Mental Health Services: Leeds

Alex Sobel Excerpts

Tuesday 23rd April 2019 Westminster Hall

[Fabian Hamilton]

I thank my hon. Friend for her intervention. York is a city that I know well, and of course York and Leeds are united together through the partnership trust. I will now go on to detail my own experience with the Leeds and York Partnership NHS Foundation Trust, because my experience is similar to the experience that many of her constituents have discussed. The points she makes are very valid and I would be very interested to hear what the Minister has to say in response, not only to her intervention but to what I am about to say.

The reply to my letter to Dr Sara Munro, the chief executive of the Leeds and York Partnership NHS Foundation Trust, was dated 1 March, and it was written by Samantha Marshall of the complaints team, who said she was

“sorry that you have reason to make a complaint and, as a trust, we have failed to meet your expectations.”

Bear in mind that I had written on behalf of my constituent and that I had raised other issues. Ms Marshall went on to say that the trust has had no contact with Mr Downey since he was referred to the IAPT, which is provided by Leeds Community Healthcare, and that she would forward my letter to LCH if I wished. However, no reference was made to any of the other more general questions that I had asked Dr Munro, questions that I believe are highly pertinent to the treatment that my constituent received, and to the treatment that many of my fellow Leeds MPs’ constituents have received as a result of the severe underfunding of mental health services in our area.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

My hon. Friend from Leeds North East is making an excellent speech. I had a similar case with one of my constituents, who visited her GP on 31 December 2018 to say that she felt suicidal. She was asked to go home and told that the crisis team would contact her. The crisis team did not contact her. Four hours later, she returned to her GP and then had to go by ambulance to Jimmy’s—St. James's University Hospital. She waited in accident and emergency for 20 hours. Eventually, the acute liaison team gave her a leaflet. That was the level of intervention that she experienced. It was not until my office intervened with the IAPT that she got a referral, and by then she had already made another suicide attempt. That is how the services in Leeds were delivered in the case of my constituent.

[Fabian Hamilton]

I thank my hon. Friend, whose constituency is next door to mine. As I suspected when I requested this debate, there are cases all over the city of Leeds—probably all over the country, but certainly in the Leeds and York area —that highlight the inadequacy of mental health services and the maze that people have to navigate if they need them. That is a source of huge concern.

Safeguarding Vulnerable Adults: Care Homes

Alex Sobel Excerpts

Tuesday 26th February 2019 Commons Chamber

[Dr Allin-Khan]

I thank the hon. Lady—I will call her my hon. Friend—who is tireless in fighting against loneliness and for people to have dignity in their communities, and she makes the most essential of points: we are at the start of a ticking timebomb.

While all this was going on, my father was admitted to hospital one afternoon for a routine issue. As we were undressing him, we found bruises all over his body. Did the Ensham House care staff phone to check on him? No. Did Optivo show any care? No. Instead, we were served an eviction notice, detailing a list of allegations against my father without any evidence. How heartless is it to receive an eviction notice while in hospital? What did Wandsworth Council do at this time? Nothing. What was London Care doing? In the space of just five months, London Care had five separate managers at Ensham House. This all started after the first incident with my father. One manager after another came and went, unfamiliar with my father’s safeguarding cases. Some were hostile, others made up incidents involving my father being difficult. Dementia is a degenerative illness, but it does not spiral downwards overnight. Prior to those incidents, as I previously mentioned, not a single issue regarding my father’s difficult behaviour had ever been reported.

In all meetings, it was agreed that the extra care setting was appropriate for my father as he still knew his way around the area, he had a level of independence and my very young daughters felt comfortable visiting him there. Why deny someone their last few months of independence? The extra care setting was deemed by the social services team and everyone involved to be entirely appropriate for him. However, each time we interacted with Ensham House care staff following the first incident in which we found my father beaten, and when we had not been called, we felt as though we were on trial, that we had somehow made up the fact that he was acting afraid, and our concerns were dismissed by a different manager every month.

We found multiple examples of my father’s medication not being written on the drug chart, with London Care saying that he had refused medication when we had seen him take it. We even found one manager had written a note in the staff communication book asking staff to write negative comments about my father in his care notes. The final nail in the coffin, and the point of no return, was when we found my father unconscious on the floor, with blood on the walls and the floor, and a carer’s set of keys left next to him. Following this, he spent one month in hospital.

Four months after that final event in October, there was nothing from Wandsworth Council addressing any of these concerns. The catalogue of disasters crescendoed last week, when the director of adult social services at Wandsworth Council, Liz Bruce—who had refused to look at photos of my father’s injuries, did not know how many open safeguarding complaints there were relating to my father, did not talk to anyone else who knew my dad and had never met him herself—declared that my father had sustained the injuries because “he had asked for it.” Despite police voicing their concerns in the meeting and saying that they cannot rule out abuse, despite her failure to investigate London Care fully and despite her clearly having no detailed knowledge of the case, she chose to use Optivo’s letter, which was full of unsubstantiated claims in the language of the Ensham House managers, as her proof. Well, I think we can all agree that this is a dangerous, highly unprofessional and highly unsatisfactory approach.

Of course it is easier to blame the patient and the family, anything other than looking inwards and accepting responsibility for the fact that the council is awarding care contracts to organisations that are, frankly, unsafe. Quoting CQC ratings in safeguarding communications, when it is well known that patients are fearful to talk, is frankly unacceptable. If this were happening to the UK’s children, the country would be in uproar, and rightly so. Someone living with dementia is just as dependent in their final years as children are in their first years.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

Will my hon. Friend give way?

[Dr Allin-Khan]

I am just finishing.

With an ageing population and an increase in degenerative illnesses, this issue will only get worse. As parliamentarians, we must act now to ensure that even more families do not experience the horror of finding their loved one bruised, bleeding and terrified. We owe it to the elderly in our community. We owe it to the vulnerable. We have to be their voice. They should not be deprived of their quality of life. We must give our vulnerable a fair chance at ageing safely and gracefully. Their voices must be heard.

[The Minister for Care (Caroline Dinenage)]

I would like to start by congratulating the hon. Member for Tooting (Dr Allin-Khan) on securing this debate. Her speech this evening has been described as brave, but she took the time out yesterday to talk me through this incredibly distressing case, so she has been brave twice. She deserves all our respect and credit for doing that, because, as has been pointed out by others, she is not just talking about her own individual case, tragic though that is, but by articulating it in such an incredibly courageous way, she is also helping to support others who do not have this opportunity to share their voice and raise their concerns in the same way.

Everyone in this House has the same motivation, which is to ensure that our care services for the most vulnerable people are safe and of the highest quality. The hon. Lady talks powerfully about dementia, which is a priority for me personally. I have experienced what it is like to have a close family member, my grandmother, living with dementia. So many people up and down the country share that experience, and I think we all recognise that a dementia diagnosis is one for not only the individual concerned but their whole family. That is why I am so passionate about the need to ensure that those affected by this condition and others are cared for in the best possible way and that a robust complaints process for redress is in place if their care falls short of that.

It would be bad enough if the terrible situation that the hon. Lady describes were taking place in care homes—that would be disgusting and terrible—but she is talking about an extra care facility. Such a facility is where people have their own self-contained homes; they have their own front doors and their own legal right to occupy. So this is a failure of care in someone’s own home—it is a domiciliary care situation. That is why I am even more concerned about what can happen behind closed doors in an individual’s own house. To have a loved one affected by a degenerative illness is terrible for the individual and a matter of huge worry for their family. So I have previously said in this House that every allegation of abuse and neglect should be thoroughly investigated, with prosecutions brought where this is found.

[Alex Sobel]

First, I wish to pay tribute to my hon. Friend the Member for Tooting (Dr Allin-Khan) for her courage and alacrity in her speech. Some constituents came to me about their mother, who had been sexually assaulted in a care home, not by the staff, but by another patient. I was dismayed to hear that unlike nurseries, care homes have no minimum staffing ratio. Will the Minister look into having minimum staffing ratios in care homes, so that these events do not happen?

[Caroline Dinenage]

That is a very interesting question. I have not considered the minimum staffing issue before. We are of course very concerned about training and ensuring that all care staff have a care certificate, so that there is a minimum level of skills training. However, the point about ratios is interesting, and I will take it into consideration.

I do not have a massive amount of time left, so I am not going to discuss in full the details of the individual case raised by the hon. Member for Tooting. However, I must reassure her that what she has raised today is something I take very seriously. My officials have informed me that her raising her concerns so effectively and our inquiries from our office as well have prompted Wandsworth Council to hold another meeting today to discuss her case and review the evidence. As a result, there will be an outcomes meeting—

World Cancer Day

Alex Sobel Excerpts

Wednesday 30th January 2019 Westminster Hall

[John Lamont]

Again, I am grateful to my hon. Friend for raising a powerful case and example. I suppose the question is what would happen were it not for all these volunteers, raising huge amounts of money and raising awareness of cancer, and filling a gap that otherwise the NHS and the state would have to provide for. That is something we should not forget.

That is not to say that we have not made huge progress in tackling cancer. While diagnosis rates have risen significantly in the past decade, the number of people dying from cancer in this country is falling.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

I congratulate the hon. Gentleman on securing this important debate. On the question of diagnosis, I congratulate Leeds Teaching Hospitals and the University of Leeds; their pathology department is the first in the world, I believe, to move away from glass slides to fully digitised diagnosis, and is now working with artificial intelligence, which will improve diagnosis rates and move us forward, so that many more people can get early treatment.

[John Lamont]

The hon. Gentleman makes an excellent point, and raises a very good example. My brother’s father-in-law sadly died a couple of weeks ago. His treatment was provided by Leeds hospital, so I know the tremendous amount of resource and expertise they have in that particular hospital.

For breast cancer in Scotland, the mortality rate was 53 per 100,000 women in 1992. That has fallen to 32 per 100,000, despite the incidence of breast cancer increasing. In short, we are much better than we used to be at both identifying and treating cancer. That is because the UK has taken the steps that World Cancer Day promotes—in particular, tackling tobacco use and obesity levels and rolling out national cancer strategies.

Big issues clearly remain; pretty much all the cancer charities I have spoken to ahead of today’s debate agree with that. We need to get better at early diagnosis, because we know how much of a difference it can make. For example, if bowel cancer is diagnosed early, nine in 10 people will survive, but with a late diagnosis, the survival rate is only one in 10.

Budget Resolutions

Alex Sobel Excerpts

Tuesday 30th October 2018 Commons Chamber

[Alex Sobel (Leeds North West) (Lab/Co-op)]

After the Government have been taken to court and lost three times over air quality, and following the Intergovernmental Panel on Climate Change report stating that we have just 12 years to avert climate change catastrophe, I expected this Budget to deliver the investment we need in clean, green infrastructure for our lungs and our planet. In a quest to bring down costs, the Chancellor has not looked to capitalise on the opportunities that a modern, green economy would bring to the UK. Instead, he has focused on miserly cost-cutting measures. This is a Budget of abject complacency in the face of climate catastrophe. As usual, the Government’s obsession with low-cost public services and their lack of any serious investment have left our environment, the water we drink and the air we breathe off the agenda.

Not only are we on track to miss our air pollution targets, but the Government have lost three court cases and had their policy on air quality ruled unlawful. It has been left to local councils, which have been subject to extreme funding cuts, to deliver change in this area. Where is the commitment to clean air? Air quality affects our health and the health of our children and grandchildren. A recent study linked air pollution to more than 40,000 early deaths in the UK—that is 40,000 people dying before their time because the air they breathe in the fifth richest country in the world fails the required standard.

This is a public health nightmare. The Government have left our national health service strapped for cash as it is. Public Health England has estimated that air pollution costs could rise to £18.6 billion by 2025. If we do nothing and the quality of our air does not improve, there could be 2.5 million new cases of air quality-related illnesses such as lung cancer, asthma and heart disease by 2035. It is not cost-effective to ignore this problem; it is short-sighted austerity politics yet again.

The UK needs to lead the fight for cleaner air and carbon reduction. To do that, we need to incentivise a just transition for health, jobs and the environment. Why, then, has the Chancellor cut subsidies for plug-in hybrid and electric vehicles? How does he expect British drivers to make the switch from petrol and diesel cars if they are not encouraged to do so? Why does a Nissan Leaf have the same VAT rate as a Hummer? Should clean cars not be VAT-exempt? Where is the investment in the electric vehicle infrastructure that we so desperately need? In my constituency there is not a single public charge point; this is fourth time I have raised this issue in the House, and there are still no charge points. There are very few rapid charge points on British motorways, too. That does not build confidence in the new technology, and it leaves EV drivers with charge anxiety. There is no point in encouraging people to buy electric or hybrid vehicles if we do not provide the necessary infrastructure. The Government must do their bit. We need charge points in every community, rapid charge points across our road network and real investment in EV infrastructure and affordability.

Further, we need proper investment in northern heavy rail infrastructure to ensure that people have an alternative to using their cars. Clean rail is lacking in my constituency, where the Harrogate line is still running dirty diesel as the Government first promised then scrapped the electrification programme—a shameful example of this Government’s craven disregard for the north of England.

I recently submitted my consultation response on the plan to scrap feed-in tariffs. This incredibly short-sighted plan will end a scheme that has been successful in encouraging communities, councils and individuals to take ownership of their energy and carbon footprint. While the Government cite increased energy bills to justify their position, they have no plan to replace the scheme with anything other than business as usual for the big six energy companies, which they have conveniently left out of their analysis of consumer energy bills. Where is the investment in proper insulation of UK homes to reduce energy consumption and take so many people out of the fuel poverty they are suffering? All this, and we are still on course to miss our next carbon budget target. When will the Government wake up and realise that we are in the midst of an environmental and public health crisis, and take the necessary action to change course at international, national and community level?

Of course, this debate is about the Budget and health. We have a health service in which our Government’s health economics put the interests of the private sector above those of the public. NHS trusts, including my own, have set up wholly owned subsidiary companies so that private companies can reclaim VAT. In Leeds it is just a service company, but many other trusts have set up wholly owned subsidiary companies that have transferred thousands of NHS staff into the private sector. The solution I had hoped to hear from the Chancellor was that he would put our hard-working public servants on an equal footing and allow the NHS to reclaim VAT in just the same way as those private companies do. But we have a Chancellor who finds a way to put the private sector ahead of our hard-working hospital porters, administrators and cleaners in the national health service.

In short, this Budget has come up short, put the interests of the few ahead of those of the many and put the planet on notice from which it might never recover.

ME: Treatment and Research

Alex Sobel Excerpts

Thursday 21st June 2018 Westminster Hall

[Dr Drew]

I agree, and the hon. Lady makes her point strongly. All I will say is that I will concentrate mainly on the medical side of things. However, everybody needs to be more aware because of the numbers—two in every 1,000 people are thought to suffer from the condition.

We have heard a lot about the PACE trial and the need for NICE to rewrite its guidelines, so I do not really want to labour those points, other than to say that it is not helpful that cognitive behavioural therapy and graded exercise therapy are still suggested as the appropriate way forward after ME diagnosis. We know for all sorts of reasons that that is not so. I am sure the Minister heard that and will want to comment on it.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

My constituent was diagnosed with ME but, after going for a private test, it turned out to be Lyme disease. That shows the lack of knowledge and the confusion in the medical profession between those two conditions and others.

[Dr Drew]

If my hon. Friend reads Dr Shepherd’s book, he will see some of the overlap between Lyme disease and ME, as the hon. Member for Glasgow North West mentioned. That is why this whole area needs proper diagnosis and a proper investigation into some of the research implications.

On research, as has been made patently clear by other Members, most of the research is self-help. That is not good enough. This is a major condition that affects lots of our constituents, and yet they are asked to raise all the money for research themselves. That is not good enough, so we clearly ask the Government—as the Minister will have heard—and the research councils to give ME the priority that it deserves.

ADHD Diagnosis and Treatment

Alex Sobel Excerpts

Tuesday 15th May 2018 Westminster Hall

[Jo Platt]

I thank my hon. Friend for that intervention. He is right that we need more awareness of ADHD. I know that people who suffer with ADHD have called for their own Act—something similar to the Autism Act 2009.

In the midst of cuts to school nursing provision, and a school funding and teacher recruitment and retention crisis, the number of school exclusions of pupils with special educational needs is no fault of our hard-working, dedicated and professional healthcare workers and teachers; it is the product of an underfunded and under-resourced health and education system. We cannot go on treating children with ADHD simply as naughty kids, and being unable to afford the time or resources to help them. Instead, we must support those young people and focus their education around their skill set.

The second way we are letting people with ADHD down is through diagnosis. A recent survey with more than 800 responses revealed that 70% of respondents had waited 18 months or more for an ADHD diagnosis, 9% of whom were, shockingly, waiting for more than three years.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

I recently asked three parliamentary questions on waiting times for assessments for ADHD, and for all three the response was that those figures were not collated. We cannot do anything about it until we have accurate data. Does my hon. Friend agree that the Minister and the Department should be collating that data?

[Jo Platt]

I thank my hon. Friend, the vice-chair of the all-party parliamentary group for ADHD, for that intervention. He is absolutely right to mention that the lack of data causes a mismatch and a bit of a postcode lottery, which I will address later.

At a recent APPG meeting, we heard stories of people waiting years for a diagnosis—years battling without the support or guidance they need, falling behind in school, or struggling in their occupation. We heard stories like that of my constituent Mick, whose son has suffered enormously, falling into crime before he was diagnosed, which unfortunately is all too common. About 25% of male prisoners are thought to have ADHD.

Education (Student Support)

Alex Sobel Excerpts

Wednesday 9th May 2018 Commons Chamber

[Karen Lee (Lincoln) (Lab)]

As Members probably know, I was a nurse until last June. I did 12 years in cardiology and almost three in out-patient gynaecology clinics. As an ex-nurse, I could not be any more in opposition to this amendment to nursing bursaries, as I am concerned that it will fail to address the problems with nursing recruitment and will intensify the fall in applications to nursing courses. Overall, applications have fallen by 33% since March 2016, when bursaries were withdrawn. At that time, the Royal College of Nursing, a much respected and non-political body, said the changes were unfair and risky, and the Royal College of Midwives argued that the move threatened the future of maternity services in England.

I hope that all of us in this Chamber acknowledge that there is a workforce crisis across the whole NHS. As the RCN has said,

“plans by the government to remove the NHS bursary for pre-registration students in England must be stopped immediately”.

It goes on to say that

“nurses need bespoke financial support if the government is to meet its commitment to grow the nursing workforce and meet the future population demand for health and care services”.

The National Audit Office has reported that the impact of the EU referendum appears to be driving EU nurses away, and both the Care Quality Commission and the NAO have raised safety concerns relating to nursing shortages—it is not just Opposition Members who are saying that.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

My hon. Friend gave many years’ service as a nurse and I am sure she worked with many nurses who came here from abroad. The Migration Advisory Committee has placed nursing back on the shortage occupation list. In the light of that, is not this statutory instrument wrongheaded, as we need nurses to come through all routes if we have a nursing shortage?

[Karen Lee]

I completely agree with that.

There are 40,000 nursing vacancies across the NHS and, for the second year in a row, more nurses are leaving the profession than joining, with one in three expected to retire in the next 10 years. The Government have made much of the nursing associate role and apprenticeships for nurses. Nursing associates provide a support role for nurses, and the RCN feels that diluting and substituting registered nurses with associate nurses has potentially life-threatening consequences for patients. That is the RCN saying that, not me.

This Government also speak in glowing terms about the apprentice nurse role. I do take the points made by the right hon. Member for Harlow (Robert Halfon)—he means well—but it takes four years to train as an apprentice nurse and our health service is, as the RCN says, in crisis right now. Furthermore, this route is not currently providing the 1,000 new nurses per year that the Government planned for, with RCN figures suggesting that there are just 30 apprentice nurses at present—I will give that answer.

I was a mature student. I was 41 when I started my training, and a single parent. We have heard a lot tonight about how we will encourage people who do not want to go down the university route. I worked in Tesco on a checkout. I had been to grammar school and it had failed me, so I had to go to night school to get my A-levels to become a nurse. That took me a year, three nights a week, on top of working. I then worked for three years as a nursing student to become a nurse. I could not have completed my training without a bursary. I also borrowed £5,000 a year from the Royal Bank of Scotland, so I came out hugely in debt, even though I had a bursary, and it took me five years to clear that debt.

Social Care

Alex Sobel Excerpts

Wednesday 25th April 2018 Commons Chamber

[Barbara Keeley]

That is almost the situation we are in at the moment. It is worth thinking about why we seem to have this issue with Allied Healthcare, given that the problem has occurred in the last few days. It was reported that Allied Healthcare’s cash-flow problems had been triggered by increases in the national minimum wage for care staff and by an £11 million bill for back pay owed to sleep-in care staff. However, Allied Healthcare is not the only provider that is facing a large back-pay bill for care workers on shift. Learning disability social care providers have warned that they will have to withdraw services or close altogether to pay the bill for back pay, placing the care of even more people in jeopardy and putting care staff jobs at risk.

This trend of closures and contract cancellations is set to continue. A recent report into residential care by the Competition and Markets Authority painted a bleak picture of the current care home market.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

I recently met Lifeways Group, which looks after thousands of people with learning disabilities and has many hundreds of staff who do sleep-in shifts. It pays above the national living wage and is a good employer, but it cannot afford the back-pay claims if the finding goes against it. Should the Government not provide the funding to support these organisations?

[Barbara Keeley]

It is reported, in fact, that the total back-pay bill across the social care providers that provide sleep-in cover will be about £400 million, so it is not surprising that a care provider such as Lifeways would say that. The Government have to come up with answers for this, because there has been a dragging of heels, the guidance has been very confusing, and it is a serious matter. I understand, too, that the Government have completed two reports, but they have not been made public. Hon. Members and I would certainly welcome having those reports placed in the Library so that we can get that information.

We have seen warnings from the Competition and Markets Authority that care homes would find themselves having to close or move away from local authority-funded care because the funding is now only just covering day-to-day running costs. It is quite clear from all this that there is a growing funding gap in social care that must be filled. The Local Government Association has said that our social care system needs an immediate injection of £1.3 billion to fill that gap, and this is projected to rise to £2.5 billion by 2020, according to the King’s Fund.

In our last Opposition day debate on social care, in October, the strain social care was under—from the weight of growing demand, reducing supply and the lack of funds from Government—was plain to see, but since then the system has cracked still further under the pressure of Government funding cuts.

Privatisation of NHS Services

Alex Sobel Excerpts

Monday 23rd April 2018 Westminster Hall

[Alex Sobel (Leeds North West) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Hosie. I thank all those who signed the petition, including the 512 signatories in my constituency. I spoke at a “Save the NHS” rally a couple of weeks ago, and privatisation was one of the top issues for people who attended that rally and spoke to me afterwards. I will make some the points I made when I spoke at that rally.

Week after week, people stop me, come to my surgeries and write to me asking why their local GP has left and been replaced by locum doctors, why A&E waiting times are increasing or why the services they rely on are verging on unsatisfactory and in some cases negligent— I have some negligence cases running. The short answer to those questions is a lack of money in the system. The more complex answer is that the decline in NHS funding has placed strong pressures on healthcare providers right across the NHS to adopt new practices and governance structures. Many of those changes have taken place beyond the public eye and without sufficient scrutiny. The benefits from those changes are far from evident. My hon. Friend the Member for Stroud (Dr Drew) asked many of the questions I had intended to, which will reduce the amount of time I will take in this debate —so I thank him for that—but that allows me to make some broader points. I support all the questions he asked the Minister. However, there is one point, which I will come to, on which I have a slightly different point of view from my hon. Friend.

The Leeds Teaching Hospitals NHS Trust, in an attempt to balance its books, has proposed to take 1,000 NHS workers out of the public sector and place them in a wholly owned subsidiary company. There was a meeting on 29 March to make a decision. After interventions by myself, four other colleagues in Leeds, the trade unions, campaigners and members of staff, there was a stay of execution on that decision and it will be looked at again. Therefore we are not quite in the situation that my hon. Friend has in Gloucestershire, where the change has already happened, but we are approaching it, which makes it all the more important for us to have the debate and to engage with the Department of Health and Social Care and its Front-Bench team. The wholly owned subsidiary company would take staff who have spent their entire career in the public sector and place them in a highly uncertain position regarding their working conditions, salaries and pensions—all points that my hon. Friend made.

A wholly owned subsidiary company structure has already been implemented elsewhere in Yorkshire—in Airedale and Barnsley—and the primary driver is financial. Once the subsidiary company is in place, it can recoup VAT and make significant savings. What is the solution? My hon. Friend suggested that the Treasury close the loophole, but my suggestion is quite different: the NHS, at trust level, should also be able to recoup VAT. Let us create a level playing field in which the NHS has the same rights and benefits as a wholly owned subsidiary company. That would effectively just be a technical change. I hope the Minister will talk to his Treasury colleagues and look at whether those same benefits can be given directly to an NHS trust.

I am not asking for that change for ideological reasons, although I have heard a lot of ideology today. Rather, I am speaking up for the porters, cleaners, lab technicians, receptionists and administrative officers who work in the trust and in other trusts that are considering going down that road or have done so. They tell me that they are motivated to work above and beyond at the trust because they are part of the NHS. They work the hours that they need to work because they are part of a family. They and their colleagues are born of the NHS—an NHS born alongside my hon. Friend the Member for Ealing North (Stephen Pound) in 1948. They do not want to be seen as a moveable commodity. They view themselves as a core part of the NHS, just as much as the clinicians. We need to recognise that.

[Rachael Maskell]

York Teaching Hospital is going down the same lines in creating a wholly owned subsidiary company, yet the staff want to belong to the NHS—that is their ethos and that is what drives them. It is also important for full integration across the whole service, because people who work as porters and cleaners are as much about patient care as anybody else in the NHS. Does my hon. Friend agree?

[Alex Sobel]

Absolutely. When I go into our local hospitals as an MP or as a patient, I see that they are the beating heart of the NHS.

I ask trusts, such as Leeds, that are considering setting up a subsidiary company to put a halt to those plans and to work with their staff, representative trade unions and local MPs prior to making the decision. I ask them to do what is best for all involved, whether patients, staff or the community.

Cost pressures create perverse incentives for people to consider privatisation. We have rehearsed that argument quite well. They affect not just NHS hospital trusts but clinical commissioning groups for primary care services, NHS England and other NHS bodies. We need to take those perverse incentives out of the system so that privatisation does not happen by the back door—instead of being done by the Government through statute—which is what is happening.

Autism

Alex Sobel Excerpts

Thursday 29th March 2018 Commons Chamber

[Paula Sherriff]

I thank the hon. Gentleman for his intervention.

NICE recently recommended the creation of an autism register so that areas where autism may be under-diagnosed can be identified. Following that, the Government committed to including autism in the primary care register. Will the Minister update the House on the implementation plans for this scheme?

We must also ensure that post-diagnosis support is in place. We know that parents have raised concerns about being left with no support during and after the diagnostic process, not being signposted to other advice and help, and not even getting a written report of the diagnosis. Too often, there are significant barriers to accessing the right treatment. In a previous debate, we heard the shocking case of a young boy who was having suicidal thoughts, but was rejected four times for treatment because he had not yet made an attempt to take his own life. The Children’s Commissioner for England confirmed concerns about that issue when she stated to the Health Committee that this type of situation was now “the norm” within children’s mental health services. That is worrying for children’s wellbeing generally, but particularly so for those living with autism.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

Does my hon. Friend agree that we need increased support in schools? Nearly 77% of parents say that their child has to wait more than six months for support at school. It is just as important that a child gets support at school as in the health system.

[Paula Sherriff]

Once again, I absolutely agree with my hon. Friend. I will go on to talk about that matter in a moment.

GPs may also need to tailor the way in which they communicate with patients. For instance, they may need to use clear language, or to find ways to communicate with somebody who does not speak. To do that, GPs must be able to access detailed and accurate records about their patients’ needs. Currently, GPs often do not record much information about their autistic patients, and may not even record at all that a patient is autistic. The five year forward view for mental health recommended that NHS England should develop autism-specific mental health care pathways. If the Minister could give us any more information on that I would be very grateful indeed.

As I alluded to earlier, early intervention is key for communication and language skills, which are closely linked to life chances for people with autism. Perhaps the Minister could address the new communication therapies that are being trialled, such as pre-school autism communication therapy, and the pilot studies in Plymouth and Bangor to test new post-diagnosis support programmes. If these programmes are successful, what steps will the Government take to ensure that they are rolled out?

In education, children with autism and other special needs are all too often paying the price for cuts. The first real-terms cuts in school budgets for a generation have put enormous pressure on schools. The vast majority of school budgets are spent on staff costs, and that makes it hard for schools to keep their current staff and maintain the necessary level of pastoral provision. As a constituency MP, I know how the cuts have hit my own borough of Kirklees. The Government’s new funding formula leaves councils needing to take money for central high-needs funding from the amount allocated to schools. That means that schools may now face a cut of up to 1.5% in per-pupil funding.

More than 4,000 children in England with approved education, health and care plans still receive no provision. There was an increase from 1,710 in 2016 to 4,050 in 2017, which was five times the number in 2010. The impact on children with autism was laid bare by the recent inquiry by the all-party group. More than four in 10 families have been turned away when asking for the extra help that their child needs, and 70% of parents said that their child waited more than six months for support at school, with 50% waiting more than a year. I could go on with yet more shocking statistics, but I think the reality is evident. Does the Minister have any response to the all-party group’s recommendations?

If we let down children with autism in education, the impact is felt when they become adults seeking employment, as we have heard from a number of Members this afternoon. In 2015, the Government pledged to halve the disability employment gap, but they watered that down in their 2017 manifesto. Analysis from the TUC found that the Government were years behind schedule on their 2015 manifesto commitment to halve the disability employment gap, and at current rates of progress that would take until 2030 to achieve.

There is an urgent need for improved in-work support for people with disabilities. The Government must act to strengthen and enforce workplace rights, and to improve support for employers to help their employees to stay in work. That would be good for everyone, because a 10% rise in the rate of disability employment would represent a £12 billion gain to the Exchequer.

The autism employment gap is even wider than the disability employment gap. Over the past 10 years, there has been no real change in the numbers of autistic people in full-time work, with the percentage rising from 15% to just 16%. The National Autistic Society found that less than a third of autistic adults were in some kind of paid work, even though more than three quarters wanted to work. There are concerns that this is not even monitored, so perhaps the Minister will address that point. The NAS has also called for an autism employment pathway, an awareness programme for employers and targets for getting people with autism into work. I hope that the Minister can tell us how the Government intend to respond.

Finally, there is the simple question of awareness, which we have touched on a number of times this afternoon, with contributions from my hon. Friends the Members for Bristol West (Thangam Debbonaire), for Cardiff West (Kevin Brennan) and for Coventry South (Mr Cunningham), my right hon. Friend the Member for Knowsley (Mr Howarth), the hon. Members for Luton North (Kelvin Hopkins), for Berwick-upon-Tweed (Mrs Trevelyan) and for Cleethorpes (Martin Vickers), and my hon. Friend and neighbour the Member for Huddersfield (Mr Sheerman). The research shows that only a small minority of people with autism feel that the condition is widely understood. The work of the charities and other organisations in this area is commendable, and hon. Members who have spoken today have done their bit to raise awareness. Will the Minister tell us how the Government will do the same?

The testimonies that we have heard from Members this afternoon starkly show just how crucial it is that more is done on the issue. The power to make meaningful change is in the Government’s hands. I hope that they have listened and will act accordingly.