Oral Answers to Questions

Alistair Burt Excerpts

Tuesday 5th January 2016 Commons Chamber

[John Howell (Henley) (Con)]

1. What progress his Department has made on integrating and improving care provided outside hospitals.

[The Minister for Community and Social Care (Alistair Burt)]

Happy new year, Mr Speaker—and happy new year to the familiar faces opposite in the shadow Cabinet.

The Government are committed to transforming out-of-hospital care for everyone, in every community, by 2020. We have seen excellent progress in areas led by the integration pioneers such as Torbay and Greenwich. The Government remain fully committed to delivering integration through programmes such as the better care fund and the vanguards.

[John Howell]

Seventy per cent. of people would prefer to die in their own homes, yet we still allow 60% of people to die in hospital. This has to change, as it has in the Netherlands owing to the better social care provided outside hospitals. What message would the Minister give to clinical commissioning groups, such as mine, which are trying hard to bring this about and to integrate services?

[Alistair Burt]

I am grateful to my hon. Friend for raising this issue. We share his view: we want to see greater choice in end-of-life care so that people are able to be cared for and die in the place they choose and which is appropriate to their needs, whether that is a hospice, a hospital or their own home. The recent Choice review set out a vision of enabling greater choice at the end of life. I am working with NHS England to see how this can be best achieved and the Government expect to comment on that soon.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

The Health Secretary recently received a letter from a range of social care organisations and charities panning the spending review offer, saying it

“is not sufficient to resolve the care funding crisis”

and warning of an

“increasing number of older people”

without sufficient support,

“increasing pressure on the NHS.”

Will the Health Secretary finally admit that the offer in the autumn statement is just not good enough?

[Alistair Burt]

That social care was an important part of the Chancellor’s spending review was noted by all. Up to £2 billion will be available through the social care precept—that will be added to council tax—and there is a further £1.5 billion available by 2020, so all in all £3.5 billion will be available by 2020. We all know resources for social care are tight; that is why we need best practice everywhere to make the best use of resources, which many leading authorities are already doing.

[David Tredinnick (Bosworth) (Con)]

As my right hon. Friend considers integrating and improving care outside hospitals, will he discuss with the Secretary of State the medical system in the People’s Republic of China, which brings together western medicine, herbal medicine and acupuncture and which is bearing down on the demand for antibiotics? Before he responds to the Report on the Regulation of Herbal Medicines and Practitioners, will he look very carefully at dispensing arrangements for the small-scale assembly of herbal products, something the Government of the People’s Republic of China are very interested in?

[Alistair Burt]

Herbal products are slightly beyond my normal portfolio remit, but anything that assists in social care and makes people feel better and can add to their vitality and wellbeing is to be welcomed. I am sure in many local areas they are taken extremely seriously.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his response. Integration and improving care outside of hospitals is just one way we can revolutionise the health service. Will he outline any links his Department is exploring between reducing pressure on A&Es and using care provision outside of hospitals to facilitate reducing that pressure?

[Alistair Burt]

Absolutely, and a number of the pilots and pioneer programmes are doing just that. Early results from the living well programme in Penwith in Cornwall show a 49% reduction in non-elective admissions to hospital and a 36% reduction in emergency admissions to hospital. So the hon. Gentleman is right: better social care and better integration may have, and should have, an impact on hospital admissions and make sure people are receiving the most appropriate care in the most appropriate place.

[Kevin Foster (Torbay) (Con)]

I was pleased to hear the Minister’s reference to the integrated care organisation that is being created in my constituency. Given the increasing challenge of providing social care to those in the later stages of life, does he agree that this is a model that needs to be looked at, and will he give it as much support as he can?

[Alistair Burt]

Indeed; the ability to see how these pilot projects respond to the different demographics in different areas enables one area to learn from another. Torbay has come up frequently in this context, and I am pleased to be able to praise it again. While I am on my feet, I should also like to point out that many of those involved in adult social care were greatly affected by the recent flooding in the north of England and that they were looking after vulnerable people and working beyond the front line. That work was very important, and I am grateful to Ray James of the Association of Directors of Adult Social Services and to all those working in local authorities in the affected areas who contributed so well to looking after vulnerable people during that period.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

The report on the appalling failures at Southern Health NHS Foundation Trust highlighted the fact that more than 1,000 unexpected deaths of mental health and learning disability patients, many of which took place outside hospital, had not been investigated. Given that the Health Secretary did not allow the House an opportunity to scrutinise those findings before Christmas, will he or the Minister respond today to the widely held concern that the experience of that NHS trust is not an isolated one? Does the Minister agree that a national public investigation is now needed?

[Alistair Burt]

The hon. Lady is quite right. As my right hon. Friend the Health Secretary said in relation to that urgent question, this is a wider concern. That is why the Care Quality Commission is looking at the picture of what has happened nationally. These deaths have not been investigated appropriately in the past, and that must change. This Government are determined to change a range of things in relation to mental health and learning disabilities, and this is one area that has been forgotten for too long. It has now been brought to light, and work is being done by the Government.

[Scott Mann (North Cornwall) (Con)]

2. What progress his Department is making on increasing access to GP services.

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[The Minister for Community and Social Care (Alistair Burt)]

NHS England has assured local transformation plans that cover all clinical commissioning groups, ensuring that all the plans address the full spectrum of need for all children and young people, including looked-after children and those who have been sexually abused and/or exploited. Further thematic analysis is being carried out, and the results will be made available in March.

[Mr Speaker]

I think it is a case of wishing the hon. Gentleman a happy birthday.

[Philip Davies]

Thank you very much, Mr Speaker—much appreciated.

Children who have suffered the trauma of abuse may benefit from a range of therapeutic services, but there is a lack of consistent data about the number of abused children in need of therapeutic support and the number of services available. Can the Minister assure me that as part of plans to transform children’s mental health, the needs of abused children will be properly monitored and considered at every level?

[Alistair Burt]

I am grateful to my hon. Friend not only for his question but for previous questions in relation to this area and his obvious interest and concern about it. He is right. Nationally, the numbers of looked-after and abused children in the new prevalence survey—the first since 2004—would be relatively small. We have therefore asked the statisticians to look at different ways of assessing the data and the numbers so that we can address this issue. I hope to be able to report further on that later in the new year after I have had that meeting.

[Maria Caulfield (Lewes) (Con)]

13. What steps he plans to take to increase the availability of nurse training in the NHS.

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[Amanda Solloway (Derby North) (Con)]

14. What steps his Department is taking to involve young people in plans for improving children and young people’s mental health.

[The Minister for Community and Social Care (Alistair Burt)]

Clinical commissioning groups have produced local transformation plans to transform their local offer for children and young people’s mental health. Those plans were decided at local level in collaboration with children, young people and those who care for them. I remember my visit to Derby very well, and I am pleased to say that the NHS in that area has collaborated extremely well with young people to produce those plans.

[Amanda Solloway]

Last year the Derby youth council ran a consultation on the provision of mental health services in Derby, which highlighted the disparity of services among different trusts. What steps is the Minister taking to ensure that NHS trusts across the UK offer the same level of support for those suffering from mental health issues?

[Alistair Burt]

My hon. Friend is absolutely right. I have talked more than once at this Dispatch Box about the variation in performance on different issues around the country. Two or three things will help. On funding and resources, there is a better tracking system to make sure that money that goes into children and young persons’ mental health services will be spent appropriately. More money is going into that. Equally, a children and young persons’ mental health improvement team is working across the national health service to make sure that those variations are evened out so that good practice in the best areas becomes the practice of all.

[John Pugh (Southport) (LD)]

T1. If he will make a statement on his departmental responsibilities.

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[Jake Berry (Rossendale and Darwen) (Con)]

T8. Will my right hon. Friend join me in paying tribute to the first responders in Rossendale, who support the ambulance service by attending 999 calls to very serious cases, including one involving a friend of mine over Christmas? Will he in particular pay tribute to Brian Pickup, who is stepping down as team leader of the first responders after 11 years of unpaid public service?

[The Minister for Community and Social Care (Alistair Burt)]

I am delighted to do so. First responders have been a valued addition to the frontline of allied health professionals whom we can all support, and I am delighted to pay tribute to Brian for the work that he has done. I am sure that I speak for everyone in the House in saying a warm thank you to all those who have been part of the first responder scheme for the effort they have put in.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

T3. On too many occasions, children in my constituency who need to be admitted to a psychiatric in-patient bed have to wait for more than a day in accident and emergency before a tier 4 bed is found. Too often, available beds are outside London, and sometimes as far away as Nottingham, Glasgow or Southampton. How long does the Minister believe it is acceptable for a child to wait in A&E for a tier 4 child and adolescent mental health services in-patient bed to become available? Does he consider it acceptable for very unwell children to be sent such a long way from home for the treatment and care that they need?

[Alistair Burt]

In short, no. That is why there has been a drive to find more beds for children and young people who are having a serious crisis, but more support is also going into community services to prevent such crises in the first place. There will always be a need for some specialist beds to be available regionally or nationally, and not everything can be dealt with locally. Where people can be treated locally they should be, and we are working towards that.

[Mark Garnier (Wyre Forest) (Con)]

T10. The Worcestershire Acute Hospitals NHS Trust now finds itself in special measures, and today its chairman has resigned, largely as a result of an over-extensive and highly complex review of clinical services in the county that has so far failed to reach an agreed conclusion. Given the complexity of the review process, and the apparent impossibility of it reaching an agreed conclusion, what steps can the Government take to untie the Gordian knot that created that situation and help the trust to get back on a stable footing?

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[Nigel Adams (Selby and Ainsty) (Con)]

Nicole, the daughter of a constituent of mine, is currently suffering from mental health issues. She has been held in a transparent police cell overnight after self-harming, with drunks on either side, as there are no other facilities available near York. Clearly, police stations are not appropriate places for secure care. What is the Minister doing to ensure that adequate places are available locally, and that police, should they need to become involved, know how to provide a less traumatic experience for mental health patients?

[Alistair Burt]

My hon. Friend is absolutely right. There has been a 54% reduction in the use of police cells for mental health cases in the past three years. This is being improved by work of the local crisis care concordat. My right hon. Friend the Home Secretary will later this year introduce legislation to prevent children and young people from being held in police cells at all, but the use of police cells has gone down dramatically because of the use of the crisis care concordat. We will continue that process.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

T9. Yesterday, the Minister’s offer to junior doctors had still not dealt with the important issue of weekend working and appropriate compensation. As a result, doctors in England will be forced to strike and the Minister will have damaged the patient safety he claims to value. Instead of attacking consultants and junior doctors, will he follow the example of the Scottish Government and work with the medical profession to help the NHS face the challenges of increased demands and private finance initiative-induced deficits?

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[Helen Whately (Faversham and Mid Kent) (Con)]

My local mental health trust recently reduced its psychiatric liaison cover in A&E and is now considering the level for the coming year. Will my right hon. Friend provide an update on what the Government plan to do to ensure specialist mental health care in A&E?

[Alistair Burt]

The mental health taskforce will shortly bring forward its recommendations. It will be looking very carefully at what is provided in A&E. It was the subject of the crisis care concordat review by CQC earlier last year. I am looking specifically at psychiatric liaison, because I saw my hon. Friend’s written question very recently.

[Graham Jones (Hyndburn) (Lab)]

What demographic impact assessment has the Secretary of State’s Department made of the potential withdrawal from the European Union on health and social care, and the consequent result it would have on demands for its services?

Conception to Age 2: The First 1001 Days

Alistair Burt Excerpts

Thursday 17th December 2015 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

I thank all colleagues who have taken part in what is a most important debate, despite being the last of this parliamentary term. It was handled in an exemplary way by a number of colleagues who know a great deal about the subject. I commend them for the breadth of interest and knowledge they demonstrated. I thank my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) and the hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) for securing the debate through the Backbench Business Committee.

I also pay tribute, as others have done, to my hon. Friend the Member for South Northamptonshire (Andrea Leadsom). The debate has been graced by a number of colleagues who have taken a huge interest in these matters over a lengthy period, often in quiet rooms, talking to people about the issues, and raising them on the Floor of the House. That often unsung work has been vital in giving us the information we need, and a number of hon. Friends deserve real credit for it, not least my hon. Friend the Member for South Northamptonshire.

I congratulate the all-party group for conception to age two—the first 1001 days on relaunching its manifesto, “The 1001 Critical Days”. I popped into the relaunch for a short time, but a few weeks earlier I was grilled by the group’s members on my interest in the subject. I am not the Minister responsible for children’s health, but one of the issues is that a number of different agencies are involved, and I understand very well that one of the requirements of the manifesto is to ensure that they work more closely together. I also have a particular interest in perinatal mental health, which I will spend a bit of time speaking about today. I certainly take the manifesto’s point about the range of different actors that need to be involved, and the fact that we need to work together more effectively. I will be glad to take that message back to colleagues. I thank the all-party group for its work.

I note that the manifesto includes a foreword by Dame Sally Davies, the chief medical officer. I must say that that is probably at least three quarters of the work done. I do not know how many Members have met Sally Davies, but they should know that anything she gets behind tends to happen. I therefore congratulate the all-party group on securing her support, which will be vital.

At the manifesto’s core is a clear and simple message: the first 1001 days of a child’s life are a critical window of opportunity. Prevention and early intervention at that stage can improve outcomes and transform life chances. There is no dispute about that across the House; there is perhaps sadness and regret that more was not done in the past, but we must all start from where we are and make progress. Much work has been done in recent years, and colleagues have been generous in their praise of it, but clearly there is more to do, and the manifesto sets out some of the challenges.

I will make a few general remarks about the speeches we have heard, and then I will refer to others as I go through my speech. The hon. Member for Nottingham North (Mr Allen), who has spent a great deal of time working on early intervention, spoke about the philosophy that was needed to understand this, and he is absolutely right—few could have done more than he has to bring that forward. Some of these issues are cultural; they are about taking people out of silos. He was generous in his praise of my right hon. Friend the Member for Chingford and Woodford Green (Mr Duncan Smith). My right hon. Friend, and I suspect a number of other Members, was much inspired by the work of a chap called Bob Holman—a family worker and an academic who chose to live in Easterhouse in the centre of Glasgow—on social justice. Bob is unfortunately quite ill at present. I would like to send good wishes to him for the remarkable work he has done. He is well known for his work in Scotland, and in the United Kingdom. We are sorry that he is ill and send our best wishes to him and to Annette.

The hon. Members for Foyle (Mark Durkan) and for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) —thank you, John Ronald, who follows on me on Twitter, for helping me with the pronunciation—pointed out the importance of all of us in the British Isles looking to what work is done by one another. I will certainly inform ministerial colleagues of the work being done by the unit at Queen’s University Belfast, and that being done in Scotland, and we can follow that up. I said to the hon. Member for East Kilbride, Strathaven and Lesmahagow after her intervention on mental health that I am keen to see what is being done in other places, and I will follow that up as well. We do have parenting skills classes in England. That provision has been much boosted by the health visitor programme, and it is as vital to us as it is in Scotland. I am sure that others will be interested in looking further at that.

The manifesto highlights the importance of high-quality universal services from conception to age two, which have rightly been described as a “lynchpin”. For the vast majority of women and babies in England, NHS maternity services provide a positive experience and good-quality care. We also have a good, strong, evidence-based universal public health programme—the healthy child programme from pregnancy to age five—which is delivered by health visitors. To strengthen the delivery of the programme, we have increased the number of health visitors by almost 50% in the past four years—one of the most rapid workforce expansions in NHS history. At the same time, the landscape for delivering services to under-fives is changing. On 1 October, responsibility for commissioning nought-to-five public health services transferred to local authorities. This change is of course a challenge for services, but it also presents an opportunity for local leaders to commission and provide more joined-up services for young children and families, across health, education and social care, based on their understanding of local need.

The manifesto contains a number of recommendations, including one mentioned by my hon. Friend the Member for East Worthing and Shoreham about the attachment needs of families:

“Childminders, nurseries and childcare settings caring for under 2s must focus on the attachment needs of babies and infants, with OFSTED providing specific guidance on how this can be measured effectively.”

The Government absolutely agree. Personal, social and emotional development is one of the three prime areas of the early years foundation stage curriculum, and forming positive relationships, including with adults, is key to this. I will ensure that my colleagues in the Department look particularly closely at that recommendation, for attachment is absolutely crucial.

My hon. Friend the Member for Congleton (Fiona Bruce) and the hon. Member for Sefton Central (Bill Esterson) raised foetal alcohol issues. I commend them for the report that has, I think, come out today, following the inquiry by the all-party group on foetal alcohol spectrum disorder.

[Bill Esterson]

It is on its way to you.

[Alistair Burt]

Thank you very much.

It is too early to respond to the report, but I can say that it is really important. It is not like a Select Committee report, in that the Government do not have a duty to respond to it, but I would be extremely surprised if colleagues did not want to do so in due course, because it is so important. The official advice given is this:

“Our advice remains that women who are trying to conceive or are pregnant should avoid alcohol…If women choose to drink, to minimise the risk to the baby, they should not drink more than one to two units of alcohol once or twice a week and should not get drunk.”

We will shortly publish a consultation on the UK chief medical officer’s alcohol guidelines review. This will offer an opportunity to work with clinicians and other professionals to ensure that they are fully informed about the content of the guidelines and able to explain them to the women they care for and help them make informed choices on alcohol consumption. I would imagine that the substance of the inquiry ought to form part of that consultation and discussion. I think that the most important part of the advice is:

“Our advice remains that women who are trying to conceive or are pregnant should avoid alcohol”.

[Bill Esterson]

I am grateful to the Minister for those comments. The international examples given by his colleague the hon. Member for Congleton (Fiona Bruce) are very clear. The advice is not in two parts; it is a simple, single piece of advice: the best advice for mum and baby is to not drink at all. That is what happens around the world. The Minister has mentioned Dame Sally Davies. I hope she will agree with that and that that is what we will end up with, because it would make a massive difference.

[Alistair Burt]

I absolutely understand the hon. Gentleman’s point and hope that comes to pass. The Government will respond in due course.

I am the Minister with responsibility for mental health, which was raised by the right hon. Member for North Norfolk (Norman Lamb) in particular and the hon. Member for Ellesmere Port and Neston (Justin Madders).

[Mr Graham Allen]

If the Minister is moving on from foetal alcohol syndrome, it is important to put it on the record again that, as of a couple of weeks ago, the attempt to have a prevalence study on foetal alcohol syndrome has not found funding. It is really important that we try to understand the issue in depth and get some evidence on how widespread it is. Will the Minister please consider looking at the matter in the light of the report he will receive today?

[Alistair Burt]

I take the hon. Gentleman’s point and I will raise it with the appropriate Minister.

I have only a couple of minutes left, so I want to cover a couple of other things. Perinatal mental health is really important to me. I am disappointed that we have lost a couple of perinatal mother and baby units over the past few years. The increased emphasis on the issue is absolutely right. An NHS England working group is doing some intensive work on the £75 million that was committed in the last Budget to improve perinatal mental health services over the next five years. The report will come to me in the early weeks of January, as we look at the first tranche of that funding and then beyond. It is not as simple as just providing the units; it is about the community support care and everything else.

I was horrified by last week’s MBRRACE report. The association between people taking their own lives and perinatal mental health issues is very stark. Both of those issues are a very high priority for me. We will return in due course to say more about the detail. I offer the right hon. Member for North Norfolk that assurance.

[Norman Lamb]

Is the Minister satisfied that Health Education England recognises the importance of building the capacity of the workforce in order to ensure that there is a national service?

[Alistair Burt]

Yes, I am. HEE takes a real interest in the issue and I am sure there is more to be done. I take the right hon. Gentleman’s point about urgency as well. I am committed to doing more about that.

I am sure we will come back to this issue. This has been an excellent debate and I want to leave time for the mover of the motion to say a few words.

Madam Deputy Speaker, I wish you and all colleagues in the House a happy Christmas. If we conclude on a consensual note, with a debate as good as this one with very well informed people, the House is more than doing its job and is ready for a break.

Primary Care: Tottenham

Alistair Burt Excerpts

Wednesday 16th December 2015 Westminster Hall

[The Minister for Community and Social Care (Alistair Burt)]

It is a great pleasure to serve under your chairmanship, Sir Roger. I congratulate the right hon. Member for Tottenham (Mr Lammy) on securing the debate and thank him for his great courtesy in sending me and my officials a copy of his speech, which will enable me to address in my remarks some of his questions. I appreciate that.

I have some knowledge of the area. I was a member of Haringey Council between 1982 and 1984. I represented Archway ward at that time, and I was on the governing body of a school in Tottenham, so I have some feel for the area and I am grateful to it for giving me a start. I sat on benches opposite the right hon. Member for Islington North (Jeremy Corbyn). I think I am now the only Member of Parliament who served on the council with him, so we have a long-standing relationship and friendship. My time in Haringey taught me that it was an outer London borough with inner-London characteristics. I saw at that time colleagues on the Labour-run council wrestling with very difficult issues and problems and I have never forgotten that.

I will tackle some of the issues that the right hon. Member for Tottenham raised. I do not follow all his argument. Yes, there is some element of market principles in the NHS, but I think Mr Blair had something to do with that as well as us. If the right hon. Gentleman would really like to reorganise the national health service completely, I am keen to hear the proposals from those on the Labour Front Bench in relation to that. The structure that we have is one we will have for some time. It does not stop the work being done but enhances the localisation of making sure that the right things are done.

The right hon. Gentleman is right on poverty and inequality. The tragedy of the United Kingdom is that this is not a short-term issue. If we laid a map of poverty in Victorian Britain over a map of the United Kingdom today, we would find remarkable similarities between the two. The issue that all Governments wrestle with is that Government in, Government out, and socialism in or liberal capitalism in, we still have not cracked all the issues of inequality that we want to crack, and everyone has given it a lot of effort. We have to do better and we have to try different things. That is at the heart of some of the different things that the Government have been trying in health service reform. It is a process that will go on, but none of the issues that the right hon. Gentleman mentioned—length of life and inequality issues—has arisen in the past six years. They are long-standing issues that go back many years, which is why it is always essential to work at new initiatives and look for things that are different, to try to make a difference.

The right hon. Gentleman raised very straightforward and serious issues. All of us in the Chamber pay tribute to those who work in front-line services—the primary care staff. GPs are the first point of contact. Of course, it is not just GPs, but nurses, physiotherapists, occupational therapists, pharmacists and many other healthcare professionals who play a part in delivering high-quality care to patients in practices and in the community every day through the NHS.

In relation to the right hon. Gentleman’s constituency, he quoted extensively from the report by Healthwatch Haringey. Healthwatch nationally is actually funded and part-supported by Government. It is part of the monitoring process that the Government use. I understand that the report “GP Access in Tottenham Hale”, published in September 2014, highlighted a number of serious issues around accessing GP services in that part of his constituency. I thank Healthwatch and all associated with it for all the work that they do.

I am aware that access to GP services is a long-standing issue for local people. I am also aware that many local practices are single handed, and that some premises are not suited to the needs of primary care in 2015. Haringey clinical commissioning group has developed a primary care strategy to address just the sorts of issues that we have heard about this afternoon. That strategy focuses on encouraging practices to work together to run services more effectively, funding initiatives for practices to improve their appointment and triage systems, and encouraging a mix of professionals to work together as part of local networks: for example, welfare advisers, nurseries and healthcare assistants.

A number of practical steps to improve primary care locally have already been taken. In north-east Haringey, a shared call centre has been set up so that staff can respond to patients more quickly. In the south-east of the borough, GPs have worked together to provide telephone consultations for patients between 6.30 pm and 8 pm. In central and western areas of Haringey, Saturday clinics have been established. I understand that the CCG plans to have Saturday clinics and evening appointments available across the whole of Haringey in the new year. The CCG has funded two part-time practice managers to support practices that are struggling to meet access demands, and it is working to increase the number of practice nurses in Haringey through a recruitment programme to enable nurses from other settings to transfer into primary care.

On the important matter of GP premises, I am advised that the CCG and the local council have worked with NHS England to develop a strategic premises plan. The right hon. Gentleman is correct in saying that those have not been adequate, and he is right—as was Healthwatch—to draw attention to that. The premises plan was completed in July 2015. It highlights a shortfall in GP provision and in premises capacity in Haringey. The shortfall was particularly noted in Tottenham Hale and, to a lesser extent, in Northumberland Park. The plan makes a number of recommendations for short and medium-term action.

To date, NHS England London has appointed a local provider of temporary services for up to 6,000 patients in Tottenham Hale. It has also, together with Haringey CCG, sought national approval to use capital funding from NHS England’s primary care transformation fund to purchase the temporary premises. It has done so because capital funding is seen as representing best value and minimising annual revenue costs. As the right hon. Gentleman said, NHS England London and Haringey CCG hope to obtain approval for capital funding of the premises on 18 December, which is Friday of this week. However, I understand that, in the event of NHS England not agreeing to provide funds from the primary care transformation fund, the purchase of the premises will still be secured by means of revenue funding. NHS England will continue to work with Haringey CCG to find a permanent site for the practice in Tottenham Hale.

The new GP practice in Hale Village is due to open in the new year. It will start with a zero list and will have the capacity to register up to 7,000 new patients. That development has been welcomed by Healthwatch Haringey as representing a positive outcome for local residents. NHS England has also asked CCGs to set out an overarching estates strategy to ensure that estates resources are used across all of health and social care. As part of that work, Haringey CCG is looking closely at how else it can help to ensure that GP local premises are fit to meet current and future primary care needs, particularly in the light of the regeneration in Tottenham that the right hon. Gentleman mentioned and projected population growth in the area.

The right hon. Gentleman made clear his concerns about the levels of primary care funding in areas of relative deprivation. The national formula is currently under review, and the possibility of giving greater weight to deprivation is one factor being considered. I can reassure him about GPs’ salaries, however. GPs are not paid differential salaries in different areas. The capitation is different, because capitation covers things other than GPs’ salaries, but clearly it could not work if GPs in one area were deliberately paid less than those in another. That is not at the heart of the problem. When it comes to capitation and things that are considered in the national formula, deprivation is being considered as an issue to be looked at further.

Getting more people into primary care is really important. The Secretary of State set out in June details of a new deal for general practice, in line with the five-year forward view, recognising the pressures that GPs are under. We are training, and plan to train, more GPs. In the last Parliament, we increased the number of GPs working and training in the NHS by some 1,700, which is a 5% increase, but we still need more. That is why we have announced plans to increase the primary and community care workforce by at least 10,000 by 2020. That figure includes an estimated 5,000 more doctors working in general practice. That will be a 14% increase in the overall number of GPs working and training in the NHS.

We have established some work to try to reduce the level of workload. Having visited a number of practices in urban deprived areas and others, I can say that there is very much a sense in some practices that GPs are worn down, that they are on a treadmill and that they are worried about bringing new people in. In others, however, sometimes not very far away, GPs are trying something different. They are working with the Prime Minister’s challenge fund pilots or the vanguard sites on different ways of providing their services. Such work can often be the trigger for more doctors being interested in coming into work.

There is a different side to the pressures on GPs. I am clear that, in practices that are very much under pressure, by reducing bureaucracy and working with them to provide support, we can lift them up from their present difficulties. The transformation fund of £1 billion that will be used to improve premises over the next few years will also make a difference, and it will ensure that premises are fit for purpose when it comes to what we want from primary care in future.

If we are to address the health inequalities that the right hon. Gentleman rightly mentioned at the beginning of his speech, it will be essential for that work to be carried out in the most deprived parts of the country, as in any other. It has been interesting to visit those pilots and look at what has been done. The reorganisation of resources in primary care and the establishment of more contacts with those who provide allied health professional services—relieving some of the pressure on GPs—can have a marked impact, as can the closer integration between the NHS and local authority services in the same area.

We are all trying to lever up standards and deal with the inequalities, as the right hon. Gentleman has mentioned. There are plans, proposals, new initiatives and new ideas, and some of those are demonstrated in London. I hope some of the practices involved, particularly the new ones, will take those opportunities to do something different where they are and try to meet the challenges that they face.

To conclude, as well as the investment in primary care that I have detailed, a number of approaches are making a difference to access to GP services: longer opening hours, to increase the sense of access; better use of telecare and health apps, which are really working and beginning to have an impact on populations that are much more used than some others to using such things; and more innovative ways to access services by video call, email or telephone. Schemes are integrating services in order to offer a single point of contact to co-ordinate patient services across health and social care. Some 2,500 practices have taken part in the access fund schemes, covering more than 18 million patients, so a third of the country will have benefited from improved access to primary care by March 2016. We want to continue to roll out such initiatives to 2020, investing in primary care and making sure that investment is made in the areas where most work is needed. It is clear from what the right hon. Gentleman said that Haringey is right up there.

[Mr Lammy]

Can the Minister get NHS England to take a greater interest, at leadership level, in Tottenham?

[Alistair Burt]

I will ask exactly that. I do not doubt that it is doing that already. Clearly, the right hon. Gentleman needs to be reassured, and we shall do so.

[Sir Roger Gale (in the Chair)]

Order.

Motion lapsed (Standing Order No. 10(6)).

Mental Health

Alistair Burt Excerpts

Wednesday 9th December 2015 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

I thank the hon. Member for Worsley and Eccles South (Barbara Keeley) for her remarks. I thank colleagues for a remarkable debate, to which I shall return in a few moments.

Less than a week after being appointed, I made a visit to the Maudsley hospital in south London. I met a parent who had an eight-year-old little girl and told me of her two-year struggle in her home county some 200 miles away to find information on what would be best for her daughter—until, by her own efforts and through the internet, she had hit upon the Maudsley. On the same visit, however, I met a team working in primary schools to introduce children to mental health difficulties, giving them the understanding that just as they would look after one of their classmates who took a tumble in the playground and grazed their knee, they would look after a friend with a hurt mind.

I went to Derby and sat round a table for a meeting organised by my hon. Friend the Member for Derby North (Amanda Solloway). I met and was inspired by Sarah Eley, who had set up Borderline Arts to promote awareness and combat stigma against borderline personality disorder, from which she suffers and about which she is up front with great bravery. At the same time, I heard once again a familiar refrain from those around the table and from mental health sufferers in too many places, especially at crisis times—that “no one listened to me”. That is how it is with mental health issues in this country—a pattern of light and shade, good news and bad.

So I welcome this debate, which has given us such an opportunity to raise a number of the issues that reflect that light and shade—issues raised in powerful and personal speeches that reveal the depth of pain that mental ill health can cause. Through those expressions we can provide a sense of the urgency and purpose with which Parliament as a whole now addresses and will continue to address such matters. There is a sense that progress is being made—and I mean real progress, not “political-speak” progress—in areas ranging from therapy to crisis care. There is, however, still too much variation in the delivery of services; there are areas of unmet need; there is much more to do. More than ever before, though, there is a belief that those of us here are listening and acting on what we are hearing.

I cannot cover everything in the time available, and I will answer by letter colleagues who raised specific questions. Let me say that we heard powerful speeches, often about local issues, from my hon. Friend the Member for Worcester (Mr Walker), the hon. Member for Rochdale (Simon Danczuk), the right hon. Member for Exeter (Mr Bradshaw), my hon. Friend the Member for Erewash (Maggie Throup), the hon. Members for Livingston (Hannah Bardell) and for Salford and Eccles (Rebecca Long Bailey), my hon. Friend the Member for Norwich North (Chloe Smith) and the hon. Members for Norwich South (Clive Lewis) and for Bootle (Peter Dowd).

I am grateful to the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who represents the Scottish National party, for offering her support for a consensual process. I look forward to visiting Scotland to see what is going on there, as I think there is much that we can share. I greatly valued the hon. Lady’s contribution.

Strong personal statements were made by colleagues who know about these things, and I particularly thank the hon. Members for North Durham (Mr Jones) and for Manchester, Withington (Jeff Smith), as well as my hon. Friend the Member for Bath (Ben Howlett). The hon. Member for Edmonton (Kate Osamor) bravely raised the issue of recent ethnic minority issues in mental health. That needed to be raised, and I am very pleased that she did so. We do not concentrate nearly enough on that issue, and I am sure I will come back to her on that.

The right hon. Member for North Norfolk (Norman Lamb), who grappled with these difficulties himself so well and is so well regarded, spoke of the matters that he wanted to be dealt with more urgently than had been the case since he left office. I assure him again that we will do that.

I can tell the hon. Member for York Central (Rachael Maskell) and my hon. Friend the Member for York Outer (Julian Sturdy) that a letter is on the way to them. It will not give the hon. Lady quite the assurance that she wants in regard to the inquiry that she requested, but it will move matters on a little further. She knows that my door is open, and, indeed, I shall be happy to see both Members whenever they wish.

My hon. Friends the Members for Bracknell (Dr Lee) and for Henley (John Howell) raised the issue of mental health in the law and justice system. That is sometimes another less regarded area, but, as my hon. Friends pointed out, mental health issues matter there as well.

My right hon. Friend the Member for North Somerset (Dr Fox), my hon. Friends the Members for Plymouth, Moor View (Johnny Mercer) and for South Cambridgeshire (Heidi Allen), the hon. Member for Ashton-under-Lyne (Angela Rayner) and my hon. Friend the Member for Lewes (Maria Caulfield) raised the important issue of suicide. I take that issue extremely seriously, and I think that we have not done nearly enough to deal with it. I shall say something about my ambition in that regard towards the end of my speech.

The concept of parity of esteem was also mentioned, and Members wanted to know where it was in the mandate. The new NHS England mandate will be published shortly, and it will refer to that concept.

This is an Opposition day debate, involving a motion and a vote. Just as it is the right of the Opposition to press the Government to do more, and to level criticism where it is due—and occasionally where it is not due—it is the duty of the Government to explain what they are doing, and, in this instance, to ask for the House’s support for our response to the mental health needs that were set out earlier by my right hon. Friend the Secretary of State. However, I do not want the message of today’s debate to be in our procedure and our vote. I want it to be in the speeches that we have heard, in the words that have been quoted from our constituents and others, in the recognition that our Parliament and its Members have “got it” in terms of mental health, and in our assurance that the progress that has been made by successive Governments over a number of years will not stop, but will be accelerated.

We will point to our world-leading IAPT programme, and to the work of Richard Layard and David Clark in that connection. We will point to the inspiration in our local areas for our crisis care concordat work, to the appointment of the first Minister for Education whose remit includes tackling mental health issues in schools, to the improvement in the diagnosis and treatment of dementia, and to our determination to see the £1.25 billion investment in children and young people’s services deliver a sea change in what were previously undervalued services.

However, I want more. I want our ambition and our vision, building on all that has been done so far, to be recognised as providing the world’s best mental health services, and I want us to be really close to that by 2020. I want to see the inevitability of suicide to be challenged and rejected as we do more to combat the scourge of too many suicides. I want a national campaign against loneliness and isolation, and the mobilisation of the millions in clubs, faith groups and associations around the country, to bring more people in, and to let no one go.

I want to see a step change in perinatal mental health recognition, and urgent work to improve the services involved. Like my hon. Friend the Member for Macclesfield (David Rutley), I want our children’s mental health—which is now at the mercy of a social media whose effects are as yet not fully calculated—to be protected by young people themselves through their own use of new technology and ingenuity, with the assistance of teachers and mentors everywhere. I want the mother whom I mentioned at the beginning of my speech to be reassured that others like her will know who to turn to quickly. I do not want anyone suffering from mental ill health ever again to feel that no one is listening.

Whether or not Members join my right hon. Friend and me in the Lobby this afternoon, I know that each and every one of us in the Chamber shares that vision and ambition, and I look forward to working with colleagues on both sides of the House to pursue it relentlessly.

Question put.

Cities and Local Government Devolution Bill [Lords]

Alistair Burt Excerpts

Monday 7th December 2015 Commons Chamber

[Mr Graham Allen]

I would like to comment on this group, which includes my own amendment 60. It is relevant to what the hon. Member for Altrincham and Sale West (Mr Brady) has talked about in moving his new clause 9. My anxiety is that the welcome devolution that is taking place—the precedent of devolving health powers to localities is particularly welcome—suggests something of “the Empire striking back”, with the Whitehall Leviathan seeking to place a caveat on the devolution of health powers. What is being set up is the ability of the Secretary of State to revoke health functions from the relevant local authority.

I fear that somebody in the Department of Health might not approve of a devolution proposal within a given area. Let us say that the cities of Nottingham or Manchester—or indeed anywhere represented by hon. Members in their places for this evening’s debate—wished to do something innovative and interesting on public health because it matched the demography in the area. What it might not match, however, is the view of people in the Department of Health. Such people might have a one-size-fits-all masterplan that they would like to impose on everybody.

My difficulty is that if we allow the Secretary of State to pull back to the centre any of these powers, there will be no safeguard in law to prevent that from happening. The Secretary of State could attempt to launch an effort at devolution, but we see again and again what can happen when the dead hand of Whitehall lies upon local government and the charitable and voluntary sectors. A year could be granted to get on with it, with a local authority either allowed to raise its own money or be given some money. If, however, the Department does not like it, it could be pulled up by the roots.

[The Minister for Community and Social Care (Alistair Burt)]

I should not be, but I am tempted to respond. If that is the hon. Gentleman’s concern, why should the Secretary of State sign the order agreeing the devolution in the first place if it does not fit in with his masterplan? If he is going to take back the powers in due course, why would he give them away in the first place?

[Mr Allen]

The Secretary of State does have the power to pull back those experiments and those efforts at devolution. That is why I am bringing forward my proposal. If the Secretary of State is not concerned, he would have no worry about the ability of an independent panel to say, “Hang on—give these guys the amount of time they need to experiment” rather than have to deliver to a Whitehall timetable. That amounts to a contradiction in terms: devolution on the one hand, with the Secretary of State pulling things back into the centre on the other hand. My proposal—which I am sure the Minister can understand—is for the establishment of an independent panel, which would not consist of the Secretary of State and his advisers, but would include representatives of local government where the devolution was taking place and representatives of the national health service. That would enable the medical side to be looked at effectively, and separately from the Secretary of State. It would end the constant process that has driven devolution: the interference of Whitehall, often in the very short term, because someone somewhere in the Department of Health—some unknown person—does not like what is being done in the locality.

--- Later in debate ---

I am seeking to create an obstacle—it may be a flimsy barrier, but perhaps the mouse can squeak at the steamroller—to prevent this aspect of devolution from disappearing once again into the black hole of Whitehall, given the power of Whitehall and the massive centre of gravity that it constitutes in our tremendously over-centralised political system.

[Alistair Burt]

I am happy to respond to this short debate dealing with new clause 9, tabled by my hon. Friend the Member for Altrincham and Sale West (Mr Brady), amendment 60—to which the hon. Member for Nottingham North (Mr Allen) has just spoken—new clause 12, tabled by the hon. Member for Hemsworth (Jon Trickett), and the Government’s three technical amendments.

New clause 9 would amend secondary legislation to require that each constituent part of a combined authority should be consulted on any major healthcare reorganisation in its area, as well as the combined authority’s being consulted. Each constituent local authority would be able to refer any such reorganisation to the Secretary of State, without such a referral having to be made by the combined authority.

As my hon. Friend knows, proposals for reconfiguration must currently meet the Government's four tests for service change: support from local GP commissioners, clarity on the clinical evidence base, robust patient and public engagement, and support for patient choice. At present, any local authority has the right and, indeed, the responsibility to raise issues about a reconfiguration. My understanding is that that right remains. I take my hon. Friend’s point about its having been given to the combined authority, but, because I do not know about the relationships between the local authorities in question, I do not know whether the combined authority would at any stage reserve the right back to itself if it wished to do so. In the meantime, however, I have one safeguard, and perhaps another, to mention to him. This also applies to the hon. Member for Nottingham North, because it is part of the same thing.

The Secretary of State is only going to accept a recommendation for devolution if it is in the best interests of health in the area and if it will improve health outcomes. He must do so by order. There is nothing in the Bill that requires an authority to take on a national health service function. Authorities can do so if they so wish, but the Secretary of State must be able to see a clear outcome, and he retains his duties and responsibilities for ensuring that the NHS mandate is maintained and that all his statutory duties and responsibilities are observed. The Secretary of State is not going to sign an order, therefore, if he does not think that the health outcomes for the area will be improved. The Secretary of State is entitled to put in the order what he wishes. That order is then debated in the House and has to be passed as an order.

It would be possible for the Secretary of State to include in the order the fact that the individual authorities that make up a combined authority have the right to make representations to him about any reconfiguration. I can give my hon. Friend the Member for Altrincham and Sale West that assurance, and if we find that the legislation is not as I believe it to be, which is that it has retained that right for the local authority, an order in relation to his local authority will contain that safeguard.

I also offer this to my hon. Friend: if he will consider withdrawing the new clause, we will check, before the matter goes before the House of Lords again, to see whether the legislation is as I believe it is, because if it is, the new clause will not be necessary; but if it is not as I believe it to be, the safeguard—the double assurance—will be included in the order and the present Secretary of State would intend to deliver on it.

[Mr Brady]

My right hon. Friend is seeking to be very helpful. The difficulty that exists is that the safeguards he proposes apply at the moment of devolution. My concern is that a reconfiguration might happen when a power has been devolved, which might not be in the interests of one of the constituent parts of a conurbation. What can be done at that point is what is crucial.

[Alistair Burt]

At that point, the order that the Secretary of State has signed to allow the devolution in the first place will allow the authority to make a representation to that effect. The order does not just apply to the moment of devolution; it applies to the substance of the devolution, which is the exercise of the health powers the combined authority will have taken on. In respect of a reconfiguration that takes place under the combined authority, the order will safeguard the right of the local authority individually to make representations to the Secretary of State. It is guaranteed not just at the point of devolution, but in the exercise of powers under devolution.

[Mr Brady]

Might I press my right hon. Friend a little further? I am avoiding being too specific about the Healthier Together proposals for obvious reasons, but in the event that those proposals were to be set aside this week and new reorganisation proposals were to be brought forward, can he give me an absolute assurance that, either under the existing legislation or measures he would introduce in the House of Lords, the individual local authority would retain the freedom to refer any reorganisation to the Secretary of State? If he can do that, I would be satisfied.

[Alistair Burt]

I believe that that assurance is present in existing legislation. If it is not, we will make sure in the House of Lords that it is. I would also query why my hon. Friend’s local authority has given up this right in the first place to the combined authority, because it if wants to retain that right, perhaps it might want to take it back from the combined authority.

--- Later in debate ---

[Mr Deputy Speaker]

Unfortunately it is me that makes the decisions—we could do this over two days—but I would have thought the Minister had at least some indication.

[Alistair Burt]

I rest my case with my hon. Friend: I believe that legislation currently provides the reassurance that he seeks. However, I undertake that, before the matter is concluded in the House of Lords, we will ensure that that assurance is there so that he is covered. He is absolutely right to make sure that his local authority has the opportunity to make representations when it needs to. I am sure that the legislation does that, but we will make doubly certain that it does.

[Mr Graham Allen]

It may well be that the current legislation covers this eventuality, but the Government’s amendment 34 makes it very clear that local government will not be consulted. If the hon. Member for Altrincham and Sale West (Mr Brady) would like quickly to peruse that amendment, he will see that local authorities will have no say whatever if devolved powers are taken back to the Department.

[Alistair Burt]

I will happily cover amendment 34 in a moment. Indeed, perhaps I should speak to that amendment before I turn to amendment 60, which has been tabled by the hon. Member for Nottingham North (Mr Allen), just to make it clear what amendment 34 is about.

Amendment 34 mirrors part of amendment 19 and amends clause 17 to provide that the requirements for combined authority and local authority consent do not apply to regulations revoking previous transfers of health service functions under clause 16. Proposed new subsections 1E and 1F, which amendment 19 would add to section 105A to be inserted by clause 7 into the Local Democracy, Economic Development and Construction Act 2009, also have the same effect in relation to health functions transfers under section 105A which are revoked.

This means that in the event that it becomes appropriate to restore NHS functions in a local area to NHS bodies, this can be achieved without the need for consent of the combined authority and local authorities concerned. This reflects the fundamental principles for health devolution, as reflected in clause 18, which builds on an amendment moved by Lord Warner in the other place, that the key responsibilities for the Secretary of State for Health and the NHS remain unchanged in any devolution arrangements. We envisage using the powers to revoke only in those circumstances where it was clear that duties and standards such as those referenced in clause 18 were not being met and that revoking the transfer was the best option to achieve the necessary improvement in performance.

The Secretary of State’s ability to use this power supports the key principle, which this House has already agreed and which the House of Lords was also insistent on, that nothing about devolution settlements will impinge on his duties in respect of the national health service, including the duty to promote a comprehensive health service, to exercise his functions with a view to securing continuous improvement in the quality of services and to have regard to the NHS constitution. The other procedural requirements and preliminary conditions will continue to apply, such as the requirement that the Minister making the regulations must consider that the instrument is likely to lead to an improvement in the exercise of the functions concerned, and that Parliament must approve the secondary legislation.

Let me explain in straightforward terms what this is about. The House has already agreed that it wants to retain the national health service, even if NHS functions are devolved to local authorities. That means that the duties of the Secretary of State in relation to the NHS remain absolute. As I said earlier, if the Secretary of State is to sign off these powers to commission services to a local authority, he has to be sure that doing so is in the best interests of healthcare and that the quality of healthcare will be improved. Otherwise, he just will not do it. There will not be any consent involved, or anything else; he just will not do it. However, if he signs it off, it means that he is satisfied that there will be an improvement in the quality of healthcare. Should that fail—should the NHS functions transferred to a new authority fail—it is the Secretary of State’s duty to take those powers back, because he is responsible for the delivery of NHS standards. If he cannot be satisfied, he is going to have to take these powers back. In the circumstances, it is possible that local authorities might disagree and want to challenge that, but his duties are absolute. That is why the requirement for consent is coming out. We are talking about a circumstance that nobody expects to happen. The Secretary of State is not going to devolve unless he is certain, but if he needs to take powers back to maintain his duties, he must have the power to do so. Even if he has to do so, the matter goes before the House, which makes up its mind on it. That is the basis of Government amendment 34 and the answer to amendment 60.

--- Later in debate ---

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

The interventions must be shorter, as I still have to get the Front Bencher in.

[Alistair Burt]

The hon. Gentleman is coming at this from the wrong point of view. He is coming at it from the point of view that the Secretary of State is deliberately pushing something towards an authority, but he is not—the authorities are asking him for something. He would not be doing that unless authorities came to him and said, “We want to do this.” The Secretary of State would not agree unless he thought it was in the best interests of healthcare, because it is not his personal judgment but his duty. If those functions are not performed properly, his ultimate duty, which the House has already agreed, must be to take the powers back. The hon. Gentleman is approaching it from the point of view that there is something malevolent about the Secretary of State which means he wants to challenge the authority. The duties he has, which are contained in statute and which the House says he must retain when NHS powers are devolved, are what impels the amendment, nothing else.

[Mr Allen]

rose—

[Alistair Burt]

I will give way one last time, but then I must finish dealing with the rest of the clauses.

[Mr Allen]

The Secretary of State may be doing the right thing—I am sure he would be, just as I am sure the local authority would think it was doing the right thing—but my amendment 60 and our new clause would allow there to be a local government representative and a medical NHS representative judging who is right in the decision about central power and local power. They, too, would make the right decision.

[Alistair Burt]

Let me turn to the independent panel idea in amendment 60, which the hon. Gentleman has tabled. The Bill provides an effective framework to support a more devolved, place-based approach to health and social care, while ensuring that there are appropriate safeguards in respect of the NHS and a clear line of accountability back to the Health Secretary. Our objectives for health devolution must be to improve the health and care outcomes for people residing in a particular local area. Clause 18 requires that where health functions are conferred by an order or regulations on a combined authority, provision must be made about standards and duties to be placed on that authority, including standards in the NHS constitution.

The Secretary of State needs to be satisfied that revoking the transfer would lead to an improvement of statutory functions in that local area. He is under the same duties if he revokes as he is when he grants the powers in the first place. The revocation would need to be debated and approved by both Houses of Parliament, and the Secretary of State would be required to make available to Parliament a report concerning his decision, including what representations had been made to him in the process. That demonstrates that the decision to revoke transfer regulations would be taken only as a consequence of in-depth consideration, as well as engagement with local organisations, and with the support of Parliament. For that reason, I resist the requirement to convene a panel to review the decision, which would not only be unnecessary, but could be burdensome and costly, and could lead to delays just at the time when swift action was required to address fundamental performance issues.

The amendment is not necessary. The Secretary of State, in the exercise of his powers, already has to do what the hon. Gentleman is asking, but the need to move sometimes at speed means he needs to retain the powers; this is therefore covered, there is accountability to Parliament and the Secretary of State has to say exactly why he is doing it. It is straightforward: either he has the power to deliver his duties, or he does not, and he can do it without convening an independent panel to second-guess him. It is his responsibility, and if he exercises those powers unreasonably, there is judicial review, which means that a local authority is doubly protected.

[Mr Allen]

If a local authority, which understands its own demography—it knows its people and its inner-city and rural areas—makes a decision on a public health matter, such as fluoridation or free dental checks for three-year-olds, and the centre does not like it, the Minister can pull back that power, which has been given in what is meant to be a devolution Bill.

[Alistair Burt]

It is not about the centre not liking the decision. The Secretary of State has statutory duties that Parliament has given him. He has to exercise his power both to grant and revoke power based on those duties, not because he likes or does not like a decision. It is that statutory duty for which he is responsible that is so important. The House of Lords pressed that matter, but the House of Commons has accepted it. It is the maintenance of those duties that is so important. Liking or disliking a decision does not come into it.

Let me make further progress on the other amendments that the Government wish to push through. Amendment 35 is a further amendment to clause 18, which applies valuable safeguards to local devolution of health functions, including where certain functions and duties should continue to be held nationally. The clause was inserted in the Bill by an amendment tabled by Lord Warner in the other place and was amended in Committee in the Commons to give further definition and clarity to support its valuable principles. Clause 18 provides that regulatory functions of national bodies held in respect of health services will not be available for transfer to a combined or local authority.

Amendment 35 makes it clear that, in addition to NHS England’s responsibilities for assurance and review of clinical commissioning groups, all its supervisory and oversight functions set out in chapter A2 of part 2 of the National Health Service Act 2006 are out of scope of a transfer order. These include functions relating to CCGs’ institutional and constitutional arrangements, including their establishment.

Briefly, amendments 46, 47, 48 and 49 amend schedule 4, which makes amendments to the 2006 Act to provide a wider menu of flexible, voluntary options for local bodies, including combined authorities, to work with each other and with NHS England in respect of health functions.

One of the amendments introduced by schedule 4 includes provision under proposed new section 13ZA of the 2006 Act for new “devolved arrangements”, whereby NHS England is able to delegate its functions to a group of local commissioners exercising them together, or to make arrangements to exercise its functions jointly with that group. The group of local partners must consist of at least one clinical commissioning group and at least one combined authority or local authority, and the delegates or partners must exercise the function jointly.

Amendments 46, 47 and 48 are minor and technical amendments, which make it clear that “devolved arrangements” may relate to one or more of NHS England’s functions.

New clause 12, which was tabled by the hon. Member for Hemsworth, says:

“The Secretary of State must, within 15 months of this Act being passed, publish a review of health services devolved under the provisions of this Act.”

The review must include an assessment of how standards have been maintained, particularly of the quality and outcomes delivered by the devolved health service.

Maintaining the integrity of the NHS standards and ensuring that there is clear accountability for quality of outcomes is a key objective, as reflected by a number of vital safeguards provided for by the Bill. An order to confer health functions on a combined authority can only be made if a proposal to do so satisfies the Secretary of State that such a transfer will lead to the improvement of statutory functions.

As the House has debated a number of times, the requirements to monitor and regulate the functions that have been devolved remain exactly the same as if they had been with the NHS. It is the Secretary of State’s responsibility to ensure that the quality of services devolved is of NHS quality. For that reason, a full formal review is not necessary. There will be constant review of the quality of work done locally, and putting a formal review in the legislation is therefore not necessary. It is inconceivable that the authority delivering the functions on behalf of the NHS would not keep up a full review and the quality of regulatory work and monitoring work ensures that a full review is carried out in any case.

I hope that the new clauses will not be pressed to a vote and that I have been able to satisfy the House about the functions that need to be retained by the Secretary of State. I hope that the technical amendments will also be agreed to.

[Liz McInnes]

I want to support new clause 12, although the Minister has made his case for turning it down. I think it is important that we build a review stage into the devolution of health simply because the implications of the Bill for the English NHS and social care system are not clear. The Bill regulates for important new powers to remove functions from NHS hospitals, commissioners and other bodies and to transfer them to the local regional authority. Depending on the implementation, interpretation and limits of the powers, such transfers might fundamentally reshape the health service in the years to come. We must ensure that the national health service stays national. We do not want a postcode lottery for healthcare.

Accountability and scrutiny remain crucial for a well-run national health service, delivering the best care it can for everyone no matter where they live. The Bill’s light-touch nature and the pace with which the agenda is moving leave a number of crucial and unresolved questions, some of which I would now like to ask. Will central and regional government argue over the responsibility for meeting population needs and making difficult decisions, such as those on whether to close hospitals or prop up overspending healthcare providers? What will happen to neighbouring areas?

Deals permissible under the Bill create the possibility of NHS funding melting into wider regional authority budgets, making ring-fencing or protecting impossible. Given the importance of healthcare spending as an issue, it needs clarity and scrutiny. Devolution to combined authorities under the Bill might actually have a centralising effect for many health and social care functions, taking power away from councils that represent smaller communities and the clinical commissioning groups that represent clinicians. Although that might be desirable in some cases, it is also important to consider how the positive developments brought to health and social care by these bodies can be preserved.

Clauses 7, 16 and 17 allowed the piecemeal transfer of health care commissioning responsibilities from clinical commissioning groups and NHS England to local government. I am concerned about the impact that will have on the NHS, especially as regards local variation in service levels, further allocation of resources and the cross-border impact of decisions. The Opposition believe that there should be a statutory duty on the Secretary of State for Health to secure and provide universal health care and that core national NHS standards should remain in place.

Mental Health: Out-of-Area Placements

Alistair Burt Excerpts

Thursday 3rd December 2015 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

We have been fortunate in having rather longer than we normally get for an Adjournment debate, and that has allowed the right hon. Gentleman to speak at greater length about some of the issues affecting the historical imbalance between mental and physical health, with particular emphasis on out-of-area mental health placements. I congratulate him on securing this debate, and I am delighted to respond to it.

I thank other hon. Members who have contributed to this debate, including the hon. Member for Ceredigion (Mr Williams), the right hon. Member for Carshalton and Wallington (Tom Brake), and my hon. Friends the Members for Torbay (Kevin Foster), and for North West Norfolk (Mr Bellingham). My hon. Friend the Member for Halesowen and Rowley Regis (James Morris), who chairs the all-party group on mental health, has dropped in as part of his responsibilities in the House, which I welcome. I also welcome the Whip, my hon. Friend the Member for Truro and Falmouth (Sarah Newton).

Before I come on to respond in more detail, let me make one or two general remarks. The right hon. Gentleman referred right at the beginning to the long-standing nature of some of these problems. These issues have not arisen in the past six months. They have been here—Government in, Government out—for some time. The coalition Government made huge strides in recognising the importance of mental health and drove forward some of the changes that needed to be made. It is certainly clear that part of my responsibilities now is to pick up on that and to build on it.

If I may just make reference to the right hon. Gentleman for a moment, I think his key achievements include: the expansion of psychological therapies; the reduction in the use of police cells for people experiencing a mental health crisis; introducing the first access and waiting time standards; and piloting the sense that there has to be parity of esteem. Those achievements absolutely underpinned what I came in to find in the Department. The intractable nature—or at least intractable up to now—of some of the problems has been graphically illustrated by the right hon. Gentleman’s passionate expression today of some of the things he was not able to do during his time as Minister. They set the baseline for what I hope to do. He asked for a personal commitment to drive forward the changes. Absolutely. The bar has been set quite high.

As the right hon. Gentleman and others have mentioned, what has puzzled me most since being in office is the variability of practice. How is it that in two areas side by side with exactly the same resources there will be one that has a set of procedures in place to ensure that good treatment is provided, while in another that is not the case? It is not always about resources, but management and leadership. I have been puzzled by why there is so much variability.

There is another puzzle that is very pertinent to what we are talking about today and to which the right hon. Gentleman referred: the perverse incentives in the system. Treatment costs are split between local authorities and the NHS. They seem to be based not on what is in the best interests of the patient, but on what suits the budget best. Now, none of us are naive. We all know this goes on. However, his description of the letter from his constituent, which I know about because I responded to him about it this week, illustrates the impact on the individual of decisions that people make for perverse incentive reasons—perhaps relating to budget, if that was one of the reasons. I am interested, as he is, in why there is such variability between areas. Some areas seem to have very few out-of-area places and others do not.

I hope to be able to deal with all the right hon. Gentleman’s questions, but before I do I want to put a few points on the record. The Government’s commitment is clear. We have given the NHS more money than ever before for mental health, with an increase to £11.7 billion last year. We have made it clear that local NHS services must follow our lead by increasing the amount they spend on mental health and making sure beds are always available. In the spending review and autumn statement, we announced an additional £600 million for mental health over the next five years to increase psychological therapies, crisis care and perinatal mental health. This reaffirms our commitment to achieving parity of esteem for mental and physical health.

In perinatal mental health services, for example, I want to ensure that women are able to access the right care at the right time, and close to home. I know that provision of specialist perinatal mental health services varies across the country. Some women have access to excellent care and support, while there are serious gaps in provision in other areas. Women suffering the most severe and complex perinatal mental illnesses need access to specialist in-patient mother and baby units, and good quality community support care in the area where they live. There are currently 15 units in England—I understand that the number fell by a couple from between 2010 and 2015—but NICE estimates there is a UK shortfall of between 60 to 80 mother and baby unit beds. That is why we announced in the March Budget that the Government would invest an additional £75 million over the next five years, £15 million a year, to support women suffering from mental ill health in the perinatal period. NHS England is leading a work programme to ensure that this extra money is spent in the right way at the right time and in the right places. The right hon. Gentleman’s work has made that base. I give him as much assurance as I can that in the areas where he set the work in progress, that work is going to continue; in places where the work is going slowly, it will be challenged; and in places where he was not able to make the progress he wanted to make, I set myself the challenge to do just that. I do not have to worry an awful lot about freedom of information requests because I will get the questions from him and from a number of hon. Friends and colleagues who have grasped how important this issue is.

Let me return to the source of the debate. I greatly appreciate the work that the right hon. Gentleman put in train earlier in the year with NHS England and mental health provider organisations to understand the pressures that lead to people being sent away from home for treatment that should be available locally. This has helped to provide a picture of the scale of the problem and to raise its profile. We know that the principle should always be for care close to home in the least restrictive setting. It is not acceptable for people to be travelling for miles when they are acutely unwell.

I know about the case that the right hon. Gentleman raised because I dealt with it this week, and I agree with him that some of the attitudes expressed by some of those responsible for people’s care are just not good enough. It cannot be acceptable and it cannot have been acceptable to listen too little to those who are in care or who are being cared for when they have made complaints about treatment. I am well aware of the problem—I am occasionally chased on Twitter about it—and I say to one or two of the groups that I am looking carefully at how to deal with it better. Sometimes people feel that they have not been listened to, and I suspect that the sort of example revealed in the right hon. Gentleman’s constituent’s letter might be rather more common than we think. Accordingly, I want to ensure that the inspection and regulation regime really picks things up. I know that there will sometimes be differences in opinion and that things will need to be clarified, but I do worry about the attitudes sometimes expressed, and I want to make sure that the Department has really got hold of ensuring that those sort of complaints are picked up and, whenever possible, really burrowed into to find out what might have gone on.

[Norman Lamb]

I appreciate the Minister’s reassurance. One of the issues highlighted in my constituent’s case was the fact that he was transported very late at night, arriving at about 1 am, and there was another person from Norfolk in the same unit that same week who was collected at 1 am from the unit to be brought back to Norfolk. This treats people like chattel; it does not treat them as human beings. Is the Minister prepared to highlight to the Care Quality Commission that it should investigate and explore that particular aspect—the transporting of people—because having to travel in a minibus with someone who does not talk to them for three hours, and arriving very late at night is simply outrageous?

--- Later in debate ---

[Alistair Burt]

Of course it is, and I share the right hon. Gentleman’s frustration. I write a lot of letters to colleagues who express concerns and I have to signpost them to the other organisations in the health sector that have responsibility for taking particular decisions. That is quite right, because local decisions ought to be local. Clinical commissioning groups or trusts need to be responsible and accountable for what they are doing. However, I have to tell the right hon. Gentleman that it is occasionally frustrating when I feel that I cannot pick up the phone and make my own inquiry. We cannot run a system in which Ministers arbitrarily pick up cases because they are the ones we know about; there has to be a structured system. When particular things come to light, I am looking at how to use my position and the authority of the Department to make sure that something has been properly gone into—even if it is somebody else’s statutory responsibility. We in this House who remain accountable for things should be able to make sure that those statutory groups, including the CCGs, have really got a grip. I am keen to pursue that.

[Mr Bellingham]

Does the Minister agree that there is something fundamentally unsatisfactory—and, indeed, wrong—about moving someone late at night unless it is absolutely necessary for medical and clinical reasons?

[Alistair Burt]

Yes. It seems very puzzling that that should be a regular practice, if it is. That should not be the case. Of course there are all sorts of different pressures on the system, and it would probably not be appropriate to say that it should never happen, but, in principle, people who are in a state of anxiety should be moved with the maximum care, at the time that is of greatest benefit to them and their health needs.

As I was saying, it is not acceptable for people to be travelling for miles when they are acutely unwell. It is also not acceptable for staff to be spending time phoning around to find beds for their patients.

Let me return briefly to the impact of social media. A couple of weeks ago, I read in a tweet from a frustrated doctor—I hope he will pick up on today’s debate—that on that particular day no bed had been available for a woman anywhere in England. Along with the hon. Member for Liverpool, Wavertree (Luciana Berger), who had raised the matter with me, I made inquiries and found that that was not technically true; beds were available. The response from the doctor was, “You may be technically correct, Minister, but it is very difficult to find them”, and the results of my inquiries suggest that that is true. We need to establish a better system of identifying beds that may be available, because that too is part of the problem. People should not be spending time looking for beds. I have an idea about that, which I shall mention later in my speech.

I had to tell the clinician that I did not think that, technically, what he had said was true. However, I recognise that for those who are in the business of finding beds for people, it should not be as difficult as it appears to be, and I want to establish what we can do to help.

We know that the need to place people out of area, away from home, family, friends and networks, is a “warning sign” of a mental health system that is under pressure, and we know that no one wants to spend scarce resources on sending people out of area. However, we cannot look at out-of-area treatments in isolation, because they are part of the mental health acute care pathway as a whole. I welcome the interim report of Nigel Crisp’s commission, which was set up to review the provision of acute in-patient psychiatric care for adults, and I look forward to reading his final report and recommendations early in the new year.

Lord Crisp’s interim report made it clear that—as I am sure the right hon. Member for North Norfolk knows—the situation is more complex than a shortage of beds. We know that there has been a long-term reduction in the number of psychiatric beds in England, but the report suggests that in many areas there would be enough beds if improvements were made to other parts of the system and integrated, community-based services were commissioned. That very point has been made this afternoon in relation to the variability of practice. The report also made it clear that the so-called bed crisis, or admissions crisis, is a problem of discharges and alternatives to admission, and can be dealt with only through changes in services and in the management of the whole system.

As the right hon. Gentleman pointed out, that can be done, as has been demonstrated in a number of local areas. Sheffield, for example, has almost entirely eliminated adult acute out-of-area treatments, and has reduced average bed occupancy to 75% by redesigning the local system, That has included investing in intensive community treatment, and working in partnership with housing. In the right hon. Gentleman’s own constituency, Norfolk and Suffolk NHS Foundation Trust has begun to reduce its historical problem of out-of-area treatments through a combination of investing in more acute adult beds and working with commissioners to develop community and crisis resolution services.

I understand that the independent Mental Health Taskforce has spent some time discussing these issues. I hope that its report, which will be published in the new year, will be an important driver for improving mental health services over the next five years, and will address many of the key issues raised in Lord Crisp’s interim report.

[Norman Lamb]

Can the Minister confirm the likely publication date of the taskforce’s report? I think he said it would be in the new year, but can he give me his best estimate of a specific date? Also, I would like to acknowledge that the Norfolk and Suffolk NHS Foundation Trust has made real progress. The number of people being sent out of area has come down significantly, and that needs to be recognised.

[Alistair Burt]

I am grateful for the right hon. Gentleman’s comment about his trust. My understanding is that the taskforce’s report will come through very shortly. I am not sure whether it will be done this month or by the start of next month, but it is imminent.

I appreciated the right hon. Gentleman’s kind remarks about the Secretary of State for Health. The Secretary of State has already agreed an action plan to tackle out-of-area treatments for adult acute in-patient care. Where out-of-area treatments are a problem, local areas will be asked to put in place clear action plans demonstrating how they can reduce out-of-area treatments, in the best interests of patients, during the course of 2016-17. Now I come to one of the right hon. Gentleman’s challenges. Building on this, I intend to go further and put in place a national ambition to address out-of-area treatments. I will do this in consideration of the Crisp commission and the taskforce report, and I will communicate details of this ambition by the end of March 2016—that is, by the start of the next financial year.

I want to wait and see what Lord Crisp and the Mental Health Taskforce say and then consider exactly what the ambition should be. Should it be an ambition for complete elimination? Should it provide a much tighter variation? I want to see those reports before I set the ambition, but I will set it, and the targets, and come back to the right hon. Gentleman and the House before the end of March next year to communicate those decisions. I hope that helps.

I also commend the right hon. Gentleman for recognising the need to improve mental health crisis care and for launching the mental health crisis care concordat, which we have discussed today. This debate has given us an opportunity to talk about variation in practice, the quality of street triage and the fact that we can do different things in different areas. I saw the work being done in Bradford, for example, where the mental health practitioner is located in the control room, as opposed to being on the street. The galvanising of local groups to work together by giving them the responsibility of doing the job has been absolutely vital. The way in which we are reducing the number of people detained in police cells is a clear example of how that process is working.

The Government are equally committed to reducing out-of-area mental health treatment for children and young people. In-patient child and adolescent mental health services—CAMHS—admission is a relative rare event. At any one time, however, there are approximately 1,300 children and young people from England in CAMHS in-patient services. Services themselves are usually subdivided into different specialties, such as eating disorder units or low secure units. That means that it is highly challenging to provide complex care in all areas, and on occasion, some children and young people may need to be referred for specialist treatment at a distance from their home, if that is in the best interests of their care. However, we are committed to ensuring that that is as rare an event as possible, and much progress has already been made.

[Norman Lamb]

One of the recommendations from the taskforce that NHS England established to look at tier 4 services, at the number of beds required across the system and at the variability of the services was that treatment should always be contained within a region —in other words, that no child who lives in the south-west should ever go out of the south-west for treatment. I cannot remember where the child from Torbay had to go—

[Norman Lamb]

Indeed. Is the Minister going to stick to that? Is he going to ensure that that is the objective, and will he monitor it to ensure that he meets it?

[Alistair Burt]

As much as possible, absolutely, yes. There will be occasions when very specialised treatment has to be given, and that will on occasion be outside the area. But apart from that, absolutely. We want to provide care that is appropriate to people in a place that is closest to where they are, as much as possible.

In 2014, NHS England published the tier 4 CAMHS review. This found a relative shortages of beds in some regions, meaning that some children and young people had to travel long distances to access a bed, owing to an uneven distribution around the country. As the right hon. Gentleman knows, there was an immediate response to this: £7 million in additional funding, taking the total number of beds now to 1,440, the highest number there has ever been. In addition, NHS England has introduced new national protocols for referrals and discharge, and a new “live” bed monitoring system to make the best use of existing capacity. I am interested in whether that capacity has reference and relevance to the adult acute beds, and could it make the job of my friend the clinician doctor that bit easier?

But while these measures have helped in the short term, we want to build on this progress still further and ensure long-term, sustainable improvements. In January this year, NHS England commenced a comprehensive review of the procurement and commissioning of inpatient beds. The aim of this is to establish the long-term requirements for inpatient services and ensure quality, sustainable services are commissioned in the right place, based on population need.

It is not enough simply to provide more and more beds. In order to ensure that improvements are sustainable, we need to improve the community-based support we offer to children and young people. This is at the heart of the vision set out in “Future in mind”, and we are determined children and young people have easy access to the right support, from the right service, at the right time and as close to home as possible.

Key to achieving this vision are the local area transformation plans now being put in place. CCGs have been asked to work with NHS specialist commissioning teams responsible for inpatient services in the creation of these plans.

I have two final points. I have been interested in what data are available and what are not, and I answer a number of questions by saying, “The data for these are not collected centrally.” I am looking hard at each and every one of those questions, asking, “Are there occasions when we should be doing more on the data?” There is a lot still to do, but I entirely take the right hon. Gentleman’s point.

On data, we are looking at the limitations. The right hon. Gentleman was right to talk about the problems in getting this dataset right, but, again, I am on to that; it is essential, and I will take the challenge of driving and moving on that data.

On providers, the responsibility seems to come down to CCGs. It is unacceptable that private providers do not submit data. Some more have started submitting since the summer. It is the responsibility of CCGs, who have the contractual levers, and need to use them. That is not good enough; if we need this information, we need this information. I am going to look at whether the CCGs are using those contractual levers, and if not, why not. If they are not, and a sanction can be applied, we will apply the sanction. That information is necessary, and I am going to do this. The right hon. Gentleman is absolutely right on that.

On the principle in respect of determination, I will come back to the right hon. Gentleman by March next year and set out the national ambition. Do I commit to ending the practice completely? I do not know yet, because I want to get the result of the commission. It is right that it should be reduced to an absolute minimum. I want to know technically whether it is possible to eliminate it, or whether that would actually not do the job that is necessary. I want to see what the commission has to say.

Will I drive these changes? Yes, I will. Will all providers provide data? Yes, they will. Will I commit to the £1.25 billion? Yes, I will. I have said that enough times in enough places to make this a very difficult Government commitment to slip away from. It is over the course of the next five years, but I am happy to repeat that.

[Norman Lamb]

I am grateful to the Minister for his patience in allowing me to intervene again. I am conscious that there is a risk that the shortfall in the first year is made up in 2020 or something like that. Because of the principle of frontloading to invest in change, it would be incredibly helpful if we could get the commitment to make good the shortfall in 2016-17. Can he commit to doing that?

[Alistair Burt]

There are things I can do and things it is unwise to take a flyer on, standing at the Dispatch Box.

[Norman Lamb]

You can try.

[Alistair Burt]

I will try, but we need to make sure all the money is used sensibly. There are a lot of pressures on the system, and I am trying to be as bold as I can without being foolishly bold and saying things just for the sake of it. I understand the importance of this £1.25 billion. I have spoken about it a great deal; I want to see it all used. I am not responsible entirely for the timescale, but I understand the right hon. Gentleman’s point and I suspect it will come up in the Opposition day debate we have next year.

I will talk to the Secretary of State about the right hon. Gentleman’s last point about comprehensive maximum waiting times. I will see where we can go further and include it in a comprehensive letter to the right hon. Gentleman.

I hope that this has been helpful. I am delighted that we had extra time to cover the ground. I am pleased to take up the challenge to do some of the things that could not be done in the past few years, and I will do my best to live up to the expectations of the House, as expressed by a number of Members today.

Question put and agreed to.

NHS (Charitable Trusts Etc) Bill

Alistair Burt Excerpts

Wednesday 2nd December 2015 Public Bill Committees

[Wendy Morton (Aldridge-Brownhills) (Con)]

It is a privilege to serve under your chairmanship and have the benefit of your experience and guidance, Sir David. It is interesting to note that you successfully steered your own private Member’s Bill through the House and, like me, you were drawn fifth in the private Members’ ballot, which I hope is a good omen for Peter Pan and me.

My private Member’s Bill makes provision in relation to two main subjects. First, the Bill makes provision to remove the power of the Secretary of State for Health to appoint trustees to NHS bodies in England, and it makes amendments to primary legislation consequential on the removal of that power. That will fulfil a commitment made by the Government in 2014, following a consultation on the regulation of NHS charities begun in 2012. The Bill will give greater freedom to such charities for fundraising; it will reduce the burden of dual governance in the form of the Department of Health and the Charity Commission; and it will provide greater liability protection for trustees than enjoyed at present.

Secondly, the Bill makes provision to amend section 301 of and schedule 6 to the Copyright, Designs and Patents Act 1988 to transfer to Great Ormond Street Hospital Children’s Charity—Great Ormond Street hospital’s new independent charity—the royalty rights to J. M. Barrie’s “Peter Pan” play. Currently, the rights are conferred on special trustees appointed by the Secretary of State under NHS legislation.

I am happy to talk the Committee through the grouped clauses for the benefit of Members if that would be beneficial.

[The Minister for Community and Social Care (Alistair Burt)]

It is a great pleasure to serve under your chairmanship, Sir David, particularly in such happy circumstances. The Government welcome the Bill as a whole, and I will perhaps say something about that in my conclusion.

The Government support the provisions in clauses 1 and 2 and schedule 1 relating to the removal of the Secretary of State’s powers under the National Health Service Act 2006 to appoint special trustees in England and to appoint trustees to certain NHS bodies in England that can hold charitable property. The removal of those powers to appoint trustees, and the supplementary and consequential provisions made in these clauses and schedule 1, will deliver on a key Government commitment made in response to the review of the regulation and governance of NHS charities in 2014. Those powers are no longer considered necessary, as the Government committed to allowing NHS charities to become independent if they so choose. Those NHS charities that do not wish to become independent will remain governed by NHS legislation, with the NHS body holding the charitable body as a corporate trustee—meaning that the board of the NHS body acts as trustee of the property.

My hon. Friend has set out the effect of these provisions and the rationale behind them, and I do not propose to detain the Committee by repeating that detail. The Government support clauses 1 and 2, and schedule 1, standing part of the Bill.

[The Chair]

I listened carefully to what the hon. Member for Aldridge-Brownhills said and, while the Committee would love to hear her voice again, given that there has already been a Second Reading of the Bill, there seems to be a will in the Committee that our proceedings be dealt with swiftly.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clauses 2 to 6 ordered to stand part of the Bill.

Schedules 1 and 2 agreed to.

[Alistair Burt]

On a point of order, Sir David. May I beg the indulgence of the Committee for one moment to pay tribute to my hon. Friend the Member for Aldridge-Brownhills for this Bill, which will forever after be known as the “Peter Pan and Wendy Bill”?

As you quite rightly said, Sir David, because we spent some time debating the Bill on Second Reading, there was no reason to do so in Committee. However, I want to put it on record that the Bill will ensure that the rights, royalties and other remuneration in respect of “Peter Pan”, the play by J.M. Barrie, are to be conferred on the new, independent Great Ormond Street Hospital Children’s Charity. Indeed, dealing with the legislative changes that have been made was one of the points of the Bill. The contribution that J.M. Barrie’s play has made to Great Ormond Street hospital over the years is, of course, well known. It has been of immense benefit and provides the hospital with an opportunity for its stories to go beyond even the extraordinary work that it does for children, to be associated forever with Peter Pan.

Making this change in legislation, as proposed by my hon. Friend, was an important thing to do. It had to be done well, properly and quickly, and it has been. It is a wonderful coincidence that her name happens to be as it is, and that we have this opportunity to pass the “Peter Pan and Wendy Bill”. I am not quite sure what role I play: that morning I was both Tinker Bell and Captain Hook—later in the morning and for other reasons—so I have learned that lesson.

The provisions of the Bill also deliver on a Government commitment made in December 2014 to Baroness Blackstone in the other place, who wished to table an amendment to the Deregulation Bill, as it was, to deliver the same result. We pay due tribute to her for all her work.

All those connected with Great Ormond Street hospital should know that the whole House supports what it does. This is a nice thing that we are able to do today, but the contribution of “Peter Pan” has been immense. Nevertheless, we are all pleased to have played a small part in the history of both the hospital and the royalties of the play, and to have set my hon. Friend on course, within her first few months of being in Parliament, to pilot her own private Member’s Bill through the House. I am grateful to the whole Committee for its attendance today, to my hon. Friend, to you, Sir David, and to all our officials.

[Wendy Morton]

On a point of order, Sir David. The Minister has put things very succinctly. I would like to thank you, Sir David, for your excellent chairmanship, the Clerks of the Committee and my colleagues from all sides of the House. Today is a busy day in the House, so I really appreciate their giving up their time. I know that they have done so knowing how important the Bill is and what a big difference it will make, especially to Great Ormond Street hospital. Thank you all very much.

Junior Doctors Contract

Alistair Burt Excerpts

Friday 20th November 2015 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the negotiations for a new junior doctors contract.

[The Minister for Community and Social Care (Alistair Burt)]

Three years ago, negotiations began between the British Medical Association, NHS Employers and the Department of Health. They were based on a common view that the current contract—agreed in 2000, when junior doctors were working very long hours—was outdated and needed reform. Between December 2012 and October 2014, extensive and patient negotiations took place, with an agreed target date for implementation of August 2015.

The negotiations were abruptly terminated by the BMA’s unilateral withdrawal from them, without warning, in October 2014. That led to the independent and expert Doctors and Dentists Review Body being asked to take evidence on reform of the contract from all parties, including the BMA, and to make recommendations. That happened because of the unwillingness of the BMA to agree sensible changes to the contract, and allowed an independent expert body to recommend a way forward.

The DDRB report on the junior doctors contract, with 23 recommendations, was published in July. The Secretary of State then invited the BMA to participate in negotiations based on those independent recommendations. Unfortunately, the junior doctors committee of the BMA maintained its refusal to negotiate, even though the negotiations would be on the basis of an independent report to which it had had an input. Both the Secretary of State and NHS Employers have repeatedly invited the BMA to participate in negotiations. It was made clear that there was a great deal to agree on based on the DDRB recommendations.

We deeply regret that the BMA chose the path of confrontation, rather than negotiation. While we continued to try to persuade it to develop a new contract with us, it instead chose to campaign against the independent DDRB’s recommendations, including by issuing a calculator, which it subsequently withdrew, suggesting—wholly falsely—that junior doctors would lose 30% of their pay. Instead, the BMA issued demands, including a right of veto on any contract change. In effect, it asked us to ignore the DDRB’s recommendations, the heads of terms agreed back in 2013, and to start again.

Given the BMA’s refusal to engage and its wholly misleading statements about the impact of a new contract, NHS Employers issued a contract offer to junior doctors earlier this month. This offer has safety at its heart and strong contractual safeguards to ensure that no doctor is required to work more than 48 hours a week on average, and it gives junior doctors the right to a work review when they believe hours are being exceeded. It reduces the maximum hours that a doctor can work in any week from 91 to 72 hours. It pays doctors an 11% higher basic pay rate, according to the hours that they work, including additional payments for unsocial hours. It reduces the number of consecutive nights that can be worked to four and of long days to five, ending the week of nights.

The hon. Member for Lewisham East (Heidi Alexander) has called for the parties to go to ACAS. The Secretary of State is not ruling out conciliation. We have always been willing to talk. The Government have repeatedly appealed to the BMA to return to the negotiating table, and that offer is still open. We believe that talks, not strikes, are best for patients and for junior doctors. The Secretary of State has said that talks can take place without preconditions, other than that an agreement should be within the pay envelope. However, the Government reserve the right to make changes to contracts if no progress is made on the issues preventing a truly seven-day NHS, as promised in the manifesto and endorsed by the British people at the last election.

It is regrettable that junior doctors have voted for industrial action, which will put patients at risk and see between 50,000 and 60,000 operations cancelled or delayed each day. I therefore call on the hon. Lady to join the Government in calling on the BMA, as it prepares for unprecedented strike action, to come back to the table for talks about the new contract for junior doctors. The Government remain firmly of the view that a strike by junior doctors is entirely avoidable, and we call on the BMA to do all it can to avert any action that risks harm to the patients we all serve.

[Heidi Alexander]

The fact that we are in this situation today, with 98% of junior doctors having voted to take significant industrial action for the first time in 40 years, makes me angry and sad. I say that because it did not have to be this way. The truth is that if we had had a little less posturing and a little more conversation from the Health Secretary, this whole sorry episode could have been avoided.

Does the Minister agree that, over the next week, everything that can be done should be done to stop the three days of planned industrial action? He said that the Health Secretary does not rule out going to ACAS, so why did the Secretary of State appear to dismiss the idea of independent mediation yesterday? Does that seemingly flippant rejection of the need for independent mediators to prevent industrial action not show a casual disregard for patient safety?

The way in which the Health Secretary has handled the negotiations has been appalling. Does the Minister understand that negotiation by press release is not the way to conduct discussions, nor any way to run the NHS? Does he understand that junior doctors are particularly angry about the way in which the Health Secretary has repeatedly conflated the reform of the junior doctors contract with seven-day services? Junior doctors already work weekends and they already work nights. For the record, not a single junior doctor I have met during the past few months would not drop everything to respond to a major terrorism incident. To suggest otherwise is to insult their professionalism.

The fundamental question hanging over Ministers this morning is this: why continue this fight? Hospitals are heading for a £2 billion deficit this year, mental health services are in crisis and the NHS is facing its most difficult winter in a generation, so why on earth are this Government picking a fight with the very people who keep our NHS running? There are nine days left before the first day of planned industrial action. Let me say very clearly to the Minister this morning: it is now time to talk.

[Alistair Burt]

I agree with the hon. Lady that we do not need to be in this situation. Absolutely. That is the whole point. The Secretary of State has kept his door open all the time. In seeking to conclude this, after starting negotiations three and a half years ago, the door remains open. It is for the BMA to come through it and say that it wants to continue the negotiations that it abruptly left more than a year ago.

Can and should everything be done to avert the strikes? Yes, it should. It would help if Labour Front Benchers made an unequivocal statement that they do not support strike action by doctors. I await to see whether that will be forthcoming. In the meantime, the Secretary of State has said that he is perfectly prepared to go to conciliation, but conciliation usually comes after a process of negotiations has broken down. The whole point is that the negotiations have not even kicked off again. The point is that the Secretary of State has offered such an opportunity, based on recommendations made by the independent Doctors and Dentists Review Body. That committee has made independent recommendations, including on the basis of information provided by the BMA.

For the hon. Lady to talk about a challenge to safety ill becomes the party that presided over Mid Staffs. The point is that, since he took office, the Secretary of State has, quite plainly and to everybody’s knowledge, made safety in the NHS his prime consideration. He wants a seven-day NHS to recognise the issues that have arisen at weekends. He has never said that junior doctors do not work at weekends. Of course they do—they carry the biggest burden of hospital work at weekends—but to make sure that the NHS is completely safe at weekends, as he intends, it is essential to spread out the burden and the junior doctors contract is part of that process. The hon. Lady said that it should be up to the Secretary of State to make the next move on the negotiations. I say to her that the door to negotiations is always open, as the Secretary of State has made clear.

The hon. Lady raised the issue of patient safety and the comments of Professor Sir Bruce Keogh, who is responsible for doctors in relation to emergencies. It is his role, as the national medical director, to ensure that everyone is safe. He wrote to the BMA yesterday and said:

“I would reiterate to both sides that I believe the best way to ensure patient safety is for the planned action not to take place. I would strongly urge you, even at this late stage, to come back to the negotiating table.”

He stated that

“patient safety is of paramount importance.”

Sir Bruce Keogh’s point in relation to an emergency situation was that although no one doubts for a second that, should there be an emergency in this capital like the one in Paris, every available doctor and member of medical staff would report for work, if it took place on the day of a strike when they were not already in the hospitals in the numbers required, it would take them time to get in. That was his concern about patient safety and it is a reasonable one.

I say again that we await a suggestion from the hon. Lady that it is not right for junior doctors to take strike action and that she will support the Secretary of State in saying that it is time to return to negotiations. The Secretary of State has been patient and fair, and he is clear that this is about safety. Negotiations should be returned to as soon as possible, and it would help if everyone said so.

[Dr Tania Mathias (Twickenham) (Con)]

For the record, I did not vote in the ballot. I urge the Minister and the BMA to return to the negotiating table, but without any preconditions. I applaud the new calculator on the Department of Health website, which is very helpful. I would be surprised if my colleagues and the people I know went on strike. I cannot imagine it. Therefore, there is an opportunity to negotiate and, if that does not succeed, to go to ACAS.

[Alistair Burt]

My hon. Friend believes, rightly, that there should be negotiations. The Secretary of State has said that. He has also said that conciliation is possible if the negotiations break down. There are no preconditions, beyond what the Secretary of State has said about his right to ensure that a manifesto commitment is delivered. My hon. Friend is right about the calculator. The initial calculator was misleading, which may have swayed some people over a period of time. She is also right to recognise, as the chief medical officer said yesterday—[Interruption.] Perhaps the hon. Member for Worsley and Eccles South (Barbara Keeley) will listen to the chief medical officer, if not to me. She said:

“I recognise the strong feeling of junior doctors and will always support them as the future of the NHS, but the severity of the action the BMA proposes is a step too far. I urge junior doctors to think about the patients that will suffer and I ask the union to reconsider its approach.”

That is a very sensible position that I think we would all endorse.

[Yvonne Fovargue (Makerfield) (Lab)]

What evidence does the Minister have that reforming the junior doctors contract and having a seven-day NHS will make the NHS safer? Will he commit to publishing that evidence?

[Alistair Burt]

The evidence is there in what has been published about the details of the contract. It was published in the press because it was not possible to get it to the BMA as it was not negotiating. It includes an upper limit of working hours of 72 hours in a seven-day period, when it was previously 91; four consecutive night shifts instead of the current seven; five consecutive day shifts instead of the current 12; and greater flexibility over rosters. That is self-evidently safer than the existing system. One reason we are where we are is that the BMA and others recognise that the old contract does not deliver the safety that is necessary. Those sort of changes will make the contract safer. That is self-evident.

[Mr Jacob Rees-Mogg (North East Somerset) (Con)]

I wonder whether my right hon. Friend saw the report in yesterday’s Daily Mail that said that under the Conduct of Employment Agencies and Employment Businesses Regulations 2003, it would be illegal to take on locums in place of striking doctors. Does he agree that if that is true, the law should be changed?

--- Later in debate ---

[Alistair Burt]

The Department has not yet had a chance to examine that report, but I have seen it. This all goes to emphasise that we should not be where we are. This matter can be settled. The Secretary of State’s door has been open for negotiations all the time. There is no reason why the junior doctors committee should not walk through that door, begin negotiations and end the risk to patients that is involved in strike action.

[Nic Dakin (Scunthorpe) (Lab)]

Why not just go straight to ACAS? From my constituents’ point of view, something has broken down and it needs fixing. Why not just get on with it?

[Alistair Burt]

Because of what happened the last time an independent body looked at this matter. After the negotiations broke down before, the Secretary of State sent the matter to an independent body, the Doctors and Dentists Review Body. The BMA took part in that and made its representations, but when the independent body reported, the BMA still did not do anything. Those recommendations form the basis on which negotiation can take place. If those negotiations are not successful, that is when conciliation can happen. That is exactly what the Secretary of State has offered. I hope the hon. Gentleman will support that and try to ensure that strike action does not take place.

[Sir Peter Bottomley (Worthing West) (Con)]

It is quite clear that,

“Changes to contracts must be best for patients, fair for doctors and sustainable for the NHS.”

That, in effect, is what the Minister has been saying, but those words were said by Mark Porter of the BMA. If the problem is getting together to have discussions, may I suggest that instead of saying that the BMA should come to Ministers, Ministers announce that they are prepared to go to the BMA, discuss everything and hopefully come to a conclusion on everything? It seems to me that if the BMA has got itself stuck by proposing a strike that doctors do not want and that cannot be good for patients, the best thing is to say to it, “We will come and talk with you. Let’s get this settled.”

[Alistair Burt]

I thank my hon. Friend, but I do not think that the venue of direct negotiations is of any concern to the Secretary of State. What is important is that the body that represents junior hospital doctors should negotiate directly with the NHS, as has been on offer for some time, following the process that was going on for some three and a half years before it reached this state. My hon. Friend is right that direct negotiations should recommence immediately.

[Sarah Champion (Rotherham) (Lab)]

The Minister quoted Sir Bruce Keogh. Will he tell us what Sir Bruce said about ACAS?

[Alistair Burt]

Let me see what Sir Bruce Keogh said. [Interruption.] I did not write the letter, so I will have to look through it. He said:

“I would reiterate to both sides that I believe the best way to ensure patient safety is for the planned action not to take place. I would strongly urge you, even at this late stage, to come back to the negotiating table.”

As far as conciliation is concerned, I have made it entirely clear that the Secretary of State has not ruled it out. I cannot see ACAS mentioned in the particular letter that I am looking at. Sir Bruce Keogh said that there must be direct negotiations between those who know most about the matter. The Secretary of State has said that if that does not work, he is open to conciliation.

The Secretary of State has reviewed the contract, published the terms and dealt with the BMA, which said first that it was a pay issue, then that it was a safety issue and then that it was an issue about imposition. At each stage, it has moved the goalposts, whereas the Secretary of State has been open about what he wishes to see. It is now up to the negotiations. We all want negotiations to happen because nobody wants to see the withdrawal of junior doctors’ work and, I suspect, neither do they.

[Mr Christopher Chope (Christchurch) (Con)]

Is not the root problem that the NHS is a monopoly employer of junior doctors? If the veterinary profession can provide 24/7 care for sick animals, why cannot junior doctors provide the same for sick people?

[Alistair Burt]

As the House is well aware, the Commonwealth Fund said recently that the NHS was the best in the world. NHS staff, by implication, are the best in the world. They do an extraordinary job and junior hospital doctors do a fantastic job. Patient satisfaction is extremely high. We want that to continue. There is no reason to believe that NHS Employers, which is also calling for negotiations to continue and for the strike action not to take place, is not in full view of what staffing it needs to create an even safer health service. Its judgment is that the contract set out by the Secretary of State to be negotiated on provides the best basis for the employment of doctors in the health service.

[Wes Streeting (Ilford North) (Lab)]

The Minister’s statements, even this morning, imply that people have been misled by the BMA. How is it conceivable that 15 heads of royal colleges and 98% of junior doctors have been so badly misled that this unprecedented strike action has been proposed? Instead of patronising people, why will he not accept that trust has broken down, cut out the middle man and go straight to ACAS, so that there can be proper negotiations and a resolution to the dispute? People do not trust the Government.

[Alistair Burt]

I take the hon. Gentleman’s point. One example of why the Secretary of State believes that he is entitled to talk about misleading is that of the pay calculator that the BMA put on its website, which indicated that all doctors would suffer a 30% to 40% reduction in their salary, or something like that. The BMA was forced to take that calculator down when it realised that it did not reflect the truth. As we have seen, the Secretary of State has said that no doctor currently working legal hours will suffer a reduction in pay. There is an 11% pay increase on basic hours, and that is why he feels that there was an element of misleading. The hon. Gentleman is right about cutting out the middle man, which is why negotiations should restart. I am delighted that he supports that approach, and if that does not work, conciliation is there.

[Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)]

Does my right hon. Friend agree that the loss of some overtime pay currently earned by junior doctors who work more than 72 hours a week should be seen firmly in the context of the safety of patients being treated by exhausted medics, and the long-term health of our junior doctors?

[Alistair Burt]

My hon. Friend is right. One difficulty with this is getting through what has built up during the course of the dispute, and getting to the heart of this issue, which is shared by everyone. There is no doctor in the land who does not want to work in safe conditions or for their patients to be treated safely. There is no Member of Parliament who does not want safety to be at the heart of this, and no one from the royal colleges or in senior executive positions in the NHS wants to compromise on safety. That is why we need to cut the number of legal hours, and ensure that doctors cannot work the number of consecutive nights or long days that they can work currently. The contract was outdated and it needs to change, and that is why people should sit down together.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Members of the Public Accounts Committee hear repeated reports about the challenges of recruiting some of the very junior doctors who will go on strike. Not only is the Government’s game of brinkmanship causing problems with morale and patient safety, it could lead to a longer term crisis in the NHS as doctors choose not to work here. Will the Health Secretary just get on with it and get around the table? It is within his gift to get talks started again and avert this strike.

[Alistair Burt]

The hon. Lady speaks with great background knowledge on this issue. She is right to say that we should all just get on with it, but she is not right to say that it is within the Secretary of State’s gift—if it was, we would not be where we are. The Secretary of State wants a negotiation based on independent recommendations and on three and a half years of work, which is not an unreasonable position. The hon. Lady’s view that this issue should be settled in a way that means negotiations continue and the strike does not happen is correct.

[Christopher Pincher (Tamworth) (Con)]

Does my right hon. Friend agree that, just as we would feel unsafe as passengers if we got on to an aeroplane that did not have a co-pilot—because not enough co-pilots work or are fit to work at the weekend—similarly we should feel unsafe because of the weekend effect in the NHS? Reasonable reform to fix that, agreed by the BMA, is necessary.

[Alistair Burt]

My hon. Friend makes a fair point. The current contract is simply not fair. It incentivises junior doctors to work long, unsafe hours, and around 500 doctors work outside legal limits at more than 91 hours a week. Safety has always been at the heart of the reasons for wanting to change the contract. People thought that the existing contract was unsafe as far back as 2008 when the BMA recognised that it did not do the job it was designed to do, and this issue has lasted from then to where we are today. One can reasonably ask what else the Secretary of State can do beyond publicising what he is doing, continuing to talk, keeping the door open, and wanting to ensure direct negotiations.

[Clive Lewis (Norwich South) (Lab)]

When the NHS is facing a winter crisis, why have the Government decided to pick a fight with the very people who will get it through that crisis?

[Alistair Burt]

The Secretary of State has not picked a fight. Three and a half years of negotiation on a new contract, publicising the offer, and being willing for negotiations—which he did not withdraw from—to restart, is a funny definition of picking a fight.

[Tom Pursglove (Corby) (Con)]

I thank the Minister for coming to the House to set out the Government’s position, and I impress on him the concern felt by my constituents about this strike. Does he agree that our constituents expect everybody to get around the negotiating table to try to sort this out, and for Members of this House to advocate that approach? That is the responsible thing to do.

[Alistair Burt]

My hon. Friend is right. In any quarter there will be puzzlement about support for action that will withdraw the work of junior doctors from their patients. We estimate that between 50,000 and 60,000 elective pieces of work are done every day in the NHS, and such work will inevitably be put off if doctors are not available. Those numbers are individual patients who will not get the care that they are looking for, and that a doctor would want and expect to give. There must be something better than this stand-off, which is why we appeal to the BMA to take up the Secretary of State’s offer and come back to negotiations.

[Anna Turley (Redcar) (Lab/Co-op)]

Given the crisis in morale in the NHS, have the Government estimated how many junior doctors might leave the NHS if they continue to impose this new contract on them?

[Alistair Burt]

No, I do not think it possible to make that sort of estimate or assessment, but the longer that doctors go on working under an unsafe contract that includes long hours, consecutive nights and long days, the more that will add to the pain and pressures of those working in the NHS. That is why a new contract with safer hours is a better option. Encouraging the BMA to return to negotiations and settle this issue, so that the threat of strike action is not hanging over us, is also important for morale.

[Philip Davies (Shipley) (Con)]

Does my right hon. Friend agree that this strike action is completely irresponsible and that such action is never an acceptable substitute for the kind of negotiations offered by the Secretary of State? Will he guarantee that the Government will not give in to this strike action, as that would be a terrible precedent for the Government to set?

[Alistair Burt]

My hon. Friend reflects well the feelings of Chief Medical Officer Professor Dame Sally Davies, who urged junior doctors to think again because the severity of the proposed action is a step too far. I find it difficult to conceive of a circumstance in which I would support a medical practitioner withdrawing their labour, and I hope that anyone would think that such things should not happen. The Secretary of State is doing everything he can to make clear the terms of the contract, the safety principles on which it is based, and to deal with misleading information. Even at this stage, he urges the BMA to come back and sit round the negotiating table and—I repeat—he has not ruled out conciliation after that.

[Andy Slaughter (Hammersmith) (Lab)]

I have hundreds of junior doctors in my constituency and I have spoken to many of them. They feel misled, but not by the BMA. Does the Minister understand that the anger that led to the 98% vote in favour of action is because junior doctors were told that they would get a pay rise, when many would get a pay cut? Disgracefully, they have been told that somehow they may be responsible for unnecessary deaths. The only way to restore trust now is independent arbitration. Will the Secretary of State agree to that without preconditions?

[Alistair Burt]

In an attempt to build on the opportunity of trust, after the BMA withdrew from negotiations last year, the work went to the independent Review Body on Doctors’ and Dentists’ Remuneration to urge an independent look at the issue and to get recommendations based on that independent review. When those recommendations appeared, the BMA still did not go into negotiations. That independent review has been sought, and the recommendations are there to talk about. When the hon. Gentleman spoke to junior doctors in his constituency—probably about misleading information that they may have had from the BMA—I hope he said clearly that he does not support strike action. It might be helpful if he told the House that that is what he said.

[Mrs Sheryll Murray (South East Cornwall) (Con)]

Many of my constituents will want to know if the Secretary of State is satisfied with the reassurances given by the BMA, which has refused to confirm it will do what is necessary to ensure patients are not hurt if the strike takes place.

[Alistair Burt]

I am quite sure I can say to my hon. Friend that no one ever wants to see anyone hurt, but, if there is a withdrawal of labour, it is not possible to say that certain procedures to relieve the discomfort of existing patients will take place. That is obviously the point of the action and why no one wishes to see it happen. I repeat that no doctor wishes to put a patient in a situation of harm. No Minister wants to see that and none of us here does. This process has been going on for three and a half years; there has been reference to independent people, recommendations that the BMA played a part in making and an open offer always to come back to negotiations. That does not seem an unreasonable position for the Secretary of State to take. That is why it should be backed by everyone sitting in the House today.

[Liz McInnes (Heywood and Middleton) (Lab)]

Negotiations have clearly reached an impasse, and winter pressures and a winter crisis in the NHS are looming. In the interests of patient safety, let us bring in ACAS. Talks have clearly stalled. If the Secretary of State is doing everything he can, will the Minister tell me where he is today?

[Alistair Burt]

The impasse was not created by the Secretary of State. The impasse was created by the BMA walking away from negotiations last year and not returning to negotiations after the recommendations of the independent body came through. That is not an impasse; that is one side deciding it does not want to take part. The Secretary of State’s response has been to say: keep the negotiations going, the door is always open.

The hon. Lady asks where the Secretary of State is today. He is working on the spending review plans for the support the NHS needs—a financial commitment the Labour party did not make at the general election. He is also working on contingency plans to make sure the NHS is safe if action takes place. I think that is pretty important work that he should be doing.

[Mr David Nuttall (Bury North) (Con)]

As the Minister previously represented my constituency for 14 years, does my right hon. Friend agree that when the Government have guaranteed no junior doctor working within legal limits will see their pay cut and that none will be required to work longer hours, the hardworking residents of Bury, Ramsbottom and Tottington will find it difficult to understand why strike action has been voted for?

[Alistair Burt]

My hon. Friend puts it very well. The people of Bury, Tottington and Ramsbottom have long experience of very good health services provided by excellent family doctors, as well as through good secondary medical care, not just in their own constituency but around and about. They will find it surprising that, with the guarantees given by the Secretary of State and mentioned by my hon. Friend, anyone should be contemplating strike action. Equally, they will find it incomprehensible that anyone from any political party is giving that strike action any support.

[Clive Efford (Eltham) (Lab)]

The Minister has just told us that the Secretary of State is across the road in his office and cannot be bothered to come here to account for an unprecedented strike by junior doctors in our national health service. That is an absolute disgrace! The Prime Minister has said that this is his miners’ strike. The doctors are prepared to go to arbitration. The public will know that if this strike goes ahead it will be because the Government will not go to arbitration. It will be the fault of the Secretary of State and the Prime Minister.

[Alistair Burt]

I think it is of primary importance for the Secretary of State to work on contingency plans this morning to make sure that we are all safe should there be a strike. That is the task he has been given by the action that has been taken. At the same time, he has repeated that he is open to negotiations to deal with the dispute. Rather than expressing anger, the hon. Gentleman should be expressing concern that a contract that makes an unsafe situation for doctors safer is not being backed more readily by those on the Opposition Front Bench, who should also be rejecting strike action.

[Craig Whittaker (Calder Valley) (Con)]

One group that has not been mentioned by the shadow Secretary of State is, of course, the patients. They receive a poor level of service at weekends, sometimes, sadly, with dire consequences. Will the Minister and the Secretary of State pledge to stand resolute in their commitment to improve weekend care, which, as Sir Bruce Keogh has said, is both a moral and clinical cause?

--- Later in debate ---

[Alistair Burt]

My hon. Friend gets to the heart of the matter. The clinical director of the NHS, Professor Sir Bruce Keogh, has said that the negotiations and the new contract are about safety and ensuring that a seven-day NHS is safe. They are about dealing with the issue of what happens at weekends, which is generally accepted to be a problem right across the medical world. The Secretary of State has put forward proposals to make people safer. They are backed by those in the NHS who are responsible for patient safety. The Secretary of State is perplexed, like everyone else, that the opportunity for negotiations is not being taken. That is what is needed to end the dispute. The Secretary of State has repeatedly made that clear.

[Rachael Maskell (York Central) (Lab/Co-op)]

The Secretary Of State was here last year in relation to the rest of the NHS staff. First, the DDRB is an advisory body to government, not a mediator, whereas ACAS is a mediator. Secondly, the dispute has provided an opportunity for both sides to step back and explore the issue with a blank sheet of paper. Will the Minister take that opportunity by entering into ACAS talks to explore the grounds for moving the dispute forward?

[Alistair Burt]

The hon. Lady’s commitment to the health service is very clear from her background and everything else. I ask her to recognise that the 2008 contract is outdated and challenging. By 2012, we reached the stage where people had to negotiate around it because it was unsafe. After three and a half years, we have got to where we are. The idea that the process should start again is just unfeasible and very unfair on doctors working long hours who need to be relieved of that. She talks about the DDRB as a mediator. No, it is not a mediator, but it does provide the independent basis for the recommendations, which the BMA took part in, on which to negotiate. Anyone concerned with patient safety would say the time for direct negotiations to restart and take up the Secretary of State’s offer is now.

[Kit Malthouse (North West Hampshire) (Con)]

Will the Minister remind the House how many entirely avoidable deaths occur at the weekend every year, so that Members can reflect on where their primary concern should lie?

[Alistair Burt]

Medical studies have demonstrated that there are a number of extra deaths at weekends. The disputes about that are intense, but the medical profession recognises that the absence of facilities, the absence of consultant cover on the level it ought to be at, and the absence of diagnostic tests and other things, make entry into the health service at the weekend less secure than it would be at other times of the week. It is very important to change that. That is what the public voted for at the general election and that is what they expect the Secretary of State to deliver. That that should be held up by an industrial dispute, essentially by a union digging its feet in and not taking the opportunity to negotiate, is unfortunate and bad news for the patients my hon. Friend referred to.

[Julie Cooper (Burnley) (Lab)]

Does the Minister accept that his insistence that junior doctors do not understand the conditions is deeply insulting to some of the most intelligent people in the country? Does he accept that this shabby and patronising treatment has led to a total breakdown in confidence in the Secretary of State, and that the only way forward is through ACAS, an independent body?

[Alistair Burt]

The Secretary of State has gone out of his way to seek to explain to doctors the basis of the contract, partly to deflect what was said about it originally by the BMA during the course of the industrial dispute. He will continue to do that. There is no doubt that we all value the work of junior doctors enormously and fully appreciate that they will be looking very hard at their conditions and everything else. Proper union representation is not delivered by a union that refuses to negotiate after three and a half years and after independent recommendations have been made. I urge the hon. Lady, who also has a valuable role in the NHS in relation to pharmacy and a deep interest in carers, to recognise what will happen for those 50,000 or 60,000 elective admissions that will not be able to take place, to think about those who will be involved and to continue to stress, as I know she will, that negotiations are the answer and that conciliation is available if they are not successful.

[Mr Philip Hollobone (Kettering) (Con)]

My constituents appreciate and value the work of junior doctors but are worried about the threat of strike action and its potential impact on patient treatment, and really would not want strike action to take place. For the benefit of my constituents, will the Minister tell the House what a typical junior doctor gets paid, whether that is likely to go up or down as a result of the contract and whether that typical junior doctor is likely to work more or fewer hours?

[Alistair Burt]

As we all know, the pay of a junior doctor varies. As the Secretary of State has made clear, there will be an 11% increase in basic pay; antisocial hours will still be covered; junior doctors will work fewer hours to ensure greater safety; and there will be more cover at the weekends to ensure that the burden junior doctors bear is more equally shared.

[Alex Cunningham (Stockton North) (Lab)]

As my hon. Friends have said, the absent Secretary of State has lost the confidence of almost everybody in the NHS, to the point that consultants, nurses and others support junior doctors in their fight against him. Morale is at an all-time low and the deficit runs into billions. How will Ministers get the NHS out of this very dark hole?

[Alistair Burt]

First, we will avoid the language of “fight” and the sense that this has become an industrial dispute, although there are elements of one, given how the BMA has behaved over the negotiations. As far as the public are concerned, however, this is not an industrial dispute: it concerns them very deeply. They appreciate and value their doctors, they want to have their treatment and they want to be safe. People must talk. The BMA, which withdrew arbitrarily from the negotiations, needs to take up the Secretary of State’s offer and start talking. We all know that ultimately this will be ended by talking. Whether that happens today or after 1 December is entirely up to the BMA. I repeat that the Secretary of State is right to be spending this morning dealing with the potential consequences of the action suggested, and I still wait to hear from any Opposition Member that they reject strike action by doctors.

[Robert Jenrick (Newark) (Con)]

When I was a lawyer, I was involved in a number of arbitrations and mediations. Does my right hon. Friend agree that it is highly unusual to go straight to arbitration or to ACAS if there have not been normal negotiations? In this case, as with all other negotiations, the best practice is for the parties to get around the table, and, if that fails, then to go to ACAS, but not to waste time in the interim.

[Alistair Burt]

My hon. Friend is absolutely right. As the Secretary of State has also made clear, we need to restart the negotiations, which are based on independent recommendations that the BMA looked for and took part in. As he says, the normal procedure is that, if the negotiations do not work, conciliation is available, as the Secretary of State has said. However, we cannot say negotiations have broken down if they are not taking place. I am sure that everyone in the Chamber wants the negotiations to continue and will urge junior doctors in their constituencies to recommend that the BMA restarts them immediately so that we can move this forward and end the threat of strikes that no one wants.

Male Suicide and International Men’s Day

Alistair Burt Excerpts

Thursday 19th November 2015 Westminster Hall

[The Minister for Community and Social Care (Alistair Burt)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. Do I have until half-past 4?

[Andrew Rosindell (in the Chair)]

Yes.

[Alistair Burt]

It is nice to get a reasonable amount of time without being shouted at for spending a bit of time on my feet. I am pleased to be in that position today.

[Philip Davies]

Me too.

[Alistair Burt]

And so is my hon. Friend.

I congratulate my hon. Friend on securing the debate and picking the topic. I thank CALM and the other charities that backed the debate, as well as all the colleagues who have spoken. I will come to everyone’s speech in due course, but a couple of colleagues—my hon. Friends the Members for Worcester (Mr Walker) and for Faversham and Mid Kent (Helen Whately)—have been in here for the whole time and have not made a speech. It is sometimes unusual for colleagues to sit and listen because they are interested in the debate, without feeling the need to contribute. We all appreciate their presence. I thank the hon. Member for Liverpool, Wavertree (Luciana Berger) for her comments, which I will come on to. I am only mildly annoyed that she said some of the things I wanted to say, but I can say them again. She either read my mind or had a look at my speech in advance.

I will spend the bulk of my remarks dealing with the suicide element of the debate, but I want to start with International Men’s Day because I recognise its significance and because it is why we are here. I have previously referred to my hon. Friend the Member for Shipley (Philip Davies) as “the Member for grit and oyster”, and he proved that to us once again today. This place is used to rough speeches. If any hon. Member wants to get anything done, say anything mildly controversial or challenge people, there is the chance that they will not only challenge but put some people’s noses out of joint in doing so. My hon. Friend is particularly good at both those things. We all have to take the rough with the smooth—we have all sat in the House of Commons and heard things from both sides that we do not like, but that is all part of it. That is what this place is about and we do not get things done by always going along with the status quo. Today, I heard from my hon. Friend things that I appreciated and things that that I thought were profoundly wrong.

I echo the feelings of those who said today that the purpose of International Men’s Day is to highlight the fact that gender equality is not a zero-sum game. It is not one thing to be gained at the disadvantage of another. The Department of Health’s approach to illnesses and conditions that might specifically affect men or women is that both deserve equal attention and neither is supported at the expense of the other. That is important. There is a strand of that argument on both sides that occasionally expresses itself in challenging ways. The hon. Member for York Central (Rachael Maskell) made brave reference to the row at the University of York to say that it is right and important to think about International Men’s Day, and for a university to censor it and prevent something from happening frankly looks rather silly. There is a lot of stuff in the United States at the moment about the prevention of free speech that is getting into that area. Academic institutions need to be particularly careful about ensuring that they do not shut down debate just because they do not like it. The hon. Lady was quite right to say what she did.

I think our debate today has emphasised that this is not a zero-sum game. There are particular issues on which men are specifically challenged. It is important that they are raised as issues in their own right and that it is not suggested that they have arisen because men have been disadvantaged by women. The underachievement of boys, particularly white, working-class boys, is a real issue that any of us would be concerned about. It does not need to be considered in the context of whether girls are doing better. It is just a fact for those boys, and what can we do about it? My hon. Friend the Member for Shipley was right about that.

The difficulties of family problems, separation and other such matters are particularly hard because the courts have as their primary objective the interests of the child. It is not about the interests of one party or the other; the paramount duty of the court is to have the interests of the child as the basis of what it does. How that is interpreted can be tough in contested situations. The pain felt by men who suffer separation is real. That is not to suggest that pain is not suffered by women in similar circumstances, but the facts are as they are and not to raise them and not to regard them as important would be to miss something. My hon. Friend was also right on that.

As for the issues my hon. Friend raised, some of his challenges to put things on the record were right and some of them, I feel, are wrong, but I am grateful to him for being prepared, as he always is, to confront issues that some others might shy away from. That is what this place is all about.

The hon. Member for Bridgend (Mrs Moon) made a quite excellent speech, again demonstrating to people outside this place that some colleagues here get so immersed in a subject that they really know their business and are able to speak authoritatively on it from years of experience and practice. The hon. Lady gave us an object lesson in that. She was right about language. When she said that the phrase we should use now is not “to commit suicide” but rather “to take one’s own life”, that was not designed to chastise my hon. Friend the Member for Shipley or anyone else. I had a conversation on this subject this week with Jonny Benjamin, who I am pleased to say is here and following the debate closely, because I had also used the former phrase. I did so because it is a common phrase, but it is right to challenge its use, because, exactly as the hon. Lady said, it suggests that to take one’s own life is similar to committing a crime. That was not my intention when I used the phrase and I understood entirely when Jonny suggested that the right wording is “taking one’s own life”. As the hon. Lady said, the feeling of loss experienced by affected families is considerable; that the language used could add to that a sense that their loved one did something criminal had not occurred to me, but on reflection I certainly understood it. Her remark was not meant to chastise anyone. I have corrected my way of looking at the matter as a result of what I was told. That is just sensible sensitivity.

The hon. Lady also mentioned the importance of coroners. In case Members do not know, because I did not know until I took on this job, I can tell them that coroners write to me if they feel that there is something in a case that has a wider governmental impact that relates to my Department. It is an important part of the process that coroners indicate when they feel that they have uncovered something in a particular case that has a wider implication and the Government can do something about. I appreciate the work of coroners and I want to take this opportunity to pay tribute to them and thank them for their thorough work in investigating deaths. It is much appreciated by Government.

My right hon. Friend the Member for Basingstoke (Mrs Miller) spoke about attitudes and the importance of gender equality not being zero-sum game, which I appreciate. I also recognise that my hon. Friend the Member for Shipley quite rightly challenged gender stereotypes in his contribution. My right hon. Friend the Member for Basingstoke mentioned parental leave, which is dealt with by the Department for Education, so we will get an answer to her on that. It is an issue, and it is strange, although perhaps not surprising, that it is handled similarly around Europe and around the world and that men do not take the opportunities that are given to them, but I suspect that that attitude may change over time. I will ensure that the Department for Education gives her an answer.

My right hon. Friend also made reference to living in a multi-generational household. I too live in such a household, but there are only two males in mine. All the rest are women. There is me and Mr Darcy, my darling daughter’s pug. We are the only two blokes in our house, and I depend on him for male company when I get home. Multi-generational houses can be a lot of fun, and I appreciate living in one very much.

I have mentioned the hon. Member for York Central challenging the University of York, but she also made reference to the issues at Bootham Park hospital, in which we are both well versed. I appreciate her work on this and that of my hon. Friend the Member for York Outer (Julian Sturdy). It is a particular situation that has arisen owing to the closure of that hospital because of the risks that she mentioned. It exemplifies the fact that work has to be done as swiftly as possible to replace the facilities that have been lost, and she is entirely right to say that the trust must have a good eye on where people are being treated now and how we can get back to local facilities as soon as possible. She knows that my door is open if she wants to see me when the moment is right, and we are pressing the local authorities to bring forward their plans.

My hon. Friend the Member for Bury North (Mr Nuttall)—may God continue to bless his constituency and all its wonderful people—spoke of the need to challenge stereotypes. He also made reference to something that I want to highlight because it is absolutely central to the problem—the hon. Member for Liverpool, Wavertree also mentioned it. This is what has been so wrong: the acceptance. My hon. Friend gave every impression of being outraged that we have sort of accepted that there is a figure for suicide in this country and a gap between men and women; we have sort of got used to it. He is right, and that will be at the heart of my remarks about how we deal with the matter. He has looked hard at the statistics to examine the gap between men and women and found that it is not only consistent, but widening. I thank him for his work.

I visited the constituency of my hon. Friend the Member for Derby North (Amanda Solloway) a few months ago to meet a group that she brought together to deal with a variety of mental health issues. She can take my kind regards back to them, because I found the meeting to be very instructive. In her contribution, she spoke of her difficult personal experience and made reference, as several colleagues did, to the issue of men’s feelings about their place in society, their feeling of inadequacy should they admit to any sense of failure, their worry about not fitting in, banter and everything else. That brought to my mind the relatively recent tragedy of Gary Speed, the Welsh international manager, and the impact it had on the sporting community that someone seemingly in full command of his life and everything else could have such things going on to lead him to do what he did. Along with other celebrities and colleagues in the House talking about such things, it is those occasions that wake people up and make us say, “This is a bigger problem than we realised.” That is probably one of the reasons why we are all present today.

My hon. Friend the Member for Derby North and the hon. Member for Liverpool, Wavertree referred to the good that can come from sports clubs, associations and so on. In my constituency I am lucky enough to be a member of a number of organisations—for example, I am president of Biggleswade athletic club and I regularly go to see matches at the football clubs. They are places where people can go, gather together and form associations. Bearing in mind the difficulties we have been discussing, including feelings of loneliness and isolation—for men in particular—the more people can be scooped up by and remain part of groups and organisations the better. They are a vital link. Perhaps women do such things differently from and better than men, but perhaps sports clubs and other such places can do something more for men. In that connection, I commend the work being done at Everton.

My hon. Friend the Member for Derby North commented on asking people how they are and getting the reply, “Fine.” Are they really fine? Most of us leave it at that, because we do not want to get involved in the conversation, but it is important to take such opportunities.

May I make another point? It is a bit personal, but not too harrowing as it turned out. It is an important point. Last year my old school magazine reached me and in the obituaries column was the name of one of my classmates, someone I had also been at university with. I was completely horrified. We had been in touch reasonably regularly over the years, but perhaps not for a year or so. I thought, “My friend has died and I don’t know anything about it.”

In actual fact, fortunately, it turned out to be a mistake. My immediate reaction had been to hit the last number I had for my friend to find out what had happened, and I had discovered that the magazine was wrong. It had shocked me, however, and I remember saying to him, “Do you know what this teaches me? We have a number of friends we haven’t been in touch with for a while—we don’t always know where they are—and we will end up seeing each other’s families at each other’s funerals.”

At my sort of advanced age, if we have not been in touch with friends for a bit—I have a lot of school friends I remember well, even if I have not spoken to them for a while—we might simply miss something. Again, I think blokes do such things worse than women. If it were not for my wife keeping up with friends using Facebook and so on, my social life would be much worse. That is something for men to think about. If we have not been in touch with friends for a bit, we should do it this weekend.

The hon. Member for Caithness, Sutherland and Easter Ross (Dr Monaghan) made reference to Scotland’s suicide strategy, and I was pleased to hear about it. The strategy goes back a long time, to 2002, so it is a long-term strategy to combat the brutal fact that the suicide rate is higher in Scotland than in the rest of the United Kingdom. Any lessons to be learned from a falling rate are important. It is right to focus on what might work.

My hon. Friend the Member for Telford (Lucy Allan), too, talked about the underachievement of boys at school and the particular issues in her constituency. She mentioned Twitter—she need not be worried about being attacked on it, because she has nothing to worry about—and I will speak about social media later. The importance of her remarks, however, was in talking about the issues.

Although the hon. Member for Heywood and Middleton (Liz McInnes) did not make a speech as such, she intervened with particular pertinence, as she always does on such occasions. It is good to see her in her place and taking a strong interest in the debate throughout.

I have a little more to say, given the time and the opportunity. I hope to be pertinent. I want to put on the record some of my own thoughts on the subject—although the hon. Member for Liverpool, Wavertree has anticipated some of my views. I want to see the ambition of our society and of the Government changed in relation to the issue of suicide. Fundamentally, I want our position to be that we challenge the inevitability of suicide. As far as our statistics are concerned, our rates are mid-range for societies such as ours, but that is not good enough.

Do we need to know more? How do our strategies compare with those of others? Have we identified the right drivers, and are our local and national strategies flexible and dynamic enough to respond? Why, in a world where gender equality is encouraged as the norm, must we speak specifically about men because this affects men more than women?

Since I have been in office, I have been much moved by those I have met in relation to suicide. I have met those who help in prevention and counselling, those who work clinically, those who campaign and, most of all, those who have been touched by the tragedy of suicide in some way. I am fortunate. I have not personally been affected through the loss of a close friend or a family member, but I have known others more tangentially who have. I have met people whose children have taken their own lives, and others who have come close to it themselves.

The other day I met Jonny Benjamin, as I said, whose story of having been persuaded against suicide by a stranger on a bridge led to his extraordinary efforts years later to find, successfully, the man who saved him. He is taking a close interest in the debate today. He spends much of his time taking his story, and the issues surrounding it, out there to help others. Other people around the country are also doing such things—I commend their work, and I deeply appreciate what Jonny is doing. The shock and emptiness left by suicide is excruciating to behold, hard to listen to and desperate to feel.

We have a new challenge. What must we do to have the best suicide prevention strategy in the world? To be mid-range is no longer good enough for any of us. With that in mind, I assure the House that mental health is a key priority of the Government, and I set our work in that context. The hon. Member for Liverpool, Wavertree raised that issue. We want to do all we can to build on our momentum and to ensure that people get access to the services they need when they need them. We have done a certain amount towards fulfilling that commitment, and the hon. Lady was generous enough to praise one or two of the things that have been done.

Jonny Benjamin and others have done a great deal of work on making people more aware. His #FindMike campaign has captured many hearts and minds. We have legislated, for the first time, for parity of esteem between mental and physical health, through the Health and Social Care Act 2012. We were the first Government to include access and waiting times for mental health. Last year we gave the NHS more money than ever before for mental health services, with an increase to £11.7 billion, and we have invested more than £120 million to introduce waiting times standards for the first time.

I am conscious that when I say such things, people say, “Well, not in our area.” There is an issue with how the national money appears in local clinical commissioning groups, but we are on to it—there will be better monitoring this year, and we have made it clear that CCGs must use a proportionate amount of an increase that they receive for mental health services. We are watching out for that, because it is a fair criticism.

We have also helped to extend the accessibility of successful talking therapies, in which field we are a world leader. We invested more than £400 million in recent years in the improving access to psychological therapies programme, to ensure access to talking therapies for those who need them. That has led to real improvements in the lives of people with anxiety and depression.

We have also invested more than £33 million in crisis care. We launched the crisis care concordat in 2014, and every local area now has in place a crisis care action plan to support people experiencing a mental health crisis to receive the right help and support when they need it. I welcome the Care Quality Commission report of some months ago, which we commissioned. Although it was a bit tough in places, it provided a sort of baseline for where we do well and where we can do better. I recognise that accident and emergency did not come out well, and we need to strengthen the relationships there. I noticed that police and ambulance services did well when responding to people in crisis, but best of all were the independent and voluntary agencies involved with such people.

There are lessons to be learned, such as the need to build on all that work through street triage and so on. I shall mention that later, but it has been one of the most interesting outcomes. The crisis care concordat is not found universally, and some local areas that I have visited might want a different approach, but there is no doubt that the concordat and what the Government have sought to achieve through it have made a real difference. It is certainly being monitored locally and nationally—the hon. Member for Liverpool, Wavertree is right about that—and I take a keen interest in it. I expect to see the CQC reports improve as times go on, because we want to look at the areas where concerns were found.

One of the ways in which we can better look after people with mental health issues is to recognise that they often have physical issues as well. Sometimes that has been poorly regarded in the past, and it can add to feelings of depression, isolation and not being considered and so play into the issues that we are discussing. It is important to address premature mortality in people with mental illness, and we have committed NHS England to doing so through the NHS mandate,. One way in which we can do that is to look at the person behind the illness and provide treatment and care for the whole person, so that we also address the physical health and social care needs of people with mental illness.

Let me say a brief word about children, because this starts early. I am particularly keen to ensure that we get the right support in place for young people. We have committed to invest an additional £1.25 billion over the life of the Parliament to improve the mental health and wellbeing of children and young people. We know that, for many people, mental illness can manifest itself early in life, and that the first experience of psychosis is often during adolescence. We are using that additional investment to improve awareness of mental health issues in our children and young people and to improve the information and support they receive at school on mental health and wellbeing.

There cannot be enough warning about the dangers of peer pressure and social media and the ways in which they can induce depression and harm among young people at a sensitive age. My hon. Friend the Member for Telford referred to Twitter, and we see that what young people face on Facebook and other social media can be immensely damaging. New technology is a boon, but it has risks and dangers and it is important to talk about that.

May I commend the report issued just this week by the British Youth Council’s youth select committee on young people’s mental health? It made this recommendation:

“Cyberbullying and sites which promote self-harm can have a significant impact on the mental health of young people. Hoping that children will simply stop using social networks is not a solution. We recommend that the Government should facilitate a roundtable for charities, technology companies, young people, and the Government to work together to find creative solutions needed to help young people stay safe online”.

The Government will issue a full response from both my Department and the Department for Education, but I commend the Youth Council and that select committee for the hard work they have put in, which will certainly be taken seriously.

About a month or so ago I got a letter from a young lady not in my constituency—she had written to the Prime Minister. She said:

“I am writing to you to express my ideas on new legislation…The topic I have chosen is extremely personal to me. I have lost a friend to suicide, and I feel as though if he had had a better understanding of his own illness, he would not have felt the need to take his own life. Not only this, I also feel that if the people surrounding him at his time of suffering were better educated on the topic, it would have helped him to feel less alone and unaccepted in today’s society.”

It was a good, brave letter and I hope to see the young lady at an event we are doing to combat stigma. She made the point that the problem starts early, and I am pleased that the Government now have a Minister in the Department for Education, the Under-Secretary of State for Education, my hon. Friend the Member for East Surrey (Mr Gyimah), who is devoted to mental health issues in schools. I appreciate his work. We are working together on that, which demonstrates the Government’s determination to work across Departments on these issues.

Finally—I appreciate the House’s indulgence—I turn to talk about suicide and men.

[Mr Robin Walker]

One issue that we have not touched on much in the debate is homelessness. Men are more likely to be homeless and sleep rough: I think that 87% of rough sleepers are men. A constituent of mine, Hugo Sugg, has talked about how sleeping rough drove him to thoughts of suicide. He now wants to campaign for a better attitude towards youth homelessness and how we encourage people to look at those who are suffering from homelessness, to give them a chance to turn their lives around, working with some of the fantastic charities in this space. Will the Minister join me in paying tribute to the charities and organisations that campaign on homelessness for the job they do in saving men from suicide?

[Alistair Burt]

My hon. Friend is absolutely right. Those connected with housing increasingly recognise the relationship between housing, mental health issues and suicide. When I was with my hon. Friend the Member for Derby North, I met the lady responsible for the YMCA there and its housing outreach, and she made some pertinent comments. Housing and homelessness are closely connected with the problem we are discussing, and I commend the constituent that my hon. Friend the Member for Worcester mentioned.

We know that men are often reluctant to talk about mental health problems. Many colleagues have referred to men’s attitudes, so I do not think that I need to labour that point. They are reluctant to seek help when they need it. In part, we know that is because some men feel that it may be a form of weakness. We need to assure men that that is not the case, as many colleagues have said. We, along with the charities Mind and Rethink Mental Illness, are seeking to reduce the stigma around mental illness through the Time to Change campaign.

Time to Change aims to empower people to challenge stigma and speak openly about their own mental health experiences—particularly men—and to change public attitudes towards those with mental health problems. The campaign has improved the attitudes of more than 2 million people. However, we know that men can be a particularly hard-to-reach group, and we are looking at further ways to improve reach in that area.

We know, tragically, what the outcome of unacknowledged mental ill health can be for a person. When someone bottles it up—that phrase was used in this Chamber today—their condition can worsen and may, in the worst cases, increase the risk of suicide. As I mentioned earlier, suicide rates in England remain low compared with in other European countries and other UK administrations, but I am concerned, as we all are, to see that rates have been rising in recent years. We anticipated that after the global financial crisis in 2008, and it has been seen in other countries around the world, as the hon. Member for York Central said. We know about that, but it is important that the inevitability of that does not go unchallenged. We can appreciate that such times bring extra pressures, but we need to ask what we can do when we know they are coming.

We know that the recent rise in suicide rates has been driven by an increase in male suicides, which is what led my hon. Friend the Member for Shipley to call for the debate in the first place. The threefold difference between male and female suicide rates has increased further, and we know that is a common experience in other countries around the world. It is right, therefore, that preventing suicide is dominated by efforts to prevent male suicide, but we recognise that this issue affects everyone. Whether men or women, boys or girls, when it happens it is an immense tragedy.

The greater risk of suicide among men is a complex issue. Many of the clinical and social risk factors for suicide are more common in men. Cultural expectations that men will be decisive and strong can make them more vulnerable to psychological factors associated with suicide, such as impulsiveness and humiliation. It is critical that, in addressing those issues, we provide information and support in a way that suits men’s needs and behaviours, and that we provide services that are appropriate for men, which may include moving away from traditional health settings.

What are we doing about it, and what will we do about it? We published the cross-Government suicide prevention strategy for England in 2012, and I am committed to implementing it by working across Government and with our partner organisations in the NHS and other sectors such as transport and the community, voluntary and charitable sectors. I will also be speaking to our partner organisations soon to discuss how we can review and strengthen the national suicide strategy. I want to make it clear that I see that as a dynamic and flexible instrument, not as something that we will do and then I will see how it works and make some decisions in years to come. We are looking at it now. It needs to be reviewed and refreshed now. It is an ongoing process, and I am committed to it.

The objectives of the strategy are to reduce suicide and to support the people bereaved or affected by it. It is right that men are identified in the strategy as a high-risk group for whom our suicide prevention activities should be and are prioritised. The strategy also recognises that schools, social care and the youth justice system have an important contribution to make in suicide prevention by promoting mental wellbeing and identifying underlying issues such as bullying, poor self-image and lack of self-esteem.

As well as having the strategy, we continue to provide financial support for the National Suicide Prevention Alliance, which brings together our key partners across Government and the community, voluntary and charitable sectors with expertise in suicide prevention. I am particularly pleased to say that many of the organisations that campaigned for the debate are members of the NSPA. It has been working with all those organisations to develop its strategy for delivering improvements in suicide prevention, which I welcome. My Department of Health officials are helping with that work. Those organisations make tremendous individual contributions to suicide prevention. The Campaign Against Living Miserably, which was prominent in calling for this debate, works tirelessly to target men specifically, and to support them, so that they feel able to talk about mental health issues. The Department of Health provided financial support to CALM in its early days, and I am proud to see how it has grown in size and profile.

I have had a variety of meetings on the issue since I took office; I have mentioned some already. I went to see the Samaritans bereavement centre in Peckham for World Suicide Prevention Day, and to mark the launch of a new initiative between Cruse Bereavement Care and the Samaritans. I met the British Transport police and saw the extraordinary work they do with Network Rail. I saw some of the triage work going on in Birmingham, including placing a mental health professional in the police control room 24 hours a day to help provide necessary information. I held a meeting on suicide prevention on 29 June, with researchers, the Samaritans, and representatives from areas such as Merseyside, the east of England and the south-west.

We have started to look at something called zero suicide. I have an interest in the concept and ambition of zero suicide. It was pioneered in Detroit by a college acquaintance of mine from many years ago, Ed Coffey, and I am very interested in his work. We can follow part of it, although some things are different in the States and will not be pertinent here. The whole concept of zero suicide—recognising that as an ambition, and challenging the inevitability of suicide—is really important and has very much grabbed my attention. Public Health England also recently published the refreshed “Help is at Hand” document, which provides compassionate support and information to people bereaved by suicide.

I will conclude by saying a little about research and data, as it will cover a number of issues raised by colleagues. One of the key drivers for improving our approach to suicide prevention is investing in research and data. I want us to lead the world in suicide prevention research, and to be at the forefront of service delivery, using the best knowledge and information to provide the best care. We have invested over £1.5 million in suicide and self-harm prevention research since bringing in the national suicide prevention strategy, to inform and target our strategy for reducing suicide rates. I will have a look at whether that is enough, and at what more needs to be done.

The hon. Member for Bridgend mentioned longitudinal studies. We are committed to carrying on the work on that. We have provided the Multicentre Study of Self-harm in England with £300,000 this year. I will very much bear in mind the opportunities that there might be for us to do more.

The zero suicide ambition I mentioned is being piloted in three areas: Merseyside, the south-west and the east of England. Early learning from the pilots has identified some innovative practice, which I am sure will help other areas to develop innovative plans for reducing suicide in their communities. There will be more research that we can work through to find whether it could have applications elsewhere.

[Luciana Berger]

Will that work extend to our prisons, which are a particular area of concern?

[Alistair Burt]

I know the Ministry of Justice is looking closely at the increase in prison and detention suicides. Again, it is not huge, statistically, but any increase is a matter for concern.

The work capability assessment has been mentioned. It started in 2008, which is about the time that the rise in suicides began. The authors of the recent study that has been mentioned have said that they were cautious about making a link or claiming cause and effect, but I have already asked the Department of Health to have a look at that study, because I feel it is important that my Department looks at the matters involved.

This has been a really good and important debate. First, it has put the issues connected to International Men’s Day on the agenda and allowed us to talk about male issues, in a way that is not a zero-sum game. We have been able to make reference to some difficult issues that are not discussed enough, and I am grateful to my hon. Friend the Member for Shipley for that. We have spent the bulk of our time discussing suicide, and Members on both sides of the House have been able to work together and demonstrate a common interest in things that affect us all. The sense I get from everyone is that none of us is prepared to accept the status quo and simply see the statistics accepted—my hon. Friend the Member for Bury North made that point.

These will not be easy issues to tackle. More men commit suicide than women, not because someone is making them do so—it is not anyone’s fault—but that is a fact. What more can we do? What can we learn from overseas and from the work being done in different areas of this country? I am absolutely confident that this House will talk about this issue again. I hope that when we do, we will have learned still more. People and organisations outside the House do such excellent work on this; with the benefit of that work, perhaps our ambition to make this the country with the best suicide prevention strategy in the world can, in time, become a reality.

Oral Answers to Questions

Alistair Burt Excerpts

Tuesday 17th November 2015 Commons Chamber

[Jack Lopresti (Filton and Bradley Stoke) (Con)]

1. What steps his Department is taking to improve care and support for people with learning disabilities and autism.

[The Minister for Community and Social Care (Alistair Burt)]

We are determined to ensure that people with learning disabilities live independent lives, with better care and improved outcomes. Taken together, the Government’s recent response to the “No Voice Unheard, No Right Ignored” consultation and the newly published “Transforming care” consultation set out the steps we will take to protect rights, strengthen choice, meet physical and mental health needs and end institutional care by default.

[Jack Lopresti]

I thank my right hon. Friend for his answer. South Gloucestershire and Stroud college, based in my constituency, is making an application to open a free school for autistic children. How does he feel that such schools can improve the support and education for children with autism?

[Alistair Burt]

I thank my hon. Friend for the question. Autism is certainly a growing area of identified special educational need across the country that requires an increasing range of provision to meet the diverse needs of the population. Although it would be inappropriate for me to comment on a particular free school application, where it is needed, a special free school can add to the local continuum of provision, by providing specialist places and specialist expertise that can be shared more widely.

[Bill Esterson (Sefton Central) (Lab)]

The all-party group on foetal alcohol spectrum disorders took evidence last week about the link between alcohol consumed by mothers during pregnancy and the growing incidence of learning disability and autism. In Canada, this has been widely known for many years, and the Canadian Government at national and federal levels have invested heavily in raising awareness. When can we expect the same in this country?

[Alistair Burt]

The syndrome to which the hon. Gentleman rightly draws attention is well known here as well. I understand from the public health Minister, my hon. Friend the Member for Battersea (Jane Ellison), that a consultation in relation to this will be announced shortly, and of course there will be new guidelines in response. The all-party group is right to draw attention to this, and anything that can protect women during pregnancy and, of course, their children is of benefit to all.

[Mr Nigel Evans (Ribble Valley) (Con)]

In one family in my constituency, three of the four youngsters have autism. Will the Minister look at the work of local authorities? In this specific case, Lancashire is clearly not working closely enough with the mother, who has one idea about how she wants her youngsters to be educated. The local authority, for cost reasons alone, is simply not working with the parents. It would prefer to see her prosecuted, rather than working with her.

[Alistair Burt]

I fairly regularly meet families and others who have had young people and older people in the system and where there is a difference of opinion about what might be done. Some of the stories are very distressing. Families will sometimes feel that people have not listened to them. There can be quite difficult clashes of opinion on occasion. Of course, any case that my hon. Friend wants to bring me I would be happy to see, but this is a perpetual issue. The important thing is always to listen to those who are closest to a problem. That is likely to be the best way forward. Even if there is a difference of opinion, if people feel that they have been listened to, there is a proper opportunity to explore what can be done.

[Jim Shannon (Strangford) (DUP)]

The autism numbers in Northern Ireland are growing. I understand that it is a devolved matter, but it is clear to me that three Departments have a responsibility: Health, No. 1; Education, No. 2; and Employment, No. 3. We need to ensure that the health of autistic children is looked after and that they have an education that prepares them for employment. Does the Minister have a strategy that takes all three Departments on board, and if so, is it shared among all the regions of the United Kingdom of Great Britain and Northern Ireland?

[Alistair Burt]

Yes. I could not have put it better myself. We have an autism programme board, on which sit representatives of the families of those with autism, which provides an opportunity to look overall at the Government strategy. The hon. Gentleman is right to say that it contains many different elements. For example, in relation to work, we have set out a challenge to halve the disability employment gap, because more people with disabilities want to take the chance of working. That must be done in the right way; we are working closely with the Department for Work and Pensions in relation to that, but things such as the autism programme board give a chance for families to be involved right across the areas where they might expect help and assistance.

[Michael Tomlinson (Mid Dorset and North Poole) (Con)]

2. What steps he plans to take to ensure that full services in hospitals are available seven days a week by 2020.

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[Simon Danczuk (Rochdale) (Lab)]

4. What steps he is taking to reduce suicide rates.

[The Minister for Community and Social Care (Alistair Burt)]

Every person lost to suicide is a tragedy. We continue to deliver the national suicide prevention strategy to reduce suicide rates by working across Government and with the NHS, community, voluntary and charitable sectors. But above all, we must challenge the inevitability of suicide, and I want us to be more ambitious about suicide prevention.

[Simon Danczuk]

In Rochdale, suicides have gone up by 25% since 2010. The rate is 11.8% against an average of 8.9% in England. We have a much higher rate of male suicide. If the Government continue to get their approach to this wrong, there will be more and more needless deaths. Are they going to fund mental health services properly?

[Alistair Burt]

Looking at mental health services is just part of what we intend to do, and more money is going into mental health. The hon. Gentleman is absolutely right about male suicide. Men are three times more likely to commit suicide than women. It is also a particular cause for concern among young men. Overall, our national suicide rates remain relatively low in comparison with others, but they have been rising, and I am worried. I am interested in the theory of zero suicide, with more work to try to ensure that suicide is not seen as inevitable and more work in detail with particularly affected communities. The work that we are doing with people at a younger age, using child and adolescent mental health services more effectively to deal with depression and similar issues before suicide becomes a greater risk, will also be important. I am really interested in this area, and I think we are going to have a debate on it later this week.

[Mr David Nuttall (Bury North) (Con)]

As my right hon. Friend says, we will indeed be having a debate on this matter later this week, on Thursday in Westminster Hall. It will be the first time that we have been able to mark international men’s day and consider the whole issue of male suicide in more detail, and it will give us the opportunity to look at why the proportion of male deaths to female deaths has increased steadily since 1981.

[Alistair Burt]

I am grateful to my hon. Friend for raising the subject and for mentioning the forthcoming debate. The subject deserves to be looked at extremely carefully. As I have said, there should be neither complacency nor a sense of inevitability about suicide, and I am very interested in what more can be done. I have met one or two of the families who have experienced these tragedies and I am deeply impressed with their commitment to doing something for those age groups particularly affected. This afternoon I will meet a gentleman who is well known for having been involved in a suicide prevention incident. We are doing work to reduce stigma and to find places for people to talk about their concerns, and the more people are prepared to talk about things that might cause suicide, the better. This is an issue that we can give a higher profile to and do more work on, because every time there is a suicide it leaves a trail of damage for families and friends that is truly distressing to behold.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Last week, yet another report—this one from the King’s Fund—warned of a mental health system that is under huge pressure. On this Government’s watch, just 14% of patients feel that they have received appropriate care in a crisis. The number of mental health nurses has dropped, and increasing numbers of people are having to travel hundreds of miles for a bed. What action will the Minister take to turn his rhetoric into reality?

[Alistair Burt]

This is a cross-party matter and it is very important. We believe we have made strides during both the previous and this Government. We are investing more money in mental health services—it was increased to £11.7 billion last year—and this was the first Government to introduce standards for access and waiting times with regard to mental health, to try to put it on a par with other conditions. That was not how it was done before. We will now try to ensure that the money that goes in nationally is used to provide assistance locally, and that the money that is put in for local use is used locally.

There are areas to celebrate. We are world leaders with the improving access to psychological therapies service, which has treated 3 million people since 2009. We want to build on that. We know that the service has lagged behind others in the past, which is why we are determined to do much more about it. I think it is the view of the whole House that we should do more about it, and we will.

[Luciana Berger]

I listened very carefully to the Minister’s response, but I reinforce the point that the suicide rate in this country is going up, not down. It is a national scandal that we need to address.

The Minister mentioned prevention. The Government have confirmed that they will make an in-year £200 million cut to local public health grants. That is a political decision. It is not going to save money and, apart from the devastating human price, it is going to cost our NHS and our local authorities more as they deal with both physical and mental ill health that could have been prevented. How can the Minister justify that?

[Alistair Burt]

First, £1.25 billion is going into creating new services for children and young people’s mental health services during the course of this Parliament. The hon. Lady’s party did not make that commitment before the general election. More work is being done in schools to provide a better base for mental health. We have, for the first time, appointed in the Department for Education a Minister with responsibility for mental health in schools.

The pressures on public health budgets are the same as those on every other budget. Those pressures on the national health service were met by my colleagues during the general election, with a commitment to provide an extra £8 billion—the figure is now £10 billion—by the end of this Parliament. That commitment was not made by the hon. Lady or her party. She asks for more money to be spent, but we have committed to do that and we are finding it. It is very important that we take the position that we have to do as much as we can with what we have got. Mental health services are moving forward and we should take the opportunity to say that and welcome what has been done. We have provided the resources in a way that I am afraid the hon. Lady’s party did not.

[Jo Cox (Batley and Spen) (Lab)]

5. If he will take steps to assist hospital trusts to mitigate the cost of car parking on NHS sites for out-patients and visitors.

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[William Wragg (Hazel Grove) (Con)]

11. What steps his Department is taking to ensure that the NHS recruits, trains and retains adequate numbers of therapists, clinicians and other staff to improve access to psychological therapies.

[The Minister for Community and Social Care (Alistair Burt)]

Health Education England, working with NHS England, is charged with ensuring that there are sufficient staff with the right skill mix to support the delivery of the improving access to psychological therapies programme, and that is monitored by an annual workforce census. For example, HEE’s plans for 2015-16 are to train 946 additional individuals—a 25% increase on last year.

[William Wragg]

As well as providing adequate numbers of high quality specialised staff, given the prevalence of mental health issues in our society, is it not also important that general awareness is raised of mental health issues and the available treatments among all medical professionals, especially GPs? What future steps can the Government take to improve that training?

[Alistair Burt]

There are two particular ways to do that. The first is to enhance GP training, and work is already going on to do that. The second is through continuing professional development, and the Royal College of General Practitioners and HEE are combining to ensure that a good range of materials is available for clinicians and others to improve their skills in that area. My hon. Friend is right to raise the issue.

[Tommy Sheppard (Edinburgh East) (SNP)]

12. What assessment he has made of the effect of poverty on the incidence of health problems.

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[Dame Angela Watkinson (Hornchurch and Upminster) (Con)]

14. What progress has been made on integrating and improving care provided outside of hospitals.

[The Minister for Community and Social Care (Alistair Burt)]

The Government are committed to transforming out-of-hospital care for everyone, in every community, by 2020. We have seen excellent progress in areas led by integration pioneers, such as South Devon and Torbay. My hon. Friend’s own area also has in place a number of initiatives, such as the community treatment team and intensive rehabilitation service, which is rated very highly in her local community.

[Dame Angela Watkinson]

My right hon. Friend will be aware that elderly people deteriorate rapidly and lose their independence skills when they are admitted to hospital. What discussions have been held with local authorities to ensure that there is an adequate supply of carers to enable older people to remain in their homes whenever possible?

[Alistair Burt]

I meet regularly, as does the Department, with our partners in the provision of social care. A new recruitment and retention strategy has been launched by the Department of Health and Skills for Care on how to ensure more care is provided by more skilled and more valued workers in the home environment. My hon. Friend is right to raise this issue.

[Mr Speaker]

Equally briefly, the last question and answer. I call Barbara Keeley.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The ResPublica report, “The Care Collapse”, states that our residential care sector is in crisis. It says:

“Providers are being faced with an unsustainable combination of declining real terms funding, rising demand for their services, and increasing financial liabilities.”

It also states that a £1 billion funding gap in older people’s residential care would result in the loss of 37,000 care beds, which is more than in the Southern Cross collapse. No private sector provider has the capacity to take in residents and cover the lost beds, so those older people will most likely end up in hospital. What is the Minister doing to protect the care sector from catastrophic collapse?

[Alistair Burt]

As the House is aware, social care is a matter of great importance as we head towards the spending review round. We are aware of pressures in the system, and there is always contingency planning to identify particular problems. We are working hard with the National Care Association to improve the quality of care provided by the sector, and my right hon. Friend the Secretary of State has commissioned Paul Johnson, of the Institute for Fiscal Studies, to look at pressures in the care home sector and how to ensure that we can meet the challenges. If challenges require more money, which they always seem to do according to the hon. Lady, she needs to come up with ideas for how to provide that money, but she never does. It is the Government’s responsibility to meet those challenges within the context of the overall economic position.

[Kate Hollern (Blackburn) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

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[Julian Sturdy (York Outer) (Con)]

T8. Can the Secretary of State assure me that the NHS funding review that is currently under way will deliver a fairer formula for my constituents and many others across York and North Yorkshire by putting age and rurality—some of the biggest drivers of health costs—at the heart of this long overdue review?

[The Minister for Community and Social Care (Alistair Burt)]

Clinical commissioning group formulae are based on advice provided by the Advisory Committee on Resource Allocation. I can assure my hon. Friend that an adjustment per head is made for morbidity over and above age and gender, but as to whether or not one area is fairer than another, I am afraid that that is always a matter for local decision and discretion.

[Margaret Greenwood (Wirral West) (Lab)]

T4. Can the Health Secretary explain how cutting £200 million from public health budgets is consistent with the emphasis on prevention and public health as set out in the five-year forward view?

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[Alistair Burt]

We are very conscious of the pressure on general practice and of the pressure of ensuring that enough GPs are available. The Government’s plans are for 5,000 more doctors to be working in primary care by 2020, and that is supported by our recruitment, retention and returning campaign, as well as by efforts to ensure that medical schools do everything they can to ensure that general practice is made more attractive. This work will continue right through this Parliament.

[Imran Hussain (Bradford East) (Lab)]

T5. According to Public Health England, life expectancy in the most deprived areas of Bradford is 9.6 years lower for men and eight years lower for women, demonstrating that there are clear health inequalities in urban areas in Bradford. The Government’s attack on the poor makes this issue worse, so will the Minister tell me what they are doing to tackle these inequalities and give people in Bradford the quality of life that they deserve?