NHS Long-Term Plan
Alex Chalk Excerpts(6 years, 5 months ago)
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Alex Chalk (Cheltenham) (Con)
I warmly welcome this enormous funding boost, which is far in excess of that proposed by any Opposition party. Does my right hon. Friend agree that local trusts should consider using these further resources to help to attract and retain additional doctors in tough-to-recruit fields such as emergency medicine, to support and extend A&E in hospitals such as Cheltenham General Hospital?
Mr Hunt
Of course I agree with that. My hon. Friend campaigns extremely vigorously on behalf of his own hospital in Cheltenham. Recruitment will be one of our top priorities. One way we want to tackle that is very simply by giving hope to people in the NHS and to people thinking of going into medicine that there is a long-term plan that has the support of the NHS, and which is at one remove from the party politics that we always get around the NHS. I think that is something doctors and nurses overwhelmingly want.
Acquired Brain Injury
Alex Chalk Excerpts(6 years, 5 months ago)
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Steve Brine
I thank my hon. Friend. This is the first time I have been at the Dispatch Box since Baroness Jowell passed away. As I said during the debate when she was sitting in the Under Gallery with her lovely family, I did not know her well but the one time I met her I was left in no doubt about her determination on this subject. It is great that we are able to do so much. I pass on my condolences to Jess, her daughter, whom I have got to know a little, and her family. The trauma of the immediate is horrible and it goes on for a long time. Our thoughts are with them. I thank my hon. Friend for what she has said. We will do well by Baroness Jowell, especially through the money that we will put into research to try to instigate new research projects, which have traditionally been thin on the ground in this area. We are hoping to stimulate the research market.
ABI can have a devastating impact on our constituents’ lives; even minor head injuries can cause short-term impairment. Those surviving more severe injuries are likely to have complex long-term problems affecting their cognitive and functional ability, personality, close relationships and ability to return to any form of independent life.
Steve Brine
I thank the hon. Lady for that point, which I shall come to. There are other Ministers on the Bench with me, including from the Department for Work and Pensions, because I wanted them to hear other parts of this debate. The hon. Lady’s point is well made.
Alex Chalk
The Minister rightly listed a number of impacts from traumatic brain injury. Does he agree that one of those can be an increasing propensity to commit criminal offences? We are starting to wake up to the fact that a number of people in custody have sustained precisely that injury. That should be a focus for preventive work in future.
Steve Brine
I thank my hon. Friend, who has professional experience of the criminal justice system. I shall come to his point in a moment, but I thank him for putting it on the record. Sometimes it is a difficult subject to talk about, but it is very relevant.
NHS Outsourcing and Privatisation
Alex Chalk Excerpts(6 years, 6 months ago)
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Mr Hunt
No, I do not think it acceptable at all, but I would ask the hon. Lady to bear it in mind that we have 2,000 more paramedics than we did in 2010 and that we have invested in a huge amount of capital equipment for the ambulance services. Of course we need to do more, but, when she talks about A&E, she should recognise the achievements of many hospitals, including her own. Every day across the NHS—even over this difficult winter—2,500 more people are seen within four hours than were in 2010.
Labour seems to think that quality problems in the NHS started in 2010. I should point out that because of what we have done to deal with the problems of Mid Staffs, which happened on Labour’s watch, including through the new Care Quality Commission regime, 2.1 million more patients every year benefit from good or outstanding hospitals than did five years ago. A couple of weeks ago for the first time the majority of hospitals in the NHS were good or outstanding, which is a huge step forward and a huge tribute to NHS staff. That might be just one reason the Commonwealth Fund last year said that the NHS was the best healthcare system in the world. When Labour was in office, it was not even the best in Europe.
There is another reason to oppose the motion. It has nothing to do with health policy, but is a much bigger point of principle. After more than five years in this role, the one thing I have learned is that good policy can be made only through frank and open discussion between Ministers and officials. It will not surprise the House to know that Ministers are human, we make multiple mistakes—not me of course—and it is critical that the Secretary of State in charge of the largest health system in the world can get honest, high-quality advice, but the motion would fundamentally undermine that.
This is not a party political point. Many Labour Members have benefitted from such advice, and all of us would want Ministers of any party in power to benefit from such advice, regardless of whether we support the Government, yet the motion asks us to release not just that written advice from officials, which would have an enormous chilling effect, but notes of confidential discussions between Ministers and officials. In short, as my right hon. Friend the Member for Aylesbury (Mr Lidington) said only last week, it would undermine the safe space within which Ministers and civil servants consider all the options and weigh up the best approach. Officials must be able to give advice to Ministers in confidence. The candour of all involved would be seriously affected if there were any fear of those discussions being disclosed.
No Government of any party have ever operated in an environment where advice is sought one week and made public the next. Let us look back to what Andy Burnham said in 2007 when he as a Minister was asked to release information. His words were:
“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1191.]
Far from increasing the accountability of the Executive to the legislature, releasing such information would risk weakening it, as more and more discussions would end up taking place informally with no minutes taken at all.
Alex Chalk (Cheltenham) (Con)
Does my right hon. Friend agree that it would be completely inconsistent with the Freedom of Information Act—passed, by the way, by a Labour Government—which deliberately carved out an exemption for precisely these sorts of communications? It would be very odd—in fact, completely counterproductive—to turn that on its head.
Mr Hunt
My hon. Friend speaks extremely wisely. He is right: it would fundamentally weaken the ability of the Executive—which the Freedom of Information Act tried to protect—to make considered, thoughtful and wise decisions. Ultimately, that would put at risk the credibility of our democracy itself.
I think it fair to say that, despite my many faults as Health Secretary, I have pursued transparency in the NHS with greater vigour than has been the case previously. I passionately believe that in this House we must be accountable for the outcomes of all the decisions that we make, but all of us are mortal—all of us make mistakes—so if accountability is the watchword after a decision is made, thoughtfulness must be the watchword before it is made. Any measures that affect the honesty and frankness of the advice that Ministers receive would fundamentally reduce that thoughtfulness and reduce the effectiveness of our Government for the people whom they serve.
For those reasons—as well as because of all the ridiculous myths about the millions and privatisation—I have absolutely no hesitation in asking my right hon. and hon. Friends to vigorously and thoroughly oppose the motion.
Alex Chalk (Cheltenham) (Con)
The allegation of privatisation of the NHS is wholly misconceived. It is a reheated and debunked myth that irresponsible elements have been trotting out for decades, and repeating it does not make it any more true. NHS outsourcing to private providers is being weaponised in a way that involves dressing it up as a threat to the NHS’s guiding principle that treatment should be provided free at the point of use and regardless of ability to pay. That is what people understand when the expression “privatisation” is used, but the reality is that nothing could be further from the truth.
That principle is fundamental, inviolable and enduring. It is all those things because it reflects so much about the kind of country we are and want to continue to be. It is the principle that says that when a member of the public is rushed into hospital needing emergency care, we take pride in the fact that the ability to pay is irrelevant. NHS staff are interested in vital signs, not pound signs. There is no appetite in this country for the Americanisation of British healthcare. Even if there were, I could never support it, my colleagues could never support it and the Government could never support it. That is why it is so important that we make that position crystal clear.
On the issue of outsourcing, we must not rewrite history. As moderate members of the Opposition concede, certain services have been provided independently since the NHS’s inception 70 years ago. Most GP practices are private partnerships; the GPs are not NHS employees. The same goes for dentists and pharmacists. Equally, the NHS has long-established partnerships for the delivery of clinical services such as radiology and pathology, and for non-clinical services such as car parking and the management of buildings and the estate. To give an everyday example, the NHS sources some of its bandages from Elastoplast. That is common sense; it would be daft if public money was diverted from frontline patient care in order to research and reinvent something that was already widely available.
That is why certain members of the Labour party have slammed this kind of argument as scaremongering. Lord Darzi, a former Health Minister, has been highly critical. In 2017, the shadow Secretary of State said on the “Today” programme that there may well be examples
“where in order to increase capacity you need to use the private sector”,
so this argument is completely misconceived. In 2009, Andy Burnham admitted that the private sector could benefit the NHS. As Labour’s Health Secretary, he said:
“the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”—[Official Report, 15 May 2007; Vol. 460, c. 250WH.]
Helen Whately
My hon. Friend is making the point extremely well that there is complete inconsistency in Labour’s argument on this point. Which of the various parts of NHS services that are provided by independent sector providers is Labour against?
Alex Chalk
My hon. Friend is absolutely right. I shall give three brief examples from my own constituency. First, Cobalt is a Cheltenham-based medical charity that is leading the way in diagnostic imaging. It provides funding for research, assists with training for healthcare professionals and provided the UK’s first high-field open MRI scanner. Is the Labour party now suggesting that that should be ditched—that we should axe that fantastic facility in my constituency?
Secondly, the Sue Ryder hospice at Leckhampton Court is part-funded by the NHS and part-funded by charitable donations; again, is that for the axe under Labour? Thirdly, what about Macmillan and its nurses? It is a fantastic organisation, yet we have the extraordinary situation in which the Labour party says, “Macmillan is all right, but another provider is not.” What is the logic of the Labour position? What about Mencap? The list goes on and on.
Let me deal briefly with the second part of Labour’s motion, whereby it wants to ensure that all communications between Ministers and their officials are revealed. The reason why that is so bogus was explained clearly by the former senior Labour Secretary of State Jack Straw in a statement that was quoted with approval in the Chilcot committee’s report. He said that meetings in Cabinet
“must be fearless. Ministers must have the confidence to challenge each other in private. They must ensure that decisions have been properly thought through, sounding out all possibilities before committing themselves to a course of action…They must not be deflected from expressing dissent”.
What about advice given by officials in the form of memorandums and so on? What would Labour Members say to those officials about a motion that might result in the making public of the advice of professional civil servants—people who, of course, can never answer back themselves—that they thought was given to Ministers in confidence? As I have already indicated, it would also be completely inconsistent with the Freedom of Information Act 2000, which was introduced by a Labour Government. On both bases, the motion is misconceived, and I shall have no hesitation in voting against it.
Oral Answers to Questions
Alex Chalk Excerpts(6 years, 6 months ago)
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Stephen Barclay
My right hon. Friend is absolutely right to signpost this as one of a suite of ways to increase the number of nurses in the profession. As he alludes to, there will be 5,000 nursing apprenticeships this year, and we are expanding the programme, with 7,500 starting next year.
Alex Chalk (Cheltenham) (Con)
This weekend, I had to take a poorly member of my family to Cheltenham General Hospital, and the skill, concern and good humour of the emergency nurse practitioners were fantastic. Will my hon. Friend join me in paying tribute to Cheltenham’s emergency nurse practitioners? Does he agree that we should be doing everything possible, through their pay scales, to reward and retain them?
Stephen Barclay
I am very happy to join my hon. Friend in paying tribute to the nurses at Cheltenham, and elsewhere, for the work they do. As he says, that is exactly why this Government, with the support of the Treasury, have backed nurses with a big pay rise in the “Agenda for Change” programme.
Privatisation of NHS Services
Alex Chalk Excerpts(6 years, 7 months ago)
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Alex Chalk (Cheltenham) (Con)
It is a pleasure to serve under your chairmanship, Mr Hosie, and to say a few words in this important debate about healthcare. Only this morning I had the pleasure of visiting Charlton Lane Hospital in my constituency. It treats people with functional mental health problems and dementia. It was striking to see so many dedicated nursing staff who work in such a challenging field, but show such consistent humanity and dedication.
NHS outsourcing to private providers is a sensitive topic, but that is essentially because it has been dressed up as a threat to the NHS’s guiding principle—namely that treatment should be provided free at the point of use and regardless of ability to pay. Nothing could be further from the truth, however. That principle is fundamental, inviolable and enduring. It is all those things because it reflects so much about the kind of country we are and want to continue to be.
This point has already been powerfully made by my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), but it bears repetition. When a member of the public is rushed into hospital needing emergency care, we take pride in the fact that the ability to pay is irrelevant. NHS staff are interested in vital signs, not pound signs. That is why it was no accident that the NHS featured so heavily in the stunning opening ceremony for the London Olympics in 2012. It did so because it reflects our nation’s values. While it is perfectly legitimate to have a debate about the precise mechanics and arithmetic of how to deliver the principle of providing care free at the point of need, it would be wholly wrong to pretend that the principle itself is in play, because it is not. There is simply no appetite for the Americanisation of British healthcare. Even if there were, I could never support it, and I am entirely confident that my colleagues on the Government Benches could never support it either. It is vital that we do not conflate the word “privatisation” with Americanisation or fragmentation. It is neither of those things.
Dr Whitford
What is the hon. Gentleman’s view of patients who are being asked to provide co-payments of more than £800 to have a second eye cataract surgery or to pay for their second hearing aid? That has been creeping into NHS England. Patients are being asked to pay for more and more items.
Alex Chalk
I am grateful to the hon. Lady. I respect her past record and her contributions to the House. There is an ongoing debate among clinicians—no doubt colleagues of hers—about what the NHS should cover. Most of the clinicians I speak to would welcome a more open, non-partisan and grown-up debate about the full extent of the NHS, but the guiding principle should not be confused. Whatever it is that the NHS can provide, the core principle is that it will provide it to individuals in our country regardless of their personal circumstances. I am at pains to emphasise that, because from listening to some of the contributions of Opposition Members—no doubt made entirely sincerely, but made none the less—one could be confused into thinking that that principle was under attack. It is not, and it never will be.
The debate is about the delivery of a common goal. Many take the view, with some justification, that we should be open to solutions that deliver that goal most effectively for patients. Last year, the respected and politically independent King’s Fund wrote in its report:
“Provided that patients receive care that is timely and free at the point of use, our view is that the provider of a service is less important than the quality and efficiency of the care they deliver.”
When debating this important question, we should not rewrite history. As the hon. Member for Ealing North (Stephen Pound) has conceded, it is a fact that certain services have been provided independently since the NHS’s inception 70 years ago. Most GP practices are private partnerships; the GPs are not NHS employees. Equally, the NHS has long-established partnerships for the delivery of clinical services such as radiology and pathology, and non-clinical services such as car parking and the management of buildings and the estate. To give an everyday example, the NHS sources some of its bandages from Elastoplast. That is common sense. It would be daft if public money was diverted away from frontline patient care to research and reinvent something that was already widely available. It would be just as daft if the NHS had to do the same for its water coolers or hand sanitisers.
As the King’s Fund put it in its 2017 report:
“These are not new developments. Both the Blair and Brown governments used private providers to increase patient choice and competition as part of their reform programme, and additional capacity provided by the private sector played a role in improving patients’ access to hospital treatment.”
Throughout Europe there are healthcare systems that offer high-quality care, free at the point of use, and make use of far greater numbers of private providers than the UK.
I want to say a few words about the impact on my constituents in Cheltenham. I will give three brief examples. First, Cobalt is a Cheltenham-based medical charity that is leading the way in diagnostic imaging. It provides funding for research, including into cancer and dementia, which it does as part of a research partnership with the 2gether NHS Foundation Trust. It assists with training for healthcare professionals, and it even provided the UK’s first high-field open MRI scanner, which is designed for claustrophobic and larger patients. Are we seriously suggesting that is an affront to patient care in Cheltenham? Not a bit of it. Are we seriously suggesting that getting rid of it would be a good idea? Emphatically no.
Secondly, we have the Sue Ryder hospice at Leckhampton Court, which is a 16-bed hospice that delivers truly excellent care in the Gloucestershire countryside. It also provides hospice-at-home services. It also supports, as I know, family, carers and close friends. It is part-funded by the NHS and by charitable donations. It shows astonishing compassion, but also creativity and innovation in how it delivers care. The third example is Macmillan and its nurses. I need say no more about it—it is a fantastic organisation. To suggest that these independent providers and charities are somehow not good for patient care is to stretch a political principle beyond breaking point.
We also need to slay the myth—there was just a glimmer of it today, but it was not really developed—that somehow different types of providers are held to different standards. All providers are held to the same standards and given rigorous Ofsted-style inspections and ratings by the Care Quality Commission. For my constituents in Cheltenham, I want to see resources allocated as effectively as possible to free up resources for facilities such as A&E at Cheltenham General Hospital, which can only be delivered there. There is growing demand for A&E in Cheltenham, and the service needs to be 24/7.
It is right to say, however, that there are some legitimate concerns that can be properly addressed. The experience of Carillion has laid bare the chaos that can be caused when private providers take on significant contracts and then fail to deliver. We have to recognise that the consequences of failure in health services would not simply be an unfinished construction project, important though that is, but could be a decline in the quality of patient care. I mention that only because community services are disproportionately served by independent providers, but let us keep this in context. Based on a survey of 70% of CCGs in 2015, Monitor published analysis in its report, “Commissioning Better Community Services for NHS Patients”, showing that independent providers were responsible for just 7% of contracts. We should be vigilant, not dogmatic and quasi-religious in our approach. The NHS as a whole must ensure that no contract ever becomes too big to fail and that contingencies are always in place to cater for such an eventuality.
Kevin Hollinrake
My hon. Friend is making a very fine speech. He mentioned the failure of Carillion. There are many lessons from that and many reasons behind the failure. One is that Carillion worked on wafer-thin margins in its contracts, which illustrates that the taxpayer gets very good value for money because of the competitive nature of the bidding process.
Alex Chalk
My hon. Friend is absolutely right. That is the point that I wanted to make. Where we can have a private provider that provides treatment efficiently and effectively, freeing up resources to go elsewhere on the frontline, that is fine, but we have to be extremely vigilant to ensure that when we enter into such a contract, it is not set up to fail. Were it to do so, that would resonate for patient care rather than simply being about a building waiting to be constructed. We must ensure that the principle is applied responsibly and intelligently, as I am sure it will be.
I want to see the best possible care for my constituents, and I know that every single person in this room wishes the same. We all wish to see the NHS free at the point of need. I want to see precious public resources go as far as possible to honour the founding principle and drive it forward. With careful scrutiny and sensible limits, charities and independent providers can play a part in a joint endeavour.
Cyber-bullying: Young People’s Mental Health
Alex Chalk Excerpts(6 years, 7 months ago)
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Alex Chalk (Cheltenham) (Con)
I am delighted to be able to lead this debate, even at this comparatively late hour, about the effect of cyber-bullying on young people’s mental health. This important debate arises out of a cross-party inquiry that I set up in Parliament to look into this issue and which published its report earlier this year. It took evidence from over 1,000 young people and was supported by the excellent charities the Children’s Society and YoungMinds, which showed conspicuous dedication, skill and professionalism. Without them, this important work could not have been done. I am very grateful too to colleagues from across the House—Conservative, Labour and Scottish National party colleagues—for their valuable input, as well as to the many witnesses who gave evidence.
Just to provide a bit of context, this all really arises out of my experiences as a constituency MP. I visited schools in Cheltenham, from Bournside to All Saints’, and I spoke to parents and agencies such as Teens in Crisis, which has been commissioned by some schools to provide regular support. I became deeply struck—I fancy that other hon. Members in this House have as well—by the apparent increase in child and adolescent mental health problems. To me at any rate, it does not feel so much like a temporary spike, but more like a lasting surge. I want to say a bit about that before turning to the specific issue of cyber-bullying and what our inquiry found.
Mr William Wragg (Hazel Grove) (Con)
As a member of that panel, I want to place on record my thanks to my hon. Friend, who has shown such leadership in this area. I also pay tribute to the young people who gave evidence to the panel. That evidence was deeply moving at times and it was a real credit to them given what they have been through.
Alex Chalk
I am very grateful to my hon. Friend for that intervention. He should not be modest about his contribution, which was absolutely fantastic and gratefully received.
To say a little more about the context, recent research by the Prince’s Trust suggested that young people’s wellbeing has declined over the last 12 months and is now at its lowest level since the study was first commissioned in 2009. What is interesting as well is that this is not just a British phenomenon. A recent article by NBC in the United States, citing research from Johns Hopkins University, referred to an acute mental health crisis happening among members of the youngest generation of Americans, with, as the article put it,
“critical implications for the country’s future.”
Similar data is emerging from France and Germany.
Much of the debate in this House has been about a cure—about how we go about fixing the problems after they have emerged. We have debated achieving parity of esteem, funding child and adolescent mental health service beds closer to home, and so on. All that is vitally important, of course, but equal attention must be paid to prevention. Why is the surge happening in the first place? How can we stop it taking root?
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Gentleman on securing the debate, and I sought his permission beforehand to intervene. With 20% of young people—that is one in five—indicating that their fear of cyber-bullies makes them reluctant to go to school, does he agree that much more must be done to thwart the faceless keyboard warriors who are making the lives of so many young people so very difficult?
Alex Chalk
I do agree. The hon. Gentleman makes the point very powerfully, and in a moment I will develop why I agree with him so wholeheartedly. I found from speaking to young people that the role of social media has become impossible to ignore. It is not the only issue, of course, but it is a recurrent theme. Although there appeared to be a correlation between the rise of social media and the decline in adolescent mental health, I, colleagues and hon. Members wanted to know if there was causation, too. The report provided powerful evidence to suggest that there is.
By way of context, I should make it clear what the inquiry and this debate are not about. The inquiry was not set up to blame all the world’s ills on the internet or social media. My view is that social media is broadly a force for good. Equally, the internet as a whole fosters social mobility and opportunity. It spreads ideas and enhances freedom across the world. The inquiry did not seek to address all the concerns posed by social media use either. It deliberately left out the issues of fake news, sexting, sleep deprivation and others. All those are important but have been traversed elsewhere, and dealing with them would have made the report unwieldy and unfocused.
Instead, the report and this debate are about one issue only, cyber-bullying, and that is because the evidence from young people, including those we spoke to in the inquiry, suggested it was the single biggest risk factor in mental ill health associated with social media use. We wanted to drill down on that by taking evidence not just from young people but from experts in brain development, and the evidence from more than 1,000 young people was clear: cyber-bullying can be utterly devastating. It is relentless and inescapable. We heard harrowing evidence from young people taken to the very edge of despair. No one is saying of course that bullying does not exist in the analogue world, but it is this added toxic cyber layer, with its extraordinary capacity to amplify torment, that can prove so destructive.
What is so troubling is that the inquiry also found that children are using social media at a very early age —61% had a social media account at the age of 12 or under—and for a long time too: nearly half use it for more than three hours a day and nearly 10% check their social media feeds between midnight and 6 am, with girls twice as likely as boys to be high-intensity users. A troubling proportion—68%—of young people were affected by cyber-bullying, and the medical evidence showed that its impact could last into adulthood, with what one expert called
“lasting consequences on the adolescent brain”.
It seems that this searing experience can be a scarring one too.
David Linden (Glasgow East) (SNP)
I am grateful to the hon. Gentleman for his powerful speech tonight. I speak as an MP from Scotland, where this is very topical, the issue of revenge porn online having been highlighted in the Sunday Herald. My colleague Councillor Rhiannon Spear, a young female councillor in Glasgow, had a powerful impact this weekend when she talked about boys taking photographs of her naked and posting them on Twitter. Does he agree that the Government need to look more at revenge porn, given how these images are distributed on social media and the impact it has on young people’s mental health?
Alex Chalk
The hon. Gentleman rightly raises a really important point. It is only recently of course that revenge porn has become a criminal offence, but I dare say there is more that could be done. It is just one aspect of the hinterland of cyber-bullying but an extremely important one to raise.
Dr Julian Lewis (New Forest East) (Con)
My hon. Friend is doing us tremendous service by bringing this topic to the House. To what extent is anonymous bullying a factor? We all know from before the age of the internet the devastating effect of poison pen letters, even on a small scale; here one can have anonymised poison pen electronic letters that are accessible worldwide. Is it people who are known to victims mainly or is it people sheltering behind anonymity?
Alex Chalk
That is an extremely good point. In truth, it is both, and not only is it the nature of the bullying but the volume. Social media provides the opportunity, whether through sham accounts, spoof accounts or whatever, to multiply the torment, so my right hon. Friend raises such an important issue.
The most striking thing of all perhaps was that 83% of the young people told our inquiry that they thought the social media companies should do more to tackle this scourge. They felt that the onus was on the victim to act—to block or delete—and that reporting all too often felt like shouting into an empty room. There is a perceived lack of consequences for those who engage in bullying behaviour online in a way that is different from real life. There is some evidence from some platforms of temporary sanctions for cyber-bullies to nudge them back to good behaviour, but they remain the exception.
In fairness, the message is starting to get through. In his new year 2018 message, Facebook founder, Mark Zuckerberg, vowed to “fix Facebook”. One of the priorities he highlighted was “protecting our community from abuse and hate”, and he admitted that enforcement of house policies was failing. I am afraid we concluded that he was right. It is particularly impactful and devastating when the people who are being affected are under the age of 18. They are just children.
While we were grateful for the constructive engagement of social media companies—and it is true to say that the larger companies tended to take the issue more seriously—the unavoidable overall impression was that announcements and measures were largely tokenistic: slow and inadequate. Because there was so little transparency about the number of reports and the nature of the response, it was, in effect, impossible to determine whether the resources allocated bore any relation to the scale of the problem. The companies essentially continue to mark their own homework. As one witness put it, companies faced with growing alarm about the implications for young people’s mental health are “walking backwards slowly”. That is not acceptable, because our evidence showed that those failures have an impact on children and young people, and that the effect is particularly profound, concerning and long-lasting.
It is important to emphasise that tackling cyber-bullying must be a joint endeavour. Parents, guardians and teachers all have a role to play, but it is equally true that when it comes to minors, social media companies bear responsibility as well. It is simply not enough to sign children up and then just let them get on with it. It is important for the companies to be age-appropriate, and to do more to identify under-13s and, when appropriate, gain explicit consent from parents or guardians. They should provide timely, effective and consistent responses to online bullying, and they must become more accountable. What do I mean by that? I mean that they must publish data about their responses to reports of online bullying. Only then—if we know the number of reports, and the nature and timeliness of the responses—will any sensible assessment of the efficacy of those responses be possible.
As for the Government, I think that they ought to do what they reasonably can to improve our understanding of the role of social media in adolescent mental health. We are very much in the scientific foothills of our understanding of these issues, and the firmest possible evidence base will help to tailor the best solutions. I recognise, however, that the Government have gone a long way with the digital charter to increase the tempo, and I urge them to continue that important work.
My final comments are thanks. I thank the young people—more than 1,000 of them—who responded to the inquiry and gave evidence, and without whom the report would have had no currency. It was their evidence that gave its conclusions their heft, and it was their experience that left such a marked impression on all who took part in the inquiry.
GP Recruitment and Retention
Alex Chalk Excerpts(6 years, 7 months ago)
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Luke Pollard
The problem is that the schemes that currently exist are not having the effect that we need them to in Plymouth, because we have a crisis today.
I want to talk about the concern that a lot of GPs have expressed to me. My remarks will be about what GPs have told me, rather than my analysis of what I believe GPs are saying, because I think it is important that their voice is heard in this debate. Will the Minister meet those GPs so that they can raise their concerns in person? There are a number of GPs who have solutions or suggestions about what can be done.
At the moment each GP in Plymouth has about 2,364 patients. As we heard earlier, the average is about 1,700, so there is a greater demand on the GPs we have in Plymouth. One GP told me last night:
“I’ve just walked in the door after a day where I saw my first patient at 0825 and left my last patient’s home at 8.15pm. Because the district nursing service is currently unreliable (through no fault of their own), I will go back to the latter at 0800 tomorrow as the patient is housebound and needs blood tests.”
He went on to say:
“A large part of the pressures on...GP’s is the fact that other community services have had such drastic cutbacks.”
He said:
“I feel very...lucky to have a secure well-paid fascinating and rewarding job but it is all a little overwhelming and I constantly worry that just one major problem will mean things become very, very unsafe.”
Luke Pollard
I will continue, if I may. Apologies.
Another GP, Dr Williams, said that the system is failing and it feels as though it might be intentional. GPs have heard NHS England say that it is watching Plymouth as a place where primary care could fall over, a sentiment that several GPs have expressed to me in private. They believe that Plymouth’s city-wide system is facing bigger concerns in primary care than elsewhere. A meeting with the Minister is vital, so that he can reassure those GPs that the Department of Health and NHS England are on top of this.
Another inner-city GP said:
“I became a GP to help people with physical and emotional health difficulties and this is a job I have really enjoyed for a number of years. During this time patient needs and demand on general practice has increased significantly but unfortunately funding has not kept pace...We only get...£115 per patient per year to provide the totality of patient care so it’s no surprise we are struggling when some patients consult us at least once a week.”
The general medical services contract includes between £73 and £117 per patient, but as we have seen in Plymouth where GP surgeries have fallen over and emergency providers have been brought in, there can be as much as £347 per patient under emergency access contracts. There seems to be a huge financial gap there that could be moderated by supporting GPs—not by giving them more money themselves, but by providing support and assistance so that they can hire more GPs, and by supporting the other professions that make for a successful GP practice.
Worryingly, the doctor I referred to said:
“I no longer enjoy being an NHS GP because I cannot keep pace with demand and I know our patients are getting frustrated with restricted access to their GP. Patients are complaining, and rightly so, but those complaints just compound my loss of joy from the job because I’m working harder than ever to try and provide the service patients want but the majority of feedback we get is negative.”
That has been echoed by a number of GPs in Plymouth, who really want to inject the joy and passion back into their role. They entered the profession not because it was easy—it was hard and difficult—but because their efforts would make a huge difference to their communities.
Luke Pollard
I will continue, if I may.
I am genuinely worried that Plymouth’s primary care crisis is going to get worse in the coming days. We know that there are GPs who are considering whether to renew or to hand back their GP contract—a decision that will be made in the next couple of days. That is deeply worrying not only for them, but potentially for patients.
My GP surgery in Plymouth closed recently, so I know what it is like to lose my GP. At the moment I am especially concerned about people who do not reregister with a new GP, effectively becoming an unregistered cohort of people in the city who then can rely only on acute A&E services. Our staff at Derriford A&E do an absolutely fantastic job, but they cannot keep going if there is a continuing crisis.
The Plymouth Herald reports that a third of GP surgeries are at risk of closure as vacancies in primary care escalate. Will the Minister meet Plymouth GPs so that they can raise concerns directly with him? There is an opportunity to avoid the crisis getting any worse through proactive measures. I do not want to see the crisis getting worse and then more emergency access having to be put in place as GPs who have worked beyond the point of exhaustion hand back their contracts. That decision can be justified because of the pressure on them and their families, but we can avert that situation if we take action today. I hope the Minister will address that in his remarks.
Dr Whitford
If the hon. Gentleman will bear with me, I shall come to that naturally later.
The issue of indemnity has been touched on. I am not sure whether it is realised how extreme the position is. GPs in England are paying three to four times the indemnity that GPs in Scotland are paying. The range in Scotland would be £1,500 to £2,300 on a range of half a dozen to 14 sessions, but in England that would be £5,500 to £9,500. That is a considerable chunk of money to ask of someone, and it is very significant when it comes to taking on the extra weekend surgeries of seven-day working, or out-of-hours work.
Alex Chalk
That is an acute point. Does the hon. Lady share my consternation, particularly with respect to out-of-hours work, that in the past few years the premiums have been rising stratospherically? I think they went up by close to 10% last year.
Dr Whitford
I absolutely agree. As I have said, it is not particularly an issue in Scotland, but it is very much one in England. I know that it is being looked at under the new contract. Hon. Members may remember the Prime Minister’s challenge fund: extra surgeries at the weekend are better paid and do not involve the same indemnity issues as going to do a stint at the local out-of-hours. Unconsidered consequences of that kind must be looked at.
There is obviously increasing demand. We talk negatively about the ageing population, but living longer is a good thing, and I would like to recommend it. I spent 30 years trying to achieve it. In Scotland the number of GPs increased by 9% between 2005 and 2015, but the number of patients over 65 increased by 18%. Obviously, much innovation across the UK is to do with trying to reduce workload. Scotland was first to get rid of the quality and outcomes framework, which had encouraged significant quality improvements but grew into a huge bureaucratic machine. We are working on developing the multi- disciplinary team, with physios, access to counsellors, and pharmacists. That is happening in England as well. One innovation in England is known as “time for care” and concerns extra training at the frontline—reception—to encourage triage of patients to the right member of the team. However, my attention has been caught by the development of a new app that allows patients to book appointments directly; that would remove the option for triage. It is important for innovations to be joined up.
We need to innovate and to use all community resources. Scotland has for 10 years had community pharmacies providing minor ailment services. Our optometrists are allowed to make direct referrals to hospital for cataracts, and now they treat 90% of all acute eye problems. Those are things that may at the moment be referred to general practice simply to ask for a letter to be passed on. That is a waste.
There has, obviously, been a climb in the number of practice vacancies, including in Scotland. Our whole-time equivalent has fallen, in the past three years, by 1.9%—in England the figure is 2.8%. There has been a 50% increase in the number of GPs taking early retirement, at the age of about 57. Some of that is because of the change in pension tax rules. The problem of having too big a pension is a nice one to have; however, if people who invested 40 years ago in very expensive added years are finding suddenly, as they approach retirement age, that that means they are accruing no further pension, we have a problem.
Brexit is definitely a threat. In Scotland, 3.5% of the health and social care workforce—and 5.8% of doctors—are from the EU. In London the figure is 14%. We know that 14% of EU doctors in Scotland, and 19% in England, are already in the process of leaving and, as has been said, that is simply because they feel unwelcome. As we have seen with the difficulty of getting tier 2 visas over the past four months, recruiting from outside the EU is a real issue. Businesses in London can increase someone’s salary to get past the limitations, but the NHS is not able to be so flexible.
Oral Answers to Questions
Alex Chalk Excerpts(6 years, 8 months ago)
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Stephen Barclay
I am aware of the issues raised by Kirklees Council, and I understand that local campaigners have referred this to judicial review. Given the imminent legal proceedings, it would not be appropriate to comment further at this stage. A decision on the referral to me by the local council will be made in due course.
Alex Chalk (Cheltenham) (Con)
Cheltenham General is a wonderful hospital, but it needs investment in theatres and wards. May I take this opportunity to commend the application for over £30 million of capital funding, which would make a huge difference to my constituents?
Orkambi and Cystic Fibrosis
Alex Chalk Excerpts(6 years, 8 months ago)
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Paul Scully
I agree. It was a fantastic effort from—it was a remarkable achievement—the petitioners to get 114,000 signatures within 10 days. I have been on the Petitions Committee since its start and, short of having a go at Donald Trump and a few of the Brexit debates, this is one of the most potent petitions, and one of the more productive.
Alex Chalk (Cheltenham) (Con)
Does my hon. Friend agree that drugs companies need to behave ethically in pricing their vital medicines? While profit itself is not a dirty word, when it comes to cystic fibrosis treatment, profiteering is.
Paul Scully
One thing I will say in favour of Vertex in this case is that, although the amount of people who suffer from this condition is fortunately restricted, the research and development still has to go in. It is not like developing the next ibuprofen or cancer drug, which will go out to millions of people; this would go out to 70,000 people in the world. In order to build that research and development budget in, Vertex needs to charge reasonable costs for the drug. None the less, those costs do need to be reasonable. That is why the negotiation needs to be absolutely above board, transparent and sensible for the sake of the sufferers, who, frankly, do not have time to wait for a prolonged negotiation.
Eating Disorders Awareness Week
Alex Chalk Excerpts(6 years, 8 months ago)
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Edward Argar (Charnwood) (Con)
Anorexia nervosa, a well-known eating disorder, has the highest mortality rate of any mental health condition. When eating disorders are not fatal, they can still lead to significant and long-lasting health issues. An estimated 1.25 million people in this country suffer from an eating disorder. Of course, it affects not just them but their families, yet eating disorders are all too rarely discussed in public.
We discuss with comparative ease physical illnesses that may devastate people’s lives, but when it comes to mental illnesses this is too often not the case. That is also true of eating disorders. Despite the ever-increasing pressures of daily life leading to increased instances of poor mental health, we still do not speak about these issues enough. These illnesses can thrive on secrecy. The longer they go unchallenged and unacknowledged, the harder it is to beat them. It is only by talking about them, bringing them out of the shadows that we can reduce the power they hold over those who suffer. To really improve the lives of those with eating disorders and prevent those at risk from falling victim to these illnesses, we must bring eating disorders, as with all mental health issues, to the forefront of the collective deliberations and consciousness of our society. That is why, in this Eating Disorders Awareness Week, I am very pleased to have secured this important debate so that we in this House, the centre of our national debate, can talk about it and play our part, however small, in raising awareness and making it that bit easier for others to talk about it. I am very pleased that this Minister is responding to the debate, because I know she is a lady of compassion, dedication and determination to improve people’s lives. May I also say, Mr Speaker, that with all the pressures on your time, I am pleased that you are in the Chair for the start of this debate, because I know the close interest you have taken in these issues as well?
Alex Chalk (Cheltenham) (Con)
Will my hon. Friend join me in commending the outstanding compassion and professionalism of the community team and other professionals at the Brownhill Centre in Cheltenham, who provide such a vital lifeline for those suffering with eating disorders?
Edward Argar
I will. My hon. Friend is absolutely right to raise this issue. Indeed, my hon. Friend the Member for South Ribble (Seema Kennedy) highlighted earlier today the work of the SEED—Support and Education for Eating Disorders—organisation in Penwortham in her constituency. They are both absolutely right to highlight the work of such organisations.
As hon. Members may know, since my election to this House I have on a number of occasions raised health and mental health-related issues on behalf of my constituents and more widely. In this case, last year I accepted an invitation from Beat, the national eating disorder charity, to the launch of its important report, “Delaying for years, denied for months”, which focuses on how long it takes from someone developing an eating disorder to their receiving treatment for it. It is a piece of research I will draw on extensively today.