(5 years, 2 months ago)
Commons ChamberThe House will not be surprised to know that the hon. Gentleman has raised this with me and my right hon. Friend the Secretary of State on a number of occasions. I am happy to reconfirm to him that we do consider it a top priority to make sure that all of his constituents get the care they need.
The hon. Lady is quite right. As part of the long-term plan, we have considered the best way to commission sexual health services, which were moved over to local authorities five years ago. We think that the responsibilities are sitting in the right place, but we need to see far more co-commissioning, where local authorities and the NHS together ensure that there is more joined-up provision, rather than the siloed provision that she mentions.
(5 years, 2 months ago)
Commons ChamberI have already set out the fact that the Department, the whole NHS management, the whole NHS, and we as a country welcome and recognise the huge contribution of EU nationals in the NHS. I have set out our desire to continue to ensure that EU nationals work in the NHS. Alongside that, I know that Sir David Behan will have also said to the hon. Gentleman that it is important that we have more routes into nursing to ensure that those 40,000 vacancies that he discussed do not continue, which is why we have set out in the plan more nursing apprenticeships, more nursing associates and more clinical placements. It is important to have both international and domestic recruitment.
The Minister has talked a lot about leadership. He said in his opening statement that there was a need to create in the NHS leaders who could create cultures that empowered staff. What is he going to do about the bullying at the top of the NHS, including in NHS England and NHS Improvement, which Dido Harding admitted yesterday at the Health Committee?
The hon. Lady is right: that culture is not acceptable and must be driven out. She will have read the interim people plan, which talks explicitly about ensuring that we create leadership that stops that culture. There is a chapter on making the NHS the best place to work. She will know that we have been working across the country to ensure that all staff know that they are valued, that they have the right to speak up and that the culture of bullying must be driven out. I shall speak with Baroness Harding, as I do regularly, to ensure that that message is spread throughout the NHS and that staff know that they are valued.
(5 years, 3 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
I am grateful to my hon. Friend for his impassioned plea; he makes an excellent point. We have spoken quite comprehensively today about how important it is that people with learning disabilities are never written off as a “do not resuscitate”, because that is absolutely wrong. I can tell him—I think he will find this useful—that we have introduced annual GP health checks for people with a learning disability to help to recognise these health inequalities, so that some long-term health conditions can be picked up much earlier and diagnosed more quickly, and prevention can be put in place much sooner.
I wonder if the Minister recognises that for many families the review feels like the NHS marking its own homework, and that there needs to be more of an independent body to look at all the cases to give the reassurance that those families want.
I do recognise what the hon. Lady is saying. It is difficult to know how best to analyse something as tragic as a death—how to bring forward all the relevant expertise. That is why NHS England works with the University of Bristol on this programme. It is a very new programme—the report to be published shortly will only be the third one—and we are always open to ways in which it can be improved and seen to be more independent, more thorough and to make more difference.
(5 years, 3 months ago)
Commons ChamberI beg to move,
That an humble Address be presented to Her Majesty, that she will be graciously pleased to give directions that the following papers be laid before Parliament: any briefing papers or analysis provided to the Secretary of State for Health and Social Care or his Ministers since 9 July 2018 including impact assessments of public health spending reductions and any assessments made on falling life expectancy and the minutes of all discussions between the Department of Health and Social Care and NHS England on funding pay risks for Agenda for Change staff working on public health services commissioned by local authorities.
A child born at this very moment in the very poorest of communities—whether in inner cities like Manchester or my own city, Leicester, or in towns such as Blackpool or Burnley—will have a life expectancy that is around nine years lower than that of a child born at this very moment in some of the wealthiest communities, such as Chelsea, Westminster or east Dorset, and they will enjoy 18 fewer healthy years of life. Two babies born today could have years of difference in life expectancy and years of difference in healthy living, due entirely to the circumstances into which they are born. The child born in the very poorest of areas is more likely to leave school obese and almost 70% more likely to be admitted to A&E. That child is less likely to receive measles, mumps and rubella vaccinations, more likely to take up smoking as a teenager, and more likely to need the help of specialist mental health services at some point.
Of course, health inequalities have always existed, throughout the 71-year history of the national health service, but nine years of desperate, grinding austerity have brought us record food bank usage and in-work poverty, and seen child poverty increase to 4 million, with 123,000 children today growing up homeless in temporary accommodation—a 70% increase since 2010. Some 4,700 of our fellow citizens sleep rough on our streets, an increase of 15%, and, tragically, nearly 600 of them die on our streets. There have also been savage cuts to public services, including social care, which have left 600,000 elderly and vulnerable people without support. We have seen nine years of all that, and we should be shocked, because the advances in life expectancy that we all take for granted and that have steadily improved for 100 years are grinding to a halt.
My hon. Friend is setting out clearly why the Opposition called for this important debate. Does he agree that the fact that for the first time since Victorian times we are seeing life expectancy falling for the poorest women in the most disadvantaged communities in our country, where the cuts have been heaviest, is a sad indictment of nine years of Conservative rule?
Absolutely. Not only are there indications that advances in life expectancy are going backwards, particularly for women, but the Institute for Fiscal Studies has been quite clear today in launching its Deaton review:
“In 2001, women born in the 10% most affluent areas could expect to live 6.1 years longer than women born in the 10% most deprived areas; by 2016, the gap stood at 7.9 years.”
That is why we secured this debate.
Yes, that is an absolutely fantastic point. I was going to mention the fact that our local sports and leisure facility has an agreement with the NHS that GPs can prescribe sports facilities to people so that they can have an exercise regime designed specifically for them. If they can benefit from such a regime, that can maximise their health. All these things actually save money in the long term, and that is why public health is so crucial. We really are investing for the good of the nation.
From my own experience of working in addiction services many years ago, I know that we have to take on board the fact that there are huge levels of comorbidity with mental health. Often, people in addiction services have a history of trauma. They are self-medicating with alcohol or drugs, and they are not coping with life due to their underlying mental health issues. However, those very same people are often refused access to mental health services treatment until they have dealt with their addiction. That is a circular argument, and those who are struggling with mental health and addiction problems never really get the support that they need or deserve. That is why integrated services in relation to addiction are so important.
I am interested to hear about what is happening with drug and alcohol services in Scotland, particularly the 9% budget increase that the hon. Lady mentioned. Has she had the same experience that I have had in Hull, where more and more people on the streets seem to be taking Spice, which turns them in an obvious way into someone who is taking drugs and which is causing real problems on the streets? Is that happening in Scotland as well? We have seen an 18% cut in drug and alcohol services since 2013.
This is always a difficult situation, because when people self-medicate, they tend to take the drugs that are available. They may take something that has an impact on their behaviour and personality, which may then have an impact on their life if they become involved in crime and so on. The types of drugs that are coming on to the market seem to lower people’s inhibitions, so they can get into terrible difficulties with the criminal justice system, but their difficulties—their underlying trauma and addiction—are not dealt with. That money is welcome, but we have a long way to go to ensure that we also deal with other issues.
Finally, it is important not to forget about our veterans when it comes to public health. These individuals who have served us may be invisible, silent or hidden in the background, but they need interventions and they need us to reach out. I wanted to mention the excellent Veterans First Point service in Lanarkshire for providing counselling without a waiting list to our local veterans to ensure that their needs are met.
I thank everybody who will take part in this extremely important and timely debate. The more that we can do in terms of public health, the better success we will have in years to come in dealing with inequality and the underlying issues that mean those in our society who did not get the best start do not get the chances that they deserve. We can achieve that only by working together on a cross-Government basis, with local councils and within communities, and I look forward to working with everybody in the Chamber who has an interest in moving this issue forward to ensure that progress is made.
(5 years, 4 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
The Government are not trying to hide anything. The hon. Lady is right that it is an important document, and it is important therefore that we get it absolutely correct. I refer her to what the chief executive of NHS England said yesterday. He said:
“We have an agreed direction in the long-term plan…We have the budget set for the next year, and we have the NHS annual planning process…wrapped up…2019-20 is…a transition year…stepping into the new five-year long-term plan.”
The chief executive of the NHS thinks that the process is working acceptably.
I am really not following the Minister on why this mandate has not been published. I wonder whether it is because of the paralysis in Government caused by the Brexit shambles or because, as the Health Service Journal reports, the Secretary of State is focused on an anticipated leadership race and his thoughts are elsewhere.
The hon. Lady does a great injustice to my right hon. Friend. He is today—
(5 years, 4 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
My hon. Friend makes a very important point. To ensure that the use of medical cannabis becomes mainstream, we need to ensure that the evidence base is there. Essentially, doctors think there is a much deeper evidence base for CBD than for THC. There is a broader point, which is that the medical profession and this House need to keep up to speed with the evidence as it is developed. In this case, that means going out of our way to develop the evidence and to have clinical trials in which some of the patients who want the drug can participate. That will provide the evidence base that allows the vast array of specialists to prescribe it.
It was clear from the evidence given to the Health and Social Care Committee that the Government raised public expectations when they rescheduled medical cannabis. I wonder whether it is time for the Secretary of State to ensure that there is a public awareness campaign, with full information about what the Government are trying to do.
I will look at that idea and discuss it with the NHS. The training programme that we are putting in place is intended to raise awareness of the evidence and the change in rules among the profession—among doctors and the specialist prescribing doctors on the register. Ultimately, it is only with clinical sign-off that we allow any drug to be prescribed. That is where the training needs to be in the first instance, but I will look at the hon. Lady’s suggestion of doing it more broadly.
(5 years, 5 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
My hon. Friend is quite right to support a deal and the action that we have taken in case there is no deal. That is the position that anybody who cares about the unhindered supply of medicines should take. When it comes to those medicines that cannot be stockpiled, we have contracts for flights to ensure that those medicines can be flown in. We have in place a flight from Birmingham to Maastricht, and the return journey, obviously, to ensure that we can get those short-term medicines in.
This must be making parliamentary history this afternoon. We have two urgent questions about the same incompetent Minister causing mayhem and chaos in two different Departments and he does not even have the face to come here and front it out—and we are left with Hancock’s half hour! Let me ask the Secretary of State for Health and Social Care: is any of the £33 million going to be reimbursed from his budget to the Department for Transport?
This was, of course, a cross-Government decision, which is why I am here. It is the medicines that will be using that capacity. In the Hancock family, we are very proud of “Hancock’s Half Hour”, and we thought that Tony was a very funny man.
(5 years, 7 months ago)
Commons ChamberI am very happy to meet my hon. Friend, who makes a very important point. Of course, future allocations of capital are for the spending review. I look forward to working with her to try to sort out the problems in Torbay and across the board.
A consultation is taking place about the closure of Faith House GP practice on Beverley Road in Hull. It is partly about the premises being less suitable for delivering modern healthcare, but also about how difficult it is to recruit GPs. What will the Secretary of State do about GP services being removed from communities? How will he support the development of GP services in those areas?
The £4.5 billion extra in the long-term plan that is going to primary and community care is absolutely targeted at solving problems like that. As it happens, I know Beverley Road in Hull quite well; I had family who lived there. It is very important that the services in primary care and in the community are there and are available to people to ensure that that crucial element of our prevention agenda is strengthened to keep the pressure off hospitals, too.
(5 years, 7 months ago)
Commons ChamberI welcome the focus in the long-term plan on the most common causes of mortality—cancer, heart disease, stroke and lung disease—and on cutting the risk factors. However, will the Secretary of State just explain to me how cuts to public health budgets and the fact that the comprehensive spending review is much later in determining the money that will be made available for public health can be part of a joined-up plan to start dealing with some of these diseases?
There is £16 billion ring-fenced for public health in this spending review. Crucially, we want the whole NHS to be focused on keeping people healthy as well as curing them when they are ill. Yes, of course it is a matter for that one budget in the spending review process, but it is also a matter of the whole £148 billion a year that will be going into the NHS.
(5 years, 8 months ago)
Commons ChamberThat is a question that the hon. Lady needs to put to her own party. What has happened up to this point is that the Government have been asked repeatedly to pause, to carry out more consultation, and to consider redrafting the Bill. There is a list of 40 organisations that have asked for a pause and a redrafting of the Bill. This is a familiar situation from health and social care legislation—it has happened before in this House. The Government could have considered a pause, and the Minister for Care, the hon. Member for Gosport (Caroline Dinenage), knows that I have discussed that with her. The whole question really falls back on the Government.
My hon. Friend refers to what happened in 2012 with the Health and Social Care Bill. We had to have a pause halfway through its parliamentary stages because it had not been thought through properly. I worry that we might end up having the same thing happen again if the Government do not take heed of what the shadow Minister is so clearly setting out.
I thank my hon. Friend for saying that, and it is the case.
Let me give an example. Just last week, the BBC’s “Victoria Derbyshire” programme exposed the horrific case of Rachel Johnston, a woman with learning disabilities who died after having an operation to remove all of her teeth. Rachel had a long-standing and extensive dental problem, but, clearly, could not consent to the dental work. Rather than doing the surgery in several treatments, the dentist opted to remove all her teeth in one operation, using the Mental Capacity Act to authorise the use of a general anaesthetic because he deemed it to be in her best interest. After being discharged, Rachel bled profusely from her gums, developed breathing difficulties and later died. How on earth can that treatment have been in her best interest? That case shows a need for greater safeguards, not fewer safeguards. We should not allow medical professionals to make decisions without considering the best interests or wishes of people who lack the capacity to consent to treatment.
I recognise that, as the Secretary of State mentioned, the Government conceded in the House of Lords that the cared-for person must be consulted, but there are still worrying aspects of the Bill that undermine that principle. We should ensure that individuals have access to an independent advocate. That is a vital safeguard that allows people to challenge authorisations, and it should be the default. The manner in which the independent mental capacity advocates can and should be appointed remains ill-defined and even contradictory.
The Minister in the House of Lords, Lord O’Shaughnessy, seems to have dismissed concerns raised about the application of a best interest test before the appointment of an advocate. The role of an advocate is essential to allowing individuals to access appeals and review their rights. Access to support from advocates should not depend on best interest tests, and the provisions in the Bill are far weaker than those proposed by the Law Commission. Yet despite that being pointed out in the debate in the House of Lords, the Minister there seemed unwilling to listen to advice, merely saying that it would work “in practice”. That is simply not good enough. These factors amount to a severe undermining of the concept of the individual’s best interests, which should be at the heart of the Bill but is sorely lacking.
I will now address the backlog of deprivation of liberty safeguard applications, because at the outset the Government presented the Bill as a cost-effective way of reducing it. On Second Reading in the House of Lords, the Minister claimed that the Bill would relieve
“local authorities of the…legal liability burden of more than £408 million by removing the backlog of…applications.”—[Official Report, House of Lords, 16 July 2018; Vol. 792, c. 1060.]
But he made no mention of how that would happen. Our conclusion is that by attempting to place the onus for assessments on care home managers, the Bill would remove the responsibility from cash-strapped local authorities.
The Government initially tried to pass responsibility for assessments on to care home managers, and that was clearly intended as a cost-cutting measure. That was amended in the House of Lords, but care home managers will still decide whether an assessment needs to take place and will also identify whether the person being cared for objects to a liberty protection safeguard for their own care and treatment. The British Association of Social Workers has said that this presents a potential conflict of interest for care homes, as they need to maintain occupancy and may not readily identify an objection by the cared-for person.
The BASW has a further concern about the grounds on which the responsible body would decide whether it or the care home manager would make the necessary arrangements for an LPS authorisation. There is a significant risk of a two-tier system, whereby local authorities under financial or waiting list pressures would default to care home managers completing the new duties, and other local authorities under less strain would do the assessments themselves. I think we have enough of a postcode lottery in care without adding to it through the Bill.
Care England, which represents the network of care providers, says:
“There is a lack of clarity about the role of the Care Home Manager...the separation of roles between care homes and community care provision seems designed to increase rather than reduce confusion and complexity.”
Indeed, the body is so concerned by this Bill that is has also said:
“This ill-considered Bill risks storing up a range of problems of a kind that we do not want and should be slowed or returned for redrafting.”
There remains a further dangerous conflict of interest at the heart of the Bill because of the role that independent hospitals are given in the assessment process. Despite debate in the House of Lords regarding the role of independent hospitals, under the Bill they would still be allowed to appoint their own approved mental capacity professionals. That would allow independent hospitals the responsibility to authorise deprivation of liberty for people in that same hospital for the assessment and treatment of mental disorders. That is plainly wrong.