National Health Service

Alan Johnson Excerpts

Wednesday 21st January 2015 Commons Chamber

[Mr Hunt]

If the right hon. Gentleman did such a wonderful job and wants to talk about Mid Staffs, why are patient campaigners so outraged by his comments and feel that he did everything he could to brush those problems under the carpet?

[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

Will the Secretary of State give way?

[Mr Hunt]

I will give way to the former Secretary of State in a moment, but I want to finish—[Interruption.] Exactly. I have read the Francis report and I have acted on it. [Interruption.] I have just listed what we have done: £700 million, 4,700 more nurses and 800 more doctors.

[Mr Hunt]

But the right hon. Gentleman’s constituency has more doctors and more nurses who are seeing more people every year within four hours and doing 4,000 more operations every year. That is working for his constituents, but there is pressure out there and we need to support people through a difficult winter.

The right hon. Gentleman mentions stories that are, of course, very tragic, but never once has he brought up stories about the problems happening in Wales. Too often, we get the impression that, for Labour Members, poor care under a Labour Government—whether in Wales today or Mid Staffs previously—does not matter as much as poor care under this Government when they can make a political point. A party that really cared about the NHS would be as outraged about problems when they are in power as they are when in opposition. For this Government, poor care is poor care, and we will deal with it wherever and whenever it happens.

[Alan Johnson]

Does the Secretary of State remember the words of the Prime Minister when he stood at the Dispatch Box and presented the report from Stafford? He said that what happened at Stafford was not the fault of any previous Secretary of State, including my right hon. Friend the Member for Leigh (Andy Burnham). The Prime Minister was a statesman on that occasion; it is a shame that the statesmanship has slipped since.

[Mr Hunt]

I have a great deal of respect for the former Secretary of State, but if he had followed the debates on Mid Staffs in this Chamber he would know that my disagreement with the shadow Health Secretary is over the reaction to Stafford and whether we will learn from those mistakes. When I have made speeches talking about the problems of poor care in the NHS today, he goes straight out to the TV studios and says that that is running down the NHS. That is not acceptable when we are taking difficult decisions to turn round failing hospitals and face up to problems in exactly the way suggested by the Francis inquiry.

--- Later in debate ---

[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

Thank you, Madam Deputy Speaker. I will do my best to comply with your instructions.

As the Secretary of State was talking, my mind went back to the “responsible opposition” of the right hon. Member for South Cambridgeshire (Mr Lansley). I remember the efforts that went on for more than 40 years around Manchester to tackle the appalling level of infant mortality by reconfiguring maternity services. As the local newspapers said, that was stopped at every stage by politicians defending bricks and mortar. In the end, when that change went through, it was the Opposition who tried to reopen the issue. Before my noble Friend Lord Ara Darzi became a Minister, he did a very important review on London, where there were more single-handed GP practices than anywhere else in the country post-Shipman, and people attending A and E was a bigger problem than anywhere else. Lord Darzi put forward sensible proposals, which were agreed by clinicians and the NHS in London, but the right hon. Member for South Cambridgeshire opposed them. He issued an unfortunate press release about polyclinics—unfortunately, he spelt it “polly”, but it was not a clinic for parrots. I said to him, “Don’t adopt a policy that you can’t spell.” There are numerous examples of the previous Opposition doing that.

I bet I am not the only one in this House—I bet there are Members in all parts of the House—who rues the day when the right hon. Member for South Cambridgeshire got his hands on the NHS. His ideas for what to do, which culminated in the top-down reorganisation, were not new—I remember them from my first day as Health Secretary. He is not a bad man who hates the NHS, by the way. In many ways, he has great affection for the NHS, but he got things totally wrong. He slung across his draft Bill on what the NHS would look like after his top-down reorganisation. I read it that evening and it was horrendous.

The Government have done two things to erode confidence in politics in this country. The first is the Liberal Democrats’ conversion from opposing tuition fees to the extent that they wished to abolish them to supporting tuition fees to the extent that they agreed to treble them. The second is the Conservatives’ conversion from a pledge that there would be no top-down reorganisation of the NHS to the implementation of a top-down reorganisation so huge that, in the words of the previous NHS chief executive,

“you can see it from space”.

That is a vivid but not inaccurate description of a reorganisation that closed 170 organisations, created 240 new ones, made 10,000 staff redundant and re-employed 2,200 of them.

[Dr Julian Huppert (Cambridge) (LD)]

I will not highlight the right hon. Gentleman’s role in tripling tuition fees. The shadow Secretary of State said that, when he came into office—this is part of his defence— he got rid of the pro-privatisation agenda that he inherited. Who does the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) believe the shadow Secretary of State was criticising in that comment?

--- Later in debate ---

[Alan Johnson]

I do not understand the hon. Gentleman’s point about my role in trebling tuition fees. I certainly was the higher education Minister who introduced tuition fees, against fierce opposition. I supported them and made the arguments—all the arguments we now hear from Liberal Democrats—against the opposition of the Conservative party.

In terms of privatisation, we did introduce independent treatment centres. At every stage, we asked the local NHS, “Have you got the capacity to get these waiting lists down? Have you got the capacity to carry out the elective surgery without denuding emergency services?” which happened all the time. Hon. Members will be surprised how many found that capacity when we said, “Okay, we’ll introduce an independent treatment centre.” Suddenly, consultants stopped going to the golf course and taking Saturdays off. They got the waiting times down. In places that did not have capacity, we introduced independent treatment centres. The role of the NHS is to treat patients, and I am very proud of the record that we and my successor, my right hon. Friend the Member for Leigh (Andy Burnham), stood on in 2010.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

Does the right hon. Gentleman agree that, since the late 1980s, every Secretary of State from both political parties, with the exception of the right hon. Member for Holborn and St Pancras (Frank Dobson), accepted that one could raise the quality of patient care by introducing competition and choice of provider in the system? The right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) quite sensibly pursued that policy, as did Alan Milburn, with particular vigour, and the shadow Secretary of State when he was in office. Will the right hon. Gentleman try to encourage his successor not to go back on that, because the health service is now much better at coping with the problems of changing demand than it was 20 or 30 years ago?

[Alan Johnson]

The right hon. and learned Gentleman knows, because we have debated this before—I will come on to some of the history—that the big difference between what he and other Governments did during the 1980s and what we did is the single tariff. They competed on price. We had a single tariff that meant that, wherever that operation took place, it was paid for at the same rate.

With that top-down reorganisation that we could see from space, all the Conservative party’s efforts to convince the public that they could be trusted with the stewardship of the NHS were thrown into disarray at a stroke. The fact that the NHS tops the list of public concerns as we approach a general election can be traced to that self-inflicted wound.

The Conservative party leader’s efforts to detoxify the Tory brand vis-à-vis the NHS could be described as an attempt to return to the consensus that existed prior to the 1980s. The great historian of the NHS, Rudolf Klein, says that following its contentious birth there followed 35 years when the NHS was “cocooned in consensus”. That changed in 1982, when the Thatcher Government’s internal think-tank, the Central Policy Review Staff, produced a paper with the option of replacing the NHS, a tax-financed health service, with a system of private insurance. This option—the right hon. and learned Member for Rushcliffe (Mr Clarke) will probably remember this—was, incidentally, presented to Ministers not by the Secretary of State for Health but by the Chancellor of the Exchequer. It was defeated thanks to the efforts of Norman—now Lord—Fowler, but it expressed for the first time the idea that a tax-funded NHS was wrong and broke that 35-year consensus.

From that moment, through weird and wonderful ideas, right up to 2005 when Conservatives Members stood on the platform of the ridiculous patient passport, their policy has been about taking money out of the NHS and changing the very principles of the service. I could not describe it better—I think there would be agreement on this—than the great American clinician and health care expert, Donald Berwick, who I believe the Secretary of State has used during his time in office as an adviser. He describes the NHS as

“one of the truly astounding endeavours of modern times”

and, in a wonderful phrase, as

“a towering bridge - between the rhetoric of justice and the fact of justice.”

This ideological battle is not over. Indeed, it has just been joined by the ultra-Thatcherite leader of UKIP. The hon. Member for St Ives (Andrew George) is no longer in his place, but he was perhaps right in thinking that we should get back to a consensus on the NHS.

We could raise relevant arguments about many aspects of the NHS. Indeed, my colleagues in Hull and I are talking to the Secretary of State about some issues central to Hull. However, in this speech I do not want to talk about clinical health or the successes of the NHS. I want to talk about one of its failures. At the tenth anniversary of the NHS in 1958, there was a debate in this Chamber. Nye Bevan, the great architect of the NHS who was mentioned earlier, stood up and said what a great success it had been, but that the failure had been mental health. He spoke, using the language of the time, of the disgraceful conditions in our mental hospitals. Of course, there has been a huge improvement since 1958, but it remains a fact that mental health is a poor relation of the NHS, and children and adolescent mental health is a poor relation of that poor relation.

I would like to cite three awful statistics published by the Office for National Statistics. First, 10% of children between the ages of five and 16—or to put it another way, three in every class—experience mental health problems. The second disgraceful statistic is that that figure rises to 60% when applied to children in care. The final disgraceful statistic is that 95% of imprisoned young offenders have a mental health disorder. Many of those young offenders should not be in prison at all. I have raised the case on the Floor of the House of my constituent, Vince Morgan, a young man with a severe psychotic illness who committed suicide in a prison cell having been failed by every single organisation and authority that was meant to help him. Section 136 of the Mental Health Act 1983 is still being used to incarcerate children, mainly as a result of the failure to provide sufficient in-patient tier 4 child and adolescent mental health services facilities.

Forgive me for being parochial, but this is a crucial issue in our area. In Hull and East Riding, we were served well by an in-patient unit called West End for 20 years. When NHS England assumed responsibility for tier 4 services as a result of the changes from the reorganisation—all other tiers being the responsibility of the local clinical commissioning groups—it changed the specifications for tier 4 units, saying that they had to be open seven days a week, 24 hours a day. There was no consultation with anyone. This was done in March 2013. As West End was open only from Monday to Friday, with children spending the weekends at home—a regular feature of CAMHS treatment—the unit was closed. The option of extending the provision, so that it was a seven-day service, was never offered. Parents of children who had benefited from this important part of the NHS had no input whatever in a decision made by a huge quango that had no local accountability and no local presence. So much for the glib slogan, “No decision about me without me”.

I raised this issue in the Chamber on 23 October. The Minister of State, Department of Health, the right hon. Member for North Norfolk (Norman Lamb), who is in his place, gave me a sympathetic response. I am convinced that he cares deeply about the problems of mental health, but he appears to be entirely powerless to do anything about them. Since then, there has been a review of tier 4 services by NHS England, which, as the Health Committee has said:

“does not provide a conclusive answer on the reasons for the current problems, nor on whether there are sufficient beds”.

In addition, that Health Committee report, published in November, pointed out that NHS England had

“presided over a system which has resulted in children being sent hundreds of miles to access care.”

There has been no resolution on this issue in Hull and East Riding, or in other parts of the country, such as Devon and Cornwall. We have a foundation trust provider that recognises the problem and has identified a site for a new seven-day in-patient service, but the commissioner at NHS England has yet to commission. The CCGs are powerless. The acute trust often has to open its adult wards to children.

Let me tell the House what this means to the victims of such failure—to the children who were once so well served by the West End unit. Maisie Shaw is a 13-year-old who has had serious mental health problems since her father died two years ago. Her mother, Sally, is a teacher. Clearly, children need to be close to their family when they are undergoing treatment. Family involvement is a crucial aspect of their recovery. In December, Maisie took an overdose after breaking into a locked medication box at her home in Hessle. As it was a Saturday, there were no CAMHS staff on duty and, of course, no in-patient facility. She was taken to Hull royal infirmary on Saturday and cared for in a locked ward at the maternity hospital, with a 24-hour guard until Monday morning. She was sent to Stafford, which is almost 200 miles away, and then to Sheffield, which involves a round-trip of 120 miles by her family to visit her. As part of her treatment, she will be home at weekends, but when her mother asked what help would be available for this very disturbed child if there was an emergency, she was told to ring 999.

The subject of my debate in October 2013 was Beth Hopper, who is now 15. Beth’s mother, Kathy, is a staff nurse for the NHS. Beth is an extremely intelligent girl who has, according to her school, huge academic potential. She suffered a severe mental breakdown at the age of 11 and spent nine months at the West End unit, which opened at weekends specifically to tend to her needs. Kathy believes that the unit saved her daughter’s life. Since West End closed, Beth has been sent away 19 times. She has been to Cheadle, 103 miles away. She has been to Liverpool. She has been to Warrington. She has been Nottingham. She has been Widnes. Of course, while there is no argument that to travel further for more expert care is a factor in physical health, it is rarely the case with mental health, particularly when the patient is a child. Indeed, Maisie and Beth’s clinicians in Hull often have to travel to care for her in these distant locations, thus adding to the cost of that care. It is no exaggeration to say that the condition of Beth and Maisie is actually being made worse by this treatment. It is truly scandalous.

So that Beth’s voice is heard in this debate, I will read out a letter that she sent to her mother the other week. She wrote this:

“I really just don’t know what to do or what I want, or what is best for me anymore.”

Forgive her grammar.

“I aren’t happy here. I am happy at home, but I am scared that things might go like they were before. I just want normality. I want to have the chance to be a kid for once, before it is too late. I feel as though nobody is listening to me. I am so isolated here I am scared to join the groups and don’t want to make new friends anyway. I want my old friends, who I miss.”

We need to hear these children’s voices.

[Sir Gerald Kaufman (Manchester, Gorton) (Lab)]

I am listening with sympathy and concern to the case histories that my right hon. Friend is describing. He might be surprised to learn that a constituent of mine with mental health problems was sent to Hull, without any consultation with his family.

[Alan Johnson]

It could not have been a CAMHS service, because we have no tier 4 service available in Hull.

I have cited two long-standing cases from my average-sized constituency, but I have recently heard about another case—that of Jordan Hatfield, a 15-year-old who, last May, took 45 paracetamol tablets in an attempt to end her own life. She spent six days on a medical ward and has been in Cheadle for the past week. Her mother does not drive and has small children, so it is impossible for her to visit. My colleagues in east and north Hull, and across the East Riding, will have other examples, because, as the Select Committee and NHS England, in its obscure way, pointed out, there is a lack of services in this huge swathe of eastern England.

On the wider question of mental health, we will not achieve parity of esteem by cutting funding. NHS trusts providing mental health care have lost £250 million of funding since 2012—the first fall in a decade. In addition, as my right hon. Friend the shadow Secretary of State pointed out, two thirds of local authorities have reduced their CAMHS budgets since 2010, while more than three quarters of adults who access mental health services had a diagnosable disorder before they were 18, yet only 6% of the decreasing mental health budget is spent on under-18s.

The report of the taskforce on mental health in society, commissioned by my right hon. Friend the Leader of the Opposition, and published on Monday, has much to recommend it, particularly the right to mental health treatment in the NHS constitution; expansion of the enormously successfully IAPT—improving access to psychological treatment—programme; and the introduction of waiting-time standards for access to CAMHS. These are good ideas, and they need to be put into practice, regardless of which parties are in government. However, somebody needs to get a grip of this issue now. We cannot go on letting our children down in this horrendous way.