The National Health Service

Mike Hill Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Mike Hill (Hartlepool) (Lab)]

It is an honour to follow the hon. Member for The Wrekin (Mark Pritchard). Let me begin by praising all the healthcare workers employed by the NHS and in social care for the work that they do—including my own daughter-in-law, who recently qualified as a nurse. In the face of austerity, in difficult and arduous circumstances, with diminishing resources and never-ending cuts, they have worked tirelessly to provide the best healthcare outcomes for the people of my constituency.

As a Labour MP, I am proud to say that the best traditions of our NHS, established by a Labour Government, are alive and kicking in Hartlepool: alive because the people of the town, together with healthcare workers, campaigners and the trade unions, have kept public health and NHS provision high on the agenda, fighting to keep our local hospital, demanding improvements in GP services and protesting against attempts to water down NHS and public health provision throughout the town, and kicking because they have been swimming against the tide for far too long, with wave after wave of cuts hitting them squarely in the face and threatening to drag them under. The people of Hartlepool will have none of that.

We lost our A&E in 2010, and we have stood our ground ever since. The plan was to build housing on hospital grounds; the people said no. The plan was to run our maternity unit down; the people said no. The people stood strong and said: “Our children should have the right to be born and registered as such in their own town.” They are fiercely protective of their NHS and rightly so.

What can the people expect from the Queen’s Speech? Is it the return of A&E to Hartlepool hospital? Not a cat in hell’s chance. Will it give more money to invest and improve our hospital? No way, and no way, too, for any hospital trust across the Tees valley, where in excess of £10 million is required to cover high-risk repairs, £5 million of which is needed in my own trust of North Tees and Hartlepool.

The truth is that the pledges on NHS funding in the Queen’s Speech will have little impact on hard-pressed NHS acute services in Hartlepool, nor will they plug the gap in mental health funding, and in regard to social care the Queen’s Speech simply dodges the bullet by kicking the can down the road and fails to tackle the growing crisis in adult social care head-on. And despite a continued 2% precept being placed by the Government on council tax to cover adult social care, this is offset by a reduction of funding to our local council of almost £21 million, or 45%, since 2013-14.

The wanton, in-your-face, upfront daylight robbery of public services funding has to stop, and stop now, if we are to tackle serious health inequalities and growing social care needs in places such as Hartlepool, and the Queen’s Speech simply does not do that.

NHS Workforce: England

Mike Hill Excerpts

Wednesday 17th July 2019 Westminster Hall

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is a pleasure to serve under your chairmanship, Mrs Moon. I congratulate the hon. Members for Wolverhampton South West (Eleanor Smith), for Lincoln (Karen Lee) and for St Ives (Derek Thomas) on their eloquent speeches.

The crisis in the NHS workforce is deeply concerning. Its effects are felt nationally, locally and personally. Like others here, I want to pay tribute to the people working at every level of my national health service within the south lakes: the hospital in Kendal, Westmoreland General Hospital, and the district generals that we travel to in Barrow and in Lancaster. Of course, there are the GPs, dentists, paramedics and those providing mental health services. They do an outstanding job, but it is particularly challenging in rural areas, where we have specific problems with workforce planning and supply, which are at the heart of the problems that we are challenged by.

There are several key elements to workforce planning, including accessible and high quality training, as well as affordable training, as has just been mentioned so eloquently. Effective recruitment is another. Alongside both of those is the issue of staff retention. The Secretary of State must surely be held to account for each of those. The huge shortages in the NHS workforce are felt heavily in numerous areas of healthcare provision in the local communities in Cumbria, and I briefly want to touch on a few of them.

The provision of ambulances and ambulance crews has been hit particularly hard. It is vital that we recruit and deploy more paramedics and ambulance technicians. Rural communities such as mine suffer because of the sheer distances that ambulances have to travel to reach patients. According to the review of NHS access standards, it is the responsibility of ambulance trusts to respond to category 1 calls within seven minutes on average. That is a tall order when there are half the number of ambulances per head in the north-west of England as there are in London, despite the fact that my constituency alone is bigger than the whole of Greater London. It leaves communities living in fear for their safety and takes a serious toll on the physical and mental health of our outstanding ambulance crews. Our local paramedics and ambulance technicians are being pushed beyond their capacity. As a result, I have had an influx of local people contacting me about having to wait hours for an ambulance to arrive to give them the treatment that they so desperately need. That is why local health campaigners have been calling on the Government to deliver two new fully crewed ambulances to south Lakeland to stem the crisis and ensure the safety of the community. It is not right that people in Grasmere, Dent or Hawkshead might be an hour away from the nearest available ambulance.

We met the Minister to raise the issue a few weeks ago. He was incredibly helpful and I thank him for his time and his response. I very much welcome the commitment to procure additional emergency ambulances. I understand that as a result of our campaigns an additional £8 million has been allocated to the North West Ambulance Service. That could be good news for south Cumbria, but only if the ambulance service allocates it in the way that we have asked. Ministers should be held to account for whether the ambulances materialise.

Mental health is another element of workforce planning that I want to raise—particularly provision for children. Four years ago the Government promised a bespoke one-to-one eating disorder service for young people in Cumbria. For young people in south Cumbria that promise remains nothing more than words. The specialists have not been recruited and the service still does not exist. I should love it if the Minister would tell me exactly when we can expect our young people to have access to the service. When will the promises be kept?

I welcome the Government’s commitment to preventive healthcare, set out in the NHS long-term plan. However, again, promises are not being fulfilled. In our area, cuts to the public health budget mean that the NHS in Cumbria currently spends only £75,000 a year on tier 1 mental health preventive care for children. That works out at just 75p per child per year. Proper investment in public health would ensure enough money for a mental health professional for every school and college, if we could recruit them, keeping young people mentally healthy and making sure that problems did not become so severe further down the line. It would also ease the burden on our massively oversubscribed local child and adolescent mental health services, and relieve the pressure on our brilliant but overworked teachers.

In our area, there is a problem with people moving out of NHS provision to work privately, particularly in the delivery of dental services. More than half of adults in Cumbria have not had access to an NHS dentist in the past two years, while one in three children locally does not even have a place with an NHS dentist. Much as with ambulances, the impact of the lack of a workforce of sufficient size is felt particularly acutely in rural areas. Insufficient NHS dentistry provision has resulted in families having to make ludicrously long journeys to reach the nearest surgery with an available NHS place. Often, people are unable to make those long journeys, or to afford to make them.

[Mike Hill (Hartlepool) (Lab)]

The hon. Gentleman raises an important issue about dentistry. There are frightening figures about my constituency showing a lack of take-up of NHS dental treatment among children in particular. That is a real worry. I wonder whether it is reflected in the hon. Gentleman’s constituency and whether he agrees that we need at least to tackle NHS provision for dental treatment for young people. It is important.

[Tim Farron]

Yes, the hon. Gentleman makes an extremely important point. I am certain it is felt across the country. If it is made too difficult to get to the nearest NHS dental surgery—if that is 60 or even 100 miles away, as has been the case on occasion for constituents of mine—people go without treatment, and so do their children.

Last November I managed to secure the agreement of the commissioners to increase the value of the contracts to NHS dentists in Kendal so they could see and treat more patients. “Brilliant,” we thought, “that is really good news.” When NHS England contacted our local NHS dentists they found that not one of them was able to take up their offer. I was told that the practices were already working to capacity within the staffing resources they had available, and were reporting difficulties in recruiting additional staff. Those staff exist, by the way. They are working in the private sector. The treadmill of a contract that is unfair to patients and dentists, and not fit for purpose, keeps them out of the NHS. As the hon. Member for Hartlepool (Mike Hill) says, that hits young people particularly.

The reasons for those difficulties include a contract that pays a set amount for a particular type of treatment, regardless of the number of teeth that a dentist treats. A dentist will get paid, on average, £75 for an entire course of treatment including six fillings, three extractions and a root canal. That is not enough to cover overheads. That is a serious disincentive to people entering NHS dentistry. It hits all areas, but particularly deprived areas, and has a massive impact on the size of the workforce. According to the Department’s website, the Secretary of State for Health and Social Care is responsible for

“oversight of NHS delivery and performance”

but if he is unable or unwilling to intervene to correct such absurd commissioning we have to ask what real power he has to perform the role. That is the kind of systemic problem that adds up to the workforce crisis we have all talked about and which proper accountability would go some way to solving.

The website states that the other part of the Secretary of State’s role is

“oversight of social care policy”.

Social care policy is key to NHS workforce planning and supply in England. We all recognise that social care provision is in crisis, and that the crisis gets worse the longer we do not address it. As it grows, so does the pressure on the NHS, which is left dealing with the serious health problems of those who did not receive the routine care they needed. The Government cannot go on delaying simply because of the personal embarrassment of having failed so far. To be fair, they are not the only ones responsible. Neither are they the only ones who can come up with a solution. We need to reach across divides and look for a cross-party solution.

I have written to the Secretary of State for Housing, Communities and Local Government and to the hon. Member for Denton and Reddish (Andrew Gwynne), the shadow Secretary of State, to invite them to join me so that between us we can constructively use this deadlocked Parliament to reimagine and then redesign a social care system that could provide us with the care we might want for our parents, ourselves or, indeed, in the future, our children. I hope that we can work together to create a new deal for social care and a chance to turn this logjammed Parliament into one of the most productive in history.

The lack in the workforce has a profound impact in each of the areas I have talked about. Common themes and problems emerge: there is a lack of planning, as well as short-sightedness and a failure to invest in preventive care or to understand that providing healthcare is harder in rural areas, as are recruitment and retention. The Government must plan to overcome those specific challenges as part of their overall strategy. The Government, in not taking responsibility for the workforce crisis, are creating huge problems for generations to come. We need accountability, both for the current workforce crisis and to ensure that we invest in long-term solutions beyond the next Prime Minister, the next Government and even the next generation.

[Mike Hill (Hartlepool) (Lab)]

It is a pleasure to speak under your chairmanship, Mrs Moon. I am grateful to my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) for securing the debate. Like everyone who knows the NHS workforce, I want to pay tribute to all the people I served, including in acute services, when I was a Unison official in public sector health. Some of the stories we heard today from colleagues who used to work as nurses or as other healthcare staff took me back to those times. I have talked to many a worker, particularly in mental health, and often they are overstretched. The work is arduous and they cannot go off shift, for the safety of the patients. More importantly, at times the environment is dangerous for staff, and I know many people, particularly in acute mental health, who have been subjected to violence in the workplace purely as a consequence of understaffing and lack of resources, yet they bravely battle on to look after the patients in their care.

There is a word that one would never expect to be associated with NHS services in a commonplace way, yet it is frequently associated with the demise or semi-demise, or shutdown or partial shutdown, of NHS units. That word is “unsafe”. It has been used time and again, especially by acute trusts, to justify the stoppage of particular patient-facing functions, including accident and emergency departments. In 2016 it was reported that in 60 towns, including Hartlepool, A&E units had closed, disappeared or been downgraded. A year later, in 2017, one in six was reported to be at risk, and a further 33 units, in 23 areas in the UK, were affected.

Even today, in the Tory heartlands of Richmond and Northallerton in North Yorkshire, the same is happening at the Friarage Hospital. It is not just A&E provision that is affected but the birthing unit at University Hospital of Hartlepool, and breast screening at nearby James Cook University Hospital in Middlesbrough. They have been mothballed or put into slow decline, with one common denominator: the services were deemed unsafe due to a lack of consultants.

The recruitment and retention of consultants is vital, of course, but so too is the recruitment and retention of nurses and other staff. I mentioned the birthing unit in Hartlepool because last year the maternity centre, at which there were once hundreds of births, reached an all-time low—just three babies were delivered at the unit, with a further five home births in the town. That so alarmed the local authority that maternity provision in the town came under specific scrutiny, with a view to promoting and boosting the use of the birthing unit and improving maternity services in the locality. In fact, the chair of the council’s audit and scrutiny committee—Conservative Councillor Brenda Loynes—is on record as saying that it was

“important to encourage more people to use the Hartlepool unit to keep the service in the town.”

Yet the will of the people, and the pride that comes from having the right to be born and registered in their own town, is continually being thwarted. Only this week a constituent told me that his partner, who was four days over her due date, had recently opted to have her baby at the University Hospital of North Tees in Stockton because there was not a consultant on hand at Hartlepool, even though they are part of the same NHS foundation trust. At her midwife appointment, his partner stated that it was a shame that there was not a consultant on hand in Hartlepool, as her preferred choice was to give birth there. The reply was, “Nobody can have their babies at the birthing centre, as they haven’t got the staff to cover it—not just consultants but midwifery staff.” To the people of my town, who thought that they had seen the back of cuts to hospital services, that will be a slap in the face.

There are 40,000 nursing vacancies in the NHS in England alone, according to the Royal College of Nursing and the other unions—GMB, Unite and Unison. We stand on the brink of a crisis in our NHS. As my brother Andrew has experienced several times, surgery and appointments are cancelled, and wards and units are closed, more often than not because of staff shortages.

Let me be clear: that is not the fault of the hard-working NHS staff, who cannot and do not drop everything at the end of their shift, in the face of short staffing and in the interests of patient safety. It is not the fault of the midwives in Hartlepool, who want to provide a service out of the local hospital. It is the fault of the Government, who have failed to get a grip of the issue and ensure that there are enough health and care staff with the right skills, in the right place, at the right time to care for patients. Their strategy for the NHS has to include taking responsibility for ensuring adequate workforce planning and funding. The Secretary of State for Health and Social Care must have a clear and explicit responsibly for the growth and development of the healthcare workforce across England. Shame on the Government for not doing so and for running the NHS further into the ground.

Health and Care Professions Council: Registration Fees

Mike Hill Excerpts

Thursday 14th March 2019 Westminster Hall

[Mr Jim Cunningham (Coventry South) (Lab)]

I beg to move,

That this House has considered registration fees at the Health and Care Professions Council.

You and I have known each other a long time, Mr McCabe, but I think that this is the first time I have led a debate under your chairmanship. I hope you will show a bit of leniency, particularly to some of my hon. Friends. I thank Mr Speaker and the Chairman of Ways and Means for making provision for the debate. In actual fact, we were granted the debate at short notice; I think somebody else pulled out. Hon. Members will have to excuse me—I have a heavy cold, to say the least. I hope they can all hear me.

The debate follows on from early-day motion 2069, which I tabled last month and which condemned the Health and Care Professions Council’s unfair rise in registration fees. To date, that early-day motion has been signed by a truly cross-party group of 118 MPs, which shows the real concern across the House; it is very hard to get such a number. I hope that the debate leads to a rethink from the HCPC and the Government.

The HCPC exists to regulate health and care professionals. It sets standards, investigates complaints and keeps a register of workers in 16 different professions. Members might be interested to know what those professions are: arts therapist; biomedical scientist; chiropodist and podiatrist; clinical scientist; dietician; hearing aid dispenser; occupational therapist; operating department practitioner; orthoptist; paramedic; physiotherapist; practitioner psychologist; prosthetist and orthotist—I do not know what those are-radiographer; social worker, in England; and speech and language therapist. That covers quite a wide range, to say the least. Notably, social workers in England are still covered, despite plans to change that from 2019. Altogether, the HCPC regulates more than 360,000 professionals, 90,000 of whom are social workers.

To register, professionals have to pay an annual registration fee, which is currently £90. In autumn last year, the HCPC announced plans to raise its registration fees from £90 to £106 per year—an 18% rise. That follows a 5% rise in 2014 and a further 12.5% rise in 2015, so with the new rise fees will have risen by 40% since 2014. The HCPC argues that the rise is necessary in order to secure its financial health, giving five main reasons for the fee increase.

First, it plans to increase efforts to prevent problems before they occur. Secondly, it wants to use innovation and technology to modernise and improve services. Thirdly, it needs to address a caseload that is growing in number and complexity. Fourthly, it needs to address the impact of inflation since its last fee increase. Finally, it needs to pre-empt the transfer of social workers to a new regulatory body. While the HCPC has faced higher expenditure since 2015, these reasons cannot possibly support an 18% rise. Expenditure increased by £2.8 million in 2017-18, but £400,000 went on redundancy packages for management staff and £1.2 million went on refurbishing the HCPC head office.

The HCPC put its plans for a fee increase to its members over the winter. Responses to the consultation were damning, with 90% of respondents opposing the increase. Despite the findings of the consultation, the HCPC decided last month to impose the 18% increase. It has defended the rise by saying that its fees are lower than those of any other health and care regulator. However, other regulators are not comparable. Some cover very few members, reducing their economies of scale.

[Mike Hill (Hartlepool) (Lab)]

My hon. Friend is making an excellent speech. Of course, this issue affects not only the HCPC’s but other registrants, such as nurses, who have to register with the National Midwifery Council. Does he agree that, along with other things, such as car parking charges, low pay and no automatic incremental progression in a lot of health-related occupations—particularly for nurses—these kind of registration fee increases are just another tax on healthcare workers’ wages?

[Mr Cunningham]

In considering that, we have to remember that a lot of those workers’ salaries—for want of a better term—have in some instances been frozen since 2010, while in some instances they may have increased by 1% or 2%. With inflation at about 2% over that period, that is roughly an 18% cut in wages. Add the increased fee, and those workers are carrying a heavy burden that they should not have to carry. Adequate funding should be provided, rather than finding it by using hidden taxation methods. We all know that nurses and so forth in some of our hospitals have to pay car park charges. Given all those hidden costs, these workers are quite frankly bearing the brunt of the recession.

--- Later in debate ---

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve under you in the Chair, Mr McCabe. I was also registered with the HCPC and the preceding bodies. Although I am no longer registered, I recognise the impact this issue has on NHS staff.

There are nine different regulators in the NHS, regulating 32 different professions. They provide a very important function: this is about protecting not only the public, but health professionals themselves in the course of their practice. The regulators are there to set, maintain and raise standards and to give confidence to the public, as well as to hold a register and protect the title of a profession, so that other people cannot set up a business pretending that they hold the professional qualifications, which people across the NHS work hard for.

Increasingly, regulators also ensure continuing professional development. The most advanced programme of professional development has been put in place by the Nursing and Midwifery Council in recent times. The regulations around that ensure that registrants are compliant with continuing professional development. The function of regulators is to ensure that professionals who fail to uphold professional standards and their duty of care are called to account, so that sanction is applied where necessary and recourse is taken.

We have already heard that—thankfully—a miniscule number of professionals are taken through disciplinary processes. That is a tribute to the great professionalism across the NHS. However, such cases do occur, and it is appropriate that rigorous processes are in place so that individuals can defend their position and have recourse to justice before appropriate action is taken. To have someone practising who is not fit for practice risks the whole profession, so it is vital that that is put in place.

However, the cost of that process has escalated substantially, as hon. Members have mentioned. When I first registered as a physio, I had to pay only £17. In 2015, the last year that I was registered, there was a huge increase—from £80 to £90. The suggested increase to £106 is, quite frankly, unacceptable, particularly given the background, as set out by hon. Members, of a decade of pay regression, pension cuts and student loan repayments. In my time we had grants, so things have changed significantly.

More and more burdens are being placed on health professionals. That means that more risk is placed on health professionals. When we had adequate staffing in the NHS, mistakes were less frequent and caseloads were safer. Unfortunately, in many professions people’s caseloads are now too big. The pressure on those individuals increases.

I was formerly head of health at Unite. We focused on organisations’ duty of care. Managers in particular must say no to the organisation and argue the case for more staff, rather than increase the pressure on health professionals by making their caseloads unsafe—that would mean that managers were failing in their duty of care, in breach of their standards of professional conduct.

[Mike Hill]

I am also a former Unison official. In view of that, does my hon. Friend agree that, as my hon. Friend the Member for Heywood and Middleton (Liz McInnes) rightly pointed out, the professional bodies cover not only full-time and part-time staff, but student social workers and student nurses? They are under the same constraints.

[Rachael Maskell]

Students do have responsibility, but the registered health professional is responsible for ensuring that they are safe under their practice while they are training in their profession. Training the future workforce is an incredibly important additional function of health professionals.

The Law Commission came forward with a set of recommendations for registrant bodies in 2012. In 2019, we still have not seen the implementation of those recommendations in full. I would like the Minister to explain why that is the case. Implementing a substantial piece of work about ensuring patient safety should surely be at the forefront of the Minister’s agenda. I am interested to hear the reasons for the delay, and what plans there are to put those recommendations in place. Training programmes for health professionals need to focus on the ethics, behaviour and conduct of health professionals, if we want to see a reduction in the number of cases. Managing that risk is really important.

I want to raise a number of points to move this case forward. First, as we have heard, 38,000 people signed a petition to register their discontent with the fee rise. That cannot be ignored. These are valuable NHS workers. Their call must be heard and reflected on. However, the HCPC hardly seems to have taken that into consideration. As my hon. Friend the Member for Heywood and Middleton (Liz McInnes) said, the number of fitness-to-practise cases being taken forward—currently, 59% of them involve social workers—will disappear. Therefore, surely the registrant body’s costs will decrease. We want to hear how that will benefit health professionals.

This is a tax on professionals. Will the Minister consider funding that regulation fee through the NHS? It does not make sense for nurses, physios and speech therapists, for example, to pay a different amount. That is a tax on professionals who have put in the training and the hours, and go over and above the hours. Why can the Government not pay the amount for each health professional? More than a gesture, it is a responsibility of the NHS to ensure that its registrants, including part-time workers, have that support. I completely concur with the suggestion made by my hon. Friend the Member for Heywood and Middleton that there should be a part-time rate.

NHS 10-Year Plan

Mike Hill Excerpts

Tuesday 19th February 2019 Commons Chamber

[Mike Hill (Hartlepool) (Lab)]

A couple of weeks ago in the train station café in Hartlepool, a constituent told me that her husband had stood outside their local GP practice for two hours to get her an emergency appointment, only to be told that there were none that day. That is not an uncommon occurrence in Hartlepool, where it is becoming increasingly difficult to access a GP. That is not the fault of GPs or practices, but a consequence of placing too great a burden on GPs over running clinical commissioning groups, and a fall in GP numbers.

The Government are calling for a major expansion of primary care and community services, saying that that is central to reducing the burden on hospitals and that they intend to introduce new 24/7 rapid response teams. Although we are making great strides in Hartlepool in tackling community and primary care needs, with ambitious projects such as creating a centre of excellence in the pipeline, improving access to GPs is vital.

I welcome the pledges in the plan to improve cancer care and diagnosis, and the greater focus on childbirth. In 2017, there were only three deliveries in the midwifery unit at Hartlepool hospital, putting it under threat. Now there are positive plans to bring about a return of full maternity services, including the creation of a maternity hub, guaranteeing the right for future citizens to be born and registered in our town. A lot of cross-party and multi-agency work has gone into this, and I hope that the Government, under their 10-year plan, will pledge to support these initiatives.

Finally, I welcome the admission that we need improvements to mental health, which for far too long has been considered the Cinderella service. Particularly for people in crisis, I would like improvements to emergency and urgent care, including the creation of local walk-in centres. There is a growing need to tackle mental health problems for children and young people. The announcement of a new NHS mental health workforce dedicated to supporting children in schools has been welcomed by many, including Barnardo’s. However, the charity has concerns about early intervention and waiting times for assessment and treatment. Its chief executive, Javed Khan, has said that the Government

“does not show enough action on how as a society we are going to stop sleepwalking into a children’s mental health crisis.”

I completely agree with him.

NHS Long-term Plan

Mike Hill Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

I pay tribute to the hon. Lady’s work as chair of the all-party parliamentary group on infant feeding and inequalities. She makes a strong and passionate case for breast feeding. I do not want to let the best be the enemy of the good. The proposal she cites is a proposal from the NHS. Of course, if other such services come forward, why should we be against it? I want to be clinically led in this area, but I very much support the thrust of her argument.

[Mike Hill (Hartlepool) (Lab)]

The people of Hartlepool lost their A&E several years ago, and there is a powerful argument for the return of those services. On the subject of urgent care, what measures does the Secretary of State intend to take to help our overstretched ambulance services?

[Matt Hancock]

There is extra support for ambulance services in the plan, which is incredibly important. The targets and accountability measures for ambulances were reviewed this time last year, and we now need to make sure that the whole ambulance service gets the support it needs.

Nursing: Higher Education Investment

Mike Hill Excerpts

Wednesday 21st November 2018 Westminster Hall

[Eleanor Smith]

My hon. Friend is totally right. Again, I will address that point in my speech, but it is noted. I am glad that my hon. Friends are intervening, because it shows the importance of this debate on nursing and the lack of it. I am glad the nurses came to my hon. Friend and told her what it is like. The situation is beyond shocking. There are almost 42,000 vacant nursing posts in the national health service in England. Without policy and funding intervention, that will grow to almost 43,000 by 2023.

[Mike Hill (Hartlepool) (Lab)]

My hon. Friend is making an important speech. On the current 42,000 shortfall, does she agree that with so many European Union nationals potentially leaving the health service, that figure could well be compounded in future?

[Eleanor Smith]

That is definitely so. My hon. Friend is completely right, and with the way Brexit is going, that is understandable. People working in the NHS understand that.

Without policies and funding intervention, as I have said, the shortfall will grow to almost 43,000 by 2023, and that number is on the low side. It does not account for the one third of nurses who are due to retire in the next 10 years. It does not include nursing shortages in social care or public health. Students are being forced to plug the gaps. They should be learning, but instead they are providing care before qualification, without supervision and before they are ready—all because we do not have enough nurses. That is deeply unfair to students. It is risky for qualified nurses and it is unsafe for patients, and all because no one wants to pay for the solution.

Poor workforce planning in health and care is not new. Even in my time, policy makers pursued a boom-to-bust approach, rather than ensuring that supply was available to meet demand. Six years on from the Health and Social Care Act 2012, it is fundamentally unclear who is accountable for workforce strategy. As a result, it is not being done by anyone. Earlier this year, Health Education England held a consultation, but Professor Ian Cumming has failed to deliver a workforce strategy. We are told that it will be dealt with in the new 10-year plan. Mr Simon Stevens, the chief executive of the NHS, has been handed an additional £20.5 billion a year for the NHS by 2023-24, and it is widely understood that his long-term plan must address the extreme gaps in our nursing workforce by fixing the supply issue and providing funding.

Autism and Learning Disability Training: Healthcare Professionals

Mike Hill Excerpts

Monday 22nd October 2018 Westminster Hall

[Daniel Zeichner]

The hon. Lady is very expert on such issues. I, too, am struck by that statistic. I do not know the answer, but it is the kind of thing we need to find out about.

To conclude Paula’s statement:

“Mencap’s Death by Indifference report, published ten years ago, set out many areas of concern behind avoidable deaths, and these findings have been built on by the detailed information now coming out of the national mortality review (LeDeR) process. Mencap’s Treat me well campaign report states that 1 in 4 doctors and nurses has never had any training on learning disability. This was our experience and is unacceptable, that’s why I launched this Government petition for all doctors and nurses to receive appropriate higher level mandatory training which could have saved Oliver’s life.

There needs to be a culture change in the way people with autism and a learning disability are treated by NHS doctors and nurses. This needs to be led from the top down by doctors and the GMC. It is not acceptable that people who have autism and learning disabilities die for no other reason than health professionals have not been properly trained on how to support them and work outside the limits of the medical model. We must do everything in our power to prevent future deaths like Oliver’s from happening again.”

That is Paula McGowan’s account. She started this petition to Parliament calling for mandatory autism and learning disability training for healthcare workers. The petition now has more than 50,000 signatures, and Paula is present in the Public Gallery to watch our proceedings.

An inquest has found that the medication was not wrongly prescribed, but Oliver’s family and Mencap were very unhappy with the inquest’s conduct and conclusions. The family firmly believe that better understanding of Oliver’s autism could have prevented his death. Paula believes passionately that Oliver’s experiences should lead to change, so that a lack of understanding does not result in future deaths.

There have been other cases such as Oliver’s, and every premature death of young person who is autistic or has a learning disability is a tragedy that we should be able to avoid. When Connor Sparrowhawk—or LB, as he is known—passed away in Slade House in Oxford, his mother called for:

“An effective demonstration by the NHS to making provision for learning disabled people a complete and integral part of the health and care services provided rather than add on, ad hoc and (easily ignored) specialist provision.”

There are, sadly, many other cases. Only last week, for example, a high-profile case was in the media about Bethany, aged 17, who has autism and extreme anxiety. She, it seems, has been locked in a seclusion room for almost two years.

Last week, I met a local volunteer-led group, Caring for Cambridgeshire’s Homeless, who help homeless people in Cambridge. I was introduced to a 21-year-old man with autism and learning disabilities who is living on the streets. His safe place: behind a wheelie bin, at the back of a shop. His case is complex, but while volunteer interventions are a lifeline for that young man, he should be getting professional medical support from those trained to understand his needs.

[Mike Hill (Hartlepool) (Lab)]

Does my hon. Friend agree with my constituent, John Hobbs, whose grandson is autistic, about the need for a national database for autism and associated conditions designed for the purposes of splitting the autism spectrum into subsets?

[Daniel Zeichner]

I am not sure that I am sufficiently expert to answer that question straight off, because it is a complicated one, but it is certainly worth looking into further.

I shall explain some wider issues too. This weekend, I attended the excellent Volunteer for Cambridge event organised by Cambridge City Council and volunteer services, where I met Heather Lord from Cambridgeshire Healthwatch and Tara Forkin from Cambridgeshire Deaf Association. Tara told me, through the signer, about the experiences of deaf people in the health system. They, too, find that treatment is sometimes administered to them in ways they find baffling and frightening, too often with no one finding a way to listen to them. As Heather rightly asked, almost 25 years after the controversies around the Disability Discrimination Act 1995, which some of us still remember, why are people continuing to have to fight the battle? Why is it not yet won?

This subject is clearly highly sensitive. The examples I have given highlight heartbreaking incidents. Clearly, we must work harder and put measures in place to ensure that other people are kept safe after we as a society have failed Oliver, LB and 1,200 other avoidable deaths each year, according to research by Mencap. Even more remains to be done, however.

We must go back to the very beginning, as access to healthcare from the start can be extremely difficult for those with autism or learning disabilities. Seemingly simple tasks—to most of us—such as making an appointment over the phone, are a barrier to many of them. If we cannot make an appointment, or if we feel anxious about doing so, we are less likely to seek healthcare, even if we are experiencing symptoms that others would immediately refer to a doctor.

Some autistic people and people with learning disabilities find expressing themselves difficult, especially if that includes discussing intimate personal health issues, whether physical or mental. Some learning disabilities or types of autism make it harder for people to work out the sensations that their bodies are feeling, which can make it more difficult for them to realise that they are ill or need support. In terms of mental health, the group therapy sessions, for example, which work so well for some people, are often inaccessible to those with autism, who can feel very socially anxious.

Last week, the all-party parliamentary group on mental health, of which I am a vice chair, published its review, “Progress of the Five Year Forward View for Mental Health: On the road to parity”, which underlined the mental health inequalities that I have been discussing. That report recommends:

“Health Education England should improve development and training of frontline care staff with a specific focus on mental health, learning disability and autism so the existing workforce is supported and equipped to deliver direct care and support to those groups.”

The report explains:

“We heard that people with learning disability or autism (or both) routinely have their referrals to mental health services turned down because some services ‘do not accept referrals from that group’. Mental illness presents very differently in people with a learning disability or autism. As a result, symptoms of mental illness can be wrongly attributed to a person’s learning disability or autism meaning that this group does not receive the treatment they need for their mental health problems.”

Also, according to the report, the esteemed Baroness Hollins, a leading member of the APPG inquiry, emphasised throughout that

“services are legally obliged to implement reasonable adjustments so people with learning disability or autism or both can engage with mental health services. This doesn’t appear to be happening.”

Many doctors and nurses of course strive to understand autism and learning disabilities, and to adapt their practice to better cater for those needs, but with increased pressures on staffing and endless demands on the time of medical professionals, alongside increased demand, that will inevitably not be the case for every single individual in the NHS. We must better equip and empower our healthcare workers.

With the right training, doctors and nurses can help autistic people and those with learning disabilities feel more comfortable and, ultimately, receive better, more focused healthcare. Everyone working in the NHS will see autistic and learning-disabled people, even if unaware of it. Some of those workers could have an inaccurate or narrow view of what someone with a learning disability looks like, or of the traits of an autistic person, due to inaccurate stereotypes or unhelpful media representation of such conditions. All frontline staff, therefore, from GP receptionists to consultants in accident and emergency, should receive some evidence-led training about autism. The development of that training should be informed by autistic people and their families.

Paula McGowan has called for doctors and nurses to receive advanced training—tier 2—in autism and learning disability as soon as is reasonably practicable. She expressed to me that it must cover legislation such as the Equality Act 2010, the Mental Capacity Act 2005 and the Mental Health Act 1983, focusing on key areas such as reasonable adjustments to care, consent and best-interests decision making. She would like it to be

“mandatory that Oliver’s story should be used as a case study in all training”,

and for the training to be named after him: the Oliver McGowan mandatory training. As Members present will agree, Oliver’s story carries huge weight, and attaching his name will exemplify the training’s deserved importance.

We need to focus on supporting the health professionals who see autistic people and people with learning disabilities most often to understand the nuances of their health. The community is diverse, and some of the physical and mental health problems those people experience require responses different from those required by non-autistic or non-disabled people.

NHS Whistleblowers

Mike Hill Excerpts

Wednesday 18th July 2018 Westminster Hall

[Dr Whitford]

Obviously, I am unaware of the individual case and the rights and wrongs of it. However, a review of the cost of whistleblowing as it stands shows that having an effective system and effective law would save us money overall.

Sir Robert Francis envisaged “freedom to speak up” guardians in each trust, to whom whistleblowers could go informally to seek advice and support. Such guardians are in all trusts across England. They include a wide range of people, and the appointment system is not altogether clear or transparent. We will have to look at what kinds of staff work best, whether appointments have been appropriate, and whether whistleblower guardians can recognise, if they are clinicians—which many of them are—that there might be a conflict of interest, because the issue might be in their department. The national guardian has been in place since 2016, but her position is non-statutory and sits inside the Care Quality Commission. Her role is described on the website as “leading cultural change” rather than deciding individual cases.

Through all the publicity, there has been quite a change in atmosphere and tone. The whole issue has had a significant airing. In Scotland, we have an alert and advice line run by Public Concern at Work. It is interesting to see the changes from the second half of 2016 to the first half of 2017. The number of concerns that the hospital, or the health board as it is in Scotland, admitted immediately were valid—instead of their having to be proved, or their being put off—went from 0% to 14%. The number of those that were ignored or denied dropped by 30%, and those reported to a manager or a senior manager went up by 30%. That suggests quite a difference in practice. The numbers are quite small, but they suggest a pattern. The data showed that, naturally, the most common group to report is nurses—they are the biggest employed group within the NHS—and the most common reason was still patient safety.

The problem is that that is all still legally underpinned by the Public Interest Disclosure Act, which was passed in 1998. It was a private Member’s Bill very similar to one that had been introduced a few months before. It therefore did not have a Second Reading, and it had only one day in Committee. At the time, it definitely was ahead of what was going on elsewhere, and was a recognition of the importance of whistleblowers, but that was 20 years ago. It really is time for change.

[Mike Hill (Hartlepool) (Lab)]

Does the hon. Lady agree that workers are still put off by responses to whistleblowing allegations and, under the legislation, the threat of disciplinary action if the complaint is perceived to be malicious?

[Dr Whitford]

I utterly agree. It is important to be clear that a disclosure in the NHS, which is what we are focusing on, regarding patient safety as opposed to employment issues, which are quite separate and dealt with differently, is in the public interest. The problem is that in cases where whistleblowers have been punished and have suffered detriment, what starts as reporting becomes a bullying and harassment issue that ends up in a normal employment tribunal setting, and the original concern is not dealt with.

--- Later in debate ---

[Mike Hill (Hartlepool) (Lab)]

Thank you, Mr Davies, for allowing me to speak under your chairmanship.

I absolutely agree with the aspiration of the hon. Member for Central Ayrshire (Dr Whitford) to put in place a separate level of protection. My experience of whistleblowing comes from my experience of many years as a full-time trade union official for Unison. I remember the original PIDA being enacted, and that immediately afterwards employers were scurrying about to design internal policies to make it hard for whistleblowers even to come forward, let alone to proceed with a complaint in comfort and with protection. Many of those policies emphasised that, if the complaint were malicious, it could end with disciplinary proceedings. Certainly the policies were not favourable to the spirit of the legislation.

I agree with everything that has been said, but I must underpin my opinion that employment law must sit alongside the matter in question—there must be protections for workers. Yes, we have had the Francis review, but let us not forget the recent Gosport War Memorial Hospital inquiry, which shows that PIDA is clearly not working as a self-policing device within big employers such as the NHS.

I remember the Winterbourne View scandal. The investigation originated with a different kind of whistle- blowing, through “Panorama”, but it came out of staff concerns. The scandal not only affected how mental health patients were treated in their communities from thereon in—it exposed the difficulties of working in such an environment—but had a knock-on effect for NHS employees. From my time with the Tees, Esk and Wear Valleys mental health trust in Hartlepool, I remember the movement of workers, with patients, into localities. That was disruptive to their jobs and lives; sometimes it led to job losses, so there are consequences.

There are also difficulties with whistleblowing. Often, whistleblowers will blow the whistle at inappropriate times. For example, they might be subject to internal inquiry or a disciplinary, and if the whistleblowing comes at that point it can be seen as disruptive, even when it is not deliberately so. However, that should not deter any important review of the basis of that whistleblowing.

I agree with the hon. Member for Central Ayrshire that local proceedings should be dealt with separately, with whistleblowing dealt with centrally from an independent perspective. We are not just talking about the NHS; there has also been whistleblowing in the civil service, for example.

I hate to see victims. As a trade union activist, I have seen too many victims. Equally, I have seen too many patients let down in mental and core health. Whistleblowers can be young or old. Young people are often concerned about peer pressure. They learn about whistleblowing on the job, and they might see obvious things that more experienced people do not. People at the older end of the shift also whistleblow, for whatever reason, about important issues that are stark-staringly obvious to them. Such things must be taken seriously. We cannot go on and have more and more patient deaths on our hands because we do not have a proper structure.

I apologise to the hon. Member for Stirling (Stephen Kerr). I was interested in the APPG, but I was unable to get there. I have always been keen on the issue. We cannot have a glass-half-full or glass-half-empty situation. We have to have protections for workers, whistleblowers and patients. We cannot live our lives through television investigations, or organisations such as the Nursing and Midwifery Council saying they have fit-for-purpose policies to deal internally with such issues. Whistleblowing is a global matter of protection for all. I appreciate the opportunity to speak in this important debate.

Oral Answers to Questions

Mike Hill Excerpts

Tuesday 19th June 2018 Commons Chamber

[Stephen Barclay]

My hon. Friend rightly points to the key issue of how we bring down the £2.5 billion of agency spend. That goes to the heart of the Prime Minister’s announcement yesterday. Up-front investment in our workforce will allow us to reduce that agency cost.

[Mike Hill (Hartlepool) (Lab)]

21. Does the Secretary of State agree that the recent High Court decision on universal credit, which determined that one of my constituents with severe mental health issues was discriminated against financially for moving from one area to another, was correct? Does he agree that people with disabilities should not be penalised in such a way? Will he commit to increasing mental health budgets to ensure that such people get the support that they need in their communities post-Winterbourne?

[Mr Speaker]

Order. The question should relate to the workforce, which is the matter we are dealing with now, but never mind. I am sure that the hon. Gentleman is interested in hearing about the workforce situation.

ADHD Diagnosis and Treatment

Mike Hill Excerpts

Tuesday 15th May 2018 Westminster Hall

[Jo Platt (Leigh) (Lab/Co-op)]

I beg to move,

That this House has considered the diagnosis and treatment of ADHD.

It is a great honour to serve under your chairmanship, Mr Streeter. A few months ago the enormousness of the struggles and barriers that those with attention deficit hyperactive disorder face on a daily basis was brought to my attention by an inspirational woman who approached me in the hope that we could establish an all-party parliamentary group for ADHD. Seven months later, I proudly chair that APPG, along with the hon. Member for Faversham and Mid Kent (Helen Whately). We have held our launch and our first meeting, which was on the economic impact of ADHD, and today we have our first parliamentary debate on the diagnosis and treatment of ADHD.

That inspirational woman is Michelle Beckett, the founder and CEO of ADHD Action, an incredible charity set up to support and offer advice to people struggling with their condition. Everyone on the APPG, some of whom are here today, would agree that we would not be here today without Michelle’s work and dedication to the issue. I would therefore like to place on the record my thanks, and those of the APPG, to Michelle for the incredible work she does.

In the months since we created the APPG, I have become ever more shocked by the stories and experiences shared with us about the diagnosis and treatment process that has been letting people down. It has been doing so in three ways. The first is stigma and attitudes. That is true of mental health more generally, and I am pleased that this debate is during Mental Health Awareness Week, which is a yearly reminder of the progress yet to be made in treating mental health in parity with physical health.

Looking at societal attitudes to ADHD in particular, we see a variety of misconceptions and stigmas. ADHD is often seen as a condition that only affects boys. It is sometimes interpreted as the product of poor parenting or just excused as naughty children playing up. All those ideas are false, but the impact of those misconceptions is enormous. Children may not be offered the correct support, and adults with the condition are often undiagnosed or even unaware that they might have ADHD.

An undiagnosed child in school, without the support they need, will in all likelihood fall behind their classmates and struggle to obtain top grades. Almost half of all school exclusions involve pupils with special educational needs. That is a truly shocking statistic, and it underlines the importance of exploring further ADHD-specific policies, perhaps in the mental health Green Paper or as part of the special educational needs and disability code of practice.

[Mike Hill (Hartlepool) (Lab)]

As my hon. Friend knows, ADHD can continue into adulthood. A constituent of mine is lobbying for it to be given the recognition it deserves. Does my hon. Friend agree that ADHD should be classed as a disability for the purposes of the law, including accessing benefits?