NHS Workforce: England

Sharon Hodgson Excerpts

Wednesday 17th July 2019 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Moon. I thank my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) for securing this important debate, and for her excellent and knowledgeable speech. I also thank all other hon. Members who made excellent speeches. They are all very knowledgeable, and some have had long careers in the health service, which really adds to the quality of the debate.

I pay tribute to the approximately 1.4 million members of the dedicated and hard-working NHS workforce, who are responsible for making our health service one of the best in the world. This debate is absolutely not about criticising them or the NHS, as others have said; it is about criticising the Government, who have continued to undervalue the NHS workforce. NHS staff too often find themselves working under unacceptable levels of pressure following nearly a decade of mismanagement and underfunding. They are consistently asked to do more with less. That pressure has led to abhorrent working conditions. Staff shortages in the NHS have spiked consecutively over the past few years. Recent estimates suggest a shortfall of about 100,000 staff, including 40,000 nurses and 10,000 doctors. If the trend continues, it is estimated that the shortfall will more than double by 2030.

We know that staff shortfalls put patients at risk. They prevent treatment and lead to a poorer quality of care. A 2017 study concluded that lower staffing levels can lead to necessary care being missed, patients being more likely to die following common surgery, and lower patient satisfaction, yet hospitals frequently have gaps in rotas and lack medical cover, which prompts significant concern about safety. Does the Minister believe that is appropriate care for patients and their families? If those substantial staff shortages continue, we will face even longer waiting lists and a deteriorating quality of care, and money ring-fenced for NHS frontline staff and services will go unspent due to lack of staff.

The effect of staff shortages is already evident. We have already seen care homes shut, an increase in agency hires, and chemotherapy treatments postponed because of a lack of staff at hospitals across the country. The effect that staffing shortfalls have on patients must not be underestimated, but we must also remember the effect on the staff themselves. NHS staff are consistently asked to take on additional responsibilities, to work harder, to do more intense shifts and to take on an excessive number of patients. Working in an already high-pressure environment without adequate resources or support not only puts patients at risk but damages the mental health of staff, leading to lower morale, poor wellbeing and a poor working life.

Working life is becoming intolerable for some of our NHS staff. It is no wonder that 20,000 nurses have left the NHS since 2010, and that the NHS has seen a 55% increase in voluntary resignations, with staff citing a poor work-life balance as their primary reason for leaving. The number of voluntary resignations due to health problems and stress has increased threefold in the past 10 years. The recent interim NHS people plan states that people are “overstretched” and admits that people no longer want to work in the NHS. What steps will the Minister take to ensure that NHS staff are retained once they are trained and experienced?

The standards of protection and safety that are rightly expected by staff and enshrined in the NHS constitution are being abandoned. On top of the cuts to staff wellbeing services that have consistently been made across England since the introduction of the Health and Social Care Act 2012, the number of understaffed shifts and overworked practitioners is forcing staff to take time off work and has led to increased requests for employed staff to take on extra shifts. That risks their health and can lead to increased locum use to cover staff rota gaps and vacancies. Staff shortages can have a significant impact on patient and professional safety.

It is welcome news that NHS Improvement will monitor trusts’ use of safe staffing guidelines. However, five years after the Francis report, the action taken on safe staffing simply is not good enough. The exodus of dedicated staff over the past 10 years, staff shortages, long waits for treatment, and frequent cancellations of operations demonstrate that the National Institute for Health and Care Excellence’s suspension of work on setting evidence-based staffing rules in 2015 was a mistake.

One way of ensuring the system has the number of staff it needs would be for England to follow the approach that is taken in Wales and is planned in Scotland, which is to legislate for safe staffing levels, yet the Government have continuously refused to bring forward legislation on safe staffing levels. Will the Minister reconsider that?

It remains unclear who is responsible for interventions in the workforce supply, as the Government certainly seem to be abdicating responsibility. The Government must consider seriously the legal proposals put forward by NHS England and NHS Improvement to amend the Health and Social Care Act to ensure that the workforce crisis is meaningfully and explicitly addressed. Can the Minister explain what impact workforce accountability requirements would have on the current legal framework? Surely the fact that Scotland and Wales have explicit accountability for the provision of the workforce across health and social care but England does not will lead to unequal progress and quality of care across the country and, inevitably, to a postcode lottery for patients.

We cannot tackle this problem if the pool of talented medical professionals in Britain continues to shrink. Safe staffing is not just a numerical issue; it is about having enough staff with the right skills, experience and knowledge. The UK trains only 27 nursing graduates per 100,000 of population, compared with the average of 50 across other OECD countries. The Government have continually undermined incentives to join the NHS workforce, which is demonstrated by their treatment of junior doctors, their introduction of salary caps, their cuts to bursaries and funding opportunities for students, and their hostile approach to those who travel from overseas to join the NHS. Does the Minister recognise that restrictive migration policies act only as a further barrier to tackling the NHS workforce crisis?

Does the Minister also recognise that the Health Education England budget has been cut by 17% in real terms since 2013-14? Applications to nursing training have fallen by 30%, particularly since the nursing bursary was removed. The NHS long-term plan set out some ambitious targets, such as diagnosing 75% of cancers at an early stage by 2028, expanding emergency service care and increasing the availability of mental health services. However, without a long-term, fully funded staffing plan for the NHS, those targets are impossible to reach.

The Government’s warm words and commitments to increase the number of NHS staff working and in training “as soon as possible” are appreciated. However, legislative action must be taken to ensure that patients and staff are not exposed to unsafe staffing levels, which can have dire consequences for patient outcomes and workforce retention. I look forward to the Minister’s response.

--- Later in debate ---

[Mrs Hodgson]

The Minister says that accountability is already in place. Staffing levels may be required and desirable, but what happens when they cannot be met because the staff are not there? Where is the accountability?

[Stephen Hammond]

The hon. Lady will know that the CQC regime puts directives in place if staffing levels are not there. The local providers are then forced to address those issues. The accountability is there.

Beyond this issue, several hon. Members talked about exactly what we are doing now. There was recognition that the Government have put in place the long-term plan and the people plan. Any reading of those will see that our overarching plan for the health service looking forward recognises explicitly that getting the workforce supply right is key. That is therefore an important part of the long-term plan, which sets out the vital strategic framework to ensure that in the next 10 years the NHS will have the staff it needs. Nurses and doctors will have the time they need to care, work in a supportive culture and allow them to provide the expert, compassionate care to which they are committed.

Hon. Members rightly said that that will not be for this Government; it may well be for the Government beyond. However, the long-term plan rightly recognises by its very nature that what we need to put in place today must continue through the next 10 years to ensure that we have the staffing levels we need.

[Stephen Hammond]

I will come to the number of nurses in training and related issues in a moment, to address the hon. Lady’s comments.

Associated with the long-term plan is the people plan, which clearly recognises, to reference what I said about Health Education England, the significant role of that organisation in securing the NHS workforce for the future. That is why my right hon. Friend the Secretary of State for Health and Social Care commissioned Baroness Harding, the chair of NHS Improvement, to work alongside and closely with Sir David Behan, the chair of HEE, to develop the workforce implementation plan. The interim people plan published in June set out the actions needed to change positively the culture and leadership of the NHS, making it the best place to work, which addresses the issues rightly raised about recruitment and retention.

The people plan commits to developing a new operating model for the workforce that ensures that activities happen at the optimal level, whether in individual organisations, local healthcare systems, regionally or nationally, with roles and responsibilities being clear.

On NHS workforce supply, hon. Members talked about demand for nursing and midwifery courses. The latest available evidence shows that we are starting to see a substantial rise. Data published only last week showed a 4.5% increase in applicants compared to 2018, with that being the second increase in as many years. To build on that, to ensure that we increase the pipeline of nurses coming into the profession, the Department has worked with NHS England to ensure that funding is available for up to 5,000 additional clinical placements for nursing degrees in England. The chief nursing officer for England has led work to identify and accelerate the availability of such clinical placements. It is vital that universities ensure that they take up offers and provide placements to ensure that places are filled at the end of this year’s recruitment cycle. That can happen.

[Mrs Hodgson]

I acknowledge the 4% increase—it is a small increase—but figures show that the numbers are still down 29% from 51,830 in 2016, when the bursary that covered training was removed. Even with that small increase, we are still 15,000 short of the figure when the bursary was axed.

[Stephen Hammond]

The figures show an increase in applicants this year. The hon. Lady will know that there are 1.4 applications for each place, and she will have heard me say that we are creating additional clinical placements to ensure that more nursing places are available. I recognise that there has been a drop, but I hope that she applauds the 4.5% increase in applicants this year. That is key.

A number of Members rightly talked about additional nursing roles and support. Health Education England is leading a national nursing associates programme with a commitment for 7,500 nursing associate apprentices to enter training this year. That builds on a programme that has already seen thousands start training in 2017 and 2018.

The RCN is leading work focused on the legislative framework for all professional groups. I should set out that work on the people plan also included examining options for growing the medical and allied health work- force, including the possibility of further medical school expansion, increasing part-time study, expanding the number of accelerated degree programmes and greater contestability in allocating the 7,500 medical training places each year to drive improvements in the curriculum.

For allied health professionals, the long-term plan sets out a commitment to completing a programme of actions to develop further the national strategy, focusing on implementation of the plan. There will be a workforce group to support that work and make recommendations, including on professions in short supply, which would address the podiatry point made by my hon. Friend the Member for St Ives. That is essential.

I do not think that anyone should be in any way complacent, and the Government are clearly not complacent. Many hon. Members will have heard me say that, as well as training the workforce for the future, it is important that we support and retain the current workforce. The interim people plan is committed to reviewing how to make increases in a number of factors. One such factor is national and local investment in professional development and workforce development.

There are examples of good practice in this area across the NHS, and I was particularly pleased when I visited Leeds Teaching Hospitals NHS Trust to see how a group of band 6 nurses had created their own in-house training programme, boosting management skills and leading to greater collaborative ways of working. That example of best practice makes the case for national investment in such programmes and for national funding for continuing professional development.

Everyone recognises the need to recruit more staff, but it is also fair to put on the record the fact that the number of staff working in the NHS today is at an all-time high—it is the highest it has been in the NHS’s 70-year history. Since 2010 there has been a significant growth in qualified staff. [Interruption.] I hear a sigh from Opposition Members, but it is worth making the point that there are now 51,900 more professionally qualified staff, including 17,000 more nurses working on wards. That is a simple fact; it is a piece of data, and we cannot get away from it. I do not suggest that one should be complacent in any way, but we should recognise that there are more nurses and doctors, and the Government are committed to delivering on our promise to ensure that the NHS has the right staff with the right skills in the right place at the right time to deliver the hugely valuable, excellent care that patients deserve.

Question put and agreed to.

Resolved,

That this House has considered the legal duties of the Secretary of State for Health and Social Care for NHS workforce planning and supply.

Child and Adolescent Mental Health Services: North-east

Sharon Hodgson Excerpts

Wednesday 10th July 2019 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

As hon. Members know, it is very difficult sometimes to secure an Adjournment debate—the last one took me over a year to obtain—so I was very pleased when this one was granted, especially as it is on such an important matter, as I will outline in some detail tonight. It is especially welcome that business has fallen early tonight, so I do not need to rush or curtail my remarks to leave time for the Minister. This is such an important matter and I know we will both have plenty of time to deal with this issue.

I would first like to thank my constituents for bringing their case to me, and for waiving their anonymity in the hope that their story can help other families and ensure that something like this does not happen again, as it could so easily have had a tragic ending. Going public like this is a very brave thing to do and I sincerely hope that their story, and today’s debate, will spark a change.

In March this year my constituent, Mr Thomas, wrote to me about his daughter Jane, and the

“deplorable treatment when attempting to access CAMHs support”.

Jane, aged 16 at the time—she is now 17—tragically lost her mother as a result of alcohol abuse. Everyone will appreciate the grief that this will have caused Jane and her family, and the lasting impact of that grief after years of watching a parent decline due to alcohol abuse. Many hon Members, such as my hon. Friend the Member for Leicester South (Jonathan Ashworth), my right hon. Friend the Member for Don Valley (Caroline Flint) and my hon. Friend the Member for Birmingham, Hodge Hill (Liam Byrne), have spoken growing up with similar experiences. I pay tribute to them, and to Jane, today.

Having experienced such loss on top of what she would have seen her mum go through over the years, Jane was understandably struggling with her mental health. Mr Thomas therefore felt that Jane needed professional intervention. Having consulted Jane’s GP, Jane was referred to North Durham child and adolescent mental health services at Tees, Esk and Wear Valleys Foundation NHS Trust. This is where Mr Thomas’s frustration begins.

Jane waited weeks for a CAMHS appointment following the referral, but it was not forthcoming. Mr Thomas went back and forth with the GP to ensure that the referral had been made, and was assured that it had. He was even shown the email confirming that. He then contacted the CAMHS team directly over the phone. As you can imagine, he was surprised to hear that they had no record of any referral regarding Jane. Mr Thomas says that this

“set the pattern of misinformation and incompetence that Jane and I were to encounter.”

Mr Thomas contacted CAMHS again to enquire whether an appointment would be made for Jane, and was told that Jane would not be seen as her need had already been assessed and her case was closed. That exasperated him further, as it referred to an earlier episode and a case from several years earlier, not the most recent case following the death of Jane’s mother. Therefore, it did nothing to inspire confidence.

Jane finally saw a CAMHS practitioner at the end of last year and was making positive progress, but her last appointment was on 4 January 2019. It is now July, and Jane has not had another appointment on the national health service in the past seven months. The initial reason for the delay was that Jane’s counsellor had left to start her maternity leave—something that, of course, she is absolutely entitled to do—but the trust will have been well aware for some time that the counsellor’s maternity leave would need to be covered. There also should have been a period of handover so that the service could continue its work smoothly. That did not happen.

Maternity cover was found after a gap of more than two months. However, just days after starting, that person resigned their position, leaving the trust unexpectedly without any cover. I am told that that was for personal reasons. It was at that point that the trust wrote to Jane Thomas, on 8 March, apologising for the delay in her treatment and suggesting that, if she had any inquiries, she should contact the team at North End House or, if she was in crisis, she could call the CAMHS crisis team. It was then three months since her last treatment.

It was upon receiving that letter that Mr Thomas contacted me to bring all this to my attention. There was nothing in the letter to Jane—I have seen a copy of it—to suggest that she should contact the trust to arrange an appointment or alternative provision; it just said to call if she was in crisis. I therefore wrote to the trust on 18 March, asking them to examine this matter further and advise Jane and Mr Thomas.

On 29 March, I received a reply that said that the trust had

“looked at interim solutions, such as part time staff working additional hours.”

It did not say whether that was actually happening, or whether that would include an offer of support to Jane, only that they were looking at it. That was just one of the many opportunities that the trust had to take another look at Jane’s case, to see what interim solutions were in place for her and to make contact with her directly, perhaps by calling her, as they did yesterday—I will come to that in a moment. But that did not happen.

Yesterday, I spoke to Mr Levi Buckley, director of operations at the trust, in advance of this debate. We had been trying to arrange a call for some time and could not get the dates to match, but obviously that changed once I secured this debate. I was told yesterday that alternative arrangements had been put in place for the majority of patients. He told me that when Jane’s counsellor went on maternity leave in January, all those patients should have had their cases reviewed and reassigned to another counsellor or another support network. However, for whatever reason, that did not happen for Jane, although I am told that it did for all the others. Jane had obviously, and shamefully, just slipped through the net. The trust realised that, no doubt prompted by Mr Thomas, and in March, when the new counsellor started and then left after two days, they contacted Jane to apologise with the letter dated 8 March that I mentioned earlier.

There was no concerted effort at any point by the trust to re-establish contact with Jane, who for all they knew was getting no support at all with her mental health. There was just that one letter. Even after I contacted the trust on 18 March to begin this dialogue, they still made no further contact with Jane until yesterday, when she was called within two hours of my conversation with Mr Buckley, prior to this debate. I understand that Jane spoke to the head of the CAMHS service, who apologised and offered her transitional provision to move her into adult services, as she is 18 later this month. It is, of course, entirely up to Jane what she decides to do.

Having spoken to the trust, they agree that they could have done more to make contact with Jane, who obviously was easily contactable, as they spoke to her without delay yesterday. There have been many opportunities available, since March when I first contacted the trust on behalf of Mr Thomas and Jane, to make that direct contact and arrange counselling provision for Jane, but that did not happen. That means that a vulnerable young person had fallen through the gaps because of incompetence, and even when it had been brought to their attention in March, nothing was done to rectify the situation until yesterday.

It does not need me to point out that this could have been fatal, had Mr Thomas not sought and paid privately for mental health provision for Jane. I understand from my call with Mr Buckley yesterday that the situation at the trust was made more difficult because, after advertising the job twice and getting no applicants, they had to lower the grade of the position—meaning that the person would require more supervision—in order to attract someone they could employ. This person is due to start in September—nine months after the counsellor on maternity leave left. Mr Thomas emailed me earlier today to say that the

“analogy of too many Generals and no Soldiers would suggest itself”.

I agree.

In April, when I met Mr Thomas in my constituency surgery, he was very clear that this was about incompetence and bad management within the trust that had allowed his daughter to slip through the cracks. What has most frustrated him about this ordeal is the lack of accountability for what he calls the

“appalling management of the service”.

He went on:

“This CAMHS organisation is poorly led, poorly administered and managed with incompetence.”

Can the Minister please inform the House who should be accountable for these failures?

A freedom of information request made in 2018 to the Care Quality Commission by a concerned parent inquiring into numbers of complaints made against CAMHS went unanswered, with the CQC stating that it did not have full oversight of this organisation and therefore could not provide the requested information. Who does oversee CAMHS? Who should be taking responsibility for the vacancy gap and the real problems that the trust has had in filling the vacancy, and for the impact it has had on vulnerable young people who need access to support? What advice can the Minister give to my constituent, who just wants to help his daughter get the professional treatment she needs, when she needs it, on the NHS? Does the Minister think that trusts should not be able to mark their own homework on such cases? They must surely be held accountable when there are failures and recognise the need for change. I hope that this debate brings about some change.

[Hugh Gaffney (Coatbridge, Chryston and Bellshill) (Lab)]

I thank my hon. Friend for bringing this debate to the Chamber, and for explaining the importance of mental health services in the north-east. In Scotland in the last five years, there has been a 50% increase in the number of suicides among 15 to 24-year-olds. We need to do something about this national crisis.

[Mrs Hodgson]

I thank my hon. Friend for his intervention. I would encourage him to apply for a debate with the same title, only with “Scotland” at the end instead of “North-east” so that he can explore that 50% increase in greater detail. If he is lucky, he might get a nice long session like me, but I know the Minister will have heard his comments.

Throughout all this incompetence it is Jane who has suffered. If this is an issue of recruitment and retention, which it seems to be, what will the Minister do to ensure that CAMHS staff are both recruited and retained nationally, and specifically in the north-east? Nationally, the number of consultant child and adolescent psychiatrists fell by 4.5% between October 2013 and October 2018, which might account for why it was so hard for the trust to recruit someone, while the Government are on track to miss their mental health workforce target by 15,000 staff. Labour research in January found that the total number of mental health nurses had fallen in every month the previous year. I should be grateful if, in her remarks, the Minister would address the issues that led to this decline in the number of mental health nurses and evaluate the impact that it is having on young people such as Jane.

If an A&E just closed its doors because of a lack of staff and stopped treating people, there would be an outcry—we would not stand for it—so why do we allow it to happen when it comes to mental health? The Prime Minister said she wanted mental health to be a priority, but the Government are nowhere near achieving that goal. Mental health awareness is one thing, but it must be matched by mental health support and treatment services, and that is where the Government are failing, especially with regard to staffing.

According to research carried out by the Children’s Society, more than 110,000 children a year are unable to access mental health support from a CAMHS service, despite being referred for support. Three out of four children with a diagnosable mental health condition do not receive the support that they need, according to similar research conducted by YoungMinds. This is therefore not a problem exclusive to the north-east—or even Scotland, as we have just heard from my hon. Friend the Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney)—which is why the Government must take action.

I wrote to Tees, Esk and Wear Valleys NHS Foundation Trust, which informed me that it did not operate a waiting list in County Durham and Darlington CAMHS. However, Jane and other young people, across the north-east and the whole country, are still waiting. It beggars belief that the trust could say that, but it is in the letter that it sent to me.

As I have said, Mr Thomas was left with no choice but to engage a private practitioner. That came at a huge cost to him and his family, but as a loving parent he felt that he had no other option. No parent should be put in that position, and not all parents have the means to step in when the services let them down so badly, as was the case for Jane.

According to the Royal College of Psychiatrists, mental health trusts have less money to spend on patient care in real terms than they had in 2012. Of course, lack of funding means that trusts are strained and unable to provide vital services. Is that what led to the staffing problems in this trust? Was its inability to fill the vacancies down to the salaries being offered, or was the workload that was being demanded of staff too high? Why did that new person leave after only two days? Will the Minister support Labour’s calls for the ring-fencing of NHS mental health budgets and an increase in the proportion of those budgets that is spent on support for children and young people? Increased funding will relax some of the pressure on services, and will ensure that they can be sufficiently staffed and resourced to improve patient experiences.

As I said at the beginning of my speech, Mr Thomas and Jane were very brave to allow me to share their story with the House in so much detail today. However, it should not have come to this. Jane, having mental health problems, should have been referred to CAMHS, been assessed and then been given therapy appointments as necessary to support her recovery—unbroken, with no seven-month gaps in provision. Instead, she and Mr Thomas have been back and forth and have had to fight, and even pay, for the support that she needs and to which she is entitled.

Mr Buckley, from the trust, informed me that North Durham CAMHS had seen an 18% rise in referrals over the last year. It follows that as the number of referrals rises, the funding must also increase to meet that need. The Government must increase the proportion of mental health budgets spent on support for children and young people: they must make mental health a priority, with actions and not just warm words.

While the staffing crisis and mismanagement at Tees, Esk and Wear Valleys NHS Foundation Trust rages on, Jane still has no access to treatment and support on the NHS, although I have been told that she received a call yesterday suggesting that the problem might be resolved shortly. I therefore ask the Minister what she will do for Jane, and young people like her, to ensure that situations like this do not occur in future.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

I thank the hon. Member for Washington and Sunderland West (Mrs Hodgson) for the sensitive way in which she has outlined the case of her constituent Jane. We often debate NHS issues in this place, and it is often a case of trading statistics and numbers, but the hon. Lady has reminded us all that there are vulnerable people needing help who are potentially at risk of more harm when the NHS fails them. I will write to her in more detail answering some of the questions that she has posed to me today, but for the moment I will address some of the issues with which I am able to deal.

We have articulated clear ambitions for improving children’s mental health services, but, as the hon. Lady outlined extremely well, this follows decades of under- investment in those services, and there is a way to go from where we are now to where we need to be. The waiting times that Jane has experienced, which the hon. Lady outlined, really are not acceptable.

We will be very clear about our ambitions, but the hon. Lady is also right to highlight that we are very dependent on the performance of individual trusts in terms of delivering that. She set out the challenge as regards the Tees, Esk and Wear Valleys NHS Foundation Trust very well. The Care Quality Commission is giving quite a lot of attention to that trust for one reason or another, and the trust will be made much more accountable. I always say that sunlight is the best disinfectant, and one of the issues that we collectively face is that because mental health has for so long been something we have not talked about enough and has been stigmatised, mental health services have been a bit out of sight, out of mind, and have not had the scrutiny that they should have had.

The comparison the hon. Lady draws with an A&E, saying if it was turning away patients like this there would be an absolute scandal, is right, and part and parcel of achieving parity of esteem is that we must expect the same high performance and standards of our mental health services as we do of our physical health services. I know that the hon. Lady will not let me get away with not taking that as seriously as I possibly can.

We have made some progress, but, as the hon. Lady has heard me say before, I am in no way complacent about where we are. It is not just that we need overall improvement; there is great disparity between various regions and areas across the country, and the hon. Lady represents an area that is particularly challenged. She made some points about waiting time standards, and I am getting quite an inconsistent picture as regards the performance of that trust, which suggests to me that there is something wrong with the data and how things are being measured. Again, we need to hold everyone to account so we can be sure that our waiting list and waiting time data are accurate.

[Mrs Hodgson]

When I spoke to Mr Buckley about the sentence in the letter that said a waiting list was not operated, he explained that that probably was not very accurate, because when everyone is seen and triaged, if they need an appointment to see a therapist they are given one in, say, six weeks, eight weeks or 12 weeks. He said that the fact that they are given an appointment explains why there is no waiting list. So as the Minister rightly pointed out, we will have to drill down on that, because I do not think we are measuring the same thing across all trusts if they are all using different forms of words.

[Jackie Doyle-Price]

There might be something we can do on standardising the approach, but that brings us to another challenge. We apply these targets to try to achieve a standardised service and to ensure that people get treated when they need it, but that encourages some perverse behaviours, and the hon. Lady has just outlined one of them. The challenge for us is how we apply standards of behaviour and targets without driving perverse outcomes and bad outcomes for patients. I still think we have a lot to do on that, and probably a lot of learning. We need to identify those areas that really are doing it well so that we can spread good practice throughout the system.

But there is obviously a good reason why we must make sure we get child and adolescent mental health services much better: because we know that people who suffer from mental health issues tend to develop those conditions when they are children—when they are young. We all know that early intervention is the best way, not least for the individual concerned, because they will suffer less harm, but it is also good for the taxpayer because it costs less money to help people sooner. So we must make sure that we continue to give children’s mental health much more priority than it has had hitherto, and central to that will be greater provision of services in the community.

I am really concerned about the story the hon. Lady has just told. The process that Jane has been taken through appears to have completely failed, and the communication with her and her father appears to be extremely poor. Again, I think we can go away and look at how we communicate with patients and their families, and particularly at the tone that is used. We are dealing with people who are in a very vulnerable position, and to put it bluntly, it should not be “take what you’re given”, should it? Ultimately, our NHS is there to serve all of us, and it needs to do so with sensitivity and tact.

The hon. Lady rightly challenged me about money and the need to ensure that it delivers extra appointments. We are ambitious to see many more children, through the investment we are making, but unfortunately I do not have a magic wand and I cannot roll it all out overnight. As she points out, we need to ensure that we are investing in the appropriate workforce to deliver these services.

I would like to make another point about NHS commissioners. While we are delivering this real step change in mental health provision for children, there are other things that can be done by local health commissioners—and by local authorities, for that matter—while people are waiting for referrals and appointments. There is still additional support that can be given by organisations doing good voluntary work to give wraparound support and take some of the pain out of the experience. I often say that good mental health care is not all about clinical interventions; it is about the wider support that can be given in the community as well.

Our reforms to mental health in schools have that kind of support very much in mind. We are rolling out a new workforce, which is going be based on people who are trained in psychology and therapies, but the ethos will be very much that they are working with voluntary sector organisations that will be able to provide that additional support to people who are going through periods of mental ill health. We want to ensure that many more children who are going through mental ill health are seen, not least because we are seeing increased prevalence and it will take substantial extra effort to ensure that we are providing that service.

I turn specifically to waiting times. We have introduced new standards for mental health services, and in particular, we have introduced targets with regard to eating disorders and to a first episode of psychosis. We are making good progress on those, but as the hon. Lady says, Jane had clearly gone through significant trauma and it would not be unanticipated that that would impact on her mental wellbeing. Our targets for psychosis and eating disorders would perhaps not capture someone with that level of need, but it is still important that she has access to that support. Sunderland clearly has longer waiting times than many other areas of the country. I understand that the trust has been successful in bidding for additional NHS England funding as part of a national waiting list initiative, and I sincerely hope that that will improve access for the hon. Lady’s constituents.

When we hear of cases such as that of Jane, I can understand why people feel that our commitments on transformation ring a bit hollow. I know the hon. Lady will understand that we see this as a long-term process of rolling out improved services. That is the only way we are going to embed the change in culture that we really need in how we prioritise mental health, but we need to redouble that progress, as she says. We are determined that NHS funding for children and young people’s mental health services will continue to rise.

The hon. Lady asked me about making sure there is a proper ring fence. We have demanded that CCGs increase mental health spending on children’s services by more than their budget rises, but I think we will be taking a more interventionist approach. I know that NHS England is having robust discussions to ensure that all commissioners do exactly what is expected of them. We expect to have been able to treat an additional 345,000 children by 2024 through the additional funding, and we are already seeing some benefits.

I understand that in Sunderland, local commissioners have commissioned Mind to work with young people aged 11 to 25 and give direct support in that way. In addition, there is the new Lifecycle service, which includes access to adult therapies—one of the issues the hon. Lady raised. I am told that in Tyneside 90% of young people are seen within five days for triage into the service, but on the basis of what the hon. Lady has told me, I would like to do a bit more digging to make sure that the figure is robust.

We know that the mental health sector is showing imagination and innovation in filling the skills gaps in mental health nursing and psychiatry, but it is worth noting that one of the upsides of us talking about this subject and giving so much more attention to mental health is that it is raising the profile of the sector as somewhere to work. The really nice thing is that people do care about it. Applications for psychiatry are increasing, in part, I guess, because would-be psychiatrists can see that there will be plenty of demand for their services. Although we are making the sector more attractive, providing the workforce will be a big challenge, so we need to encourage more imagination about how that is delivered.

New roles are emerging, such as peer support workers, making use of lived experience. It strikes me that people going through mental health issues often find it intimidating to talk about it and to respond to treatment. Getting support from someone who has been through a similar experience can be enormously important to their recovery, and we want to encourage much more of that. We have the new nursing associates, and we want to encourage more mature workers—perhaps women re-entering the labour market—to explore careers in mental health. We will need much more imagination in the coming years if we are to continue to deliver the workforce we need.

[Mrs Hodgson]

I am sure the Minister can guess what I am about to say. Previously, the nursing bursary was so important for older people going back into the workforce or making a career change, and especially the group of people who now do not even apply for those opportunities. Is there any influence she can exert on the Government, any hope that at some point in this Parliament they will bring back that bursary?

[Jackie Doyle-Price]

I walked right into that one, didn’t I? The hon. Lady is right in the sense that we need to enable people to learn and earn. That is the key. I have conversations with Health Education England about how we can meet our ambitious workforce targets, and I am sure that it will have noticed what she just said and my reply. Applications are increasing despite the removal of the bursary, but I believe we could do more to encourage people who are considering entering the sector, perhaps later in life, when they have a family and they need to earn.

The NHS long-term plan, which contains some very ambitious commitments on mental health, is a huge opportunity for commissioners to think much more creatively about how they deliver their local services, because we are going to have to deliver a step change in the provision of services available in the community.

I have talked a bit about the mental health support teams going into schools, and it is pleasing to see that they are being rolled out. I do not believe we currently have a trailblazer that serves the hon. Lady’s constituency, but clearly if the local trust could work with local schools on delivery, it would make a huge difference to delivering services for children and young people. I believe teams are now covering Newcastle Gateshead, Northumberland and south Tyneside, and they will be testing the four-week waiting time, which she will believe is important, particularly when viewed through the prism of Jane’s experience. Later this week, we will be delivering the next wave of those sites, so let us watch this space—hopefully we will be able to get more provision.

The hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) mentioned the issue of suicide and self-harm, which is clearly a considerable priority for me. We have been fortunate in seeing declining rates of suicide for a number of years, but we are beginning to see it on the rise again among children and young people. We could all speculate as to the reasons for that. They will be complex, because every suicide has its own story, and it is usually an escalation of factors that leads to someone taking their own life. We need to take a good look at exactly what pressures our young people are facing. Clearly, Jane had had adverse childhood experiences. We know they contribute to mental ill health, but other things are involved, too. If we can identify people who are at risk early—clearly, adverse childhood experiences are a good indicator—we can make sure we give that support sooner and then we will genuinely be able to tackle suicide prevention. We are on it, but we have a lot more learning to do on that.

I am really grateful for the sensitivity with which the hon. Member for Washington and Sunderland West has outlined Jane’s case, and I will take that away and respond in detail to the issues she has raised. As a pathway of experience, that clearly is not good enough, but I suspect it is all too common. Sometimes it is useful to use a particular case study to see exactly what is going wrong and what we can learn from. I would, however, say that I am proud of the progress we are making on improving services. We need to do much more. I wish I could do it quicker, but I will do the best I can.

Question put and agreed to.

Genetic Haemochromatosis

Sharon Hodgson Excerpts

Wednesday 3rd July 2019 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is an honour to serve under your chairmanship, Mr Sharma. I thank the hon. Member for Rugby (Mark Pawsey) for securing this important debate, and for his excellent and detailed speech, which set the scene. I congratulate him on establishing the all-party parliamentary group on genetic haemochromatosis earlier this year. I have set up a number of all-party parliamentary groups and am a big believer in them. I know how important they are in getting things one, cross-party, in this House. I am pleased that he was able to bring the condition to the House’s attention.

I thank all hon. Members who have spoken in the debate—in particular my hon. Friend the Member for Heywood and Middleton (Liz McInnes) and the hon. Members for West Dunbartonshire (Martin Docherty-Hughes), for Ceredigion (Ben Lake), and for Paisley and Renfrewshire North (Gavin Newlands)—as well as my hon. Friends who made helpful interventions.

As we have heard, GH is a genetic disorder that causes the body to absorb excessive amounts of iron from the diet. Iron overload occurs in one in every 200 people and is now recognised as the most common genetic disorder. Although GH cannot be prevented, its symptoms and health implications can. When untreated, GH can cause serious health problems, including fatigue, weight loss, irregular periods, type 2 diabetes, early menopause and depression.

GH was previously thought to be a low-level health risk, but a study by the University of Exeter found that the genetic condition usually quadruples the risk of liver disease and doubles the risk of arthritis and frailty in older age groups. As hon. Members have already said, treatment of those conditions comes at a huge cost to the NHS, so it is important to ensure that symptoms are prevented by diagnosing GH early and advising on how to avoid iron overload.

[Sir George Howarth (Knowsley) (Lab)]

My hon. Friend must have extra-sensory perception because I was going to ask if she agreed with everybody else who stressed the importance of early diagnosis, and she just did.

[Mrs Hodgson]

Excellent. If something is worth saying, it is worth saying more than once.

With early diagnosis in mind, I have a number of questions for the Minister; I will rattle through them quickly. What assessment has she made of the diagnosis pathway for patients suspected of having GH? How early are patients diagnosed after presenting with symptoms, and which diagnosis route is the most successful and least painful and invasive for patients? Is that diagnosis route available across NHS trusts and clinical commissioning groups? When someone is diagnosed, is it routine for their family to be tested and treated?

GH can be aggravated by environmental and lifestyle factors, so can the Minister assure the House that patients with GH are clearly advised on how to care for themselves if they have the disorder? Are patients given direct advice on their diet and on alcohol and tobacco consumption? As we have heard, that can make the condition easier to manage, if the advice is taken on board, of course—often people do not want to hear what is good for them, myself included. Where necessary, is support available to help patients reduce their alcohol consumption and to quit smoking?

As we know, diet, alcohol and tobacco consumption have huge health implications for all society and cost the NHS millions in treatment. It is therefore crucial that public health services are available to everyone to allow them to live heathier lives, especially patients with GH, who are more susceptible to health problems relating to the heart and liver.

I never miss an opportunity to call on the Minister once again—if she can; it might be above her pay grade—to reverse the public health budget cuts that have decimated our vital public health services. I also urge her to ensure that when the prevention Green Paper is published—I have heard rumours that it could be as early as Monday—patients with any existing conditions are also taken into consideration for prevention, so that their symptoms can be controlled, too. I look forward to her response.

Electromagnetic Fields: Health Effects

Sharon Hodgson Excerpts

Tuesday 25th June 2019 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Hollobone.

I start by thanking my hon. Friend the Member for Gower (Tonia Antoniazzi) for securing this debate and for her excellent speech, which set the scene and informed us all about this issue. Earlier this year, I met her to discuss it, so I am pleased that she was able to secure the debate on it.

I also thank my hon. Friend the Member for Stroud (Dr Drew) and the hon. Member for Linlithgow and East Falkirk (Martyn Day), who spoke for the Scottish National party, for their thoughtful contributions to this debate. There were also excellent interventions by my hon. Friend the Member for Swansea West (Geraint Davies); I am pleased that he is still with us in Westminster Hall, as he had said that he had to leave early.

As we have heard, the World Health Organisation has concluded that current evidence does not confirm the existence of any health consequences from exposure to low-level electromagnetic fields. I know that the Government have followed a similar line, with the independent Advisory Group on Non-Ionising Radiation concluding that although a substantial amount of research has been conducted in this area, there is no convincing evidence that electromagnetic field exposures below guideline levels cause health effects in either adults or children. However, as we have heard, concerns exist about the long-term impact of electromagnetic fields, and although my hon. Friends did not go into great detail about individual cases, I have read of such cases and I am sure that all hon. Members have also read some of the details about them. As we become ever more reliant upon modern technology, such concerns will only increase.

On a more light-hearted note, those people who have Netflix might have seen the impact of electromagnetic fields being played out, albeit in a fictional sense, in a programme called “Better Call Saul”, in which the brother of the main character is terribly affected—indeed, he is housebound—by EMF. It is often said with these types of issues that Hollywood leads the way in bringing them to the public’s attention, and this example is definitely a case in point.

International studies, such as the cohort study of mobile phone use and health, or COSMOS, and national studies, such as the study of cognition, adolescents and mobile phones, or SCAMP, exist to continue research into any possible impacts. It is important that such studies continue, so that the public can be aware of all the current advice about electromagnetic fields. As we have heard, as technology develops there will be concerns—new and old—about the impact that it could have on our health. What assessment has the Minister made of all those studies, specifically those that conclude that radio waves are carcinogenic? As we have heard, Cyprus and Austria advise children and teenagers how to limit their exposure to radio waves. Will the UK Government consider doing that, too?

Some of my constituents have written to me with concerns about the new 5G network, as also reported by other hon. Members, and I am grateful for the Minister’s response on that. I know that my hon. Friend the Member for Gower has had conversations with her constituents, who are concerned about the new technology being rolled out across the country. As she said, she would like white zones to be considered and protected. White zones give people who are sensitive to electromagnetic fields, or are concerned about their impact, somewhere to live without interference from radio waves, and that is why it is important that the matter is looked at cross-departmentally.

[Geraint Davies]

Is my hon. Friend aware of the concern that 5G cannot penetrate trees and that, as a result, we are looking at the destruction of thousands and thousands of trees? That destruction has already started around Swindon. How can we possibly be serious about our ambitions for zero carbon if we are destroying the trees and have this huge carbon footprint? It does not add up and is clearly environmentally ridiculous.

[Mrs Hodgson]

I was not aware of that, but my hon. Friend has put it out there on the record. I had heard, though, that 5G can go through us, where other things go around us, so it cannot go through trees but it can go through humans. There is a lot more we need to know about the technology.

As I was saying, anything that looks at this must be cross-departmental because of the impact on health, business, digital and the environment. Each of the Departments responsible for those areas should consider the health implications of electromagnetic fields, whether it is for a small minority of the population or the majority. Is that something the Minister has considered?

As we roll out digital technology, particularly in rural areas, the protection of white zones should be considered. We can be world leaders in digital, but that must not be at the expense of health and wellbeing. I therefore urge the Minister to ensure that all the information about the health and wellbeing impacts of electromagnetic fields is made available to the public, and kept under constant review as we find out more. I also urge her to work with her colleagues, across several Departments, to ensure that health and wellbeing is prioritised throughout the digital roll-out.

Oral Answers to Questions

Sharon Hodgson Excerpts

Tuesday 18th June 2019 Commons Chamber

[Mr Speaker]

If the hon. Member for South West Bedfordshire (Andrew Selous) has been trugging round Amsterdam in pursuit of the public interest he is a remarkably assiduous and dedicated fellow. We are all deeply obliged to him—it is way beyond the call of duty, but we are appreciative none the less.

We now come to topical questions. I call Justin Madders.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

rose—

[Justin Madders (Ellesmere Port and Neston) (Lab)]

rose—

[Mr Speaker]

The hon. Gentleman will think it is a conspiracy, but he will get his moment in a moment. I call Mrs Hodgson.

[Mrs Hodgson]

Thank you, Mr Speaker. The Government’s second childhood obesity plan will celebrate its first birthday a week today, but we will not be celebrating. The Government have ducked and dived on their responsibility to the children in this country and have failed to produce any policies as a result of the six consultations the plan has promised, but the rate of childhood obesity is still at a record high. Instead of waiting for the chief medical officer to report on obesity, will the Government act now to tackle the childhood obesity crisis, and introduce and implement the policies they have consulted on already?

[Seema Kennedy]

We have a very ambitious aim to halve childhood obesity by 2030. We are still considering all the answers to the consultations, and we are hoping to respond to them very shortly.

Public Health: County Durham

Sharon Hodgson Excerpts

Wednesday 12th June 2019 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Owen. I thank my right hon. Friend the Member for North Durham (Mr Jones) for securing this important debate and for his excellent speech. I also thank my hon. Friends the Members for Sedgefield (Phil Wilson) and for City of Durham (Dr Blackman-Woods) for their insightful and powerful contributions.

As I have said many times before, under the Tory-led coalition and the current Conservative Government, public health budgets have been cut by £700 million since 2013, with no financial settlement agreed so far post-2020. As we have heard, that means that vital public health services, such as those for smoking cessation, obesity, sexual health and many more, have been stripped back to the bare minimum. That has consequences: gonorrhoea is at its highest level in 40 years and syphilis at its highest level in 70 years; rates of smoking among pregnant women have risen for the first time on record; and Victorian diseases, such as scarlet fever, whooping cough, malnutrition and gout, have seen a 52% upturn since 2010, with an increase of over 3,000 hospital admissions per year.

Life expectancies are stalling and, in some places, declining, with the north-south divide as wide as ever in terms of health and productivity. For a number of us in this Chamber, it was the north-south divide that drove us into politics; to see it as wide as ever, and not closing, drives us to come to debates such as this one. This is a welcome opportunity to highlight and discuss public health in County Durham.

Overall, health and wellbeing have improved significantly in County Durham, but it still remains worse than the England average. Although it has improved in the north, the rest of the country has also improved, so the gap remains wide. In addition, large health inequalities still remain across County Durham, especially with regard to breastfeeding, babies born to mothers who smoke, childhood obesity and premature deaths. The impact becomes obvious when we look at life expectancy. As we have heard, a child born today in the most deprived areas of County Durham can expect to live between seven and eight years less than one born in the least deprived areas.

With that in mind, it is concerning and shocking that County Durham is the worst affected local authority in England when it comes to cuts to the public health grant. Current predictions suggest that Durham County Council will lose £18 million this year from its public health grants. To put that into perspective—I will repeat the figures we have already heard, because they are more shocking the more times you hear them—this means County Durham will be receiving an £18 million cut to public health budgets but Surrey County Council will receive £14.4 million extra and Hertfordshire County Council will receive a boost of £12.6 million.

What assessment has the Minister made of this funding disparity between councils in the north and south, and the impact that has on health outcomes? Does she agree with me that where there is need, funding should follow? How will the Minister support Durham County Council in delivering vital public health services to those who need them most?

The current grant for County Durham, with a population of 525,000, is £47.4 million, which equates to £90 per head. Does the Minister believe that this is a substantial amount of funding per person to tackle all the public health issues, as well as look at prevention for smoking, alcohol and drug misuse, obesity and weight management? Does she believe that £90 per head is enough to also fund early years services, nutrition and physical activity programmes and support mental health and wellbeing services?

As has already been mentioned, there is a life expectancy gap between the north and south of England: it is clear that money follows higher life expectancies, rather than the other way around—or, indeed, deprivation—as it used to. In County Durham, women have a healthy life expectancy of 59. That is compared with Hertfordshire, where women have a healthy life expectancy of 66, and Surrey, where it is 68.

[Albert Owen (in the Chair)]

To give time for the Minister, can the hon. Lady finish up, please?

[Mrs Hodgson]

Yes, I will. I ask the Minister: when will the Government agree a future funding settlement for public health? I am under the impression that this has been postponed now until after the leadership contest. Local authorities and public health services need to know where they stand. As my right hon. Friend the Member for North Durham said when he opened the debate, we cannot have County Durham or other local authorities being left behind any longer.

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

It is a great pleasure to serve under your chairmanship, Mr Owen. I thank the right hon. Member for North Durham (Mr Jones) for raising this important issue, and the hon. Members for Sedgefield (Phil Wilson) and for City of Durham (Dr Blackman-Woods) for their contributions.

The Government fully appreciate the importance of protecting and improving the health of the population. We share hon. Members’ commitment to prevention and public health, which this debate has highlighted. The costs, both to individual lives and to the NHS, are simply too great to ignore.

The population in England is growing, ageing and diversifying rapidly. Some 40% of morbidity is preventable, and 60% of 60-year-olds have at least one long-term condition. Helping people to stay well, in work and in their own homes for longer is vital. As hon. Members have highlighted, the gap in healthy life expectancy between the most and least deprived areas of England is approximately 19 years for both sexes. As somebody who was born in Lancashire and represents a Lancashire seat, I see that disparity in my constituency. It is a great motivating factor for me in my role, as it was for my right hon. Friend the Prime Minister when she set her grand challenge of extending a person’s period of healthy, independent and active life by five years by 2035.

However, we will not achieve that by simply adding five extra years at the end of life; as with many things, the earlier we start, the more we stand to gain. Investment in early years and onwards is essential if we want positively to influence future lifestyle choices, prevent disabling conditions and enable people to contribute fully to society. We must continue to focus our efforts on areas such as digital technology and behavioural science so that we can show the public that the healthy choice is the easy choice.

We are doing work—on childhood obesity, smoking, air quality and more—that has the potential to make a real difference to people’s health and wellbeing. The amount of sugar in drinks has been reduced by 11% and average calories per portion have been cut by 6% in response to our soft drinks industry levy. By 2020, the NHS diabetes prevention programme will support 100,000 people at risk of diabetes each year across England. Last year’s ambitious prevention vision statement and the forthcoming prevention Green Paper will enable us to meet the ageing grand challenge and address health inequalities, supporting people to live longer, healthier lives.

We recognise that the funding position for local authorities is extremely challenging and understand the huge efforts that local government has made to focus on securing best value for every pound it spends. The 2015 spending review made available £16 billion of funding for local authorities in England over the five-year period. I remind the House that that is in addition to the money the NHS spends, which is part of the public health offer on prevention and includes our world-leading screening and immunisation programme and the world’s first national diabetes prevention programme.

Today’s debate has highlighted an important issue about the distribution of funding for local authority public health functions. Historically, funding for public health services in the NHS was left to local decision and was not necessarily based on need, which led to wide disparities in the amount of funding dedicated locally to public health services. Before these functions were transferred to local government, we asked the independent Advisory Committee on Resource Allocation to develop a needs-based formula for the distribution of the public health grant. The introduction of that formula meant that some local authorities received more than their target allocation under the ACRA formula and others received funding under target. In 2013-14 and 2014-15, when the overall grant was subject to growth, local authorities’ funding was iterated closer to their target through a mechanism called “pace of change”.

In 2015, ACRA was asked to update the formula to take account of the transfer of responsibility for commissioning health visiting services from NHS England to local authorities. We consulted on this formula and ACRA made recommendations to Government in 2016. I understand that the public health formula is more heavily weighted towards deprivation than either the adult social care formula or the clinical commissioning group formulation.

[Mrs Hodgson]

It is not working.

[Seema Kennedy]

Of course we want evidence. The shadow Minister says from a sedentary position that it is not working. We did an impact assessment in 2015-16 and we are reviewing all the evidence in preparation for the next spending review.

[Phil Wilson]

Just for clarification, did the Minister actually say that the formula is not working?

[Mrs Hodgson]

No; I said that.

Cystic Fibrosis Drugs: Orkambi

Sharon Hodgson Excerpts

Monday 10th June 2019 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hanson, in this very important debate. I thank the hon. Member for Sutton and Cheam (Paul Scully) for opening this debate on behalf of the Petitions Committee and for his excellent opening speech, in which he took many interventions. I thank all hon. Members for their passionate contributions. I counted more than a dozen speeches by Back Benchers, but I lost count, because I was distracted by the mouse that joined us. Given that it has been such a busy day in the main Chamber, this debate has shown how important this issue is to the House, as well as to all our constituents who have signed this important e-petition.

Access to drugs for patients with cystic fibrosis is an issue that is incredibly important to us all. I congratulate, in particular, my hon. Friends the Members for Bristol East (Kerry McCarthy) and for Jarrow (Mr Hepburn), and the hon. Member for Dudley North (Ian Austin) on their tireless campaigning on this issue, along with patients, campaigners and charities, such as the Cystic Fibrosis Trust. I commend the trust for its expert briefings and support to patients and their families over many years.

Finally, I thank the 108,144 people who signed this e-petition, 310 of whom live in my constituency. As has been said, we debated a similar e-petition in March 2018, and there have already been five parliamentary debates about access to such medicines. I hoped, as others did, that by now cystic fibrosis patients would have access to the drugs that they need and deserve. Unfortunately, that has not been the case.

Just over a year ago, on 16 May 2018, in response to a question from my hon. Friend the Member for Erith and Thamesmead (Teresa Pearce), the Prime Minister called for a “speedy resolution” to the crisis. However, the only speedy thing has been the deterioration of the health of cystic fibrosis sufferers while they wait for a resolution of the crisis.

More than 10,000 people in the UK live with cystic fibrosis, and it is thought that around 50% of CF patients could benefit from Orkambi; that is more than 5,000 people. Although that is a lot of people, in NHS terms it is a small cohort. And yet Orkambi is still not available to patients, despite being licensed for use in the UK since 2015.

The UK is currently a world leader in cystic fibrosis outcomes, but that is changing. People with cystic fibrosis are physically sicker than they would be if these medicines were available to them. NHS England continues to make offers to Vertex, including the largest ever financial commitment in its 70-year existence, but that was rejected. Since then, an even better offer has been made, but again Vertex has been unwilling to accept it.

I know that that is frustrating for patients and their families, who have waited years for access to these life-saving drugs. We are all frustrated on their behalf. As my hon. Friend the Member for Colne Valley (Thelma Walker) Valley mentioned, in March it was reported in the news that nearly 8,000 packs of Orkambi had been destroyed because they were past their sell-by date. That would have particularly stung patients and their families. Those drugs were valued by Vertex at £104,000 per patient per year. With my limited maths skills, I reckon that means that more than £60 million of drugs were destroyed by Vertex—drugs that could have been given to patients.

It is an outrage that Vertex would destroy so many packs of a life-saving drug while in a cost dispute with NHS England. So many patients could have benefited from those drugs. It was spiteful of Vertex to watch those drugs go out of date so they would have to be destroyed. In the midst of all that, Vertex reported a 40% rise in its revenues, with net income doubling in the previous quarter. I am sure I am not alone in feeling shocked and angry at that.

By refusing to play fair with NHS England, Vertex is holding lives at ransom, and patients and their families are the ones left suffering. Therefore, I was not surprised by the feature on “Newsnight” last week about parents and families establishing a cystic fibrosis buyers’ club to buy the generic drug Lucaftor from Argentina. The stress and frustration that families face because of Vertex mean that they now feel they have no other option but to take matters into their own hands.

[Laura Smith]

It is great to hear my hon. Friend’s response. It seems perverse to me that the interests of big pharmaceutical companies can hold such enormous sway in this country, to the extent that cystic fibrosis sufferers can be left without their treatment—treatment that has the potential to prolong their lives significantly.

[Mrs Hodgson]

I agree with my hon. Friend. I hope that the Minister will have some ideas about how this drug company can be held to account and not be allowed to continue in this way. I hope the Minister agrees that the situation should never have been allowed to get to this stage.

Lucaftor has the same active ingredients as Orkambi, and the Argentinian pharmaceutical company Gador is offering a price of £23,000 per patient per year, which drops to £18,000 if patients and their families can get together a group of more than 500 patients to purchase Lucaftor as a collective. That is significantly lower than the £104,000 Vertex wants for Orkambi. I say “want” deliberately—it is not the cost, but what Vertex wants. Of course, for many patients in the UK, Lucaftor will still be way too expensive to access, so it is not a feasible alternative at all. That is why NHS England and Vertex need to come to a conclusion that puts cystic fibrosis patients first, and ensures that they have access to the life-saving drugs they need and deserve.

[Kerry McCarthy]

I thank my hon. Friend for all her support on this issue. I agree that the issue with the Argentinian solution is that in a buyers’ club where people have to pay privately, the drugs will still be out of reach for many people. However, the fact that Gador is offering this drug for so much less than Vertex is charging for a similar product means that the NHS could, if it decided to trial the drug, buy it for 4,000 patients who would benefit from Orkambi. Therefore, no one would have to pay for it privately. The NHS could fund it, but at much less than Vertex is asking for. I ask the Minister: why is that not the solution?

[Mrs Hodgson]

I was going to come on to that, but if a point is worth making once, it is worth making twice. I will make it to the Minister as well, so she will have plenty of time to think about it.

As we all agree, patients and their families should not be put in the position—as some are—of having to pay thousands of pounds for their treatment. Family income should not determine who lives and who dies. That is why the NHS was founded—so that all could have access to the same excellent treatment, regardless of means. That was true 70 years ago when the NHS was formed, and it is still true today.

As the hon. Member for Sutton and Cheam pointed out, our NHS is there for us all and should not be held to ransom by a pharmaceutical company, but neither should access be denied because of unfit processes and systems in the NHS. Over the years, as a shadow public health Minister, I have met many patient groups, including those with cystic fibrosis, who are missing out on life-changing medicines because their condition is not rare enough and is therefore not deemed by NICE to be cost-effective. We need an appraisal process that is fit for purpose and that will capture rare diseases such as cystic fibrosis effectively.

Without drugs such as Orkambi, patients and their families are being harmed physically and psychologically. Every day without the drugs that patients need makes their condition worse and threatens their lives. What steps will the Minister take to ensure that patients with rare diseases have access to the medicines that they need and deserve? It is about access not just to Orkambi, but to other precision medications such as Symkevi and the next generation of cystic fibrosis drugs that could help patients who are suffering.

Vertex recently announced the headline results for its fourth cystic fibrosis medicine, a triple combination therapy that could radically transform the lives of nine in 10 people who live with cystic fibrosis in the UK, delivering unprecedented improvements in acute lung health. That is amazing news, but patients fear that they will never be able to access this ground-breaking drug. I urge Vertex to put patients first and consider the real-life impact of this cost dispute on patients and their families.

Vertex and NHS England must come to an agreement urgently, because patients have already waited far too long. If an arrangement cannot be made soon, will the Minister personally step in and pursue the alternatives that my hon. Friend the Member for Bristol East mentioned, such as a Crown use licence or a clinical trial? Cystic fibrosis patients need urgent access now to the drug that they have been denied for three years. It is time the Government considered all alternatives.

--- Later in debate ---

[Seema Kennedy]

I thank the hon. Gentleman for his intervention. As my hon. Friend the Member for Sutton and Cheam said in his opening speech, which was very well made, we recognise the importance of British pharmaceutical companies and that companies invest hugely in developing new drugs. However, as the other examples of drugs for rare diseases that I have given show, it is possible to go through the NICE appraisal process and reach an agreement with NHS England. As one hon. Member who is no longer in their place said, this is an offer for a long-term agreement.

Vertex is an outlier, and I would like to put that on the record.

[Mrs Hodgson]

Will the Minister give way on that point?

[Seema Kennedy]

Yes, and I hope that I will be able to remember the hon. Lady’s question.

[Mrs Hodgson]

At this point I should clarify, for the benefit of the campaigners who I have spoken to about the Crown use licensing option, that it is not an immediate solution from their point of view; I understand that it would take at least a couple of years. If an agreement can be reached, there would be an immediate outcome. That is why the campaign is called Orkambi Now; it is about trying to get the drug now. Although the Crown use licensing option would be an option to consider if nothing else can be found, it would not give the sufferers and their families the drugs as quickly as we would like.

[Seema Kennedy]

As always, the shadow Minister makes an excellent point. Crown use licensing is not something that any Government would consider lightly. It is very rarely used in health. It has probably not been used—my officials will correct me if I am wrong—since the 1970s.

The ideal thing is to get a deal, and deals have been done with other pharmaceutical companies; that is the point I want to make. As I have said, Vertex is an outlier in this regard, but that does not mean that I do not have an obligation to look at other options. I will do that.

Health

Sharon Hodgson Excerpts

Tuesday 14th May 2019 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I am happy to be closing an excellent debate on public health in what is, as we have heard, Mental Health Awareness Week. I thank those who have contributed to the debate: the hon. Members for Fareham (Suella Braverman) and for Bury South (Mr Lewis); the right hon. Member for Chipping Barnet (Theresa Villiers); my hon. Friend the Member for Wolverhampton South West (Eleanor Smith); the hon. Members for Chichester (Gillian Keegan), for Westmorland and Lonsdale (Tim Farron) and for Taunton Deane (Rebecca Pow); my hon. Friend the Member for Birmingham, Edgbaston (Preet Kaur Gill); the hon. Member for Lewes (Maria Caulfield); my hon. Friend the Member for Rotherham (Sarah Champion); the hon. Member for St Ives (Derek Thomas); and my hon. Friend the Member for Stockton South (Dr Williams), whose speech was absolutely excellent and is the only one I am going to highlight—[Interruption.] Yes, there is a little bit of favouritism. I also thank the hon. Member for Redditch (Rachel Maclean), my hon. Friend the Member for Oldham West and Royton (Jim McMahon), the hon. Member for Chelmsford (Vicky Ford), and my hon. Friends the Members for Swansea West (Geraint Davies), for Heywood and Middleton (Liz McInnes), for York Central (Rachael Maskell) and for Bethnal Green and Bow (Rushanara Ali). There were a lot of excellent speeches in among all those.

It has been a passionate debate—with good reason—and I am pleased to see so many Members who are as passionate about public health as I am. Let us be clear: it is not talking down the fabulous work that our NHS does day in, day out, or the amazing doctors, nurses, radiographers, clinicians, porters, catering staff, cleaners—indeed all NHS workers—to say that the health of our nation is at risk because of this Government’s callous and careless cuts to public health services. The public health grant is expected to see a £700 million real-terms reduction from its 2014-15 level. That includes £85 million in the current financial year, at a time when the Government are peddling the phrase “prevention is better than cure”. That phrase means nothing without adequate funding for our public health services.

I therefore ask the Minister, since prevention is a priority for this Government, whether she will commit today to reversing years of public health budget cuts. Public health spending is just a tiny proportion of the overall spend on health in England. It was just 2.8% in 2018-19, and that figure is falling year on year. Because of that, the Association of Directors of Public Health says that reductions in services are now “inevitable”— and that is a direct quote. This is at a time when services are needed more than ever, as we have heard.

Gonorrhoea and syphilis rates are on the rise, rates of smoking among pregnant women have risen for the first time on record, Victorian diseases—scarlet fever, whooping cough, malnutrition and gout—have seen a 52% upturn since 2010, and there has been an increase of more than 3,000 hospital admissions per year: that is all on this Government’s watch. This Government are making our country ill. Local authorities were given the responsibility for public health in 2013, rightly so in my opinion, but without sustainable funding they have buckled under the pressure of austerity. Their ability to maintain and improve the health outcomes of local residents has been jeopardised. Last year, for the first time in over a century, increases in life expectancy stalled, and in some parts of the UK they have even decreased, as we have heard.

The life expectancy gap between women in the most deprived and least deprived areas is 7.4 years. The healthy life expectancy gap between men in the most deprived and least deprived areas is almost two decades. Yes, you heard me right, Mr Speaker—I said two decades. That is 20 years of difference in healthy life. There is a persistent north-south divide in life expectancy and healthy life expectancy, with people residing in southern regions of England on average living longer and with fewer years in poor health than those living further north. As someone from the north, as Members can probably tell, that particularly concerns me.

The Northern Health Science Alliance, or NHSA, set out why that is so important in its “Health for Wealth” report, published last year. I recommend that every Member reads it. Productivity is worse in the north, because health is worse in the north. Improving health in the north of England would therefore lead to substantial economic gains. What will the Minister do to address these regional health inequalities? Obviously, I agree with the notion that prevention is better than cure, but I do not share the Government’s belief that prevention is possible without sustainable funding. If we are to reduce the ever-growing pressure on our NHS, we should therefore be investing in our public health services to ensure that everyone has the opportunity to live a healthy life—[Interruption.] I am pleased that we have been joined by the Secretary of State, and I shall have to try to repeat some of my best lines for him.

Analysis by the British Medical Association shows a continued trend of decreased funding, despite hospital admissions in which obesity, smoking, and alcohol was a factor increasing over a similar time period.

We have an obesity crisis in this country. The UK has one of the worst childhood obesity rates in Europe, but the Government’s childhood obesity plans have failed to seriously tackle this crisis, and with consultations still ongoing we have yet to see any material action by the Government. The UK spends about £6 billion a year on the medical costs of conditions related to being overweight or obese, and a further £10 billion on diabetes, but less than £638 million on obesity prevention programmes. Will the Minister commit to correcting that funding imbalance today?

Smoking remains the No. 1 cause of death in England, yet Action on Smoking and Health, ASH, found that in England from 2014-15 to 2017-18 local authority spending on tobacco control, including stop smoking services, fell by 30%. Furthermore, an annual survey conducted by ASH, commissioned by Cancer Research UK, found that, in 2018, 30 local authorities had no budget for tobacco control activity outside of stop smoking services. Although smoking costs the NHS an estimated £2.5 billion, NICE estimates that for every £1 invested in stop smoking services, £2.37 will be saved on treating smoking-related disease and lost productivity. Will the Minister therefore justify the Government’s reasoning for not investing in stop smoking services?

Alcohol is the leading risk factor for ill health, early mortality and disability among people aged 15 to 49. Even though hospital admissions associated with alcohol have nearly doubled since 2006-07, and have risen tenfold when obesity is also a factor, the budgets for alcohol and obesity services have been cut by more than 10% over the past three years. Does the Minister agree that if there is a need funding should follow? Will she ensure that public health services are funded sufficiently?

Demands on sexual health services have also increased. At a time when sexually transmitted infections such as gonorrhoea and syphilis are on the rise, the Government have cut funding for sexual health services by £55.7 million since 2013-14. I welcome the Government’s commitment to end HIV infections in England by 2030, but that progress risks being undone by those cuts. Sexual health services are essential if we are to end new HIV transmissions in the UK, but clinics report that they have to turn people away because of cuts to services. Does the Minister agree with the assessment by the Terrence Higgins Trust? [Interruption.] If the Minister’s two colleagues will allow her to listen to what I am saying, the trust said that

“sexual health services are at crisis point”.

The Secretary of State may shake his head as much as he likes, but that is not me saying that—it is the Terrence Higgins Trust.

Finally, I would like to state my disappointment and frustration at the fact that there is no future funding settlement for the local authority public health grant after 2019-20. The Minister will know all too well that time is ticking by, so will she set out the Government’s plans for a funding settlement post 2020? We need a settlement that will ensure that people can access the public health services they need so that they can live healthier and longer lives. I hope that after this debate the Minister will see how important that is to our constituencies and local authorities, which are responsible for this area of work. That is why the Opposition are calling on the Government to publish impact assessments on public health spending cuts and stalling life expectancy. I look forward to the Minister’s response. This is only her second or third time at the Dispatch Box—it is the first time we have faced each other across the Dispatch Box—and she is still finding her feet, but she will be keen to make her mark. Now is her chance. I urge her to publish those impact assessments, then do the right thing: properly fund public health now, because people’s lives really do depend on it.

Draft Food and Feed Hygiene and Safety (Miscellaneous Amendments) (EU Exit) Regulations 2019

Sharon Hodgson Excerpts

Monday 13th May 2019 General Committees

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is an honour to serve under your chairmanship this afternoon, Mr Robertson. I want to start by officially welcoming the Minister to her new role. It is the first opportunity I have had to do that and the first time we have faced each other in a debate. I am sure it will not be the last. I look forward to shadowing her and no doubt opposing her when I need to, but I hope that we can work together on all things public health, as I did with her predecessor, to ensure the better health of everyone in the country, regardless of where they live, how much they earn or who they are.

Earlier this year, as we approached the 29 March Brexit deadline, some of us would be in in this room, or one very like it, regularly as SIs were rushed through in haste. As has been said, the Minister’s predecessor and I debated 15 SIs relating to food safety in a matter of weeks. For many reasons I am pleased that we were able to secure a Brexit extension, but in this case I am particularly happy because if we had left on 29 March, some of the minor deficiencies that we are discussing today could have turned major very quickly.

The regulations have not previously been addressed in Brexit preparations, so it is good that we have time to discuss them now. They also deal with recent changes to EU law, which could not have been addressed in earlier instruments. As the Minister said, public safety is paramount. That is why any future changes to regulatory controls after the UK leaves the EU should provide the same, or hopefully an improved, level of consumer protection.

Any changes as a result of the regulations must be effectively communicated to the affected agencies in a timely manner. Will the Minister please tell the Committee whether she has had any further communication with those agencies since March? I am sure that they are awaiting further information from the Government about Brexit, and their business is no doubt hanging in the balance in the meantime. As this is a matter of public safety, changes must be communicated clearly and in a timely manner to ensure that the industry can be in line with current legislation. Will the Minister give assurances that that will not affect the safety or quality of foods available in the UK, now and in the future?

As we have heard, the SI relates to trichinella, which is a pork nematode worm parasite. I am sure that none of us had ever heard about it before, and hope never to need to do so again, or to deal with its effect. The SI also relates to the transitional provisions for official laboratories. The retained EU law regarding specific official controls that apply to trichinella in meat and trichinella testing requirements may not be fully enforceable until the specific inoperabilities are addressed by the SI. Is the Minister confident that the legislation sufficiently addresses the inoperabilities regarding the testing requirements for trichinella, and when does she think that they will be fully enforceable, on passing the SI?

The instrument states that facilities approved by EU member states would in future no longer be automatically approved for food imported from the UK. Does the Minister know what impact that will have on supply and businesses? How long will the process be to approve facilities for food imported from the UK, and will a list of approved facilities be available? The instrument also includes provisions to set minimum charging rates for hygiene controls for fishery products by amending the Fishery Products (Official Controls Charges) (England) Regulations 2007. Will the Minister outline what the charges will be and what impact any new set rates could have?

The explanatory memorandum for the SI states that functions currently undertaken by the European Commission in adopting some implementing regulations rendering applicable the controls on imported food will in future be the responsibility of the Secretary of State. Can the Minister provide information on how decisions on those controls will be decided and managed? What will the arrangements be for collecting data monitoring the effectiveness of the regulations and regularly reporting the findings? What bodies will be able to scrutinise performance and delivery, and what assessment has been made of their capacity to take on that work, as my hon. Friend the Member for Wallasey mentioned?

Finally, what conversations has the Minister had with devolved nations regarding the SI? We do not know for sure exactly when we will leave the EU, but it is best to be prepared, especially when dealing with parasites such as this little worm. That is why the Opposition do not oppose the regulations, but rather express some concerns that I hope the Minister can address.

Pre-eclampsia

Sharon Hodgson Excerpts

Thursday 9th May 2019 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship again, Mr Hollobone. I am sure that happened just earlier this week or maybe it was last week; maybe it is every week.

I thank the hon. Member for North Ayrshire and Arran (Patricia Gibson) for securing this important debate, just ahead of World Pre-Eclampsia Day on 22 May, and for her heartfelt, thoughtful and passionate speech. She is so brave, as has already been said, to do this. I know, and she knows, how hard it is to speak in a debate about something as personal and hurtful as the loss of a baby; nothing can ever be harder. I have the honour of being vice-chair, along with the hon. Lady, of the all-party parliamentary group on baby loss, which we set up. All the Members who set up the group have had the awful experience of baby loss, which makes it such a powerful all-party group. We all take the work it does very seriously and have had some small achievements, thanks to the Government listening to the voices from the group.

Some changes are being made and implemented across the country because of it. I am proud that we are able to use our own tragic experiences of loss to campaign for better care, treatment and diagnosis for future parents, so that hopefully they do not ever have to go through anything like the experience that the hon. Lady has been through. Let us hope that the debate today, which, as the hon. Lady said, is the first debate of its kind, will lead to some future changes that will ensure that even fewer people will have to go through that experience. I was so very sorry to hear the details of the hon. Lady’s own personal experience of pre-eclampsia. I knew that was how she had lost her son, but not the detail. I thank her for sharing her story with us and I am sure that Kenneth would have been very proud of his mum.

I also thank the hon. Members for Paisley and Renfrewshire North (Gavin Newlands) and for Glasgow East (David Linden) for their excellent speeches, and I join everyone in saying how disappointing it is that there are not more Members attending this important debate. Perhaps the debate about acquired brain injury, taking place in the Chamber, has drawn a bigger crowd of available Members. Nevertheless, what we have lacked in quantity we have certainly made up for in quality; this has been an excellent debate so far, and we have yet to hear from the Minister.

As we have heard, pre-eclampsia affects around 6% of pregnancies; that means 1,000 babies a year are stillborn due to this awful condition. That is not good enough; it has to be and it can be reduced, as we have heard. The last triennial audit of maternal deaths in the UK reported that of the 22 deaths from pre-eclampsia, 14 were avoidable. Again, that number can be reduced. Because the symptoms of pre-eclampsia are so similar to the general symptoms of pregnancy, they are often missed and that can be fatal. That is why we are here today: to raise awareness and ensure change.

Women with diabetes, high blood pressure, kidney disease and a body mass index of over 35 are more likely to develop pre-eclampsia. Many instances of these conditions can be prevented with a healthy lifestyle. As the Shadow Minister for Public Health, I cannot miss any opportunity to mention prevention and the cuts to health services of £800 million between 2015 and 2021 under this Government. If public health budgets, which fund services such as obesity services, had not been slashed so vigorously by the Government, the number of women with these conditions would be reduced. Even so, where cases have not been prevented, these women should still be a priority for midwives and healthcare professionals, and offered the tests that exist for pre-eclampsia, and support throughout their pregnancy. The same goes for women with lupus, women over the age of 40, women expecting multiple babies and women who have had pre-eclampsia before.

If we target the women most at risk of developing pre-eclampsia, we can detect the condition early and prevent fatalities. Finding at-risk women is now much easier as tests are available, as we have heard, that can predict with nearly 100% accuracy which mothers are at risk of pre-eclampsia, but unfortunately the tests are not being used to their advantage. The test that is currently the only NICE-approved clinically available diagnostic test for pre-eclampsia in the UK has seen uptake in only a handful of trusts so far, meaning that very few women in the UK have access to those life-saving tests. Will the Minister write to NHS trusts urging them to take up those tests, and advising them of the clinical guidance to do so?

Those tests can improve patient safety through accurate diagnosis upon the suspicion of pre-eclampsia, reduce the number of unnecessary admissions of suspected pre-eclampsia and reduce the direct costs to the system from the array of in-patient monitoring tests that are undertaken on the woman and her foetus. They will also relieve the stress and anxiety felt by expectant mothers that their symptoms are pre-eclampsia. We still do not know the root cause of pre-eclampsia. Does the Minister have any plans to fund research into the causes of pre-eclampsia so that more cases can be prevented each year?

Expectant mothers must also be made aware of pre-eclampsia and the signs and symptoms to look out for. I can remember being told about this terrible condition and every time my legs swelled or I had a urine test I would worry that I would get it. Maybe I was more informed or just a worrier, but I probably did not know enough about pre-eclampsia then. I might have been worrying needlessly; information is always a good thing. The knowledge will also fuel patient-led demand for testing and will, again, help to prevent deaths.

I hope the Minister will be able to assure us that the Department will look at this important issue further in the future, so that no more families have to go through the pain and suffering of losing a child to pre-eclampsia that we have heard about today.