Junior Doctors Contract

Helen Whately Excerpts

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

I reassure the hon. Gentleman that we are in constant touch with the devolved regions and countries to make sure that they know the changes that we are making, and to share any learning that we have from the processes that we have been through, so we will certainly do that. Across the country, we are doing everything we can to catch up with the backlog of operations, procedures and out-patient appointments—all the things that have been affected by the industrial relations dispute. Trusts will always prioritise the areas where clinical need is the greatest, but I know that that work is ongoing across the country.

[Helen Whately (Faversham and Mid Kent) (Con)]

I very much welcome the agreement that has been reached. We know that the Secretary of State recognises the importance of having a happy and well-motivated workforce, and this contract addresses many of the causes of unhappiness for junior doctors. It is particularly good to hear the points made today about addressing the problems of couples who are both junior doctors. However, there is clearly more to do, as has been acknowledged, especially on the reasons why junior doctors feel unsupported and often not valued by their employers. My right hon. Friend commissioned Professor Sue Bailey to carry out a review of the underlying problems experienced by junior doctors during training. Will he advise us whether the review will now proceed?

[Mr Hunt]

The request from the BMA was to find a new way of proceeding with that very important work, and that is what we will do. We will do so with the input of Professor Bailey, because she has a very important contribution to make. My hon. Friend is absolutely right to say that, as well as more flexible working for people with family commitments, the big issue for many junior doctors is the way in which the training process happens. In particular, the issue is about the way that continuity of training has been undermined by the new shift system—we need that system for reasons of patient safety—and that often means that someone is given advice by a different consultant on different aspects of care from one day to the next, which is frustrating. We will look at all those issues with Professor Bailey, Health Education England and the BMA to see whether we can find a better way forward.

Oral Answers to Questions

Helen Whately Excerpts

Tuesday 10th May 2016 Commons Chamber

[Alistair Burt]

It is absolutely essential that workers are paid the national minimum wage, and for care workers that includes travel. The Department has been very clear in that regard. Extra money is being provided to local authorities to pay for social care, as we know, but matters are tight—I am well aware of that. We are looking to providers and local authority providers to meet their statutory obligations to ensure that hard-pressed care workers have the financial support they need to do their vital job.

[Helen Whately (Faversham and Mid Kent) (Con)]

14. What progress his Department has made on delivery of the NHS five year forward view.

[The Secretary of State for Health (Mr Jeremy Hunt)]

We are making good progress in implementing the five year forward view, including £133 million invested in new models of care and 18 million people benefiting from extended GP access.

[Helen Whately]

It is estimated that a third of patients in acute hospitals could be better treated elsewhere, for instance at home, and in east Kent our vanguard aims to address this with new models of care, but it is early days. Will my right hon. Friend advise us of what he is doing to drive progress on new models of care, bringing together health and social care so that more people are cared for in the right place?

[Mr Hunt]

My hon. Friend is absolutely right to draw attention to what is, in a way, the most fundamental point of the five year forward view, which is getting care to people earlier to help them live healthily and happily at home. Perhaps the most significant announcement we have had in the past few weeks has been the extra £2.6 billion a year that will be invested by the end of the Parliament in general practice. That is a 14% increase that will allow us to recruit many more GPs and, I hope, dramatically improve care for her constituents and others.

NHS Bursaries

Helen Whately Excerpts

Wednesday 4th May 2016 Commons Chamber

[Heidi Alexander]

I have already given way to the hon. Gentleman, and I want to make some progress.

These changes will effectively charge students for working in the NHS. Of course, longer term times and clinical placements also make it harder for these students to get a part-time job to supplement their income in the way many other students do. It is not just the course that makes healthcare students unique; they are much more likely to be women, much more likely to be mature students, much more likely to have children and more likely to be from BME backgrounds.

Many nursing students have already completed one degree and turn to nursing in their late 20s or early 30s—indeed, the average age of a student nurse is 28. When I think of my own friends who are nurses and midwives, I find that three out of four took the decision to re-train, having done a different first degree.

The Minister probably moves in different circles from me, but I can tell him that if he wants a dose of reality, my friends would, I am sure, be more than happy to oblige. I understand that he may not have experienced the conversations that I had in my working-class family about the pluses and minuses of racking up debts to get a degree, but I can tell him that for many nurses, under his proposals, that consideration will be all too real. Does he not realise that for the one in five healthcare students with children, the fear of debt is greater than it is for carefree, privately educated history students bound for Cambridge? My concern about these proposals is that we ultimately end up with those best placed to pay becoming nurses and midwives rather than those best placed to care. That brings me on to why these proposals are bad for patients.

[Helen Whately (Faversham and Mid Kent) (Con)]

I think we are all agreed on the need for more nurses; the question is how we fund them. Will the hon. Lady tell us how much money she would take away from front-line NHS care in order to fund the expansion of nursing places that the country needs?

[Heidi Alexander]

We set out at the last election our clearly costed plans for how to recruit additional nurses, doctors and care staff to the NHS.

The NHS should have a workforce that reflects the population it serves—just as this place should, too. The mental health sector in particular relies on mature students and the additional life experience they bring to what is a very demanding environment.

A few months ago, I met Marina, a young woman who has not had an easy life, but who is now on a mission to become a mental health nurse. When Marina says that she thinks some of the people best placed to care for others are those who have experienced hardships themselves, I think she has a point; and when she says she would not have been able to start her training without the bursary, I believe her. Why is the Minister so convinced that the NHS can do without people like Marina in the future? Why does he think they should pay to train, and why will he not consider other options for increasing student numbers?

The quality of training that student nurses, midwives and other allied health professionals receive will also depend on the quality of their clinical placements. Government Ministers claim these changes could deliver up to 10,000 extra places over the course of this Parliament, so can they set out what capacity hospitals and other providers have to accommodate these extra students, and confirm whether Health Education England has sufficient funds set aside to fund these placements? Will the Minister be clear about how this 10,000 figure was arrived at? Is it the Government’s assessment of what the system needs, what Health Education England can afford to fund or simply a big-sounding number plucked out of the air at random?

An extra 10,000 compared with when? What is the baseline year on which we should judge the Minister’s policy? I have asked him that three times in written parliamentary questions, and each time I have not received an answer. Does he not understand that if his Department cannot even answer a simple question relating to one of its key claims about the policy, that does not exactly inspire confidence? There are so many questions that the Minister needs to answer that it is impossible to do all of them justice in a single speech.

--- Later in debate ---

[Helen Whately (Faversham and Mid Kent) (Con)]

If we ask any patients about their experience in hospital, one thing they are sure to talk about is the nurses who looked after them. In doing so, they are usually talking about both nurses and healthcare assistants—in my experience, patients do not tend to make a distinction. We know that nurses have far more interaction with patients, day to day, than doctors. Nurses’ quality and time are absolutely critical to patients’ experience.

Nurses are also critical to outcomes for hospital patients. Good nursing can be the difference between life and death. We have known that since Florence Nightingale, we were reminded of it by the inquiry into Mid Staffordshire and the Francis report, and we can see it from recent research into stroke outcomes. It will be clear to anyone who has looked at how Salford Royal has such good outcomes and such a good reputation—a lot of that is because of the focus on extraordinarily high standards of nursing.

The excellent NHS that I believe we all want needs excellent nurses. It also needs enough of them. This afternoon, people have talked about how we need something in the order of perhaps 10,000 to 20,000 more nurses—the numbers range widely. We also know that we need a shift in nursing skills, as we will need more nursing care for older people and people with long-term conditions, as well as more mental health nurses.

Right now, however, there are not enough nurses in our system, and hospitals across the country have vacancies. We know that they use large numbers of agency staff, and international recruitment is important to many hospitals, including those serving my constituents in Kent. I am not confident that more of the same will solve the problems, and neither was the nursing department of a London university that I spoke to last year. It said that it needed more funding per nurse place, but recognised that asking for more money for their nurses could mean taking money from front-line care in the NHS. That was not a good answer, and the department was open to a new funding model.

Last summer, the Council of Deans of Health and Universities UK stated that the

“current funding system is no longer working for either students or universities.”

Universities have to subsidise the cost of nursing and physio degrees from other courses, and NHS-funded nursing students have less to live on than others, even though they often study longer, more intense degrees with more hours, and are therefore even less able to do other work outside their qualification. We know that we need more nurses, and that the current funding system is not working.

How should we get more nurses? Around 2008-09, when plans were being drawn up for the Centre for Workforce Intelligence, I remember hearing that the answer was better workforce planning, with lots of skilled experts doing fabulous modelling of future workforce demands. I remember being a sceptic about that then, because when we consider the history of the NHS, and systems around the world that have centralised planning for the healthcare workforce, we find that it is almost always wrong. There are periods of over-supply and of under-supply—right now, we are in a period of under-supply, with all its knock-on consequences. Doing things better and having more experts sounds great in theory, but in practice we have seen that it does not work.

A much better answer is to set universities free to offer more places to all those students who, as we have heard, want to study nursing but are currently being turned away. I hope that we will have more nursing applicants, and that that career will become even more attractive, particularly as universities work more closely with employers on what is needed, and we must consider more of the specialist skills and expertise required within nursing by our care system now and in future.

To do that we must uncouple the funding of nurse training from the NHS, and take away the constraint that every £1 spent on training an NHS nurse is £1 potentially taken from front-line care, because that puts a premium on avoiding excess nurses. That is the right direction of travel, and it is also important to increase maintenance grants for nurses so that they do not struggle with their living costs as currently happens. There should be more routes into nursing. The nurse associate role is welcome, as is the apprenticeship route so that nurses can work and train in parallel. We know that that is appealing to more mature students who need an income and who want to be more hands-on during their training, and for whom a university environment has less appeal. Having worked for some time with healthcare assistants, I would like more recognition to be given to their role and qualifications, and I recognise the opportunity to support them even more to train to become qualified nurses.

We must invest more in continuous professional development for nurses. We know that we need a more flexible workforce that can adapt to future demands, yet in times of financial pressure, the investment and time given to ongoing training are often squeezed. Let us use this opportunity to try to shift that balance, and repurpose the workforce to meet the system’s demands and needs.

I would also like more attention paid to the appeal of nursing and the experiences of nurses in work. I have heard many nurses on the frontline say, “This weekend, I’ll be on my own—I will be the only permanent nurse on this ward. I will be working alongside agency nurses who do not necessarily know this ward, and it will make this weekend really difficult.” We badly need to put an end to that. The only way to do that, alongside the ongoing work to reduce the use of agency staff, is to increase the number of nurses who have been trained to work in the NHS.

I am out of time, but to sum up I think the direction of travel is absolutely right. Let us make sure that we get the details right on how the proposals are put into practice.

World Autism Awareness Week

Helen Whately Excerpts

Thursday 28th April 2016 Commons Chamber

[Mrs Gillan]

The hon. Lady is absolutely right. I will mention some of the organisations involved at the end of my speech. Ambitious about Autism is just one of the many organisations that are trying to help people with autism into employment. I want to mention that later as well, because it is very important.

To build on the intervention on the criminal justice system by the hon. Member for Cardiff West (Kevin Brennan), I should say that I recently visited Her Majesty’s young offenders institution in Feltham to see at first hand how a deeper understanding of the issues and how some adjustments in the physical environment can help people on the spectrum. The prison recently underwent accreditation from the NAS, and the prison staff’s enthusiasm in, and dedication to, helping the young people in their charge is absolutely admirable and really wonderful to see. I very much hope that members of the all-party group will go there on a visit to see exactly what Feltham has done. Custody can be a really traumatic experience for anyone, but without specific adjustments for those with autism, it is much harder for them to engage in their own rehabilitation. Familiarising staff with autism, allowing prisoners to use communal areas at quieter times, and reducing posters and notices to prevent over-stimulation are just some of the small things that can make a significant difference to the experience of autistic prisoners in custody.

I now want to pay tribute to the Minister for prisons, the Under-Secretary of State for Justice, my hon. Friend the Member for South West Bedfordshire (Andrew Selous), who wrote to every prison in this country asking them to undertake autism accreditation. Currently, over 20 have been in touch with the NAS and its accreditation team and, alongside Feltham, four are going through the process. We want this kind of Government leadership and we want such leadership to be sustained. When I ask the Government to do more on the awareness and understanding of autism, I expect to get this type of response. Far more could be done in the criminal justice system, particular in the Courts Service.

Following the example of Feltham, the public sector can and should do much more to make sure all its services and buildings are more accessible to autistic people, so that they and their families can feel confident that they can visit public buildings and use public services in the same way as everyone else. For example, I was very pleased at the weekend to read that Asda is piloting a “quiet hour” in one of its stores in Manchester, when it will turn off escalators, screens and music for an hour to create a more comfortable shopping experience for those with autism. That is to be commended.

At this point, it would be remiss of me not to mention that Parliament is itself working, under the leadership of Mr Speaker, towards an autism access award and to make sure that autistic visitors to our place of work feel confident that they will be understood and treated well right across the board. In the light of this positive work on the parliamentary estate, I hope the Minister will meet me and representatives from the all-party group and the NAS to discuss how, together, we can build on the early successes of the “Too Much Information” campaign and ensure that all public buildings become accessible to people on the spectrum.

I want to turn to one of the biggest issues facing people with autism and their families, which is the time it takes to get a diagnosis in the first place. I can see from the nods that that rings a bell with everyone in the Chamber. Recent research suggests that, on average, adults have to wait more than two years for a diagnosis. For children, the figure stands at 3.6 years. An autism diagnosis can be life-changing, explain years of feeling different and help to unlock professional advice and support. Government guidelines say that a diagnosis should not be a barrier to putting in place the right support, but 58% of people on the spectrum have told the NAS that a diagnosis led directly to getting new or more support. How can the right support be identified without the clarity of a diagnosis?

[Helen Whately (Faversham and Mid Kent) (Con)]

It is fabulous that we are having this debate today. I want to back up my right hon. Friend on her point about the delay in diagnosis. I have spoken to many families in my constituency who have waited for months for a diagnosis for a child, while the child could and should have been receiving help for their enormous difficulties, but months if not years have been wasted. Yet we cannot even get the data about diagnosis from either the county council or the NHS. Not only are there delays, but there is a lack of transparency about waiting times for a diagnosis.

[Mrs Gillan]

Absolutely. It is clear that, despite the best intentions of the Government, getting such a diagnosis is still crucial, as my hon. Friend says.

Meningitis B Vaccine

Helen Whately Excerpts

Monday 25th April 2016 Westminster Hall

[Helen Whately (Faversham and Mid Kent) (Con)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I thank the hon. Member for Walsall North (Mr Winnick) for his powerful contribution and my hon. Friend the Member for Bath (Ben Howlett) for his comprehensive opening speech.

I want to start by paying tribute to my constituents, Neil and Jenny Burdett, who are with us this afternoon. Their two-year-old daughter, Faye, died on Valentine’s day this year after an 11-day battle against meningitis B. It is their determination that something good should come of their loss that has brought us all here today. More than 800,000 people signed the petition after they published a picture of their daughter gravely ill in hospital. They have shown incredible courage over the past few weeks and months since her death. They did not expect to receive this much attention; they just wanted to prevent other families from suffering as they have. The scale of the response to the petition shows how strongly people in this country feel about meningitis and the level of fear and concern that there is out there among parents.

I am proud that Britain was the first country in the world to vaccinate the most at-risk group of babies against meningitis B. In this debate, we should not overlook the important fact that the rest of the world is watching our vaccination programme and seeing how it fares. In the evidence sessions prior to this debate, we heard Britain’s immunisation programme described by one expert as

“the envy of the world”,

but that does not mean we cannot do more.

It feels cold-hearted to talk about cost-effectiveness, but we have to introduce that to the debate because we know that NHS resources are limited, and we must recognise that money spent on meningitis cannot be used to fight other diseases. After extensive research and the work that was done to make the case for the vaccination to be introduced, costs were included that would not normally be included in such a case for vaccination. For instance, litigation costs and health losses to family members were included. The JCVI, which makes the recommendations, concluded that it would be cost-effective to vaccinate babies up to 12 months, but not older children. If I understand it correctly, the Government are legally bound by that decision. I am sure the Minister will confirm this, but I do not know whether we can simply call for that decision to be overturned and an instant change in the programme introduced. But questions can be asked, particularly as a group is looking at the moment into how the cost-effectiveness calculation is carried out.

[Mrs Helen Grant]

Does my hon. Friend agree that we should not ignore things simply because they are hard to measure, especially in a situation such as this? Issues that have already been mentioned such as peace of mind and public preference are really important.

[Helen Whately]

I completely agree with my hon. Friend and neighbour in Maidstone. I know she has been contacted by many of her constituents about this issue. We need to ensure that the formula used to calculate whether the vaccine should be introduced includes things such as peace of mind and the level of fear about meningitis. It should also take into account the public preference for protecting children from illness.

[Catherine McKinnell]

The hon. Lady is making an important point. My understanding—I would be grateful if the Minister would clarify this in her response—is that in calculating the cost-effectiveness of the meningitis B vaccination, the JCVI has not fully considered the potential outcome for those children who contract meningitis but survive and the long-term costs for them and their families for the rest of their lives. Such costs are often borne by the state, so, along with the factors that the hon. Lady is outlining, there are other financial costs that have perhaps not been considered fully.

[Helen Whately]

I thank the hon. Lady for that comment. We may well hear from the Minister that some of those extra costs have been taken into account, but when the Select Committee took evidence a few weeks ago we heard from the Meningitis Research Foundation and others that the cost-effectiveness model tends to privilege near-term costs over long-term costs and benefits. It does not look at the long-term lifetime health impacts, positive or negative, from a person having had or not had meningitis.

That brings me to something called the discount rate, which is applied at 3.5%. I have been told that, as a result of that discount rate, the benefits of a vaccine reach zero by the time somebody is 27. People clearly live for much longer than that, so is enough account being taken of the long-term benefits of a vaccination programme when cost-effectiveness is calculated? For instance, it has been calculated that if a 1.5% discount rate were used instead of the 3.5% rate, the answer would be different and a catch-up programme for under-fives would be cost-effective. The NICE guidance states that a 1.5% discount rate can be applied if health benefits would be attained over long periods and for public health interventions. Surely vaccinations should fall under those categories?

[Mims Davies (Eastleigh) (Con)]

Given my hon. Friend’s experience in the NHS and the clear point she is making, does she think we are missing a trick if we do not listen to that argument now?

[Helen Whately]

The arguments I am putting forward should certainly be looked into, and it is timely to consider them now, because a working group is currently looking at the cost-effectiveness calculation. We need a real sense of urgency about the report on the calculation and it should be published as soon as possible. According to the conversations I have had, there seems to be uncertainty about how it is progressing and when we will be able to discuss the findings.

In the meantime, ever greater awareness of meningitis is important, particularly as it strikes so quickly. Parents need to trust their instincts if a child seems unusually ill, and it is critical for health professionals to listen to them. We have heard many tragic cases of children getting meningitis in which the parents had suspicions that their child was really sick. They have gone to hospital and seen doctors, but they have been sent home with instructions to give the child Calpol or something similar. We know that meningitis is very difficult to diagnose, but it is worrying that there is such variability in how children are treated when they turn up with potential symptoms.

[Mrs Helen Grant]

During the Select Committee’s evidence sessions it was suggested that information about the disease could be put in babies’ red books to raise parents’ awareness. Does my hon. Friend think that that is a good idea that should be considered?

[Helen Whately]

It should most certainly be considered. The Government should look into all possible avenues for raising awareness. Charities such as Meningitis Now are working very hard and have some excellent leaflets, but parents are often still not aware. I have three young children and I have worried about meningitis. I would look out for a rash, but through being involved in this petition I now know that the rash comes so late in the process that it can be too late by the time it is seen. Parents have to be ready to spot a whole host of other symptoms and, when they speak to doctors, to be really confident that they think their child is more sick than usual and that it does not feel like a case for just Calpol. Parents have an instinct. We need to encourage them to trust it, and health professionals need to encourage them to speak up about it.

I know that other colleagues want to speak, so I shall conclude my remarks. We need a much greater sense of urgency about the work on the cost-effectiveness of vaccination. Bearing in mind the points I have made about the discount rate and the value that society attributes to the life of a child, a case could be made for extending the vaccination programme to more children. Work should be done on how health professionals deal with possible cases of meningitis B. Whether or not the NICE guidance is still right, it is certainly confusing. We also need more transparency about doctors’ reactions to possible cases of meningitis B, because it is hard to see the difference in the data—we only have anecdotes about how doctors and others respond when they see a possible case.

The Government must do all they can to raise awareness. Whatever the outcome of the debate, I thank Neil and Jenny very much for all that they have done. The petition and debate have surely raised awareness of meningitis B throughout the country, which in itself will have saved lives.

[Several hon. Members rose—]

Junior Doctors Contracts

Helen Whately Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

I hope the hon. Lady understands that I am not going to go into the details of the legal cases that we are currently arguing. However, let me make it clear that the Secretary of State does have that power and that we are using it correctly, and we will argue that case very strongly in the High Court.

[Helen Whately (Faversham and Mid Kent) (Con)]

Many hundreds of operations were cancelled during the last strike. The next strike will see the unprecedented step of emergency cover being withdrawn, and many junior doctors are themselves worried about that. Does my right hon. Friend agree that it is time for the BMA’s leaders, who are calling for the strike, to heed the worries of those junior doctors and of patients, and to call it off?

[Mr Hunt]

I absolutely agree. It is entirely legitimate to disagree with the Government of the day about contract reform—we have tried to make the case as to why that reform is important—but it is wrong for patients to pay the price for that disagreement. While the NHS can cope with the withdrawal of labour for elective care, it is a much bigger deal when emergency care is withdrawn, and people throughout the NHS are extremely worried about the impact of that. Doctors should also worry about how the public will view their profession if they proceed with this wholly unnecessary step.

Junior Doctors: Industrial Action

Helen Whately Excerpts

Thursday 24th March 2016 Commons Chamber

[Ben Gummer]

The right hon. Gentleman should know that we have negotiated with the BMA for more than three years. We have a choice either to cave in, which would produce a bad contract—much like the 2000 and 2003 contracts, which we are trying to correct, because everyone agrees they are wrong—or to move forward, accepting the fact that 90% of this contract has been agreed. We believe that it is in the interests of patients and doctors to do the latter.

[Helen Whately (Faversham and Mid Kent) (Con)]

Does my hon. Friend agree that this time the BMA has gone too far, and will he join me in calling on junior doctors to reach beyond the BMA and put their patients first and the BMA leadership second? Junior doctors are the future of the NHS, and they must play their role in constructively solving this problem.

[Ben Gummer]

I agree entirely with my hon. Friend, and we need this new contract to help junior doctors to achieve a better work-life balance, so that they can maintain their studies, training and experience in a better way than is currently allowed. We must also ensure that they are not exhausted by the contract, which is what happens under the current failed contract. It is in their interest for the new contract to be introduced, and I hope that in the coming weeks they will revise their view of whether this industrial action is truly necessary.

Oral Answers to Questions

Helen Whately Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Mr Hunt]

We consulted widely with NHS leaders about the terms of the new contract, and they confirmed that it was fair and reasonable. Any decision to proceed with a new contract when it is not possible to have a negotiated settlement is inevitably controversial, but we wanted to ensure that independent people thought that the terms of the contract were fair. I think we have done that, and when junior doctors see their new contracts—as they will do shortly—they will realise that we were right to say that.

[Helen Whately (Faversham and Mid Kent) (Con)]

Underlying the dispute over the junior doctors contract is a long-standing problem of morale among junior doctors, and a failure to pay enough attention to their experiences in training. I welcome the Government’s decision to launch an independent review led by Professor Dame Sue Bailey, and I ask my right hon. Friend to update the House on the progress and timing of that review.

End of Life Care

Helen Whately Excerpts

Wednesday 2nd March 2016 Commons Chamber

[Helen Whately (Faversham and Mid Kent) (Con)]

I welcome this debate, not least because end-of-life care, or death, is something we as a society tend to avoid talking about, and there are parallels with mental health. Another parallel is that, like mental health, this issue is too often overlooked in our healthcare system. Talking about it here is therefore a step in the right direction.

It is of course good to see that the UK ranks No. 1 in international studies, as other hon. Members have said, but we know that we as a society do not do end-of-life care well enough—in fact, too often we do it badly. One reason that many constituents wrote to me before the assisted dying debate to support assisted dying was that they lacked confidence in the system’s provision of end- of-life care and were not confident that they would have the chance of a good death. As many of us know, it is possible to have a good death, and that is what is experienced in many hospices, which do excellent work, as well as, sometimes, in hospitals and care homes.

Too few people die where they want to, quite apart from the quality of the experience they have. For example, only 6% of over-75s in Kent want to die in hospital, yet 40% actually die there. Some 86% want to die at home or in a hospice, but only 29% die in either of those places.

Every year about 500,000 people die in the UK. As the hon. Member for Heywood and Middleton (Liz McInnes) said, about one in five of them do not even receive palliative care. Those 500,000 people have family and friends who are affected by their death, so quality of death, on the basis of scale alone, should be a priority. In their final weeks and months, most people are highly dependent on the NHS, and there are frequent emergency hospital admissions for people towards the end of their life. Those hospital admissions account for 70% of health costs in their last three months of life. Unnecessary admissions to hospital are not only a bad experience for many individuals towards the end of their life, but expensive, and the NHS has scarce resources. That is another reason why it should be a priority to prevent people from dying in hospital when they do not want or need to. The question is whether it is yet a priority. The Public Administration Committee heard evidence that end-of-life care was still consistently overlooked across the NHS.

For the situation to improve, four things need to happen. There needs to be a focus on it from the very top of the NHS—from the leadership and from Government. There needs to be investment in capabilities to give people a better quality of death—not only capabilities of staff in terms of their skills, but in the technology that is needed. There needs to be better learning from what works; many places around the country, and internationally, do this well. There needs to be much greater transparency and measurement of where it is going well and where it is being done badly, and accountability on quality.

On the technology point, many people lack a plan for how they want to die, yet that that can make a real difference. In the absence of a plan, there is often a default response when something happens to somebody who is frail and possibly close to death: an ambulance is called, they are taken to A and E, and they end up in the acute ward of a hospital and may never leave. Only last week, I spoke to a local GP who was very frustrated about this happening to his patients. He has often discussed with them what they would like to happen if their end of life is approaching, and sometimes even written it down. However, too often, in the moment of crisis, what he has written down makes no difference at all, because the people on the scene at the time—for instance, if an ambulance is called out of hours—do not have access to the plan that he has discussed with the patient.

That said, the GP was optimistic that this could change, because his CCG, NHS West Kent, is implementing an electronic care broadcasting system whereby other doctors, A and E and the ambulance staff would be able to access what the patient had said they wanted to happen in that situation. There is strong evidence of the benefits of such systems, which means that far more people are able to die in their preferred place. In some cases, this has resulted in the number of people getting to die in their preferred place of death rising to about 80%, and brought hospital deaths down from the average of about 53% across the country to below 40%, or even as low as 4%. Implementing such systems should therefore be a priority, as should learning from where they are going well.

Transparency and monitoring are a crucial part of improving end-of-life care. We need more transparency. We need to know about the variability that has been mentioned. As MPs, we need to know how good the end-of-life care is for our constituents. I welcome the CQC’s increased attention to end-of-life care, but there are yawning gaps in reporting on quality. There is great inconsistency between what is reported in different areas and different institutions, and between CCGs, and relatively little is reported consistently at a national level. There needs to be a much greater focus on reporting. That was one of the recommendations in the Select Committee’s report, and NHS IQ—Improving Quality—looked at it before being transferred into NHS England. I would be grateful if my hon. Friend the Minister updated us on what is going on with regard to transparency on quality of end-of-life care, as I know that this Government do understand the importance of transparency.

All of us here today know that end-of-life care must improve; that this affects hundreds of thousands of people every year; that improving it will require continued and greater leadership and focus from the very top of the NHS and from Government; that investment will be required in capabilities and in technology, and should also lead to some cost savings; that there should be greater transparency, monitoring and accountability in respect of quality; and that there should be more, and more effective, sharing of the success stories and evidence of what works. Those things would mean that end-of -life care really was a priority for the health and care system, and that it should improve.

Mental Health Taskforce

Helen Whately Excerpts

Tuesday 23rd February 2016 Commons Chamber

[Alistair Burt]

I understand the right hon. Lady’s point. I know that such issues are being considered extremely carefully by those who are responsible for developing the policy, but I will ensure that her further concerns are noted and that the Departments recognise them.

[Helen Whately (Faversham and Mid Kent) (Con)]

There is so much good stuff in this report that I must congratulate the authors on their work and my right hon. Friend the Minister on his interest. I particularly welcome the recognition in the report of the gap in the provision of psychiatric liaison services, and the commitment to have such services at the core 24/7 level in at least half of all hospitals by 2020. Will my right hon. Friend advise me on whether such provision is fully funded? Given the difficulties of getting such services in place at the moment, will he take a close interest in the plan to make it happen in practice?

[Alistair Burt]

I thank my hon. Friend for her interest in this subject, which she had expressed to me previously, and her work on it. Yes, our determination is that the extra £1 billion a year that will be spent on mental health services will cover the training and the commitment that we have made to 24/7 cover. It is very important that such cover is there. The issue was identified when the Care Quality Commission looked at the work of the mental health crisis care concordat, which has been so successful in its first 12 or 18 months. I can assure her that I am determined to ensure that we provide these facilities.