ME: Treatment and Research

Lord Bellingham Excerpts

Thursday 21st June 2018 Westminster Hall

[Carol Monaghan]

There are many conditions that we now think could be grouped under the wide umbrella of auto-immune conditions. Lyme disease, multiple sclerosis, rheumatoid arthritis and ME may all be in that group, but without research we do not know.

Some people consider ME to be a psychological condition, despite the fact that people with ME are not allowed to be blood or organ donors. Unfortunately, those who hold such beliefs often are in influential positions and have a blinkered view of the condition. I wonder what they have to fear from proper biomedical research into ME. If such research showed they were correct, their views would be vindicated. However, if it threw up new information that had an impact on ME treatment and care, as medical professionals they should surely support that.

[Sir Henry Bellingham (North West Norfolk) (Con)]

I congratulate the hon. Lady on securing the debate. Is she aware that the UK charity Invest in ME Research recently opened a centre of excellence for ME research at Norwich Research Park? That was funded by patients and carers, who raised a staggering £800,000 for what will be groundbreaking, world-class research.

[Carol Monaghan]

I was not aware of that specific centre, but I am aware that almost all the biomedical research currently taking place in the UK is funded by charities and patient groups, rather than by the Government or research councils.

Interestingly, Professor Sharpe, one of the authors of the PACE trial whom I already mentioned, emailed me this week and told me that my behaviour is “unbecoming of an MP”. I say to Professor Sharpe that if listening to my constituents, investigating their concerns and taking action as a result is “unbecoming”, I stand guilty. [Hon. Members: “Hear, hear!”] If Members of Parliament are not willing to stand up for the most vulnerable in society, what hope do any of us have?

--- Later in debate ---

[Sir Edward Davey]

I share the hon. Gentleman’s concern. I should say that we still need a lot of research into MS, so it is not one or the other, but given the incidence of ME, as he rightly says, the case for research into the biomedical aspects is strong. Invest in ME Research makes a number of proposals in its recent report. For example, it proposes a ring-fenced fund of £20 million a year for the next five years for biomedical research. That recommendation comes from a detailed report; it is not just plucked out of the air. That sort of figure would show that the Government mean business.

I am aware that Ministers cannot stand up at the Dispatch Box and say, “Yes, of course we will direct research money into this probe; I myself will do it.” I am not suggesting the Minister can do that today. I know he cannot. He has to work with research councils and others to direct the research. I am also aware that if researchers do not make proposals, sometimes research moneys cannot be granted.

[Sir Henry Bellingham]

As I mentioned earlier, Invest in ME Research has set up a centre of excellence for research in the Norwich Research Park, and it is planning to create a hub for European biomedical research, which is good news indeed. It already has five PhD students and is hoping to push out a consultant-led clinical service. Here we have the infrastructure and base for that extra Government funding, to build on the money that has been raised by patients and carers.

[Sir Edward Davey]

The hon. Gentleman is absolutely right, and it is good that he is here to champion that centre. He makes the point I wish to make to the Minister: a pipeline of research proposals is likely to come about not only from the centre in Norwich, but no doubt as offshoots from research elsewhere—particularly the United States, which is beginning to get its act together on the research side. There is a pipeline, and I urge the Minister to anticipate that, to talk to the research councils and to say with his colleagues, “We will be ready and we will have the funds ready so that when the research proposals come through”—as I am confident they will—“we will back them.” Then we can start making progress. I say to the Minister, please, not to wait to see whether they come through before he dedicates the money and starts pressurising the research councils, because we know that process can take too long. People have already waited too long.

I will conclude my remarks by underlining two points touched on by the hon. Member for Glasgow North West. The first is the need for respect for patients. Sometimes it seems, from the stories I have read, that some in the medical profession—I say some—do not respect patients. They make comments that it is all in people’s minds and that they are making it up. That is no way to talk to adults. A constituent of mine who has been suffering from ME, who I talked to last night, recently went to see her consultant. The consultant said in terms, “All ME people are crazy, except you.” That did not make her feel very happy. I am afraid that type of view among senior medical people is not acceptable, and I hope Ministers will make it clear that they expect patients not to be treated like that.

That links to my final point, on the need to train doctors. We need better guidance and better training so they understand that situation. In that light, I am worried that we are seeing some pressure to reclassify ME. That is sending a dangerous signal, and I hope the Minister will say that the Government are questioning that reclassification and putting it on hold. Otherwise, the training for doctors will not happen, the respect for patients will not happen and we will not see the change that our constituents demand. I look forward to the Minister’s remarks and to the contributions of other hon. Members.

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[Sir Henry Bellingham]

I hope the hon. Gentleman will support my campaign to get the Government to invest in the Invest in ME Research centre of excellence in Norwich. I did not mention that it has a really good chance of forging first-class links with not only European biomedical research institutes but institutes in the United States and Asia, where other groundbreaking research is being done. The Government should support and invest in success.

[Dr Drew]

I think that was aimed more at the Minister than me, but I totally agree with the hon. Gentleman. I gather that the National Institutes of Health in America has begun to grapple with this and to put some quite serious funding into it. ME is an international condition, so we should hope that the Medical Research Council is also able to provide that level of support.

We have heard about the impact of ME on people who go for benefits interviews with the Department for Work and Pensions. As the hon. Member for Glasgow North West mentioned, it is difficult to get those who judge people’s conditions to understand how variable ME is. When people are going for employment and support allowance, personal independence payment or, as has been the case more recently, universal credit, account needs to be taken, when practitioners are making decisions, of the fact that the condition is variable. Sadly, all the evidence is that that is not fully understood. Again, this matter is not the Minister’s responsibility, because it overlaps with the remit of the DWP, but I hope that he can take away from what has been said here today the fact that the DWP needs to be much more aware of what the condition entails, rather than making judgments on what they see the person performing in front of them.

I think that the most important point of all is that we all could put pressure on our local clinical commissioning groups to show greater recognition of how important it is that they fund ME, in terms of both support for the individual patient and looking at how they commission the moneys that go into the services. Clearly, this remains a Cinderella subject, but given the numbers affected and the misery suffered by people with the condition, that is not in any way acceptable, so I hope that as a result of today—again, the Minister will hear this—we might all be able to go out and talk to our CCGs about what evidence they can provide us with to show that they are properly funding treatment of this condition. As we all know, what has happened in the past has been totally unacceptable. Let us hope that there is a better world now and that we can all play our part in ensuring that this condition is treated with the seriousness that it deserves.

Oral Answers to Questions

Lord Bellingham Excerpts

Tuesday 19th June 2018 Commons Chamber

The House observed a minute’s silence.

[Sir Henry Bellingham (North West Norfolk) (Con)]

8. What steps he is taking to encourage the adoption of personal health and care budgets.

[Andrew Lewer (Northampton South) (Con)]

18. What steps he is taking to encourage the adoption of personal health and care budgets.

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

I know that the thoughts of the whole House are with the families affected by the terrible atrocity a year ago.

Personal health budgets have a transformative effect on people with very complex health needs, and we plan for 50,000 to 100,000 more people to benefit from them by 2021.

[Sir Henry Bellingham]

I thank the Secretary of State for that reply. Does he agree that a key part of integrating health and social care is giving individuals more say and flexibility in how they use their entitlements? Will he consider extending his pilots to my constituency of North West Norfolk?

[Mr Hunt]

Absolutely, and not just to North West Norfolk, but to the whole country. We are currently consulting on giving a right to personal health budgets to people with the most complex health needs. That would be about 350,000 people and would include anyone with a continuing NHS need combined with a mental health need, a learning disability, autism or PTSD. Obviously, it would be hugely significant if we were able to proceed with that.

Oral Answers to Questions

Lord Bellingham Excerpts

Tuesday 20th March 2018 Commons Chamber

[Mr Hunt]

That is totally unacceptable, which is why we announced a £300 million expansion of CAMHS in the autumn. CAMHS funding went up by 20% last year. We are specifically trying to end precisely the situation that the hon. Lady mentioned, whereby people are told that they are not yet ill enough to get treatment. We have to put a stop to that.

[Sir Henry Bellingham (North West Norfolk) (Con)]

T8. Will the Secretary of State join me in paying tribute to all the staff of my local Queen Elizabeth Hospital, which he knows very well? Indeed, the Minister—my hon. Friend and neighbour the Member for North East Cambridgeshire (Stephen Barclay)—also knows the hospital very well because it serves his constituency. Does he agree that the hospital has done a superb job this winter, and that assurances and clarity on the current nurses’ pay negotiations will help with both recruitment and retention in the future?

Oral Answers to Questions

Lord Bellingham Excerpts

Tuesday 15th November 2016 Commons Chamber

[Mr Speaker]

Or even admonition.

[Sir Henry Bellingham (North West Norfolk) (Con)]

2. What progress has been made on turning around hospitals in special measures.

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

In the past four years, 31 trusts have been put into special measures, more than one in 10 of all NHS trusts. Of those, 15 have now come out and I particularly congratulate the staff of Sherwood Forest, Wye Valley, and Norfolk and Suffolk trusts which have come out of special measures in the past month.

[Sir Henry Bellingham]

Does the Secretary of State agree that the sustainability and transformation plan for Norfolk and Waveney is a vital part of the Queen Elizabeth hospital’s future as it successfully moves out of special measures? Although there is overwhelming support for integrating health and social care, will he confirm that there will be full consultation with different patient groups on the STP?

[Mr Hunt]

I can absolutely give that assurance. Through my hon. Friend I congratulate the staff of King’s Lynn hospital who have turned things around there. It was a great privilege for me to visit it and see the work that they have done. My hon. Friend is right—the next step is to integrate the work done in acute hospitals with what happens in the community and the social care system. That is why the open and transparent STP process is so important.

Oral Answers to Questions

Lord Bellingham Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Dunne]

I am grateful to you, Mr Speaker, for drawing the hon. Gentleman’s attention to the fact that the topic is procurement. The hon. Gentleman is right to highlight the fact that we have looked at an acute heart treatment strategy. We are creating centres of excellence across the country to ensure that if people suffer from an acute heart incident or a stroke, they are treated by the specialists who will give them the best prospects for recovery.

[Sir Henry Bellingham (North West Norfolk) (Con)]

8. What progress his Department is making on turning around hospitals in special measures.

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

In the last four years, 29 trusts have been put into special measures; that is more than one in 10 of all NHS trusts. Of those, 12 have now come out, having demonstrated sustainable improvements in safety and quality of care. There are nearly 1,300 more doctors and 4,200 nurses working in trusts that have been put into special measures.

[Sir Henry Bellingham]

The Secretary of State will be aware because he visited it last year, that the Queen Elizabeth hospital in my constituency has come out of special measures. It has made excellent progress, not least by introducing Saturday lists for in-patients and putting in place numerous measures to transform the out-patients department. Will he join me in paying tribute to all staff of the hospital, particularly the chief executive, Dorothy Hosein, and the chairman, Edward Libbey, for the excellent progress that they have made?

[Mr Hunt]

I am very happy to do that, and I very much enjoyed my visit to the QE with my hon. Friend a couple of years ago. This is a very good example of how trusts can be transformed when they go into special measures. Since coming out of special measures, the QE has opened a state-of-the-art laparoscopic theatre, got a dedicated breast unit, and expanded its A&E. It has got 72 more nurses over the past few years. It is a good example to many other trusts in special measures, and it shows that that really can be a turning point, bringing about benefits for patients and staff.

Mental Health: Out-of-Area Placements

Lord Bellingham Excerpts

Thursday 3rd December 2015 Commons Chamber

[Norman Lamb]

My right hon. Friend makes a good point. Again, it means that we need to think afresh and innovate. The third sector has been very good at coming up with concepts such as crisis houses, where at quite low cost a facility can be provided in a locality where someone can go at a moment of crisis. They therefore might not need a formal hospital admission, and it might be a much more therapeutic place to be as they get through their crisis. I recently visited the Hertfordshire Partnership NHS Foundation Trust, which, in addition to crisis houses, has host families that someone can go to be with, if that is appropriate, for a week or however long is necessary. That might be exactly what is needed, rather than the cold, clinical environment of a hospital ward. That sort of innovation is what we need in order to ensure that we have services that meet patients’ needs.

I want to share with the House the testimony of a constituent who has experienced an out-of-area placement. It has been anonymised, for obvious reasons, but it is very powerful none the less. It is quite shocking. It reads as follows:

“I was admitted to accident and emergency at Norfolk and Norwich Hospital on a Wednesday afternoon, following a suicide attempt. I regained consciousness the following day, having been transferred to the Acute Medical Unit, and it was quickly decided that I needed to be admitted to a mental health ward.

I had previously been on Glaven Ward at Hellesdon.”

That is the mental health hospital in Norwich. My constituents continues:

“At this point I was very woozy, suffering from a dangerously low mood, and angry that my suicide attempt had failed. I was at grave risk of making another attempt on my life. Throughout the Thursday and Friday efforts were made to find a mental health bed.”

That is what happens in the system.

“My parents were frantically trying to find out what was happening, as they were desperate for me to be looked after locally. For a time we were told that I would be going back to Glaven Ward at Hellesdon, but the news kept changing between there and a unit in London.”

London is between 120 and 130 miles away from Norwich, and further away from my constituent’s home.

“I was expecting to go to Hellesdon on Friday morning, but we were then told later that day that I would be going to south London. During the Friday, I twice walked off the ward and out of the hospital, without my absence being noticed, and went down to the Watton Road”—

which is near the hospital—

“with the intention of walking in front of a bus or a lorry. The main reason I didn’t go through with it was that I did not want the vehicle to swerve into an oncoming car and cause death or injury to someone else.

Meanwhile, my parents resorted to contacting the crisis team, as they could not get any information from the bed team. A member of the crisis team took responsibility for finding out what was happening and he was able to let me and my parents know that I would be transported to south London later that Friday evening.

Finally, after more uncertainty”—

this is really shocking—

“two men arrived to take me to London. At 10 pm, feeling suicidal, frightened and confused, I got into the back of a private ambulance (which was no more than a pretty austere minibus) and was driven away from the Norfolk and Norwich Hospital. Throughout the three-hour drive, I was spoken to just once by one of the two men, and felt more like a prisoner being transported than a patient.”

That is the way our NHS deals with someone who is acutely ill. It is really shocking. It ought not to be accepted. My constituent went on:

“At 1 am, by now completely disorientated, I arrived at the front door of the mental health unit in south London. After lots of knocking at the door, someone answered, and I was handed over with a quick ‘good luck’. I was booked in and shown to my room. I felt isolated and scared. My room was nice, but the unit felt like a prison. The internal doors were like cell doors, and there was a tiny outdoor area, fringed by a high fence with spikes on the top. It was a mixed ward, both in terms of sex and in terms of illness: people with depression and anxiety were alongside those with psychosis, personality disorders and acute problems.”

It is really shocking that a whole load of people with completely different conditions were thrown together like that. It is probably the least therapeutic environment imaginable. That is about containing people, not caring for them, and it ought to be a thing of the past.

[Mr Henry Bellingham (North West Norfolk) (Con)]

I had a similar case in King’s Lynn, although I cannot go into it because it ended in tragedy, with the individual committing suicide, having previously made an attempt. Does the right hon. Gentleman agree that it is absolutely essential in such cases that there is proper monitoring and supervision of the individual, whose life is obviously at risk during such an episode?

[Norman Lamb]

It is absolutely critical that that happens —not only monitoring but proper treatment. As I will go on to describe, that is not what happened in this case.

The constituent continues:

“The following morning, I had a meeting with my named nurse. Extraordinarily, it was the only real conversation I had with him until I was discharged back to Norfolk 10 days later.”

That is not therapeutic care—it is neglect. I have asked whether there are any contractual requirements on the private provider who provided that “care” and received a substantial sum of money for it. I have been told that it was understood that there would be therapeutic care but no apparent requirement that that should be undertaken in return for a substantial amount of public money being spent on his care. He goes on:

“The care was unacceptable. It felt as though I was being kept in a holding facility, and my mental health deteriorated, with my suicidal thoughts increasing. In stark contrast to Glaven at Hellesdon, the staff were holed up in an office with a heavy steel door that you couldn’t see into. I was being checked up on every 15 minutes, as I was a suicide risk.

But I rarely had a conversation with a member of staff. My parents came down from Norfolk twice to see me, and were horrified by what they encountered—both the level of care and my deterioration. They were constantly contacting Norfolk and Suffolk mental health trust to try to get me moved back to Hellesdon. The stress made them both ill.”

That shows the impact there is on families as well. He continues:

“Thankfully their persistence paid off, and after 10 days, I was told that I was going to be recalled. I had a brief period of uncertainty, as I didn’t know whether I would be going to Hellesdon, King’s Lynn or Great Yarmouth.

Eventually, I was told it would be Glaven at Hellesdon, and I got into a taxi with a member of staff and was driven from south London to Glaven Ward.

When I arrived there, I cried, mainly through relief. I was greeted with compassion and understanding by the staff, and—after 10 wasted and expensive days—my recovery finally began.”

That experience, sadly, is repeated day in, day out across the NHS. It is a scandal that it continues. One of the things I will put to the Minister when I conclude is that I want his commitment to end this practice, because it is intolerable that it continues in this day and age.

I mentioned cost. An analysis has been done by the national confidential inquiry into suicide and homicide by people with mental illness, which, having looked at 29 providers, says that the cost of out-of-area placements went up from £51.4 million to £65.2 million in 2014-15. That is an extraordinary amount of money to spend on an unacceptable practice, demonstrating that with smarter use of the resources available it should be possible to bring that practice an end.

The national confidential inquiry also found that being treated out of area increases someone’s risk of suicide. The pattern is most apparent in England, where suicides by in-patients and patients recently discharged from hospital have fallen, although suicides following discharge from an out-of-area ward have increased. The annual number of suicides after discharge from a non-local unit has increased from 68 in 2003-07 to 109 in 2008-12. Experts have warned that mental health patients are at the highest risk of taking their own lives in the first two weeks after being discharged from hospital, and these figures confirm that. When we are talking about a risk of people actually losing their lives, surely we have to see the absolute importance of bringing this practice to an end.

I want to refer to a recent report by the Independent Mental Health Services Alliance called “Breaking Down Barriers: Improving patient access and outcomes in mental health”. It says that we must prioritise something that I have argued for consistently—the introduction of comprehensive waiting time standards in mental health so that someone with a mental health problem has exactly the same right of access to treatment as anyone else. It also says that people who end up in an out-of-area placement, sometimes a long way from home, get “lost in the system”; they are almost forgotten about. They are away from the commissioners and the normal provider, and they can sometimes languish in these centres for far too long. That, again, is completely intolerable.

The report also refers to the problem of delayed discharge. It says:

“We have found that between 2013/14 and 2014/15, the average number of days of delayed discharge per month for trusts providing mental health services increased by 22.2 per cent. This indicates that delayed discharges are having an increased impact on patients’ access to appropriate care.”

In other words, if beds are clogged up by people who are ready to leave and go home or to go to another facility, but they cannot because nothing else is arranged for them, then someone else at a moment of crisis cannot get access to a bed and is shunted off, sometimes to a place a long way from home. That is a completely unacceptable practice.

The report refers to children and young people’s mental health services. The Minister will be particularly aware of the acute concern about children being shunted off, often to places hundreds of miles away from home—an intolerable practice. I know that that has happened in the south-west, where there has been a particular shortage of beds for children. A team within NHS England undertook an inquiry that came up with recommendations for eradicating that problem. The taskforce’s report, “Future In Mind”, which we published shortly before the general election, pointed to the absolute need to care for people close to home and to have better crisis support to avoid admissions where possible. Yet the practice continues, and it must be a priority for the Minister to bring it to an end.

One of the things that “Future In Mind” sought to address is the perverse incentive that exists in the system with the awful tiering of care within children’s mental health services. If a child is put into tier 4 from tier 3 because it is judged that they need more acute in-patient care, then the financial responsibility for their care is transferred to NHS England. There is therefore an incentive for local commissioners to push them into the top tier, which is precisely the opposite of what ought to be happening. We ought to be focusing our incentives on preventing deterioration of health, not shunting people into the most acute care, too often away from home. Imagine what it must be like for the parents of, say, a 14-year-old child who is taken to a unit 100 miles or 200 miles away from home. It is really shocking, and I hope that the Government will feel the need to commit to eradicating that practice as quickly as possible.

When the issue came to my attention as a Minister, I asked my officials to provide me with data to find out what was happening around the country. I was confronted by freedom of information requests by campaigning organisations and by news reports of shocking things that were happening in the system, but I had no information on which to base my own judgment. I was told by the officials that they did not collect data on the issue. The Government are operating in a complete fog, and we have to rely on campaigning organisations to make inquiries under the Freedom of Information Act 2000.

Incidentally, I urge the Minister to use what powers of persuasion he has to argue against undermining the Freedom of Information Act. At the moment, a process is under way that runs the risk of doing precisely that. It seems to me that freedom of information is a really important way of holding the Government to account.

I was faced with having no information or data on that practice, so we initiated a process to collect such data. We have now collected those data. They are still in experimental form, but they are better than nothing. The data show that there is extraordinary variation around the country. That brings me back to the point that this is about not just extra money, but good practice. It is about learning from areas of best practice. We now discover that many mental health trusts have no out-of-area placements, but they are funded in broadly the same way as those in areas that have a persistent and unacceptable problem.

There is a three-month delay before the data are published, so the latest data are those from the end of August, but 2,198 people were in out-of-area placements at that time. We are not entirely clear about whether the drift upwards is caused by the collection of more data or by a worsening of the problem. I do not want to draw the wrong conclusion from the numbers, but they certainly do not appear to be going down.

I want to raise with the Minister the issue that the data are incomplete because some private providers refuse to return data. Under their contractual dealings with the NHS, they are obliged to return those data. When I was a Minister, I raised that matter with officials and with the information centre. Surely, it is completely unacceptable. I have no difficulty with a good private provider providing a good service, but they must absolutely play by the same rules as everybody else.

[Norman Lamb]

I agree. There should be a level playing field, which there is not at present. We now have the unacceptable situation that data are incomplete because some private providers refuse to play ball. That leaves one suspicious, because if they do not provide data about how many people are held, it is impossible to hold the system to account or, indeed, to hold such private providers to account. The Minister must find a way to hold those providers to account and to ensure that they return the data they are obliged to provide.

A horrific number of people are still sent a considerable distance away from home. In August, 501 people were sent more than 50 km away from home. Surely that practice is intolerable, given what I have said about the increased risk of suicide, the fact that it does not provide therapeutic care and that it can lead to someone being confined for 10 days at enormous cost to the public purse. It seems to me that this is the most outrageous misuse of public money.

There are areas where that problem is persistently at its greatest. In August, the Devon Partnership NHS Trust had 45 people in out-of-area placements. The caveat is that we do not know precisely where responsibility lies, and whether this is a commissioning or a provider issue. However, that is the local provider, and one would normally expect such people to be in a bed provided by the local provider. The figure of 45 people means that significantly more than one person a day is shunted more than 50 km away from home, which is outrageous.

[Mr Bellingham]

Has any analysis been done of whether the families have been contacted in such cases? It is incredibly important that one strand of support for these patients is through their families. What percentage of cases involve families being informed, having given permission for the patient to be moved?

[Norman Lamb]

We do not have that information—the data are very basic—but that matter is crucial. I imagine that communications often fall down when urgent referrals to another location take place.

I would raise another issue about families. If they have to visit a loved one 50 km or 100 km from home, just imagine the cost involved. Members in the Chamber— any of us could be in this situation—can afford to visit a loved one, but many people cannot do so. That is another reason why the situation is intolerable.

--- Later in debate ---

[Alistair Burt]

Of course it is, and I share the right hon. Gentleman’s frustration. I write a lot of letters to colleagues who express concerns and I have to signpost them to the other organisations in the health sector that have responsibility for taking particular decisions. That is quite right, because local decisions ought to be local. Clinical commissioning groups or trusts need to be responsible and accountable for what they are doing. However, I have to tell the right hon. Gentleman that it is occasionally frustrating when I feel that I cannot pick up the phone and make my own inquiry. We cannot run a system in which Ministers arbitrarily pick up cases because they are the ones we know about; there has to be a structured system. When particular things come to light, I am looking at how to use my position and the authority of the Department to make sure that something has been properly gone into—even if it is somebody else’s statutory responsibility. We in this House who remain accountable for things should be able to make sure that those statutory groups, including the CCGs, have really got a grip. I am keen to pursue that.

[Mr Bellingham]

Does the Minister agree that there is something fundamentally unsatisfactory—and, indeed, wrong—about moving someone late at night unless it is absolutely necessary for medical and clinical reasons?

[Alistair Burt]

Yes. It seems very puzzling that that should be a regular practice, if it is. That should not be the case. Of course there are all sorts of different pressures on the system, and it would probably not be appropriate to say that it should never happen, but, in principle, people who are in a state of anxiety should be moved with the maximum care, at the time that is of greatest benefit to them and their health needs.

As I was saying, it is not acceptable for people to be travelling for miles when they are acutely unwell. It is also not acceptable for staff to be spending time phoning around to find beds for their patients.

Let me return briefly to the impact of social media. A couple of weeks ago, I read in a tweet from a frustrated doctor—I hope he will pick up on today’s debate—that on that particular day no bed had been available for a woman anywhere in England. Along with the hon. Member for Liverpool, Wavertree (Luciana Berger), who had raised the matter with me, I made inquiries and found that that was not technically true; beds were available. The response from the doctor was, “You may be technically correct, Minister, but it is very difficult to find them”, and the results of my inquiries suggest that that is true. We need to establish a better system of identifying beds that may be available, because that too is part of the problem. People should not be spending time looking for beds. I have an idea about that, which I shall mention later in my speech.

I had to tell the clinician that I did not think that, technically, what he had said was true. However, I recognise that for those who are in the business of finding beds for people, it should not be as difficult as it appears to be, and I want to establish what we can do to help.

We know that the need to place people out of area, away from home, family, friends and networks, is a “warning sign” of a mental health system that is under pressure, and we know that no one wants to spend scarce resources on sending people out of area. However, we cannot look at out-of-area treatments in isolation, because they are part of the mental health acute care pathway as a whole. I welcome the interim report of Nigel Crisp’s commission, which was set up to review the provision of acute in-patient psychiatric care for adults, and I look forward to reading his final report and recommendations early in the new year.

Lord Crisp’s interim report made it clear that—as I am sure the right hon. Member for North Norfolk knows—the situation is more complex than a shortage of beds. We know that there has been a long-term reduction in the number of psychiatric beds in England, but the report suggests that in many areas there would be enough beds if improvements were made to other parts of the system and integrated, community-based services were commissioned. That very point has been made this afternoon in relation to the variability of practice. The report also made it clear that the so-called bed crisis, or admissions crisis, is a problem of discharges and alternatives to admission, and can be dealt with only through changes in services and in the management of the whole system.

As the right hon. Gentleman pointed out, that can be done, as has been demonstrated in a number of local areas. Sheffield, for example, has almost entirely eliminated adult acute out-of-area treatments, and has reduced average bed occupancy to 75% by redesigning the local system, That has included investing in intensive community treatment, and working in partnership with housing. In the right hon. Gentleman’s own constituency, Norfolk and Suffolk NHS Foundation Trust has begun to reduce its historical problem of out-of-area treatments through a combination of investing in more acute adult beds and working with commissioners to develop community and crisis resolution services.

I understand that the independent Mental Health Taskforce has spent some time discussing these issues. I hope that its report, which will be published in the new year, will be an important driver for improving mental health services over the next five years, and will address many of the key issues raised in Lord Crisp’s interim report.

Health and Social Care

Lord Bellingham Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Henry Bellingham (North West Norfolk) (Con)]

It is a great pleasure, as always, to follow the right hon. Member for Cynon Valley (Ann Clwyd), who is one of the most indefatigable and courageous campaigners on health issues in the House. It is also a pleasure to congratulate the hon. Member for Central Ayrshire (Dr Whitford) on an excellent maiden speech. My great grandmother was brought up just outside Ayr, and I was christened in Symington church. I will look out for the hon. Lady when I next visit the church, because I am sure she will be a very good MP indeed. It is a particular pleasure to follow so closely my hon. Friend the Member for Vale of Clwyd (James Davies) and to congratulate him on an excellent maiden speech. To oust an incumbent is certainly a result, but to do so in such style, adding 1,200 to the Tory vote—a swing of nearly 4%—is a great achievement. I wish him well in his career.

I admire my hon. Friend the Member for Vale of Clwyd not only for making such an excellent speech, but for making it so early. When I was first elected to the House, I wanted to make my maiden speech in the debate on the Address. I asked my Whip, a young man called John Major, but was told, “You could make it during the debate, but it is high profile and you really have to get it right. You could make a 10-minute speech then, but my advice is to wait.” I therefore waited until an Adjournment debate on small businesses, for which I had an excellent 10-minute speech ready to go. Whips in those days had none of the tact and charm of the current occupants of the Whips Office, particularly my hon. Friend the Member for Croydon Central (Gavin Barwell). About 20 minutes into that debate, the Whip on duty passed me a note that read, “We’re short of speakers, so can you make it 25 minutes?” My maiden speech was therefore a disaster, unlike the two that we have heard already today.

There is a great deal in the Queen’s Speech that appeals to me. I particularly welcome those measures designed to boost enterprise and wealth creation. During the election campaign in my constituency there was a lot of focus on the NHS—I will come to that in a moment—but also on wealth creation, the private sector and small and medium-sized enterprises. I particularly welcome the full employment and welfare benefits Bill and the enterprise Bill, which will look again at some of the regulations that need to be removed from small businesses.

I was struck by a recent report from Open Europe that noted that since 2010 the EU has introduced more than 4,500 new business regulations. Some of them might be very positive, but some will impinge upon the ability of small businesses to operate flexibly and profitably. It is therefore incredibly important that the Prime Minister, when renegotiating our membership of the EU—I wish him well in that—looks at some of the social costs, particularly with regard to social and employment law. I hope that he takes his time in doing that, because I do not believe that we should be in a huge rush; it is far better to have successful negotiations that are conducted over a lengthy period than to rush into them in the way some people have recommended.

My constituency has an outstanding local foundation hospital. It unfortunately went into special measures, but it is now making really good progress. I pay tribute to the staff and the new management, who are turning it around, and to the efforts that many people are making in that regard. There are three areas that I want to flag up briefly, and I hope that the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), whom I congratulate on his appointment, will take them on board.

The first area, which has already been mentioned by my hon. Friend the Member for Totnes (Dr Wollaston), is the cost of agency staff. We have seen a boom in agencies supplying doctors and nurses to hospitals. One of the key drivers pushing up debt in many foundation hospitals is the cost of agency nurses and doctors. I have seen that in the Queen Elizabeth hospital in King’s Lynn. As my hon. Friend said, there is then a domino effect whereby hospitals find it more difficult to employ permanent staff. I was appalled to read a recent report showing the amounts of money that some of the biggest medical recruiters are making, and therefore the money that is being taken out of the NHS. It is really important that the Minister and his colleagues wrest the initiative from those expensive agencies and look carefully at a nationally negotiated framework to ensure that the NHS uses its obvious power and strong collective bargaining to sort the problem out.

The second area I want to mention is the need to make every conceivable effort to join up NHS acute care and continuing care, into which the right hon. Member for North Norfolk (Norman Lamb) put so much effort and work when he was care Minister. As he pointed out, it is not just about resources; it is about better co-ordination, more dynamic and innovative management and having a really strong partnership between the private sector, where most of the care homes and nursing homes lie, and the public sector. I am very impressed by what the Minister has said about that, and by what the Secretary of State has said. I hope that they can work together to make real progress on that.

The third area, which I heard about regularly while campaigning in my constituency, and particularly in my discussions with doctors, is the current GP contract. In my judgment, it is not just a question of the problems with care causing the crisis in A&E; it is also the fact that many people cannot see their doctor when they want to. Lynndoc is a federation of different GP practices in King’s Lynn that does outstanding work to provide out-of-hours cover. I believe that it can be done, and it really is an absolute priority.

Those three areas are crucial to ensuring that the £8 billion that has been dedicated for the next few years is properly spent. But today we heard a tale of two speeches: the Secretary of State, who was calm, statesmanlike and receptive; and the shadow Secretary of State, who was still fighting yesterday’s war and trying to weaponise the NHS. We have to move on from that and work together to make this great service an even greater success.

GP Services

Lord Bellingham Excerpts

Thursday 5th February 2015 Commons Chamber

[Derek Twigg]

The Minister makes an interesting point. At Prime Minister’s Question Time, we keep hearing the Prime Minister say, “Look how many extra GPs and nurses we have recruited,” but how long does it take to train them? I suggest that the Minister look at the figures on the number of additional GPs and nurses recruited between 2003 and 2009.

[Mr Henry Bellingham (North West Norfolk) (Con)]

What is the hon. Gentleman’s view on the last Labour Government’s decision to change GPs’ contracts to relieve them of out-of-hours cover?

[Derek Twigg]

Again, that is an interesting point. There is a perception that every GP practice provided out-of-hours cover with the GPs themselves going out to see their patients. Of course, some of them did that, but many did not. Many of them were already using locums. During my childhood, I was a particularly bad asthmatic, and most of the doctors who came out to see me were locums, not my GP. We must look at how we organise out-of-hours services, but the key thing to focus on today is that we have not got enough GPs.

--- Later in debate ---

[John Howell]

I agree that that is a very good local initiative that could be spread across general practice.

Let me give the House an example. I happened to be visiting a surgery one afternoon, so I asked the staff what the problem with access was. I was told that a good example was a lady who had come in that morning to have her plaster changed. I imaged plaster being removed from a suppurating wound, but it was actually a small plaster on her hand. She was told to go away. I think that is an abuse of a GP practice by a patient.

[Mr Bellingham]

Will my hon. Friend consider the role of pharmacies in providing more cover and more care, for example for the type of complaint he has just mentioned? Surely those people should be going to their local pharmacy, rather than their GP practice.

[John Howell]

I completely agree. If I manage to get through my speech, I will say a few words about that.

The way forward is for patients to take responsibility for their own health, but there is a basic education point that stands in the way. I have a minor condition that requires my blood pressure to be monitored. I do that myself at home, and then send the results remotely to the surgery. We then have a conversation about it remotely, hopefully by e-mail. It is ironic that the internet is increasingly used by the over-50s, but the view of GPs providing a public service stands in the way of, and even contradicts, the over-50s being able to use the internet to achieve that result.

--- Later in debate ---

[Stella Creasy]

Although I am a doctor, I am not a medical doctor, so I warn the hon. Gentleman that if he needs treatment, he should not come and see me. However, I could tell him why he has no friends—that is the sort of doctorate I have.

There are many issues and the number of single practices might be one of them. My point is that nobody has got a grip of this issue over the past couple of years, despite the fact that I, as the Member of Parliament, have raised concerns. In 2011, the complaints about access to GPs started coming in. I went to the primary care trust, but because of the reorganisation of the NHS, nobody was interested in the case that we were trying to make. The PCT said, “Wait until the CCG is organised.” I tried the new CCG, but six months after saying that it would look into the repeated complaints that I had raised, it said that this was not its issue and told me to go to NHS England.

Initially, NHS England told me that I could not raise the issues on behalf of patients because of patient confidentiality. It could not respond to any of the concerns that I was raising because they related to patient records. It then tried to say that unless the residents had complained to the GPs about GP access, it would not look into the issue, even though I had a binder full of complaints, which showed that it was a problem not just with an individual practice, but with many local practices in my local community. There was widespread concern. The problem continued and, eventually, NHS England came back to me and said, “It’s all right. We’ve spoken to the practices and they have said that if people want an appointment, they can ring up and get one.” It was a circular and deeply frustrating experience.

[Mr Bellingham]

Will the hon. Lady give way?

[Stella Creasy]

I will happily give way one last time, but then I want to get on.

[Mr Bellingham]

I understand the hon. Lady’s annoyance and frustration with her CCG and local health service. In my patch, the CCG is chaired by a GP. It has been incredibly responsive to my concerns and has worked with GP practices. I am just sorry that she has not found that in her patch.

[Stella Creasy]

I appreciate that that is the hon. Gentleman’s experience. This is precisely my point: why is nobody taking a strategic view of these issues?

I will give the hon. Gentleman an example and it goes to the heart of what the hon. Member for Henley was saying. One concern that people have raised is about missed appointments. The appointments that doctors give people do not always match the times when people need to see them. There is no recording of missed appointments because of the fragmentation of the NHS. Who should take responsibility for that?

A snapshot survey that my CCG did, possibly because of nagging from me, showed that on average 10% of appointments are missed in my local community. However, that is an average. In one surgery, 40% of appointments are missed and in another only 12% of pre-booked appointments are used. Irrespective of whether that is just because patients are missing appointments or because appointments are not at the right time, it is a waste of resources. Surely there is a public interest in having a central co-ordinating body that looks at these issues and at where there are problems in the NHS. It is a waste of money for everyone concerned. Crucially for my constituents, it means that they are not getting access to doctors, even though there may well be the facilities to see them.

Even if people can get access to a doctor, the quality of the practices in my local community is very poor. I know that other Member have raised similar concerns. That might be one reason why it is difficult to retain doctors. I have one practice that has been waiting 25 years to be rebuilt. It serves 12,000 patients. Because of the poor quality of the facilities, it cannot offer some basic services such as blood tests. It has not had central heating since January 2014. That is not an acceptable environment in which to provide a health care service.

The problems with GPs in Walthamstow are not just about the facilities. Since becoming an MP, I have worked with a group called WoWstow, which is a group of women who are fighting to get basic sexual health care services in Walthamstow, because we do not have them. When I talk about basic sexual health care services, I am talking about the provision of contraception, the provision of the coil and the provision of basic facilities to help women maintain their public health. We have doctors who refuse to prescribe such things, and then people wonder why my local area has a level of sexually transmitted diseases that is significantly worse than the national average.

There have been widespread complaints about other doctors, to the extent that the General Medical Council is involved. As far as I can see, there is little concern about how we deal with patients who are asked to go to doctors in respect of whom there are known to be concerns about the quality of care that they provide. Nobody is picking up the pieces. Nobody is gripping the issue to ensure that we do not see health care problems in my local community, which very much needs to be able to access GPs.

As my hon. Friend the Member for Halton has set out, all of this means that there are pressures on my local hospital, Whipps Cross university hospital. There are concerns about Whipps Cross itself. One resident wrote to me to say, “All I want is to be able to get an appointment for my child and not have to worry that if she or another member of my family ended up at Whipps I would have to fear for our lives, and that is not an exaggeration.” Barts Health, which runs my local hospital, is a large provider of acute services. It serves a population of 2.5 million in north-east London. The Care Quality Commission has taken enforcement action against it in the past couple of years because of the quality of care.

The CQC pointed out that if patients in my local community had access to an urgent care centre, they would be able to see somebody and it would improve the quality of care. However, I have just been told out of the blue that the commissioning process for more urgent care centres has been paused because of a lack of remaining bidders. Again, that is a separate part of the NHS from the GP surgeries and the hospitals that is also trying to deal with patients. The system is fragmented and piecemeal, and that is causing problems in a community that needs health care. Without the urgent care centres, there is a risk that many of the health care services in Walthamstow will simply collapse.

I have written to the Secretary of State about GP access. I have raised it with the CCG and NHS England. We have even organised local patients to act as mystery shoppers and go to doctors’ surgeries to ask to join their patient involvement groups. Not one of those people has been able to join a patient involvement group. That is a problem.

In 1958, Nye Bevan spoke in this place about the point of the NHS:

“Many people have died and many have suffered not because the knowledge was not there, but because they did not have access to it. To all the suffering which attends illness, there was always added the bitterness that, if the poor could have had access to the knowledge available, they might have been saved or, at least, might have been helped. It was this situation that the National Health Service was intended to put right.”—[Official Report, 30 July 1958; Vol. 592, c. 1383.]

Sixty-seven years later, the same concerns remain for a new generation of patients facing lifestyle diseases. I am making an open plea to Ministers at the Department of Health urgently to review the provision of health care in Waltham Forest. Please, let us not make early diagnosis a provision only for the rich in this country.

Special Measures Regime

Lord Bellingham Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

I am afraid that that is the difference between Government and Opposition Members. The hon. Lady says that there was denial over Jimmy Savile, but I stood at this Dispatch Box and apologised to relatives and members of the public for the mistakes relating to Jimmy Savile. I do not call that denial; I call it facing up to the past.

Of course, inspection is not the only answer, but the reason it was so wrong to abolish the expert-led inspections we used to have in social care is that the first step, if we are trying to improve standards, is at least to know where the problems are. Until we have those expert-led inspections, we will not know that. The next step is to work out how to solve the problems. We will be doing both.

[Mr Henry Bellingham (North West Norfolk) (Con)]

The Queen Elizabeth hospital in King’s Lynn serves my constituency and that of the Secretary of State’s deputy, the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb). Will the Secretary of State pay tribute to the superb acting chief executive, Manjit Obhrai, and the former acting chairman, David Dean, who have done a sterling job, along with the hard-working staff, on the hospital’s comprehensive improvement plan? When will that hospital come out of special measures, and will he pay tribute to the excellent work that has been done in the past few months?

[Mr Hunt]

I am happy to do so. The hospital has recruited 95 more nurses and nursing support staff since last July. It has appointed a director of nursing and a medical director and lead for patient safety, which strengthens clinical leadership. Some very important changes have been made, and I pay tribute to the hospital’s leadership for making that possible. I hope my hon. Friend understands that, under the new system we have set up, it is not for the Secretary of State or any Minister to say when a trust is ready to come out of special measures. We have deliberately given that judgment to an independent chief inspector, so that no one who has a vested interest or a hope that a hospital will come out of special measures, and no one who is involved in turning around a trust, is responsible for that important independent judgment. However, that means that, when hospitals come out of special measures, people can have confidence that the judgment has been correctly made.

Adult Autism Strategy

Lord Bellingham Excerpts

Wednesday 5th March 2014 Westminster Hall

[Mr Buckland]

I entirely agree. It is time that we recognise that conditions such as autism are particular disabilities that open a gateway to specialised housing. Unless we deal with that, we will carry on down the failed route of institutionalisation. We can see the logical conclusion of that in Winterbourne View and other serious examples. The Minister has a passion to deal with these issues, and I know he agrees that independent, supported living in properly tailored, properly built housing—it does not yet exist in any great measure—is what is needed for adults with autism if we are to avoid the tragedy that I and other hon. Members see week in, week out, whether we are canvassing or in surgery. We see young people sitting upstairs in the family home, without a job and they do not know what to do. They have no support, and their families are at their wit’s end in knowing what to do. We have to do better than that, and they deserve better.

On interface with agencies—I was talking about criminal justice—in many police areas, we now have autism alert cards. That system works well in Wiltshire, which is the police force area in which I live. We relaunched our autism alert card only last week. It is a simple thing: a bit of plastic with next of kin details on it. Importantly, the card tells the reader that the person carrying it has autism. That should trigger a series of events happening and make the police aware that autism is a factor. If various support services and care services are needed, they can be brought into the package and the family and the support network can also be informed about the incident or problem that the adult is having. Those simple measures can make a great difference.

[Mr Henry Bellingham (North West Norfolk) (Con)]

My hon. Friend is being incredibly generous. Where do GPs sit in all this? He has mentioned awareness and the need for different agencies to work more closely together. Does he agree that GPs should be given more training on autism at medical schools?

[Mr Buckland]

In a word, yes. GPs would welcome it and it would, at a stroke, deal with a whole range of unidentified problems. With greater awareness among general practitioners, referrals can take place. Where there are existing diagnostic services, as there are in Swindon, they can be used and, as I have mentioned, SEQOL and other organisations in other areas can get to work, using the pathways and identifying the condition.

What is next? What else is needed? I am a great believer in advocacy services, and I can see their power in some excellent local examples. The Swindon Advocacy Movement has recently had more funding to extend its remit to help people with autism and Asperger’s. It is a wonderful organisation, with a one-stop shop in the centre of Swindon that gives support to adults with learning disabilities. Its motto is that it is not there permanently to do things for people, but to empower people to help themselves. With that little bit of help, support and advocacy, lives can be changed for the better, and I see that happening through its wonderful work.

We also have Discovering Autism Spectrum Happiness, a voluntary organisation set up by a group of like-minded individuals some years ago in Swindon. It is now working from the Pinetrees community centre, offering the Swindon autism information and advice service, which is an invaluable resource. It only started last year, and it has already reached out to more than 150 individuals with autism and their families. By its estimate, there might be a couple of thousand of people in the community who have not yet been identified. Through its support work and its network, it is giving advice and empowering people with autism. I had the pleasure of visiting it only two weeks ago to talk about some of the cases that it is finding and some of the cases that are coming across my desk. There is a lot going on in local communities, but there is much more that we can do on an overall strategy to identify best practice, to knit that together in a co-ordinated and coherent way and to give other commissioning bodies and other authorities a gold standard from which they can work.

The Minister knows that I am not into lowest common denominators or prescriptive measures when it comes to this sort of thing, because I believe in localism. There has to be, however, some standard to which all commissioning bodies should work. Like adults who are neurotypical, adults with autism should not be frightened or worried to move about. If they can move to another part of the country to secure employment, they should reasonably expect that autism services in their new town or city will be of a similar standard to where they have come from. When they have a family support network, the tendency is for people with autism to stay close to home, and in many cases that is not a bad thing at all. Bearing in mind the Winterbourne View example, bringing people with a disability closer to home and to their network is a good thing, but there will be many high-functioning people with autism who want to travel, want to move about and want to take that job at the other end of the country. Why can they not do that? At the moment, there is a fear that the support network that they might enjoy in Swindon would not exist in another part of the country. That is the function that the strategy could fulfil; it is an empowerment strategy, not some prescriptive “We know what is best for you, so we will tell you what to do” strategy.

On community autism awareness, I have talked somewhat about advocacy services and information, but I want to talk about the sense of isolation that many with autism and their families feel. In a survey conducted by the National Autistic Society, 82% of adults with autism said that they have days and 42% said that they have weeks when they do not talk to anybody outside their household. Just think about that for a moment. Some 72% said that they have been bullied or discriminated against. A survey by Ambitious about Autism found that 87% of parents and carers of people with autism felt unsupported by the community. Those are stark statistics, but some of the solutions are simple. Small adjustments are all that is needed to change things. In the supermarket, staff are often not trained to know how best to deal with individuals who have autism. In the hairdressers, a few sensory adjustments would allow someone with hypersensitivity to access those facilities. The cinema at Greenbridge in Swindon regularly hosts autism-friendly screenings for children and young people, which make all the difference in the world. Parents at those screenings do not need have to have eyes in the back of their heads or worry about whether their child will be seen as naughty or misbehaving. They can relax, secure in the knowledge that everybody around them is accompanying someone with autism. Such adjustments make a huge difference in the lives of not only the individuals who have autism but their carers and families.