We do not believe that that is the case. We recognise that trusts, when they severely fail, may have to change the services they deliver. We want to protect trusts from the closure that the right hon. Gentleman envisaged in his remarks. His own words indicate that Labour had a hospital closure clause in the TSA regime. The Government, however, are making it clear that this is about service change in the interest of patients when all other avenues have been exhausted, which is a good thing.

Let me turn now to new clause 16, tabled by my right hon. Friend the Member for Sutton and Cheam, my hon. Friend the Member for St Ives (Andrew George) and other hon. Members.

--- Later in debate ---

[Dr Poulter]

I am happy to give my right hon. Friend that assurance. It will be for him to lead the review, and we look forward to the work he does.

New clause 16 would make a second key change: to prevent the Secretary of State or Monitor from making decisions about recommendations affecting other trusts. Instead, local commissioners would have to undertake a further process of consultation and make their own decision. The effect would be to completely undo the changes that clause 119 is seeking to make—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. If hon. Members across the Chamber wish to have private conversations, they should leave. The Minister is answering some important points and ought to be listened to.

[Dr Poulter]

It would take outside the administration process and the timetable recommendations that affect other trusts. It could mean that a complete solution for the trust in administration and local patients could not be found. As before, my right hon. Friend the Member for Sutton and Cheam said that examining in isolation a trust that is failing significantly would be like throwing it to the wolves on its own. New clause 16 would render the strict legal timetable for the regime ineffective by significantly delaying resolution. I know that it is not his intention, but the new clause would undo the core purpose of clause 119 and the very aims of the regime, which are to put in place sustainable and safe health care services for patients when a trust has significantly failed.