Junior Doctors: Industrial Action

Diane Abbott Excerpts

Monday 5th September 2016 Commons Chamber

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The prospect of a rolling five-day strike by junior doctors was one of the utmost gravity. The junior doctors have suspended next week’s action, which is a step I believe the whole House welcomes, but the remaining programme of industrial action stays in place. If it eventually goes ahead, it will be the first such strike by junior doctors in the entire history of the national health service.

What the current situation shows is that there has been a complete breakdown in trust between junior doctors and the Government. The morale of junior doctors could not be lower, and that is not something for the Secretary of State to dismiss. But somehow the Secretary of State continues to take no responsibility for the current state of affairs—no responsibility for repeatedly arguing that the only problem was that doctors had “not read the contract”, no responsibility for the misleading use of statistics by claiming that thousands of patients were dying because of poor weekend care.

The president of the Royal College of Paediatrics and Child Health, Professor Neena Modi, said:

“despite concerns raised by senior officials, Jeremy Hunt persisted in using dubious evidence about the so-called ‘weekend effect’ to impose a damaging Junior Doctor contract under the bogus guise of patient safety”.

The Secretary of State still insists that the contract is about a seven-day NHS when we know now that his own officials were telling him that the NHS had too few staff and too little money to deliver what he was talking about.

The Secretary of State well knows that the public simply do not believe him in his attempt to demonise the junior doctors. Try as he might, he has failed to convince the public that somehow junior doctors are the “enemy within” or mere dupes of the BMA. Far from being manipulated, doctors voted emphatically against the new contract.

Everyone in this House will remember the 7/7 bombings and the No. 30 bus which exploded in Tavistock Square, a few yards from the headquarters of the British Medical Association. Everyone will remember the pictures of doctors, who had been in meetings and their offices, pouring out of the BMA building, heading for the 14 dead people and the 110 victims, without flinching or faltering, fulfilling their vocation of saving lives. These are the people that the Secretary of State seeks to vilify.

Today we know that the junior doctors—who, contrary to what the Secretary of State implied, have always made patient safety a top priority—have cancelled the action planned for next Monday, but if we are going to remove the threat of industrial action, there are questions that the Secretary of State has to answer. There are widespread reports of deficits and financial crises, so how can the NHS move to enhanced seven-day week working, even with the proposed £10 billion the Secretary of State mentioned in his statement, when there are not the resources to maintain the status quo?

I welcome the structural work going on outside the contract on issues such as work-life balance, the gender pay gap, the rota gaps, strengthening whistleblowing protections for junior doctors and, importantly, looking at the role of guardians of safe working hours, but the Secretary of State talked in his statement about confrontation: what could be more confrontational than seeking to impose a contract? Even at this late stage, I ask him to listen to the junior doctors’ leader, Dr Ellen McCourt, when she says:

“We have a simple ask of the Government: stop the imposition. If it agrees to do this, junior doctors will call off industrial action.”

The public are looking for the Secretary of State to try to meet the junior doctors: stop vilifying them, stop pretending they are the “enemy within”, and meet their reasonable demands.

[Mr Hunt]

I will respond to the hon. Lady’s comments, but she needs to be very clear to the House about the implications of Labour’s position on this. She has just said that she welcomes the suspension of next week’s industrial action, but that was not her position at the weekend. At the weekend, when the medical royal colleges, the General Medical Council and even The Observer criticised the proposed strike, what was she saying? She was saying that she would join them on the picket line—something her predecessor refused to do. The fact is that strikes cause harm, misery and despair for families up and down the country. When one of the most extreme members of the BMA junior doctors executive, Dr Yannis Gourtsoyannis, said that these strikes were

“the single most positive thing that has occurred within NHS politics in decades”,

what was Labour’s response? Did it condemn that? No. The shadow Chancellor actually invited him to advise Labour on policy. I just say this because—

[Ms Abbott]

rose—

[Mr Speaker]

Order. For clarification, I must emphasise that there is no concept of giving way in respect of a statement. Although this might resemble a debate to those who are attending our proceedings from beyond the confines of the Chamber, it is a statement with a response. There are no interventions.

North Middlesex University Hospital NHS Trust

Diane Abbott Excerpts

Tuesday 12th July 2016 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I congratulate my right hon. Friend the Member for Enfield North (Joan Ryan) on securing the debate and giving a masterful summation of the situation.

There have been some important speeches today, including from the hon. Member for Enfield, Southgate (Mr Burrowes), my right hon. Friend the Member for Tottenham (Mr Lammy) and my hon. Friend the Member for Hornsey and Wood Green (Catherine West). I also note the presence of my hon. Friends the Members for Hampstead and Kilburn (Tulip Siddiq), for Hammersmith (Andy Slaughter) and for Edmonton (Kate Osamor).

This debate is about more than an individual hospital such as Central Middlesex or North Middlesex. There are certain underlying issues, which I will touch on. One source of pressure on an accident and emergency department—whether it is in the North Middlesex hospital, the Central Middlesex hospital or any other hospital around London—is what is happening in social care. For years, local authorities, both Labour and Conservative, have said that they are struggling to meet social care need, and studies show that many of the people who turn up at A&E would not have to go there in the middle of the night to get the care they need if the social care system was functioning properly.

There is also the difficulty of getting GP appointments. The level of difficulty may vary from constituency to constituency, but in the City and Hackney area, for quite a long time now—for years, in fact—it has taken two weeks to get a GP appointment. I am afraid that means that many of my constituents take it upon themselves to go to A&E, because they know that, however long they wait there, they will ultimately be seen. Another problem is the lack of investment in public health, which could deal with some of the health conditions that people turn up to A&E with.

There is also the issue of alcohol abuse. On a Saturday night, too many people are in A&E as a consequence of alcohol abuse, and we must consider how we can deal with those cases and stop A&E departments being filled up.

On the issue of staff recruitment, I am not seeking to be particularly party political, but I cannot believe that the junior doctors dispute will make it easier to recruit staff. One thing that was manifest in the junior doctors’ refusal of a contract that the British Medical Association had recommended to them was the complete collapse in morale among doctors, and that will be reflected in the difficulty of recruiting staff.

Part of the problem with outer-London hospitals may be the changing demographics of the areas they serve. I said I would not be party political, but I campaigned for many of my right hon. and hon. Friends at the last general election, and I was struck by the situation in areas such as Enfield, Edmonton and parts of Hornsey. When I was a child, those areas were very much leafy suburbia, but now they have a much greater density of population, a much more complex demographic profile and much more complex health and social care needs.

As shadow Secretary of State for Health, I hope to look at that issue further. We should remember that outer London does not have many socially connected teaching hospitals such as those that exist in inner London. I am not sure whether the level of funding that outer-London areas get reflects the demographic and social changes in those areas that I have seen in my lifetime.

It is easy to talk about the issue abstractly, and to talk about reports and hieroglyphics, but it is about people. The tragedy at North Middlesex is a tragedy for patients. Who would want their mother to be dead on a trolley for four and a half hours and have no one come to look for her?

We also have to think about staff morale. People have congratulated the staff but, strikingly, the unpublished Health Education England report, for which 24 members of staff were anonymously interviewed, said that some doctors found working in the A&E unit so stressful that they cried when they finished their shifts. It stated:

“Foundation doctors had been reduced to tears by the sheer volume of patients they had to deal with, for example 200 patients and a six-hour wait, and they felt that they regularly had to send children home without having discussed their case with anyone senior…They often finished their shift and returned home full of anxiety that they had not been able to provide care at an appropriate level.”

This is about the patients and their families, but it is also about the staff who know that they are not providing the right level of care and are demoralised and upset.

As my right hon. and hon. Friends and the hon. Member for Enfield, Southgate have reminded us, we are told that North Middlesex is implementing a safer, faster, better programme to bring down waiting times and address the issues in the Care Quality Commission’s report. As the hon. Gentleman said, why should there have to be a shiny new programme to ensure that our constituents get safe, fast, high-quality treatment? It is good to hear that a new A&E clinical director—Turan Huseyin from Barnet A&E—has been appointed, and that there is a new A&E nursing lead and five additional middle-grade doctors and consultants on loan from other London trusts. It is also good to hear that in July the Care Quality Commission said that although North Middlesex was still inadequate, it had “turned a corner”.

I want to raise a few points with the Minister. One, which has already been made today, is that what happened could have been foreseen. The drop in both standards and performance at North Middlesex is intimately tied up with the closure of the A&E at Chase Farm in 2014. Members who are here today raised that point at the time. I would also like to hear from the Minister about how much support is being given to the emergency care intensive support team. In response to a parliamentary question asked by my right hon. Friend the Member for Tottenham we heard that the trust had requested such support, so what is happening?

My final point is about doctors being kept in the dark. I want to avoid crudely party political points, but I spent three years in the Opposition health team dealing with the health Bill, and we were concerned about transparency and accountability. When there is a crisis in a hospital, despite all the different organisations that my right hon. Friend told us about, there seems to be no simple method of ensuring accountability to local representatives, and therefore to local people. Something is lacking in accountability, and we need to consider that. The fact that the collapsing performance at North Middlesex hospital was an open secret among the health service professionals but none of my hon. Friends knew about it—except anecdotally from constituents—is alarming.

This is about more than North Middlesex. There are systemic issues. There might be a systemic issue with NHS funding failing to keep up with changes in local demographics, and there is a systemic issue in social care. I am sure we will return to that in this Chamber, because local authorities have been flagging it up for some years now.

In closing, I can only repeat what the hon. Member for Enfield, Southgate asked: how bad does it have to get? It is troubling if our constituents, who pay their taxes and rates, cannot get a basic level of care when they go to A&E. For most of them, that is their engagement with hospital care. They are getting almost a third-world service. I do not say that lightly—someone being on a trolley for four and a half hours after they have died, and there being only one commode between 100 people, is more like a third-world than a first-world standard of healthcare. How bad does it have to get? Will the Minister assure us that we will not have a situation again in which a collapsing service at a major hospital is an open secret within the professional health services but not made apparent to Members of Parliament and the wider community?

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I thank the right hon. and hon. Members who have given such thoughtful, considered, well-researched and knowledgeable speeches, and also the hon. Member for Hackney North and Stoke Newington (Ms Abbott) who provided such a thoughtful reflection from the shadow Front Bench. Members will be pleased to know that I agree with much of what they have said. I will come on to how I think the NHS has let Members and their constituents down and what we will do to try to fix the situation.

If Members do not mind, I will first set the issue in a bit of context. North Middlesex hospital was classed by the Care Quality Commission as requiring improvement for reasons that have been mentioned. The quality of care was not consistent enough and there were concerns about patient safety. It was not one of the worst hospitals in London, or in the country, but it was certainly not one of the best. Until July 2015, it was largely meeting its institutional standards. The 95% waiting time target for A&E was being met most months, even though the department is one of the larger ones in the capital, and in spite of the reorganisations that were discussed at length by the right hon. Member for Enfield North (Joan Ryan).

We need to be careful, therefore, with causality, and I will not give a definitive reason why the problems came about. A direct connection between the reorganisation of Chase Farm, which began under the Government before the coalition, and the problems experienced at North Middlesex over the past year, cannot be made with great surety because the hospital was dealing with the A&E caseload within the required timelines, albeit with a standard of care that was not at the level it should have been.

Nor is this about money. It is important to point out that organisations across the NHS, as the shadow Minister knows well, have reported deficits in the past year and this is one of the smaller ones. The posts that are established in the hospital are fully funded; the problem is trying to get the right people into them. I do not deny that the hospital has a staffing problem—I will come on to that in a second—but it is not connected with funding.

Let us get to the core cause of the problems that Members have noticed and brought to the attention of the House. I am afraid that I am not able to give a complete answer at this stage, but Members are entirely right to ask why this happened. We need a better explanation. This morning, I agreed with officials and NHS England that we will look in detail at the reasons within the hospital why the performance standards slipped so significantly in the middle of last year, and why the training routines and practices slipped as well. That is the first part of the review.

The second part is on why the system did not react with the speed it needed to when concerns were first expressed about a year ago. Here, I offer an apology to Members on behalf of NHS organisations. Members were not informed at the pace and the time they should have been, and for that I offer regret. Members are right to say that they should have been the first to know there were problems so that they could properly represent their constituents and hold local leaders to account.

I offer that apology within the context of a much better story across the NHS of what happens when hospitals fail. A warning notice was issued—that was the first reason that the right hon. Member for Enfield North knew something was going wrong—because of a change to the law under the coalition Government in 2014 on when the CQC was able to issue warning notices.

[Ms Abbott]

Will the Minister give way?

[Ben Gummer]

I will in a second. The whole system of CQC Ofsted-style inspection ratings, which are designed to be user-friendly so that non-clinicians can understand how well hospitals are performing, was instituted by the Secretary of State because we wanted to shine a light on the performance and quality of care in hospitals. Through two and a half years of having special measures routines and regimes for hospitals, we have a much better understanding of why things go wrong and can put them right far more quickly. Most importantly, we have a process for engaging Members of Parliament right at the beginning. That did not happen in this instance, and I will explain why after I have taken the right hon. Lady’s intervention.

[Ms Abbott]

The Minister may be coming to this, but I wanted to ask who Members should look to inform them of a catastrophic drop in standards. They should not have to wait for the CQC to issue a warning.

[Ben Gummer]

Ideally, if things are going wrong and that has been noted within the hospital, the hospital chief executive or commissioners should inform local people, but in the past—and over the two and a half to three years since we instituted the special measures regime—it has taken a Care Quality Commission investigation to highlight poor standards of care so inadequate that the hospital needs to be placed under special measures. At that point, before the public are informed, Members of Parliament are informed by the CQC and what was Monitor and the Trust Development Authority, but is now NHS Improvement.

Blood Cancers

Diane Abbott Excerpts

Thursday 7th July 2016 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

This debate illuminates an extraordinarily difficult subject: the clash between the fact that ultimately there must be constraints on NHS spending, whatever party is in power, and the desperation of cancer patients and their friends and family to obtain any drugs and treatments that will give them a few extra months of life.

The cancer drugs fund was a manifesto commitment by the Conservative party. As such, I venture to suggest, it was partly a political response to a series of terrible stories in the media about NICE—the rationing body—not allowing people access to drugs. However, it was always intended to be time-limited; the Government were clear from the beginning. Sadly, it has been overspent. In 2013-14, NHS England overspent the allocated budget for the fund by 15%, or £31 million, and in 2014-15, it was overspent by 48%, or £136 million. The overspend was partly offset by NHS England underspending against other budgets, but it also meant the deferral of some planned spending on primary care services.

The Government’s response to the fact that the cancer drugs fund was always going to be transitional is to introduce a new model. The cancer drugs fund will become a transitional fund that will only pay for new drugs until NICE carries out a full assessment of whether the drugs should be recommended for routine commissioning. After the assessment, the drug will either be approved by NICE for routine commissioning or removed altogether from the cancer drugs fund. That is clearly a horrifying and shocking reality for cancer patients and their families to face. Labour Members believe that the Government could have done more in setting up a new system.

This situation is serious. At the last count, 5,500 cancer patients and 1,750 blood cancer patients were dependent on some of the drugs that might be struck off. Although they personally will be unaffected, their successors as patients and the health professionals who care for them will be left in limbo. The Government have delisted seven of 14 drugs to treat symptoms of blood cancer, even before the CDF has published its report. The independent accelerated access review is also not complete, and the pharmaceutical price regulation scheme has come in for widespread criticism.

It is not clear—the Minister might be able to shed some light on this—whether there has been any proper evaluation of the efficacy of the existing programmes. Prolonging life and the palliative effects of such drugs are key issues, as well as—this is where I started—the relative costs of the drugs themselves. Any decisions made on the availability of drugs should be rational and transparent, taking those factors into account. Although I await the Minister’s response with interest, the decisions of the CDF under this Government do not appear to meet the criteria of either rationality or transparency.

We must be honest: cancer treatment in this country is poor by international standards. We have some of the worst cancer survival rates of the advanced industrialised countries. Some of our nearest comparators are much poorer countries such as Lithuania and Estonia, which have similar if not better cancer survival rates. NICE comes in for extensive criticism, particularly from pharmaceutical companies, but the truth is that NICE, as an independent regulator that takes decisions on the efficacy and cost-effectiveness of drugs, is a model admired around the world. It is a difficult situation.

We in the Labour party want an investigation of the causes of our low cancer survival rates and a plan for Government. At this time, the whole House is waiting for the Minister to say how the Government balance issues of cost-effectiveness and the need for life-extending and palliative care. Are they satisfied that their model for phasing out the cancer drugs fund and turning it into a transitional arrangement is really the best model? What have they done to alleviate the concerns of cancer patients, their friends and family, and people who speak for the sector?

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

It is a great pleasure to serve under your chairmanship, Mr Walker. I thank and congratulate the hon. Member for Strangford (Jim Shannon) and my hon. Friend the Member for Crawley (Henry Smith) on setting up the all-party parliamentary group and initiating this debate. It is another example of Westminster Hall providing an important forum as an adjunct to the main Chamber for hon. Members to raise specialist issues, and I welcome it hugely. I thank Members from all parties who have spoken. Again, it is an example of the House at its best, working together in a non-partisan way on an issue that our constituents want us to see is important.

While I am here, I take the opportunity to welcome the hon. Member for Hackney North and Stoke Newington (Ms Abbott) to her role as shadow Health Secretary. I look forward to working with her here and in the main Chamber.

I pay tribute to Bloodwise and other charities that work in the blood cancer space. Charities are playing an increasingly important role in the sector; the Association of Medical Research Charities recently released figures that show that our charities now invest more than £1.4 billion a year in medical research. That puts them above any of our UK pharma companies. Charities make a major sectoral contribution, not only with their research but by advocating on behalf of their patients, driving care pathway reform and leading and supporting integrated care pathway initiatives with NHS England. I put on record our gratitude to them for that work.

I congratulate Members on setting up the new APPG, which has a really important role to play, working with parliamentarians, Government and everybody involved in the blood cancer community, in ensuring that the voice of blood cancer patients is heard here in Westminster and that policies affecting blood cancer patients, their families and carers are patient-centred and evidence-based.

The word “cancer”, as you know Mr Walker, still strikes fear into people’s hearts up and down the land. The truth is that, through extraordinary biomedical advances and treatment improvements, more than 850,000 people are now living and working with cancer. It has become a treatable condition. Some cancers are now preventable with early screening and intervention—for example, there have been stunning breakthroughs in breast cancer, which now has a full survival rate of more than 95%. But other cancers, particularly some of the rarer cancers, still strike fear into people’s hearts, which is partly why I welcome this debate and the increasing number of debates in Westminster Hall on specialist and rare diseases.

Most Members present will have experienced the diagnosis of a family member or a loved one. We have heard powerful contributions from colleagues about that; I too experienced it when my sadly late mother-in-law was diagnosed with chronic myeloid leukaemia. My wife and our family had to watch the tragedy of a young, wonderful, healthy grandmother leaving us. Members have spoken with great passion about the need for us to do everything we can to speed up research and ensure that those people have not died in vain—that their experience helps others to avoid similar suffering. That is why the availability of effective drugs and other cancer treatments is so important to us all and why it drives me in my work as Minister for Life Sciences.

Let me set out how the Department views blood cancers and how they are grouped together, because that shapes our policy on research and treatment. Haematological or blood cancer is a term used to describe a range of cancers that affect the blood, bone marrow, lymph or lymphatic system. The symptoms can be quite vague and many of them, such as tiredness, fever, lumps or an infection, are similar to those for colds or other much less serious illnesses. I repeat the exhortations of other hon. Members: if in doubt, go and see a doctor early for a check-up.

The charity Bloodwise estimates that around 230,000 people are now living with blood cancer in the UK. It is the fifth most common cancer in UK adults and the most common in children and young adults. It is the third biggest killer.

There are three main kinds of blood cancer. The first is leukaemias, which affect the white blood cells that are so vital to our immune system—the police of our blood system, if you like. Leukaemias include four main types: acute myeloid leukaemia, acute lymphoblastic leukaemia, chronic myeloid leukaemia and chronic lymphocytic leukaemia. The second kind of blood cancer is lymphomas, which affect the lymphatic system—another crucial part of our immune system that helps to protect the body from infection and disease. The two main types are non-Hodgkin lymphoma and Hodgkin lymphoma. The third kind of blood cancer is myelomas, which affect the plasma cells that produce antibodies, which help fight infections.

Across those three core groups, there are more than 130 different blood cancer conditions. Most start in the bone marrow, where blood is made; many different types of blood cells are made in the bone marrow, with the type of blood cancer depending on the type of blood cell that is affected. In most blood cancers, the affected blood cells stop developing in the normal way and become cancerous. The cancerous cells stop the blood doing what it normally does, such as fighting off infections. I am conscious that Members present are probably familiar with this, but many watching may not be, and it is important that people understand what the underlying symptoms and causes of the condition are. Common treatments are chemotherapy, radiotherapy and, in some cases, a stem cell or bone marrow transplant.

Many people throughout the country are working hard to improve cancer diagnosis, treatment and care. In particular, I draw attention to the work of some of the pioneers— Bloodwise, Anthony Nolan and Myeloma UK should all be applauded. The work of those charities is also supported by the UK’s world-class scientific and academic life sciences research community, which is driving forward patient-centred research into blood cancers. Let me highlight a few groundbreaking centres that can give us all a lot of hope.

The Francis Crick Institute here in London—the flagship biomedical centre next to King’s Cross—hosts Dominique Bonnet’s programme. Dominique’s team is studying both normal and leukaemic blood stem cell biology and has published work in developing immunotherapeutic approaches to targeting leukaemia. A number of other groups are studying the development of cancers and identifying opportunities to develop novel therapeutic approaches more broadly.

Blood cancer is a key theme behind the Medical Research Council’s £30 million funding over five years for the molecular haematology unit at the University of Oxford, which I am visiting tomorrow. The unit is building on its programmes to understand the development of the blood system from the embryo through to adulthood and how that can go awry, leading to a variety of haematological malignancies, as well as a number of other disorders.

Similar programmes in understanding the development of the blood system and the pathogenesis of blood cancers are supported by the Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute, now under review at the end of its first five-year review period. The institute originally received an £8 million award over five years from the funders, with a strong push to translate those discoveries into clinical application.

The MRC centre for regenerative medicine hosts a number of programmes to improve understanding of the developmental biology of the haematological system and of stem cell compartments, how stem cells go on to make adult blood components and how that can go wrong and lead to leukaemias.

I make particular mention of the work of Professor Charlie Craddock, director of the blood and marrow transplant unit at University Hospitals Birmingham NHS Foundation Trust, who leads the trials acceleration programme, funded by Bloodwise and supported through the National Institute for Health Research experimental cancer medicine centre funding and its clinical research network.

In the last decade, a wave of new drug and transplant therapies have been developed that offer the prospect of dramatically improving the outcomes for patients with blood cancers. It is important that we get those therapies to patients quickly, not only for the patients’ own benefit but because patients’ response, feedback and data drive intelligent research.

The trials acceleration programme was opened in 2011 specifically to address the vital importance of accelerating patient access to novel therapies in blood cancer. By funding a regulatory hub with the capacity to rapidly work up clinical trials of novel agents, coupled with an integrated network of research nurses at major leukaemia units throughout the UK, it has been possible to develop an internationally competitive portfolio of 17 clinical trials. Experience to date has shown that the trials acceleration programme is able to dramatically shorten the time to trial set-up: it is now routinely less than 12 months, which is a substantial breakthrough from where we were just a few years ago.

Professor Craddock tells me that, in the process, patients have accessed more than £150 million of new, potentially life-saving drugs that they would not otherwise have had access to, and vital new data concerning drug activity have been generated. The trials acceleration programme has proved itself a highly effective model for acceleration of new drug therapies, and it is partly those pioneering projects that have informed my thinking on the accelerated access review, which I will say more about in a moment.

The National Institute for Health Research, which we fund to the tune of £1 billion a year, is investing more than £4 million over five years in blood disorder research at the Oxford Biomedical Research Centre, including research into lymphoma, leukaemia and myeloma. In addition, the Department has allocated £200,000 to NHS Blood and Transplant to explore issues on the establishment of UPTAKE, a new research collaboration platform designed to work closely with the NIHR clinical research network to develop and deliver prospective clinical trials in transplant and cellular immunotherapy.

We are leading in the development of genomics to drive insights into new diagnostic and treatment methodologies. The 100,000 genomes project is assembling one of the world’s largest datasets of genomic and phenotypic data, linking hospital outcome data with genotypic data from patient volunteers to provide what I have referred to elsewhere as the NASA of 21st century personalised biomedicine. The focus is on cancer and rare diseases.

This is a good day to be having this debate because just yesterday Dame Fiona Caldicott reported back to the Secretary of State and me. We had asked for her thoughts on how we get the balance right on data security consent and opt-outs so that we can harness patient and public trust in the use of data in our health service for research.

[Ms Abbott]

I listened with interest to the Minister, citing several organisations that speak up on the issue of blood cancer. I draw his attention to the African-Caribbean Leukaemia Trust, which had done a lot of good work encouraging people from the African-Caribbean community to donate blood—their chances of getting a properly matching blood donor are extremely low. The trust was founded by Beverley De-Gale and Orin Lewis, whose six-year-old son was diagnosed with leukaemia. I would not want the debate to finish without their work being mentioned.

[George Freeman]

The hon. Lady makes an excellent point. I thank her for it and endorse her sentiments. In several research areas important initiatives have been taken by black and minority ethnic and other communities with particular genetic predispositions. It is important that we support those initiatives, which I very much welcome.

The Genomics England programme operates on an explicit volunteer consent model. I want to take this opportunity to reassure the House that our announcement that we are dropping the care.data programme, which most colleagues would admit was not exactly an award-winning exercise in carrying public trust and confidence in data, is by no means, and should not be mistaken for, an abandonment of our commitment to a digital NHS. We are completely committed to making sure that our NHS is fit for purpose in the 21st century, which means that, in order to fulfil the most basic contract with our users, we need to have information for individual care, for system safety and performance and for research.

Raising awareness is the central issue of the motion. I assure Members that raising awareness and improving the early diagnosis of cancer, particularly blood cancers, is a priority for the Government. We absolutely recognise that earlier diagnosis makes it more likely that patients will receive effective treatments. On average, GPs in England see fewer than eight new cancer cases per year, but many more patients present with symptoms that could be cancer. In truth, we are missing huge opportunities to harness our daily diagnostic footprint for better cancer diagnosis.

In order to continue to support GPs to identify patients whose symptoms may indicate cancer and urgently refer them as appropriate, the National Institute for Health and Care Excellence published an updated suspected cancer referral guideline in June 2015, which includes new recommendations for haematological cancers in adults and children and young people. NICE noted that more lives could be saved each year in England if GPs simply followed the new guideline, which encourages GPs to think about cancer sooner and lowers the referral threshold.

Following the publication of the updated guideline, the Royal College of General Practitioners has worked in collaboration with Cancer Research UK on a programme of regional update events for GPs, to promote the new guideline. They have also worked to develop summary referral guidelines for GPs, including by introducing an interactive desk easel for them, to enable them to adopt the guideline. The British Medical Journal has also published summaries. In addition, NHS England’s Accelerate, Co-ordinate, Evaluate—ACE—pilots are exploring new models for delivering a diagnosis more quickly and effectively, including by piloting a multi-disciplinary diagnostic centre, which we hope will be particularly effective for patients with vague or unclear symptoms.

In conjunction with the Department, NHS England and other stakeholders, Public Health England currently runs the Be Clear on Cancer campaigns, which are designed to raise the public’s awareness of specific cancer symptoms and encourage people with those symptoms to go to the doctor at an earlier stage, when cancer is more treatable. Mr Walker, I know that you are a great champion of male health issues and have worked against stigma in health, and it is very often men who are slow to present and who tend to feel the stigma and take the traditional view, saying, “I’ll only go when I have a real problem.” The enlightened fairer sex tends to go to the doctor quicker. It is important that we remind men to be quick to go to the doctor.

Junior Doctors Contract

Diane Abbott Excerpts

Wednesday 6th July 2016 Commons Chamber

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The NHS is only as strong as the morale of its staff, and the rejection of this contract by the junior doctors sadly reveals that morale and trust in the Government are at rock bottom. Yesterday, to mark the 68th anniversary of the NHS, I visited my local hospital, Homerton University hospital, and met some of the wonderful nurses. One of their main concerns was the abolition of the bursary, but they were also genuinely worried that NHS staff were no longer valued. The Secretary of State must accept that his handling of the junior doctor dispute has exacerbated this feeling among all NHS staff.

I have sat in this Chamber and heard the Secretary of State say that junior doctors have not read the new contract, do not understand the new contract, or have been bamboozled by their leadership, but now that the junior doctors have rejected a renegotiated contract recommended by their leadership, he must begin to understand that his handling of this dispute has contributed to the impasse. There should be no suggestion that the junior doctors’ decision is somehow illegitimate. The turnout in the ballot was higher than in the general election in 2015.

I welcome the fact that the Secretary of State will not let up on efforts to eliminate the gender pay gap and that he will commission an independent report on how to reduce and eliminate that gap, and look at shared parental leave as well. That is an important concern among doctors. I also welcome the fact that the imposition of the contract will be phased, but at this time of general instability I urge the Government to reconsider imposing the contract at all.

It has not helped for the Government to treat junior doctors as the enemy within. It has not helped junior doctors’ morale that it was implied at one time that the only barrier to a seven-day NHS was their reluctance to work at weekends, when so many of them already work unsocial hours, sacrificing family life in the process. I am glad that the Secretary of State acknowledged today that junior doctors are some of the hardest working staff in the NHS, working some of the longest and most unsocial hours, including many weekends, but the vote to reject the contract is a rejection of the Government’s previous approach.

The Secretary of State knows that the BMA remains opposed to the imposition of any contract, believing that imposing a contract that has not been agreed is inherently unfair and an indictment of the Secretary of State’s handling of the situation. The junior doctors committee is meeting today to decide how it will proceed. Labour Members look forward to hearing the outcome of that meeting and how we can best continue to support the junior doctors.

Public opinion is not on the Government’s side. It is evident that the public will have faith in their doctors long after they have lost faith in this or any other Government. It is not too late to change course. The Government need urgently to address the recruitment and retention crisis and scrap the contract. Although I appreciate that the contract has been in negotiation for many years, the Government should give talks with the junior doctors one more chance. If they crush the morale of NHS staff, they crush the efficacy of the NHS itself.

[Mr Hunt]

I welcome the hon. Lady to her place for the first statement to which she has responded and welcome her on the whole measured tone, with one or two exceptions. I will reply directly to the points she made.

First, the hon. Lady maintains the view expressed by her predecessor, the hon. Member for Lewisham East (Heidi Alexander), who is in her place this afternoon, that somehow the Government’s handling of the dispute is to blame. We have heard that narrative a lot in the past year, but I say with the greatest of respect for the hon. Member for Hackney North and Stoke Newington (Ms Abbott)—I do understand that she is new to the post—that that narrative has been comprehensively disproved by the leaked WhatsApp messages that were exchanged between members of the junior doctors committee earlier this year.

We now know that, precisely when the official Opposition were saying that the Government were being intransigent, the BMA had no interest in doing a deal. In February, at the ACAS talks, the junior doctors’ aim was simply to

“play the political game of…looking reasonable”—

their words, not ours. We also know that they wanted to provoke the Government into imposing a contract, as part of a plan to

“tie the Department of Health up in knots for…months”.

In contrast to public claims that the dispute was about patient safety, we know that, in their own words,

“the only real red line”

was pay. With the benefit of that knowledge, the hon. Lady should be careful about maintaining that the Government have not wanted to try to find a solution. We have had more than 70 meetings in the past year and we have been trying to find a solution for more than four years.

The question then arises whether we should negotiate or proceed with the introduction of the new contracts. Let me say plainly and directly that if I believed negotiations would work, that is exactly what I would do. The reason I do not think they will work is that it has become clear that many of the issues upsetting junior doctors are in fact nothing to do with the contract. Let me quote a statement posted this morning by one of the junior doctors’ leaders and a fierce opponent of the Government, Dr Reena Aggarwal:

“I am no apologist for the Government but I do believe that many of the issues that are exercising junior doctors are extra-contractual. This contract was never intended to solve every complaint and unhappiness, and I am not sure any single agreement would have achieved universal accord with the junior doctor body.”

The Government’s biggest opponents—in a way, the biggest firebrands in the BMA—supported the deal and were telling their members that it was a good deal, which got rid of some of the unfairnesses in the current contract and was better for women and so on. If the junior doctors are not prepared to believe even them, there is no way we will be able to achieve consensus.

If the hon. Lady wants to stand up and say that we should scrap the contract, she will be saying that we should not proceed with a deal that reduces the maximum hours a junior doctor can be asked to work, introduces safeguards to make sure that rostering is safe and boosts opportunities for women, disabled people and doctors with caring responsibilities—a deal that was supported by nearly every royal college. If the alternative from Labour is to do nothing, we would be passing on the opportunity to make real improvements that will make a real difference to the working lives of junior doctors.

The hon. Lady and I have a couple of the more challenging jobs that anyone can do in this Chamber. She has been in the House for much longer than I have, so she will know that. The litmus test in all the difficult decisions we face is whether we do the right thing for patients and for our vulnerable constituents, who desperately need a seven-day service. The Government are determined to make sure that happens.

NHS Spending

Diane Abbott Excerpts

Wednesday 6th July 2016 Commons Chamber

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I beg to move,

That this House notes that the Vote Leave group during the EU referendum campaign claimed that an extra £350 million a week could be spent on the NHS in lieu of the UK’s EU membership contribution; further notes that senior figures who campaigned, including the hon. Member for South Northamptonshire, the hon. Member for Uxbridge and South Ruislip and the Rt hon. Member for Surrey Heath have subsequently distanced themselves from that claim; and calls on the Government to set out proposals for additional NHS funding, as suggested by the hon. Member for South Northamptonshire on 4 July 2016.

It is a pleasure once again to face the Secretary of State for Health.

Nobody can doubt that much of the case that was made by the Vote Leave EU campaign was based on assertions that have since crumbled. For instance, within hours of the vote to leave the European Union, the Tory MEP, Daniel Hannan, said that taking back control of immigration did not necessarily mean cutting it. That will have been news to millions of people who voted to leave.

We also heard that there was no hurry to get on with leaving the EU. Why then the urgency of the campaign? The most striking reversal of all came from Nigel Farage. Within hours of the vote, he said that it was a mistake for the Vote Leave campaign to claim that leaving the EU would mean £350 million a week more for the NHS. Some of us were surprised by that, because this was no ordinary campaign slogan; it was painted on the side of the Vote Leave battle bus, which travelled thousands of miles up and down the country. It was emblazoned on the backdrop to speeches by the luminaries of the Vote Leave campaign. The British public is entitled to ask: where is the £350 million a week and when can we expect to see the Government start pumping that new money into our NHS? We all know about the financial and other pressures already facing the NHS.

[Mr Adrian Bailey (West Bromwich West) (Lab/Co-op)]

Does my hon. Friend not think the public are also entitled to ask where the serried ranks of leave campaigners are today?

[Ms Abbott]

My hon. Friend makes an important point. I do not see a single solitary leave campaigner in the Chamber this evening. It makes me wonder what the whole campaign was about. Was it about their egos? Was it some elaborate Eton wall game? Are they not concerned that the public may have been misled?

As I was saying, we know about the financial pressures already facing the NHS. A survey by the Healthcare Financial Management Association of 200 NHS finance directors in hospitals and clinical commissioning groups reveals that no fewer than one in five believe that the quality of care will worsen in 2016-17, and even more of them—one in three—fear that care will deteriorate in 2017-18 as a result of financial pressures. Waiting times, access to services and the range of services offered were seen to be among the most vulnerable areas. There is no doubt that those pressures will be made worse when we leave the European Union.

[Keith Vaz (Leicester East) (Lab)]

I begin by congratulating my hon. Friend most warmly on her appointment as the shadow Secretary of State for Health. We miss her on the Back Benches, but we are delighted that she has reached the dizzy heights of the shadow Cabinet.

One place where we are feeling the pinch is in diabetes. We have had a number of reports that the DESMOND and DAFNE—diabetes education and self-management for ongoing and newly diagnosed, and dose adjustment for normal eating—schemes to provide structured education for type 1 and type 2 diabetics, are being cut. Does my hon. Friend agree that prevention is so important that we should ring-fence resources to deal with the crisis affecting diabetics?

[Ms Abbott]

I am grateful to my right hon. Friend for making that important point. We are seeing pressures on public health services and expenditure across the piece. What he says about ring-fencing money for diabetes is very important and I support him.

The Health Foundation think-tank says that

“Leading economists are…unanimous in concluding that leaving the EU will have a negative effect on the UK economy”.

As a result, the NHS budget could be fully £2.8 billion lower than currently planned by 2019-20. In the longer term, the NHS funding shortfall could be at least £19 billion by 2039, equivalent to £365 million a week—and that assumes that the UK is able to join the European economic area. If that does not happen, the shortfall could be as high as £28 billion, or £540 million a week.

Those figures are not just numbers in a ledger. We know what poor care means in practice. Today’s Care Quality Commission report on North Middlesex University Hospital revealed a series of terrible incidents: an evening when only one commode was available for more than 100 patients; a patient left sitting on a bedpan for more than an hour; and a patient who lay dead in A&E for four and a half hours before being found. We can foresee similar consequences in other hospitals if pressures bear down on the NHS budget, not only because of all sorts of externalities, but because of our leaving the EU.

We know about the endemic problems in the NHS. Earlier today, we discussed the junior doctors rejection of the Government’s new contracts. We know that nurses and midwives are in uproar because of the Government’s plan to scrap the bursaries that would-be nurses and midwives rely on when they are studying. A fresh injection of cash, as promised by the Vote Leave campaign, could not be more timely.

While we are talking about the implications of Brexit for the NHS, I remind Members that any restrictions on freedom of movement—a subject that is being discussed extensively in the wake of the Brexit vote—will be little less than disastrous for the NHS; 55,000 men and women in its workforce originate from the EU. It would be completely catastrophic for social care; 80,000 men and women out of 1.3 million workers in that field are EU nationals.

I represent a constituency that voted strongly for remain—I think that Hackney had the second highest remain vote in the country—and I believed that a remain vote was in the best interests of the UK, but as we heard earlier today in the House, there has been a horrifying upsurge in racist abuse and hate crime, triggered by the Brexit vote. It is as if people now have permission to be openly racist. It is interesting that Vote Leave supporters are now distancing themselves from anti-immigrant politics, but the unpleasantness unleashed by the Brexit campaign is already poisoning public discourse. However, I believe strongly in democracy, so I believe that we have to respect the referendum vote. In many cases, it was a cry of pain and rage against Westminster elites, on which we all have to reflect.

The late Member for Chesterfield, the right hon. Tony Benn, who was an opponent of the EU to his dying day, said:

“My view of the EU has always been not that I am hostile to foreigners but I am in favour of democracy.”

I respect those people who voted to leave. My experience of the EU campaign is that people wanted information, were trying to compare competing claims, and were doing their best to exercise their right to vote responsibly. The turnout was high. Nobody wants to think that the Vote Leave campaign peddled deliberately bogus slogans. I speak on behalf of not just Labour Members, but the British voting public as a whole. At a time when money was never more needed for the NHS, when can we expect to see the £350 million a week extra for the NHS that the Vote Leave campaign promised would be a consequence of the Brexit vote—or was it deceiving the public?

[The Secretary of State for Health (Mr Jeremy Hunt)]

Perhaps I will cut down my speech a bit. I give a particularly warm welcome to all my Back-Bench colleagues here; it is wonderful to see them coming out in support in such numbers. I thank the shadow Health Secretary for calling this debate. She is right to talk about the issues of NHS funding—though not particularly through this motion, which I will come on to speak about. I welcome her to her first Opposition day debate, as I welcomed her earlier to her first statement. This is a brief that she knows well, having been shadow Public Health Minister, and having campaigned on a lot of very important topics, including plain paper packaging for cigarettes. She has done a lot of work with the all-party sickle cell and thalassaemia group as well. I wish her luck in two areas. The first is with her parliamentary questions, after last week’s question to the Department for International Development about a drought in Indonesia, when it was in fact in the Philippines. Secondly, I wish her luck finding some Front-Bench colleagues, just as I need luck finding some Back-Bench colleagues in these debates.

We are in agreement on Brexit; we were both on the remain side, and I campaigned strongly with the hon. Lady. I agree with her that however much we may have disagreed with the vote, it is very important that we respect it. She and I both worried about the damage that it might do to our economy and society if we left, but we also agree that it would do incredible damage to something even more important than them—to our democracy—if the British people were to think that the Westminster establishment was trying somehow to ignore their decision.

From the reasonable tone of her comments, I know that the hon. Lady understands that Vote Leave was not speaking for the Government when it said that there would potentially be an extra £350 million for the NHS. In fairness to the Vote Leave campaigners, at various points they clarified downwards that slogan on the side of the bus and said that they were really talking about a net figure of more like £100 million that could potentially go to the NHS, rather than £350 million.

[Ms Abbott]

rose—

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

rose—

[Mr Hunt]

I will give way first to the shadow Health Secretary, then to the Scottish health spokesperson.

[Ms Abbott]

If the Vote Leave campaigners brought down the figure that they thought could potentially be given to the NHS, why did they not repaint the wording on the bus?

[Mr Hunt]

That is, perhaps, not a question for me as a Government Minister to answer, but I take the hon. Lady’s point. I give way to the hon. Member for Central Ayrshire (Dr Whitford).

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 5th July 2016 Commons Chamber

[Jane Ellison]

The Government are always interested in anything that can be proven to be cost-effective and efficacious.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Millions of people around the world are dying annually from resistant infections. In the light of that and the positive correlation between antibiotic resistance rates and antibiotic consumption, urgent action needs to be taken. What steps and cross-departmental work is the Minister taking to address the findings of the Review on Antimicrobial Resistance and to reduce the unnecessary use of antimicrobials in agriculture?

[Jane Ellison]

There is consensus on the importance of this issue. It is worth highlighting the work that the Government are doing internationally, through the creation of the Fleming fund, in which we are investing £265 million, to help poorer countries to tackle drug resistance and to make sure that we have proper monitoring systems in place. Without a baseline to understand where we are even starting from, it is very difficult. We will respond more fully to all the issues highlighted by the hon. Lady when we respond formally to the O’Neill review, but it goes without saying that we are trying to take this work forward internationally and we are working towards further meetings at the United Nations this autumn.

--- Later in debate ---

[Mr Hunt]

I enjoyed our many exchanges in this House, and it is a loss on our side as well that they will not continue. I would like to welcome the hon. Lady’s successor to her post, and I hope that I will have a chance to do so again when she asks a question later.

I agree with the hon. Member for Lewisham East (Heidi Alexander). Migrants, or the people who work in the NHS who come from different countries, make an extraordinary contribution. It is fair to say that the NHS would fall over without the incredible work that they do. It is also true that the British people voted to control migration on 23 June, and we have to accept that verdict. In terms of the NHS and social care system, I did not hear, and I have not heard in my time as Health Secretary, enormous amounts of worry about the pressure of migration on NHS services, because on the whole migrants tend to be younger and fitter people. While accepting the verdict of the British people and what they said on 23 June, the important reassurance that we now need to give is to the many people from outside the UK who make a fantastic contribution to the running of our health and care system.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Secretary of State may be aware that in the wake of the Brexit vote NHS commissioning bosses have delayed funding for vital medicines and services because of the fall in the value of the pound. One affected patient is Abi Longfellow, the teenager who won her battle for a wonder drug thanks to a campaign by the Sunday People. Abi currently spends 11 hours a day on a dialysis machine and was due to start on a drug that would give her a fighting chance with a kidney transplant. We were all aware that the pound might fall post referendum, so will the Secretary of State explain why no contingency plans were put in place and what he will do to ensure that, despite the Brexit vote, patients like Abi receive the lifesaving treatments and medicines that they need?

[Mr Hunt]

First, I welcome the hon. Lady to her position. She is the third shadow Health Secretary I have faced in less than a year, and I am beginning to worry that it may be something personal. I wish her well; she knows the brief extremely well and has campaigned on it a great deal in her long parliamentary career. I will look into the case she brought up. I would not want anyone to be deprived of vital lifesaving drugs because of exchange rate fluctuations. The whole British economy, including the NHS, will have to deal with the economic shock that we may now face as a result of the Brexit vote. But now that the decision has been taken by the British people we must look for the opportunities for the UK and the NHS, and not simply worry about the uncertainties, although there will be lots of things we have to deal with.

--- Later in debate ---

[Ben Gummer]

The Home Secretary said she was confident we could get a deal ensuring that they could stay, but we need a new Prime Minister able to start the negotiations caused by the decision of the British people on 23 June. I say in my capacity as a Health Minister— the House has heard from other Members, including the Secretary of State—that we have full confidence in the EU nationals working in the NHS and wish to praise their contribution, which makes the NHS a better organisation.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The head of the NHS, Simon Stevens, has strongly defended the role of immigrants in the NHS, saying that there has never been a time in its 68-year history when the NHS has not

“relied on committed employees from around the world”.

One of these employees was my own mother, who migrated from Jamaica to the UK in the 1950s to be a pupil nurse. Workers from the EU and other countries are the backbone not just of the NHS but of our social care system, which is facing many challenges. Does the Minister agree that we should be thanking these hard-working individuals for their service, not leaving them with questions about their status and job security?

[Ben Gummer]

I agree entirely with the hon. Lady that we should be thanking EU nationals working in the NHS and social care system. She herself is evidence of the enormous contribution of migrant labourers, not just in the first generation but in subsequent ones. We, as a nation and a House, should be grateful for it. This is a difficult time for many EU nationals in this country, and we should be thanking them not just for the numbers but for the special qualities they bring. In my constituency, the amazing Portuguese nurses in Ipswich hospital bring qualities and skills that some of our own nurses in our own country do not possess in our own hospitals.

Hearing Loss: Action Plan and Commissioning Framework

Diane Abbott Excerpts

Thursday 30th June 2016 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Vaz. I congratulate my fellow east end MP, my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick), on securing this important debate; I also congratulate my hon. Friend the Member for Nottingham South (Lilian Greenwood) on her thoughtful speech.

As we have heard in the debate, hearing is at the heart of the human experience. I think we will all have seen online the short films of babies who, through hearing aid devices, suddenly hear their mothers’ voices for the first time. Those babies’ faces are transformed, and that reminds us how important hearing is.

There is much to welcome in the Department of Health’s action plan on hearing. The aim of reducing the stigma related to hearing loss is important. I think that sense of stigma is the reason for people waiting so long before they get the help they need. Designing public services and public spaces to support good communication is also important. Here, and certainly in the Chamber of the House of Commons, the design is good and hearing loss need not stop any Member following what is going on; but there is more to be done in other public spaces, such as cinemas, theatres and so on.

The action plan also seeks to provide better communication support and understanding in the workplace. That is important, because for people of working age I think the worst thing is the feeling that hearing loss is cutting them off from the workplace. The workplace is not just source of income; it gives people a sense of identity, self-worth and importance. For that to be cut off through hearing loss is tragic. The things that are wanted in the workplace are timely access to assistive devices, language support—such as learning British Sign Language or sign-supported English—and speech to text. Another aim of the action plan is that there should be more research into the causes and management of hearing loss and tinnitus. Tinnitus is a particularly alarming issue. It is sometimes written and talked about as if nothing can be done. It can be as bad for people’s ability to function in society as absolute hearing loss. It is important that we have more research on its management, rather than just accepting that nothing can be done about it.

An important aspect of the action plan is the promotion of strategies for the prevention of hearing loss, and an understanding of hearing awareness. Some hearing loss is workplace-related, and my hon. Friend the Member for Poplar and Limehouse said that his may be related to his working life as a fireman. Some hearing loss happens as people get older. However, we need strategies to prevent it, if that is possible. Early awareness, diagnosis and management is vital. That is why we think the issue of stigma is so important. We want person-centred planning that is responsive to information and social needs and that reaches out into all communities.

We should not assume that communities whose first language is not English will be able to get access to all the things that are made available. Many communities, particularly in the east end of London, are wary of approaching the authorities—even their GP. A lot of thought needs to be given to the sort of information outreach programmes that will reach people of every age in every community. In big urban centres in particular, if thought is not given to outreach and an understanding of early awareness, diagnosis and management, thousands of people in a given area will not be able to get the help they need. So we need person-centred planning, and timely access or signposts to communication support, lip-reading classes, hearing therapy, counselling, support groups, befriending services and assistive technologies. I reiterate that we must consider that we are not in a mono-cultural society. It should be as easy for a Bengali widow in Poplar and Limehouse to get access to lip-reading classes, befriending services or support groups as it is for a retired man in Nottingham. Finally, one of the aims of the Department’s action plan is to promote inclusion and participation, through ensuring that all public services are accessible, and to support language and communication needs. Those are excellent aims.

The purpose of today’s debate is to consider how far the aims are being achieved, and my colleagues have touched on two major issues that are worth considering again. The question of hearing aid rationing arises in the context of pressure on NHS resources. One way in which the NHS and CCGs are seeking to manage the pressures is by raising the bar before someone can get access to a service or to help. One of the most alarming aspects of that approach is its effect in mental health, where people must manifest more extreme symptoms before they can get help. It might seem to CCGs that rationing hearing aids is a less obvious form of rationing, because only the patients know or understand what has happened. Thus, as we have heard, since October 2015 one CCG—North Staffordshire—has stopped providing hearing aids to patients who have mild hearing loss, and it subjects those with moderate hearing loss to a questionnaire before it decides whether to provide them with a hearing aid.

As the Minister heard from my colleagues, it is not acceptable to ration hearing aids in that way. There is a danger that people’s hearing loss will get more severe before they can get the help they need. There are some exemptions, such as for people with dementia; hearing loss can make people more susceptible to dementia, physical disability or tinnitus. However the approach in question is not good enough. If the Government feel that we must have rationing in the NHS, we need clarity about that—it must be transparent and there must be debate. It cannot happen just because the Government feel that somehow they can get away with it.

Ten further CCGs have consulted on proposals to stop the provision of NHS hearing aids to patients with mild to moderate hearing loss, although none, as we have heard, has gone ahead with the proposals. Some are seeking alternative cost savings and others await the publication of the commissioning framework. As the Minister has heard, hearing aids are good value for money. The cost to the NHS of a pair of hearing aids and three years’ support is under £400, but the average price for an individual purchasing them privately is £3,000. In the part of the world that I come from— the east end of London—£3,000 for a hearing aid is prohibitively expensive. Furthermore, the sad fact is that 30% of audiology providers have had their budgets reduced in real terms over the past two years, and 33% said that increased demand is directly impacting on the scope or quality of the service that they can provide.

The other point, apart from the notion of hearing aid rationing, is to do with routine health checks. The charity Action on Hearing Loss commissioned a cost-benefit analysis of hearing screening, which found that screening everyone and providing support to those who need it at the age of 65 would save £2 billion over 10 years, for a cost of only £255 million. Low levels of diagnosis mean that two thirds of people are not getting the treatment and support they need. The research suggests that there is an average 10-year delay in people seeking help for their hearing loss and that, when they do, GPs fail to refer fully 45% of those reporting hearing loss to hearing services.

Hearing loss can be a gradual process. The stigma around hearing loss might make people reluctant to get the help they need, in particular as they get older and feel it is a sign of ageing to which they do not want to admit. Imagine, though, the reality for people who gradually and incrementally find their hearing going, and find themselves increasingly shut off from the world, the workplace, family and friends. Some excellent work has been done on the issue, and I await with interest the Minister’s response to the points that have been made.

--- Later in debate ---

[Alistair Burt]

Absolutely. Again, there may be more to be done through charities, the third sector, the Royal College of General Practitioners and perhaps the British Medical Association, certainly about the thing that people have in the back of their mind and do not always raise. Clearly, if there has been a sudden change, people may mention it. I suspect that part of it may be that people’s hearing loss is gradual. Perhaps there is an earlier stage.

All colleagues mentioned early intervention and perhaps there is a point at which it should be stated that hearing loss is not necessarily a natural thing that people should accept; it is something that they could and should do something about. My father is a GP and he always said that the most important part of any consultation was when the patient had taken their coat from the chair and put it on and was just leaving the room and said, “Oh, there’s one more thing, Doctor.” At that point, he always brought them back. I wonder whether, for a number of patients, that one more thing that they think they might not bother the doctor with is actually that: “I’ve just been getting a little bit hard of hearing. Maybe it is something and nothing” and so on. Perhaps that is something we could promote and say, “If that is your circumstance, do let someone know, because there is support available.”

Let me develop the discussion. We spoke about rationing services. I am aware that NHS England supported a recent decision from North Staffordshire CCG because it was able to demonstrate that its commissioning policy was evidence-based and had followed extensive public engagement. The hon. Member for Nottingham South was right to say that I am extremely wary of rationing early intervention and hearing aids at the very early stage. I fully accept all the evidence that says that it is doing something at that early stage that prevents something else later on. As colleagues have said, no one else has yet followed that. There has been a lot of challenge. It remains possible for NHS England to intervene if it thinks that commissioning has gone badly askew, but for now that has not been followed.

I will make a general—if slightly light-hearted—remark about resources in the national health service. Due to the decision taken by the nation last week, those who promoted a decision to leave the EU have promised, I think, £350 million a week—or maybe it is £100 million a week—to come to the NHS. My understanding is that that will not happen immediately, but perhaps in two or three years’ time we might see that money written into the health service’s baseline. It would be nice if that were to be. That remains to be seen. Certainly if that comes to pass, it would be one silver lining in the clouds of last week, but I suspect that that will not be a decision for me to take.

[Ms Abbott]

I want to press the Minister on the issue of rationing—I was involved in the discussions on the current reorganisation in my earlier incarnation on the Front Bench. Is he saying that nothing can be done until a CCG announces that it plans to ration, or is there any way—even under the reorganised NHS—of giving central direction to CCGs about that?

[Alistair Burt]

There is not a way of giving a central direction, because the whole direction of travel in the health service in recent years, as we know, has been to allow decisions to be made as close to people as possible. CCGs and the areas covered by them vary in the nature of their provision—there is variation in services, as we know—and if we were to go back to giving national direction on virtually everything and taking decisions that amount to micromanagement, as this one would, we would be moving away from that.

I will come on the commissioning framework and the action plan in a moment, but the commissioning framework should set out what the expectations are. However, it is right to leave local decision making to those working locally. Indeed, the recent decision and the pressure in other places have reminded CCGs of the importance of early provision, which has probably been far better than any directive from the centre.

[Ms Abbott]

So the Minister is saying that, in respect of the rationing of hearing aids, all we can really do is cross our fingers.

[Alistair Burt]

No, in all fairness I am not, because it has happened in only one CCG. It has not spread everywhere, and I think that is because the concerns that have been raised in the NHS and elsewhere have persuaded CCGs that they would not like to make that restriction.

To come back to the issue of resources, and to be a little more serious, the NHS remains under significant financial pressure. We have committed to making an extra £10 billion available to the NHS by 2020, as the chief executive has requested, but money will remain tight. Unless we want to go back to a situation in which everything is directed from the centre, we must leave local decision making to those closest to an area—that idea will remain in place. To characterise that as crossing our fingers is not entirely fair, and it has not proved to be the case.

The forthcoming commissioning framework will support CCGs to make informed decisions about what is good value for the populations they serve, using an evidence-based methodology to determine policy. NHS Improvement has received expressions of concern about commissioners reducing prices for audiology services, causing firms to exit those services, and reduced access and choice for patients. So far, except in one case, those allegations have not been substantiated and no formal complaint has been made to enable NHS Improvement to consider taking regulatory action.

NHS England could consider any immediate concerns about a CCG’s behaviour at local level under the assurance framework, and there may be scope for NHS Improvement to consider them under the National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013, under the pricing rules contained in the national tariff.

Hon. Members raised the issue of screening. I am aware that the “Hearing Screening for Life” campaign has called for hearing screening to be introduced for everybody at the age of 65. However, advice from the UK national screening committee—the expert group that advises Ministers on all aspects of screening—suggested that the evidence did not demonstrate that screening would provide any hearing-related improvement in quality of life in comparison with the identification of hearing loss in other ways.

That is different from screening for newborn children—I have seen some of that work in action. I went out to Hounslow, where I will always recall the three-week-old baby who was cradled in her mother’s arms and being tested by the lady responsible, who was watching for the brainwave patterns. The hearing test could only be done when the baby was asleep and the brainwave patterns were absolutely level. The care and consideration taken with that baby was really quite remarkable. We should be proud that that programme exists. Seeing such things in action—even in one individual example—really cuts through all the statistics. In that instance, screening is the right response.

There are, however, a number of other policy solutions under active consideration by NHS England and CCGs, such as better training as part of the ongoing work to support the uptake and dissemination of the action plan and framework, including better training for GPs to identify and improve the response to hearing loss in adults. That will feed into what we discussed earlier about better recognition at an earlier stage.

The hon. Member for Poplar and Limehouse raised the subject of BSL and sign language in general. My hope is that access to personalised information in appropriate formats and support for communication will improve because of the new accessible information standard, which is mandatory. All organisations that provide NHS or publicly funded adult social care must implement and conform to the standard by 31 July this year. More generally, responses to the Department for Work and Pensions review of the market for BSL and communication support for people who are deaf, deaf-blind or have hearing loss are currently being analysed, and the results will be reported this autumn. From my previous work on disability, I know how important British sign language is. It is a culture and a language that is capable of expression, of drama, of comedy and of all sorts of things. We discussed earlier the life and culture of people who are hard of hearing or deaf, which is very important, and we look forward to the conclusions of that DWP review.

NHS England, along with patient groups, charities, CCGs, providers and professional groups, set out to respond to some of the challenges I have mentioned with the forthcoming commissioning framework. The framework ensures that first and foremost, CCGs have a clear guide to what good commissioning looks like. It is designed to ensure that CCGs are properly supported not only to provide more consistent, high-quality integrated care to meet the needs of local people, but to make informed decisions about what represents good value for the populations they serve. A golden thread throughout the publication is action to be taken to help reduce inequalities in access and outcomes. The framework is a real attempt to deal with the issues of variation that we come across.

The framework underscores the value of co-ordination and integration. In a climate of financial constraint, improved understanding of prevention means that effective measures can be taken to improve services and save money. The framework encourages CCGs to utilise outcome-based commissioning to incentivise change and advocates improving patient access to and choice of services. Implementing contracting, pay and monitoring outcomes and referrals from all providers should ensure fair choice and drive up quality. That shows that we are moving in the right direction, but a lot more work is needed to encourage action and promote the change we all want to see across the public sector and across the age range.

System partners have shown demonstrable commitment to working together to ensure that progress is made to achieve the goals set out in the action plan. Although there is no one perfect model, NHS England and the sector need to continue to collaborate to support CCGs to improve value, innovate and build sustainable services. I also think that lessons can be learned and applied across the system from the valuable work of NHS England and system partners.

It is clear, as this debate has demonstrated, that there are passionate advocates out there who are eager to achieve the improvements in outcomes, experience and services that we all want to see. The publication of the framework provides us with the opportunity and the incentive for action. We all need to be on the front foot on prevention. We will only achieve gains through concerted action across all the partners in the hearing landscape.

I will continue to play my part in holding system partners to account for commitments made. Collaboration and partnership working at national, regional and local level are key, and the work of colleagues here in the House and the all-party group in ensuring that interests are constantly represented here will also be of great importance. On behalf of the Department, I am very grateful to the Backbench Business Committee and to colleagues for raising such an important subject and contributing to the debate.

Alcohol Consumption Guidelines

Diane Abbott Excerpts

Tuesday 28th June 2016 Westminster Hall

[Byron Davies]

That is the crux of the matter—my hon. Friend makes a very valuable point, which I am delighted that he, as a practising GP, has made.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The hon. Gentleman talks about the alcohol guidelines as social engineering, when they are actually designed to bear down on the health harms from alcohol consumption. How can he call it social engineering when the Government are trying to ensure that our fellow citizens are healthier and live longer?

[Sir Alan Meale (in the Chair)]

Order. Before the hon. Gentleman resumes, it pains me to do so but I have to point out that it is not in order for the Front Bench spokesperson to participate in questioning. The hon. Member for Hackney North and Stoke Newington (Ms Abbott) will get time to sum up for the Opposition at the end.

--- Later in debate ---

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I congratulate the hon. Member for Gower (Byron Davies) on securing this very important debate. The most important thing to stress is that this is not a moral issue—hon. Members have talked about abstinence and so on—nor is it about pubs, many of which are reinventing themselves by serving food and providing craft beer. I welcome the social haven provided by pubs. This is about the health of the nation, and it is interesting that Members have skirted around the health issues. That is why we have guidelines; it is not because the chief medical officer wants to stop people having fun. At the end of the day, any Government must have care and concern for the health of the population, and particularly of young people.

Let us spell it out: alcohol is one of the most well established causes of cancer. It increases the risk of mouth, throat, voice box, food pipe, breast, liver and bowel cancers. It astonishes me that Members who I suspect know those things are still standing in this Chamber criticising Government attempts to bear down on alcohol consumption.

This is about not just the scientifically proven contribution of alcohol consumption to ill health, but its contribution to social disorder. In 2014, the University of Bath estimated that the annual cost of binge drinking was about £4.6 billion. That includes A&E attendances, road accidents, alcohol-related arrests and the number of policemen involved. If someone goes into any A&E department almost anywhere in England or Scotland on a Saturday night, they will see disproportionate numbers of people who are there because of alcohol abuse. It astonishes me that hon. Members show no concern about the billions that that is costing our health service, or about the life chances and quality of life of people who engage in binge drinking. Of course, the abuse of alcohol is also very closely related to domestic violence. If Members are not concerned about the link to cancer and ill health, or about what alcohol is costing our health service, or about social disorder or domestic violence, I wonder what it will take.

[Andrew Griffiths]

Can the hon. Lady tell me of just one sentence today in which any Member has said that they are not concerned about the effects on health, or about domestic violence or alcoholism? This is a ridiculous speech—I realise that she is new in her position, but I suggest that in future she does a little more research before she comes to the Chamber.

[Ms Abbott]

I have to advise the hon. Gentleman that I was a spokesperson on public health for three years for the Labour party. Not only did I do research on the health issues around alcohol, but I visited other countries—notably Scandinavian countries—to see what they had done. My point is that if hon. Members are willing to come here without spelling out the issues that I am describing, it must suggest to anybody listening to or reading the debate that they put them below the interests of the pub trade.

[Patricia Gibson]

Does the hon. Lady agree that as well as health issues, social disorder and domestic violence, there is a huge impact on the economy from lost productivity and work days caused by people phoning in sick because they had too much to drink the night before?

[Ms Abbott]

I thank the hon. Lady for that. We can only look at the guidelines in the context of the social harm of alcohol abuse, and the guidelines are designed to bear down on alcohol abuse. It is too early to say how effective they are, but the principle of the Government acting to bear down on the social harms and costs of alcohol abuse must be correct. Like some other Members, I have visited hospital wards that have to deal with people whose health has been ruined by binge drinking. If hon. Members had seen what I have seen—

[Byron Davies]

Will the hon. Lady give way?

[Ms Abbott]

I am afraid I have to complete my remarks. If some hon. Members really understood the social harms and costs to the nation of alcohol abuse, they could not have made the speeches they made this afternoon.

I welcome the guidelines. It will take time to decide whether they are exactly right and what their effects are, but we need a holistic strategy on alcohol abuse. When I was public health spokesperson for my party, I believed in a minimum price for alcohol. There is more that we can do on classroom-based education, but I have no doubt that the thinking behind the alcohol guidelines is correct. I also have no doubt that as Members of Parliament with a responsibility to our communities, we should do everything we can to bear down on problem drinking.

NHS Success Regime

Diane Abbott Excerpts

Thursday 4th June 2015 Commons Chamber

[Ben Gummer]

I thank my hon. Friend for his question and welcome him to this place. To repeat the answer I have given several times so far—[Interruption.] Those on the Opposition Front Bench say that I do not know, but I must explain to them once again that this is not about a Minister sitting in Whitehall making a decision having never visited an area. That is what the right hon. Member for Leigh (Andy Burnham) did when he tried to destroy local services in my constituency and other places in Suffolk. This is different. It is about trying to fix problems in these challenged local health economies, which in some places have been present not for months or years but for decades. We are trying to ensure that the decisions are corrected and made by the local commissioners and clinicians.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Ministers will be aware of the plight of the Barts Health NHS Trust, which is in special measures. Part of its problem is the weight of the interest on its private finance initiative, a new Labour policy that I did not support. It is having to pay that back at £500,000 a month. Surely a success regime for Barts and other hospitals burdened with PFI debt would be a serious attempt to renegotiate those PFI agreements.

[Ben Gummer]

I am so glad that the hon. Lady welcomes the success regime and the potential it might have. I spoke to one of her colleagues the other day about the troubled hospitals that she mentioned and I was about to invite her in to have a discussion about them, as we must try to find out what the core issues are with Barts Health NHS Trust. She raises an interesting point about PFI, however. One reason we are struggling in some cases, and why we have struggled over the past five years to provide the funding within the NHS that it requires, is the enormous NHS PFI debt that was loaded on to it by the previous Government and that has cost it billions of pounds over the past 10 years.

Mental Health and Well-being of Londoners

Diane Abbott Excerpts

Thursday 12th February 2015 Commons Chamber

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I beg to move,

That this House has considered mental health and wellbeing of Londoners.

First, I would like to thank the Backbench Business Committee for giving me the opportunity to raise the important question of the mental health and well-being of Londoners. Mental health touches all classes and cultures in London. In consequence, it is important not just that it be viewed within the paradigm of health care but that we understand that all elements of London’s socio-economic development are deeply rooted in the well-being of our city’s residents. Unless we start seriously to tackle what I believe to be a rapidly unravelling crisis of service provision for mental illness, we will begin to see dire ramifications surfacing in all aspects of society, including education, family stability and public order.

As the House will be aware, I have thrown my hat into the ring to be Labour’s candidate for London Mayor. If anything, this has sharpened my interest in these matters. Fundamentally, however, my interest in this subject derives from the fact that my mother was a nurse, and in the latter half of her career, she was a dedicated mental health nurse. I saw the mental health system through her eyes—the problems, the challenges—but above all I saw that she loved her job and that she genuinely loved the people she nursed. Through her, I have always had an instinctive idea that people with mental health issues are human beings, too, and deserving of our love and care.

For three years, I was privileged to be shadow public health Minister, and I was able to meet and learn from many dedicated workers in both the public and voluntary sectors in the mental health field. The sad truth is that mental health provision has long been chronically underfunded, and now, during a time of unprecedented demand, the concern is that spending might be falling dramatically in real terms.

[Clive Efford (Eltham) (Lab)]

On the point that funding might be falling, we in London also face the problem that the cost of living is growing. Many people working in public services such as mental health nurses and workers in mental health care are often low-paid in comparison to others. People who come to see me are having difficulty finding places in London and some services are finding it difficult to recruit staff, which has a knock-on impact on the standard of services. I wonder whether my hon. Friend would comment on that.

[Ms Abbott]

I very much agree with my hon. Friend. As he says, there are cost of living issues. Then there are spiralling housing costs. Health care in London has some of the biggest turnover and some of the highest vacancy levels of any health care provision in the country. The pressures of the cost of living crisis and the housing crisis are making it increasingly difficult to provide permanent staff to meet the health care needs in general and the mental health needs of Londoners.

I shall focus in my speech on the cost to London of the mental health crisis and the importance of parity of esteem between mental and physical health, about which Members on both sides of the House have spoken. It is important to stress it, because we are nowhere near parity of esteem when it comes to the questions of finance and resources. I also want to talk about the mental health and well-being of London’s lesbian, gay, bisexual and transgender community, and about the growing crisis of mental illness among our children, adolescents and young adults. I shall also deal with something not often spoken about—mental health issues in our black and minority ethnic communities in London.

It is important, because mental health is sometimes a marginalised issue, to talk about the huge cost of the mental health challenges to London. Recent figures indicate that almost a million adults of working age in London—15.8% of the adult population—are affected by common mental disorders such as anxiety and depression. I was in the House about 18 months ago when Members of all parties bravely talked about their own experience of depression and how they felt a stigma and found it very difficult to get treatment.

It is estimated that 7% of London’s population have an eating disorder, that one in 20 adults has a personality disorder; that 1% of Londoners are registered with their GP as having a psychotic disorder such as schizophrenia, bipolar and other psychoses; and that nearly half of Londoners are anxious. London has the UK’s highest proportion of people with high levels of anxiety. In addition, almost a third of Londoners report low levels of happiness, which must clearly be exacerbated by the cost of living issues we have mentioned. The number of Londoners reporting low levels of happiness is well over 2.5 million. We London MPs see many of them in our surgeries week after week.

In basic economic terms, almost £7.5 billion is spent each year addressing mental health issues in London, while according to the Greater London Authority, the wider health, social and economic impact of mental illness costs the capital an estimated £26 billion. In social care costs alone, London boroughs spend around £550 million a year treating mental disorder, and another £960 million each year on benefits to support people with mental ill health. There are some concerns about the changes in welfare and the—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I fully appreciate that the hon. Lady is a parliamentarian of great experience, and I am not making this point for the sake of it, but she is not addressing the Chair. She is speaking to somebody over there on the Government Benches, but while somebody over there might be able to hear what she is saying, the Chair cannot. I am sure she is speaking of matters of great interest. It would be appreciated by the rest of the Chamber if she addressed the whole Chamber.

[Ms Abbott]

I am grateful to you, Madam Deputy Speaker. As ever, you are punctilious about matters of order.

London boroughs spend about £550 million a year on just the social care costs of treating mental disorders. Another £960 million is spent each year on benefits to support people with mental ill health. Across the population, the net effect of those wider impacts substantially affects London’s economy, infrastructure and population. Mental health is not simply an issue for health and social care; it is an issue for everyone. Mental health conditions debilitate London businesses each year by limiting employee productivity and reducing the potential work force. Every year £920 million is lost owing to sickness absences, and a further £1.9 billion is lost in reduced productivity. Moreover, the costs extend more widely: the staggering sum of £10.4 billion is lost each year to London business and industry as a result of mental health issues.

The London criminal justice system spends approximately £220 million a year on services related to mental ill health, and other losses such as property damage, loss of stolen goods and the lost output of victims cost London a further £870 million. Those costs are already too high, but treatment costs are expected to grow over the next two decades. Mental health issues also prevent physical health conditions from being addressed properly. However, mental ill health remains one of the least understood of all health problems. The problem is exacerbated by the existence of an obstinate and persistent stigma that prevents people from talking about mental health or paying attention to the debate about it, and therefore prevents us as a society from addressing it properly.

I want to say a little about the issue of parity of esteem between mental and physical health. The continuing lack of parity of esteem, in terms of both funding and attitudes, underlies some of the mental health problems not just in London, but throughout the country. As the daughter of a mental health nurse, I am very clear about the fact that there is no parity of esteem between mental and physical health. My mother came here as a pupil nurse in the 1960s, and was part of the generation of West Indian women who helped to build our NHS. She took time off work to bring up a family, but she returned to nursing in the 1980s, and her subsequent career in mental health exemplified the issues involved in the lack of parity of esteem.

The first thing that I want to say about parity of esteem is that those who might be described as the high fliers in health do not necessarily go into mental health. That has always tended to be the case. I shall never forget something that happened in 1987, when I was a brand-new MP. The then chief nurse at City and Hackney told me that I must visit the hospitals in the area. She said that I should meet her at 10 pm, and she would take me to the three major hospitals in hospital: Bart’s, Homerton, and Hackney mental hospital. I met her, and we went around Bart’s. She did not think it in any way remarkable that in Bart’s, even at the dead of night, we did not see a single black nurse. Then we went to Homerton, where there were quite a few black nurses doing the night shift. The chief nurse said to me innocently, “You know, they”—meaning nurses of colour, I assume—“seem to prefer the night shift; our day shift is quite different.”

Then I went to Hackney mental hospital. Although this happened in 1987, I have never forgotten it. The mental hospital was, literally, an old workhouse. It was as grim as anyone could possibly imagine—and, of course, all the nurses there, day and night, were BME. I am afraid that that pointed to a lack of parity of esteem, in the context of the way in which nurses were allocated and the direction in which their careers were leading. I am not in any way detracting from the specialists in mental health, but in respect of nurses there has long been a stratification when it comes to who should work in mental as opposed to physical health.

My mother was a devoted mental health nurse who dealt with geriatric patients with dementia. When my brother and I were older and she went back to nursing, she worked in a hospital outside Huddersfield called Storthes Hall. Thankfully, it has now been closed. It was another former Victorian workhouse, and it looked exactly like a Victorian workhouse. One had only to visit that hospital, see the conditions there and then visit the new Huddersfield royal infirmary in the centre of Huddersfield to see physically demonstrated the complete inequality in services offered to people with physical illness as opposed to people with mental illness.

For a number of years, there has been more focus on mental health in all parties, which is to be welcomed, and more focus on the importance of parity of esteem. However, the financial issues are a challenge. For many years, mental health has been chronically underfunded and it has the reputation of being a Cinderella service. At national level, mental health accounts for 28% of the pressure in the NHS, yet on average clinical commissioning groups spent just 10% of their budget on mental health in 2013. Separate investigations by Community Care and the BBC showed that mental health trusts had their budgets cut by 2.3% in real terms between 2011-12 and 2013-14. The effects of some of those cuts have been felt throughout the system. There have been difficulties in accessing talking therapies. Service provision is creaking at the seams. Over 2,000 mental health beds have been closed since 2011, leading to several trusts with sky-high bed occupancy rates.

There is no question—perhaps Ministers will query this—but that austerity and issues with welfare, access to housing and unemployment have put some of London’s most deprived communities under pressure. Welfare cuts, the lack of stable tenancies and improperly enforced employment regulations must have an effect on the incidence of mental health-related illness. Therefore, on the one hand we have cuts to funding and on the other a rise in the conditions that affect people’s well-being and ultimately their mental health. That is a double-edged sword that spells disaster for the well-being of Londoners.

The specific mental health needs of LGBT Londoners are not discussed often. For a long time, London has been a city where young people come to find themselves. It is an inclusive environment where LGBT people are welcome. London boasts a dynamic gay scene and has successfully hosted World Pride. LGBT Londoners are now able to get married, to raise families and are equal before the law. We must safeguard those achievements by ensuring that they have access to appropriate health care and mental health provision.

It is time to change the stereotype that LGBT people are busy partying and having a good time. Unfortunately, it is not a wholly accurate depiction of the community. There are various estimates about the incidence of mental health problems in LGBT groups, but research I have seen says that sexual minorities are two or three times more likely to report having a long-standing psychological or emotional problem than their heterosexual counterparts; and that two out of five LGBT people will experience a mental health problem at some point in their lives, which is quite a high proportion. In 2014, Stonewall said:

“Compared to the general population, lesbian, gay and bisexual people have higher rates of mental ill health as well as alcohol and drug consumption. Lesbians are also more likely to have never had a cervical smear test, while gay and bisexual men are more likely to experience domestic violence.”

Particularly among young LGBT people, we see rising levels of self-harm. Homophobic behaviour is going unchallenged in the workplace and on London’s public transport system, and hate crimes against LGBT people remain stubbornly high. There are also issues about access to mental health services for LGBT groups.

The situation is even worse for black and minority Londoners who identify as lesbian, gay or bisexual, among whom rates of suicide and self-harm are higher than among than the population generally. Some 5% of black and minority ethnic lesbian and bisexual women have attempted to take their own life in the last year, compared with just 0.4% of men over the same period, and one in 12 have harmed themselves in the last year compared with one in 33 in the general population. What are the Government doing to improve the training of NHS staff on the specific health needs of LGBT people and black and minority ethnic LGBT people, because at present they are both challenged with higher levels of mental health issues but have difficulties accessing services?

There are particular challenges in London associated with the recent reorganisation of the NHS, moving responsibility for public health to local authorities. In principle that move makes it much easier to address the social determinants of ill health, including mental health, but the concern is that because of pressures on local authorities funding for mental health will drop and the ability to provide London-wide services for groups, such as the LGBT community, will weaken.

The House will know that my party is not proposing to put the NHS through a further reorganisation when we return to office in a few months’ time. However, it would make sense for existing structures in London to monitor outcomes for LGBT people throughout the capital, and given the complexity and size of London we cannot simply take a one-size-fits-all approach to LGBT issues.

Young people today are living in a time of unprecedented pressures, with smartphones, the internet, a world of 24-hour communication, new avenues for bullying, new fears and new concerns. The issues are plain to see in the growing demand for services for young people across London, with London hospital admissions for self-harm rising from 1,715 in 2011-12 to 2,046 in the last year. At least one in 10 children in the UK is thought to have a clinically significant mental health problem, which amounts to 111,000 young people in London. The impact of childhood psychiatric disorders costs London’s education system approximately £200 million a year, and in 2013 the Children and Young People’s Mental Health Coalition found that 28% of joint health and wellbeing strategies in London did not prioritise children and young people’s mental health.

What are the Government doing to ensure that joint strategic needs assessments look at, and include information about, the size, impact and cost of local children’s mental health needs, to ensure that sufficient services are being commissioned? Will the Minister ensure that data about BME young people and children will be comprehensively included in the new national prevalence survey of child and adolescent mental health being commissioned by the Department of Health? Concerns have been raised in this House previously about the funding of services for children and adolescents, but it is clear in London in particular that there is an unravelling crisis in relation to young people and mental health.

As I said at the outset, London’s youth, and youth nationally, live in an era of unprecedented pressure. Data obtained from a freedom of information request of top-tier local authorities in England by the mental health charity Young Minds revealed that in 2010-13 local authorities in London cut their children and adolescent mental health service budgets by 5%, at a time of increasing pressure on young people. The latest data show that Southwark cut its budget by 50%, as did Lambeth and Hounslow. Tower Hamlets cut its budget by 30%, and Haringey cut its budget by 10%. Those are some of the most deprived boroughs in London, and if they are really cutting their expenditure on young people’s mental health care to that extent, it is very serious.

[Jeremy Corbyn (Islington North) (Lab)]

I thank my hon. Friend for giving way and congratulate her on securing the debate. She must be aware that the cuts in mental health budgets are, basically, arbitrary because no one knows what the long-term demand will be. No one knows what levels of demand are not being met within communities because people are afraid to come forward even to discuss their need for some kind of help. This is a huge problem and it needs to be given much greater attention by the Department of Health.

[Ms Abbott]

My hon. Friend is right to say that the cuts are arbitrary, and they certainly do not account for unmet need. In my time as a Member of Parliament—my hon. Friend must have had similar experiences—I have met many mothers and other people who are unable to access the mental health care that they need, particularly talking therapies. Cutting provision at a time when we do not even know the size of unmet need is very dangerous.

I want to turn now to mental health care provision for the black and minority ethnic community. I have looked at this issue over many years, and I believe that the manner in which the mental health system fails people of colour is a tragedy that has been consigned to the shadows for too long. As well as talking about parity of esteem between mental health and physical health, we need to talk about a parity of care between all sections of the community, and at this point that is not happening. I hope to set out briefly some of the findings of the research that has been carried out over the decades on black people and mental health, but my central point is that black and minority ethnic people are not getting parity of care and service. This is a long-standing issue that goes back decades, and I call on the Government to do what they can. I shall also call on the incoming Labour Government to pay attention to this issue in a way that has not happened in the past. Governments genuinely need to understand and address these needs.

Black and minority ethnic mental health is a particular issue for London because half Britain’s black and ethnic minority community is inside the M25. Sometimes it is hard to get the data we need, but we know, for instance, that in Lambeth—less than a mile from this Chamber—more than half the people admitted to acute psychiatric wards, and more than 65% of the people in secure wards, are from the Caribbean and African communities. I know from regularly visiting Hackney’s psychiatric wards, and the Hackney forensic unit, that the proportion in Hackney is as at least as high, if not higher, than that. We have accurate statistics for Lambeth, but we only have to walk into psychiatric wards across London to see that the majority of beds in the big mental health institutions such as the Maudsley are occupied by people of colour.

I remember, as a new MP in 1988, raising the disproportionate number of black people on wards with the head of psychiatric services in City and Hackney. I asked, “Why are so many people on your wards black and minority ethnic? It’s way out of proportion even with the population of City and Hackney.” City and Hackney produced three very senior psychiatric doctors to talk to me about this. They turned to each other, paused, muttered, and one suggested that it might have something to do with “ganja psychosis”. Another then ventured the opinion that perhaps more mad people were migrating from the Caribbean. I had to say to him, “It’s hard enough to get into this country if you’re sane; it is to the highest degree unlikely that the authorities are allowing all these mad people to come into the country.” But the striking thing about that conversation was that it was not some casual conversation on a ward; the head of psychiatric services had marshalled the three most senior psychiatric doctors in City and Hackney, and the only explanation they could offer for their wards being full of black people was “ganja psychosis”. I was struck by how low the level of knowledge was and how low the level of interest was.

I also know from my years as a Member of Parliament how many black families are struggling with the consequences of the mental health system’s failure to offer the right support at the right time, and the help and services to which they are entitled. One of the saddest things I see in my work as a Member of Parliament is black mothers, single heads of household, struggling with black males in their household who clearly have chronic mental health problems. I have had women come to see me who have been assaulted by their own son. When they are told that they should go to a GP and that perhaps their son needs to be sectioned, they say,” No, no, no.” That is because there is a terrible fear in the black community of the mental health system. Some women would rather risk assault by their own son and live in fear than consign their son to the mental health system, because their understanding is that once that system gets their child, the child is pumped full of drugs and never comes out again or, if they do, they are not the same. So it is time this Government and any incoming Government give more attention to issues relating to black people and mental health.

Those issues have not altered in decades: there are disproportionate numbers of black people, particularly men, in the system; we are more likely to be labelled “schizophrenic”; we present later to the system, which makes matters worse; we are more likely to come to the mental health system through the criminal justice system, particularly by being picked up by the police on the street and finding ourselves sectioned; and we are less likely to be offered talking therapy. I remember going in the ’90s to a mental health therapy centre in west London that specialised in talking therapy and did excellent work. I noticed that there were no black and minority ethnic people there and when I asked about this I was told, “Oh, we find that black and minority ethnic people don’t benefit from talking therapy.” That is an extraordinary attitude. We need to do more to make talking therapy available across communities, including BME communities. Black people are also statistically more likely to be offered electroconvulsive therapy—in other words, they are more likely to be plugged into the mains. There is also a terrible history of deaths in mental health custody, which are often to do with the type of restraint used and a fear of a violent black male. There is a whole string of such cases, of which Sean Rigg’s is one of the most recent.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I appreciate that the hon. Lady is developing some very important points, but I should draw to her attention the fact that the allotted time for an introductory speech in a Backbench Business Committee debate is 20 minutes. I have allowed her well over half an hour, as I appreciate that not many people are making demands on the time in the House this afternoon and that she is addressing important issues. Even given all that, I trust that in the very near future she is likely to come to a conclusion.

[Ms Abbott]

I am grateful to you, Madam Deputy Speaker, as you are so precise about order. I would not want to think that the length of my speech will prevent anyone else who wishes to speak from entering into the debate.

In conclusion, let me say that the issues I am raising about mental health in London—the cost of mental health to Londoners, and the effect of the under-provision of mental health services in London, not only to the individuals and families who suffer, but to London as a whole—are vital ones. I am glad I was able to bring them to the House and I am sorry if you feel I have gone on at too great a length, Madam Deputy Speaker. The issues associated with what is happening to black people and mental health include the lack of provision, the over-representation in the system and the fear that black families have of the mental health system. So this is a huge issue, and it is one that is not debated enough in this House. I am sorry that you felt I spent too long on the issue of black people in London and mental health. What is happening to our young people and children is a new crisis, which is definitely not being debated in this House, and I am glad to be able to draw it to the attention of the House.

Absolutely in conclusion, may I say that these are vital issues for Londoners. In the end, addressing health care is about addressing all the social determinants—the welfare system, housing, employment or education. I am glad to have had the opportunity to draw the House’s attention to how serious the crisis is, particularly in relation to our young people. I wait with interest to hear what the Minister has to say.

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[Ms Abbott]

I probably did not make myself clear. I was saying that people of colour—black and minority ethnic people—are far more likely to enter the mental health system as a result of being picked up by the police. That is all I was saying. I was not making a general point, but a specific point about that being one of the main ways we enter the mental health system.

[Dr Offord]

I am grateful for that clarification and I thank the hon. Lady for it.

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[Jeremy Corbyn (Islington North) (Lab)]

I congratulate my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) on obtaining the debate. It is a pleasure to follow the hon. Member for Hendon (Dr Offord) and I am delighted that he had such a profitable morning at the Whittington hospital in my constituency. The ambulatory care centre is indeed excellent. It was a product of a community and all-party campaign to defend the A and E department some years ago. We won that campaign, and as a result we have a thriving A and E department and a new and very efficient ambulatory care centre. I attended its opening with colleagues. It is a great place and I am glad that the hon. Gentleman was well treated there. I hope he will write and tell the hospital so.

The point that the hon. Gentleman raised on policing, on which I intervened, is serious. I make no general criticism of the police force as a whole, but I do think that when the police are called to an incident in a shopping centre, or in the street or elsewhere, they need to be well aware that some of the people there may be suffering from a mental crisis, may be mental health patients, and need to be treated with some degree of care and understanding. Many police officers are very understanding and very careful about that; I am not trying to make any general criticism. I just think we need to send a gentle message to the Metropolitan police that within training, there should be as much awareness as possible of the mental health conditions that exist within the community.

We have moved on a long way in debates on mental health in this House during the time that I have been here. When I was first elected, a person with a mental health condition was not allowed to stand for Parliament. The Speaker had the power to section Members of Parliament under the Mental Health Act—may still do, for all I know. Mental illness was generally the butt of humour—of universal jokes—so that people going through a crisis, perhaps depression, felt unable to talk about it and felt it would blight their career prospects in any walk of life if they did talk about it. Consequently, only if they had the money did they seek private help and private counselling; if they did not have the money, they suffered, and might lose their job and end up with a blighted career.

All of us can go through depression; all of us can go through those experiences. Every single one of us in this Chamber knows people who have gone through it, and has visited people who have been in institutions and have fully recovered and gone back to work and continued their normal life. I dream of the day when this country becomes as accepting of these problems as some Scandinavian countries are, where one Prime Minister was given six months off in order to recover from depression, rather than being hounded out of office as would have happened on so many other occasions.

The issues that I shall raise are much the same as those raised by my hon. Friend the Member for Hackney North and Stoke Newington in opening the debate—on the disproportionate extent to which the people one finds in mental health institutions come from the black and minority ethnic communities, and the socio-economic imbalance on mental health issues. People who lead stressful lives, without housing security, without job security, without financial security, frightened about the consequences of what their children are up to or whether their children can get a job and so on, are sometimes affected by levels of stress that the rest of us would not even want to think about.

The access point to mental health services is usually the GP. That is the great thing about the national health service, although sometimes it is the problem of the national health service. A GP surgery at its best is brilliant, recognises the holistic needs of the patient and does its best to accommodate those holistic needs. The GP system at its worst is a single-handed GP who may have been there a very long time, become rather set in their ways, is not very interested in people coming to them with stress or other psychiatric-related problems, and does not refer them for any kind of therapy or counselling.

I am concerned about the length of time people wait for counselling or support. A report commissioned by the British Psychoanalytic Council and the UK Council for Psychotherapy, based on over 2,000 psychotherapists working across the NHS, the third sector and in private practice shows that in the NHS and the third sector

“57% of practitioners said client waiting times have increased over the last year, 52% report fewer psychotherapy services being commissioned in the last year, 77% report an increase in the number of complex cases they are expected to deal with.”

The report continues:

“The strain on publicly funded therapy services means that the private psychotherapy sector is increasingly ‘picking up the pieces’ with individuals who have been failed by the NHS. The vast majority of private therapists (94%) report they regularly see clients who feel let down by the NHS”.

I am absolutely not attacking the national health service. That is the last thing I want to do. I want the national health service to be there and available for all. I do not want it to so ration its services that those with fairly desperate needs are forced to suffer, seek voluntary help if they can get it or, if they can afford it, get private support.

There are excellent local organisations in my area, including iCope—Camden and Islington Psychological Therapies Service, and the Women’s Therapy Centre, which do a great deal to improve the local service and put a lot of pressure on the local health authority. An excellent report was produced by Louise Hamill and Monika Schwartz, who both work in my area and have done a great deal of work on the subject. I urge the Minister to have a look at that report and at the very serious proposals that they put forward.

The network for mental health did a survey which identified the 10 most important issues relating to mental health treatment. I will not list them all, but the most important seems to me to be access to timely and appropriate treatment. If someone going through a mental health crisis or depression cannot get seen by somebody, they become more and more agitated and stressful. If we have target times for cancer treatment, we ought to have target times for being seen and getting the necessary support at times of mental stress. Likewise, reducing stigma and discrimination is important, as is looking at the effects of benefit and welfare system reforms.

I have had far too many anecdotal reports from constituents and others who go for a Department for Work and Pensions availability for work test. If they have a physical disability, it is usually fairly obvious and it can be quantified and, we hope, taken into account in how the interview and test are conducted. If somebody has a mental health condition, it is not so obvious and cannot be so easily quantified. There are far too many cases where the stress levels are unbelievable for people who have been forced into these tests. Their condition has not been taken into account, they have been declared fit for work, and they then go into a crisis of stress because they feel they simply cannot cope. It is place where we could all be, and we should have some respect for people in that situation and do our best as a society to help them get through it.

That leads me on to education and publicity and how these issues are dealt with. The media have got somewhat better. It is now not routine for TV and radio comedians always to make jokes about people being stressed out, mad, depressed and so on. Things have moved on a bit and I pay tribute to colleagues in all parts of the House who have stood up in the Chamber during the annual mental health debate and said exactly that about ending discrimination.

[Ms Abbott]

Does my hon. Friend agree that one of the worst examples of the way in which the media treat mental illness was The Sun which, when the well known boxer, Frank Bruno, had mental health issues, had a front page headline, “Bonkers Bruno”, for which it eventually had to apologise?

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[Sir John Randall (Uxbridge and South Ruislip) (Con)]

First, I would like to apologise to the hon. Member for Hackney North and Stoke Newington (Ms Abbott), because I was not able to be here for her speech. I heard some of it upstairs, but I had been detained in my constituency and did not think the debate would start quite so early. My powers of being able to work out such things when I was a Whip are obviously diminishing fast with my impending retirement.

This is a very important subject and, unfortunately, it is not often tackled. As Members of Parliament we see a large number of people who suffer from some form of mental health issue, and I have to say that it is one of the things that I find most difficult to deal with. In the past 12 months, one of my constituents, Miss Deborah King, who is very active in making people aware of the problems, has drawn my attention to a mental health first aid course, but I regret that I have not had time to go on it. The course tells people not how to treat others, but how to recognise and deal with the issue. I have said that I have not had enough time, but I should have made time. It is rather like saying that I do not have time to exercise. Time should be made for such things and I urge those who will be Members after the general election to see whether such mental health first aid courses will be available. Mind organises them in our area, but there may be others, too.

I would also like to suggest some form of training for first-time MPs—perhaps the House authorities could lay something on—because this is one of the issues of most concern. As hon. Members have said, we now know that mental illness is much more common than we would have liked to have thought 20 to 30 years ago. We know the statistics of how many people will be touched by some form of mental illness—it could be a person’s close family member, for example, or that person themselves—but we do not know the reasons for it. We can think of obvious reasons, some of which have been mentioned. One example I have come across—and not just during my time as a Member of Parliament—involves people who come here from another country. Their spouse may not be too conversant with the language and find themselves incredibly isolated. They do not have the stress of unemployment, but a culture change can cause a lot of problems and that may explain why quite a lot of the people I see in this context were born abroad.

I am also worried that some families, for reasons that are human and understandable, do not want to believe there is a problem. We have to educate ourselves that mental illness should be treated in exactly the same way as physical illness. I might find it easier if my spouse or one of my children came to me with a physical complaint. I could cope with that and understand how we might be able to get treatment, but mental health is still incredibly stigmatised.

That leads on to what my hon. Friend the Member for Hendon (Dr Offord) and the hon. Member for Islington North (Jeremy Corbyn) said about jobs. Over the decades, Members of Parliament have had serious mental health issues, but they have been hushed up because it would not have been particularly good for their electoral chances; there also used to be a ruling on such matters. It is the same with other jobs. If someone came to us and said that they had a history of mental illness, we as employers would have to make a difficult decision. I was delighted to hear my hon. Friend the Member for Hendon say that he would take someone on; I hope that I would. It should not be a difficult decision, but something innate in us might give us concerns.

[Ms Abbott]

I am listening with great interest to the right hon. Gentleman’s very thoughtful speech. His earlier point about how people who come from abroad can feel isolated may account for the very disproportionate mental health figures for the black and minority ethnic community.

[Sir John Randall]

I am grateful to the hon. Lady for making that very valid point. Anecdotally, I can bear that out from constituents I have seen, although not by any means exclusively.

Another issue I have come across is when someone desperately needs help—they need to see someone to try to sort things out and to get treatment—but, possibly because they are quite far down the line, they do not accept that they have a problem. I can think of several cases where a husband or a wife was so nervous that they looked at me and said with their eyes, “Can you please do something?” but when I said that they should perhaps go to see their GP because it was a very stressful time for them, the immediate reaction of the ill person was to say, “There’s nothing wrong with me—I’m not going.” I do not know how to get round that: we do not want to force people, but it is very difficult to help them if they will not accept that something is wrong.

Another group with which I have become connected, because I am interested in this area, involves victims of human trafficking and modern slavery. People who have been, as it were, freed we now call survivors. They have been taken away from the world in which they were working —forced labour or sexual exploitation—and outwardly they seem fine, but they do not appear to have any help. We have only to think of what they have been through to realise that they almost certainly have severe mental health issues, but there do not seem to be readily accessible services for them. In many cases, they are not EU citizens or have entered the country illegally, so they are concerned that if they present themselves to the immigration authorities, the first thing that will happen is that they are deported. That only makes the situation worse.

The hon. Member for Islington North made the very valid point that when we talk about health—a general election is coming, and there is lots of discussion and dispute about the health service, with figures and statistics bandied around—mental health statistics are hardly ever mentioned. As he said, we should have targets on how quickly people see successful outcomes, as far as they can, and on where resources are going, but we do not have them. As Members of Parliament, we are aware from our meetings about the various illnesses that people have, and we know that a lot of people feel like Cinderella because their illness is perhaps not as well known as cancer or something else. Mental health services, however, probably deserve the title of Cinderella services, because people do not recognise them.

My hon. Friend the Member for Hendon spoke about a confessional, but I will say only that during my time in this House—particularly serving in the HR department in the Whips Office—I have seen people who suffer from extreme depression and stress caused by all sorts of things. The House authorities, to their credit, have improved mental health services and people can be referred to them, although often they do not want to be. We must be much more sympathetic. If such things happen here with the people we have in this place, goodness knows what it is like for people in the less affluent areas of our constituencies.

London has a problem because of the nature of big cities—I am sure that is the case. The title of this debate mentions the well-being of Londoners, and that is something we should consider. My personal therapy involves open spaces and bird watching, although I recognise that is not for everybody. Open space, a bit of exercise, walking around—that is good therapy, and we should ensure that those facilities are open to all.

I congratulate the hon. Member for Hackney North and Stoke Newington on securing this debate. I am sorry for my late arrival and also that—last thing on a Thursday and just before a recess—this debate has not attracted large numbers of people. That has allowed me to speak, for which I am grateful, and I wait to hear the Minister’s response.

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[Ms Abbott]

I listened with care to the Minister’s speech and she can be sure I will be returning to many of these issues in the coming months. I was particularly glad to be able to put issues relating to London’s LGBT and black and minority ethnic communities on the record, because they are rarely discussed.

I beg, in the gentlest way possible, to differ with the Minister on the issue of whether there is a crisis in respect of mental health and young people. The correspondence that my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) explained to the House about the cut in beds is very worrying. This is an important issue all over the country, but particularly in London. In a city that is so fast-moving and with individuals subject to so many pressures, it behoves the House to pay constant attention.

Question put and agreed to.

Resolved,

That this House has considered mental health and wellbeing of Londoners.