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—]