Hospice Funding

Munira Wilson Excerpts

Monday 22nd April 2024 Commons Chamber

[Sally-Ann Hart]

I do, and I will be coming to that a little later.

The future of end of life care is uncertain, as increasing costs and demands are putting huge pressures on hospices and care providers. When it comes to the debate on assisted suicide, it is important that people feel confident that their end of life care will protect them from pain and suffering.

Certainly, we need increased funding. More resources are needed for end of life care services, including hospices, home care and palliative care teams. St Michael’s Hospice, for example, costs around £7 million a year to run and it receives about £2 million a year from the integrated care board and the remaining £5 million comes from the community in various forms. Like all hospices, St Michael’s is heavily dependent on the generosity of local individuals, companies, groups and trusts. This funding model is uncertain and unsustainable and places hospices under considerable strain.

[Munira Wilson (Twickenham) (LD)]

I thank the hon. Lady for giving way and congratulate her on this important debate. On the point that the hon. Member for Brent North (Barry Gardiner) made about children’s hospices, I have the fantastic Shooting Star children’s hospice in Hampton in my constituency, which serves a wide catchment area. The hon. Lady mentioned the statutory duty, introduced by the Government, on ICBs to commission and fund palliative care, but the problem is that there is such huge variability. Surrey Heartlands, which is one of the ICBs that Shooting Star serves, spends only a paltry £39 per child, even though the average should be about £151, and other ICBs will not even disclose the amount. Does she agree that we need multi-year contracts with ICBs to serve these hospices?

[Sally-Ann Hart]

I agree, and will come to that later in my speech.

Demelza receives just 10% of its income from the children’s hospice grant, which ends in March 2025, and just 4% of its income from spot purchases, so 86% of its income must come from fundraising. I am concerned that neither the UK Government nor NHS England has set out whether the children’s hospice grant, which is worth £25 million, will continue beyond 2024-25. The grant is a vital source of funding for children’s hospices. Dependence on the generosity of members of the public to pay for vital healthcare would not be tolerated in other core areas of healthcare such as maternity services, cancer care or A&E. Hospices are the only statutory service that relies on fundraising to keep going, despite end of life care being an essential service that so many of us will need.

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[Bambos Charalambous (Enfield, Southgate) (Lab)]

I thank the hon. Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) for securing this important debate.

Hospices do incredible work. In communities across the country, they hundreds of thousands of people every year with essential palliative and end of life care. The services that hospices deliver are absolutely crucial to improving the quality of life for people in their final weeks and days, helping to provide a dignified, comfortable and compassionate end of life. That support is vital not just to people at the end of their lives, but to their family and friends. End of life care impacts not just the patient but all their loved ones, and the specialist support that hospices provide patients in their final stages of life, and their families who are watching them pass away without suffering or pain, is immeasurable. It is why hospices are so important.

In my Enfield, Southgate constituency, we are lucky to have a facility of the incredible North London Hospice, which has been caring for people since 1984. Its health and wellbeing centre in Barrowell Green helps to enable the best of life at the end of life for people across the boroughs of Enfield, Haringey and Barnet, providing tailored care, including physical, emotional, spiritual, wellbeing and bereavement support for patients, friends, carers and loved ones. I must also mention those in the wonderful North London Hospice photography club, who support each other and take amazing pictures, which they sell to raise funds for the hospice.

I remember hearing from a constituent of mine, Joy Watkins, who was receiving care and support at the hospice. Joy has sadly now passed away, but her words about the importance of the hospice and the care that she received were incredibly moving. Joy spoke about going to something called a death café—an informal space for people to talk about end of life, share their concerns and listen of others express their thoughts, hopes and experiences of death. She said that going to the death café enabled her to make choices about the end of her life. She could make choices about who to spend time with and about the finances that she would make use of at the end of her life. It transformed the way in which she viewed and handled the end of her life.

The way in which we talk about and approach dying matters, and Joy’s words have really stuck with me. Indeed, they were one of the reasons I introduced my private Member’s Bill—the Terminal Illness (Provision of Palliative Care and Support for Carers) Bill—back in 2018. Next month, Hospice UK will be promoting its campaign for Dying Matters Awareness Week, and I look forward to supporting its efforts on that important initiative. Honest and timely conversations about death and dying are essential to good end of life care, but barriers including lack of confidence, taboos around discussing death, and confusion about who should be having these conversations all too often mean that patients, carers and families may not understand what is happening or get all the information and support that they need. That is where hospices and their brilliant staff come in. More recently, a close family member of mine received support from North London Hospice, and although Gabby sadly passed away, I am so grateful for the hospice’s specialist care.

Yesterday I and about a dozen hon. Members ran the London marathon. I was proud to do so to raise money for North London Hospice. When pounding the streets of London in such a wonderful festival of community yesterday, I was struck by how many runners were, like me, raising money for their local hospices. That demonstrates the sad reality of inadequate central funding for hospices. I have been trying to bang the drum for North London Hospice since I was first elected, and although it took me a few years to muster the courage to put on the running vest and put my knees on the line, as each year passes it feels as if the challenges facing hospices grow greater and more acute.

As we know, hospices are an integral part of our health and social care system. They work in partnership with local health and care systems, helping to reduce the pressure on our NHS by caring for patients who would otherwise be directly supported by NHS services. As a community, we are reliant on hospices—they are important parts of the communities that they serve—but they are also reliant on us for support, through fundraising and donations, because they are largely charitably funded. On average, around two thirds of adult hospice income is raised through fundraising such as charity shops and marathons, and the figure is higher for children’s hospices, which must raise around four fifths of their income.

[Munira Wilson]

On children’s hospices, Shooting Star in my constituency, which I have already mentioned, is very grateful that the Minister has committed to the children’s hospice grant for 2024-25, which comes centrally from NHS England. The problem is that that is a year-to-year commitment, which does not help hospices such as Shooting Star to plan for the long term. Does the hon. Gentleman agree that a ringfence should be placed around that funding and that it should be pegged to inflation year on year so that children’s hospices can plan properly?

[Bambos Charalambous]

The hon. Member makes an excellent point. Long-term funding is absolutely essential if hospices, particularly children’s hospices, are to be able to plan ahead.

North London Hospice is reliant on donations from the community each year to fill its £10 million funding gap, as only a small proportion of its costs are funded by the NHS. Of course, the cost of living crisis continues to eat away at people’s finances, which directly impacts on our communities’ ability to provide the vital charitable support that hospices rely on. The reality of the current state of funding is that hospices are struggling to keep up with inflation and rising costs, which is leading to services being cut. However, demand for palliative care continues to grow—for North London Hospice, it has grown at a rate of 5% year on year. The costs of running hospice services, including energy bills and the cost of paying staff a fair wage, also continue to rise rapidly.

Hospices recruit from a small pool of staff in the NHS and care sector, but they are not provided with the same Government funding to meet NHS pay levels, meaning that many hospice staff are doing the same job as their NHS colleagues but being paid less for it. As a result, Hospice UK’s figures suggest an 11% growth in payroll costs this year, which means around £130 million of additional spending that is not met by increased statutory funding. As I have mentioned, those costs are not met with additional uplifts from NHS funding or contracts, and despite a legal requirement for ICBs to commission palliative care services that meet the needs of the local population, the funding that hospices receive from ICBs varies significantly across the country and means that charitable donations make up much of their income.

Children’s Cancer Care: South-East

Munira Wilson Excerpts

Wednesday 13th March 2024 Westminster Hall

[Munira Wilson (Twickenham) (LD)]

I beg to move,

That this House has considered children’s cancer care in the South East.

It is an honour to serve under your chairmanship, Sir Christopher. In 2020, Jackson’s parents received some of the worst news a parent possibly can: Jackson had been diagnosed with leukaemia, at just two years old. He soon began treatment at St George’s Hospital in Tooting; and after three years, in April 2023, he finally rang the bell that signified the end of his treatment. It was a very difficult experience for Jackson, but his family are extremely grateful for the treatment they received at St George’s Hospital. Reflecting on the experience, Jackson’s mum, Samantha, said:

“Thank you St George’s for being such a great hospital and to everyone who works there, you have made our journey so much easier to deal with because you’re the best team.”

Tomorrow, NHS England will make a decision about where to place a new children’s cancer centre, which will serve south-west London and the surrounding areas, such as Surrey, Sussex, Medway and Kent. NHS England will decide between two proposals: one submitted by St George’s Hospital, and the other by the Evelina London Children’s Hospital in Lambeth. After listening to staff, patients and others affected, I am here, with colleagues from both sides of the House, to make the case that children’s cancer care must remain with St George’s.

[Florence Eshalomi (Vauxhall) (Lab/Co-op)]

I thank the hon. Member for making a powerful speech and for referring to Jackson. Does she agree that the independence of NHS England is important, that any decision it makes tomorrow has to be based on the clinical knowledge of medical experts, that the decision must be free from any political interference and that the world-class facilities at Evelina, which the hon. Lady has seen at first hand, should be considered alongside the other hospital? Does she agree that we must ensure that the decision is independent, and that we do not undermine the public reputation of NHS England or put undue pressure on it?

[Munira Wilson]

This is not about political interference; it is about ensuring that there has been a fair, balanced and transparent process. I will talk about the process in a moment, but that is the concern. The hon. Lady talks about clinical input. The consultation, albeit that it was run in a very flawed way, had 2,500 responses—some were from clinical experts, and many were from patients and their parents—and it provides very strong evidence that St George’s is best placed and that the Evelina has been predetermined. I have nothing against the Evelina, and in fact I was just about to sing its praises, because I have had personal experience.

To make myself clear, the Evelina is a brilliant hospital that does incredibly important work in treating children. My own daughter, who is nine, is currently undergoing treatment at the Evelina and has received outstanding care. This is not about pitting hospital against hospital; it is about looking at the process and the evidence before us. As the hon. Member for Vauxhall (Florence Eshalomi) has alluded to, I would like to personally thank the medical director at the Evelina, who showed me around its excellent facilities on Monday. However, as I have mentioned, the evidence overwhelmingly demonstrates that, in this case, St George’s is best placed to deliver for this highly specialist cancer service.

Before I come to that evidence, I want to raise serious questions about the decision-making process to date. [Interruption.]

[Sir Christopher Chope (in the Chair)]

Order. There is a Division in the House. I do not know whether there will be just one Division. If there is only one, we will come back in 15 minutes; if there are two, we will come back in 25 minutes.

--- Later in debate ---

On resuming—

[Munira Wilson]

To pick up where we left off, before we look at the evidence and arguments for keeping this precious service at St George’s, I want to raise the serious questions that have been highlighted around the decision-making process that has brought us to this point. NHS England first publicly expressed its preference for the Evelina proposal at the start of last year, long before it had even launched its public consultation. This has raised concerns that NHS England has created a process in which the views of patients, clinicians and patients’ families have not been seriously listened to and taken into account.

[Stephen Hammond (Wimbledon) (Con)]

The hon. Lady is quite right. I congratulate her on this debate. I have spoken to the Department and NHS England about the process, as there have been real concerns about the scoring and whether that has been based on evidence or preference. There is also real concern that clinical outcomes are not being given quite the highest priority they should be, which will be key if we are looking at the cancer survival rates for young children.

[Munira Wilson]

Absolutely. There is the point about transparency, the fact that it has been predetermined, and the point about outcomes, which I will touch on briefly in my speech.

In a consultation response submitted by Healthwatch Richmond and Healthwatch Merton, the groups concluded that the consultation design was insufficient because it “fails the legal test” for consultation and appears to have no prospect of altering the decision to award the new service to the Evelina. I am therefore keen to hear from the Minister what assessment her Department has made of how NHS England has carried out this process. Further, can she give an absolute assurance to Members that the decision made tomorrow will have been made fairly?

Regardless of the way in which it was carried out, the consultation received over 2,500 responses from affected groups, such as patients, their families, clinicians and professional organisations. Those voices must be heard, and I will seek to ensure that they are. One of the most important themes raised was specialist knowledge and experience of children’s cancer care. It is undeniable that St George’s has invaluable experience to offer: it has already been treating child cancer patients, in partnership with the Royal Marsden, for over a quarter century. Not only is that experience highly valued by patients and their families, but it has resulted in excellent outcomes, as the hon. Member for Wimbledon (Stephen Hammond) said. According to national data collected from intensive care units, St George’s children’s cancer intensive care outcomes are the best for a large unit in the UK. All the institutional knowledge, specialist expertise and professional networks that have been built over decades risk being lost if cancer care were to move away.

Another key theme that was repeatedly mentioned in responses was that the centre should be conveniently located. Travelling via public transport with a vulnerable and immunosuppressed child is both stressful and very risky, so patients and families have repeatedly stressed that a new centre must be easily accessible by car. Anyone who has lived or worked in central London knows how difficult and unpredictable driving in and out of central London can be. However, located in Tooting, St George’s is much easier to access, and has strong road links to parts of the south-east. That is particularly appreciated by those travelling from afar.

Finally, responses highlighted the importance of having most specialisms on a single site. One service that is particularly vital to child cancer patients is neurosurgery, which is required by one in four of them. Currently, out of the two options, only St George’s offers neurosurgery. According to the Children’s Cancer and Leukaemia Group, the fact that the Evelina does not currently provide cancer surgery is not an issue that can be resolved quickly, and relocating surgery services comes with associated risks to both patients and staff. In its consultation response, the British Association of Paediatric Surgeons notes that where that has happened in previous cases, a lack of support and structure has resulted in staff “leaving the relocated unit.”

Further, clinicians have shared concerns that, if children’s cancer care were to move from St George’s, other services could be disrupted, which may create unforeseen consequences for the many areas served by St George’s. By contrast, placing the new centre at St George’s would ensure that NHS services are not overly centralised, but rather evenly distributed across the region. What assessment have the Government made of this crucial clinical evidence and the associated potential risks to the cancer service and other children’s services?

The decision is such an important one because at its heart are children with cancer: a group who have dealt with the most challenging and frightening of circumstances so early on in their lives. In many cases, the children can go on to lead full lives. One such example is Zoe, a teenager who was treated by St George’s when she was just four. She has since recovered and now has dreams of becoming a children’s nurse. She says:

“I’m so grateful to the paediatric staff at St George’s Hospital for looking after me, and for always being there for me throughout my life. Thank you to the nurses who told me to follow my dreams and never give up.”

The experience, expertise and convenience that St George’s offers are extremely valued by patients and those who care for them. That must be reflected in the final decision that is made tomorrow, and that is why it is so crucial that no doubt is cast over whether the decision is being made fairly and transparently. Yet, as I have set out, the way that NHS England has handled the process means that it is very difficult to make that judgment at this point.

Last week, together with my right hon. Friend the Member for Kingston and Surbiton (Ed Davey) and my hon. Friend the Member for Richmond Park (Sarah Olney) I wrote to the Secretary of State requesting that she uses her formal powers to call in this decision should NHS England press ahead tomorrow with awarding the children’s cancer service to the Evelina; and a group of cross-party council leaders from across south-west London and Surrey have done the same.

I conclude by urging the Minister in the strongest possible terms to join that call and to support us in saying that this decision must be called in tomorrow if the Evelina is chosen, because of the serious process and clinical arguments that I have laid out today.

[Sir Christopher Chope (in the Chair)]

Back Bench speeches in this debate will have to finish by 5.38 pm.

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[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

Thank you, Sir Christopher. It is a pleasure to serve under your chairmanship in what has been quite a drawn-out debate on such an important topic. The hon. Member for Twickenham (Munira Wilson) has raised an incredibly important issue. I hope she and all hon. Members accept that clinical assessment and knowledge are crucial to making vital decisions that affect children’s health at such a difficult time for them and their families.

I am responding to this debate on behalf of my right hon. Friend the Member for Pendle (Andrew Stephenson), but I will endeavour to respond to each colleague and commit to writing where necessary. The debate has understandably stirred some strong emotions, because every colleague has had direct or indirect exposure to some of the questions it has raised. I am therefore grateful to all hon. Members for their contributions, which demonstrate the huge importance to us all of getting the right outcome.

Each of us has helped a parent who has called our constituency offices seeking help at an incredibly difficult time. I want to assure everyone that each person in the Government, from the Prime Minister down, knows the importance of getting this right. That is why cancer services for children are an absolute priority. From my own work in the Start for Life programme, and in the few months I have been in my current role, I have seen a collective determination to ensure that children right across the country receive the highest possible standards of care. Children with cancer are the key priority.

The Royal Marsden Hospital and St George’s Hospital currently care for most of the children with cancer in south London and the south-east. I pay tribute to the work of those dedicated doctors and nurses who do everything they can to look after the children entrusted to their care, and I want to be clear that NHS England’s proposed changes do not reflect on the stellar service that those staff members have given and continue to give. Rather, the proposals follow advice from Professor Sir Mike Richards’ review, which made it a clinical requirement for cancer services to be placed in the same location as an intensive care unit in order to give critical life support to the most unwell children.

Sir Mike’s reasoning was simple. First, we need to end transfers between hospitals for very sick children, which add risks and stress for them, not to mention their families, during what is already an unimaginably difficult time. Secondly, while we will not compromise on safety, we need to ensure quality of care. As every Member will agree, children deserve to benefit from the very latest technology available. Thirdly, we need to ensure a seamless, joined-up approach.

NHS England has listened to patients, parents and clinical experts to hear how we might best improve their care. The NHS England process has been rigorous, and it has been immensely important for all those patients, parents and specialists to put forward their own significant insights. Last year, NHS England carried out a 12-week public consultation on two options for the future location of the principal treatment centre for south London and much of the south-east: Evelina London Children’s Hospital and St George’s Hospital. Under both options, all radiotherapy for children with cancer would be at University College Hospital.

Both Evelina London and St George’s deliver outstanding-rated children’s healthcare. They also provide outstanding-rated education in their hospital schools. Both are capable of delivering a future principal treatment centre that meets our high standards. They are also both adept at listening to children, young people and their families to improve on the care they deliver.

The experience and expertise of specialists working side-by-side with intensive care and surgical teams will make a real difference: enabling children to get care where they need it, when they need it, on a specialist cancer ward; bringing down the number of children admitted to intensive care; making it easier for different specialist teams treating the same child to work closely together; improving care for children; upskilling the workforce and supporting new kinds of research. Importantly, it will also mean that the future cancer centre will be capable of offering the most innovative and cutting-edge treatments, which may bring precious new hope for children and their families.

The centre will build on the strengths of the existing service, including high-quality care by expert staff and access to clinical trials. It will be a family-friendly centre for children and young people, at the forefront of groundbreaking research and continuing the close relationship with the Institute of Cancer Research.

[Munira Wilson]

The Minister said a moment ago that the new centre will build on the service and the experience. The point that I and many Members have made is that St George’s has that experience. While the Evelina is brilliant in many paediatric specialisms, it does not have children’s cancer experience, so what will it build on? On the point about process, it was already predetermined, as I pointed out. It has been made clear in meetings we have had that a lot of the responses will not be taken into account unless there is new evidence. The views of children, their parents and clinicians are not being listened to in the consultation.

[Dame Andrea Leadsom]

I am afraid I fundamentally disagree with the hon. Lady on that point. The consultation has been open, with an open mind and following the best principles of open consultation. I think she is taking quite a liberty to suggest it is a foregone conclusion. I do not think she is correct in her belief. It is essential that clinicians can take all the inputs from those consultations to come to the right decision.

--- Later in debate ---

[Dame Andrea Leadsom]

I absolutely agree with my hon. Friends that the consultation is critical, that it has been an open consultation and that all views are being taken into account. I am grateful to them for supporting the process. As Members of Parliament and constituency representatives, we all want the best for our constituents, but in the case of clinical care, it is vital that those with specialist knowledge and understanding should be able to make such important decisions that will affect life and death outcomes for children.

The new centre will be a family-friendly centre forusb children and young people at the forefront of groundbreaking research, continuing a close relationship with the Institute of Cancer Research. The centre will lead joined-up working between different children’s cancer services so that children get proper access to care, wherever they live. Importantly, it will have many more services on site, reducing the need for some families to travel, which will be particularly helpful for children with complex needs and families that struggle to speak English.

I assure colleagues, and anyone who might be watching at home, that once the decision has been taken, there will be no sudden changes to how patients receive care. Of course, some families will naturally be worried about what the change might mean for their children. That is entirely normal, and NHS England will carefully involve every clinical team currently providing care, keeping parents and families closely updated at every stage. NHS England will encourage experienced staff to move to the future centre so that they can continue to provide a friendly and familiar face to the children they serve. No one from among the clinical staff will be made redundant in any future changes resulting directly from this decision. NHS England has met staff to listen to their views, and they assure me that that will continue.

The consultation heard from children, their carers, and families who have received the worst news. They have talked about their own experiences selflessly to try to help others. The consultation closed in December last year, and an independent research organisation published its findings in January. NHS England has taken into account every word of feedback and every inch of evidence to inform the decision-making process. NHS England leaders are meeting tomorrow to decide the future location of the centre. The meeting will be livestreamed so that everyone who is interested can hear the discussion and the decision.

In conclusion, wherever the future centre is placed, I am confident that tomorrow’s decision will offer the right outcome for our children and take all views into account.

[Munira Wilson]

Before the Minister sits down, will she give way?

[Dame Andrea Leadsom]

No, the hon. Lady will have her chance in a moment. Throughout this process, the guiding principle has always been safety, quality of care and the best outcomes for children with cancer, now and for the long term. The children and their families deserve nothing less.

[Munira Wilson]

I am sorry that the Minister would not give way again; I wanted to ask her a direct question, but I do not believe that she has the opportunity now to come back to me.

I start by thanking all the right hon. and hon. Members who have participated in this rather drawn-out debate. I particularly thank my right hon. Friend the Member for Kingston and Surbiton (Ed Davey). I thought the clinical case that he made was forensic; he went into great detail in making the compelling case of why this service should be placed at St George’s, where it already exists and is being built upon. I did not quite understand the intervention of the hon. Member for Mole Valley (Sir Paul Beresford), in which he suggested that I was insulting clinicians; I was merely explaining that it is already there and it is being built on.

The hon. Member for Mole Valley and the hon Member for Carshalton and Wallington (Elliot Colburn), who is no longer in his place, laid out the huge research opportunity we have. The Minister talked about innovative therapies. My right hon. Friend the Member for Kingston and Surbiton talked about CAR-T and all the other innovative therapies that they are already working on at St George’s. He also highlighted staffing concerns, and both he and the hon. Member for Mitcham and Morden (Dame Siobhain McDonagh) talked about the cost implications of moving the service.

I thank my hon. Friend the Member for Richmond Park (Sarah Olney) and the hon. Member for Sutton and Cheam (Paul Scully) for highlighting the travel issues. I strongly agree with what they said, which came through very clearly. I want to repeat this again, because I think some Members have suggested that we are knocking the Evelina: everyone agrees that it is an outstanding children’s hospital. The point is that St George’s also has paediatric services that are recognised by the CQC as outstanding. The royal college of paediatric surgeons also recognises it as having some amazing specialities.

There is deep concern—not just from Members of Parliament and politicians, but from professional groups and local Healthwatch groups, as I mentioned in my opening remarks—that this consultation has not been transparent and fair and that the process has not been fair. I ask the Minister again: if the decision is made tomorrow by NHS England to move the service to the Evelina, will she urge the Secretary of State for Health and Social Care to call this in and have it looked at once again by Ministers so that all the very compelling arguments we have heard today on the clinical case and, most importantly, the risk to children’s cancer care and other services are taken into account? The voices of children, parents, clinicians and patient groups must be heard, and I do not believe that they are being heard at the moment.

Question put and agreed to.

Resolved,

That this House has considered children’s cancer care in the South East.

Pharmacy First

Munira Wilson Excerpts

Wednesday 31st January 2024 Commons Chamber

[Dame Andrea Leadsom]

I would love to hear more about that from my right hon. and learned Friend. I will be happy to look into it.

[Munira Wilson (Twickenham) (LD)]

In recent months, Boots has closed two of three pharmacies in the Hampton area of my constituency. That has left Hampton North, which is one of the most deprived wards in the London Borough of Richmond upon Thames, without a single pharmacy, so elderly residents and those with long-term conditions have to walk for a lot longer than 20 minutes to access a pharmacy. Local GPs tell me that it is just not viable to set up a community pharmacy facility. Will the Government review the pressures on community pharmacy and consider the community pharmacy contractual framework so that we can make this initiative work and take the pressure off GPs?

[Dame Andrea Leadsom]

As I have already mentioned, there are many community pharmacies starting up all the time, as well as closing down. The hon. Lady will appreciate that the Pharmacy First initiative is a real boost to community pharmacies. I am happy to discuss it with her, but I would imagine that there will be the capability to open new community pharmacies in her area.

Mental Health Treatment and Support

Munira Wilson Excerpts

Wednesday 7th June 2023 Commons Chamber

[Dr Allin-Khan]

I entirely agree with my hon. Friend, who works tirelessly on this issue.

After more than a decade of Tory Governments, if people need help, all too often no one is there. Last year, emergency service workers took more than a million sick days because of stress. NHS staff are at the sharp end of this mental health crisis. I know them, I work with them, and I see what they are coping with daily. They are heroes, but they simply do not have the resources, the staff or the leadership from Ministers that would enable them to do their jobs. They themselves suffer exhaustion, depression, stress and anxiety. About 17,000 staff—12% of the mental health workforce—left last year.

You will be pleased to know that I have had a look at the Government’s amendment, Mr Speaker—I do my homework. There is the tired old £2.3 billion figure. How many times have we heard that trotted out? Actually, I can tell the House that it has been used more than 90 times over five years, and it has been spent in myriad different ways. Then there is the £150 million for mental health crisis units. But the amendment fails to mention the serious patient safety concerns that doctors have raised, and it is clear that the pressure on A&E remains as fierce as ever. There is also nothing about the recent announcement from the Metropolitan police that they will not help people in a mental health crisis.

Ministers need to get out of Whitehall and see what is really happening in our mental health service. If they did so, they would see what I have seen in recent months. They would see the junior psychiatrists whom I met recently—junior doctors who have devoted all their training to this profession, and half of whom plan to leave the NHS at the end of their training. They would see the doctor who told me of an incident in which six police officers were in A&E for 18 hours with a patient detained under section 136 of the Mental Health Act 1983. They would see a child arriving at A&E after self-harming, having been referred by the GP a long time ago but not been seen for weeks, which led to an escalation point and a crisis in A&E. We are seeing a system in crisis, people in pain and families in distress.

[Munira Wilson (Twickenham) (LD)]

The shadow Minister has referred several times to children’s mental health and the crisis that often occurs when they present at A&E departments. Does she agree that schools have an important role to play when children have moderate mental health conditions, before those conditions escalate? The role of mental health support teams in schools is critical, but their funding is due to end abruptly next year, with only about half the programme complete. Will she join me in asking the Minister to commit himself to funding the full roll-out of mental health support teams or, better still, to back the Liberal Democrats’ plan to provide a qualified mental health practitioner in every school?

[Dr Allin-Khan]

I invite the hon. Member to have a look at the plans we already have in place. She will be pleased to learn that one of our pledges is the provision of a mental health specialist in every school. I invite her to support those Labour plans—and to come and join us over here if she feels like it.

--- Later in debate ---

[Neil O’Brien]

This is an extremely important issue that the hon. Gentleman is quite right to raise. We will be producing the results of the rapid review in the coming weeks, so he will not have to wait very long.

[Munira Wilson]

Like other colleagues, I see many children in my constituency waiting well over a year, sometimes two years, to access child and adolescent mental health services, so I was alarmed when NHS England recently told me that, on the latest modelling, the number of NHS-commissioned training posts in London for child and adolescent psychiatry will halve by 2031. I have no idea what is driving this modelling, but given that one in six seven to 16-year-olds have a probable mental health disorder, will the Minister at least look into these figures and undertake to write to me to explain why we are seeing such a drop in the number of training places?

Hospice Sector: Fiscal Support and Cost of Living

Munira Wilson Excerpts

Thursday 2nd March 2023 Westminster Hall

[Munira Wilson (Twickenham) (LD)]

I confess that I had planned to make a couple of interventions, as opposed to a speech, but given that more hon. Members could not be present, I will try to add a bit more to what I was going to say. Forgive me if I am a little rusty and not very well prepared.

I thank the hon. Member for North Ayrshire and Arran (Patricia Gibson) for securing this really important debate. I have a particular interest in children’s hospices, because there happens to be a Shooting Star children’s hospice in Hampton, in my constituency. It is a much-loved institution in the area that serves children not just from my constituency, but from right across London and Surrey, and well beyond. It looks after children with life-limiting conditions and those who, sadly, have terminal conditions, and it provides respite care as well as ongoing care, particularly at the end of life. The hospice is therefore highly valued by the families it has served, and they were keen for me to make representations to Ministers.

I am fond of the Under-Secretary of State for Health and Social Care, the hon. Member for Harborough (Neil O’Brien), but I am disappointed that there is not a Treasury Minister present, given that the debate is about fiscal support for the hospice sector and hon. Members will be largely talking about funding streams. I know it is the job of the Department of Health and Social Care to advocate for them, but at the end of day it is a Treasury decision. We therefore call on the Chancellor and his Ministers to think about funding for hospices.

Demand has been rising, particularly in the children’s hospice sector; it rose about 40% between 2009-10 and 2017-18. At the same time, as we have heard, costs, including staff costs, are rising across the sector. From visiting Shooting Star, I know hospices are constantly trying to compete with the NHS and the rest of the social care sector, which are increasingly going after the same staff. The staff shortages across the sector are well documented. The hon. Member for North Ayrshire and Arran mentioned energy costs, but I will give a specific example from Shooting Star. It is paying £90,000 per year in energy costs. That is predicted to skyrocket to £230,000 per year by the end of September 2023—about two and a half times the current spend. That £140,000 increase is equal to the cost of covering the hospice’s family support line for three years, or the salary of three nurses.

As the hon. Member laid out, hospices have not been classified as an energy-intensive industry, whereas many other places—including even botanical gardens, I think—have been. Hospices are therefore not getting the additional support, yet supporting care for those with very serious conditions is an energy-intensive task. Hon. Members who have visited hospices will have seen the paraphernalia and the equipment, and children and their families also have to be kept warm. It is absurd. I plead with the Minister to make strong representations to his colleagues in the Treasury to ensure hospices are reclassified as energy intensive. Earlier this week in departmental questions, my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) asked the Secretary of State for Energy Security and Net Zero to consider a specific fund to support hospices with their energy costs. The Secretary of State said he would look at those concerns. I therefore task the Minister with speaking to both the Secretary of State and colleagues at the Treasury to see what can be done to support Shooting Star and many other hospices.

We have heard that food and other supply costs are rising, which brings me to funding streams. We know that hospices are heavily reliant on fundraising, and in recent years, children’s hospices have been receiving a children’s hospice grant from NHS England, which they are grateful for. In 2023-24, that funding is due to rise to £25 million. I recognise and welcome that, and I thank the Department of Health and Social Care for making the grant available. However—and this is an important “however”—beyond 2023-24, there is no guarantee that that funding will continue. The grant represents about £1 in every £6 that children’s hospices spend. Another important point is there is no commitment that NHS England will continue to deliver it as a ringfenced grant. If it is not directly distributed to children’s hospices as a ringfenced grant from NHS England centrally, but is instead devolved down to integrated care boards, some of which are already projecting deficits, there is concern that the grant may go to plug black holes in ICB budgets. When the Minister rises to speak, will he first give some sort of commitment on funding continuing between 2023 and 2024? Clearly the quantum cannot be specified while discussions are ongoing with the Treasury, but will he give some reassurance to the children’s hospice sector that that money will continue beyond 2023-24, and that it will be centrally administered as a ringfenced grant rather than going via ICBs?

Together for Short Lives says that if that grant were to be cut, nearly one in five children’s hospices would cut end of life care, over a quarter would cut symptom management services and nearly two thirds would cut short breaks for respite. Children who are critically ill and very sick deserve better, so I implore the Minister to provide those assurances to Shooting Star in my constituency and all the children’s hospices across the country that provide such vital support and care.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

It is a pleasure to serve under your chairmanship, Mr Paisley. I congratulate the hon. Member for North Ayrshire and Arran (Patricia Gibson) on securing this debate and thank her for the support that she gives to the palliative, end-of-life care and bereavement sectors. The Minister for Social Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), is unfortunately unable to be here today, so I am here to represent the Government. I extend my gratitude to all Members here today for their contributions, which I have heard and learned from. I pay tribute to my own local hospices in Leicestershire, LOROS—the Leicestershire and Rutland Organisation for the Relief of Suffering—and Rainbows, for the work that they do.

The Government are acutely aware of the pressures and challenges posed by the rising costs that have been mentioned in today’s debate. While they affect us all in every sector, the impact on the hospice sector has rightly been raised for debate. Everyone here recognises the incredible importance of palliative and end-of-life care services, and the invaluable work that hospices, charities and the people who support them do to ensure that dignity, care and compassion are present in our lives when we need them most.

The efforts of organisations such as Hospice UK and Together for Short Lives play a vital role in ensuring that we as a nation provide world-leading palliative and end-of-life care. Like pretty much everyone in the country, I thank them. I take this opportunity to say thank you for everything that they do.

The hospice sector supports more than 200,000 people with life-limiting conditions in the UK each year, as well as tens of thousands of family members with bereavement support. We know we have an ageing population presenting with more complex health needs for more years of life. On average, about 600,000 people die every year in the UK, and that number is expected to increase. With that expected increase, the number of people needing palliative care is also likely to rise. Health is of course a devolved policy area, so in terms of direct hospice policy, I can only speak to the English experience, although I will of course talk about some UK-wide areas that are highly relevant, such as energy policy.

While so much palliative and end-of-life care is provided by NHS staff and services, hospices also provide significant support to people at the end of their life and to those important to them. They are mainly independent charitable organisations that receive funding from a mix of public sources and charitable donations. The sense of purpose that is shared with the community—the community cares for the hospice and the hospice cares for the community—is something that we should cherish. I see that strongly in my constituency. It is emblematic of the incredible rallying of compassion and care that we see around hospices all over the country. We should also note the important role that hospices played at the height of the covid pandemic when considering their important place in their communities.

In England, integrated care boards are responsible for commissioning end-of-life and palliative care services to meet the reasonable needs of their local populations. In the Health and Care Act 2022, palliative care services were specifically added to the list of services that an ICB must commission. That will ensure a more consistent national approach and support commissioners in prioritising end-of-life and palliative care, as hon. Members have called for. In July 2022, NHS England published new statutory guidance on palliative and end-of-life care to support commissioners with that new duty. It includes specific reference to ensuring the sufficient provision of specialist palliative care services and hospice beds, and ensuring their future financial sustainability.

I recognise the importance of quality palliative and end-of-life care for children and young people. NHS England is investing £23 million via the children’s hospice grant by March 2023, rising to £25 million by 2023-24, in order to provide care close to home for seriously ill children when they need it.

On the question that the hon. Member for Twickenham (Munira Wilson) asked, although we only set out funding to date in the spending review, that does not mean that all funding will be cut off at that point. We are exploring exactly how that funding will be provided in the future. Furthermore, this financial year, NHS England has made £5 million of match funding available to ICBs for local children’s palliative and end-of-life care services. That will rise to £7 million in 2023-24, demonstrating the value of those services.

The funding of hospices and the sector is indicative of the Government’s commitment to their work and the vital societal role that they play. We recognise, however, that hospices, like every other organisation and household across the country, are having to contend with a range of budgetary pressures, including huge energy costs following the Russian invasion of Ukraine.

[Munira Wilson]

I thank the Minister for addressing one of my key questions about the children’s hospice grant. I am sure the sector will be grateful to hear that it is expected to continue. Although hospices will understand that he cannot commit to that at this stage, the problem is that if they do not know what they will get for the next three to four years, how can they make plans for their workforces and services? Will he say anything more than that something will continue? I do not know whether he is coming to this, but will he also say something about the ringfenced grant being administered directly, rather than via ICBs?

[Neil O’Brien]

Those are both really important points. The hon. Lady knows that it is not for me to set out the future of funding, but I hear the points she makes about ensuring that funding flows to hospices and that they are prioritised by ICBs, and about providing as much certainty as quickly as possible. Both those points have landed with me.

To meet the energy pressures, the UK Government’s energy bill relief scheme provides a price reduction in wholesale gas and electricity prices for all UK businesses and all other non-domestic customers. That means that they will pay wholesale energy costs below half of the expected prices this winter. A new scheme—the energy bills discount scheme, which has been mentioned— was announced in January, ahead of the current scheme ending in March. It is intended to help hospices’ budgetary planning into the future and provide certainty. That follows a Treasury-led review of the energy bill relief scheme some months ago.

The energy bills discount scheme will provide all eligible non-domestic energy users, such as hospices, with a discount on high energy bills until March 2024. It will apply to all UK domestic energy users in the voluntary and public sector, including hospices. We will invest up to £5.5 billion to support those non-domestic users. Furthermore, hospices may also be entitled to a reduction in VAT from 20% to 5% and exclusion from the main rates of the climate change levy on the energy they use for non-business purposes, as long as they meet the criteria in the scheme.

In addition to those two specifically energy-focused interventions, in 2022 NHS England released £1.5 billion in additional funding to ICBs to provide support for inflationary pressures, with local ICBs deciding how best to distribute that funding according to local need, including to palliative and end-of-life care providers such as hospices. I have previously mentioned the steps we have already taken in legislation and guidance to ensure that hospices are prioritised by ICBs.

A large part of hospice activity—probably the majority—actually takes place in people’s homes. That is why we are also taking action on domestic energy pressures. In fact, this winter we are spending a total of £55 billion to help households and businesses with their energy bills. That is among the largest support packages in Europe. A typical household will save about £900 this winter under the energy price guarantee, in addition to the £400 energy bill support scheme for households. On top of that, we are also spending £9.3 billion over the next five years on energy efficiency and clean heat, making people’s homes easier and cheaper to heat.

To help with some of the other cost of living pressures on households—which is the last thing people need when they are in need of hospice care—we are taking measures such as the extra £900 cost of living payment for 8 million poorer households, the largest ever increase to the national living wage for 2 million workers, and a total of £26 billion for cost of living support next year. I hope some of these supportive measures will reassure Members about the Government’s commitment to the sustainability of the hospice sector, particularly during this challenging fiscal period. I understand that the rising cost of living has caused all kinds of uncertainties, and we continue to engage proactively with the sector to try to understand the issues it faces.

[Munira Wilson]

Will the Minister give way?

[Neil O’Brien]

I will close my speech by again expressing my thanks to those who have attended the debate—including the hon. Lady, to whom I now give way.

[Munira Wilson]

I thank the Minister for giving way again. On his point about the energy bill relief scheme, will he at least acknowledge the absurdity of leaving hospices out of the energy-intensive grouping, while botanical gardens, zoos and museums, deserving though they are, have been included? Does he not recognise that that is utterly absurd, given the sort of services that hospices are delivering?

[Neil O’Brien]

Although this is not my policy area, as I understand it, this applies to the energy-intensive and the traded sectors, so organisations need to pass through two different filters to qualify: they have to be very energy intensive and in the traded sector. That would explain the organisations that are chosen or not chosen, but as I said earlier, I absolutely hear the point that the hon. Lady is making.

I pay tribute to all those working in and supporting the palliative and end-of-life care sector and providing essential support to those who need it. I hope I have reassured Members of the Government’s commitment to supporting these invaluable services.

NHS Workforce

Munira Wilson Excerpts

Tuesday 6th December 2022 Commons Chamber

[Wes Streeting]

I wholeheartedly agree. To deal with that problem—and, indeed, to satisfy the demands of the Conservative party, which looks to Labour for answers—we are putting forward a plan today to solve the crisis, to bring down waiting times, to get patients the treatment they need and to build a healthy society.

Where the Conservatives are holding the best and brightest students back from playing their part in the health of our nation, Labour will unleash their talent in the NHS: we will double medical school places, training 15,000 doctors a year so that patients can see a doctor when they need to. Where the Conservatives have left nurses working unsafe hours, unable to spend the time they need with patients to provide good care—where the Conservatives have left the NHS so short of midwives that expectant mothers are turned away from maternity units that do not have the capacity to deliver their child—Labour will act: we will train 10,000 more nurses and midwives every year.

We will go further. The way we deliver healthcare has to change. For many patients, a hospital is not the best place to be, yet in the past 12 years all the other parts of our health and care service have been eroded by underinvestment. When our society is ageing and people increasingly want to be cared for in the comfort of their own home, surrounded by their loved ones, why have four in 10 district nursing posts been cut? Labour is proud to have district nursing at the heart of our plans to modernise the NHS, and we will double the number of district nurses qualifying every year.

Many colleagues across the House have campaigned for years on the importance of the early years of a child’s development. All the evidence says that the first 1,000 days of a child’s life are vital to their development and life chances, yet the number of health visitors has been cut in half since 2015. Labour will ensure that every child has a healthy start to life, training 5,000 more health visitors. That is what our motion would deliver.

[Munira Wilson (Twickenham) (LD)]

The hon. Member raises children and early intervention, but one area he has not touched on is the tidal wave of cases relating to children and young people’s mental health. As we all see in our casework every week, children and young people who have not been treated early get worse and worse and therefore get referred to acute services. In the past year, referrals to child and adolescent mental health services have gone up almost 25% and consultant psychiatrist numbers have come down. In terms of early intervention, we are not seeing enough mental health support in our schools. In Richmond, we cannot recruit clinical psychologists even though we have the money to do so. Does the hon. Member agree that we really need to focus on the future of this country—our children—by training more psychiatrists, counsellors and psychologists?

[Wes Streeting]

I totally agree. We have had lots of perfectly good speeches from Conservative Prime Ministers over the past 12 years, and we have had more than our fair share of unbelievably bad Conservative Prime Ministers over the same period. One thing that each of those speeches has had in common is warm rhetoric and no delivery. We are not prepared to make the same mistake, so although it is not on today’s Order Paper, I am pleased to confirm that my right hon. and learned Friend the Leader of the Opposition has announced a mental health pledge that will mean 8,500 more mental health professionals being recruited. It will enable us to provide mental health hubs in every community, dedicated mental health support in every school and the aim of guaranteeing treatment within a month.

Our pledge will be transformational to mental health support in this country. It will particularly benefit young people, whose mental health and wellbeing have borne the brunt of the pandemic. It will really help to free up capacity for GPs and accident and emergency departments, which are increasingly seeing mental ill health cases coming through their door because the specialist support that people need is unavailable. Our plan, like our motion on today’s Order Paper, is fully costed and fully funded and will make a real difference to patients. Just as the Conservative party is welcome to steal Labour’s NHS workforce pledge, it is very welcome to steal our mental health plan too.

As well as recruiting the doctors, nurses and allied health professionals we need, we also need to keep the staff we have.

--- Later in debate ---

[Steve Barclay]

I discussed this issue with the Home Secretary this week: how we work together across Departments, not just on the visa system, but on other equities. For example, the amount of time spent by police on mental health is an issue of concern to not just the Home Office, but wider government. So there is scope across Departments to work more closely together and we are doing that, both on the issue of international recruitment, which is a key equity within the Department of Health and Social Care, and on mental health pressures on the police, which is an issue within the Home Office. That is how we are working more collaboratively across government, but we are clear that we are boosting the numbers in the short term while, in parallel, increasing the domestic supply of recruits, for example, with the boost in medical undergraduate places. We are also looking at what more we can do in areas such as apprenticeships: how we hire more nursing apprentices and boost supply through that as well.

Finally, the motion does not reflect the pay uplift that was awarded, where the Government accepted in full the recommendation of the independent NHS Pay Review Body. More than 1 million staff have seen an increase of at least £1,400 in their pay. Of course, that comes on top of the 3% rise last year, at a time when pay was frozen across the wider public sector.

[Munira Wilson]

rose—

[Dr Luke Evans]

rose—

[Steve Barclay]

I will give way to the hon. Lady first and then to my hon. Friend.

[Munira Wilson]

One bit of feedback that my colleagues in outer London constituencies and I have had from health leaders in our area is that the high-cost area supplement, which is available for many inner-London boroughs but is not available for outer London boroughs, is causing huge problems with recruitment and retention. For example, somebody can earn £2,000 more for the same job in Wandsworth than they can in neighbouring Richmond or Merton. Health leaders are calling for a review of the high-cost area supplement, so is that something the Secretary of State is willing to look at?

[Steve Barclay]

The hon. Lady raises a fair point. That fund has been set up because there is an issue with how recruitment sometimes applies between different areas. We always face the challenge of where one draws that boundary, but I will of course look at specific data on any particular case she wants to raise. The fund is there more widely to recognise that often some areas—

Edenfield Centre: Treatment of Patients

Munira Wilson Excerpts

Thursday 13th October 2022 Commons Chamber

[Will Quince]

Having seen some of the footage, it is hard for me to disagree with the words that the hon. Gentleman has used. I know that the Greater Manchester Mental Health NHS Foundation Trust has already identified and suspended staff involved in the behaviour at Edenfield that was revealed in that documentary, the police have launched an investigation into the allegations, and disciplinary proceedings have now commenced post broadcast. As I said, does that meet the threshold for an independent inquiry? My view is that it does.

[Munira Wilson (Twickenham) (LD)]

As this shocking investigation shows, the Mental Health Act 1983 often leaves vulnerable people at risk of cruelty and a distinct lack of care, and too many people have endured poor treatment or been detained for many years against their wishes. Reform of the 40-year-old Act is long overdue. We had the Wessely review back in 2018 and the White Paper in 2021. When will we see legislation come to the Floor of the House so that we can finally get that overdue reform?

[Will Quince]

I thank the hon. Lady for her question. I understand that a Bill to reform the Mental Health Act is in the Lords. I cannot give her a further update on that as I am not the responsible Minister, but it is important to stress that it is part of a number of measures that the Government have taken to improve on some of the challenges that she rightly pointed out. Whether that is the use of force Act, the NHS patient safety strategy, the mental health safety improvement programme, the patient safety networks that I mentioned, the new requirement for learning disability and autism training for staff or the HOPE(S) model, a lot is going on. I know that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), will be happy to meet her to update her further.

Women’s Health Strategy for England

Munira Wilson Excerpts

Wednesday 20th July 2022 Commons Chamber

[Steve Barclay]

I am grateful for the work that my hon. Friend did as a Health Minister in championing this agenda. She is right to highlight the difficulty, often, of accessing contraception, which is very much at the heart of the responses we had on the fragmented service that many women have experienced. She will be aware that a key part of our approach is the health and wellbeing funds and working with the voluntary and community sector on support in areas such as pregnancy loss.

A key part of this is the visibility of the women’s health strategy. Putting that to the fore in terms of a women’s health ambassador is, as she says, part of these conversations with the integrated care systems to ensure that this gets greater prioritisation within commissioning. A key part of securing that is having the data to demonstrate its importance and benefits.

[Munira Wilson (Twickenham) (LD)]

I, too, pay tribute to the hon. Member for Sheffield, Hallam (Olivia Blake) for her very powerful and moving personal testimony.

Last year, my constituent Nicola experienced her seventh miscarriage, which was her third in just 12 months. One in 100 women suffers recurrent miscarriage, often without known cause and without effective treatment, and a disproportionate number are black, Asian and other ethnic minority women.

I welcome the Secretary of State’s commitment to boost research in this area, but I am afraid that we have not heard any specifics on how much. Last year, the National Institute for Health and Care Research spent only 5% of its budget on reproductive health and childbirth, yet these issues affect some 17% of the population. Will he give an indication of how much more he is going to spend on research in this area?

[Steve Barclay]

Through highlighting the tragic case of Nicola, the hon. Lady demonstrates very effectively why research in this area is so important and the fact that it has been insufficient in the past. The amount of funding is, to a large extent, shaped by the research proposals that come forward. A key part of the strategy is the clear signal that we are sending to the research community that we are encouraging those willing to do research in the areas that have not been focused on in the past so that funding can be prioritised to them.

Infant Mental Health Awareness Week

Munira Wilson Excerpts

Thursday 16th June 2022 Westminster Hall

[Munira Wilson (Twickenham) (LD)]

It is a pleasure to serve under your chairmanship, Mrs Murray. I congratulate the right hon. Member for South Northamptonshire (Dame Andrea Leadsom) on securing the debate and for championing this issue with such expertise and passion for so many years. It is great to see her commitment and the support she has managed to secure from the Government recently. There is always much more that we can do, which is why we are here debating that today.

I will not take up much time—others can expect to have plenty of time to speak—but I want to touch briefly on the social care system for children and mental health, and how poor mental health affects infants in contact with the children’s social care system.

As we have heard, according to the Parent-Infant Foundation, a major predictor of the effect of an adverse childhood experience on a child’s development is how strong and secure their relationship is with their parents. For looked-after children or for children in kinship care, the relationship with their birth parent may be strained or non-existent. Abuse and neglect by caregivers will sometimes be the reason why babies are not living with their birth parents in the first place.

The foundation notes that this relational trauma can be more damaging than other forms of early trauma. The independent review of children’s social care—the MacAlister review—published a couple of weeks ago makes the same point. As we have heard, safe, stable and nurturing relationships serve as a buffer to adversity, build resilience and support children to develop skills to cope with future adversity in an adaptive and healthy manner. It is vital that the children who are most likely to have suffered early trauma are able to access the therapeutic support that they need.

I want to mention a couple of points. The first is NHS child and adolescent mental health services support for infants. I was struck by a Health Committee report, which found “highly concerning” the findings of a Parent-Infant Foundation survey of CAMHS professionals. Some 26% of respondents had not been trained to work with children aged zero to two, and only 36%—just over a third—agreed that there were mental health services in their area that could effectively work with children aged zero to two. Given that the NHS long-term plan commits the Government to achieving 100% access to specialist support for all children and young people aged zero to 25 by 2029, I would be interested to hear from the Minister how she expects that goal to be achieved for the under-threes.

Outside of the NHS, there are some fantastic voluntary sector organisations that are doing amazing work, and I particularly want to call out to an amazing charity in my own constituency. It is based in Twickenham itself and is called the Purple Elephant Project. The word “Elephant” is there because family bonds within a community of elephants are very strong apparently—more so than among other animals. Elephants display emotion when they are grieving or when the herd is under threat.

The charity was founded by a fantastic, inspirational woman called Jenny Haylock, who is a therapist herself. On their small site—they have just been able to install a beautiful little sensory garden thanks to funding secured from Richmond council recently—they offer play therapy, art therapy and other categories of therapy, including filial therapy, which is where parents and caregivers are part of the therapy with the children. The whole ethos is that parents and carers come in with the child. Even if the child is having separate therapy, there is a lovely space where parents can go to relax and recharge or have somebody to talk to. The charity is looking after the whole family, not just the child who has suffered whatever trauma. Jenny is also a specialist in adoption support.

I welcome the Government’s extension of the adoption support fund until 2025. Several of my constituents have told me how vital it is. We and the Minister are all well aware of how difficult it is to access CAMHS and therapy—that is well documented and we regularly hear examples in the main Chamber. I know that the adoption support fund has been a lifeline for a number of parents in my constituency whose children have needed therapy and support and have used the ASF to buy it in when they cannot access it in a timely manner from the NHS. Although the fund has been extended to 2025, I urge the Government to put it on a permanent footing.

Most of the 150,000 children in kinship care in England and Wales are not eligible for that funding, however. The ASF supports children who were previously in care but who are now subject to a special guardianship order or a child arrangement order, but those eligibility criteria are clearly nonsensical, because the majority of SGOs and CAOs are entered into by grandparents. Again, there are examples in my constituency of grandparents looking after their grandchildren because something has happened to the parents, who are no longer able to care for the children. That stops those children going into the care system, which saves the taxpayer a lot of money. We all know that the outcomes for children who enter kinship care—as opposed to care by people with whom they have no connection—tend to be better.

Kinship carers are unsung heroes. They save the taxpayer money, but they do not have the same rights as foster carers to weekly allowances or the entitlement to the ASF that adoptive parents have. There are almost twice as many children in kinship care as there are looked-after children—many would be in the care system were it not for their kinship carers—but many of them will have suffered the same or worse experiences of early trauma.

I urge the Minister to support Kinship’s campaign to widen the eligibility criteria for the adoption support fund. That is probably a matter for the Department for Education, so the Minister might not be able to give me a commitment today—the Chancellor might have something to say about it if she did—but I hope that she will take my request and see whether her colleagues at the DFE will consider widening the eligibility criteria for the ASF so that all children in kinship care can access the therapeutic support that they need.

The right hon. Lady said that every party believes that every child, regardless of their background, deserves the best start in life, and I echo those comments on behalf of the Liberal Democrats. Too often, money spent on children’s services, the education system and therapeutic support for children and young people is viewed as a cost. To my mind, we should look at those as huge capital investments. We are not investing in buildings or roads, but we are investing in tiny little people who could be our future entrepreneurs, teachers, doctors and politicians. The return on investment from investing in children is huge, and I do not think that the Treasury fully appreciates that.

If there is another campaign that we can all gather around and make the case for, it is investment in children and young people. Although we would not see the return on investment in one, two or perhaps even three election cycles—it is a long-term thing—I hope that we can all come together to make the case for that investment, which will pay huge dividends. We all want our children to grow up happy and healthy, and to thrive and reach the very best of their potential.

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in the debate. The right hon. Member for South Northamptonshire (Dame Andrea Leadsom) deserves every credit. She and I came to this House in 2010, and she has spoken about this issue in Westminster Hall and in the main Chamber on many occasions since. She will correct me if I am wrong, but I do not think that there has been a time when I have not supported her in such debates.

I do that for a number of reasons: first, because of our friendship as MPs, but secondly, because I fully support and endorse the right hon. Lady on this issue. I am always challenged by her contributions because they are so full of detail and knowledge about the right way to do things. The input of mothers is so much greater than the input of the dad. As a father and not as a mum, I cannot take any credit for how my children turned out; it is really down to my wife. She is the lady who did all the hard work—I was very rarely there—so I recognise the role of the mother in particular is critical, and it moulds the child for the future. For that reason, I am really pleased to come along to this debate.

[Munira Wilson]

Will the hon. Gentleman join me in saying that it is a wonderful thing to see cultural change and dads taking a much more active role? My husband is the primary carer of our two children and is very much the dad at home, and he has been since they were tiny, while I have always been out there working.

[Jim Shannon]

I was reminded when the hon. Lady mentioned that that I was at a function last Friday for the centenary of the Royal Ulster Constabulary. One of the councillors of my party is a house dad and he looks after two children. I will not mention his name, but he said to me last week, “Jim, I’d rather be working.” I said, “You are working, you’re just looking after the children. It’s slightly different.” But yes, the hon. Lady is right; society is changing, and sometimes that is the way it is. I have to say that I do think the role of the mother is much more important. That is just me; maybe I am old fashioned. I just see a slightly different and more critical role for the lady.

A growing body of evidence from the fields of clinical and social science shows that the areas of the brain that control social and emotional development are most active during the first three years of a child’s life. The hon. Member for Twickenham (Munira Wilson) referred to that, and referred to three to five years as well. That is important. Careful nurturing of a child’s social and emotional health during their early years is vital to provide them with the skills necessary to form relationships and interact with society later in life. It is so critical to get that right in those first few years. The hon. Lady has always said that in debates in the Chamber and elsewhere. I am my party’s health spokesperson, so I am pleased to be here, given my personal interest in the issue and as a grandfather with five grandchildren. The sixth is on the way, so we will shortly have a sixth one to nurture and look after. It means that the Shannon name will live on, and more so when the sixth grandchild arrives.

Developments start during pregnancy, and the choices and experiences of the mother during that period can have a significant impact on maternal and infant social and emotional health. With that in mind, Northern Ireland has a dedicated mental health strategy. I know that the Minister is aware of all those things, not just because some of her ancestry comes from that part of the world, but also because she makes it her job to be aware of what is happening in the regional Administrations. Although we have a mental health strategy in place, the pressures of lockdown and covid have greatly impacted child mental health, and any strategy must take that into consideration.

I want to focus on that issue, which the right hon. Member for South Northamptonshire referred to in relation to covid. Covid has put extra pressure on what the right hon. Lady is trying to achieve, and what we are trying to achieve in this debate. We have more children than ever who, as we say in Northern Ireland, make strange with strangers. I will try to explain what that really means. The right hon. Lady referred to isolation during covid, and it is as critical and stark as that. Covid babies were literally prevented from seeing other children; that is a fact of life. “Being strange with strangers” means nothing more than not knowing how to act with wee children of their age or how to react to adults who want to be friendly and acknowledge them. Children being strange with strangers, having not seen other children and adults during formative periods of their lives, is a critical issue that needs to be addressed.

Ever mindful that health, education and so on are devolved matters—although the issue for Northern Ireland will be similar to here—I have a major ask of the Minister, which I will be happy if she can respond to. What extra assistance, help, funding or advice can be given to parents whose children were born or were between two and five during covid—those two stark years when life was so different and we could not interact? What can be done to address that issue as we come out of covid and move forward in a constructive way?

Naomi from my office—who is my speechwriter, by the way; I keep her busy and make sure that she is across all these things—and I are of a kindred mind and spirit, so it is easy for us to discuss the issues that I want to speak about, because we look at how to do things the same way. She helps with the creche and the children’s church on Sunday morning, and she has told me, based on her personal experience, that it is only after a full year of being back that some mothers can slip back into the main service without their children getting upset. Let me explain what that means, Madam Chair. In the last two years, the covid pandemic put pressures on families like never before, which meant that the children probably did not leave their mum very often. Now that the creche and the children’s church is back, the children are able to stay there and their mums are able to leave.

That wee period is an example. In Naomi’s opinion, it has taken a year for those children to feel safe, even in a safe place—wow!—if their mother is not there. My fear is for those mothers who have been unable to leave their children—those who do not attend church, do not have a creche or nursery, or do not have access to other adults who could help. The right hon. Member for South Northamptonshire said how important it was for mums to have another mum to talk to, and even that was partially lost in the pandemic. I also wonder about pre-school and nursery children.

We must consider the effect of lockdown in a very detailed way. It is a genuinely big question to ask the Minister, but I see it in my constituency, and I am sure that everyone in this debate will be on the same page. I recently read a report by the National Children’s Bureau that highlighted the post-covid position. Although support for babies and infants, and their families has always been critical, the unprecedented covid-19 pandemic has refocused efforts on prevention and early intervention to address new or increasing risks, which is what this debate is really about.

Although it will be some time before the long-term impact of the pandemic is known, evidence already suggests a number of areas for concern, including the rising cost of living. The pandemic has moved on, but other things are impacting on young children, from babies right through to five-year-olds, including the cost of living and increasing fuel poverty. These are real things that every mother and every dad has to look at every day. I am no different from anybody else in this Chamber; I think that we are all the same. We are hearing regularly from our people and our constituents about these issues, and we worry about that. Again, that is not all the Minister’s responsibility; it is just to show the impact that these things are having.

Many people and families are increasingly reliant on food banks, which comes on top of already unacceptable child poverty rates, and against the evidence about the links between poverty and adverse childhood experiences. I never fail to get quite upset when I read those stories in the press about wee children who have been abused or, in the cases that make the press unfortunately, killed. I just cannot understand how those things can happen. I cannot understand the mindset of anybody who does that, and I cannot understand how social services did not step in earlier. This is just me, speaking from the outside. I find those stories quite painful to read, Madam Chair; I think we are all the same in that regard. Sometimes, you just have to flick over the page—not that you are disregarding it, but because it is so awful that you just cannot read it all. Those are some of the things of the day, along with concerns about parental mental ill-health, which is being driven by isolation, job uncertainty or the loss of a job, the loss of loved ones, illness and anxiety, among other factors.

I will just make a couple of quick points—I am coming to the end of my remarks; time is flying on here. I am greatly encouraged by foster families. The right hon. Member for South Northamptonshire is absolutely right about that. I know foster families who do some fantastic work, and they have a love for their children. Although they are not their biological children, they are their children. Those children get the love they did not have in their own homes, for whatever the reasons were. I know some foster families who have adopted maybe 20 or 30 children—that is incredible. They give affection and love, which is so necessary for a wee baby or small child between three and five, which are such important years.

Increased pressures in the home and the rising incidence of domestic violence—which is unfortunately another issue that happens with a regularity—are putting young children at risk of witnessing or experiencing abuse, and it impacts parental wellbeing. They see their mummy or daddy—let’s be honest, more often their mum—getting beaten, and that affects the child. The right hon. Lady is right: the experience of that three to five-year-old seeing that will have an impact for years to come. That is why this debate is critical and why over the years, when she has brought us to Westminster Hall and the Chamber, I was always there. I understand—not as good as the right hon. Lady does—what she is trying to achieve.

Services are facing pressure as they seek to continue the delivery of essential support to infants, parents and their families within the constantly changing environment that they find themselves in. The environment is changing all the time, and the pressures are great. There have been delays in access to services and support during lockdown and the pandemic, particularly for isolated and vulnerable families with newborns. Sometimes mothers have difficulty dealing with their children—it happens. It is a fact of life, but having someone to speak to and to help at that early time is so important.

The hon. Member for Twickenham is absolutely right about the need to invest in our children and young people. I see it as an investment and an opportunity to get it right, so that the children of the future can grow up to be Ministers, Chairs of Committees, doctors, teachers or MPs. We should give them the opportunity to do that. Let us get things right at the early stages. Every child deserves a good start in life, as the right hon. Member for South Northamptonshire said. I agree wholeheartedly with that, and I hope the debate can in some way move us towards that.

The need is clear, and we need to be just as clear in our pathway to support and help and in how this will be funded and promoted in every area of this United Kingdom of Great Britain and Northern Ireland. I am pleased to be an MP here and part of a nation that is united across the four regions. I say that to the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—she and I are good friends. It is important that we have a strategy and a way forward for all four regions to achieve what the right hon. Member for South Northamptonshire said: giving every child a good start in life. If we could do that, we would be doing well.

Access to NHS Dentistry

Munira Wilson Excerpts

Thursday 10th February 2022 Westminster Hall

[Munira Wilson (Twickenham) (LD)]

It is a pleasure to serve under your chairmanship, Mr Efford.

I, too, congratulate the hon. Members for Waveney (Peter Aldous) and for Bradford South (Judith Cummins) on securing this important debate. Lots of important points have been made about the situation nationally and about the contract, and some solutions have been offered.

I will use the short time available to pay tribute to Healthwatch Richmond, which back in the 2020 was the very first Healthwatch in the whole network to express concerns about dentistry. It was the first to produce a report on it, which prompted Healthwatch England and various local Healthwatches to do so. I pay tribute to Healthwatch Richmond’s lobbying of Healthwatch England and NHS England for bringing us to the point where we have the information to hand and can put pressure on NHS England and on Ministers. I thank Mike Derry for his work.

I also want to give a voice to my constituents. Yes, the London Borough of Richmond is a relatively affluent borough. That does not mean that there is not need and that everyone can afford to go to a private dentist. Our borough has the lowest funding for NHS dentistry in London, apart from the City of London, and the Healthwatch Richmond survey found that less than half of those seeking NHS care could get a routine appointment. One in three could not even access urgent or emergency care; private patients were 16 times more likely to be able to access treatment. Clearly, the problem is not with the supply of dentists, because those who needed to get treatment, if they are able and willing to pay, could access care in the space of a week. Hundreds of others, however, could not access such care.

I want to bring two or three examples to light. Only last month, a resident of Hampton wrote to me. She is a full-time carer for her daughter and they both have special needs. She was tearing her hair out, because she had phoned scores of NHS dental practices but no one would take her daughter. She said:

“I have to use my disability money and my heating money and food money to pay £700.00 to help my daughter. I even wanted my dental practice to give my daughter my place at the practice as she is in so much pain.”

They have various special needs and are concerned, as so many are, about the cost of living crisis—she has heating bills and food bills, but here she is having to pay for care.

Another recently retired individual, whose income dropped significantly in retirement, said that they ended up paying

“£1000 for x-rays and the 30 second removal of the implant! The second dentist I went to in Twickenham quoted me £6k for removal of a wobbly tooth and replacement”.

That is simply not affordable, and it is unfair to say that affluent boroughs such as Richmond do not need additional NHS provision. There are countless more stories. As we have heard, prevention is important. Another resident who wrote to me eventually ended up getting referred to hospital for emergency treatment months after they should have been treated.

I have sympathy for the argument made by the hon. Member for North East Bedfordshire (Richard Fuller) that, clearly, there is not a bottomless pit of taxpayer cash allowing everybody as much NHS treatment as they need all the time. We know it is a false economy to restrict NHS access because people are, as he pointed out, ending up in A&E and with far worse problems down the line, which costs the NHS a lot of money.

I agree with what the Father of the House, the hon. Member for Worthing West (Sir Peter Bottomley), said about everybody being entitled to NHS care. I know the Minister will talk about the recent £50 million injection of cash into NHS dentistry, but that will offer just 350,000 appointments. Nine million children missed dental appointments in the year following the first lockdown. The Liberal Democrats are calling for a minimum standard of service, with a personal dental plan that helps people to understand how frequently they need a check-up, gives them good advice on looking after their teeth and, critically, includes access to an NHS dentist. I look forward to hearing what the Minister has to say to my constituents and millions of others around the country who cannot access the care that they need.