Health and Social Care Budgets

Norman Lamb Excerpts

Tuesday 14th March 2017 Westminster Hall

[Norman Lamb (North Norfolk) (LD)]

The consensus in this room on the scale of the challenge that we face strikes me as remarkable. The £1 billion for social care this coming year is welcome, but against the £2 billion gap identified by the Health Foundation, the real risk is that this will result in more older people ending up unnecessarily in hospital because care fails at home, which puts more pressure on the NHS. In the following financial year, 2018-19, real-terms spending per head on the NHS will start to fall. That is a remarkable statistic. At a time when demand is rising rapidly, that makes no sense to anyone, wherever they are on the political spectrum. I want to touch on the human consequences of that.

Across the country families with children who have significant mental health problems routinely wait months for treatment. They suffer enormous anxiety. A man in my constituency was told he had a two-year wait for the adult ADHD clinic. Routinely across the country we are breaching the referral to treatment standard on cancer care. There is now an awful insidious trend whereby anyone who has money—we cannot blame people for this—is minded to opt out and fast-track treatment privately. Families faced with long delays do what they can for their loved ones, but do any of us really want to live in a country where timely access to treatment and potentially survival depend on whether we can pay? That is where we are heading.

No party has come up with a full solution to the crisis facing our NHS and care system. We have to be honest about that. Collectively, we are letting down the people of this country. It is remarkable how many speakers today have called for the Government to embrace a cross-party process. A load of MPs—senior MPs, Select Committee Chairs and former Ministers—have come together to call on the Prime Minister to establish an NHS and care convention to engage with the public in the mature discussion that we know we need to have but keep putting off. So I call on the Minister to support us within government, be audacious and recognise that this is a once-in-a-lifetime challenge. The Government will get credit for working with others to achieve the solution that this country badly needs.

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[The Minister of State, Department of Health (Mr Philip Dunne)]

I congratulate you on chairing this substantial debate so efficiently, Mr Bailey. Some 31 colleagues were present—that is a very high turnout for Westminster Hall—of whom 18 spoke, including three distinguished Select Committee Chairs and two Opposition spokesmen. Certainly I have not attended such a significant debate in Westminster Hall, and it reflects our common interest in ensuring that the NHS and social care services in this country provide as high-quality a service to the public as possible.

Virtually all speakers welcomed the developments in last week’s Budget, and I welcome that broad consensus across the Chamber. Only one discordant note was struck—reference was made to a march in the streets of London led by the shadow Chancellor, the right hon. Member for Hayes and Harlington (John McDonnell). That march obviously demonstrated a degree of concern, but it happened before the Budget, which, as I shall touch on, responded to many of the concerns that have been raised.

We all recognise that the NHS faces a significant challenge, given the increasing demand for health services as a consequence of our ageing and growing population, new drugs and treatments, and safer staffing requirements, and that in turn is increasing the pressure on social care services. We know that finances are challenging for both areas, which is why we have ensured that spending on the NHS has increased as a proportion of total Government spending each year since 2010.

We backed the “Five Year Forward View” as part of the spending review in late 2015. That ensured that real-terms NHS funding will increase by £10 billion by 2020-21 compared with the year before the spending review. Some hon. Members said that they wanted to see a plan. We have supported the NHS’s own plan—the “Five Year Forward View”—and announced that we will publish a Green Paper this summer looking at how social care is funded in the long term, which hon. Members have welcomed, so it is churlish to deny that this Government are providing long-term strategic thinking about the way we fund both those services. I remind colleagues that the NHS budget was £98 billion in 2014-15 and will be £119.9 billion in 2020-21. That is a £21.8 billion increase in cash terms, which seems to get lost from time to time in these discussions.

We are almost at the end of the financial year. The NHS received a cash increase of more than £5 billion in 2016-17. That was front-loaded, as NHS chief executive Simon Stevens requested. For the year that starts on 1 April, there will be another significant increase in funding once the mandate is settled. The hon. Member for Bristol South (Karin Smyth), who is a member of the Public Accounts Committee, asked when we will see that document. It has to be published by the end of this month, and I assure her that it will be.

The measures announced last week, which many hon. Members referred to, have three features. I will not go into them in detail, because they have all been covered. Much of the focus has been on the additional £2 billion that we will provide for social care over the next three years, half of which will start to come in next month, when the new financial year begins.

Some hon. Members are aware of the numbers for their areas and some are not, and one colleague came up with a slightly incorrect figure. I will not go through every area, but I applaud the presence of Devon MPs in particular, given the manner in which they have massed themselves with colleagues from across the House. Devon will get a £30.3 million increase in its social care budget over the next three years and will receive half of that in the year that is about to start. My hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) referred to an £18 million increase for North Yorkshire. I can give him a bit of good news: it will actually be £19.6 million over the next three years. I am grateful to the Chair of the Public Accounts Committee, the hon. Member for Hackney South and Shoreditch (Meg Hillier), for her support for the Budget measures. Hackney will receive £12.8 million, as she acknowledged. Like many colleagues, she sought a long-term funding settlement.

[Norman Lamb]

rose—

[Mr Dunne]

I am afraid I cannot take interventions, as we have very little time.

The spending review provided a settlement for the NHS. The Chancellor indicated that there will be a social care Green Paper this summer. Several colleagues called for a cross-party consensus. The Green Paper will provide an opportunity for debate and consultation, and such discussions should focus on that.

The second Budget measure was a £100 million increase in funding for A&E services, so that people who present at A&E who do not need intense or urgent care can be diverted to GPs or clinics run by nurse practitioners. That best practice has been proven to work in A&Es that have such a streaming service, so we are looking to provide facilities for basic capital spend to ensure that every A&E hospital across the country has streaming in place by next winter. I am pleased that that has been welcomed by hon. Members from across the House.

The third measure—this was touched on in the debate, albeit not in such detail—is the £325 million capital investment in the first set of sustainability and transformation plans. Those who make the strongest case for investment and can deliver better, more joined-up services, which can bring real improvements to patient care, will benefit from the funding. We look to that to be an exemplar for other areas whose plans are less well developed, to encourage them to develop a better, more integrated approach to patient care for the future, including closer working with local authorities for the provision of social care. That should encourage areas to bring forward more comprehensive plans for the next wave of STPs, which will be supported. As hon. Members have said, we look forward to explaining more about that at the time of the next Budget.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

I absolutely agree. About 3% of schoolchildren have severe anxiety, but if we get treatment to them quickly, often we cure the condition and it does not come back. My hon. Friend is absolutely right that we need to be as imaginative as possible.

[Norman Lamb (North Norfolk) (LD)]

T8. I have to report back to a constituent who is desperate for treatment that the current waiting time for the adult ADHD clinic is two years. In 2014, the Secretary of State and I published a vision to achieve comprehensive maximum waiting time standards in mental health so that people with mental ill health had exactly the same right to access treatment in the same time. Why on earth can the Government not end the outrageous discrimination against people with mental ill health?

[Mr Hunt]

I am always somewhat disappointed by the right hon. Gentleman’s rhetoric, given that we are spending about £1 billion more every year than when he was mental health Minister. This April, we will reintroduce maximum waiting times for eating disorders. As he knows, we have committed to publish pathways for all conditions during this Parliament. That will include his constituent who, I agree, is waiting much too long at the moment.

Agenda for Change: NHS Pay Restraint

Norman Lamb Excerpts

Monday 30th January 2017 Westminster Hall

[Catherine McKinnell]

My hon. Friend makes an important point. It is not enough for us to state our support for our NHS workers; we must show it through real action.

[Norman Lamb (North Norfolk) (LD)]

I agree with the points that the hon. Lady has made. Does she agree that, given the shortage of about 24,000 nurses, the fact that about one in three are due to retire in the next 10 years, and the challenge of Brexit, which might make recruitment more difficult, one potential consequence of pay restraint, along with the sense of injustice for nurses, is that we will face a real recruitment crisis? People will just vote with their feet and not work in the NHS. That presents us with a real challenge.

[Catherine McKinnell]

I very much share the right hon. Gentleman’s concerns. He anticipates some of the points that I would really like to get across.

My view of the importance of those who work in our NHS is shared not only by Opposition Members. The Department of Health stated in its response to the e-petition:

“Agenda for Change staff are vital. They work incredibly hard for patients and deserve to be fairly rewarded. We are committed to ensuring trusts can afford to employ the staff the NHS needs.

NHS staff are our greatest asset. Despite the pressures on the NHS driven by an increasingly aged and frail population, nurses, and all our hard working NHS staff continue to put patients first, keeping them safe whilst providing the high quality care patients and their families expect.”

How have we found ourselves in a situation in which hard-working, dedicated, exhausted nurses, midwives and other healthcare professionals are genuinely struggling to make ends meet?

Breast Cancer Drugs

Norman Lamb Excerpts

Thursday 26th January 2017 Commons Chamber

[Siobhain McDonagh]

The answer to the right hon. Gentleman’s question is both. There are issues with how NICE assesses new drugs, particularly cutting-edge drugs such as Kadcyla. He will know, because of his involvement in the last Government, that they established the cancer drugs fund. It is not an either/or, but something we all need to come together to discuss, and that people with more scientific knowledge than me might wish to consider.

[Norman Lamb (North Norfolk) (LD)]

I congratulate the hon. Lady on securing this important debate. Does she share my concern at news that the Government appear to be ready to leave the European Medicines Agency following the Brexit vote? Many people fear that that will lead to a slowdown in access to new medicines. She talks about the importance of NHS patients getting access to medicines; this could make the situation worse and leave us disadvantaged compared with other countries in Europe.

[Siobhain McDonagh]

Breast cancer knows no boundaries, whether class, social or geographic. Anything that reduces access to better forms of treatment is detrimental.

The ability to lead an enriched and longer life as a result of medical advances should not be limited only to those who can afford private healthcare. Those advances should be accessible to us all. This debate will focus particularly on the provision of the breast cancer drug Kadcyla, which is under threat. Most Members will be aware of the lease of life that Kadcyla has brought to thousands of women in England with incurable secondary breast cancer. These women rely on Kadcyla to enrich their lives and to give them extra precious years to live. Indeed, in many ways it is a revolutionary drug. By targeting cancer cells directly, it helps to reduce the number of side effects, boosting women’s quality of life immeasurably. Members who have heard these women talk about their experiences will be humbled to learn of the distress and despair that they face as a result of NICE’s decision to provisionally reject the future use of Kadcyla on the NHS.

Today we are all supporting Breast Cancer Now’s “Keep Kadcyla” campaign to encourage NICE to reverse its decision and enable continued access to the drug, which both improves the quality of life and extends the lives of thousands of women in this country, on the NHS. Since NICE’s decision was announced at the end of December, thousands of people throughout the country have had their views heard. They have signed the petition and contacted their local MPs to ask that we do not give up on women, on the children who are dependent on mothers, and on the families who want that precious extra time with their loved ones. That is why we are all here today: to raise our collective voice in support of these women and defend the treatment that allows them to live their lives.

The focus of much of what I have to say today will be on Kadcyla, but we also need to consider other specific breast cancer drugs, as well as the broader issue of how decisions about access to treatment are made. Unfortunately, we are yet to see any improvements in access to off-patent drugs, some of which can prevent the development of certain cancers, thereby saving countless lives, as well as saving the NHS a great deal of money. Just a few months ago, the front pages of national newspapers highlighted the poor access to vital bisphosphonate drugs, which can prevent women from developing secondary cancer, yet the Government have barely acknowledged the problem of access to such treatment. I look forward to hearing from the Minister about when we can expect tangible results regarding access to off-patent drugs, including bisphosphonates. To be clear, many of the women who today owe their lives to Kadcyla might never have developed secondary breast cancer had they had access to bisphosphonate drugs in the first place.

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[Siobhain McDonagh]

I completely agree with my hon. Friend. I appreciate that the equations and calculations are difficult, and I do not underestimate NICE’s work, but it is about life and quality of life, and it is about so many more people than only those who have the cancer.

My friend Leslie said:

“In 2013 my world was turned upside down when I was diagnosed with inflammatory breast cancer, a rare and aggressive kind of cancer that develops in the lymph vessels.

After 15 months’ treatment comprising 8 chemotherapy treatments, a mastectomy, 15 radiotherapy treatments and a year of Herceptin, it appeared that the cancer had gone. However, 4 months later I noticed a rash around the scar tissue of the mastectomy and a biopsy showed that the cancer had recurred in my skin.

My oncologist told me that I was in a very tight corner. Because the cancer had returned so quickly I wasn’t eligible for the usual drug treatments, radiotherapy wasn’t an option because I had recently completed a course, and surgery wasn’t possible because of the location of the cancer. I was told the cancer was incurable and referred to the Royal Marsden. They confirmed that surgery was not feasible because the cancer had spread so quickly over a large area making skin grafts impossible. I was told Kadcyla was my best chance.

I have now been treated with Kadcyla for 22 months and I have been told of others that have been treated for 5 years. Signs of the cancer disappeared very quickly and so far I have remained cancer free. Kadcyla has enabled me to live a reasonably normal life and participate in and contribute to my local community. Kadcyla has been a life saver for me and without it my future was very uncertain. I feel profoundly fortunate to have received it and I am incredulous that such an effective drug will now be denied to other people in my situation.”

I also wish to mention Rosalie, who was featured in Friday’s Evening Standard. She is just 33 and is living with incurable breast cancer. She is a single parent to two children, aged three and six, and is terrified of a future without the option of Kadcyla and terrified of her kids’ growing up alone. These are Rosalie’s own words:

“I hate feeling like a victim. But I have to fight for my kids. They are more important than me feeling vulnerable about going public. I have to fight for life for them.”

Then there is Mani. Members may have seen her last week on the “Victoria Derbyshire” programme when she spoke so eloquently about how Kadcyla had given her hope. She said that it had improved her life both significantly and quickly, enabling her to live a much fuller and richer life, going on holiday and playing an active part in her young daughter’s life.

These are just a few of the many women whose lives have been made possible through access to Kadcyla. I am sure that many hon. Members will share the experiences of their constituents. The hon. Member for Croydon South (Chris Philp) will no doubt talk about the incredible Bonnie Fox, the face of the Keep Kadcyla campaign of Breast Cancer Now. Thanks to the hard work of Bonnie and of Breast Cancer Now, this campaign has seen more than 100,000 people sign the petition, calling for NICE and Roche to come together to reassess the decision and find a solution to keep Kadcyla available.

Bonnie is an incredible advocate for the Keep Kadcyla campaign, inspiring so many others as she leads the case for this treatment. Bonnie says that her inspiration comes from wanting to have as much time as possible with her two-year-old son, Barnaby. These are her own words:

“I already feel cheated being diagnosed with secondary breast cancer at 37 with a baby, so having a drug taken away that would potentially add years to my life and give me more quality time with my son is so cruel.”

[Norman Lamb]

I am really grateful to the hon. Lady for giving way again. She will be aware that the Government’s accelerated access review last October recommended that NICE should review its whole health technology assessment processes and methods. Is she concerned that the review of Kadcyla and other drugs under the cancer drugs fund is happening before that review takes place? We might learn the lessons about how the review process needs to improve, but we will not benefit from them.

[Siobhain McDonagh]

I agree with the right hon. Gentleman. I am sure that he knows more about this process than I do. It clearly makes sense to consider these unique, unusual first-tier drugs in the light of that reconsideration.

I hope that we will hear the stories of the many women whose lives, having been affected by secondary breast cancer, have been enriched by Kadcyla. The drug Kadcyla matters so much to all these women for one simple reason: it works. It is effective. It has already been available on the NHS for more than two years and, compared with other treatments, its side effects are limited. Today, it is nothing short of a tragedy to know that countless women who thought that Kadcyla would be the next treatment they would receive for their breast cancer are having their lives shortened before their eyes.

I ask Members to imagine this: they are living with breast cancer; there is no cure, but there is something that could give them extra time with the people they love—the people who depend on them. It could be a year, five years or even longer. If they needed the drug today, the NHS would give it to them, but if they needed it in a few months’ time, they may have lost their chance.

NHS and Social Care Funding

Norman Lamb Excerpts

Wednesday 11th January 2017 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right, and I talked about these issues when I visited her in her constituency. The truth is that, to solve this problem, we are going to have to have a dramatic increase in the number of people working in general practice, which is why we are funding the second biggest increase in the number of GPs in the NHS’s history.

It is a great shame that the Leader of the Opposition is not here, because this is the bit that I wanted to address to him—his proposal to put extra funding into the NHS by scrapping the corporation tax cuts. That reveals, I am afraid, a fundamental misunderstanding of how we fund the NHS. Corporation taxes are being cut so that we can boost jobs, strengthen the economy and fund the NHS. The reason we have been able to protect and increase funding in the NHS in the last six years, when the Labour party was not willing to do so, is precisely that we have created 2 million jobs and given this country the fastest growing economy in the G7, and that is even more important post-Brexit. To risk that growth, which is what the Labour party’s proposal would do, would not just risk funding for the NHS, but be dangerous for the economy and mortally dangerous for the NHS.

[Norman Lamb (North Norfolk) (LD)]

I just want to understand exactly what the Secretary of State was saying on Monday about the four-hour A&E target. Is it conceivable that some of the people who are currently within the A&E target will, at some stage, fall outside the A&E target?

[Mr Hunt]

I am committed to people using A&Es falling within the four-hour target, but I also think that we need to be much more effective at diverting people who do not need to go to A&E to other places, as is happening in Wales, as is happening in Scotland and which, frankly, is the only sensible thing to do.

However, going back to the funding issue, I just want to make this point: for all the heat in this Chamber in debates on the NHS, probably the biggest difference between the two sides of the House is not on NHS policy but on the ability to deliver the strong economy that the NHS needs to give it the funding that it requires. I am afraid that the proposals in the motion today reveal that divide even more starkly.

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[Dr Sarah Wollaston (Totnes) (Con)]

I will try to be mindful of those comments, Madam Deputy Speaker, as I follow the hon. Member for Central Ayrshire (Dr Whitford), my colleague on the Health Committee. As always, she made thoughtful and thought-provoking comments, and I would like to endorse her points and expand on some of them.

First, I thank NHS and care staff. We have heard that they are facing unprecedented demand over the winter, but it is not just winter pressures that they face now—the pressures extend into the summer. As we have heard, that is not just about numbers but about the complexity of conditions and the frailty of those presenting in our accident and emergency departments. The Health Committee heard in its recent inquiry that the trusts that are most successful in getting close to the four-hour target are those that see it as an entire-system issue, and in which both health and care staff contribute to the effort, not as a tick-box exercise but because they recognise that it is fundamentally about patient safety and the quality of patients’ experiences. That is why the four-hour target matters, and the Secretary of State is right to endorse it.

The Secretary of State is also right that we sometimes need to be more nuanced about our targets and that he needs to be open to listening to what clinicians are telling him about how we can improve the way in which targets are applied. It would be a great shame if we in this House prevented those sensible discussions from taking place because of political furore. I urge him to continue to have them and to take advice and listen to clinicians about how we can improve the use of targets, but he is absolutely right in being clear that he will keep the four-hour target.

We must talk about this as a whole-system issue. Accident and emergency is a barometer of wider system pressures, as has been pointed out, and I want to focus my remarks on the integration of health and social care.

I agree with colleagues throughout the House who have called for a convention on reviewing funding as a whole-system issue. We have heard that next year is the 70th birthday of the NHS, and what could be a better present than politicians changing the debate and the way in which we talk about the funding of health and social care, so that we do so in a collaborative manner that works towards the right solution for our patients? The consequences of our not doing that would be profound for our constituents, who would not thank us for not being prepared to put aside party differences and work towards the right solution.

Ultimately, this issue is about a demographic change that we are simply not preparing for adequately. In the case of the pension age, we recognised that there had to be a different debate given the change in longevity. Over the decade to 2015, we saw a 31% increase in the number of people living to 85 and older. Of course, that is a cause for celebration, but there has not been a matching increase in disease-free life expectancy.

I welcome the Prime Minister’s focus on tackling inequality, but unfortunately we are not making sufficient progress on that, either. In her very first speech in the job, she talked about tackling the “burning injustice” of health inequality. We in this House have a role in doing that together in a consensual manner.

[Norman Lamb]

I very much agree with the hon. Lady. Does she share my welcome for the Prime Minister’s response today in which she stated that she was prepared to meet us and other Members of Parliament from across the House and my hope that it might start a more constructive approach?

[Dr Wollaston]

Absolutely. It was extraordinarily encouraging to hear the Prime Minister say that she was prepared to consider that and to meet Members from across the House. I urge colleagues who feel that this is a better way forward to sign up to it, speak to their party Whips and make it clear that it has widespread support.

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[Norman Lamb (North Norfolk) (LD)]

I join many others in commending those who work in our NHS and in our care system, including the hon. Members for Lewes (Maria Caulfield) and for Central Suffolk and North Ipswich (Dr Poulter) both of whom continue to work in the NHS, I think without payment—[Interruption.] Not any longer. It is important that we acknowledge that many people in the NHS are working under incredible strain, and we owe them a debt of real gratitude.

I make it clear that I support the Labour motion, and I recognise the importance of access standards in our health service. After arriving here in 2001, my first Westminster Hall debate was on waiting time standards in Norfolk for orthopaedic cases. People in those days were sometimes waiting three years for treatment. So the waiting time standards that were introduced dramatically changed people’s experience of healthcare, and we should celebrate that. But it is also right to say that sometimes the standards distort behaviour, and those distortions need to be addressed, as the hon. Member for Lewes made clear. Another example to cite is that of the ambulance standards, where I am concerned about a very serious distortion of behaviour, which often causes enormous frustration for paramedics, who are also working under ludicrous amounts of pressure.

The other point I wish to make on access standards is that although I totally applaud the Labour Government for introducing them, they did not introduce them for mental health. That is why we now have to complete the picture. This Government have confirmed that they accept in full the Paul Farmer taskforce report on mental health, but it includes the proposal to roll out comprehensive maximum waiting time standards in mental health, so that someone with mental ill health has exactly the same right as anyone else to get access to good-quality, evidence-based treatment on a timely basis. We put this in an amendment that we tabled for this debate but which was not selected, but I urge the Government, as they have accepted that report, to make sure it is now implemented. The current situation amounts to a discrimination in the health service; how can we possibly justify the fact that someone with mental ill health does not have the right to timely treatment that other people enjoy? We have to end that discrimination.

The final thing I wish to address relates to the question I asked the Prime Minister today. I asked her to meet a group of cross-party MPs who are proposing that the Government should establish what we are calling an NHS and care convention. We feel that is an opportunity to engage with the public in a mature debate about the scale of the challenge we all face. We can trade insults across this Chamber, but we all know in our heart of hearts that the system is under unsustainable pressure—that is the truth of it, and we know it. At some point, as the hon. Member for Lewes conceded, we will need extra resources in the future, so let us plan now. Let us get everybody on board and get cross-party support, because sometimes, just as we saw with Adair Turner in the last decade under the Labour Government, we need a process to unlock a problem that ordinary partisan politics has not been able to resolve.

I welcome the fact that the Prime Minister agreed today to meet a group of us who are making this call. We have also set up a petition on the Parliament website, so that any member of the public can join this call. I urge hon. Members from across this House who support this call to join in, because not only is it in the Government’s political interest to do this, but it is fundamentally in the interests of the citizens of this country that we in this House collectively address an enormous existential challenge to the NHS and the care system. We surely cannot tolerate more than 1 million older people not getting access to the care and support they need. I do not want to live in a country where someone’s access to care and support in old age depends on whether they can pay for it, but we are at genuine risk of slipping towards that situation. If we all believe that that is not tolerable, we have a duty to act. We must be prepared to act together, not just trade insults at each other. There is a real opportunity now to do what the public are desperately pleading for us to do: bury our differences and work together to achieve a long-term, sustainable settlement for the NHS and the care system.

Children’s Wellbeing and Mental Health: Schools

Norman Lamb Excerpts

Tuesday 10th January 2017 Westminster Hall

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House has considered the matter of supporting children’s wellbeing and mental health in a school environment.

It is a pleasure to serve under your chairmanship, Mr Nuttall, I think for the first time. It is timely to be discussing the incredibly important issue of children’s mental health and wellbeing, particularly in the context of schools, given what the Prime Minister said yesterday. I welcome the fact that the Prime Minister of this country chose to make a speech that was significantly about mental health. That in itself is quite a novelty and should be acknowledged as such. She spoke powerfully about the “burning injustices” in society and focused particularly on those who suffer mental ill health.

My problem is that the response must match the scale of the injustice, and I think that the response has ultimately fallen short, but as a society we are on a journey and it is an important step that the Government are now saying the right things. I suspect that it is acknowledged by many Conservative Members that there is still a gap between the rhetoric and the reality for many people throughout the country, particularly families experiencing mental ill health, who sometimes have to wait horribly long for any access to treatment.

I will briefly describe my own family experience. This goes back to the last decade, which makes the point that the situation we are discussing is not the fault of any individual party or Government. When our oldest son required treatment and as a family we were fairly desperate, we were told that he would have to wait six months to start treatment, so we did what I guess any family would do and paid for treatment. Of course, very many people cannot do that. I do not want to live in a country in which people who have money can access great care, but those who do not are left waiting. That for me is the injustice that we must confront, but I welcome the fact that the Prime Minister has raised this incredibly important issue.

One in 10 children are estimated to have a diagnosable mental illness, and 75% of mental health problems in adulthood started before the age of 18, so there is both a moral and an economic case for dealing with mental ill health among children and teenagers, because by neglecting it we store up enormous problems for people later in life, at enormous cost to the state—that is the key point that we must recognise. However, despite the prevalence of illness among children and teenagers, three in four children and young people with a clinically significant mental illness are not in touch with appropriate mental health services, and sometimes it can take up to 10 years before the first symptoms are diagnosed and addressed.

I stress that I do not want to over-medicalise this problem; we do not want to drive everyone into treatment. What we want to do, of course, is prevent the need for that, so we must shift the system so that it focuses much more on preventing ill health and deterioration in health, and schools are necessarily central to that.

[David Simpson (Upper Bann) (DUP)]

I am sure that the right hon. Gentleman will agree, in relation to mental health and schools, that it is important that young teachers are trained to recognise the difficulties that some children have, so that there can be early intervention to try to prevent the need for all the children to go into treatment.

[Norman Lamb]

I am grateful to the hon. Gentleman for that intervention. I totally agree. As I will explain later, giving professionals the tools to manage the issues in front of them seems to me to be fundamental to a sensible approach.

There appears to be growing evidence of increasing mental health problems among young girls. In August 2016 a survey for the Department for Education found that rates of depression and anxiety have risen among teenage girls in England, although the rates appear to be more stable among boys. The survey found that 37% of girls reported feeling unhappy, worthless or unable to concentrate; that was more than twice the percentage for boys. According to the Children’s Society’s latest “Good Childhood” report, a gender gap has opened up between girls and boys in relation to both happiness with life as a whole and appearance. One in seven girls aged 10 to 15 felt unhappy with their lives as a whole, and the figure had gone up over a five-year period. We need to seek to understand that situation better in order to make the right response. I pay tribute to the Children’s Society, which has supported me in bringing this debate to Parliament. I also thank, as I should have done at the start, the MPs who joined me in applying for the debate.

There also appear to be problems among women between the ages of 16 and 24, according to a major report by NHS Digital. Reports of self-harm in that group trebled between 2007 and 2014, so something very serious is going on. Research is urgently needed to understand the causes of the trend. Social media appear to be part of the picture—there are concerns about sexting, cyber-bullying and so on.

We must also remember the issues that relate to boys and young men. Horrifically, suicide remains the biggest killer of men under the age of 45 in the UK, and the rate has been increasing in recent years. In 2014 the male suicide rate was three times higher than the female rate. I am pleased that the Government focused on suicide in yesterday’s announcements. Ultimately, there is nothing more serious or important than seeking to prevent lives from being lost in that horribly tragic way, with the impact that it has on families—my family, along with many others in this country, have gone through that experience—so we need to give it the greatest possible attention.

The overall lifetime costs associated with a moderate behavioural problem amount to £85,000 per child, and with a severe behavioural problem they are £260,000 per child. That is why it is so important to deal with these issues early, rather than allowing them to become entrenched.

The Children’s Society has highlighted school-based counselling, which can be highly effective for children experiencing emotional difficulties. It can be used as a preventive measure, an early intervention measure, a parallel support alongside specialist mental health services, and a tapering intervention when a case is closed by the specialist services to help a child or teenager through to recovery. Research shows that children perceive it as a highly accessible, non-stigmatising and effective form of early intervention.

Studies have also shown that attending school-based counselling services has a positive impact on studying and learning. In 2009 Professor Mick Cooper assessed the experiences of and outcomes for 10,000 children who had received counselling in UK secondary schools. More than 90% reported an improvement, which they attributed to counselling, and 90% of teachers reported that counselling had a positive impact on concentration, motivation and participation. So we end up achieving better academic attainment if we make the investment for those children who need it. It can be cost-effective, given the long-term cost to the economy of problems that continue into adulthood; some studies have indicated that the long-term savings can be in the region of £3 saved for every £1 invested, and data from Wales indicate that the average cost of school-based counselling is significantly lower than the specialist treatment children get if that is the only alternative. So we save money by giving children access to school-based counselling rather than delaying intervention and referring the child to a distant service, probably with a long waiting time, which is also far more stigmatising.

The British Association for Counselling and Psychotherapy has estimated that the overall cost of statutory provision of school-based counselling across all of England’s state-funded secondary schools would be in the region of £90 million per year. On the basis that 60% of schools are already delivering it, the additional delivery would cost around £36 million. I suggest that that investment is well worth making given the improved preventive care.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I am grateful to the right hon. Gentleman for giving way and apologise for being a few minutes late for the start of his important speech. I am sure that he, like me, will have had the privilege of visiting a number of schools, not only in his own constituency but across the country, that are really committed to their students’ mental health and have invested in school-based counselling. Does he share my concern that in this past year we have already seen cuts to those services within schools because they have seen their budgets reduced and they are having to incur the additional costs of pensions, for example? The prospect for the years ahead is to see some schools that fund counsellors five days a week going down to three, or three days down to one, and some having to scrap the provision altogether because they simply do not have the resources to make this very important service available in their schools.

[Norman Lamb]

I thank the hon. Lady for that intervention and pay tribute to the tremendous campaigning work that she does on mental health. Her point highlights the gap between the rhetoric, which is often well intentioned, and the reality. There is now a much greater focus on prevention in the Government’s argument, but what too often happens with a system under impossible strain is that the preventive services are cut first because there is a desperate need to prop up acute services within the system. She makes an important point.

Let me address the issue of stigma in schools. Stigma can exacerbate mental health conditions and prevent people from speaking out and seeking help. In October 2016 the YMCA launched a nationwide campaign aimed at tackling the stigma associated with mental health difficulties and to help to encourage young people to speak out. It found that more than one in three young people with mental health difficulties had felt the negative impact of stigma. School is where most young people experience stigma, and more than half of those who have experienced stigma said it came from their own friends. There is often a lack of understanding among young people—teenagers—about what mental health really is. That is why it is so important that we get this on the curriculum so that every teenager learns about their mental, as well as physical, health and wellbeing, and about how they can become more robust in coping with the challenges they face.

The impact of stigma is profound and pervasive, affecting many areas of a young person’s life. Young people reported that the stigma affected their confidence and made them less likely to talk about their experiences or to seek professional help. I can remember the moment when our eldest son said to me, “Why I am the only person who is going mad?” I just thought that here is a teenager feeling that and having stored it up inside himself, having not been able to talk about it for a long time. We can just imagine the strain of trying to cope with that on top of all the normal pressures of being a teenager. We have to do far more to combat stigma if we are to improve young people’s experiences.

I want to mention “Future in mind”, which is the blueprint we published in March 2015 just before the coalition Government came to an end. It was widely welcomed across the sector. We involved educationalists, academics, practitioners and young people, in particular, in the work we did. Central to the recommendations was the role of schools, and among the recommendations was the proposal that there should be a specific individual responsible for mental health in every school to provide a link to the expertise and support available, to discuss concerns with an individual child or young person and to identify issues and make effective referrals.

There should be someone taking responsibility but also a named contact point in specialist mental health services—too often we find that schools do not have the faintest idea who to contact when a child needs support—and also joint training. The hon. Member for Upper Bann (David Simpson) made the point about the training of teachers. If we can get teachers working alongside specialist mental health workers in schools, everybody will benefit.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Will the right hon. Gentleman also pay tribute to the work of the Samaritans? It has a scheme called DEAL—developing emotional awareness and listening—which it is rolling out across Wales in particular. There is a resource pack available for teachers if they want to take it into schools, or the Samaritans will send volunteers into schools to undertake, separate from the school system, talks and raise awareness for young people. That is the sort of low-cost—not expecting lots of money to be involved—involvement of people and organisations such as the Samaritans, with their specialist knowledge and awareness, that is extremely helpful in reaching young people.

[Norman Lamb]

I pay tribute to the hon. Lady for the incredibly valuable work that she has done, particularly on suicide. I join her in paying tribute to the work of the Samaritans and the army of volunteers who give up their own time to save people’s lives. The sort of initiative that she described is incredibly important. Do the Government remain committed to implementing “Future in mind”? There is a danger in Government that we just replace one initiative with another. There is a very good plan there, which has all the right principles, and the important thing is just to do it and make sure that the money—I will come to that in a moment—actually gets through to where it is required.

[Luciana Berger]

I am grateful to the right hon. Gentleman for kindly giving way again. May I echo his very important points? “Future in mind”, the report for which he was responsible, was released in March 2015. We are nearly two years down the line and, despite the fact that the “Five Year Forward View” explicitly stated that it accepted the recommendations of the “Future in mind” report, we are yet to see the vast majority of them implemented. I echo what he said and urge the Government to address that very important point in their response.

[Norman Lamb]

I thank the hon. Lady for that intervention. Given that I was responsible for that report, I feel very strongly about its absolute importance. I chaired a commission for the Education Policy Institute that reported last November, and we were pleased that the Secretary of State for Health came to speak at the launch, which I thought was important in itself. We looked at what has happened since “Future in mind” and in some parts of the country they are doing great work, but in others very little is happening. Very little has changed, with the bulk of the money still going to the acute end of the spectrum and not being reinvested in preventive care.

Critically, in many areas of the country, as the YoungMinds survey showed, 50% of clinical commissioning groups are not spending all the money—the additional investment secured in the coalition Government’s last Budget. They are not spending the full allocation on children’s mental health. I think that is scandalous. It amounts to theft of money solemnly pledged by the Government for children’s mental health, yet in many areas it is being diverted to prop up local acute hospitals. We cannot tolerate that. The Government have to find ways of ensuring that all that money is spent as intended. I know that the Government plan to have greater transparency, with Ofsted-style ratings for CCGs, but frankly there needs to be more than that. When a CCG is under financial stress, it is just too easy to shave a bit off children’s mental health to spend it where the public are clamouring for action, because ambulances are stacked up outside the A&E department.

In the first year after “Future in mind”, the system that we designed meant that local areas would get the money only if they produced a transformation plan to show how the money would be spent on changing the system to focus more on prevention. My proposition to the Government—the EPI commission report said this—is that every year the money should be tied to a commitment from the CCG that every penny of it is spent on children’s mental health. The CCG must also demonstrate that it has stuck with the plan from the previous year and that it has a plan to continue the change in the subsequent year. Unless we use the money to drive change in local areas, it will not happen because the system is under so much strain.

The other point argued for by the Education Policy Institute commission was that the Prime Minister should launch her own Prime Minister’s challenge on children’s mental health, as the former Prime Minister did on dementia, because that sort of prime ministerial stamp of importance for this subject would be incredibly valuable. Yesterday was a start, but I challenge the Prime Minister to go further and launch a formal challenge of that sort.

My final point—I am conscious that other Members wish to contribute to the debate—relates to the importance of ensuring that when a child needs specialist treatment, they get it on time. This goes to what I regard as a discrimination within the NHS, because anyone who has a physical health problem benefits from a maximum waiting time. Whatever their issue is, they know that a standard maximum waiting time applies nationally. It is accepted that those standards are under strain, but at least they exist, and I know that they drive the system, from the Secretary of State’s office downwards, in looking at every individual hospital’s performance across the country.

On mental health, however, apart from the two maximum waiting time standards that we introduced in the last two years, there are no other maximum waiting time standards. There is no standard for children. Families across the country can be left waiting, sometimes for months, to get any treatment at all, and when they get referred too often they have to clear high thresholds. In other words, someone has to prove that they are really sick before they get any help at all. That dysfunctional and irrational approach completely contradicts the principle of early intervention.

When you have a child aged 15—as I did, a girl—who had an eating disorder and was turned away from treatment because her body mass index was not low enough, and who then got admitted as a crisis case two months later because the problem had been neglected, you are left in a state of despair. We need to ensure that children with mental health problems have the same right to timely, evidence-based treatment as anyone with a physical health problem does, and that they should be treated close to home rather than being shunted sometimes hundreds of miles away.

These are the burning injustices that exist for many families across the country who cannot pay to opt out of the system. We have a duty and a responsibility—the Government, in particular, have a duty—to ensure that those children get the treatment they need on a timely basis.

[Mr David Nuttall (in the Chair)]

Five Members wish to speak in the debate and I intend to call the Front-Bench spokesmen at 10.30 am, so if Members could keep their remarks, including interventions, to about seven minutes each, I calculate that we should get everyone in and share the time equally.

Mental Health and NHS Performance

Norman Lamb Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I add to Mr Speaker’s comments my very good wishes and confidence that my hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) will get superb care from the NHS. I thank her for campaigning on patient safety. I am sure she will be pleased to hear that our principal safety campaign this year is on maternity safety.

In bald numbers, the plan will mean that we will treat 1 million more people with mental health conditions a year by the end of this Parliament. Of course, many of those will be in Yorkshire. An additional 70,000 young people will get treatment every single year and I hope that will bring down the CAMHS waiting times. We also want to do work in schools to prevent people from getting on the CAMHS waiting list in the first place.

[Norman Lamb (North Norfolk) (LD)]

The YoungMinds survey published before Christmas showed a failure in 50% of clinical commissioning group areas to spend the full amount of extra investment allocated to children and young people’s mental health. That is scandalous. I note the Secretary of State’s point about Ofsted-style ratings, but does he not need to introduce a system that guarantees that the money the Government promised for children’s mental health is actually spent as intended?

[Mr Hunt]

The right hon. Gentleman is right to want to ensure that we live up to those promises. He was a Minister when some of those promises were made and they are very important. I would say that we are delivering what he wants. We are on track this year to spend around £1 billion more, compared with two years ago when he was Minister for mental health. It has taken time for the NHS to get the message on mental health, but it is getting through loud and clear.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Dunne]

I join my right hon. Friend in congratulating her chief executive on her commitment to the NHS. As I said in answer to a previous question about the STP for my right hon. Friend’s area, the issue is being reviewed at the moment by NHS England, and I am afraid that I am not in a position to give her any advance notice of the outcome.

[Norman Lamb (North Norfolk) (LD)]

The Secretary of State will be aware of the horrifying case of Fiona Hollings, a 19-year-old with anorexia who for the past four months has been nearly 400 miles away from home, in a bed in Glasgow. Her family have travelled 8,000 miles in that time to see her. The Government commit to ending this horrific practice by 2020, but do families really have to put up with it until then? How would he feel if it was his child?

[Mr Jeremy Hunt]

We are taking action and I agree with the right hon. Gentleman that what has happened in that case is completely unacceptable. We are currently commissioning a record number of in-patient mental health beds, and it is a very big priority for us to eliminate the problem entirely by the end of the Parliament.

CQC: NHS Deaths Review

Norman Lamb Excerpts

Tuesday 13th December 2016 Commons Chamber

[Mr Hunt]

My hon. Friend has spoken very eloquently about that issue many times in this House. If a baby is born with a serious brain injury there will typically be a court case that lasts 11 years, and a settlement of around £6 million. That family are having to cope with the shock of having a disabled child—some families say that that is a kind of mourning process because the baby is not the one they were expecting, although they then go on to give the most extraordinary love to that child—and we compound it by making them go through a legal process that lasts more than a decade. It is absolutely shocking and despicable if that happens. We need to find a way to get those families the financial support that they need earlier, and make sure that we learn the lessons more quickly. That is absolutely what this agenda is all about.

[Norman Lamb (North Norfolk) (LD)]

I also pay tribute to Sara Ryan, the mother of Connor Sparrowhawk, who has fought tirelessly for justice for those with learning disabilities. I warn the Secretary of State that I think she will take some convincing that things really will change, given all the resistance she has come up against. I hope he has managed to meet her; if not, would he be willing to meet her, with me, to discuss the plans going forward?

One key issue not covered in the report or statement is the timeliness of investigations. A report nine months or a year after the incident is often no good at all: the organisation has moved on, and people have forgotten what has happened. I commend Mersey Care, which does a very quick, thorough investigation within 48 hours, when the information is really current and people are still shocked by what has happened. That is how Mersey Care seeks to implement the lessons from every tragedy.

[Mr Hunt]

I want to put on the record that the right hon. Gentleman was a big champion for people with learning disabilities when he was in my ministerial team, in particular over issues such as Winterbourne View, which he brought to my attention and did a huge amount of positive work on.

I have met Sara Ryan. I spoke to her again yesterday. I repeat what I said in my statement: that without her campaigning we would not now be making the huge changes on a national level that we are. I wholeheartedly agree with the right hon. Gentleman’s other comments.

Social Care Funding

Norman Lamb Excerpts

Monday 12th December 2016 Commons Chamber

[David Mowat]

I agree and I commend my hon. Friend for his work on the Morleigh homes in his constituency, which had significant issues and have now been substantially closed down. He is right that the issues there were not principally about money; they were about quality and about people doing their jobs properly.

[Norman Lamb (North Norfolk) (LD)]

Does the Minister share the view of the CQC that the system is close to tipping point, and does he understand the impact that has on many frail elderly people? Does he not agree that now is the time to bury our differences and work together to come up with a long-term settlement for the health and care system?

[David Mowat]

Today is not the day on which to announce a royal commission on the funding of care in the future, but I do agree that it is important that we put care funding on to a better structural footing for the future. The right hon. Gentleman is right to say that.