Children’s Mental Health Week 2024

Dan Poulter Excerpts

Tuesday 30th January 2024 Westminster Hall

[Dr Allin-Khan]

I thank the hon. Member for that intervention. Yes, I wholeheartedly agree that there is definitely space for more research. Adverse childhood experiences are the single biggest driver of mental ill health in children and, later on, in adults. I will touch on that later.

I want to know today when the Government will finally get their act together to end the wait for children’s mental health services. We are sick and tired of the same old meaningless platitudes from the Government. I know the Minister: I had the pleasure of working with her in my role as a shadow Minister. I know she is decent, good and kind, and she absolutely wants the best for children. I believe that. I also understand that her hands, regardless of what she might want to do, will be tied. However, in my role as shadow Cabinet Minister for mental health over three and a half years, the number of times the Minister and her predecessors have harped on, quite frankly, about the £2.3 billion they have put into mental health services! They have used that figure no fewer than 90 times in five years for many different things, depending on the focus of the debate. Whenever we have a debate about eating disorders, the £2.3 billion comes out. Whenever we have a debate about access to IAPT—improving access to psychological therapies—the £2.3 billion comes out. Whenever we have a children’s mental health debate, it is again rolled out. I understand that, but we really need tangible answers because the waiting lists grow, children are let down and families suffer.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I commend the hon. Lady for securing a debate on this important issue. She is absolutely right to highlight the fact that we have known there are challenges in CAMHS for many years: we know there are problems with commissioning CAMHS and we know there are workforce challenges. We know there has been a failure to properly recruit mental health doctors and nurses to posts across CAMHS. Does she agree that we need to hear proper answers from the Minister today? We have known about these challenges for a long time. It is time we got on and did something about it.

May I apologise, Mr Pritchard? I should, at the beginning, have drawn the attention of the House to my entry in the Register of Members’ Financial Interests as a practising NHS psychiatrist.

[Dr Allin-Khan]

I thank the hon. Member, whom I would like to call my hon. Friend, because we have worked very closely on this issue for a number of years. He speaks not just as a politician, but as a practising NHS psychiatrist and I take my hat off to him. He speaks from a position of authority. We also sat together on a pre-legislative scrutiny Committee for a number of months, where we heard how black people and those with autism and learning disabilities are affected by current policy. We made cross-party, cross-House recommendations, but all of that has been scrapped. The Bill has not been introduced to the House and we are wondering how, with such cross-party agreement, that can be.

--- Later in debate ---

[Tim Loughton]

There is something in that, and people from better-off backgrounds may have recourse to the private sector as well, but the point is that the illness impacts on everybody, although I certainly agree that the capacity to get early help for that illness is differentiated across families.

The impact of covid should not be underestimated. During covid, we saw the impact on new parents, particularly new single parents. One of the biggest impacts was the absence of health visitors able to go across the threshold of new parents’ homes, particularly on single parents having a child for the first time. There were the other horrors of covid going on, and people were detached from the normal family networks they might have, such as grandparents coming along to share their experience and give support. On top of that, they did not have a health visitor coming to visit them physically, because about three quarters of health visitors were diverted to the frontline of dealing with covid. It was only in the most deprived cases, where there were concerns, that health visitors physically got to go and visit.

On top of that, we had a decline in the numbers of health visitors, which reversed the position that the coalition Government produced, where we had an additional 4,200; quite rightly, that was a pledge by the Government, and it was actually delivered in the lifetime of one Government. Since then, numbers have declined again. I think there is absolutely a false economy.

[Dr Poulter]

I agree entirely with what my hon. Friend said about health visitors. I think I was actually the Minister who oversaw that increase in the number of health visitors. The change to commissioning by local authorities has been a very big mistake in the provision of health visitor services. I wonder more generally—after reflecting on the link between poverty and poor mental health—whether he would also reflect on family nurses, who provide significant support to deprived families and families with challenges. That workforce also struggled to do its good work during the pandemic, which has had a consequential effect on those families and indeed the mental health of young people.

[Tim Loughton]

My hon. Friend is absolutely right. Family nurse partnerships were another great success story, for which he can take part of the credit. There are various ways of providing that support, in particular to new families, but a lot of it was not available during covid.

I have a real concern about babies born during covid. We are only starting to see the consequences. I remember well one of our own colleagues in a debate in this Chamber during covid saying that she gave birth during that time and it was five months before her own baby got to meet another baby, and the baby did not react well—“What on earth is this? Another baby?” There were no mum and toddler classes available then, and there were no support networks of grandparents and others coming in. If there were no health visitors or other professionals there as well, it was difficult to spot signs of attachment disorder or safeguarding issues within a household—and we are only starting to see the consequences now. It has compounded the issues for these children. Now at last, they are at least being diagnosed with a mental illness, but it might have been prevented earlier if all that support was there. That really needs to be on the radar of the Department of Health and Social Care and the Department for Education.

Then there is the impact of school lockdowns, which should also not be underestimated. There is a strong correlation when it comes to children, particularly younger children, not being able to go to school and socialise with their friends, or go through all the normal disciplines of what school brings. There are also safeguarding concerns that teachers and early warning exercises can pick up. We are seeing the impact of children being cooped up at home and not able to get on with the ordinary day-to-day business of growing up and being a child, and there were many safeguarding problems as a result of the schools lockdowns.

I will not apportion blame here, but it was a big mistake that the schools were closed down, and the unions forced those closures in the early days. We are seeing the consequences now. I agree with many of the solutions. Of course we need more investment. The Government have been investing, but they need to invest more, and we need more professionals to come into the system, because they do not grow on trees. It is absolutely right that awareness is needed of mental health first aiders and the mental health support available in schools—and we need more of that.

The trouble is that when somebody’s mental health problem is spotted in school, the thresholds for getting the treatment, therapy or whatever they require are so high that it takes too long, and in too many cases the condition worsens over that time. It really is a false economy. We need far quicker referrals, and without having to go through so many hoops. As the hon. Member for Tooting said, parents are waiting weeks or months on end to get a referral—in many cases, just to get the diagnosis before they can actually get the appropriate treatment.

I also have big concerns about eating disorders. The Government have put a lot of investment into increasing eating disorder specialist placements, but they are full up. I had a particularly tragic case in my constituency. The father rang every hospital in the country, including all the private hospitals because he could afford to fund treatment for his daughter, but everywhere was full. Eventually he secured a bed on, I think, Christmas eve. This was a teenage girl who was suicidal and had been through various episodes before. Eventually she got good treatment in hospital.

But there is a problem when people come out of hospital; often it is a case of falling off a precipice because the support services are no longer there. We need a much better system where people who need residential intensive support can be supported when they come out of that residential environment, which is a particularly tricky time because too often they end up having to go back into that intensive residential environment.

[Dr Poulter]

rose—

[Tim Loughton]

I will give way one more time. I have one more point to make and then I will finish.

[Dr Poulter]

I thank my hon. Friend for giving way. He is making an excellent contribution to this debate. His points about eating disorders are absolutely right. On the arrangements that are in place for discharge from in-patient units and also on preventive care such as community services for eating disorders, does he agree with me that one of the challenges is that there has been a failure to develop the workforce in that area? There are many unfilled posts in community eating disorder services. Unless we get that right, we will not address the challenges of eating disorders that he has outlined.

[Tim Loughton]

Again, my hon. Friend reinforces my point. I think we have done better on the provision of beds for that intensive care, although there are still not enough of them, but we have not done nearly enough on picking up afterwards and on preventing people from getting to that stage in the first place. The issue disproportionately affects young girls, who have all the pressures of social media. The Media Bill is being discussed in the main Chamber at the moment, and we are clamping down on sites that pretend to be there to offer support but that actually encourage vulnerable teenagers into obscene eating disorders as though they are a badge of honour. So much more needs to be done. It is so expensive—financially, as well as socially—when we do not act at the appropriate time.

My final point comes back to early intervention and prevention. The Best Start for Life project, pioneered by my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), really is a game changer. It has had the buy-in of all the political parties. I was a part of the various advisory research groups that we had in this place working with Members across the Floor, and we now have the roll-out of family hubs. This is all about supporting families, particularly mums, but not exclusively mums because fathers have a role; too often they are neglected and yet they are a part of the support mechanism. There are mental illness problems affecting new fathers, which are quite severe, as well as the perinatal mental illness around women. We need to do much more to make sure we have happy mothers and that we attack domestic violence problems, a third of which happen during pregnancy. If we have a happy mum, we have a happy baby, who is likely to grow up well attached, happier, well balanced, and more resilient against all the pressures and problems of mental illness in society that are manifested in schools and beyond.

It is not true to say that the Government have done nothing and have not invested in this issue. We need them to do more and invest more. The Best Start for Life project is one of the most exciting and fundamentally important projects for attacking a problem right at the beginning, before it becomes a much bigger problem for children, families and society as a whole.

Tackling Rogue Builders

Dan Poulter Excerpts

Tuesday 13th June 2023 Westminster Hall

[Mark Garnier]

My hon. Friend raises the most important point. We have had six phoenix companies wind up; what we do not want is another six—another six victims who have to have their homes pulled down. That is why we are trying to come up with a system of regulation that can prevent that.

Most of us will only infrequently need the work of a builder or tradesman. When we do, most of us get lucky—it is important to say that. We hear stories of people who endorse workers and pass on their names, as their work is of good quality. However, when someone gets caught by a rogue builder, their life descends into a nightmare. I know what that is like. In the interests of full transparency, I declare my interest, having found myself in such a position a few years back. It is because of that experience that I am keen to help other victims find a way out of the problem and draw the issue to a close once and for all.

When a problem starts—from poor and potentially dangerous work, as we have heard, through to the other end of the scale, which is fictitious bills—ultimately the only recourse is expensive legal fees. My experience opened my eyes to just how many people are victims of those types of rogue traders in so many different ways.

Rogue builders do not just prey on their clients. Others who lose out are the subcontractors and suppliers who do not get paid, as well as the plant hirers who do not get paid and find their machinery is often stolen. Other building firms do not see business because rogue builders will undercut their prices only to hike them later. All of us lose out through tax fraud, as rogue builders take cash in hand to dodge VAT and corporation tax. Tax fraud distorts the market, with rogues undercutting legitimate builders, creating a false impression of costs. The wider economy also loses out; the Federation of Master Builders has estimated that billions of pounds of building work is not undertaken because consumers fear being ripped off.

After my presentation Bill had its Second Reading, I was contacted by a number of victims of rogue builders. I also appeared on an ITV programme talking about the issue, leading to more victims making contact with me. The Petitions Committee contacted me to let me know that there is not one but four petitions seeking a resolution to the problem. Between them, they have gathered over 4,000 signatures, and I urge anyone who hears this debate who has been a victim, or is interested in resolving the problem, to sign one of those petitions.

It is the stories of victims that crystalises the problem, as we heard earlier. I was contacted by a police officer married to a nurse—two fine public servants. They bought their dream home and engaged a builder to renovate it. The work turned out to be massively substandard: it failed building standards and was deemed so dangerous that they could not move back into their home without remedial work. They contacted trading standards, but the builder is refusing to engage and is hiding behind his solicitor.

Similarly, someone else who contacted me had wanted to improve her home so that her disabled sister could get access. She was so let down by the system that she was motived to get in touch with the FMB, and has now launched one of the petitions I referred to in order to seek a licensing regime. Again, I urge people to go on to the Parliament petitions page and add their name.

The problem is that there is actually little redress for victims of rogue builders. Trading standards will probably have a good go at trying to sort it out, but if the builder holds fast, it can do little more than give the builder a telling off and flag their name for future people. The reality is that the only recourse for everybody is the courts, but the legal process is hopeless. Those are not my words; they are the words of a number of solicitors and barristers who advised that, irrespective of the merits of the case, the risk of prosecuting was way too high, so people should cut their losses. “Cut your losses”—do we really think that is a way for 21st-century Britain to tackle a known problem that keeps repeating itself?

The reality is that rogue builders hold all the cards: they can do whatever they like, and there is no recourse. Anyone can pick up a brick and call themselves a bricklayer, anyone can pick up a plank of wood and call themselves a carpenter, and anyone can pick up a pipe and call themselves a plumber. Ironically, they cannot pick up a gas hob and call themselves a gas fitter; that job requires compulsory certification, so there is an acceptance that regulation can be necessary. When a problem arises, however, the only redress is in the courts.

A consumer can be completely rolled over by a rogue trader, but in order to get redress, they need to put aside up to £150,000 to prosecute a legal case, securing barristers, surveyors, solicitors, court fees and all the rest of it. They may win—in fact, they probably will win—but they then need to recover their costs and damages from the builder, who closes their business and moves on to the next scam, having taken all the money out of the business so that there is no way to recover anything. The next victim is engaged and the circus goes on, but our successful litigant is left facing appalling, unrecoverable costs. Meanwhile, more suppliers, subcontractors, plant hirers and the wider building trade lose a little bit more.

However, the solution is simple. The problem lies in the imbalance of jeopardy between the victim and the perpetrator. The reason why there is so much rogue building going on is because it is an easy way to rip people off. In some ways, it is a basic level of fraud, although proving fraud is incredibly difficult. With no loss to the perpetrator, they can go on and on while the victim bears all the costs. How do we balance the jeopardy between the victim and the rogue builder? The answer must lie in regulation, with something such as a compulsory licence that the builder will lose if he or she falls foul of the rules—rules, by the way, that can and will save lives.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on securing the debate. Rogue builders will often go into liquidation to avoid potential litigation or paying out when they have been taken to court and successfully sued, so should we also look at potentially holding the individual responsible in a fiduciary manner, not just the company? That may be a much more effective mechanism for people to be able to chase potential assets that they can then charge against successful litigation.

[Mark Garnier]

My hon. Friend gets to the nub of the point. At the end of the day, individuals have to find some sort of personal liability if rogue builders perpetrate these endless infringements. The point is that they have nothing to lose at the moment. If they run the risk of losing their livelihood, they will think again before acting in such a way. It may be that they go on to another type of criminal activity, but we would at least get them out of the building market.

The Minister and I have had informal conversations about this issue, and I know that he and the Minister who replied to my Bill’s Second Reading in 2021—my hon. Friend the Member for North East Derbyshire (Lee Rowley)—are instinctively against licensing and overregulation. To a certain extent, I can see their point. Why burden an industry that gives opportunities to people who choose to work with their hands and avoid a life of form filling? Indeed, I can see from the Wikipedia page for the Under-Secretary of State for Business and Trade, my hon. Friend for Thirsk and Malton—for whom this Minister is standing in—that he was a very successful estate agent. There is limited regulation around estate agents beyond the Estate Agents Act 1979 and the Consumer Protection from Unfair Trading Regulations 2008.

Conversely, I was an investment banker and investment manager, and I know what it is like to be regulated up to the eyeballs. Having been on the Treasury Committee during the passage of the Financial Services Act 2012, and on the banking commission for the Financial Services (Banking Reform) Act 2013, I can see why people might accuse me of being an instinctive regulator. However, even residential estate agents have to be members of a redress scheme. The estate agency of the Under-Secretary of State for Business and Trade would have been required to be signed up to either the property ombudsman or the property redress scheme. Without membership, I understand that it would not have been allowed to trade under the Consumers, Estate Agents and Redress Act 2007.

When I, the two victims I referred to earlier or any of the millions of people who want to improve their home undertake this momentous challenge—as I have said, they might do that only once or twice in their lives—they start by approaching an architect. They may speak to surveyors, and they may go to their bank or mortgage broker to secure a loan to pay for the improvements. They will apply for planning permission from the local planning authority. They may even seek legal advice, and then they will engage a builder.

The architect is regulated by the Architects Registration Board, established by the Architects Act 1987. The surveyor is required to be a member of the Royal Institute of Chartered Surveyors, set up by royal charter and independent of the Government. The mortgage broker is required to be regulated by the Financial Conduct Authority, which was set up by this Government, and cannot trade without that membership. The local planning authority is subject to the oversight of the local government and social care ombudsman. When our home improver starts to pay the builder, it is done from a bank regulated by both the FCA and the Prudential Regulation Authority, the latter of which is run by the Bank of England. Both were set up by the Financial Services Act 2012. Legal advice is regulated by the Solicitors Regulation Authority.

Our home improver then pays the money—their hard-earned cash—having had to go through umpteen regulatory hoops, to someone with no meaningful regulation. That is ridiculous. Not only is the builder not subject to any meaningful regulation, but they could do something that results in someone being severely injured or even losing their life. It is all very well saying that the builder may then be subject to criminal proceedings, but that is small consolation to the relatives of a dead father or a mother with life-changing injuries.

The only outcome that would be satisfactory would be a scheme that honest and decent builders—the majority—would be both happy to sign up to and of which they would enjoy the benefit through being part of a system of excellence. Meanwhile, rogue builders who either game the system or care not one iota about their customers will have something to lose. Without membership of whatever scheme we come up with, they would never be able to trade again, either as individuals or as businesses.

My appeal to the Minister was originally going to be for a meeting, but I am delighted that he, or someone from his office, has got in touch with me. I have every confidence that nothing will get in the way in the diary to stop that meeting happening. I very much look forward to meeting the Minister in early July. However, this is the really important point: will his Department—I know that it has been working to a certain extent on this—work with us to find a solution to this problem and stop the scourge of rogue builders once and for all? Every one of us who comes to Parliament baulks at unnecessary regulation, but just how long are we prepared to knowingly allow people to be ripped off without any usable form of redress?

[The Minister of State, Department for Business and Trade (Nigel Huddleston)]

I congratulate my constituency neighbour, my hon. Friend the Member for Wyre Forest (Mark Garnier), on securing the debate. He is a great champion for his constituents and for many causes that impact right across the country, this being one of them. I am well aware that he has proposed a private Member’s Bill to improve consumer protection from rogue builders. I am also grateful to him for giving other hon. Members the opportunity to discuss this important subject today. I thank the hon. Member for Strangford (Jim Shannon) and my hon. Friends the Members for Clacton (Giles Watling) and for Central Suffolk and North Ipswich (Dr Poulter) for their contributions, because I suspect that every Member has had correspondence and interaction with constituents on this issue. It impacts right across the country.

I assure my hon. Friend the Member for Wyre Forest that the Government are committed to ensuring that there are high standards in the construction industry and that consumers can have confidence that the work they commission will be undertaken competently and will comply with building regulations to ensure safety. We are also committed to ensuring that there are high standards of consumer protection and redress for those who pay for work that falls short of acceptable standards of quality and safety.

The construction industry makes a great contribution to the UK economy. In 2021, it had a turnover of £439 billion, accounting for nearly 9% of the economy, and employed 2.2 million people in about 430,000 firms, with an additional 700,000 self-employed workers. That speaks to some of the challenges that my hon. Friend mentioned in terms of the fragmented nature of the industry. He is also right to point out that the vast majority of those engaged in this sector are hard-working, honourable and decent people, but there are rogues—there is no doubt about it.

The domestic repair, maintenance and improvement sector is a vital part of the industry, employing about 60% of all those who work in it. The small firms and tradespeople who make up this sector deliver essential work to people right across the country. They play an important role now, which will become only more important as we seek to improve the environmental and carbon performance of homes. They are critical to our approach to reducing the 40% of carbon emissions generated by the built environment, and to achieving our net zero targets. However, it is also a part of the industry where genuine concerns about consumer protection exist.

As I have said, while the majority of tradespeople are honest and competent and provide excellent service, there are some incompetent or dishonest firms and individuals who exploit consumers, undertake defective work or overcharge for the services that they deliver. That must be stopped. The Government are committed to working with the industry and local authority trading standards to improve standards of competence and consumer protection, and to take action against rogue builders. While we are not convinced that the introduction of a licensing scheme in such a large and varied sector would be practical or cost-effective, I hope that I will be able to reassure my hon. Friend and other hon. Members that the Government take the issue of consumer protection from rogue builders seriously, and that we are taking meaningful action.

The Government have taken action to strengthen consumer rights. The Consumer Rights Act 2015 sets out the standards that consumers can expect when a trader supplies goods and services, including building work, and remedies if those rights are breached. Under the Act, traders are required to carry out a service with reasonable care and skill, and, where the timeframe is not specified in the contract, within a reasonable timeframe. Where a trader fails to meet the standards required by the CRA for the supply of a service, or if the service does not conform to the contract, there is likely to be breach of contract and the consumer is entitled to ask for a repeat performance of the service or for a price reduction. If a trader and a consumer cannot agree to a remedy, the consumer can pursue a claim against the trader in the courts. The small claims procedure provides the means to pursue a claim for up to £10,000, at a modest cost and without the need for a solicitor. Consumers have up to six years to bring a claim against a trader for breach of contract.

The Government have also signalled their intention to go further in order to protect consumers with provisions in the Digital Markets, Competition and Consumers Bill, which will give enforcement bodies the power to levy tougher fines. However, we know that many individuals and businesses are reluctant to have recourse to the courts to resolve a dispute, with the costs and time that that entails.

[Dr Poulter]

My hon. Friend will be aware that the cost of even relatively modest building works is likely to exceed £10,000, but that is the small claims court limit, so that form of redress is not open to many of the victims of rogue builders.

[Nigel Huddleston]

Yes, we are aware of the challenges with the small claims court. Of course, many building works go above £10,000. The Ministry of Justice is also looking at other forms of redress and procedures, and I understand that those are live considerations within Government. I am happy to forward my hon. Friend’s comments to the relevant Ministers, but we do understand the challenges with the small claims court. It works in many circumstances but it is not right for everybody.

We know that consumers would prefer swift, cost-effective and less time-consuming measures to settle their differences with business. That is why, following the recommendations of the independent “Each Home Counts” review in 2016, the Government have worked with the industry to establish the TrustMark scheme. This created the first Government-endorsed quality scheme for homeowners across a range of trades and types of work. TrustMark provides consumers with a single brand to identify schemes run within the industry that require participating firms and tradespeople to demonstrate competence, and which provide for consumer redress.

We are also working with the industry to ensure that high standards of consumer protection are embedded in relation to domestic households.

Norfolk and Suffolk NHS Foundation Trust

Dan Poulter Excerpts

Tuesday 7th March 2023 Commons Chamber

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

It is a pleasure to bring some positive news and, I hope, some reasonable asks to the Minister regarding Norfolk and Suffolk NHS Foundation Trust. May I first declare an interest as a practising psychiatrist? I do not work for the trust, but I think it important to bring the House’s attention to that point.

Over the past few years, we have had many debates in this place and many meetings with Ministers about Norfolk and Suffolk Foundation Trust. The good news is that in the last few days, the trust has been taken off special measures and is no longer rated “inadequate”. The tremendous effort of the board and the staff has paid off, and, as a result, we have seen in the latest Care Quality Commission report a considerable improvement in the quality of patient care.

The background is, as we know, that Norfolk and Suffolk Foundation Trust, which serves roughly 1.6 million people across Norfolk and Suffolk, and has about 87,000 patient contacts a year, has been in difficulties for a number of years. Over the past eight years, the trust has been rated “inadequate” four times, which I think probably places it not just as an outlier but as historically the worst-performing trust in the country for both physical and mental health.

A tremendous amount of work has needed to be put in to turn things around. I am optimistic that the new leadership team at the trust, the board and the staff have done the necessary work and that they will now continue that work to ensure that the people of Norfolk and Suffolk with mental ill health receive the improved care that they need.

In its most recent inspection, the CQC conducted an unannounced comprehensive inspection of two core services: child and adolescent mental health wards and community-based mental health wards. That inspection took place towards the end of last year. The CQC highlighted in its report, which was published on 24 February, a number of areas of improvement. It awarded NSFT an improved overall rating. It still requires improvement as a trust, but that is much better than being inadequate. The trust is now rated “requires improvement” rather than “inadequate” across all CQC domains, with the exception of the caring domain, in which the trust continues to be rated “good”. On individual services, 60% of those inspected are now rated “good”, and the trust no longer has a legal warning notice relating to concerns about the quality and safety of its patient care.

The CQC reported:

“The trust has moved at pace to make the necessary changes and significant improvements could be seen at all levels”.

It also described largely positive feedback from patients and service users, who said that they

“felt safe and well cared for...staff were supportive of their needs and friendly and approachable…staff were kind, they felt listened to…staff helped them when they needed it”

and that

“they were fully involved in their care”.

That is positive feedback from patients.

Key areas of good care highlighted by the CQC included the NSFT’s child and adolescent mental health ward, Dragonfly, which achieved a significantly improved overall rating of “good”; acute wards and community-based mental health services, which support working-age adults and achieved positive improvements in overall ratings; and the community-based mental health services for adults of working age, whose Bury St Edmunds pilot programme for dialectical behavioural therapy—a type of therapy generally provided to people with personality disorders—was recognised for outstanding practice.

[Peter Aldous (Waveney) (Con)]

I congratulate my hon. Friend on securing the debate. He mentioned improvements on the acute wards, and I wanted to highlight that a recurring theme of my 13 years as an MP has been the lack of acute beds in the region, and how for so many people with real challenges beds have to be sourced out of region, which causes them a lot of stress and their families a great deal of anguish as well. I am aware that the trust has plans to address the deficit, but does he agree that this issue must be addressed as a high priority?

[Dr Poulter]

My hon. Friend is absolutely right. He has been a strong advocate for patients in his constituency receiving the care they need locally, which is something we all want for mental health patients. The trust has identified that out-of-area placements have been a problem, which is now being addressed at board level and throughout all services. Part of that work will be about improving and developing the mental health estate, improving the in-patient facilities available locally in Norfolk and Suffolk, and part of it will be about transforming the model of care, moving away from inappropriate in-patient admissions where people can be better cared for in the community. I will return to that subject, but my hon. Friend is right to say that the trust must continue to focus on reducing out-of-area placement, which is not good for patients or for their families, who want to support them while they are being cared for in hospital.

A key point that the CQC highlighted was strengthened leadership across the organisation, in individual services and particularly at board level. That was reflected in the trust now having a rate of mandatory training compliance among staff of at least 90%, and the trust rolling out accredited training in the prevention and management of violence and aggression, following a case in which restraint had been carried out incorrectly.

There has been significant change at board level, which I believe has been vital in driving the improvements in the quality of patient care. There has been a number of new appointments: trust chair Zoe Billingham, non-executive directors Dr Roger Hall and Sally Hardy, chief executive Stuart Richardson, deputy chief executive and chief people officer Cath Byford, chief medical officer Dr Alex Lewis, who is particularly impressive, and chief operating officer Thandie Matambanadzo have all brought significant experience and qualifications to the trust. It is by bringing in that external expertise that the trust has been able to understand what good looks like, and to begin to transform services and patient care.

The trust’s clinical and other governance processes have been strengthened. The number of board sub-committees has been reduced to streamline systems of assurance. External stakeholders have become more active participants through committee memberships. An evidence assurance group has been introduced to ensure that progress-monitoring data is accurate. The strengthening of a ward visit quality assurance team has also been important to driving up standards; this team carried out 100 comprehensive visits between March and October 2022. The introduction of a new digitised and simple method of completing clinical audits is another key element of driving up standards at the trust.

[Tom Hunt (Ipswich) (Con)]

My hon. Friend has great expertise in this area, so when he speaks his words carry weight. I welcome some of these improvements, but does he agree that, such is the extent of the failure over such a long period, a huge job for the new leadership is to regain the trust of families throughout Norfolk and Suffolk who have lost trust in the organisation, who think it is broken, and who believe a new organisation is the only way forward?

[Dr Poulter]

I agree with my hon. Friend and neighbour about the importance of rebuilding trust. The CQC highlighted a lot of the work done over the last year as good because the NSFT has rebuilt trust with both staff and the patients who use the service. The patient feedback, which was highlighted by the CQC, has been overwhelmingly positive in that time. That area has been addressed. It is an ongoing piece of work for the trust to focus on. It is also important, before we think about reorganisation—I understand why my hon. Friend has highlighted that—to understand what the consequences of that might be, and I will come to that in my later remarks. My view would be that we now need to get behind and support the new leadership team and recognise that for the first time in eight years we have a trust that is moving in the right direction and now needs to show consistent progress. Reorganisation would be a distraction from continuing that progress and could be detrimental to patient care. Whereas I might have agreed with my hon. Friend a year ago that reorganisation could be a viable option, at this stage, given the progress made and for a number of other reasons that I will come on to, I believe that the solution does not lie in breaking up the trust, but in supporting the board and staff to do the job that they have started and to get the trust not just to “requires improvement”, but to “good” and then to “outstanding”, which is what they would like to do.

The trust has recognised that it has needed to bring forward work to align its strategy with the plans in the broader health and social care system. One of the problems in the past was that the trust was often operating in isolation and not joining up the focus of its care with the work done by other healthcare partners. If we are talking about preventive care and upstream early intervention, a lot of the work going on between NSFT and primary care partners has meant that there is more focus on early intervention and preventing people becoming unwell, and hopefully therefore reducing inappropriate hospital admissions, and that is an important ongoing piece of work.

However, improvements still need to be made. A key area that has been highlighted for improvement by the Care Quality Commission and internally by those who work at the trust is that trust data is not as unified as it could be. While the trust has a large amount and range of data, it is not brought together effectively to focus on patient care and reduce risk in the way it needs to be. The effect is that struggling services are not always identified quickly enough to be provided with the necessary support, and I know that that will be a key focus over the next year to 18 months. Essential environmental improvements, for example on in-patient wards, do not always happen fast enough within the trust to address patient safety concerns. There is variation in the abilities and confidence of ward and team managers and middle management in clinical care groups, and managers do not always escalate concerns quickly enough to gain the necessary support. The strategic leadership team at the trust has recognised that and is now focusing in particular on ensuring that quality improvement is embedded in everything that everyone at the trust does so that it becomes everyday business, rather than an aspect of clinical audit, as may have been the case in the past.

[Duncan Baker (North Norfolk) (Con)]

I thank my hon. Friend for bringing this debate to the House. I think we should give credit where credit is due, and it is positive that we now have some green shoots at the Norfolk and Suffolk NHS Foundation Trust moving forward, but my concern is that those should be sustainable green shoots and that this is not a yo-yo where the trust goes back into special measures. It should be on a sustainable footing going forward. I know that the chair has reassured many of us that she feels it is a good platform from which to move forward.

One of the points to address is culture and the improvements that need to be made. Does my hon. Friend agree that one of the key statistics is that 41% of staff leave within the first two years? The trust has to improve on that. People who need a lot of mental health support must form relationships with those who are treating them. The number leaving within those first two years is something that the trust has to improve.

[Dr Poulter]

I agree with my hon. Friend. A key issue faced by a lot of mental health trusts, but which is particularly acute at Norfolk and Suffolk, has been a high rate of staff turnover, and that is not good for continuity of patient care. It is not good when we are talking about embedding a culture of safety and quality improvement. It does not help. It is undoubtedly the case that one of the key challenges going forward that has been identified by the trust and the CQC as well as by NHS Improvement, which has been providing external support, is the need to improve staff recruitment and retention. Some of that is a national challenge, but effective initiatives have been introduced at a local level. The new chief medical officer, for example, has introduced staff recruitment and retention initiatives, some of which are financial and some of which relate to improved job planning, which can help to make the trust a more attractive place for staff, not just to work, but to remain for the longer term. We need to see that kind of work being built on and continue in the months and years ahead. The same is true across nursing and all other staff groups.

Other areas to highlight where things are going well include investment. The trust has invested £3.2 million in digital improvements, £1.6 million in improvements in clinical areas, £1.3 million refurbishing bungalows for people with learning disabilities, £1 million to address safety issues, and £600,000 to improve the pharmacy at Hellesdon Hospital in Norwich. There are new services, including 95 new primary mental health nurses working across the trust directly with primary care, offering more than 80,000 appointments in GP surgeries across Norfolk and Suffolk. There is a 22-strong rehabilitation team and a new armed forces veterans wellbeing service in partnership with Walking with the Wounded and Outside the Wire to help to improve mental health support available to veterans across Norfolk and Suffolk —we have many veterans living in our constituencies.

The trust still has a lot to do, but it has achieved a lot in the past year under new leadership. I should like to put on record my thanks to the board and all the staff for the work they have done in turning things around so effectively and quickly. Key challenges, as we have outlined, remain the recruitment and retention of staff. The trust has launched programmes to address that, but there is still more to do. The CQC report recognised that the NSFT is changing at pace, but it needs to do more than show improvement over a year—it needs to embed the changes, sustain them and secure not just “requires improvement” but “good”. The NSFT needs to continue its work with system partners across Norfolk and Suffolk to improve commissioning and the delivery of mental health services across the patient journey.

The trust requires ongoing support, and I have some brief asks of the Minister. First, the trust requires from the Government another £3 million of funding to complete the £54 million needed for a new campus at Hellesdon Hospital, which would secure the development of three new wards. That is a key aspect of addressing the problem that my hon. Friend the Member for Waveney (Peter Aldous) outlined, so that there is less reliance on out-of-area beds. We need more wards to treat more local patients in Norfolk and Suffolk, and less reliance on out-of-area placements. I hope that that £3 million of funding can be secured, and I would be grateful if the Minister outlined how we can go about that.

Secondly, the trust has made inroads into issues associated with its estate, but it needs significant and urgent capital investment in addition to that £3 million to help to develop those new wards and modernise Hellesdon Hospital. More generally, can the Minister outline what capital programmes are available to support the trust in those ambitions?

Thirdly, funding for mental health services has been constrained despite increased needs and patient demand, and, when we are talking about parity of esteem when funding increases for the NHS, my general plea—I would say this as a practising psychiatrist—is for greater funding for general adult and other mainstream psychiatric services.

The next area of asks for the trust is from NHS England. The trust has benefited from strong and experienced outside support from NHS Improvement and from experienced leaders such as Nick Hulme from East Suffolk and North Essex NHS Foundation Trust, who was seconded to support the trust. Now that the trust is out of special measures, I hope there is still an opportunity for some of that external support to be maintained, even in a more informal capacity. I look to the Minister to perhaps outline how that may continue or whether she may be able to give some direction to help with that ongoing support, which the trust has found very helpful during these difficult times.

On local decision makers and stakeholders, the trust supports a new model of care for Norfolk and Suffolk, and ensuring that local ICBs work effectively with it to deliver more preventive upstream care and more care in the community. Reducing inappropriate and unnecessary in-patient admissions is a key priority in the trust’s ambition to transform services and improve patient care, and any support the Minister can offer to encourage or enable the local ICBs to be more effective at doing that would be gratefully received by the trust.

On the issue of breaking up the trust, I would urge the Minister to give a commitment at the Dispatch Box today that, given the progress that has been made by a very effective new board—a group of individuals with a good skillset—and given the commitment that has been shown to staff and to turning around the trust and moving it away from special measures and away from “inadequate” towards “requires improvement”, the threat of the trust being broken up can be taken off the table at this stage so that the trust can focus on caring for its patients. Breaking up the trust now would be very disruptive to patient care. It also would be financially inefficient and would lead to a worsening of the retention and recruitment challenges, which have been outlined by my hon. Friend the Member for North Norfolk (Duncan Baker), with staff feeling that their jobs are insecure.

To sum up, we are asking for support with capital projects, particularly around Hellesdon Hospital. We are asking for ongoing support, be it informally from NHSI or key national stakeholders. And we are asking for some encouragement to be provided to the local health and care system to support the trust’s service transformation model. Finally, I hope the Minister can give a commitment this evening that there is no threat of the trust being broken up, so that it can get on and continue to deliver the improvements that have been put in place.

I will cease my remarks, Mr Deputy Speaker. I look forward to hearing the Minister’s response, but I will put on record once again my thanks to the board and the staff for turning around what was the worst-performing trust in the country and, I hope, putting us in a place where we can be proud of our local NHS mental health trust and where patients will receive a much better quality of care not just today but in the future.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I thank my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) for bringing forward this important debate about the Norfolk and Suffolk NHS Foundation Trust, and for highlighting the progress that has indeed been made. The difficulties at the trust have been well documented, and there have been performance and quality issues for many years. Those have been highlighted on behalf of their constituents by many Members of the House, including my hon. Friends the Members for North Norfolk (Duncan Baker), for Bury St Edmunds (Jo Churchill), for Waveney (Peter Aldous) and for Ipswich (Tom Hunt), many of whom are here this evening. However, all the MPs in Norfolk and Suffolk have worked constructively to make progress and to support the trust, patients and staff.

To understand the root causes and to ensure that effective plans are in place to improve patient outcomes, I and many of my ministerial predecessors have met right hon. and hon. Members from Norfolk and Suffolk collectively on several occasions, alongside NHS England, the CQC and representatives from the trust and the newly formed ICBs, to review progress and to ensure that there was an effective plan to achieve the quality of care that patients and families clearly deserve.

I am pleased that the latest CQC report recognises some key progress in areas that need improvement. The leadership team and staff across the trust should be congratulated on their hard work on that, and on the fact that the trust’s overall rating has moved from “inadequate” to “requires improvement”. Many elements of the report were found to be “good”, however, which indicates that things are moving in the right direction. The CQC also reports that

“the trust had moved at pace to make the necessary changes and…significant improvements could be seen at all levels”,

which is encouraging.

I understand that my hon. Friend the Member for Central Suffolk and North Ipswich and other hon. Members from Norfolk and Suffolk were invited to attend a briefing on 23 February, prior to the publication of the inspection. I hope that those who could attend found that session constructive; it sounds as though there is collective agreement that progress has been made. I had a similar session with the CQC the day before and I found the progress encouraging. I was reassured that many of the issues raised previously are being addressed, but there are clearly still significant challenges at the trust that must be addressed, which my hon. Friend outlined well this evening.

I welcome the progress that the trust and its leadership team have made and the fact that they have set out a realistic improvement delivery plan and a commitment to take it forward. I am pleased to hear from the CQC that the trust and all its partners are clear that they cannot take their foot off the pedal. Now is the time to double down on their efforts and not just assume that the progress of the last few months will continue.

I am pleased to confirm that NHS England will continue to provide the existing level of support to the trust. A full-time improvement director is in place, with representation at the trust’s governance meetings, so they have full visibility of the latest data and improvements needed. They will continue to work closely with the trust and key stakeholders to ensure that they continue to build on the recent progress. As part of the next steps, a rapid quality review meeting between the trust and its partners will take place on 27 March.

I will continue to watch closely and to ensure that any concerns that arise are dealt with quickly and at pace. Alongside NHS England, I am keen to ensure that the joint meetings that we were having continue to take place. I intend to hold a follow-up meeting with the relevant Members of Parliament and our system partners in early May, once the rapid quality review meeting has taken place on 27 March and the options review work has concluded. I hope that gives my hon. Friend some reassurance about how seriously we are taking the issue.

On mental health more generally, on 23 January I announced that we were commissioning a rapid review into mental health in-patient settings, with a focus on how we use data and evidence to look at the quality of in-patient services in mental health across England more broadly, including complaints and whistleblowing alerts, to identify risks to safety. The review is being chaired by Geraldine Strathdee and will run for eight weeks. We will shortly get her report and I am keen to implement her findings. That relates to the point that my hon. Friend the Member for North Norfolk made about the culture in mental health and how we change that to improve outcomes for patients. NHS England recently announced a new in-patient quality transformation programme to support cultural change in mental health and to develop a new, bold, reimagined model of care for all NHS-funded mental health services, particularly in an in-patient setting.

In the minute or so I have left, I will touch on a couple of key asks. Capital funding is available for mental health services. A few weeks ago, we announced funding for crisis centres, community support teams and mental health ambulances, so that they can respond more quickly to those going into crisis, in order to try to avoid admissions. More generally, record levels of funding are going into mental health—£2.3 billion extra each year. I encourage the local trust to speak to its integrated care board, which has access to that funding, if it is interested in capital programmes. That is a whistlestop tour of the support that we can give.

[Dr Poulter]

Will the Minister give way?

[Maria Caulfield]

I have only a few seconds left.

In conclusion, I hope that reassures all hon. Member across Norfolk and Suffolk that we take the issue seriously. I am delighted that progress is being made across the trust.

Question put and agreed to.