Mental Health Support

Danny Chambers Excerpts

Thursday 10th October 2024 Westminster Hall

[Dr Danny Chambers (Winchester) (LD)]

Thank you, Mr Dowd, for calling me to speak.

As a veterinary surgeon, I come from a profession that has a suicide rate four times the national average. Like many people in this Chamber, I have experienced the pain of losing friends and colleagues to suicide. That led me to become a trustee of a mental health charity for several years, and I am honoured to be the spokesperson on mental health for the Liberal Democrats.

Although we have undoubtedly focused on NHS clinical services in this debate, we often underestimate the profound impact that non-medical issues, such as living in poverty, financial worries, debt and insecure housing, can have on mental health and how they can hinder people’s recovery from a mental health crisis.

I am incredibly proud of a project that I visited just last week in my constituency of Winchester that is run by Melbury Lodge mental health hospital and the citizens advice bureau in Westminster. This project provides one-to-one advice and support to in-patients on matters relating to living in the community, from relationship and financial advice to management of debt and benefits and housing problems. Someone who ends up being admitted to a mental health unit will find that their post—correspondence relating to their benefits, mortgages and other bills—all goes to their home address, and if nobody else lives there, they will not receive any of it. When they are discharged, they may get out and find that there is a problem with their benefits, or that they have received a huge bill that they were not expecting.

Amazingly, the Melbury Lodge and Citizens Advice team have demonstrated that for every £1 spent on this project, the NHS system avoids spending on average £14.06, which is a huge return on investment. As we extrapolate out, the research shows that having the Citizens Advice service on site means that Melbury Lodge has avoided spending nearly a quarter of a million pounds. This cost avoidance is achieved through shorter in-patient stays, fewer readmissions, reduced medication and better engagement with community services. That is a staggering amount of money that can now be spent directly on clinical care. I urge the Government to look at the results of this initiative with a view to rolling it out in other parts of the country, because it is good for patients, good for NHS staff and good for the taxpayer. I am really excited that this project has been shortlisted for an NHS parliamentary award next week, and I look forward to supporting the team in person.

We need to acknowledge the impact that the lack of mental healthcare has on other public services. When I go out with the police in Winchester, they tell me that they spend between 40% and 50% of their time dealing with mental health issues in some capacity.

The hon. Member for Hastings and Rye (Helena Dollimore) mentioned the cost when people in a mental health crisis, who are often already on a mental health waiting list, arrive at accident and emergency departments. One of the biggest issues raised with me by parents in Winchester is the huge delay for children who are waiting for diagnoses of ADHD and autism.

The hon. Member for Ashford (Sojan Joseph) has already mentioned that the Darzi report acknowledged that 20% of the NHS disease burden is due to mental health issues.

[Lola McEvoy]

Does the hon. Member agree that too often people confuse neurodiversity, which we should celebrate; severe mental illness, which we need to support people with and help them manage; and poor mental health, which is a day-to-day thing that can often be caused by circumstances?

[Dr Chambers]

That is a good and important point. We also need to acknowledge that people with certain issues—neurodiversity, undiagnosed ADHD or autism—who do not get the support they need are more likely to develop mental health issues as a result. It is a bit of a chicken-and egg-situation.

Finally, as I was saying, only 10% of the NHS budget is for mental health, but it is 20% of the disease burden. The obvious question people ask is: how do we afford that? When I look at the pressure on the police, A&E and the education system, the question I would ask is: how can we afford not to treat mental health properly?

Maternity Services: Gloucestershire

Danny Chambers Excerpts

Wednesday 9th October 2024 Westminster Hall

[Max Wilkinson]

I would. The hon. Member makes a strong case, and I will come on to some of the evidence from the Royal College of Midwives later. It has done some important studies into the stress that midwives are put under in the system.

I will move on to Stroud—the hon. Member for Stroud (Dr Opher) is in his place. In Stroud, six post-natal beds were closed around the same time as the closure to new births at the Cheltenham Aveta centre. The reason given by the trust was that the temporary closure would consolidate staffing across the county and provide a safer level of care for births across the whole of Gloucestershire. I am certain the hon. Member will have more to say on this if he is called to speak later, and I am pleased to see him here.

In our county, the 6,000 families who rely on our maternity services each year view this as a significant downgrade in service, and it is a cause of worry for a large number of families. It is clear that these services can only reopen when staffing levels improve. At the moment, the trust says it is around 13% below the staffing level required to return to the previous level of service, with Cheltenham open and the beds reopened in Stroud. However, the nature of midwifery means that quite a lot of the midwives will be off on maternity leave themselves at any one time. Indeed, I will come on to talk about the stress that midwives are under and some of its causes, which have led to a larger proportion of midwives being off for a significant period of time each year than staff in the rest of the NHS.

Research into what is driving the recruitment and retention crisis exposes the scale of the challenge we face in Gloucestershire and across the rest of the country. We are told that recruiting to a trust under a section 31 safety notice is even more challenging than it is elsewhere. Midwives who are already under significant pressure are subjected to additional strains in the form of monitoring and bureaucracy, and that can have an impact on staff morale. Of course, monitoring and bureaucracy are important when we are trying to get trusts out of safety notices; however, we cannot look past the fact that that makes it more difficult to overcome those recruitment challenges.

If that were the only barrier, it would be somewhat simpler. The Royal College of Midwives conducted a randomised survey of weekly hours worked by midwives and maternity support workers. The findings were absolutely shocking. It found that the staff surveyed reported a collective total of nearly 120,000 unpaid hours that week. That is a stark illustration of the demands placed on frontline NHS staff, who go above and beyond in a system that appears to be falling apart at the seams.

It is no wonder that the Darzi review reports that there is a high rate of sickness absence among midwives at 21.5 days a year per midwife. The most common reasons cited for absence were anxiety, stress or depression, or other psychiatric illnesses. Midwives go into the profession because of a commitment to the health of women and babies and to giving care at a critical moment, and to be part of a joyful moment in so many families’ lives. The fact that they are collectively suffering such high levels of stress tells us just how badly wrong the system has gone.

[Dr Danny Chambers (Winchester) (LD)]

As the Liberal Democrat spokesperson on mental health, I believe we should acknowledge and pay tribute to NHS staff in general and specifically midwives because we know that one factor that causes stress is overwork. We are also aware that the NHS very much runs on good will—people working extra hours and unpaid hours. That has been the norm for many years, but it is not sustainable. We need to acknowledge the support they need from a mental health point of view.

[Max Wilkinson]

My hon. Friend makes a strong point. Employee assistance schemes have a strong role to play here. I understand that in the NHS there is quite good support in general. However, it is a massive struggle when people are working so many extra hours to ensure that they get the support they need. In the case of midwifery, it is a stressful job—a life-and-death matter in many circumstances.

There is a clear and obvious link between the extreme overwork identified in the RCN survey and the findings of the Care Quality Commission. Obviously, if staff are working so many extra hours, they will suffer. Gloucestershire Hospitals NHS Foundation Trust has identified staff turnover levels and low morale due to the workload as significant factors. The Darzi report also calls for a shift away from care in centralised hospital settings towards communities, and states that that is a likely route towards the recovery of our health services. That being the case, and with a Minister in the room, I say that there is a clear argument for restoring Cheltenham families’ access to a fully functioning birth unit in our town as soon as it is safe to do so.

I have three questions for the Minister, if she would be so kind as to answer them. First, what is the Government’s position on seeking to reinstate maternity services in places such as Cheltenham and Stroud, which have been recently downgraded? Secondly, what will the Government do to address the ongoing recruitment and retention crisis in midwifery? Thirdly, in cases such as Gloucestershire’s, where a section 31 notice is exacerbating recruitment and retention issues, what can the Government do to help local trusts improve their staffing position? I understand that there are examples of trusts around the country being supported to pay high wages and salaries to ensure that midwives can be properly recruited and to overcome shortages.

--- Later in debate ---

[Dr Danny Chambers (Winchester) (LD)]

One of the biggest problems that has come up time and again in every maternity inquiry is that women are not being listened to, and too many times their concerns about their care are dismissed. That really needs to change, so we need to start prioritising the voices and experiences of women if we are serious about fixing this crisis.

I said earlier that I am the Liberal Democrat spokesperson on mental health, and I need to mention the shocking statistic that suicide is now the leading cause of death for women between six weeks and 12 months after they have given birth. World Mental Health Day 2024 is tomorrow and it is heartbreaking to think how many new mothers must be really suffering without the support they need.

We need to recognise the financial impact of this crisis. The NHS faces a £21 billion maternity negligence care bill—money that should be going into providing maternity care. When the negligence payout is three times the actual funding for the care, the system absolutely needs resources to be poured into it to ensure that we get that bill down and instead use the money to deliver safe and effective care.

In Winchester, people are particularly concerned about proposals to downgrade our consultant-led maternity services to a service that does not have consultants and surgeons on site. Unlike the hon. Member for Stroud (Dr Opher), who is a doctor, I am a vet, so I do not have his experience. However, I have done countless emergency caesareans, so I know that when something starts going wrong in childbirth, especially halfway through a birth, timing is everything. The thought of starting to give birth in Winchester but then having complications and having to be transferred up to Basingstoke is understandably concerning and terrifying for many constituents. We are therefore fighting to keep consultant-led maternity services in Winchester, because the problem in Gloucestershire arose partly because of the downgrading of services and the move to other hospitals.

The safety of maternity services is a concern nationwide, including in the Hampshire hospitals NHS foundation trust area. In 2023, the Care Quality Commission downgraded the trust’s maternity services from good to requires improvement after it found serious safety concerns. The trust’s amazing staff have been working really hard to improve things, and I am pleased to report that the trust exited the maternity safety support programme in July this year. However, there is still a long road ahead to restore public trust in these vital services.

I want to acknowledge the brilliant work of a Winchester resident who is here today. Jo Cruse launched the Delivering Better campaign, and I urge everyone here today, who will obviously have a particular interest in maternity services, to engage with and learn more from it. Jo has shared her story with me, and with her permission I will read it out:

“My daughter’s birth in October 2021 was the most terrifying experience of my life. I entered motherhood injured by a series of poor clinical decisions, and deeply traumatised by a three-day labour during which my calls for help and pain relief were repeatedly ignored or dismissed.

The experience eroded my trust in a healthcare system I have always revered, pushed my marriage to the brink, stripped me of my dignity, led me to develop suspected PTSD and many months of painful recovery. It has had a significant impact on how I feel about whether I will have more children. I cannot overstate how far the shockwaves of that experience have extended in my life.

I live with the knowledge that what happened to me was not only avoidable, but is happening every day in maternity wards across the country. This is not an issue localised to a few ailing trusts. This is a public health crisis being allowed to unfold in plain sight.”

NHS Performance: Darzi Investigation

Danny Chambers Excerpts

Monday 7th October 2024 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

The findings in Lord Darzi’s report are shocking, but Liberal Democrats—there are many of us here today—find that they echo the hundreds of thousands of conversations we had with people on the doorstep across the country throughout the election campaign. In too many ways, the NHS just is not working as it should, and that is a tragedy, because we all cherish the NHS and want it to succeed. It is one of our country’s greatest inventions and a great Liberal idea. It is one of the things that makes us proud to be British.

We all owe so much to the NHS and the incredible hard-working staff who have kept it going under the most intense pressure imaginable. Despite their heroic efforts, there is no doubt that we have a major crisis in the NHS. Let us not forget, because it is so important—these things are intrinsically linked—that we also have a major crisis in care. The message that the British people sent at the general election in July was clear: fixing the health and care crisis must be this Government’s No. 1 priority.

Before I turn to the Government’s plans, it is worth reminding ourselves of the scale and urgency of the challenge. Far too many people wait weeks to see a GP or NHS dentist, if they can find one. Far too many wait months or even years to start vital treatment for serious conditions. Far too many wait for hours in pain and distress for an ambulance to arrive. I recently spoke to a constituent, Emma, whose 11-year-old daughter Charlotte suffers from a medical condition that means she is red-flagged, or a category 1 priority patient, in the case of a medical emergency. Unfortunately, Emma and Charlotte were recently involved in a car crash. Charlotte urgently needed an ambulance, but after two hours of waiting, her father decided to take her to hospital in the back of his car. She starts her journey to senior school this autumn. Her family have had to devise their own response network to keep her safe and secure, and to allow her to attend school in confidence. Our ambulance service failed Charlotte and her family when they were in crisis, and we cannot let that continue.

The problems do not stop there. Across the country, almost 6.5 million people are stuck on hospital waiting lists. That is one in every nine people in England. Two million of them have been waiting for more than six months. Over the past year, more than 100,000 people have waited more than two months to start cancer treatment after an urgent referral. In my constituency of North Shropshire, almost 20% of urgent referrals took more than 43 days and 10% took more than 62 days. The target is 28 days. It is truly heartbreaking. We know that every day counts when patients are battling cancer.

Young people needing help with their mental health are waiting months and even years to access child and adolescent mental health services. There is no help for them until they are in crisis. As if all that was not bad enough, we have hospitals that are literally crumbling. There is a maintenance backlog of £11.6 billion. Buildings are decades past their use-by date. It is shocking but, as my Liberal Democrat colleagues and I know, far from exceptional. Most of these problems go back decades. The truth is that Governments of all parties have failed to put enough capital investment into the NHS. They have failed to face up to the challenge of an ageing population and, crucially, they have failed to tackle the care crisis, with one honourable exception: the Care Act 2014 was passed by Liberal Democrat Ministers a decade ago, with cross-party support. Sadly, it was ripped up by the Conservative Government after 2015.

The failure and neglect of the Conservative Government left the NHS teetering on the brink. There were so many grand promises—6,000 more GPs, 40 new hospitals and cross-party talks on social care—but they were all fantasies. In Shropshire—which is not an outlier—the Royal College of General Practitioners found that the average GP is seeing 475 more patients than they were in 2016. Patients and their loved ones have been let down so badly.

When the scale of challenges across health and social care is so enormous, it would be easy to succumb to pessimism and defeatism—doom and gloom—but we cannot afford to do that. The patients of today and tomorrow cannot afford for us to do that. This moment demands the same urgency, ambition and vision that drove the creation of the NHS all those years ago. We very much hope that the Government will show that ambition. I welcome the Secretary of State’s recognition of the fundamental importance of shifting more focus to primary care—to GPs, dentists, mental health practitioners and community pharmacists—for our young people.

[Dr Danny Chambers (Winchester) (LD)]

As the newly appointed Liberal Democrat spokesperson on mental health, I was really concerned to see in the report that mental health is about 20% of the NHS’s burden yet receives only 10% of its funding. Certainly in Winchester—it will be the same for nearly all hon. Members in the Chamber—mental health, and especially the mental health of children, is one of the most commonly brought up subjects.

I know that the Secretary of State agrees that mental health and physical health need to be treated with the same level of importance, but I urge us to recognise that we cannot treat it with the same level of importance if the level of funding does not accord with the demand it is putting on the service. It is not just about funding; it is about making sure that the mental health support that is needed is there in schools, in social care and for people struggling with debt. So many non-medical factors contribute to mental health that we need a cross-departmental look at how we support people’s mental health.

[Helen Morgan]

My hon. Friend is exactly right, and we put mental health and access to primary care and health prevention front and centre of our manifesto for that very reason. I encourage the Secretary of State to take our plans where they are complementary to his and run with them. We are happy to have our ideas plagiarised—we will welcome it.

Welcome as that focus is, some of what we have heard gives me cause for concern. First, some weeks ago the Prime Minister suggested that investment can come only after reform. I warn the Secretary of State that I do not think that that will work. The reforms that our NHS needs cannot be done on the cheap. Improving access to primary care means investing in more GPs, more NHS dentists and more community pharmacists. Boosting productivity means investing in better IT systems and bringing hospitals up to date with the new facilities they need. I agree that it cannot be just more investment without reforms, but nor can it be just reform without more investment. We need that investment now. The reports that we have heard of potential cuts to spending in the Budget are deeply concerning. I urge the Secretary of State to guarantee today that they will not happen.

Finally, I am afraid that there still seems to be nowhere near enough focus or urgency when it comes to care. We simply cannot fix the crisis in the NHS without fixing the crisis in care. Right now, more than 12,000 people in hospital are ready and well enough to go home but stuck there because the care they need is not available. That is awful for them and their families, and it is awful for the NHS that 12,000 beds that should be getting used by patients who need them and allowing better patient flow through hospitals are being held up because the care system is in crisis. I urge the Secretary of State again not to put this off any longer but to set up a cross-party commission now so that we can agree a long-term solution to ensure that people get the care they need, when and where they need it, and that carers are properly supported, too.