Oral Answers to Questions

Lyn Brown Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Dunne]

I am grateful to the hon. Lady for raising some of the issues at the Pennine trust. We are well aware that it needs improvement, which is why we have buddied it up with the outstanding Salford Royal NHS Foundation Trust next door. The Salford trust is led by Sir David Dalton and the Secretary of State referred to it earlier. I will take up the matter raised by the hon. Lady directly with Sir David.

[Lyn Brown (West Ham) (Lab)]

7. What steps his Department is taking to work with community pharmacies to reduce (a) waste and (b) the cost of medicines.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

NHS England has a range of initiatives for waste and medicine cost reduction. We estimate that there is a prize of up £150 million a year to be realised across the system on waste. Community pharmacies have a significant role to play in that, partly through their existing duty to review prescriptions when repeat dispensing and partly through the separately commissioned medicine use reviews.

[Lyn Brown]

The Minister is absolutely right to say that community pharmacies have an important role to play. On 17 October, he told the House:

“We do not believe that any community pharmacies will necessarily close as a result of these cuts.”—[Official Report, 17 October 2016; Vol. 615, c. 597.]

However, the impact assessment published by his Department just two days later described a possible scenario in which 1,000 pharmacies close. Will the Minister confirm that nobody in Britain will have to travel further to get to a chemist as a result of his cuts?

[David Mowat]

The impact assessment set out an upper range, which we do not believe represents an accurate reflection of what will happen. The facts of the matter are that we need our community pharmacy network to move towards services and away from dispensing. Paying every community pharmacy in the country, or 91% of them, £25,000 just for having an establishment does not achieve—[Interruption.]

Young People’s Mental Health

Lyn Brown Excerpts

Thursday 27th October 2016 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) and the hon. Member for South Cambridgeshire (Heidi Allen) on securing this debate. I warmly congratulate, too, the clearly very talented Youth Select Committee on producing such an excellent report, which cogently highlights the need for additional and better mental health services for young people. It is a job very well done indeed.

For too long, those suffering from mental ill health have received far less care and attention than those suffering from physical ailments. Even though mental ill health accounts for 28% of the total burden of disease, it gets just 13% of the NHS budget. One in four adults is diagnosed with a mental illness at some point in their lives, but only about a quarter of those who need mental health services have access to them. Serious medical conditions are going untreated because of the disparity of esteem between physical and mental health that everybody—the Government, health professionals, patients, the voluntary sector—speaks of wishing to end. There is such a long way to go.

The consequences of our neglect of mental health services are devastating. Over a third of people with mild mental health problems and almost two thirds of those with more severe mental health problems are, in fact, unemployed—yet research shows that the vast majority of them wish to work.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

I thank my hon. Friend for giving way and congratulate the Select Committee on this report. She makes an important point about the number of people with mental health issues who are unemployed. I have been struck by the message from schools; one in my constituency told me that it was referring 40% of its pupils for mental health support. Does she agree that early intervention, as highlighted in the report, is vital? Does she recognise the work of Members of the Youth Parliament, including Tafumi Omisore in Hounslow, who raised these important issues with us?

[Lyn Brown]

Absolutely. I totally agree with my hon. Friend, and as I go through my speech I am hoping to provide an example to show how intervention is particularly important for a very young child because of the impact on the rest of the family. Early intervention can do a lot to mitigate other events and difficulties occurring in the family that might include other family members, too.

Unfortunately, tragically and outrageously, young people’s mental health services often receive less attention than adult mental health services, so that young people’s mental health services have been called the “Cinderella of Cinderella services”. In November 2014, the Health Committee found that there were

“serious and deeply ingrained problems with the commissioning and provision of services for young people’s mental health.”

Many providers reported increased waiting times and increased referral thresholds for specialist services, where patients would have to show severer symptoms to receive treatment than they would have done in the past. GPs reported feeling ill-equipped and lacking in confidence when dealing with young people’s mental health issues. The Select Committee found that early intervention programmes were

“suffering from insecure or short term funding, or being cut altogether.”

There really is no excuse for this failing. Around half of people with lifetime mental health problems experience symptoms by the age of 14, and about 75% of them before the age of 18. Catching these problems early could well lessen the severity of adult problems, possibly saving the NHS money in the long term. More importantly, I would suggest, it would reduce unnecessary suffering and enable people to live better lives.

I want to be fair to the Government, who have recognised that there is a problem. In 2014 they set up a children and young people’s mental health and wellbeing taskforce, which made a number of recommendations in its 2015 “Future in mind” report. The taskforce identified a number of problems with young people’s mental health services. The right hon. Member for North Norfolk (Norman Lamb), who was then the responsible Minister, said that there needed to be a fundamental shift in culture, with a much greater focus on prevention and early intervention.

The taskforce rightly recognised that one of the challenges facing young people’s mental health services was—unsurprisingly—funding. I was pleased when the Government responded by announcing the provision of an additional £1.4 billion of transitional funding for youth mental health services, but that additional money needs to be considered in the context of the less encouraging overall picture of mental health services funding. NHS England’s planning guidance states that all clinical commissioning groups must increase their spending on mental health services by at least as much as their overall budget increases. However, there have been warnings from organisations including mental health trusts that mental health funding is not properly ring-fenced, and that NHS England’s target is being missed.

Let me again follow in the footsteps of my hon. Friend the Member for Dulwich and West Norwood. We know from the responses to a series of freedom of information requests from my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) that more than 50% of CCGs intend to spend a smaller proportion of their budgets on mental health in 2016-17. That clearly demonstrates that what the Government tried to do has failed, and that that target is being missed as well.

[Mike Wood (Dudley South) (Con)]

The hon. Lady is making some important points. She referred to the taskforce’s “Future in mind” report. According to one of its startling statistics, only between 25% and 35% of young people with diagnosable mental health conditions access support. Does that not underline the need for much better training and much more awareness among both teachers and GPs, in respect of early identification as well as early intervention?

[Lyn Brown]

We need early identification and we need early intervention, but we also need the funds to ensure that there are services to which people can be referred. That is the rub of this whole debate. There does not seem to be the necessary funding at any point in the journey of young people who need help, whether in the form of awareness, intervention or services.

I have been looking into the good work done in my borough, the London borough of Newham. Even in these difficult times, it is increasing its mental health spending in both absolute and relative terms, and its children’s mental health services received an “outstanding” rating from the Care Quality Commission. I wanted to find out how we could improve young people’s mental health provision, and to learn about the challenges that an “outstanding” local provider continued to face in its fight for better services. Professionals in Newham recognise that a good young people’s mental health service does not just help those who have already developed severe and serious conditions, but provides early intervention and preventive programmes so that problems can be dealt with at source.

[Seema Malhotra]

Is it not important for young people’s mental health services to consider the needs of parents as well? I was struck by a recent case in which the parents did not understand where the issues had come from and could not identify what they were, and felt unable to understand how best to help their child.

[Lyn Brown]

My hon. Friend is right. The family is often key to the provision of the support that a young person needs, but a family may itself need intervention to gain the support that it needs to lead a mentally healthy life.

The national lottery funded a programme in Newham called HeadStart, which helps 10 to 16-year-olds, particularly in schools. It trains teachers in secondary schools to develop programmes that help to build resilience among their pupils. It also provides children directly with mentoring schemes so that they can learn from each other about how to manage mental health issues—it is peer-to-peer learning—and works directly with parents to show them how they can work through mental health issues with their children. Unfortunately, the scheme relies on lottery money rather than core funding, which means that its future as a core service cannot be guaranteed. It is often difficult to obtain the necessary proof that would persuade funders—including the Government—that core funding should continue, because the timescale is often not big enough to be persuasive.

Newham would love to run more services directly in the community, and more integrated services, because it knows that they make a real difference to people’s lives. M, aged two, and her baby brother T, just seven weeks old, were referred by a perinatal psychiatrist, who was helping their mother to deal with chronic mental ill health. M was still frequently breastfed, and showed a very insecure attachment to her mum. Her anxious, and therefore sometimes controlling, behaviour was making it difficult for her mum to wean her and to attend to the needs of the new baby, who was being bottle-fed. M’s speech was also delayed.

Following assessment, the family were offered parent-infant psychotherapy, which enabled them to reflect on the needs of both children, and gradually to help M to become more independent of her mum. At the same time, T was able to have more appropriate attention from his mum as the baby of the family. I am pleased to say that, following that intervention, M is more confident and her speech is developing. She sleeps in her own room, and has settled well into nursery. That is an example of our physical and mental health services working in tandem to improve real lives.

J was a 17-year-old who had been arrested and charged with possession of a weapon and affray. He had a history of violence and non-engagement with services. During the course of his referral to a youth offending team, the team became concerned about his mental health, and referred him directly to a child and adolescent mental health services specialist for an urgent examination. During that assessment, J was having suicidal thoughts, was highly anxious, and showed quite severe symptoms of obsessive-compulsive disorder as well as softer symptoms of attention deficit hyperactivity disorder.

The youth offending team nurse arranged for J to have urgent psychiatric treatment. He was put on medication for his anxiety, with an accompanying course of cognitive behavioural therapy for his obsessive-compulsive disorder. He will also be assessed for ADHD in the longer term once his more acute symptoms abate. I am pleased to report that J has not offended since he has engaged with the mental health services offered through the youth offenders team. That shows that integrated services are better for individuals, and better for the whole community.

Those are just a few of the stories that I have been told, but I believe that there are enormous challenges to the provision of community-based and fully integrated services. I am told that Newham would love to run services directly from general practices, but they cannot currently do so because they do not have the necessary resources. With the current staffing levels it would not be efficient, because staff would spend as much time travelling to and from general practices as they would spend helping patients.

Health professionals acknowledge that early intervention work often increases rather than reduces workload in the short term. Professionals in Newham worry that they simply will not be able to deliver the clinical hours that are necessary to help more patients. Over 50% of patients in Newham already have to wait for more than five weeks to see a specialist, and that figure can only increase when further cases are uncovered without corresponding additional resources.

Some well integrated and community-based mental health services are delivered in Newham and, I am sure, throughout the country, but if we want to preserve and expand those programmes, we must be aware that they need stable and long-term funding. A good place to start would be ensuring that money designed for mental health services actually finds its way to the front line.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) and my hon. Friend the Member for South Cambridgeshire (Heidi Allen) for initiating this debate on the Youth Parliament Select Committee report on young people’s mental health. I want to add my voice to those from both sides of the House in paying tribute to the Youth Select Committee for its powerful report—it is an important and timely intervention. As my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) said, Rhys Hart was, by all accounts, a remarkably effective Chair, and the 10 members were dedicated and focused. They won the admiration of the House of Commons staff who were involved, and they made particular mention of that to me before this debate.

The hon. Member for Ilford North (Wes Streeting) demonstrated quite clearly that he is an elected president of the BYC, with his particularly eloquent speech. He is right that we should thank those young people who have had the courage to speak up on their mental health experiences and opinions, and who have allowed us to refer to them today, because the value of those first-hand stories in this Chamber cannot be overestimated.

I would like to make a particular point of thanking the constituents of my hon. Friend the Member for High Peak (Andrew Bingham), Lucy Boardman and Martha Banks Thompson, and my own Youth Parliament representatives, Tara Paxton-Doggett and Rowan Ibbotson, who spoke to me about the mental health campaign. A number of colleagues have spoken about the impact of meeting the Youth Parliament representatives. As has been said today, what is important now is to prove that we have not just heard them; we have listened to them, and we are taking action on their words. That is why this has been such a moving and necessary debate.

Members have shared some very personal experiences of mental health and the services and support that they and their constituents have received. All of us will know the cases that haunt us. All of us know that we need to do better. As colleagues have said, over half of all mental ill health starts before the age of 14, and 75% has developed by 18. We know the distress that mental health problems cause to individuals and all those who care for them, and we know that the earlier we intervene, the better.

Children’s and young people’s mental health is a priority for this Government. Not only has the Health Secretary made it his personal priority, but so has the Prime Minister. It is time for a step change in the way that we deliver mental health services in the UK, and we are determined to deliver that. But we must not underestimate or under-sell some of the progress that has already been made, because that is thanks largely to the efforts of dedicated NHS staff, stakeholders, voluntary services and others. We have heard some success stories today, and it is important that we praise those involved for the hard work that they do in the face of great challenges.

We agree with recommendation 3 that funding needs to increase, as many colleagues have said. That is why we have increased investment in children’s mental health, with an additional £l.4 billion. While we do believe that it is right that local CCGs, led by clinicians, are best placed to prioritise their spending to meet the needs of local populations, we have been clear that this money is provided for mental health services, and we are requiring CCGs to increase their spending year on year.

[Lyn Brown]

Has the Minister considered the request from my local mental health providers that the Government consider ring-fencing the money for mental health so that it gets passed to the frontline?

[Nicola Blackwood]

I was attempting to deal with that point, but obviously not being very clear. As I said, we have been listening to these requests. We are looking very closely at how effectively the money is getting to the frontline, but at the moment we still believe that local clinicians are best placed to decide how to target these services. However, we have put in place a requirement for CCGs to increase spending on mental health year on year. We are also very clear that STPs must reflect the NHS mandate, which says:

“We expect NHS England to strive to reduce the health gap between people with mental health problems, learning disabilities and autism and the population as a whole”.

That will require great strides to be made in improving care.

[Lyn Brown]

This is happening in Newham, but not elsewhere. How long is the Minister going to wait for it to happen elsewhere before taking action?

[Nicola Blackwood]

One of the ways in which we are ensuring that money reaches the frontline is through driving accountability through transparency. Mental health services have lagged behind the rest of the NHS in terms of data and our being able to track performance. That is why the NHS will shortly publish the mental health dashboard, which will show not only performance but planned and actual spend on mental health. This is real progress.

National Arthritis Week

Lyn Brown Excerpts

Thursday 20th October 2016 Westminster Hall

[Lyn Brown (West Ham) (Lab)]

I thank the hon. Member for Strangford (Jim Shannon) for securing this important debate, and for his excellent contribution. I also thank the charities, such as Arthritis Research UK, that work every day to reduce the suffering brought about by joint disorders.

Last week was National Arthritis Week. The pain of arthritis is often invisible. Trying to explain its constant, chaotic pain to someone who has not lived with it can be very hard. A survey conducted by Arthritis Research UK found that 28% of women with arthritis feel that people do not really understand the pain they face. Despite trying to talk about it, they feel lonely with the disease. That is why today’s debate is so important. By talking about arthritis in this place, we can begin to tell people that they are not alone.

I want to do that in a literal sense, by sharing my experiences of arthritis. In March 2015, we were two months away from a general election, which, as Members on both sides of the House know, is a difficult, stressful and busy time to be a politician. As part of the shadow ministerial team, I was driving up and down the country with my tiny dog Cara in tow, visiting fire stations and sharing Labour’s plans for the future of the fire service. It should have been an exciting spring, sharing a vision that I was passionate about, and introducing my little four-legged friend to a bunch of soppy but very brave firefighters. However, it was made difficult as I had been experiencing mobility problems for quite a while, and it was not unusual for me to be in constant pain and experiencing stiffness. However, until that point I had been able to fight through. I had not considered that I had a condition.

In March, I finally hit a brick wall. I felt completely and utterly drained of energy and could barely walk more than a few steps. I had to drag myself up the stairs of my house by pulling on the bannister. I was unable to stand at street stalls for any length of time, or go canvassing. I contacted voters only on the phone, or at meetings where I could be completely sedentary. I needed help putting on my bra. I felt humiliated, embarrassed and a complete and utter failure. At the worst, I was struggling to stay awake for more than six hours a day. It can be imagined what that did to my mental health. The stress of not being able to fight that election on my own terms was overwhelming. The tiredness and pain were looked after by a specialist, but throughout that period I had no idea whatever of what the problem was. At times like that, the internet is not a best friend. My imagination was in overdrive. Only the support of good friends, comrades, my wonderful husband and my family got me through that election.

Let me be clear. I do not want to come across as some kind of stoic hero. I am not. I cried, mainly in my doctor’s surgery as I was trying to get some answers. The staff must have thought I was completely wet. I found it really difficult to cope with the condition and the demands of work at that time. I know that many people have that feeling, and it is little wonder that musculoskeletal conditions account for one in five working days lost to ill health in the UK.

Despite being referred to my arthritis service in November 2014, it was early May 2015 before I was finally diagnosed with seronegative inflammatory arthritis. I now know that fatigue is very common among sufferers of arthritis due to pain, stress and sleep disturbance. More specifically—this is not very well known out there—fatigue is a symptom of inflammatory arthritis. Chemicals called cytokines are found in the inflamed tissues and cause extreme fatigue.

At that point I was put on a course of methotrexate, which thankfully caused the aggressive nature of the condition to begin to recede, but it was still quite aggressive, and I needed additional medication to get me to where I am now, taking methotrexate and injecting myself every fortnight with CIMZIA, a biological injectable medicine. The pain and restrictive movement have now subsided considerably. A number of colleagues have told me as I walk around the House that I seem to be doing much better, and I am.

When I first met my arthritis specialist, she asked me what my goals were. I said I wanted to be able to walk Cara again, to wear heels and to play tennis, which would be some feat as I have never played tennis before. She laughed and said, “Let’s keep this realistic and start with walking the dog.” I am happy to say that with the support of the NHS I can now walk Cara for over an hour, almost entirely pain-free. At Christmas last year, I bought a pair of blue polka dot shoes as an incentive and a symbol of hope. I have worn them twice and, although they are not as high as those of the Prime Minister, or indeed our former shadow Chief Whip, my right hon. Friend the Member for Doncaster Central (Dame Rosie Winterton), they are a symbol of the progress I am making. What is more, I have just enrolled on a course of tennis lessons, which I will start in March next year, two years after I hit that dreaded wall.

I have had good treatment, advice and support, and I thank my doctors for that from the bottom of my heart. Ten million people in the UK suffer the pain of arthritis and not all are as lucky as I have been. Moreover, I am told that with an ageing population and rising physical inactivity, the number of people living with arthritis will rise. We must make sure that every patient has access to excellent treatment. Due to the high cost of the drugs and the guidelines of the National Institute for Health and Care Excellence, most patients have to wait at least a year before they can access the transformative biologics that have made such a huge difference to my life. I had to wait just over a year, and that year was hard.

The wait means that we are not controlling the condition at an early stage or enabling patients to stay active, independent and in employment. Surely this wait is not cost-effective to industry and the economy. I know that this is ultimately an issue for NICE, but making these drugs more widely available will transform arthritis care for many, as it has done for me. Let us be honest: there are problems with traditional treatments. Although methotrexate has been really important for me, it can have long-term negative effects on the liver, but coming off it is certainly not an option for me at the moment. I urge the Government to support research on the long-term effects of existing drugs, and to continue to support vital research into new treatments and life-saving drugs, so that we can help people to live pain-free into old age.

I will be positive: there have been substantial breakthroughs in arthritis treatment as a result of research funded by Arthritis Research UK. They include treatment for rheumatoid and inflammatory arthritis, and treatment to prevent miscarriages in women suffering from antiphospholipid syndrome, which again is something I have. If only I had known a couple of decades earlier.

World-leading scientists, working in British institutions, such as Leeds, Birmingham and Keele Universities, the Kennedy Institute at Oxford, and St Mary's hospital, London, developed these treatments. The biological treatments I am on have been developed here in the UK. We should be so proud of these achievements, but we must make sure that our medical research sector remains at the cutting edge. Now more than ever, the UK’s excellence in medical research is under threat. Many of us warned before the EU referendum that funding for medical research would be hit if we voted to leave. Vicky Forster, a researcher, wrote in The Guardian:

“many scientific disciplines will lose EU funding post-Brexit”.

That is certainly the case with arthritis.

Figures provided by Arthritis Research UK show that between 2011 and 2015 the EU contributed over £2.5 million to its projects. Those researchers have gone on to secure more than £18 million of European funding to support the next stage of their work. It should be a priority for the Government to maintain our world-leading medical research sector. To do this, they need to ensure that overall investment in UK science and research is protected and grown in the longer term.

The risk to research posed by Brexit does not stop at funding. Sir Paul Nurse, director of the Francis Crick Institute, said:

“Science thrives on the permeability of ideas and people and flourishes in environments that pool intelligence, minimise barriers, and are open to free exchange and collaboration.”

Leaving the European Union threatens this melting pot of ideas. In 2014-15, Arthritis Research UK committed more than £30 million to research that was hosted in the UK, but had collaborators in 13 European Union countries. If the Government want to make sure that our medical research sector remains as vibrant and as successful as it is, it is important to maintain the current ease with which those involved in medical research are able to travel and work across the EU and the UK.

We should be truly ambitious as a country and aim to expand arthritis research and medical research more generally, not merely preserve what we have. I have been told that structures need to be in place to encourage our NHS clinicians to participate in research. At the moment, this is not possible due to the demands on the NHS and a medical culture that puts research second.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I commend my hon. Friend on making this excellent debate so moving. She shows how important this issue is. She is a living, breathing example of why research is so necessary. She looks 10 years younger than she did last year.

[Lyn Brown]

rose—

[Mr Betts in the Chair]

I say to the hon. Lady that four other hon. Members want to speak, and there are only 20 minutes left.

--- Later in debate ---

[Lyn Brown]

In conclusion, Mr Betts, I hope that sharing my experience today has helped to play a small part in letting people who live with arthritis know that they are not alone. I was lucky to have good treatment. I can now walk Cara, wear heels and look forward to playing tennis. I want the Government to make sure that the UK remains a world leader in medical research, so that we continue to find ground-breaking treatments and more of the 10 million people living with arthritis can live their lives relatively pain-free.

[Several hon. Members rose—]

Defending Public Services

Lyn Brown Excerpts

Monday 23rd May 2016 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

Each year, the Government put before Parliament their expenditure programme, the Budget, and their legislative programme, the Queen’s Speech. These two moments in the parliamentary calendar are meant to encapsulate what the Government are all about, what they will do and how the country will change. Ministers like to make grand claims on the merits of their programmes, and it is our duty to detach the cheerleading and scrutinise the reality of what is being said.

The scrutiny of the March Budget saw the Government’s triumphalist claims fall apart under the weight of reality. Debt forecasts are up, growth is down, and public services are continuing to be chipped away, with inner-city constituencies such as mine hit the hardest. We saw little ambition to enable the fifth largest economy in the world to work for ordinary people, or any ambition truly to invest in our futures.

Two months on from the Budget, the new legislative programme is now before us. It comes with more triumphalist claims about life chances, but in reality those claims mask a Government coming apart at the seams. We know the Prime Minister’s eye is on Europe, and his potential successors are sizing up his job. It is a Tory Game of Thrones. The White Walkers are out to get him, but before we feel sorry for this beleaguered Prime Minister struggling to keep Britain in the EU, let us remember that it is his weakness before his party and his MPs that has brought us to the brink of an exit from Europe—an exit that would be disastrous for our country.

Let us look at the Queen’s Speech. It is possible that not everything in it will be bad. It is possible that the lifetime savings Bill is a positive development, but we cannot be sure without seeing the detail. There is a lot more that is not good for Britain and will exacerbate the public service crisis. Above all, there is a glaring gap, which is a lack of purpose and a lack of direction. The programme does not even attempt to tackle the country’s many challenges, which include: a growing housing crisis with a need for many more social, intermediate and affordable homes; an ageing population and health inequalities; a skills deficit and productivity gap that contribute to chronic low growth; and an air pollution crisis in our capital and, as I understand it, elsewhere.

Ministers claim that the programme is about life chances and a one nation approach, but let us look at what is happening. There is a growing gap in life chances across the country. The Government’s own Social Mobility and Child Poverty Commission says:

“There is a gulf between today’s divided Britain and the ‘one nation’ the Prime Minister desires to lead.”

The commission says there is

“a growing social divide by income and by class.”

Wealth inequality has risen for the first time in almost a decade, says that deeply socialist paper, the Financial Times. The Institute for Fiscal Studies says two thirds of children in poverty live in working households, up from just over half in five years. The number of children living in absolute poverty, after housing costs, has risen by 500,000. Public services are under ever more pressure, and things are getting markedly worse than they were in 2010.

NHS waiting times in England are longer, with more than 3.5 million people on waiting lists. A&E has seen the worst performance figures on record, with patients waiting longer to be seen. There are also longer waiting times to see a GP. Cuts to older people’s care have seen delayed discharges from hospitals reaching a record high. Cuts to nurse training places have led to staff shortages, and also created a massive financial hole as agency staff have had to be hired to cover the vacancies.

There are fewer police and fewer firefighters. Social services are under strain, and social worker vacancies are on the rise. Sure Start centres have closed. Teachers and doctors are leaving the professions. Museums and libraries have been decimated, leaving children and families without basic educational resources to supplement their schooling. House building is at its lowest since the 1920s, and homelessness in London has leapt 80% since 2010. These are not just figures, but personal stories of anguish. We are seeing a real impact on lives, on jobs, and, ultimately, on life chances. That is the real story of Britain under Conservative rule.

I must praise the valiant efforts of councils, especially Labour councils, to try to keep things running. They are innovating, but with the financial squeeze—a 25% cut in budget during the last Parliament and an 8% cut set for this one—and the policies of this Government, it is becoming ever more difficult to do so. That is the rub: the Government have the wrong priorities. Who supports what is happening in the NHS—the unnecessary reorganisation and the attack on junior doctors? It is certainly not the patients or NHS staff. The NHS is a prized national asset and provider of collective health security. The Government’s approach is more about the prejudices of the former Health Secretary and the bunker mentality of his successor. I am glad that there has been some backing down, but it is simply not enough.

Who supports the Government’s plans for the BBC? Looking at my postbag, it does not seem to be the licence fee payers, the actors or the programme makers. What benefit is it to Britain to run down the BBC, a prized national asset with a global reputation? The action seems to be more about the prejudices of the Secretary of State for Culture, Media and Sport. There has been a backing down, but it is not enough.

Who supports the forced academisation of all schools? It is not the teachers, the parents, the pupils, or even the Tory councils. What does it solve to force good schools to concentrate on unnecessary reorganisation? It is more about prejudices relating to state schools. There is little consideration of the real issues of falling school budgets, chronic teacher shortages, not enough good school places and children being left to fall behind. There has been another backing down on academisation, but why the need for so many U-turns, and why is the Bill even in the Queen’s speech? Those are just some examples of the wrong priorities; there are many more.

A long time ago, the Prime Minister said:

“We will trust the professionals.”

How little we hear of that now. The Government’s approach is riven with contradictions. The devolution agenda offers a real opportunity for improved services. I am talking about the opportunity to bring services together in localities and to use new technologies and ways of delivery. We also have new leadership. I am delighted that Sadiq Khan was elected Mayor in London and Marvin Rees in Bristol. There is a real opportunity there, but devolution is going hand in hand with a raft of Government cuts. It is the political interference that is having a lasting effect. The Government are driving the destruction of the sense of public value, public service, and public assets and the principles of collaboration and excellence. I plead with Ministers and Government Members to be a little more honest. The right hon. Member for Chingford and Woodford Green (Mr Duncan Smith), freed from the shackles of Cabinet responsibility, admitted when he resigned that there is a lack of fairness and compassion. He said that the disabled will be impacted by the Government’s policies, which have been

“enacted in order to meet the fiscal self-imposed restraints that I believe are more and more perceived as distinctly political rather than in the national economic interest.”

This Queen’s Speech is not about the challenges that are facing Britain. It is not an honest conversation about how public services can be improved and reshaped to meet the needs of all of us in the 21st century. Sadly, it is a missed opportunity from a Prime Minister who is running out of time to prove that he can leave a positive legacy for our public services and indeed for our country.

Junior Doctors’ Contracts

Lyn Brown Excerpts

Wednesday 28th October 2015 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

Countless junior doctors have been in touch with me to say that they are worried and in despair about the Government’s threat to impose an unfair contract on them. They tell me that the dangerously long hours that the contract will introduce will be a threat to patient safety. Doctors tell me that rostered hours are not a realistic gauge of total working hours, and that reducing them will not prevent dangerous increases in working time.

Sofia, an anaesthetist in my constituency, says:

“A ‘normal’ rostered day starts at 7.45am and finishes at 5.45pm. In reality there is no such thing as a ‘normal’ day, because the clock strikes 5.45pm and it is impossible to walk out the door with an operation ongoing.”

Doctors like Sofia are content to work longer hours out of a sense of duty, but they are deeply concerned by plans to remove the financial penalties placed on hospitals to prevent dangerously long hours. She describes the Health Secretary’s assurances as follows:

“It’s a bit like trying to stop speeding on a busy road by lowering the speed limit, but at the same time getting rid of all the speed cameras, police and speeding fines.”

What does all this mean for patient safety? I was contacted by another doctor, Keir, a paediatrician in a neonatal intensive care unit in West Ham. He cannot see how his team could be spread more thinly during the week in order to provide more doctors on Saturdays. He is rightly concerned that doctors would be at risk of exhaustion. He says:

“High intensity specialties are particularly affected from a safety point of view. You don’t want any delay putting a three-month premature baby on life support. Putting in a breathing tube, getting a tiny line into tiny veins—all require skill and concentration. Any tiredness affects the swiftness and accuracy of these procedures.”

Doctors like Keir are aghast at what the Government are telling them.

Doctors are also deeply disheartened by the Government’s handling of the new contracts. One doctor, Simi, has told me:

“The mood is grim in hospital at the moment. We feel under-appreciated and undervalued. We are not being misled by the BMA. We can read the facts and analyse them for ourselves.”

Whatever the Health Secretary has said today, it is evident that some doctors will lose out financially. This uncertainty over pay is causing anxiety. Sofia says:

“Come August 2016, I have no idea how much I will be paid, whether I will be able to afford to pay my bills or even spend time with my children.”

I agree with Oliver, another West Ham doctor, who says:

“Not one doctor should be taking home less pay than they do now.”

This will have serious consequences for staff retention. Doctors are making plans to leave the NHS. Nick, a medical student in West Ham, says:

“I studied medicine to become not just a doctor but an NHS doctor. Under the proposed contract, I’ll be left in the sad situation of being forced elsewhere.”

That will be this Health Secretary’s legacy. Kirsty, a histopathologist, says:

“The health secretary has been nothing but belittling and demeaning. He has suggested we have lost our sense of vocation. Imposing a contract on us and treating us like children rather than professionals is so wearing.”

We trust these doctors with our lives and with our loved ones. Our NHS staff are truly phenomenal. They deserve nothing but the utmost respect, and they certainly do not deserve to have an unfair, unjust contract imposed upon them. The people in this country love the NHS. For their sake, the Government must put forward fair proposals, withdraw the threat of contract imposition and return to negotiations with the BMA.