Health Protection (Coronavirus) (Restrictions) (England) (No. 4) Regulations 2020

Lord Barwell Excerpts

Wednesday 4th November 2020 Lords Chamber

[Lord Barwell (Con)]

My Lords, I support the regulations, although it gives me no pleasure to do so. I concede that the lockdown will damage our economy and people’s mental health and will restrict our freedoms —all the arguments that my noble friend Lord Forsyth so eloquently spelled out. I do so because the lesson from the first wave is very clear: that the consequences of not acting are worse. The countries that took quick and decisive action did not see more damage to their economies and more people out of work; they saw less damage. Countries that, like us, were late to act did not better protect their economies; they saw a sharper fall in GDP and more job losses.

My noble friend Lord Robathan said that there was uncertainty about the sums. He is quite right, but at every stage during this process, we have suffered from optimism bias. Back in February and March, we believed that we were several weeks ahead of Italy, before it became apparent that that was not the case. We came out of lockdown in May and June too quickly, failing to achieve suppression of the virus—particularly in the north of the country, which is why the pandemic has recurred there first.

We did not listen to SAGE back in September, when its advice was for a short circuit-breaker lockdown. The Prime Minister clearly did not want to adopt the policy that he is now pursuing. We were told that this was all going to be over by Christmas. Even now, some noble Lords seem to believe that what is happening in Belgium, the Czech Republic and France will somehow not happen here.

I fear that we live in an age of increasing unreason, where experts are maligned. I have a lot of sympathy with those noble Lords who have asked to see the assumptions that underpin the modelling, but others go further. My noble friend Lady Noakes said that, although she could not comment on this herself, some have said that there is a deliberate plot to curtail our civil liberties. Who would benefit from such a plot? How can what the Government are recommending to the House possibly be in their interest? It will make their job over the next few years immeasurably more difficult.

I believe that a vaccine and improvements in treatment and testing are on the way. However, lest noble Lords fear that I am suffering from the optimism bias that I have criticised in others, let me say that, if we look around the world, there are countries that, even before those developments, have achieved suppression and returned life to normal.

As I come to the end of my time, I say to the Minister that the Government need to use this period to achieve proper suppression of the virus—to get the tracing system working properly and ensure better compliance—so that, if I am wrong in my optimism about vaccine treatment and testing, we do not find ourselves in January or February back debating a potential third lockdown. This measure is the right thing to do now to protect our NHS. It is better than any alternative course of action.

[The Deputy Speaker (Lord Alderdice) (LD)]

My Lords, the noble Lords, Lord McConnell of Glenscorrodale and Lord Greaves, have withdrawn so I call the noble Earl, Lord Clancarty.

Covid-19 Update

Lord Barwell Excerpts

Monday 16th March 2020 Lords Chamber

[Lord Barwell (Con)]

I welcome the Prime Minister’s commitment to a daily press conference. It is vital over the difficult weeks and months ahead that people hear directly from him and from the Chief Medical Officer what the Government’s position is. If large numbers of people are either going to have to self-isolate because one of their family is symptomatic or going to have to effectively withdraw from society for four months, a lot more people will need their food delivered to their home. What can the Government do, first to encourage people not to panic and hoard things when it is not necessary to do so, and secondly to allow the supermarkets to scale up their at-home delivery? At the moment, if you register as a new customer, you cannot get a booking for three or four weeks.

[Lord Bethell]

My noble friend Lord Barwell is entirely right. The question of deliveries is an acute concern. There are intense conversations going on on a daily basis between Defra and the food retailers. I understand that there are assurances that there are significant stocks of food and that these are going to be made more available. It is not something that we are currently deeply concerned about. The belief is that as people fill their larders, they will reach a certain point when they will begin backing off the kind of stocking up that they are doing at the moment and it will be possible for those who need it to get those deliveries.

Accident and Emergency Departments

Lord Barwell Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

I know that the hon. Lady has campaigned assiduously and determinedly for her constituents. Even though we have different views, I hope she will understand that at every stage I have taken the decisions, often difficult decisions politically, that I think will best serve her constituents and the people of Lewisham. I accepted the advice of the medical director of the NHS that that decision on Lewisham would save a significant number of lives. That is why I took that decision. As to what we do going forward, I will continue to do what I think is the right thing for her constituents. If she does not agree with the decisions I make, I hope she will at least show greater respect for the motives behind them.

[Gavin Barwell (Croydon Central) (Con)]

I have discussed with my right hon. Friend on many occasions the issues facing Croydon University hospital. I am very grateful for the £4.5 million that has been announced today. May I ask him both to look kindly on the bid for capital investment for the A and E department there, and to pay tribute to the doctors and nurses in my A and E department and others across the country who are working so hard under such pressure?

[Mr Hunt]

I thank my hon. Friend for making that point. It cannot be said enough how hard A and E staff in particular work—antisocial hours in very challenging conditions. Many hon. Members will have seen that in their local hospitals. With respect to the capital allocations, I hope that the House has a sense from today that we are looking to solve the long-term problems facing A and E departments, as well as giving immediate help for this winter and next winter, so of course we will look carefully at the business case put forward by his local hospital for capital.

Oral Answers to Questions

Lord Barwell Excerpts

Tuesday 11th June 2013 Commons Chamber

[Anna Soubry]

That was a very interesting speech but I am afraid that I do not accept the hon. Gentleman’s analysis at all. All cancer waiting time standards are being met, with over 28,000 patients being treated for cancer following a GP making an urgent referral for a suspected cancer. We have already heard about the action that this Government are taking to address the situation in accident and emergency; it was very well explained in last week’s debate

[Gavin Barwell (Croydon Central) (Con)]

7. What steps he is taking to increase accountability in the NHS.

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

We have transformed accountability in the health system by setting up Healthwatch and introducing stronger local democratic accountability through health and wellbeing boards.

[Gavin Barwell]

Croydon PCT’s accounts for 2010-11 showed a £5.5 million surplus; it subsequently turned out to be a £23 million deficit. The former chief executive and two former finance officers have adamantly refused to give evidence to a scrutiny committee set up by councils in south-west London. Does the Secretary of State agree that that is unacceptable and that NHS managers must be held to account, and given that two of these individuals still work in the NHS, does he have the power to compel them to give evidence?

[Mr Hunt]

Accountability is extremely important. Local authorities can require members or employees of local health service commissioners to appear and answer questions, and NHS organisations and individuals should co-operate with that. I am extremely concerned by what my hon. Friend says. He knows that I have received a report on this from the joint overview and scrutiny committees for six south-west London boroughs, and I will be responding shortly.

Accident and Emergency Departments

Lord Barwell Excerpts

Thursday 7th February 2013 Commons Chamber

[Gavin Barwell (Croydon Central) (Con)]

I have quite a bit of sympathy with some of the points that the hon. Gentleman is making because some of my constituents work at Lewisham hospital and have contacted me about this issue. However, he has to make his argument in a balanced way. Is it not the case that under the previous Government, when there was a problem in one PCT neighbouring PCTs were required to subsidise it, and that that, to a degree, unfair as it seems to people, is the consequence of having a national health service rather than separate individual units?

[Jim Dowd]

No, that is not the case.

It is a question of whether being reasonable gets one anywhere. People in Lewisham have tried being reasonable with the trust special administrator and with the Department of Health, but so far it has got them nowhere, so they are having to consider other methods.

Just how many hospitals up and down the country are under threat is evident from the Members who are present this afternoon. In many cases, the accident and emergency unit is the heart of a buoyant and thriving hospital. So much else stems from the work of A and E units. My hon. Friend the Member for Barrow and Furness (John Woodcock) outlined the point that in many parts of the country outside London, it is as much a question of geography as the number of people because of the threat that people will have to travel great distances to get the treatment they need. A and E units have such a critical function that Professor Sir Bruce Keogh, the medical director of the NHS who has already been mentioned, has highlighted the scale of the problems across the country and, I am led to believe, is undertaking a review of A and E units.

I am somewhat less reassured by Sir Bruce’s view of democracy and the role of local representatives. He is not alone in holding that view. Many medical professionals and particularly administrators—Sir Bruce straddles both roles as he is an administrator and a clinician—believe that they should decide what is best for people and that people must put up with it. They believe that local representatives, whether they be Members of Parliament, local councillors or the local council, have no right to interfere. I have to say to Sir Bruce and the other professionals at the Department of Health who operate under that illusion, that that is not how a democracy works. In a democracy, people need to be persuaded that what is being done is in their best interests. If there is to be change, the result must be a system that is safer and more reliable than the one that it replaces. Simply turning to people in a patronising and condescending fashion and saying, “You don’t understand what we understand,” is not the way to treat the citizens of this country.

The threat posed by the unsustainable providers regime in the South London Healthcare NHS Trust is a threat to every single trust in the country. If the Government get away with the way in which they have conducted the regime in Lewisham, they will be able to do it anywhere. The whole scheme has been designed, promoted and decided on by the Department of Health without any objective external appraisal.

The objective of the exercise in the case of the South London Healthcare NHS Trust was to revive a dormant and defunct NHS London scheme to reduce the number of A and E units and functioning hospitals in south-east London from five to four. That plan was put before the previous clinically led review, “A picture of health”, and rejected. It was also rejected by the subsequent review of that review by Professor Sir George Alberti, who is now the chair of the trust board at King’s College hospital. The plan did not survive because it does not make sense on clinical grounds. What is happening now in south London is being done entirely on financial grounds.

Although Lewisham hospital is being devastated via this back-door reorganisation, the Secretary of State and his predecessor originally denied that it was a reconfiguration. Unfortunately, in his statement last Thursday, the Secretary of State confirmed that it was a reconfiguration. Had they been honest and straightforward and told the truth at the outset, there would have been an entirely different procedure, which would have been amenable to external review and would have had an appeals process. They would have had to stand up the case for the action that they are now contemplating. This situation has been engineered entirely by the officials and their acolytes within the fortress of Richmond house. All the clinical evidence that they have taken any notice of has been paid for. It has come from people who work at the Department of Health or people who have been brought in to the so-called clinical advisory group by the trust commissioner.

It is an irony bordering on contempt, not only for the people of south-east London, but for people from much further afield, that the trust special administrator who was brought in to save the overspending South London Healthcare NHS Trust overspent his own budget by more than 40%. The final bill is not yet in, but he has spent £5.5 million. All he did was take off the shelf a scheme that NHS London, while in its death throes—it has only a month or so before it is replaced—wanted to use. We need only look at the chronology to see that this is what was intended all along. The trust special administrator did not reach a conclusion; he started with the premise to shut down Lewisham hospital.

--- Later in debate ---

[Gavin Barwell (Croydon Central) (Con)]

For the second time this week I have reason to thank you, Mr Speaker. Six minutes seems like an eternity compared with four. A number of colleagues kindly commented positively about my speech on Tuesday, but this one is going to be much less popular, particularly with the hon. Member for Mitcham and Morden (Siobhain McDonagh), and I apologise to her at the outset for that. I am going to strike a slightly different tone from that of many of the people who have spoken in the debate.

The hon. Lady mentioned the “Better Services, Better Value” review, which has been commissioned for health services across south-west London. In the final clinical report’s introduction, the clinicians involved in the review found that

“health services in south west London are not sustainable in their current configuration. In the opinion of the clinicians leading the review, no change is not an option.”

A number of points made in the review are specifically relevant to A and E departments and I wish to draw the House’s attention to them.

The review looked at the number of full-time equivalent emergency medicine consultants in each of the four A and E departments in the area and compared that with the recommended minimum number to achieve cover for 16 hours a day, seven days a week. Croydon Health Services NHS Trust should have 16 whole-time equivalent consultants, but it has 4.9. The figures for St Helier show that it should have 12 but actually has 4.5. Kingston Hospital NHS Trust should have 16 but it has 10. St George’s should have at least 16 but it has 21. So that provides clear evidence that the departments across south-west London, with the exception of the one at St George’s, do not have anything like the recommended minimum level of consultant cover.

The review says specifically:

“In London, data shows that the probability of dying as a result of many emergency conditions is significantly higher if the admission is at the weekend, compared to a weekday.”

That is because of that low level of consultant cover. It continues:

“Each year, there are around 25,000 deaths following emergency admission to London’s hospitals. If the weekend mortality rate in London was the same as the weekday rate there would be a minimum of 500 fewer deaths a year.”

[Heidi Alexander (Lewisham East) (Lab)]

How does the hon. Gentleman know that those different mortality rates that he cites are down to less consultant cover at weekends and are not, for example, the result of a sicker population entering A and E at weekends?

[Gavin Barwell]

The honest answer to the hon. Lady’s question is that I do not know. I am simply relying on the report, which is suggesting that that analysis points to 500 as the number of deaths that are purely due to the timing of the week. We could argue about the figure, but I hope that she would agree on the point of principle that having fewer consultants on at the weekend must impose some level of risk.

The report also says:

“The Royal College of Surgeons state that a critical population mass is required in order to provide an efficient and effective emergency service. This is supported by literature that suggests that surgeons who perform a high volume of procedures tend to have better outcomes. The preferred catchment population size for an acute general hospital providing the full range of facilities, specialist staff and expertise for both elective and emergency surgical cases would be 450,000-500,000.”

We have a problem. We have a large number of hospitals in London with accident and emergency departments and they do not have the recommended level of full-time equivalent consultant cover to provide the best medical outcomes. Every single Member of this House will defend their local hospital, as that is where their constituents go for treatment. If I was in the same position as the hon. Member for Mitcham and Morden, I would be doing exactly the same.

[Mr Charles Walker (Broxbourne) (Con)]

rose—

[Siobhain McDonagh]

rose—

[Gavin Barwell]

I shall give way to my hon. Friend, because I promised that I would.

[Mr Charles Walker]

The problem in north London—and in Broxbourne on the edge of north London—is that Chase Farm is serving a growing population. I do not want to keep Chase Farm A and E open because of any emotional attachment to it, but because we have a population that is due to grow by another 40,000 over the next few years.

[Gavin Barwell]

My hon. Friend has put the case for his local hospital firmly on the record. I do not know the detail and would not want to comment. I shall try to make time to allow the hon. Member for Mitcham and Morden to intervene once I have advanced my argument a little. I referred to her, so it is only fair to give her that opportunity.

The point I am trying to make is that there is a need for balance. Constituents want to be able to access facilities at a local hospital, both from their own point of view and because if they have an extended stay they want friends and relatives to be able to come and visit them easily. There is a balance to be struck between convenience and quality of treatment. For example, my hon. Friend the Member for Banbury (Sir Tony Baldry) referred to someone with a serious aortic problem who was able to go to a hospital with specialist expertise.

Let me make a couple of points about improving the quality of care, which was also touched on in the “Better Services, Better Value” review. One concerns the European working time directive’s impact on the NHS. The review states:

“The implementation of the EWTD has resulted in shorter sessions of work with complex rotas as well as more frequent handovers. Resulting difficulties in maintaining continuity of care can have implications for patient safety.”

The review also contained some powerful findings about the four-hour target, introduced by the previous Government for laudable reasons, which included wanting to monitor the level of care people received. The data for south-west London show that A and E admissions spike between 245 and 260 minutes in all south-west London acute trusts, suggesting that internal standards are aligned solely to the four hours rather than other quality issues.

There are a range of issues relating to A and E in south-west London. I want to say a brief word about Lewisham, but first I shall give the hon. Member for Mitcham and Morden a chance to intervene.

[Siobhain McDonagh]

Last year, 90,000 people turned up at St Helier’s A and E, 26% of whom were admitted to a bed. The idea that we can condescend to 90,000 people and tell them that they turned up in the wrong place is untenable. They are making an entirely rational decision to go to A and E because there is nowhere else to go. The GP out-of-hours service is woeful, its standards are poor and as long as there are no alternatives, people will continue to go to A and E whatever the hon. Gentleman says or does.

[Gavin Barwell]

I am grateful to the hon. Lady for that point. She said earlier that “Better Services, Better Value” talked about a figure of 60%, but she was actually misleading the House—unintentionally, I am sure—as the report specifically rejects that. It states that

“there is no firm evidence”

to support the Healthcare for London figure. It conducted a local study across south-west London that found that 48% of all activity was coded as minor and that 40% of patients were discharged with no follow-up treatment required. The conclusion was that they could be dealt with in an urgent care centre, which could be attached to the A and E. That would mean we could ensure the provision was available to deal with such cases.

Let me comment briefly on Lewisham. I listened with great sympathy to the arguments made by the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham West and Penge (Jim Dowd), who is no longer in the Chamber. I have constituents who work at Lewisham hospital and feel very angry, as the right hon. Lady does, about what has happened there. Let me make one point, which I tried to make to the hon. Gentleman in an intervention: we have a national health service and as a consequence when things go wrong in a neighbouring area it has a knock-on effect.

[Dame Joan Ruddock]

rose—

[Gavin Barwell]

I am afraid I cannot take any more interventions.

The hon. Member for Lewisham West and Penge was wrong to state that that has only started to happen under this Government. In my part of London in the past things have gone wrong in neighbouring boroughs and Croydon PCT has had to help them out. In the past two years Croydon PCT has got into trouble and neighbouring boroughs have helped us out. That does not mean that what is happening is right. I am not making a judgment on it. I am just saying that it is not fair to suggest that the present situation is a wholly new departure.

Hon. Members have made powerful arguments for their local hospitals, but there is a balance to be struck between convenience of locality and ensuring sufficient acute cover. I completely understand the point made by the hon. Member for Mitcham and Morden (Siobhain McDonagh) in relation to St Helier, but as a Croydon MP I have to say that there must a solution that gets us to the recommended minimum level of consultant cover in our hospital, and I will continue to fight for that.

Oral Answers to Questions

Lord Barwell Excerpts

Tuesday 15th January 2013 Commons Chamber

[Dr Poulter]

I thank the hon. Lady for her question. I recognise her concerns for her constituents. As has been outlined, there are seasonal variations, and I am sure that local commissioners will want to take such issues into account when they make decisions, and they must meet the reconfiguration tests set out by the previous Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley).

[Gavin Barwell (Croydon Central) (Con)]

The Better Services Better Value review of NHS services in south-west London identified that Croydon university hospital does not have sufficient senior doctors in its A and E, and nor did it under the previous Government. The review has been put on hold because Surrey has asked to be included. Will the Minister reassure my constituents that there will be a rapid solution to ensure that we have the A and E care that we deserve?

[Dr Poulter]

My hon. Friend is right to highlight a long-standing problem—it has not happened just recently —of a lack of particularly middle-grade doctors in A and Es. Although the number of consultants has increased by about 50%, as A and Es move rightly towards becoming a 24/7 consultant-led service, attracting middle grades to the specialty has been a problem. We set up a task force to consider that, as well as making better use of a multidisciplinary work force and emergency nurse practitioners to meet some of the staff shortages.

Mental Health

Lord Barwell Excerpts

Thursday 14th June 2012 Commons Chamber

[Gavin Barwell (Croydon Central) (Con)]

First, I thank the Backbench Business Committee for securing this debate. In my limited experience in the House, the Committee’s debates often show the Chamber at its best. I also want to congratulate my hon. Friend the Member for Loughborough (Nicky Morgan), who is one of the stars of the 2010 intake on the Government side of the House. She is an example of the work that Lord Maples, who sadly passed away this week, had done to diversify the make-up of Members on our Benches. That is about a lot more than tokenism.

As a number of Members have said, I came fourth in the private Member’s Bill ballot. I found that out because my inbox was suddenly swamped by a large number of e-mails congratulating me, and my mobile phone and desk phone started ringing at the same time. For a Back-Bench Member it is a fairly rare opportunity to change the law of this country. I have taken my time and thought long and hard about what I wanted to bring forward. On Wednesday, I will be presenting the Mental Health (Discrimination) Bill, which was introduced by Lord Stevenson of Coddenham in the last parliamentary Session, as the right hon. Member for Leigh (Andy Burnham) has said. I am doing that partly for personal reasons. Two of my closest personal friends suffer from mental health conditions, and two teachers who had a very formative role in my education, when I was a teenager, have also suffered from mental health conditions. My predecessor, the former Member for Croydon Central, Andy Pelling, who some Members in the House will have known, also suffered from a mental health condition.

In addition, since I have been a Member of the House, in my surgeries I have met a significant number of constituents who are suffering, including people whose children have been detained under the Mental Health Act 1983. There is one gentleman I will never forget who came to my surgery suicidal because he had lost his job and was at risk of losing his home and the ability to support his family. A couple of weeks ago I visited the South London YMCA and met a man who had witnessed someone commit suicide and had gone to his GP for help but had not received proper help and had suffered a breakdown. His marriage had broken up, he had lost his job and he had ended up sleeping in the park. So my decision has been prompted by a mix of personal reasons and what I have seen as a constituency MP.

The Bill is supported by the Royal College of Psychiatrists, Mind, Rethink Mental Illness and the Law Society. Its purpose is very simple: to remove the last significant form of discrimination in law in our society. This country has changed a huge amount since I was a young child. I remember the first Asian family moving into our road when I was growing up. Some of the people who lived in our road put pressure on the people selling their house not to sell to an Asian family. I also remember the arguments about section 28 and the language that was used in my school playground. We have made a huge amount of progress since then as a country, but we have not got there yet. To our shame, however, the law still discriminates against those with a mental health condition. An MP or a company director can be removed from their job as a result of a mental health condition even if they go on to make a full recovery. Many people who are perfectly capable of performing jury service are barred from doing so. If my private Member’s Bill is approved by the House, we will look back in a few years’ time and be amazed that the nonsense I have described was on the statute book in 2012.

As my hon. Friend the Member for Loughborough said, one in four of us will experience a mental health condition in our lifetime; three in four of us will see a member of our immediate family experience such a condition. As the right hon. Member for Leigh said, the numbers have increased because, while the physical conditions in which we live and work have improved, our lives are busier and much more stressful. The World Health Organisation estimates that by 2030 more people will be affected by depression than any other health condition. The law as it stands sends out the message that if someone has a mental health condition their contribution to public life is not welcome.

Lord Stevenson’s Bill had four aims: first, to repeal section 141 of the Mental Health Act 1983 under which a Member of Parliament, of the Scottish Parliament, of the Welsh Assembly or of the Northern Ireland Assembly automatically lost their seat if they were detained under the Act for more than six months. There is no equivalent provision to remove an MP if they suffer a physical illness that affects their ability to perform their role and, furthermore, someone who lacks mental capacity, as defined by the Mental Capacity Act 2005, can be detained for up to 12 months and not lose their seat.

Secondly, the Bill would amend the Juries Act 1974 significantly to reduce and better define who is ineligible for jury service. At the moment, the Act says that mentally disordered persons are ineligible. The definition of a mentally disordered person is extremely wide and includes people who manage their mental health condition through a prescription from their GP or counselling from a psychiatrist, thus eliminating all sorts of people who would make excellent jurors. Only 2% of people tick the box, but many more should probably do so. Not only is the law discriminatory but it is ineffective. If someone is on trial, they have a right to be confident that the jury is of sound mind. The Bill would better define who should be ineligible, thus making it much more likely that those people would identify themselves in the process.

Thirdly, the Bill would amend the Companies (Model Articles) Regulations 2008, so that someone no longer ceased to be a director of a public or private company purely because of their mental health. All companies are required by statute to have articles of association, and model articles operate where a company has failed to draw up its own. Many companies incorporate them into their own articles. They include a provision that someone ceases to be a director if a registered medical practitioner who is treating them gives a written opinion to the company stating that they have become physically or mentally incapable of acting as a director and they remain so for more than three months—in other words, the correct test of capacity. However, they go on to include a totally unnecessary additional provision relating solely to mental health.

Finally, the Bill would amend school governance regulations so that people detained under the Mental Health Acts would no longer be disqualified from holding office as school governors. Clearly, while someone is detained they are unable to attend governors’ meetings, but that may be for only a short time, and there is no reason why they should not resume their role.

I am delighted that the Government have dealt with one of those issues—the School Governance (England) (Amendment) Regulations 2012 came into force on 17 March, and rightly set the disqualification test as failure to attend six meetings in a period of six months without consent from the governing body. The Government made a public commitment, when they published their mental health strategy, to change the legislation in relation to Members of Parliament. I hope that they will support the rest of the Bill. In the other place, Lord Wallace of Saltaire said that the Government were considering the detail of what was proposed on jury service, and he hoped that the Bill would be reintroduced in this Session. I hope that it receives all-party support, and I was delighted to hear what the right hon. Member for Leigh had to say.

I want to end with two simple contentions. First, Parliament, schools, companies and the court system benefit from the involvement of people with experience of mental health conditions. Indeed, our debate has been illuminated in particular by the contributions of my hon. Friend the Member for Broxbourne (Mr Walker) and by the hon. Member for North Durham (Mr Jones). I do not know the hon. Gentleman very well, but I have always pictured him—and I think he would regard it as a compliment—as a bit of a political bruiser. For someone with that reputation to have the courage to say what he said will change people’s opinion of him, and very positively. The whole House has a high regard for what he has said, but I am sure that when we move on to other debates, normal hostilities will be resumed.

A school may have a pupil with a mental health condition; in a court case, the accused’s state of mind may be a key issue. How much better will that school be if a governor has experience? How much better will that court case be if there is a juror with the necessary experience? The Bill will directly help a relatively small number of people, but it also sends a clear message that discrimination is wrong: people have a right to be judged as individuals, not labelled or stereotyped.

In September, the excellent Time to Change campaign, run by Mind and Rethink Mental Illness, surveyed 2,700 people with mental health conditions. Of those, 80% said that they had experienced discrimination, two thirds were too scared to tell their employer, 62% were too scared to tell their friends and, worst of all, more than a third were too scared to seek professional help. Having a mental health condition is nothing to be ashamed of or to keep a secret. It is high time we dragged the law of this land into the 21st century.

NHS Future Forum

Lord Barwell Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

This Bill and our proposals were never to support privatisation; they are not to support privatisation and they will not be to support privatisation. The hon. Gentleman should have attacked the Labour Government who gave the private sector £250 million for operations it never carried out; they paid it 11% more than they would have paid the NHS for that. They tried to push the NHS out of the provision of services when it could have provided them and competed. The Labour Government did that, and we shall legislate to make it illegal for a Secretary of State or any regulator to engage in that kind of preferential treatment for the private sector in future.

[Gavin Barwell (Croydon Central) (Con)]

I welcome the revised proposals, in particular the focus on competition not as an end in itself but on informed—[Interruption.]

[Mr Speaker]

Order. I apologise for having to interrupt the hon. Gentleman. Whatever feelings the hon. Member for Blyth Valley (Mr Campbell) entertains in relation to the Liberal Democrats, who seem unlikely to feature on his Christmas card list, I urge him to exercise what modicum of self-restraint he can muster in the circumstances.

[Gavin Barwell]

Thank you, Mr Speaker.

I welcome the focus not on competition as an end in itself, but on informed patient choice to improve patient care. Can my right hon. Friend confirm that, unlike the Opposition, the Government believe that NHS patients in my constituency deserve the best that the public, private and voluntary sectors can offer them?

[Mr Lansley]

I understand. What my hon. Friend says is absolutely clear. We know that informed choice for patients is a serious contributory factor in improving outcomes for patients. When there is informed choice, of necessity we must have a diversity of providers to support it. There is no doubt that to that extent competition is an essential part of delivering improving care in the future, but it is not an end in itself. It should not be elevated to that point, over and above delivering the integrated services that best give patients the care they need.

Oral Answers to Questions

Lord Barwell Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

I am grateful to the hon. Gentleman for his question. The Department does not issue guidance, but the National Institute for Health and Clinical Excellence does. Its guidance on improving outcomes in breast cancer states that mammography and ultrasound imaging should be available in breast clinics as part of the triple assessment of women with suspected breast cancer. In addition, the guidance states that ultrasound is useful in predicting tumour size and in planning surgery, and that it can complement mammography in differentiating malignant and benign disease. That guidance is the key tool used in making such decisions.

[Gavin Barwell (Croydon Central) (Con)]

15. What recent progress he has made in establishing foundation trusts in London.

[The Secretary of State for Health (Mr Andrew Lansley)]

The Department is currently in the process of working with NHS London to establish timetables for each NHS trust and agree the actions required to achieve foundation trust status by April 2014. This work is ongoing; once it is finalised, plans will be published locally.

[Gavin Barwell]

In 2010-11 Croydon Health Services NHS Trust delivered an operating surplus of £4.5 million. May I commend its FT application to my right hon. Friend in the hope that in future years, that money can be reinvested in local health services in my borough?

[Mr Lansley]

Yes, I understand and entirely sympathise with my hon. Friend’s desire to see Croydon Health Services NHS Trust achieve foundation trust status. He will know that the trust was recently the subject of a responsive review visit by the Care Quality Commission, which revealed areas in which further assurance will be needed ahead of its foundation trust application going forward. He will appreciate, as I do, that in the past foundation trust status did not depend sufficiently on the achievement of high-quality services, rather than merely viable services. We intend that in future, foundation trust status will depend on both.

--- Later in debate ---

[Paul Burstow]

No, because it was an accurate statement of the legal position, which is what the question required.

Since these issues became a cause for concern many months ago, the Department of Health has been very much engaged with them at both official and ministerial level. We have also ensured that all parties—the local authorities, the Care Quality Commission and others—are clear about their responsibilities. I should have thought that that was what the hon. Gentleman would expect us to do, and it is what we have done. We are ready for any eventuality.

[Gavin Barwell (Croydon Central) (Con)]

T6. Croydon University hospital recently took on responsibility for community care, which will allow much better integration of acute and community services. What scope does my right hon. Friend think exists for wider application of that model in our NHS?

[Mr Lansley]

As my right hon. Friend the Prime Minister made clear today, we continue to believe that we can achieve more integrated services for patients, and we are determined to do so. That must be at the heart of the way in which reform and modernisation of the NHS deliver improving outcomes for patients. For patients, the results of care, and indeed their experience of it, will be greatly enhanced if it is designed and integrated to meet their needs. We know that that is effective, we know that it works for patients, and we are determined to make it happen. My hon. Friend has given just one example, and an important one, of the way in which hospital and community services can be integrated.