NHS Funding Bill

Anne Marie Morris Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

It seems to me that the NHS Funding Bill is really just the beginning. If the Government are serious about identifying specifically how much money they will commit to particular parts of the NHS budget, that is to be welcomed, and certainly any increase in any part of NHS spending is welcome. A 3.4% increase compared with what we have had during the very challenging period of the past three to four years is therefore very welcome. I believe that it actually is a floor, not a ceiling. I totally understand the interpretation, which I think is correct, of the money resolution, but that relates specifically to amendments to this Bill. My reading of the money resolution is that we can, in further Acts, expand and increase these amounts.

My real concern is trying to get to the bottom of how these figures have been arrived at. There has been an assumption that it is all about inflation and looking at comparative figures, but there are three pieces to this. What are the assumptions underlying the decisions that have come to these figures? What assumptions have been made about inflation, because Brexit has changed much since these figures were first arrived at? How are we looking at demand and need? Do the Government really understand what the unmet need is? Certainly, reports by the Public Accounts Committee indicate that the Government do not really have a grasp of that. That then leads me to question whether these are the right figures to do what everyone in this House wants, which is to meet the needs of all our citizens for good healthcare and, ultimately, good social care, which is not part of this Bill. I think the Government have missed a bit of an opportunity here. It would be helpful if they had set out how they will flex if the assumptions with regard to savings and efficiencies changed, if the inflation rate changed, or if demand changed. The bits missing from this Bill are a formula to calculate the increase and some honesty about the basis on which the Bill has been put together.

As we have heard, some specific promises have already been made in a five-year plan. We have said that mental health spending will go up by £2.3 billion, which is a 4.6% increase a year; that mental health spending for children and young people will grow faster as a part of that budget; and that there will be an increase in primary and community healthcare spend in the areas of highest health inequalities. But as yet we do not have any mechanism for an annual statement on exactly where we are on this spending. In addition to a formula that explains how we got to this magic figure, there should be an annual statement on these figures so that we can see how the 4.6% a year increase for mental health has actually been delivered and whether children and young people are actually getting the biggest chunk.

It has been said, quite rightly, that in this Bill we are looking at only part of our total health and care ecosystem. We must look at what we do about infrastructure—hospital—spending. The £2.8 billion hospital infrastructure promise in the spending review last year was very welcome, but, as the hon. Member for Central Ayrshire (Dr Whitford) pointed out, what about the repairs? With regard to the training budget, the spending review refers to a 3.4% increase. Is that really going to cover it? How are we going to measure whether it is actually spent? The hon. Lady referred to the 1% increase in public health grant. Can that really be enough? For me, what is really needed is an annual report on all health spending. The biggest challenges to getting this right—I am not the first and I will not be the last to say it in this Chamber—are stopping the slippage from revenue budgets to capital budgets and the slippage that will inevitably occur if social care is not properly funded. We absolutely have to fix the social care challenge, and this Bill is not enough, and cannot stand alone, in terms of solving these issues.

This Bill is welcome, but it is in many ways a missed opportunity. We need to see the total picture. We need to have proper accounting. We need to have proper visibility of the numbers so that we as a House can demonstrate clearly to the great British people that we are delivering on what we have promised and what they need.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Does my hon. Friend accept that the purpose of the Bill is not to set out the absolute detail of every single possible thing that could happen over the next few years, but simply to provide assurance to the NHS in England of the minimum funding that it could possibly receive, and the massive increase that we are giving it, so that it can continue to plan for the future?

[Anne Marie Morris]

My hon. Friend is absolutely right that we should provide a long-term plan and a long-term budget. However, if we are to be honest with the public and with ourselves, we need to measure what we are doing and be clear and accountable to the public that what we have said we will spend delivers the outcome we have promised.

This is about openness, transparency and accountability, and that is the missed opportunity. It may well be that this sum is right and that the savings that have been promised can be made to enable it to be adequate, but there is some serious doubt about that. Without openness, honesty and the figures being reported on each year, we cannot put our hand on our heart and say that we are doing what we promised the British people we would do. There is a saying that what gets measured gets done, so let us measure this. Let us get to the crux of this spending and prove to the British people either that we have got it right or, if not, that we have a formula to get it right so that we can do what is right. We need a plan to monitor the10-year plan, which is great in ambition but needs to be properly scrutinised and properly monitored so that not just the Government and the Conservative party can be held accountable, but all of us in this House can be held accountable, because it is for all of us to get this right. It is not just down to the Government: it is for all of us to ensure that we deliver what people, frankly, need and deserve, and what we have promised.

NHS Funding Bill

Anne Marie Morris Excerpts

Legislative Grand Committee & 3rd reading: House of Commons & Legislative Grand Committee: House of Commons & Programme motion: House of Commons & 3rd reading & Programme motion
Tuesday 4th February 2020 Commons Chamber

[Patrick Grady]

I wholeheartedly agree, Dame Rosie. I have addressed the amendments that we have an interest in, and I am contextualising why they are relevant to our constituents, but points are being extremely well made by my colleagues. There is a simple solution to this, which we in the SNP have been promoting for 84 years, since 1934: Scotland can become an independent country and England can have the Parliament that it wants. As my hon. Friend the Member for Airdrie and Shotts (Neil Gray) says, with the greatest respect for the Speaker, it should not be for the Chair or for the Government to decide what does and does not apply to Members from different parts of the UK. My job and that of my colleagues is to look at each measure before this House and determine for ourselves whether it is relevant to our constituents and act accordingly. Today, we are being actively prevented from doing that. There are amendments and new clauses on the amendment paper that we deem to be of interest to people in Scotland, which would take forward commitments in our manifesto, but we will not be able to vote for them. That is not a precious Union. That is not a partnership of equals. That is not leading instead of leaving. It is not something that is going to be sustainable for much longer, and 52% of people in Scotland seem inclined to agree.

[Anne Marie Morris (Newton Abbot) (Con)]

I rise to speak to new clause 9, tabled in my name and those of the hon. Member for Central Ayrshire (Dr Whitford) and my hon. Friend the Member for Broxbourne (Sir Charles Walker). I am pleased that Scotland will have its say, at least with regard to this new clause.

Conceptually, the Bill will absolutely do the right thing, because for long-term decision making we need some clarity as to how much money there will be. As I said on Second Reading, my concern is about whether or not the figures are right, and at that point I proposed a formula that would enable the figures to be flexed to properly determine the need and whether the figure would to be sufficient to meet it.

New clause 9 deals specifically with the issue of mental health. There is agreement among all parties that it is crucial that we get mental health right. It is crucial that it is properly respected and properly resourced. Members from all parties have talked about and supported parity of esteem between physical health and mental health. It might be useful—this is not in the new clause, but we are talking about the issue more broadly—if at some point the Government could give some clarity on, if not a formal definition of, what parity of esteem means.

--- Later in debate ---

[Dr Whitford]

We have discussed today, and on many other occasions, the issues relating to child and adolescent mental health and the pressure that young people are under right across the UK, and training for teachers to support them in schools was mentioned. In Scotland, we are putting 350 counsellors into schools. Does the hon. Lady recognise that putting that level of investment into education, where these young people are, would reduce the pressure on CAMHS, and that any assessment would need to include that? If children end up in CAMHS who do not need to be there and who could have been helped earlier, that is also a failure.

[Anne Marie Morris]

The hon. Lady makes an apposite and correct point. We cannot talk about mental health just within the health and care bucket, so to speak. What do we do to help young mums? What do we do in the school environment for youngsters, who are increasingly put under huge pressure, with cases of stress and depression growing daily? What are we doing in the workplace? Historically, mental health has been something that we do not talk about; indeed, people almost dare not to for fear of being demoted and losing their job. There are many aspects of mental health that need to be taken into account if we are truly to deliver parity of esteem. I would like to think that the Government, and perhaps the Minister when he responds to the debate, would acknowledge the breadth of the need to work together across Government Departments so that we look properly at the outcomes and at the different pieces that affect those outcomes, which go well beyond the Minister’s particular brief.

[Dr Poulter]

I thank my hon. Friend for giving way. She is making some very good points. An interesting amendment has been tabled by the hon. Member for Twickenham (Munira Wilson) on the need for greater transparency more generally in mental health funding. It is difficult to understand properly what level of investment is currently going into mental health services, be it CAMHS or general adult mental health services. Would it not be a good thing if the Government took on board the spirit of that amendment and published data on mental health spend on an annual basis across all mental health services, from CAMHS and general adult to older adult and learning disability services? That would help to make the argument that money is actually going into what has been a Cinderella service for far too long.

[Anne Marie Morris]

My hon. Friend is right in that the things that are relevant to mental health cannot exclude the budgets in other parts of the system. He is absolutely right, as the hon. Member for Twickenham (Munira Wilson) is, that these things need to be looked at together. Yes, I certainly agree that a written report that sets out what money is being spent where would be very welcome, but I guess that my amendment goes beyond that and says that we should be sure that we are getting something for that money, rather than simply putting in that money and not having any grasp as to whether it is actually making a difference, which is crucial.

[John Redwood (Wokingham) (Con)]

I should like to reinforce that point. I in my constituency, as she in hers no doubt, have need that should be tackled and that requires support and treatment, but it is important that it is worthwhile treatment under the right protocol so that things get better. I would value much more information on who is being treated and whether the treatment is working rather than more information on money.

[Anne Marie Morris]

That point is extremely well made. Let me say, if I may, that there is also a challenge for any Government to be able to properly ascertain what the actual need is. There is a lot of hidden need. In rural communities such as mine, the real challenge lies with isolated elderly people and with lone workers—whether it be a farmer or a policeman. We know that farmers have the highest rate of suicide of any profession. Much of that mental health challenge is not understood or measured, which makes it critical that we look at that need and then, as my right hon. Friend sets out, make sure that what we do properly meets that need. He is absolutely right.

[Munira Wilson (Twickenham) (LD)]

I agree with the hon. Lady’s point about measuring outputs as well as inputs, but does she agree that one of the big challenges with CAMHS is the real dearth of data? There are many gaps in the data that is collected. I make this point advisedly, because there is another challenge in gathering more data. I have been lobbied in my own constituency by a charity supporting children and young people with mental health issues. Its funding has been put under threat by NHS England unless it starts to report the date of birth of the young people accessing its service and other information, which then undermines the anonymity that it guarantees to those children and young people, so reporting on the outputs is not actually that straightforward.

[Anne Marie Morris]

The hon. Lady makes a very good point—I think there are probably two points there. The first is what we should be measuring and when, and the second is about data and the privacy issue. The points are related, but separate. The first one, which is about measurement, is a point very well made. Certainly, the point at which my constituents are counted as being in the box and in need and being referred for mental health can be very far down the line from their first presentation. The figures will often not properly represent the number of people who are actually in need, so I think she is right that we need to be clear at what point we measure an individual coming into the system. I am not clear from what I have heard anecdotally that it is. Some clarity and perhaps an investigation into that would be very helpful. The hon. Lady’s point about privacy is a much broader issue, and I think it would be beyond the scope of this debate to look at it now. The point was well made, but it is a much bigger point for another day.

Through new clause 9, I am asking for an annual report that would show how mental health provision has improved. Such a report would state how we identified what we included in the mental health bucket that I mentioned; how we identified who is in need; how we measured whether that individual received an intervention, and whether any such intervention was timely; whether the individual’s condition has improved or got better; and how any improvement has been assessed, because that can be a very difficult question. I appreciate that for many individuals with mental health concerns, these are lifelong conditions. We would therefore not simply be measuring whether somebody is “cured”, but looking at the level of improvement and the extent to which the intervention has helped—or not helped—that particular individual. It is very complicated.

My new clause would require the Government to look specifically at how we are going to measure the extent to which we have been able to prevent mental health problems. Specifically, we need to start looking at the support we give in schools, to pregnant mothers and in many other situations. This provision would also require information on how we have diagnosed mental health problems. Too often in constituents’ cases, I find that it is only when a diagnosis is finally and formally made that there is any intervention or help. I have heard from a number of parents of young children and teenagers who have faced problems such as eating disorders and attempted suicide, but much to my concern and that of the parents, as no diagnosis has yet been made—because they cannot get an appointment and so on—the individual youngster who is self-harming is not yet considered to have a mental health problem. The consequence is that they do not get the support and assistance they need, so diagnosis is very important.

[Steve Brine (Winchester) (Con)]

I support what my hon. Friend is saying in her new clause about outputs. This is an issue that I tried to address—and failed, I readily admit—when I was the primary care Minister. She will be aware of the NCT’s Hidden Half campaign, which aims to improve the six-week postnatal check. Does she agree that there are opportunities for the NHS to make an intervention and assessment, but that those opportunities are currently missed? For example, we should be changing the GP contract so that when new mums go for the six-week check with their babies, they get a maternal mental health check at the same time. There are already opportunities, but we are missing them.

[Anne Marie Morris]

My hon. Friend makes an excellent point. Just like physical health checks, which are very much part of the standard GP system, mental health checks should equally be a part of the standard checks that take place when people present at surgeries. I entirely agree.

[Dr Whitford]

Does the hon. Member recognise that we all know what we should be doing to look after our physical health—there is a handful of five key points—but that most of us have no idea what we should be doing to look after our mental health? As well as talking about primary care in schools and workplaces and public campaigns, we should all be being taught how to develop our own resilience and how to look after our own mental health better.

[Anne Marie Morris]

That is one of the best points that I have heard in this debate, and it is extremely well made. However, it is a real challenge trying to help individuals to accept even that they might be vulnerable to mental health problems, because it has been such a taboo—let alone the second stage of learning what we can do to try, as the hon. Lady says, to make ourselves resilient. I am pleased that we are having mindfulness classes across the House, not just for MPs but for our researchers. That is not the total solution, but it is at least a step in the right direction. However, her point is about something much bigger than just an intervention—it relates to a big piece missing from this whole agenda. We spend a lot of time talking about illness and not enough time talking about wellness.

[Dr Whitford]

Is it not particular to mental health that when we use the phrase “mental health” we actually mean illness? We all have mental health, sometimes good and sometimes bad. If we changed the language, it might be easier for people to talk about.

[Anne Marie Morris]

The hon. Lady is absolutely right. The challenge, as she recognises, is how we change the language in a way that is accepted and becomes the norm. Part of this is having a much greater focus, as I hope the Secretary of State and his team ultimately will, on wellness, because that is absolutely as important as dealing with the illness when it happens.

We need to remember that in terms of stages of intervention, the whole lifecycle is not just about birth, education and the workplace; it is also about the elderly and veterans, for whom there is often not as much done to identify need and provide support. An older person in a rural area will often have the need but because they are simply out of scope—under the radar—they will, for a very long time, suffer in silence to a point beyond which they cannot be helped. The challenge of mental wellness/illness for older people needs to be a specific focus.

For all that we say, and rightly, about the importance of ensuring that our veterans are properly diagnosed and properly supported, I am certainly conscious of veterans in my constituency who are struggling to get help and support, or even an initial diagnosis. Sometimes the support they need is so complex that they can only get it in London. For somebody who does not have good mental health, the journey from Devon right the way up to London is something they simply cannot conceive of and make a reality.

I am extremely grateful to the Minister for sitting and listening to my thoughts, and for understanding my approach in terms of looking at this in a much more holistic way and seeing how we might measure and report on it so that we can demonstrate to people that we are making progress on parity of esteem. We should look at inputs as well as outputs. I look forward with a great deal of interest to his reply on the points that have been made, particularly on outputs in mental health.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

I rise to speak to the amendments in my name and the names of my colleagues.

As we have all heard, our NHS needs to be properly resourced in both physical and mental health, but far too often patients are losing out under this Government, with longer waiting times, a huge increase in cancelled operations, and crumbling hospitals. Colleagues have already raised these important issues. I urge the Government to accept the amendments in the name of the Leader of the Opposition as a real signal of their intent to reverse the damage that their party has done to our national health service over the past 10 years.

My amendments focus specifically on mental health. The Government have made much of the need to ensure parity of esteem. This would mean us valuing mental health equally with physical health and adopting an approach that tackles it using the same standards that we expect for physical health patient treatment as a template for treatment that we provide for mental health patients.

I have heard warm words from the Prime Minister, the Secretary of State and Ministers about the importance of mental health and the growing need to tackle mental ill health as an urgent priority, but I have not yet seen that wholehearted commitment manifest itself in actions to tackle the situation we are in. The British Medical Association found that the mental health workforce has had little growth over the last 10 years. The Royal College of Psychiatrists found that the rate of unfilled NHS consultant psychiatrist posts in England has doubled in the last six years. The first briefing paper from the Centre for Mental Health’s Commission for Equality in Mental Health found that mental health inequalities are closely linked to wider injustices in society. Far too many patients with a mental illness are still being sent hundreds of miles away from home.

By accepting the amendments in my name, the Government would show that they are willing to be transparent about the way they go about achieving their long-stated aim of parity of esteem. The Government have already shown, with the presentation of this Bill, that they think it is a good idea to commit, in law, to a minimum allotment that the Secretary of State will make to the health service in England in each financial year for the next four years. That is designed to show that their promise is legally binding and can be scrutinised by Parliament and the public if they do not reach those targets.

To ensure that our mental health services are properly resourced and truly responsive to the various complex conditions that people present with, the public need to know how much is being spent, including how much is being proposed, and what happens in practice. That is all my amendments seek to do—they would provide Parliament and the public with the opportunity to compare the proposed allotment with the final allotment across different years.

Of course, that is not enough, and it is clear that additional resources for mental health services are only one part of the answer to tackling the mental health problems in this country. We know that education and training services are essential to bring about the necessary increase in the workforce. We know that local government provides significant elements of mental health support through public health, youth services, housing and social care, and two thirds of schools fund their own mental health support. We also know that the Government’s roll-out of universal credit will exacerbate mental health inequalities, which all too often relate to people’s economic and social circumstances. This is not the time to go into those in detail, but I urge the Government to remember the need for those essential services to have a long-term funding settlement and, in the case of social care, an agreed basis for future financing. With ambitious targets to meet in the long-term plan, there is a risk that resources will be diverted from other areas of mental health support to achieve compliance.

I would like to invite colleagues across the House to join me on Thursday for my adjournment debate on Children’s Mental Health Week, which is this week, to discuss these issues further. I know what a commitment to transparency on mental health spending would mean for all those suffering mental ill health and those fighting for them. I hope that the Secretary of State will accept amendment 1 and new clause 1, to ensure that mental health services get a fair deal from the legislation and that pledges made by the Government and NHS England are realised in practice.