Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 10th October 2017 Commons Chamber

[Jackie Doyle-Price]

On World Mental Health Day, I can confirm that we are spending £574 million more on mental health this year. It remains our principle that decisions should be made locally by CCGs, but we have very clear expectations of them, and they will be held to account via inspections.

[Norman Lamb (North Norfolk) (LD)]

The ‘Five Year Forward View’ suggested that the Government accepted the case for comprehensive maximum waiting time standards in mental health to match those in physical health. Given that children throughout the country are routinely waiting for months to start their treatment, may I ask what progress the Government are making with the introduction of a maximum waiting time standard for children’s mental health?

[Jackie Doyle-Price]

The right hon. Gentleman has raised an excellent point. Our Green Paper on children and young people’s mental health will address exactly those issues. We have made clear that we will tackle mental health through early intervention, and early intervention for children and young people is central to that.

Autism Diagnosis

Norman Lamb Excerpts

Wednesday 13th September 2017 Westminster Hall

[Bambos Charalambous]

The hon. Gentleman makes an excellent point. The NICE guidelines are drawn up by experts who are qualified in their field, and it is only with the collaboration of the experts that the guidelines are set. They are set by experts and should be strictly adhered to.

The delay between referral and diagnosis not only causes more potential harm to children, but leads to untold stress and anxiety for parents and carers who cannot understand their child. If the delay was a matter of weeks, that would be bad enough, but thanks to research done by Dr Laura Crane at Goldsmiths, University of London we now know that in a sample of 1,047 parents who were surveyed, the average delay from referral by a health professional to diagnosis was three and a half years. The delay was more than four years for children diagnosed with Asperger’s syndrome.

The delay is alarming, and I have had difficulty corroborating it with any Government data. That is because data on the length of time from referral to diagnosis of autism are not collected by NHS trusts or clinical commissioning groups, so there is no way of holding the NHS to account for that failing. Since this debate was made public, I have had numerous tweets and emails, as have colleagues, that support the findings of Dr Laura Crane’s study and suggest that the delay in diagnosis is taking years, not months.

[Norman Lamb (North Norfolk) (LD)]

Does the hon. Gentleman agree that NICE needs to look at reviewing its guidance? It is not just about the first appointment. There is a risk that there is gaming of the system. People get their first appointment, but then it is stretched out to three and a half years, as we know. Getting the diagnosis is the critical thing.

[Mr George Howarth (in the Chair)]

Order. Before I call Bambos Charalambous, I should say that those seeking to make a speech in the debate may consider it unnecessary to make an intervention, enabling those who for one reason or another cannot make a speech to make a short intervention. I say that in an advisory sense; it is up to the hon. Gentleman whether he accepts any interventions. As they glance around the Chamber, Members will become aware that it will be difficult to get everyone in.

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[Norman Lamb (North Norfolk) (LD)]

What is so powerful about this debate is that we have heard similar stories from all over the country of what feels like a completely dysfunctional system—stories of families fighting against the system for help for their children. I am always left thinking, “What about those families who don’t have the wherewithal to fight the system and don’t know about contacting their MP for help?” When we get involved, sometimes we can help those families, but what about the families who do not get in touch and do not know how to battle against the system?

One of my constituents is a 14-year-old boy who will wait so long that he will have left school by the time he has a diagnosis. Another is a 12-year-girl who has been pushed from pillar to post between a mental health trust and a community trust because autism diagnosis and mental healthcare are dealt with by two different trusts, for goodness’ sake. I also have a family who paid—with great difficulty—for a diagnosis, but felt dreadful because they knew that many other families are not able to do that.

The need for action is absolutely acute. Why is it so important? We know that early diagnosis and intervention can make a massive difference to life chances. It can give an individual the chance of a happy, good and fulfilled life, and it can significantly improve employment prospects. The employment rate for people with autism is horribly low, yet many have the potential to be great in the workplace, with some help and understanding. A more enlightened approach would save the state a fortune.

When I was the Minister responsible for mental health and autism, I embarked on a process of introducing maximum waiting time standards. We introduced maximum waiting time standards for early intervention in psychosis and for access to psychological therapies. I wanted those standards to be comprehensive across mental health so that there was an equilibrium between mental health and physical health. The need is just as great with autism. As the hon. Member for Stockton South (Dr Williams) said, the Government have an absolute obligation to set a national maximum waiting time standard —not for the first appointment but for achieving a diagnosis—to give families hope. If we do that, we will end the awful postcode lottery and ensure that every child, wherever they live in the country, has the right to an early diagnosis. That would have a massive impact on their life chances and would save the state a fortune.

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[Jackie Doyle-Price]

There is a good argument for being very open about this generally. The self-assessment framework obviously requires local authorities to mark their own homework, and even then we are not seeing the increase in performance that we would like to see. One of my main messages is that we can all learn from good practice elsewhere, and bad practice can also be a learning experience. The more sunlight we can bring to what is happening, the better. I am happy to write to my right hon. Friend on that.

That brings me to the results of the most recent self-assessment exercise, which show that only 22% of local authorities are meeting the recommendation of a maximum three months between referral and first appointment for an assessment. That is obviously not good enough. On the plus side, a further 23% said that they anticipated meeting recommended waiting times by March this year and that they would be able to sustain that, but that is still only half. Although the direction of travel is positive, there is a lot more work to do.

[Norman Lamb]

The Minister may be coming on to this, but will the Government consider introducing a national maximum waiting time standard for diagnosis, rather than for first appointment, so that every child knows that they will get that within a specified time?

[Jackie Doyle-Price]

I fully appreciate the right hon. Gentleman’s point. I am slightly uncomfortable about this, because often it can take a considerable amount of time for a proper assessment between first appointment and diagnosis, but perhaps we need to look at other measures. Generally, the more data we have in this area, the better we can measure performance. Clearly we need to ensure that we have sufficient specialists who are able to undertake these assessments and diagnoses. Sometimes that can be a challenge, so we need to ensure that local commissioners have access to those specialists.

NHS Pay

Norman Lamb Excerpts

Wednesday 13th September 2017 Commons Chamber

[Mr Hunt]

I am going to make some progress, because I want to deal with the issue of morale, and then I will give way for a final round of interventions.

A lot of comments have been made about the NHS being at breaking point, at a tipping point and so on. There is huge pressure on the NHS, but, as has been said by my right hon. Friend the Member for Broxtowe (Anna Soubry), who is no longer present, that is not the whole picture. What the shadow Health Secretary did not say is that 7,000 people are alive today who would not have been had we stayed at the cancer survival rates of just four years ago. We are having probably the biggest expansion of mental health treatment in Europe, and an independent NHS England report says that for most major conditions outcomes have dramatically improved over the past three, five or 10 years.

[Norman Lamb (North Norfolk) (LD)]

I feel that as the sole Liberal Democrat present it is my duty to intervene. Does the Secretary of State accept, as a principle, that ultimately we cannot sustain the NHS on the back of real-terms cuts to people’s pay within the NHS and that that would be unconscionable year after year? Does he also accept that as the difference between public and private sector pay narrows so much, people will just vote with their feet and leave? Therefore, not only is this morally wrong, but it will not work ultimately.

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[Dr Whitford]

It is very important that people recognise the role that everyone plays, but for nurses in particular this is not just a matter of pay. Last year, we spent a lot of time debating changes to working tax credits, which can leave a lone parent nurse very much worse off. We also spent a lot of time debating the imposition of tuition fees and the removal of the nursing bursary. The nursing bursary still exists in Scotland. It is a non-means tested bursary of £6,500, potentially with a caring supplement of £3,500. We know that the average age to take up nursing study is at the end of the 20s, which means that people often have family commitments. Such people will receive approximately £10,000 a year so that, at the end, they will not face what future nurses in England will face, which is a debt of more than £50,000. The repayment on that kicks in immediately, because graduate nurses start at around £22,000, which is over the limit. At the lower end of band 5, that is another £400 a year off. By the time a nurse gets to the top of band 5, it is another £1,000 a year off. They will never manage to pay off that £50,000 to £60,000, which means that their salary will be reduced by that amount throughout their careers.

[Norman Lamb]

Does the hon. Lady agree that what appears to be happening is that many of the mature students who previously went into nursing often do not want to take on that debt? That means that we are losing people who seek to transfer from other professions, which is really damaging.

[Dr Whitford]

I totally thank the right hon. Gentleman for his intervention. That is absolutely the case. It has never been a negative—in fact it has always been a benefit—that we have attracted people who were a bit older to the role of student nurse. Perhaps they had another degree or a student loan to pay off, but they always had a bit more life experience under their belt.

As a very junior doctor in my first year, I remember what it was like when my hours alternated between 132 and 175, and I had no life that did not involve people who were dying or ill or who had been hit by a car. That is very difficult for a person who has just come out of uni, and who is used to going out for a pint and having parties. There is real advantage in training people who may have had a family and who have lived a bit of life. As the right hon. Member for North Norfolk (Norman Lamb) said, there are people who are attracted to nursing but who will not take it up because they will not put their family through it. We have seen that already with a 23% drop in applications.

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[Dr Wollaston]

The hon. Lady is absolutely right. Look, for example, at the applications for nursing courses. Even though the number of applicants has gone down, it may not ultimately result in a loss of numbers entering nursing. Some of the applicants from that overall drop in numbers might have gone on to other courses, so we need to look at the bigger picture. In opting to look at the nursing workforce, the Health Committee is not saying in any way that other parts of the workforce are not important. The NHS is a team, but it would be difficult for us to report within a certain timeframe if we looked at the entire workforce. I have no doubt that we will look at other aspects of the workforce over the course of this Parliament. I assure the hon. Lady that we will not lose sight of the bigger picture and I hope that she will contribute to the inquiry.

We need to look at the big picture regarding the total budget for health and social care. The right hon. Member for North Norfolk (Norman Lamb) has long made this point, and we have both made it clear that it is time for us to take a cross-party approach to sustainable funding for health and social care in the long term. I look forward to working with him on that over the course of this Parliament.

[Norman Lamb]

I totally agree with the hon. Lady and I am keen to continue working with her. Did she see the Independent Age survey that showed that well over 80% of Members of Parliament on both sides of the House agree that there needs to be a cross-party settlement for the future of the NHS and the care system?

[Dr Wollaston]

I welcome that and I look forward to working with the right hon. Gentleman over the coming months to try to encourage colleagues on both sides of the House, including the Front Benches, to agree to the idea. Next year is the 70th anniversary of the NHS, and I cannot think of anything more constructive we could do than to work across political parties in order to deliver sustainable long-term funding for health and social care.

I will bring my remarks to a close because I know that many hon. Members wish to speak. I look forward to hearing suggestions from colleagues in the House and outside this place about the points they would like the Health Committee’s inquiry into the nursing workforce to cover.

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[Norman Lamb (North Norfolk) (LD)]

I start by acknowledging just how long the constraints on pay in the NHS and across the public sector more generally have applied, and I say that fully recognising that I was a member of the coalition Government. I understood and accepted the reason why constraint was necessary at that time, because public sector pay had run quite a long way ahead of private sector pay, but the situation is very different now. Ultimately, we cannot justify year-on-year real-terms pay cuts for workers in the public sector as a way of sustaining our vital public services, but that is what they are facing and we have to face up to it.

Alongside the moral case is the fact that the cap simply will not work. The Royal College of Nursing says that the NHS in England is some 40,000 nurses short, and that has consequences. Among the doctor workforce, rota gaps are endemic—I suspect the hon. Member for Tooting (Dr Allin-Khan) recognises that. It is particularly bad in some parts of the country and in some specialties. The hon. Member for Halesowen and Rowley Regis (James Morris) spoke about psychiatry. According to the survey published by the Royal College of Psychiatrists earlier this week, the numbers of psychiatrists vary significantly around the country, with some areas disturbingly short.

We often talk about doctors and nurses in this House, but so many other people work in the NHS. Allied health professionals, caretakers, orderlies and all sorts of other people are affected by the cap, many of whom are on very low pay. I want to give a particular shout-out to paramedics in the east of England, many of whom regularly work very long shifts and often get home utterly exhausted after dealing with traumatic events. I pay particular tribute to the 70 staff from the East of England Ambulance Service NHS Trust who have signed up to become blue light champions to highlight the importance of mental health among that organisation’s workforce. That has been done with the support of Unison and the involvement of Mind, which does really important work with frontline workers.

When we talk about pay levels in the NHS, we should also think about pay levels in social care. Non-payment of the minimum wage is endemic in many parts of the social care system, which is intolerable. Too many workers who provide care in people’s homes are still not properly paid for travel time. Information I got from Her Majesty’s Revenue and Customs recently showed that millions of pounds of unpaid wages had been recovered following an exercise in social care. When we talk about the need for a fair deal for NHS workers, we also need to talk about a fair deal for people working in social care, who do often very unattractive but vital work.

[Danielle Rowley (Midlothian) (Lab)]

The right hon. Gentleman mentioned public sector workers more widely. In Scotland, despite voting not to scrap the cap in May, the Scottish National party Government have now listened and done so. However, public sector workers in UK bodies in my constituency and across Scotland are still left out, and will continue to be left out by the recent Tory announcement to lift the cap selectively. Will he join me in urging the Government to value and properly pay all public sector workers across the UK and ensure that none is left behind?

[Norman Lamb]

I agree that we have to treat people with justice across the public sector to ensure that they are not unfairly and unreasonably left behind.

On the comments made by the hon. Member for Totnes (Dr Wollaston), behind this issue is the inescapable question of the amount of money that we are putting into health and care services, because that ultimately determines how much we can pay and how many people we can employ. The bottom line is that we cannot carry on as we are; it is not sustainable. We are not being honest with the British people. The truth is that, at the last election, none of the political parties had a solution for the NHS and the care system. I was challenged earlier about the fact that the Lib Dems argued for a 1p increase in income tax. I absolutely acknowledge that that is not a panacea and would not solve all the problems, but it would provide an immediate £6 billion, which would have a big impact on the sustainability of the system.

The bottom line is that we need to work together across the party divide. If we do not, we will be letting down the people of this country. We can continue to shout at each other, but that does not help the family whose loved one is let down by failures of care because the NHS and the care system do not have sufficient resources. More than 1 million older people have care needs that are not being met because of the underfunding in social care. As the Independent Age UK survey showed, well over 80% of Members of Parliament, on both sides of the House, agree that we need to work together to come up with a long-term, sustainable solution. Please, Government, get on with it.

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[Kwasi Kwarteng]

That was a fair intervention, but I completely disagree with the hon. Lady’s point. The deficit had nothing to do with the then Secretary of State for Health. It was not the previous Secretary of State for Health who caused the £160 billion deficit the Government inherited in 2010. Naturally, when running a huge deficit—I think it was something like 12% of GDP—one has to find savings in the budget. The question I pose to Labour Members is, how would they find the extra money? There are only two ways to do that: the Government can either raise the money through taxation, or the Chancellor has to borrow the money. It is very unclear to me what the Labour party proposes to do to increase the pay of public sector workers. No doubt it will have a plan to increase it by 5% or 10%—I do not know by exactly how much it wants to put up public sector pay—but it would have to fund that. I looked at the Labour election manifesto and I think it spent the tax on people earning over £80,000 about 10 times over to fund their various projects and policies.

We cannot go on kidding ourselves and kidding the British people. I very much like the point made by the right hon. Member for North Norfolk about the fact that we have to be serious about how we are going to fund the NHS and social care provision. He described the current model as—his word—unsustainable. I do not share that view—I think we can fund the NHS adequately for the rest of the Parliament—but his general message was right. It does not make any sense for Labour Members to scream, holler and shout about Tory cuts without having a serious proposal.

[Norman Lamb]

To work together in a constructive, rational and mature way requires the Government to agree to do it. We are still waiting. I met the Prime Minister in February. Please make a decision.

[Kwasi Kwarteng]

I am not privy to the conversations the right hon. Gentleman has had with the Prime Minister—that is something he might wish to take up with her—but this is a serious debate. As he said, we cannot be honest with people on this issue if we are simply screaming and shouting across the Dispatch Box.

Conservative and Opposition Members have made the point that we have extremely impressive professionals across the public services. The level of public service provision here in Britain is right at the top of the global rankings. I have spent time in Europe, Africa and across the middle east. The public services we have in Britain are really world class and we must never lose sight of that in these discussions. The nature of the debate has been very fruitful and we have had a measure of courtesy, but it does not make sense simply to holler “Tory cuts.” That is what I have heard in seven years of trying to address what are very serious problems.

Contaminated Blood

Norman Lamb Excerpts

Tuesday 11th July 2017 Commons Chamber

[Diana Johnson]

My hon. Friend makes that point well.

I want to comment on how we handle disasters and on the best way forward for a Hillsborough-style inquiry established by the Government.

[Norman Lamb (North Norfolk) (LD)]

I add my congratulations to the hon. Lady on her brilliant leadership on this issue. While the announcement is incredibly welcome news, does she agree that there is an urgency here, because the people who continue to suffer need help now? There is a danger of the process going on for years and leaving them still waiting for support.

[Diana Johnson]

The right hon. Gentleman makes an important point. The timetabling of any inquiry needs to be set out clearly, and I hope that the Minister may be able to help us with that.

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

I thank you, Mr Speaker, for explaining to the House the sequence in which we are speaking today in this very important debate.

I wish to start by offering my personal apology to all those who have been affected by the tragedy of infected NHS-supplied blood or blood products. This has had a terrible impact on so many individuals and families. I know that, quite rightly, there have been many debates on the subject in this Chamber, which have been prompted by the quite proper concern of Members on both sides of this House over many years.

There have been two previous inquiries on this issue: the privately funded Archer report, which was published in 2009, and the Scottish Government-funded Penrose inquiry report, which was published in 2015. However, I am aware that, over the years, there have been several calls for a full independent inquiry.

In addition to those reports, the Department of Health has worked to bring greater transparency to the events. Many documents relating to blood safety, covering the period from 1970 to 1995, have been published and are available on The National Archives website. Those documents provide a comprehensive picture of events and decisions, many of which were included in the documents reviewed by the Penrose inquiry. However, I recognise that, for those affected, these steps do not go far enough to provide the answers that they want or to get to the truth of what happened.

In the light of those concerns and of reports of new evidence and of allegations of potential criminality, we think that it is important to understand the extent of what is claimed and the wider issues that arise. I am pleased to be able to confirm to the House that the Government intend to call an inquiry into the events that led to so many people being infected with HIV and/or hepatitis C through NHS-supplied blood or blood products.

[Norman Lamb]

I am very pleased with the news that the Minister has just confirmed. Will he ensure that the process that is followed—I very much support a Hillsborough-style inquiry—facilitates the ability to bring criminal charges so that the full force of the law can be applied to anyone who may be guilty of criminal wrongdoing?

[Mr Dunne]

I shall come on directly to the form that the independent inquiry should take, and I hope that that will help to address the right hon. Gentleman’s question.

We have heard calls for an inquiry based on the model that was used to investigate the Hillsborough tragedy—the so-called Hillsborough-style panel—which would allow for a sensitive investigation of the issues, allowing those affected and their families close personal engagement with an independent and trusted panel. There have also been suggestions that only a formal statutory inquiry led by a senior judge under the Inquiries Act 2005 will provide the answers that those affected want. Such an inquiry would have the power to compel witnesses and written evidence—an apparent shortcoming in previous reports. The Government can see that there are merits in both approaches, and to ensure that whatever is established is in the interests of those affected we will engage with the affected groups and interested parties, including the all-party parliamentary group, before taking a final decision on the type of inquiry.

Adult Social Care Funding

Norman Lamb Excerpts

Thursday 6th July 2017 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

I hope the Minister will agree that these widespread failures of care are intolerable in a civilised society. Does he share my view that we will have to confront the need to increase taxes to ensure that we have an efficient, effective and compassionate system, and will he embrace a cross-party approach to come up with a long-term settlement?

[Steve Brine]

Of course I want to work—as will the current Care Minister, the Under-Secretary of State for Health, my hon. Friend the Member for Thurrock (Jackie Doyle-Price)—with the respected former Care Minister, and with any other Members who have any sensible suggestions. Taxation is of course a matter for the Chancellor at financial events, and there will obviously be a Budget later in the year.

On the areas where there are care challenges, we have picked up 12 local areas for review, as the Secretary of State said earlier this week. We have published the details that are suitable for the review, which we have developed from the dashboard criteria. We will give those involved every possible support, as we do with the inspection regime for hospitals, for instance. Such inspections are to get hospitals out of special measures and get them to a better place, and we will do the same for those areas. I will be very happy to meet the right hon. Gentleman. In fact, if he had not asked me, I would have offered to meet him.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 4th July 2017 Commons Chamber

[Jackie Doyle-Price]

I can give my hon. Friend that assurance. Indeed, the Care Quality Commission is undertaking a thematic review to see what works. He is right to identify early intervention as key but, as the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) highlighted, there is a need to consider the transition as well.

[Norman Lamb (North Norfolk) (LD)]

rose—

[Mr Speaker]

The right hon. Member for North Norfolk (Norman Lamb) is not exactly standing; he is more perched like a panther about to pounce.

[Norman Lamb]

Thank you for the encouragement, Mr Speaker.

I have been alerted to an online posting yesterday on the social network Nextdoor by the father of a teenager who suffered awful trauma witnessing the horror at Grenfell Tower. He was after therapy for his daughter. Clearly there is an absolute need to ensure that everyone who may be in need knows how to get such therapy. What are the Government doing to ensure that everyone does know? Also, what are they doing to ensure that there is sufficient funding locally so that mental health services can provide for what will clearly be ongoing needs?

[Jackie Doyle-Price]

I thank the right hon. Gentleman for his question. I would be grateful to receive more details so that we can make sure that such support is going where it is needed. I advise him that, certainly in the case of the too-frequent disasters that we have had recently, we have been relying on more intervention on the ground. In our work on mental health first aid we are prioritising exactly those areas.