(6 years, 1 month ago)
Commons ChamberLet me start by congratulating and thanking the right hon. Member for North Norfolk (Norman Lamb) for securing this debate and the Backbench Business Committee for granting the time on this very important issue. As the motion today notes, the transforming care programme was created with the stated intention of improving quality of care and quality of life for children and adults with a learning disability or autism who display challenging behaviours.
As we have heard from Members today, people with learning disabilities too often suffer from neglect, abuse, poor care and even premature death. Unfortunately, as the right hon. Gentleman set out, the transforming care programme simply is not delivering the promised improvements in their lives. Instead, too many are wrongly admitted to assessment and treatment units, in which they remain trapped, rather than living independently where they can be with their families and friends and, of course, the support network that comes with them. The community services that should be part of that support network are themselves underfunded and simply do not have the capacity that is needed. As it stands, the transforming care programme is unlikely even to come close to the ambitions rightly set out in the “Building the Right Support” strategy by March 2019, when it is due to conclude. Let us take, for example, the target to decommission 900 learning disability beds in conventional hospitals. The Minister admitted just this week, in an answer to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), that the Government have not even come close to meeting the halfway point to that target.
Seven years after Winterbourne View and more than two years on from the start of “Building the Right Support” strategy, there has been a startling lack of progress in key areas. There has been little reduction in the number of people in in-patient units and in the number of admissions. Indeed, the most recent data, from May 2018, shows that there are 2,400 people with a learning disability and/or autism in in-patient units, which is an increase since the last monthly data was released. It should be of great concern that the number of children in in-patient units has also increased. The latest NHS Digital data shows there are 250 children in these units, more than double the number of children—110—who were reported as being in in-patient units in March 2015. There are 465 young people aged between 18 and 24 in in-patient units, and this age group makes up a significant proportion of the whole transforming care in-patient cohort. This data suggests that the transition from child to adult services is the point at which people with learning disabilities are particularly at risk of admission, as Dame Christine Lenehan pointed out in her review last year.
As we have already heard this afternoon, the average length of stay in in-patient units has stayed largely the same, at approximately 5.4 years. Similarly, in answers to my hon. Friends Ministers have admitted that discharges into the community actually went down in the last year, and quite significantly so for those with learning disabilities. It is clear that transforming care is not delivering the promised outcomes at this time. Unfortunately, this failure fits the wider picture of neglect for people with learning disabilities and the services on which they rely.
The recent learning disabilities mortality review came seven years after Winterbourne View and nearly three years since the death of Connor Sparrowhawk, which in part prompted it. Its findings show the scant regard with which people with learning disabilities are treated.
The fact that the risk of people with learning disabilities dying before the age of 50 is 58 times higher than the rest of the population is scandalous in itself.
My hon. Friend makes a very valid point. Everybody here this afternoon could not fail to be shocked and horrified by the case outlined by my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) regarding her young constituent, Matthew, and the quality of care that he received on an in-patient unit.
Some 1,311 cases were passed for review between July 2016 and November 2017, but only 103—that is 8%—have finished so far. The report cited a lack of local capacity to review cases, inadequate training for people completing mortality reviews and insufficient staff capacity to complete a mortality review. Will the Minister update the House on when the remaining cases will be finalised and what the Department is doing to ensure that these barriers are tackled? In 13% of cases reviewed, the person’s health had been adversely affected by delays in care or treatment, gaps in service provision, organisational dysfunction, neglect or abuse.
Just how many more deaths must occur before the Government tackle the unjust treatment of people with learning disabilities? Dr Ryan, Connor Sparrowhawk’s mother, was also damning in her assessment. She said that too many agencies had shown “systematic disregard” for some people with learning disabilities and she felt that certain people “simply don’t count” in the eyes of the authorities. We must do better, and we must show that every single life matters. But our fear is that, without some fundamental changes in the Government’s approach, the problem is set to get worse, not better.
Take the NHS workforce, for example. The latest figures from Health Education England show that the number of learning disability nurses working in the NHS has gone down by a third over five years. HEE data from March 2017 shows that learning disability nursing had the highest proportion of vacancies, at 16.3%, compared with all other fields of nursing. Will the Minister tell us how the Government plan to tackle this?
It is bad enough that the failures of transforming care have left too many people inappropriately in hospital settings, but the lack of trained staff when they are there makes that failure all the more stark.
I am with the hon. Lady in her criticisms, and in wanting some constructive developments and improvements, but I would not want her to stay at the Dispatch Box and paint a picture that is completely negative. There are some inspirational stories about people coming out of these settings and institutions after being dealt with by a caring team, who have put a particular emphasis on communications and turned lives around. Some of the case studies published by Dimensions show that that really is one of the ways forward, and that is what we should seek. It is possible to take an aggressive individual out of an in-patient setting and give them the quality of life and meaning to life that we would all want and expect.
I thank the right hon. Lady for her intervention. I absolutely agree. There are some incredible examples around the country of excellent work that is being done, but that makes it all the more important that we share that good practice so that it is disseminated more widely. Particularly on this very special day of the NHS’s 70th anniversary, I pay tribute to all those people who are involved in being innovative, and not just doing exactly what they have to and no more.
It is bad enough that the failure of transforming care has left too many people inappropriately in hospital settings, but the lack of trained staff when they are there makes that failure all the more stark. It is also a matter of great concern that the Government are not including people with learning disabilities, or working-age people with disabilities, in the social care Green Paper, but are instead having a “parallel workstream”. Once again, the care needs of people with learning disabilities seem to have been put in second place.
If this catalogue of failure were not enough, the issue around sleep-ins threatens to make it even worse. It has been woefully mishandled thus far. Having admitted that earlier guidance on pay was misleading both for providers and commissioners, Ministers are now playing for time rather than finding a solution, ignoring warnings from care providers, charities, and the Local Government Association. The consequences for people with learning disabilities and autism could be disastrous. Some 70% of learning disability providers have warned that they will no longer be viable. It could drastically reduce the number of providers available to provide community services. For people with learning disabilities, autism or challenging behaviour who are personal budget-holders in receipt of funding from local authorities to pay care staff themselves, this crisis could lead to difficulty in paying their personal back-pay bill and, in turn, having to reduce their level of support to cover costs.
Let me be clear, as a former healthcare worker and trade unionist, that the care workers affected should receive historic back pay for national minimum wage sleep-in shifts rather than paying the price for underfunding of social care. Given the state of the sector, without imminent investment we run the risk of a systemic failure that could leave thousands of people without the care that they desperately need. That is why we continue to call for the Government to reveal the full scale of financial liability and to increase funding for social care so that care providers can continue to deliver services to vulnerable people in need of care and workers can receive the pay to which they are entitled.
A Labour Government would provide care workers with paid travel time, access to training, and an option to choose regular hours. That, of course, comes in the context of proper investment, increasing social care budgets by £8 billion over the next Parliament, including an additional £1 billion for the first year to ease the Tory social care crisis. We have made our alternative crystal clear. Our policy will include all people with care needs, with the aim of ensuring that they can live independently and, most crucially, with dignity.
The question that the Minister must now answer is whether and how this Government can work towards that goal. Will there be a successor programme to transforming care? How will the shift to early intervention, prevention and community care be prioritised and properly resourced, given that what we have now is clearly not sufficient? In the end, this is a question of how we value human lives.
(6 years, 2 months ago)
Commons ChamberThe hon. Lady is right to raise this issue. We are determined to end out-of-area placements, but clearly that will require behavioural change on the part of commissioners, as well as making sure that the investment takes place. I know she will continue to hold me to account on this issue, because it is clear that out-of-area placements can cause harm and we must tackle them.
According to data from 48 of 56 NHS mental health trusts, 3,652 patients suffered an injury in 2016-17 through being restrained—the highest number ever. There are concerns that increased use of insufficiently trained agency and bank staff since 2013 is contributing to this increase. Employing 21,000 new staff by 2021 just is not good enough. What is the Minister doing now to ensure that wards are safely staffed and patients are not injured?
(6 years, 2 months ago)
Commons ChamberThis has been an excellent debate, and I thank all Members for their contributions. I congratulate my hon. Friend the Member for Rhondda (Chris Bryant), whose persistence week after week has undoubtedly facilitated the debate. I thank the Government for allowing it time.
Although we have first-class acute care in this country, and advances in medicine in recent years that have resulted in many more lives being saved following a brain injury, it is undoubtedly in long-term rehabilitation where much more support is required in order to save and preserve the quality of lives for those suffering from acquired brain injuries—and, of course, their loved ones. Somebody who has suffered a traumatic brain injury could have had three months in intensive care, six months in therapy, and maybe a year in residential care, and then they are often sent home and the help stops. Quite often personalities will have been affected, and the person who comes home could barely resemble the one before the accident or incident that led to the acquired brain injury.
A report by the Centre for Mental Health stated that 1.3 million people live with the effects of brain injury, at a cost to the UK economy of £15 billion per annum, based on premature death, the health and social care required, and lost work contributions and continuing disability. This cost is the equivalent of 10% of the annual NHS budget.
Two suggestions have been made about rehabilitation that might change things: first, that we should have a rehabilitation prescription just like a medical prescription so that the person knows, and the family know, what support there is going to be on an ongoing basis; and secondly, that every single major trauma centre should have a rehabilitation consultant, because one in four do not. Is that not essential to be able to make sure that we change this world?
I thank my hon. Friend for those suggestions, and I hope that Minister will respond to them. It is clear that my hon. Friend cares very much about this issue.
Neuro-rehabilitation is one of the most cost-effective services that the NHS provides, and one of the few services in medicine that results in long-term decreased costs to the economy. However, the number of available beds across the UK is inadequate, service provision is variable, and consequently long-term outcomes for brain injury survivors are compromised.
ABIs can result from many different causes, including stroke, tumour or brain haemorrhage. They can also be caused by a trauma to the head through assault, a road traffic accident, and accidents at work or in the home, as we heard from my hon. Friend the Member for Barrow and Furness (John Woodcock). Sporting injuries are the cause of many acquired brain injuries and have been subject to much media attention in recent years, with concern growing surrounding the long-term effects of concussions sustained through sporting activities. Awareness must be raised as to the dangers of head injuries in sport in order to prevent ABIs, along with stricter guidelines on how long an individual should rest following a concussion.
As we heard from my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), one of the most common effects of an ABI is breakdown in marriages, relationships and family units as people struggle to cope with the changes in circumstances, and often personalities, following an ABI. The hon. Member for Cheltenham (Alex Chalk) discussed the increased propensity to commit crime after an ABI. Today I spoke to Peter Taylor, the business manager of a charity based near my constituency called Second Chance Headway, which specialises in caring for people with brain injuries. He talked about the amazing work that they do. He also mentioned that quite often families fall apart as children struggle to understand why the lady who looks like mummy can no longer do the things that mummy used to be able to do—simple tasks like making tea or washing—and wonder why she is angry a lot of the time when she used to be so patient and loving. Obviously this can apply to daddy too. Those are just some of the devastating effects of ABI that often happen behind closed doors.
Peter stressed the importance of raising awareness, and especially of the fact that an ABI is a brain injury for life, that a person could face 40 to 50 years of trying to adjust and come to terms with a devastating change in their life circumstances and that they may have to learn how to live again, with some of the most basic tasks having to be relearned, including how to make a cup of tea and how to dress themselves—things that we all take so much for granted.
Peter also spoke about the lack of funding and the finger pointing between social services and health commissioners over who should foot the bill for rehabilitation services, with no clear direction over where the money should come from. Second Chance Headway survives without a penny from the Government, as do many other similar charities across the country. There has to be a more co-ordinated and systematic approach to ensure that everyone with an ABI has the same quality of care and the same life chances. This service should not be reliant on the charity sector, especially in these times of austerity in which charities are struggling to access vital funds.
I would like to end by echoing the requests of my hon. Friend the Member for Rhondda for a Government taskforce across all relevant Departments, including Health, Education, Justice, Work and Pensions and Defence and for adequate funding for services. In the words of Peter Taylor of Second Chance Headway, “A life has to be worth living, otherwise what is the point in saving it?”
(6 years, 4 months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
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As a member of the Petitions Committee, I am independent; as a Labour MP, I agree. I will come to that point later.
Private practice is only one aspect of the worrying trend towards the increased privatisation of NHS services. As the BMA points out, the recent legal action that Virgin Care brought against several clinical commissioning groups should serve as a stark reminder of what can happen when the relationship between the NHS and the private sector sours.
My hon. Friend is being very generous in giving way. Many Members know that I worked in the NHS for more than 10 years. That service was privatised and taken on by Virgin Care, which destroyed it. What concerns me is that I have given Conservative Health Ministers, including the Secretary of State, the opportunity to talk to me on a number of occasions about Virgin Care’s many failings, some of which were very dangerous, but they have never taken up that opportunity. Does my hon. Friend share my concern?
I want to be clear about some of the dangers of privatisation. When Virgin Care took over our dermatology service, it would not subscribe to the SystmOne computer system, so we had to use another system, which was not operable for more than a year. Patients were coming in, but we had no idea what they were coming in for—we had to ask them questions such as, “Is the lesion on your left or right arm, or on your leg?” That is particularly difficult with patients who have dementia or learning difficulties, for example, and it represents a significant hazard to patient safety.
Going back to my hon. Friend’s point about fragmentation, the service I worked in had pathways to the acute trust, so that if somebody came to us with something that looked malignant, we could refer them to the acute trust and the patient would have an appointment within two weeks. When Virgin took over the service, there was no aspiration or desire from the people at the top to create those pathways, so the patient had to go back to the bottom of the waiting list. Ultimately, it is a lose-lose situation for patients.
My hon. Friend makes a powerful point and states the case well. My caseload of NHS issues is rising, and often they are about the gaps in service because of that fragmentation. Sometimes it is about poor service, or privatised services that are not providing what people once received when they were under the NHS. It is a complete disaster for my constituents; I have yet to meet a constituent who says that the changes since 2012 have improved the health service and are for the better. Everyone who comes to me—from all parties, of all types and from all walks of life—says exactly the opposite. The fragmentation, the lack of accountability and the cuts need to be looked at again. Healthcare inflation is outstripping the money going into the NHS, resulting in cuts and the STPs.
We are getting a different provider model for our local walk-in centres—it is starting to be swapped again. Our centre is a much-valued service but it is being closed, despite 23,000 people signing a petition. Its 42,000 patient visits will be transferred somewhere else—perhaps off to the second busiest A&E in the country. At the same time as all the fragmentation and chaos, we found out this week that in Clitheroe, the out-of-hours GP service is about to be closed, with patients being told to go to Accrington.
The fragmentation of our NHS is a complete and utter disaster. We are trying to outsource and privatise services or shift them to another trust and shuffle them around to try to save some money, but that will not save money. A patient visit at Blackburn A&E costs £120; it costs £60 at the walk-in centre. The change is a false economy. We shift more patients at the walk-in centre, but it is going to close. Where in all this is a system that is not fragmented, that is holistic and that thinks about the patient and puts them first? I completely agree with my hon. Friend the Member for Hartlepool: it is about time that we revoked section 75 of the Health and Social Care Act.
It is a pleasure to serve under your chairmanship, Sir Graham. I congratulate my hon. Friend the Member for Hartlepool (Mike Hill) on bringing the petition forward for debate.
I thank the 237,462 individuals who signed the petition and gave us the opportunity to raise the issue of NHS privatisation, which is important for many of my constituents. I know that the same is true for all Members present. The petition was signed by 442 of my constituents, and I was proud to join 200 of them outside Warrington Hospital in February to protest against NHS privatisation. The level of public concern about this issue shows just how important the NHS is to our country and its citizens.
The NHS is our most sacred and treasured institution. It was founded 70 years ago on the fundamental principle that everyone is entitled to free healthcare, and it does not discriminate on the basis of wealth, gender or race —it does so only on the basis of need. Every day, thousands of lives are saved by NHS staff at NHS hospitals, and we are extremely grateful for their extraordinarily hard work. The Government have a duty to protect the NHS and its staff, and to ensure that they can continue to provide world-class healthcare to the British public, free at the point of use.
We all use the NHS, and we all have a vested interest in ensuring that it is run effectively and efficiently, but let us be clear: privatisation and outsourcing do not do that.
Privatisation forces NHS hospitals to outsource vital services to private companies, which are often more interested in making a profit than helping sick people. That is a fundamental conflict of interest. The NHS has a duty to its patients, whereas private companies have a duty to their shareholders, but shareholders care about profits, and often the only way to make a profit is by cutting corners. That compromises the quality of care.
The Government claim that private sector outsourcing is good for the NHS and that it allows patients access to treatments based on the best quality of care and value for money.
My experience is that we used to offer one-stop surgery shops, so that when patients came in they could have minor surgery on the same day. We were stopped from doing that. Patients had to come in on two occasions, and we were told explicitly by the management of Virgin Care that it was because it generated two tariffs, and made more profit. I should be interested to hear the view of those who defend the privatisation of healthcare about that.
That supports my point, and is a great example.
The Government view of outsourcing does not reflect the reality of privatisation. Did patients receive the best quality of care from the private firm Circle when it took over management of Hinchingbrooke Hospital in 2012, making it the first privately run NHS hospital, only to withdraw from its contract two years later after it was placed in special measures by the Care Quality Commission because it had found serious failings in its emergency and medical care services? What about the 2013 Public Accounts Committee report on Serco’s running of GP out-of-hours care in Cornwall, which accused the private company of bullying employees, providing a short-staffed and substandard service, and manipulating data to hide the truth? Were patients receiving the best quality of care then? What about the imposition of financial penalties on the same company by NHS commissioners in Suffolk in 2014, after it missed key targets in its community health services contract? In 2012 Harmoni, a private provider of NHS out-of-hours GP services, having put in place an aggressive cost-cutting agenda, faced allegations from senior doctors that its service in London was so short-staffed that its patients were unsafe. I could recount many more examples of failed healthcare privatisation, but we do not have time.
The Government also claim that outsourcing allows the NHS to save money, but that is not necessarily true. The process by which private companies bid for contracts allows them effectively to cherry-pick the most profitable forms of treatment—usually low-risk elective surgeries. That allows the private sector to benefit from the predictable, and usually low, cost. That is far from providing the best quality of care for patients.
Why, then, do the Government insist on continued NHS privatisation? Since 2010, under successive Conservative-led Governments, the private sector’s involvement in NHS services has more than doubled. Evidence shows that that has seldom made the situation any better for staff or patients. The NHS is in crisis. Chronic underfunding compounded by a growing and ageing population has put an unbearable strain on the NHS and resulted last year in yet another winter crisis. My local NHS Trust, the Warrington and Halton Hospitals Trust, is on track for a forecast financial deficit of £16.8 million, and in December 2017 only 73.8% of A&E patients were seen within four hours, which is well below the target. Yet the Government’s only answer to the crisis is more privatisation.
Let me review the facts. Privatisation is bad for quality, budgets and the NHS. More privatisation is not going to help the NHS. The only way to help it is to give it the funding that it needs and that it has been telling us it needs. If we truly love the NHS, we will stop privatisation.
I thank the hon. Gentleman for his comments. That is part of an issue that he is certainly keen to discuss, and part of what is in the petition.
The point I was going to make, which is relevant to that, is that there is a difference between sensible, profitable and innovative businesses and profiteering. There has been, in my view, one clear example of profiteering taking place in the NHS since 1948. It came with the private finance initiative policy during the new Labour period of Blair and Brown, which brought capital into the NHS that was off balance sheet and not recorded in the public finances, at exorbitant cost. It saddled hospitals around our country with interest rates that they could not afford to pay back, and it was the Conservative-led coalition Government who did what was legally possible, although not as much as any of us in this House would wish, to dismantle those contracts.
I think I am right in saying that we took out about £2 billion of costs a year by renegotiating the PFI contracts that could be renegotiated—somebody may know the precise figure. Opposition Members, some of whom were here at that time, should be ashamed of their complete responsibility for introducing the only obvious example of profiteering that has happened in the NHS since it was created.
I wonder whether the hon. Gentleman is attempting to remove the architect of privatisation within the NHS, who I understand was Sir John Major. I agree with the hon. Gentleman about PFI; there have been some arrangements where it is difficult to argue that value for money is being achieved. But we must remember history, and it was Sir John Major who introduced the PFI scheme.
I am happy for the hon. Lady to correct the record on John Major’s introducing PFI, but the point about PFI and all private financing is that the devil is in the detail. The principle of bringing private finance into the public sector is fundamentally a good one and approved of by, I think, all major parties. I am afraid that what went wrong during the 13 years of new Labour, as she knows and has implicitly agreed, was rampant exploitation of the NHS, with public servants signing agreements that frankly should never have been signed.
That is in the past—the fairly recent past, but the past. We have moved on since then. Since the petition was written, other things have also moved on. The most important is the issue of pay, with the Government committing several billion pounds from taxpayers to give 1.1 million NHS staff significantly higher pay over the next three years. I think we all strongly applaud what has happened—we know what an enormous job the NHS does in all our constituencies.
I will briefly raise what matters more in the longer term about the NHS, a subject that this petition could have tackled. The real issue is the long-term funding of the NHS. As a nation, we cannot lurch from year to year with the Secretary of State for Health and Social Care effectively going cap in hand to the Chancellor of the Exchequer for more cash to bail out the NHS. We need a longer-term, agreed basis on which to fund the NHS; I suggest at least five and ideally 10 years, so that everyone can plan ahead on what is needed to fund our NHS, with cross-party consensus. That way, never again can we face a situation in a general election of leaflets saying, “24 hours to save the NHS”. It is an old bogeyman that we must do away with.
I believe that the only effective way to do that is by bringing in equal contributions from the self-employed as well as the employed, and from those still generating income over a certain limit in retirement, through a dedicated source of funds or a hypothecated fund. The most obvious of those is national insurance, which does not really insure anybody for anything. It should be renamed the NHS fund. I put that proposal to our party before the last general election; understandably, there was not really enough time for it to be seriously considered. It would be a major change of direction and one not entered into lightly. There would be huge challenges with it. For example, what would we do in times of high unemployment, such as 2008 to 2010? Could the Budget effectively top up the NHS fund in such times?
That is why I am so pleased that the King’s Fund is researching that very issue now—would it be possible to have a hypothecated fund to fund the NHS? Would national insurance be a good starting point? What sorts of hazards and potential would that throw up? The King’s Fund report will be an important guide to hon. Members on both sides of the House about whether we can look at having a serious, long-term source of funding for the NHS around which we can have consensus, so that some of the endless debates and arguments, particularly around the word “privatisation”, can be dealt with and we can know that we have a source of long-term public funding for our NHS.
That is where I wish to finish. I regret attempts by some Opposition Members to try to create differences between political parties on something as precious as the NHS. All of us—all our families and all our constituents, wherever we were educated, whatever sport we like, whatever job we have and whatever sort of retirement we have—depend on the NHS for our health and, I contend, for our care as well. That is the other reason we need to find a hypothecated source of funds for the NHS—so that it can deal with care as well. That is a subject that the Health Secretary is wrestling with in his Green Paper as we debate. That is why in today’s debate we should leave the partisan efforts at point-scoring on privatisation and focus on what we can all contribute to the bigger debate about a long-term source of funding for a fully publicly owned NHS.
(6 years, 4 months ago)
Commons ChamberI congratulate the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan) on securing this debate and thank the Backbench Business Committee for providing the time for it. It is an important debate because, as we have heard, there are several hundred thousand people with autism, and of course millions of people will be in a family with one of those autistic people. It is important to thank Autistica, the National Autistic Society, Ambitious about Autism and all the other charities and organisations in the sector for the work that they do and the support that they give to those with autism. I also wish to recognise the Whole Autism Family in my constituency, which is run by Anne-Marie and Martin Kilgallon. They have two sons with autism and provide amazing support to other families in the area.
It is important to say that, although I am the shadow Mental Health Minister, as we have heard this afternoon autism is not a mental health condition. It is entirely possible for people with autism to have good mental health, but, sadly, for too many that is not always the case. As we heard from the hon. Member for North Ayrshire and Arran (Patricia Gibson), it is estimated that between 70% and 80% of autistic people develop mental health problems such as anxiety and depression, and four out of 10 children with autism have at least two mental health challenges. Indeed, Autistica highlighted mental health as the top concern facing people with autism and their families.
It is clear that more needs to be done to support the mental health needs of people living with autism. The reduction of the health inequalities experienced by people living with autism is a priority for the NHS mandate for 2017-18. That is of course welcome, but to tackle the disparities it is necessary to ensure access to appropriate mental health care.
The motion rightly highlights diagnosis—the vital first step towards getting support for people with autism. As we heard in the excellent contributions from the right hon. Member for Harlow (Robert Halfon) and my hon. Friend the Member for Alyn and Deeside (Mark Tami), getting a diagnosis is the first hurdle that children with autism and their parents need to get over to secure the support and education to which they are entitled. The NICE quality standard on autism recommends a maximum wait of three months from referral to first diagnostic appointment. It is clear that currently that standard is too often breached, and that the waiting time can be gamed by delaying later appointments. Some children have quite literally been left waiting to wait.
My constituent Patrick Samuel had to wait nine years before he was diagnosed with autism. It was only when he was diagnosed that he got the drugs and support that he needed. He is now a flourishing, successful artist. Does my hon. Friend agree that it is totally unacceptable for someone to have to wait for nine years?
I think all Members would concur that waiting nine years is absolutely unacceptable. To be fair, that is at one end of the waiting-time limit, but it is clear that there are many delays in many areas, often running to years. One local authority has recently admitted that it has delays of 125 weeks. Collectively, Members from all parties need to work together to try to bring down delays of that length, because they mean that support and intervention may be less effective when it arrives, and lead to parents losing confidence in the system. As with many other conditions, illnesses or whatever we call them—it is difficult to find a suitable noun that actually describes autism—early intervention is absolutely the key.
There is clear evidence that a positive experience in the diagnostic process is associated with lower levels of stress and more effective coping strategies for families. We have heard in previous debates about the lack of data on waiting times. This April is meant to see the start of new standards on the collation and publication of such data. I hope the Minister will update the House on where we are with that. There is a need for better data on the number of diagnoses and who is being diagnosed with autism, so that we can identify where there are gaps. The National Autistic Society has reported that more than three quarters of people who use its adult services are male, but there is a concern that that may be related to a lack of recognition for women and girls with autism. Similarly, there is a generation of people for whom autism was not a recognised condition when they were younger.
I rise in support of the hon. Lady’s point. I bet there are a heck of a lot of people who have autism, and no one can really understand that they have it—they probably do not understand it—but a lot of people are like that and they are adults.
I thank the hon. Gentleman for his intervention.
NICE recently recommended the creation of an autism register so that areas where autism may be under-diagnosed can be identified. Following that, the Government committed to including autism in the primary care register. Will the Minister update the House on the implementation plans for this scheme?
We must also ensure that post-diagnosis support is in place. We know that parents have raised concerns about being left with no support during and after the diagnostic process, not being signposted to other advice and help, and not even getting a written report of the diagnosis. Too often, there are significant barriers to accessing the right treatment. In a previous debate, we heard the shocking case of a young boy who was having suicidal thoughts, but was rejected four times for treatment because he had not yet made an attempt to take his own life. The Children’s Commissioner for England confirmed concerns about that issue when she stated to the Health Committee that this type of situation was now “the norm” within children’s mental health services. That is worrying for children’s wellbeing generally, but particularly so for those living with autism.
Does my hon. Friend agree that we need increased support in schools? Nearly 77% of parents say that their child has to wait more than six months for support at school. It is just as important that a child gets support at school as in the health system.
Once again, I absolutely agree with my hon. Friend. I will go on to talk about that matter in a moment.
GPs may also need to tailor the way in which they communicate with patients. For instance, they may need to use clear language, or to find ways to communicate with somebody who does not speak. To do that, GPs must be able to access detailed and accurate records about their patients’ needs. Currently, GPs often do not record much information about their autistic patients, and may not even record at all that a patient is autistic. The five year forward view for mental health recommended that NHS England should develop autism-specific mental health care pathways. If the Minister could give us any more information on that I would be very grateful indeed.
As I alluded to earlier, early intervention is key for communication and language skills, which are closely linked to life chances for people with autism. Perhaps the Minister could address the new communication therapies that are being trialled, such as pre-school autism communication therapy, and the pilot studies in Plymouth and Bangor to test new post-diagnosis support programmes. If these programmes are successful, what steps will the Government take to ensure that they are rolled out?
In education, children with autism and other special needs are all too often paying the price for cuts. The first real-terms cuts in school budgets for a generation have put enormous pressure on schools. The vast majority of school budgets are spent on staff costs, and that makes it hard for schools to keep their current staff and maintain the necessary level of pastoral provision. As a constituency MP, I know how the cuts have hit my own borough of Kirklees. The Government’s new funding formula leaves councils needing to take money for central high-needs funding from the amount allocated to schools. That means that schools may now face a cut of up to 1.5% in per-pupil funding.
More than 4,000 children in England with approved education, health and care plans still receive no provision. There was an increase from 1,710 in 2016 to 4,050 in 2017, which was five times the number in 2010. The impact on children with autism was laid bare by the recent inquiry by the all-party group. More than four in 10 families have been turned away when asking for the extra help that their child needs, and 70% of parents said that their child waited more than six months for support at school, with 50% waiting more than a year. I could go on with yet more shocking statistics, but I think the reality is evident. Does the Minister have any response to the all-party group’s recommendations?
If we let down children with autism in education, the impact is felt when they become adults seeking employment, as we have heard from a number of Members this afternoon. In 2015, the Government pledged to halve the disability employment gap, but they watered that down in their 2017 manifesto. Analysis from the TUC found that the Government were years behind schedule on their 2015 manifesto commitment to halve the disability employment gap, and at current rates of progress that would take until 2030 to achieve.
There is an urgent need for improved in-work support for people with disabilities. The Government must act to strengthen and enforce workplace rights, and to improve support for employers to help their employees to stay in work. That would be good for everyone, because a 10% rise in the rate of disability employment would represent a £12 billion gain to the Exchequer.
The autism employment gap is even wider than the disability employment gap. Over the past 10 years, there has been no real change in the numbers of autistic people in full-time work, with the percentage rising from 15% to just 16%. The National Autistic Society found that less than a third of autistic adults were in some kind of paid work, even though more than three quarters wanted to work. There are concerns that this is not even monitored, so perhaps the Minister will address that point. The NAS has also called for an autism employment pathway, an awareness programme for employers and targets for getting people with autism into work. I hope that the Minister can tell us how the Government intend to respond.
Finally, there is the simple question of awareness, which we have touched on a number of times this afternoon, with contributions from my hon. Friends the Members for Bristol West (Thangam Debbonaire), for Cardiff West (Kevin Brennan) and for Coventry South (Mr Cunningham), my right hon. Friend the Member for Knowsley (Mr Howarth), the hon. Members for Luton North (Kelvin Hopkins), for Berwick-upon-Tweed (Mrs Trevelyan) and for Cleethorpes (Martin Vickers), and my hon. Friend and neighbour the Member for Huddersfield (Mr Sheerman). The research shows that only a small minority of people with autism feel that the condition is widely understood. The work of the charities and other organisations in this area is commendable, and hon. Members who have spoken today have done their bit to raise awareness. Will the Minister tell us how the Government will do the same?
The testimonies that we have heard from Members this afternoon starkly show just how crucial it is that more is done on the issue. The power to make meaningful change is in the Government’s hands. I hope that they have listened and will act accordingly.
(6 years, 5 months ago)
Commons ChamberI could not have put it better myself, and this is exactly why we have brought forward the proposals in the Green Paper. We recognise that early intervention is the best way of protecting people’s mental health, so we will be encouraging all schools to appoint a designated mental health lead. We will be rolling out mental health support teams to support schools and we will be trialling a four-week waiting time standard. This will lead to a material improvement in children’s mental health.
The Care Quality Commission has reported that young people are waiting up to 18 months to receive vital treatment. The Royal College of Psychiatrists says that some health trusts are spending less than £10 per child on mental health services and that spending today is less than it was in 2012. So will the Minister tell us exactly what she is doing to fix what many health professionals say is a broken child and adolescent mental health services system?
I welcome the hon. Lady to her place on the Front Bench. I believe this is the first time we have had exchanges, and I am sure it will not be the last. We invested an additional £100 million last year. We know that more than half of providers have an average waiting time of fewer than 12 weeks and 4% of providers have a waiting time of fewer than four weeks. She is right in that six trusts are outliers and they are receiving significant attention from NHS England. We are having targeted work with them to address what might be the issues there. As I said earlier, as part of the Green Paper we will be trialling a four-week waiting time standard, and we are determined to achieve improvement in this area.
(6 years, 6 months ago)
Commons ChamberI wholeheartedly agree with my hon. Friend. He makes an incredibly important point. This is absolutely not about shaming anybody into doing anything they do not want to do. If anybody, for whatever reason, decides they do not wish to be part of the scheme, they have the right to opt out. It is incredibly important that we be clear about that.
It is also worth reflecting on the point made by my right hon. Friend the Member for Leeds Central (Hilary Benn): the current system requires people to take the time to discuss this most serious and difficult matter with their loved ones in order to reach a judgment about whether, in the event of some tragedy occurring, they would want their organs to be donated. It is incredibly important, if people feel they can have that conversation with their loved ones, that they do so, but we understand that people lead busy lives, and many of us will be guilty of not having had these conversations and of putting these tasks on hold.
I believe, however, that we can no longer afford to ignore this issue. It is a matter of life and death for thousands of people around the country, which is why we must increase the number of people on our donor register and make sure we save as many lives as we can and that no more people die waiting for a transplant simply because a potential donor was not able to sign up.
I thank my hon. Friend for making such a powerful speech. We often think of donors as being younger people whose bodies and organs are in particularly good shape, but my beloved grandfather, when he died a few years ago—I think he was 96—was able to donate parts of his eyes and so give the gift of sight to other people. We received a letter from the hospital telling us how many people he had been able to help. Everyone has an opportunity, no matter how old they are, to offer that amazing gift to another after they have gone.
My hon. Friend makes an incredibly important point, as she always does. As others have said, the Bill is only a part of the way to increase the number of people, whatever their age or background, willing and able to contribute their organs. In concert with the Bill, however, we also need to have an open discussion in our communities about the importance of making a proactive contribution in this way.
I pay tribute to my hon. Friend the Member for Coventry North West (Mr Robinson) for introducing this Bill, which speaks to our common humanity. To be in the Chamber today to support it is a great honour for me. Three people die daily in the UK because of the lack of available organs for transplant, and this Bill would increase the chance of an unwell person and a life-saving organ being united.
I pay tribute to my hon. Friend the Member for Sunderland Central (Julie Elliott), who described very similar situations to those of a member of my family who was successful, in the end, in getting their transplant. She was a mother with a newly born third child. We did not know what was wrong with her. She had no energy, could not pick the other children up from school, was not eating, and was often going to the hospital. Eventually, after her husband took her to hospital, she was whisked off to Birmingham. Fortunately she got a kidney transplant while she was there, but unfortunately it was not successful, and we were told that it was highly unlikely that another suitable kidney would be found within the time when it was needed. Thankfully, we got that kidney, she lived, and three children still had their mum. The trauma that the family went through during that time was just unbelievable. We saw the care that the immediate family had to give those three children when she and her husband—my cousin—were in Birmingham. They took care of the children and did what they could. We have been the recipients of the saving of a family—a dear family.
This Bill will change individuals’ autonomy to choose what happens to their own body. Opt-out organ donation carries with it the weight of 80% public support, the support of the British Medical Association, and cross-party political support—all seven parties are represented among the Members who have sponsored the Bill. It also carries the support of past and present Prime Ministers.
I would like to talk about another case in the town that I represent. Last year, tragically, we lost a little girl aged four, Violet Grace, who was killed in an accident on her way home, with grandma, from the nursery. It was a criminal act, with a car going at 80 mph in a 30 mph zone. The parents of little Violet Grace took the brave decision to donate their four-year-old daughter’s organs. Today, we know that two lives were saved. The family tell me, and all the town, that they get great comfort from that. When her little brother asks about her, they try to explain that to him so that he can grow up with that knowledge.
The parents of Violet Grace have been joined by the widow of another person in my town, Steve Prescott, a former champion rugby league player. He had a multiple organ transplant that was successful, but unfortunately there were some other complications.
Does my hon. Friend agree that although it can sometimes be a difficult conversation, these situations also bring about the opportunity for families, friends and loved ones to talk about what they want to happen after their death, including things like funeral arrangements? I knew from a very early age that when I went, I wanted to donate my organs. I still have my original organ donation card, which is over 30 years old now. Hopefully this debate will get the media attention that will encourage people to have that conversation with those they love.
Yes, I do agree.
Steve Prescott’s widow, along with colleagues, friends and members of the community of St Helens, set up the Steve Prescott Foundation. She also approached the parents of Violet Grace to give comfort and support. They have set up a huge and very successful campaign in our town, urging us all to donate our organs. Steve died, unfortunately. The actual transplant—a multiple organ transplant—was a success, but it was other things that killed him. I pay tribute to the families involved, and to the parents of little Violet Grace for their bravery. This Bill would have saved them the trauma of making that decision at such an emotional time when their little girl was dying. It could save people a lot of trauma.
This is the moment to act. A move to opting out would save a predicted 500 lives a year. Done properly, with the right publicity, the right engagement and the right involvement of all communities, changing the law on organ donation should have the support of all of us. The support shown here today is really gratifying, and I pay tribute to the Daily Mirror, which has run a fantastic campaign. It has urged people sign up for donation even now, without waiting for the change.
I understand—perhaps the Minister could enlighten us on this—that the Government intend to go out to public consultation on how opt-out donation would be implemented sensitively. The proposal in the Bill to involve a person’s family in decisions, as a safeguard against any unregistered objection to donating, is an important protective measure that will reassure families who have concerns.
Only 5,000 people a year in the UK die in circumstances where they can successfully donate, while 6,500 people are currently waiting for life-saving donations. None of us ever expects, or perhaps even thinks about the possibility, that we or someone we love may need an organ from someone else to survive, but many Members have pointed out how it can suddenly happen in our own families. However, there is a gulf between the supply of organs and the urgent need for them, and it is time that we made a conscious decision to take affirmative action. The time is right—80% of the public support organ donation, but only 36% are on the register. That needs to be addressed.
In the first six months since Wales adopted the opt-out, 60 organs donated by 31 people have been transplanted. Consent had been received from 50% of those people. Those are the latest facts from Wales. An opt-out system has therefore been proven to work, even in its infancy. I urge the House to back deemed consent as a proven, popular policy.
The British Medical Association makes a point that goes to the heart of this debate. As a result of this Bill, the choice for the individual about what should happen with their own body will remain the same—to donate, or not to donate—but a change in the law means a switch of the default position, towards donation and towards saving more lives. I urge the House to support the Bill.
(6 years, 6 months ago)
Commons ChamberResearch by the Children’s Commissioner revealed that the spend on children and young people’s mental health services varied by CCG from 0.2% to 9%, resulting in services in some areas being described as “shockingly poor”. Can the Secretary of State therefore explain the reason for the variation, and will he commit today to matching Labour’s pledge to increase the proportion of the mental health budget spend on CAMHS services?
The hon. Lady is right to shine a light on that variation, and that is why this Government have introduced Ofsted ratings for all CCGs—to make sure that we understand. It is not just in children and young people’s mental health, but in all mental health where we see that variation. Specifically when it comes to children and young people’s mental health, she will be pleased to know that last year overall spending went up by 20%, and the Green Paper that we published announced an additional £300 million in investment.
(6 years, 7 months ago)
Commons ChamberI will give way to the local MP, and I will then try to make some progress.
I am sure my hon. Friend will join me in thanking the staff for their gargantuan efforts this winter and over the festive period. Just this week, I spoke to a nurse at the very same hospital, who advised me that staff had had to clear out the cleaning cupboard to put in a bed for a patient to receive an infusion. Does he share my horror at that? What on earth is our NHS coming to under this Government?
Beds in broom cupboards—the Tory NHS: isn’t it a disgrace?
I want to make some progress before I give way again.
A very important point that we have not talked about much in this debate, although it is extremely relevant to people on the NHS frontline, is flu. This year, we have had a much bigger spike in the number of flu cases than at any time since the winter of 2009, but we also have in this country the most comprehensive flu vaccination programme in Europe. This year, for the first time, it was made available to those who are eight years and under and to care home staff. As a result, a million more people have been vaccinated for flu this year than in the year before. Uptake among NHS staff is at 59.3%, which is its highest ever level.
I say that because while the shadow Secretary of State tries to make the case that no preparations were made, the reality is that the NHS could not have been working harder to prepare for this winter. The result of those preparations is that A&E performance, having declined for six years in a row, last year stabilised for the first time, according to the latest verified data. In the week after Christmas, compared with the year before, we had fewer A&E diverts and more calls to NHS 111. Many Members have talked about trolley waits. It is totally unacceptable for people to be left on a trolley for a long time, but November’s figures, which are the latest verified figures, showed that the number of trolley waits had fallen by three quarters compared with the previous November, so a huge amount has been happening.
Does the right hon. Gentleman think that patients being treated in cleaning cupboards and six patients in four-bed bays without lockers, curtains or call bells are signs of good preparation for the winter crisis?
That is completely unacceptable, but it is disappointing that the hon. Lady stands up and runs down the NHS when her own trust, which received £3.4 million before Christmas to help with winter, has managed to improve its performance: last November’s figure was 91.8% compared with 77.7% a year earlier. That is a huge achievement for Mid Yorkshire Hospitals NHS Trust. Why will she not praise what is happening, rather than running the NHS down?
I thank the hon. Lady for her intervention.
Obviously, the shape of medicine has changed. More is delivered in primary care—as a surgeon, I well know that more surgeries are delivered in a day—but if we are doing a straightforward operation on an older patient, they will still always require longer rehabilitation; they are more likely to stay overnight or several days, and if they have fractured their hip, they will require full rehabilitation before they go home. The problem is that the number of beds in England has been halved since 1987—under successive Governments—and the NHS stats released for the end of the second quarter of 2017-18 show that almost 1,000 beds have been lost even since the winter of last year, when the situation was described as a humanitarian crisis. That was a mild winter that did not have a flu outbreak on top.
England has only 2.4 beds per 1,000 population, whereas the EU15 that the Secretary of State refers to has 3.7, and we in Scotland have more than four. If we are running constantly with bed occupancy rates of over 85% or 90%, that is where the issue lies.
The hon. Lady refers to the decreasing number of available beds; does she agree that we have a bottleneck now in many hospitals due to the lack of social care? In one day over the festive period in my area, just over half of ambulance transfers were completed within the required period. The Secretary of State likes to quote statistics at me, but I would like to give him that one to think about.
There will obviously be lots of bandying around of figures, and talking about the four-hour target and the achievements and the numbers, and, as I have said, it serves as a thermometer to look at the entire system from the patient turning up at A&E to their going home. That is what this is a measure of, and it is there to flag up concern. While we will be getting that data, we do not need it; we have already seen ambulances 12-deep, and have already heard that 75,000 patients are stuck in ambulances for between half an hour and an hour, and 17,000 stuck for more than an hour. As was mentioned by the right hon. Member for North Norfolk (Norman Lamb), who is no longer in his place, this means that those ambulances are not available to respond to other 999 calls, which endangers patients.
Here we are again discussing the latest winter crisis in our NHS. I stood here last year and spoke of the horror stories I had heard from my constituents and ex-colleagues of hospital staff working their fingers to the bone and doing the jobs of two, three or even four people, often without food, breaks or even time to go to the toilet. Yet, 12 months on, here we are again with many of the same challenges and none of the fixes promised by this Government.
I join my parliamentary colleagues in expressing a huge thank you to each and every one of our hard-working NHS staff—doctors, nurses, receptionists, cleaners, porters, radiographers and everyone else. I often speak of our public sector heroes, and today is no different. Thank you from the bottom of my heart.
I express a special thank you to the paramedics who rushed my father, my dear dad, into hospital on 28 December. My gratitude is infinite.
Last year, the Government said the winter pressure was due to more patients being seen by the NHS. That figure is rising year on year, so why have the Government not put sufficient resources in place to deal with it? The Health Secretary previously said there are far more doctors and nurses in our NHS than there were seven years ago. In my area, the Mid Yorkshire Hospitals NHS Trust currently has 230 nursing vacancies, compared with 110 last year, with nursing numbers across the trust down over the same period from 1,752 to 1,607. That picture is somewhat different from the one painted by the Secretary of State, who has used figures that the Library says should be “used with caution” as suggesting
“Changes in the number of staff can sometimes reflect organisational changes and changes in the structure of services, rather than genuine changes in staffing levels.”
Indeed, staffing levels are so low at Mid Yorkshire Hospitals NHS Trust that the Care Quality Commission has deemed it to be a risk to patient safety.
My colleagues and I were heavily criticised during last year’s debate for asking the Government to spend more money, and once again we hear the same criticism this year. Will they tell us what the solution actually is? We need more nurses, and obviously there are training implications, but more money is needed to pay for them, and it is the same with doctors. There needs to be less bed-blocking, and more money is needed in social care. It is only right that serious questions are asked in this House when the Budget gives more money to pay for Brexit than to pay for our NHS.
The sad reality is that NHS deficits are rising astronomically across the country, with multimillion-pound shortfalls being recorded and balancing the books becoming impossible for most trusts. The £350 million made available in the Budget is no more than a drop in the ocean, and it has been proved over and again over the past few weeks that the money does not even scratch the surface.
And what of the cost of cancelled operations, both to trusts and especially to patients? People are being left in tremendous pain and at significant risk as a result of cancellations. I know of one man who is waiting for an operation to close his skull following life-saving brain surgery earlier this year. The surgery itself is not classed as urgent, but until it is completed, he is at increased risk of death should he bang his head accidentally. As a result, he rarely leaves the house and has to wear a helmet at all times. Another person who contacted me is waiting for a new knee. He is in excruciating pain and is unable to move around unaided. He has been on sick leave for three months and is suffering severe financial hardship as a result of loss of earnings.
As well as the accounts of cancelled operations, in recent days I have heard stories from local hospitals of six patients being squeezed into four-bed bays with no curtains and no dignity, no lockers and no bells. Patients are being given hand bells or are told to ask the patient next to them to ring the bell should there be an emergency. Patients are being placed in store cupboards, as we heard earlier. It has now become almost the norm at this time of year—
(6 years, 7 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Cumbria is one of the parts of the country that has had persistent challenges in the delivery of healthcare. I am pleased that decisions have been taken over the past year or so, including those about investing in improving cancer facilities in Carlisle that my hon. Friend referred to, which we hope will address long-standing issues that have not been addressed under successive Governments.
Despite the best efforts of NHS staff, patients in my area routinely waited over 12 hours just to be seen at hospital. We have heard from my hon. Friends about patients having to sleep on the floor. Will the Minister therefore take this opportunity to say that he will halt all further downgrades and closures of services in my area at Huddersfield Royal Infirmary and Dewsbury and District Hospital until a full assessment of capacity has been undertaken?
A significant amount of funding—some £3.4 million—was made available to the hon. Lady’s area. Reconfiguration proposals are being driven by the STP process. It is down to local authority leaders and local NHS leaders and clinicians to determine what is the best configuration of services in their area.