Brexit: Reciprocal Healthcare Arrangements

Edward Argar Excerpts

Thursday 26th September 2019 Written Statements

[The Minister for Health (Edward Argar)]

Today I am notifying the House about an announcement that the Government have made about transitional healthcare arrangements across the EU if we are unable to secure a deal.

The UK is leaving the European Union (EU) on 31 October 2019, with or without a deal. The UK Government are working hard to secure a deal that covers healthcare arrangements, but it is important that people understand what will happen if the UK leaves without a deal and what support the Government have put in place for that scenario.

Our priority is to maintain reciprocal healthcare arrangements with member states (MS) when we leave the EU. That is why the UK Government have proposed consistently to all MS that existing reciprocal healthcare arrangements (under regulation 883) continue until 31 December 2020 in a no-deal scenario. These arrangements safeguard healthcare for the hundreds of thousands of UK-insured persons who live in Europe or require medical treatment while holidaying in Europe. They also ensure that EU citizens can receive healthcare in UK, whether they are here on holiday, or to live and work.

Regulation 883

Current EU reciprocal healthcare arrangements (Reg (EC) No 883/2004) support large numbers of UK nationals living in, working in, or visiting the EEA or Switzerland to access healthcare. The arrangements require equal treatment between EU/EFTA citizens when accessing healthcare in other MS. Any EU citizen (or economically active third country national) resident in the UK who moves to the EEA or Switzerland can access state-provided healthcare by paying the same taxes as nationals of that country or people who are eligible for state healthcare.

In addition, the UK reimburses other MS for the state-funded element of healthcare for certain groups known as “UK-insured” who do not need to pay local taxes:

(a) S1—the UK covers the healthcare costs of S1 holders, which include state pensioners, people with disability benefits, certain workers and their dependents living in the EU.

(b) European health insurance card (EHIC)—the UK funds “needs-arising” healthcare when UK residents visit the EU temporarily (for tourism, study or work).

(c) S2—the UK Government fund UK-insured individuals who travel to receive pre-authorised planned treatment in the EU (e.g. maternity).

The UK administers reciprocal healthcare, including paying for overseas medical costs, on behalf of England, Scotland, Wales, Northern Ireland and Gibraltar.

Arrangements with member states

Arrangements are already in place with a number of MS, and the UK Government are still seeking further reciprocal agreements ahead of leaving the EU on 31 October. The Government are currently undertaking technical discussions with countries such as Belgium who have already passed domestic legislation that will support reciprocal healthcare with the UK after Brexit.

The UK Government stand ready to reciprocate all arrangements with MS, and have the necessary legislation in place, under the Healthcare (European Economic Area and Switzerland Arrangements) Act 2019 and the European Union (Withdrawal) Act 2018.

Ireland

Under the common travel area (CTA). British citizens living in Ireland will be able to access healthcare in Ireland on the same basis as Irish citizens which means that they may need to make a financial contribution. The UK Government are in detailed discussions with the Irish Government to reach an arrangement which would enable current reciprocal healthcare arrangements to continue. British and Irish citizens who live in Ireland will also continue to have access to free-of-charge healthcare while visiting the UK. This is regardless of the circumstances in which the UK leaves the EU.

Spain

Healthcare access in Spain will remain the same after exit day, whatever the Brexit scenario. This is because the UK and Spain have each taken steps to ensure that people living in each country can continue to access healthcare as they do now until at least 31 December 2020, using their S1 forms. UK EHIC holders in Spain, and those who have planned treatment in Spain using an S2 form will also be able to continue to access healthcare in the same way when they are in Spain until at least 31 December 2020. The UK Government are now seeking to work closely with Spain to agree how this will work in practice. The Spanish Government’s guidance on access to Spanish healthcare and Brexit can be found here:

www.lamoncloa.gob.es/lang/en/brexit/Paginas/index.aspx.

Switzerland

The UK has reached an agreement with the Swiss Confederation to ensure that the rights of UK nationals living in Switzerland and Swiss nationals living in the UK are preserved in a no-deal scenario after the UK leaves the EU on 31 October. This means that UK-insured individuals who reside in Switzerland at the time of Brexit will still be able to access healthcare using their S1 form, as they do now.

Moreover, UK nationals travelling to Switzerland, before the UK leaves the EU will continue to be covered by their UK issued EHIC for the duration of their stay. This includes visits which started before Brexit and end after the UK’s withdrawal from the EU. If a visit starts after the UK leaves the EU, EHIC may no longer be valid.

Norway, Iceland and Liechtenstein

The UK has reached an agreement with the EEA-EFTA states (Iceland, the Principality of Liechtenstein, and the kingdom of Norway) to ensure the rights of UK nationals living in these countries, and that nationals of Iceland, Liechtenstein and Norway living in the UK, by 1 November are preserved after the UK leaves the EU on 31 October 2019. This means that UK-insured individuals in these countries at the time of the UK’s exit will be able to access healthcare using their S1 form, as they do now, after 31 October.

Moreover, UK nationals travelling to Iceland, Liechtenstein or Norway before the UK leaves the EU will continue to be able to rely on their UK issued EHIC for the duration of their stay. This includes visits which started before Brexit but end after the UK has left the EU. If a visit starts after the UK has left the EU, EHIC may no longer be valid.

Other EU countries

Updated information has been published on gov.uk and nhs.uk on the situation for each MS, including what arrangements have been put in place. These pages will be kept updated as further assurances from MS are received.

Those living in the EU whose healthcare is funded by the UK should not delay in reviewing their circumstances in order to secure their future healthcare needs. It is important that people review their own needs now and consider options carefully by checking the guide for the country they live in. People can also sign up to email alerts to check these country guides regularly as the situation may change as the UK gets closer to leaving the EU.

Preparing for leaving the EU

The UK’s offer to EU citizens resident in the UK is clear. We offer complete assurance to EU citizens who are living in the UK on or before 31 October 2019, that they will be able to access free healthcare on the NHS after we leave the EU on 31 October. Should EU countries not agree to our offer to continue the existing reciprocal healthcare arrangements until December 2020, visitors from those EU countries will be charged for NHS care.

Beyond the bilateral arrangements, it is difficult to predict what exact arrangements will be in place for UK nationals in other MS as we continue to hold our technical discussions with them. This is because of the varying nature of each country’s healthcare system. In view of this uncertainty, UK-insured individuals living in the EU should be ready for possible permanent changes to how they access healthcare.

Everyone living in the EU is strongly encouraged to think about their own healthcare needs and circumstances and consider the steps they need to take to be assured of continuing healthcare coverage. The Government have produced detailed advice for each country which can be accessed here: www.gov.uk/uk-nationals-livinq-eu

Specifically, individuals should consider: whether they need to register as a resident under local rules; the documentation they need to have in place; taking steps to understand how the local healthcare system operates and how their healthcare cover may change; and, if appropriate, purchasing private insurance.

Contingency arrangements

While we continue to promote our offer to all MS to continue existing reciprocal healthcare arrangements until at least 31 December 2020, the Government recognise that as we leave the EU, arrangements may not be straightforward and people may experience some challenges. As such, while countries and individuals put arrangements in place, we have taken a number of steps to support and protect UK-insured individuals living in the EU.

Not all UK-insured individuals will need to access these UK arrangements, as we may negotiate some further arrangements and many countries have put in place comprehensive arrangements already for UK-insured individuals and others may follow suit. However, coverage does vary, and the UK Government want to ensure that all UK-insured individuals are in a good position to assess their options and prepare for what comes next.

Specifically:

(1) We have provided information online and are sending a letter to S1 holders living in EU and EFTA MS, encouraging individuals to consider their circumstances and options and to take the necessary steps to ensure they have appropriate coverage in place. The steps necessary will vary depending on individual’s circumstances and by country.

(2) For UK-insured individuals who may find themselves in a particularly vulnerable situation because they fall ill before the UK leaves and require treatment that spans exit day, we have made specific transitional provisions. If an individual requires healthcare treatment before the UK leaves the EU and the treatment will continue until after Brexit, the UK Government will pay for this course of treatment for up to one year (or the authorised period in relation to an S2) or the period of treatment if shorter. This will apply for those receiving healthcare as an S1, S2 or as an EHIC holder.

(3) The UK Government will fund the healthcare of existing UK-insured individuals living or working in the EU, on the same basis as now, for a further six months from the point of Brexit. This provision is aimed at providing individuals time to make alternative arrangements for their future healthcare cover, including registering for healthcare in their country of residence.

The UK-funded protection may be required if the EU or MS refuse to enter into arrangements with the UK or refuse to offer comprehensive protections to UK-insured through domestic legislation.

In addition, some MS do not fund healthcare for those who are going through the healthcare registration process. To give as much protection as possible to UK-insured individuals, after the six months is over, the UK Government will continue to fund healthcare for the length of the registration period if that MS does not fund healthcare for that period (up to one year) and the individual has taken steps to register in-line with local timeframes and no later than six months from exit day. This will ensure there is appropriate coverage should there be delays or overly lengthy registration processes. If a UK-insured individual leaves their country of residence to travel to another country, they will have to take out full travel insurance as their EHIC will not be valid.

(4) The UK will also continue to cover those travelling to the EU, whose visits commenced prior to Brexit day until they return to the UK, up to a period of six months.

(5) Students may find themselves in a particularly challenging position if they are already studying abroad. All students are encouraged to take out comprehensive travel insurance and to investigate local healthcare schemes that they may be eligible for. However, given the circumstances, the UK Government have agreed to continue existing cover of healthcare costs for students for the duration of their course, should they be already studying in a MS at the point that the UK leaves the EU and on the basis of evidence from their Institution. More information on support for students can be found here: www.gov.uk/guidance/studying-in-the-european-union-after-brexit.

(6) In exceptional circumstances, the UK Government have put in place provisions to provide bespoke support to people who find themselves in a challenging position due to a change in their healthcare cover after Brexit. This scheme will run from 1 November 2019 for at least a year with strict criteria and will only support those with very limited financial means.

The overall contingency package will be most relevant in MS whose domestic legislation does not protect UK-insured individuals during the registration period, exposing them to gaps in healthcare coverage and potentially high costs. We are seeking to agree with MS that they will accept our payments for healthcare cover if the UK leaves the EU without a deal. Where a MS does accept these payments, this would mean UK-insured individuals could continue accessing healthcare as now, beyond deciding whether to register with the local scheme or return to the UK within six months of Brexit. If a MS does not agree to this, then the UK Government will step in to pay healthcare costs directly. To access this support after the UK leaves the EU, UK-insured individuals will need to contact the NHS business services authority (NHS-BSA) to provide them with the healthcare provider’s details, so that the BSA can arrange for the healthcare provider to invoice the UK Government directly.

Individuals should not delay taking action to put appropriate permanent arrangements in place for when the UK leaves the EU on account of this additional support, particularly as for some EU countries the timeframe for UK-insured individuals to register with their domestic health system is far shorter than six months.

Planned treatment

The UK Government will fund planned treatment within MS (S2 scheme) if authorisation for that treatment has been applied for before Brexit and later granted or authorised before Brexit, even if that treatment is scheduled to start after Brexit. The UK Government will pay for these treatments if the provider agrees to honour their commitment.

Returning to the UK

After the UK leaves the EU some people may decide to return the UK. UK nationals living in the EU whose healthcare is currently funded by the UK will be able to access free NHS care when temporarily visiting England, Scotland and Wales. UK nationals living in the EU will be eligible for NHS care if they move permanently back to the UK (including Northern Ireland) and meet the ordinarily resident test. Accident and emergency services and services that are deemed urgent or immediately necessary will always be provided free at the point of delivery first in the UK, with entitlement to NHS care determined afterwards. More information can be found here: www.gov.uk/guidance/using-the-nhs-when-you-return-to-live-in-the-uk.

[HCWS1832]

Gosport Independent Panel

Edward Argar Excerpts

Wednesday 21st November 2018 Commons Chamber

[Matt Hancock]

The point about coroners is a matter for the Ministry of Justice, but I am pleased to see that the Under-Secretary of State for Justice, my hon. Friend the Member for Charnwood (Edward Argar) is present. He would delighted to meet the hon. Lady to take up that point—

[The Parliamentary Under-Secretary of State for Justice (Edward Argar)]

indicated assent.

[Matt Hancock]

Yes: good.

I will, of course, be happy to meet the families, but the advice of Bishop James Jones is that that will be appropriate after this stage of the police investigation. I wrote to the families to explain the position before making my statement. It is important that we go through the process properly during the police investigation to ensure that justice can be done, but I shall be more than happy to meet the families at the appropriate moment.

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 20th March 2018 Commons Chamber

[Jackie Doyle-Price]

First, I commend the hon. Lady for the work she does on tackling knife crime and I know it is an issue close to her heart. The work with Redthread is being co-ordinated with the Home Office, and I would not want to allocate its expenditure, any more than it should be allocating mine.

[Edward Argar (Charnwood) (Con)]

12. What steps the Government are taking to support Dementia Awareness Week.

[The Minister for Care (Caroline Dinenage)]

Dementia Awareness Week runs from 21 to 27 May, and the Department of Health and Social Care is expecting to participate fully in a range of activities that week, working with partner organisations and the voluntary sector.

[Edward Argar]

Alongside the work of Governments of both parties to improve dementia research, care and awareness—Dementia Awareness Week is a key part of that—the role of voluntary organisations and dedicated volunteers around the country is vital. Will the Minister join me in paying tribute to the fantastic work of specialist dementia care Admiral Nurses and in backing Leicestershire Dementia UK volunteers in their campaign, which is well on track, to raise the £50,000 needed for an Admiral Nurse for our county?

[Caroline Dinenage]

First, I pay tribute to my hon. Friend for the sterling work he does as co-chair of the all-party group on dementia. He is absolutely right to say that Admiral Nurses do fantastic work in many parts of the country, helping people with dementia to maintain their independence, and improve their quality of life and that of their families. I very much support all the fundraising activities going on in his local area.

Eating Disorders Awareness Week

Edward Argar Excerpts

Tuesday 27th February 2018 Commons Chamber

[Edward Argar (Charnwood) (Con)]

Anorexia nervosa, a well-known eating disorder, has the highest mortality rate of any mental health condition. When eating disorders are not fatal, they can still lead to significant and long-lasting health issues. An estimated 1.25 million people in this country suffer from an eating disorder. Of course, it affects not just them but their families, yet eating disorders are all too rarely discussed in public.

We discuss with comparative ease physical illnesses that may devastate people’s lives, but when it comes to mental illnesses this is too often not the case. That is also true of eating disorders. Despite the ever-increasing pressures of daily life leading to increased instances of poor mental health, we still do not speak about these issues enough. These illnesses can thrive on secrecy. The longer they go unchallenged and unacknowledged, the harder it is to beat them. It is only by talking about them, bringing them out of the shadows that we can reduce the power they hold over those who suffer. To really improve the lives of those with eating disorders and prevent those at risk from falling victim to these illnesses, we must bring eating disorders, as with all mental health issues, to the forefront of the collective deliberations and consciousness of our society. That is why, in this Eating Disorders Awareness Week, I am very pleased to have secured this important debate so that we in this House, the centre of our national debate, can talk about it and play our part, however small, in raising awareness and making it that bit easier for others to talk about it. I am very pleased that this Minister is responding to the debate, because I know she is a lady of compassion, dedication and determination to improve people’s lives. May I also say, Mr Speaker, that with all the pressures on your time, I am pleased that you are in the Chair for the start of this debate, because I know the close interest you have taken in these issues as well?

[Alex Chalk (Cheltenham) (Con)]

Will my hon. Friend join me in commending the outstanding compassion and professionalism of the community team and other professionals at the Brownhill Centre in Cheltenham, who provide such a vital lifeline for those suffering with eating disorders?

[Edward Argar]

I will. My hon. Friend is absolutely right to raise this issue. Indeed, my hon. Friend the Member for South Ribble (Seema Kennedy) highlighted earlier today the work of the SEED—Support and Education for Eating Disorders—organisation in Penwortham in her constituency. They are both absolutely right to highlight the work of such organisations.

As hon. Members may know, since my election to this House I have on a number of occasions raised health and mental health-related issues on behalf of my constituents and more widely. In this case, last year I accepted an invitation from Beat, the national eating disorder charity, to the launch of its important report, “Delaying for years, denied for months”, which focuses on how long it takes from someone developing an eating disorder to their receiving treatment for it. It is a piece of research I will draw on extensively today.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing the debate. Over the years, a number of my constituents have had these problems. Through the good work of the NHS and the Beat organisation, to which he has just referred, they have been able to pull through to the other end. In Northern Ireland, we have some 20,000 people who suffer from eating disorders at any one time. Given that fact, does he feel that the Government could enter into discussions with the regional assemblies across the whole of the United Kingdom of Great Britain and Northern Ireland to agree a strategy that can accommodate where we are in the UK?

[Edward Argar]

The hon. Gentleman makes a very important point. This is one of those issues on which I would hope we can see the widest engagement across the UK, across all involved in government and the provision of services, to come up with a coherent and common approach to beating eating disorders.

[John Howell (Henley) (Con)]

My hon. Friend is making a very good point. I wonder whether he has a feeling for how much extra training GPs will require to be able to spot the signs of these disorders.

[Edward Argar]

My hon. Friend makes a very important point and if he will perhaps be patient for a few more minutes, I will turn to, among other things, exactly that point.

At the launch that I referred to, I met and heard from some impressive and inspiring people, who had grappled with eating disorders and who wanted to share their experience and raise awareness. I subsequently met Beat to discuss its work and what more needs to be done. The people I met at Beat’s launch event did something important and brave in speaking out, but they had already done something brave in seeking help for their illness in the first place.

[Margaret Greenwood (Wirral West) (Lab)]

One of my constituents is an ambassador for Beat, and I met her recently. Does the hon. Gentleman agree that one of the organisation’s strengths is that it draws on people who have been through the experience, so they can speak knowingly and convincingly to people they recognise as being in the same situation that they were in not that long ago?

[Edward Argar]

The hon. Lady is absolutely right. It is always true in any situation that someone who has been there can speak with much more power and in a much more compelling way than someone who has not, however empathetic they are. The reality is that the recognition of an eating disorder for what it is—an illness—and getting the help and treatment for it is, all too often, still too slow. With an eating disorder, as with illnesses generally, the earlier an intervention and treatment take place, the easier it is to treat and the better the outcome for the patient.

[Sandy Martin (Ipswich) (Lab)]

Does the hon. Gentleman agree that mental health services require the ability to provide advice and counselling, especially to younger people, and that in many cases that is lacking?

[Edward Argar]

The hon. Gentleman makes a very important point. Mental health services, whether they are statutory mental health services or supported services from the voluntary sector, have to be able to address the needs of the individual as an individual. I will come shortly to funding and the provision of those services.

Beat’s report last year found that the average cycle of relapse and recovery could be six years, and that it took an average of three and a half years, or 176 weeks, between someone getting an eating disorder and their getting the treatment that they need. That average of 176 weeks goes across people who are under 19 and adults. For those under 19, the average is 130 weeks, and for those over 19, the average is 256 weeks.

Those statistics are worth unpicking a little. It is important to be clear that 91 of the 176 weeks come before an individual or those around them recognise that they have an eating disorder, and a further 58 weeks come after that point, before they seek professional help. Increasing awareness of the symptoms of eating disorders is vital. As a recent YouGov survey found, 79% of the people who were surveyed could not list a single psychological symptom of eating disorders, and 34% were unable to name any correct sign or symptom. Alongside that, however, it takes real bravery for someone to admit to themselves that they need help. It is incredibly hard for someone to talk about an eating disorder.

[Kirstene Hair (Angus) (Con)]

I congratulate my hon. Friend on bringing this important debate to the Floor of the House. He says that it takes a lot of encouragement for people to say that they need help, and I commend the Government for their four-week target of 95% of patients to be seen within four weeks of referral. Will he join me in urging the Scottish Government to reduce the number of weeks from 18 weeks to four?

[Edward Argar]

I certainly join my hon. Friend in urging that. I daresay that were the Speaker to express a political opinion, he might, too, but of course, he cannot.

It will always take courage to talk about an eating disorder, but by talking about them in this House and in our communities, we can help to make it easier and to reduce the 149 weeks that I talked about. I hope that in the Minister’s response, she will set out what is being done to raise awareness and to help the national conversation to take place, working alongside charities such as Beat.

The remaining 27 weeks of the total come from an average of 11 weeks between someone first visiting a GP and receiving a referral, often with three visits to a GP taking place before that happens; eight weeks between referral and formal assessment; and eight weeks from assessment to receiving treatment. We can and should be able to further reduce this 27-week period.

Let me be clear: this is not, and should not be, a partisan or party political issue. Governments of different political colours have all made significant progress, but of course there remains more we can all do. When someone has made the important leap to talking about their illness and seeking help, it is at this time that they are most receptive to engaging with that help when offered. When they make that leap of faith, we must meet them with action.

[Matt Warman (Boston and Skegness) (Con)]

I want to unpack what my hon. Friend has just said and pay tribute to the work done by all Governments on this important issue. Ultimately, however, pressure on resources sometimes means that people who seek help are effectively told to come back when they weigh less. That is at the heart of the challenge we have to address.

[Edward Argar]

My hon. Friend makes an important point. One of the key themes drawn out from this and related research is that it should not just be one symptom or factor that determines when someone needs help; there is a basket of factors and considerations that demonstrates when that need is there and when treatment is needed. He is absolutely right, therefore, to highlight that point.

As we know, GPs do an amazing job, but, as my hon. Friend the Member for Henley (John Howell) said, we need to ensure that doctors’ medical training gives them the tools they need in this area, as in others, to recognise all the symptoms of an eating disorder; and to ensure that that training is kept up to date and that medical professionals are familiar with and follow National Institute for Health and Care Excellence guidelines on eating disorders, including its guidance that single measures—this touches on the point my hon. Friend the Member for Boston and Skegness (Matt Warman) has just made—such as body mass index and duration of illness alone should not be used to determine whether to offer treatment or what treatment to offer.

The Government have made huge strides in focusing on reducing delays through investment and funding and waiting-time targets, but these targets are not always fully applicable to everyone. As my hon. Friend the Member for Angus (Kirstene Hair) set out, the Government have a target of 95% of non-urgent cases involving under-19s being seen for treatment within four weeks. I understand from the latest figures that that target is now being met in 79% of cases. That is good progress, but there is still more to do. It is vital, however, that these waiting-time standards for accessing treatment also apply to over-19s. I would welcome the Minister’s reflections on that, and, of course, I reiterate what my hon. Friend the Member for Angus said and hope that the Scottish Government will follow the very positive lead set in this respect.

More broadly, I would also highlight the waits experienced for child and adolescent mental health services and adult mental health services more generally. In some parts of the country—I have highlighted this in my county of Leicestershire—delays in treatment can have a profound effect on individuals and the families who care for them. I hope that the Minister will touch more broadly on that bigger picture.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

I attended an NSPCC event yesterday where we were made aware that young people, despite accounting for 20% of mental health need, receive only 9% of the mental health budget. Does the hon. Gentleman agree that more needs to be spent on meeting young people’s mental health needs?

[Edward Argar]

I will come very shortly to overall spending, but part of that is not just the overall size of the pot, but how that money is spent and works its way through the system to reach the frontline. In 2016-17, we spent a record £11.6 billion on mental health services, and that amount will continue to rise year on year until 2020-21, by which point 21,000 new mental health posts will be in place. This is all very welcome, and I commend the Health Secretary and his colleagues in the Department for it. Funding is vital. However, although £30 million per annum will be available over the next five years to fund eating disorder services, the way in which such funds are spent by clinical commissioning groups sometimes lacks transparency. At times it is hard to follow the funding from its source to ensure that it reaches the frontline. Implementation is key, and I hope the Minister will tell us how the Government are working to ensure that every penny reaches the frontline eating disorder services for which it is needed.

Community-based mental health services are often the most effective local services to help people, but they and in-patient mental health services are commissioned separately, by the CCG and by NHS England respectively. That can lead to a sense of a lack of joined-up care, and it can mean that people have to receive treatment many miles from their homes and families. That can place a huge strain on families, and, indeed, on family finances. Beat’s report suggests that in some instances the cost can be up to £32,000 as a result of lost earnings, travel and a range of other expenses. I believe that funds for eating disorder treatment should be held locally by the same budget holder in the same pot to create incentives for the development of improved treatment and reduced costly in-patient care, with CCGs working to extend their focus on early intervention to include the earlier stages of the illness.

[Rachael Maskell (York Central) (Lab/Co-op)]

Will the hon. Gentleman give way?

[Edward Argar]

Very briefly.

[Rachael Maskell]

I am grateful to the hon. Gentleman, who is making an excellent speech. Would what he is suggesting include support in schools?

[Edward Argar]

That is indeed very important. A key issue is the need to ensure that, as far as possible, there can be school referrals or, indeed, self-referrals as well as referrals made via a professional medical route. Some people may choose those ways of reaching out for the help that they need.

I hope that the Minister can update us on the progress of NHS England’s “Testing New Care Models in tertiary mental health services” pilot, which I understand is currently under way, and can tell us whether any initial findings are emerging in respect of the opportunity to put in-patient and community funding into a common pot.

I cannot end my speech without highlighting the impact that eating disorders have on the families and loved ones of those with the illness. Many of them care for people patiently and lovingly, and delays in securing the help that is needed can have devastating consequences for them. While in some cases it may not be appropriate, for good reasons, in many others, engaging those who are caring for someone receiving treatment—the “whole family” approach that I understand is used in Leicester, which will serve some of my constituents—can be hugely positive. I would welcome any reflections on that from the Minister.

Finally, I pay tribute to the work of Beat, which has campaigned tirelessly to highlight this issue, and to the work of those who operate its advice helpline. I commend its report to the Minister, and to all colleagues. However, I pay the greatest tribute to all those who suffer from an eating disorder and have had the bravery to talk about it, to seek the help that they need, and to face down an illness that depends on secrecy, isolates sufferers, and affects every aspect of their lives and those of their families. We must ensure that we match the courage of those who face it, determined to beat it, with an equal determination to give them the support, treatment and investment that they deserve. We must continue to drive down the delays and waiting times, raise awareness, and strip this disease of some of the power that it has over people by talking about it. We must stand shoulder to shoulder with all who face it, with the clear message that, together, we will beat eating disorders.

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 6th February 2018 Commons Chamber

[Michelle Donelan (Chippenham) (Con)]

5. What steps he is taking to improve mental health provision for children and young people.

[Edward Argar (Charnwood) (Con)]

8. What steps he is taking to improve mental health provision for children and young people.

[Kirstene Hair (Angus) (Con)]

13. What steps he is taking to improve mental health provision for children and young people.

--- Later in debate ---

[Mr Hunt]

I thank my hon. Friend for raising that issue, and I understand that in that particular case clinicians are meeting this week to resolve those issues. She is right: we need to expand the number of beds available for children and young people. They are at a record level—1,440, and that went up by another 81 last year—but more needs to be done, which is why we published our children and young people’s mental health Green Paper.

[Edward Argar]

I have been approached by a number of my constituents in Leicestershire who are concerned about the wait between a referral to child and adolescent mental health services and the allocation of a named caseworker and formal treatment. Will my right hon. Friend enlarge on how the steps that he is taking, which he has set out, will help to reduce such waits in Leicestershire and across the country?

[Mr Hunt]

I am happy to do that. The simple truth is that it is a tragedy for every child who has to wait too long to access mental health care, because half of all mental health conditions become established before the age of 14. If we do not nip them in the bud, they can get a lot worse. What are we doing? We are setting up a whole new service inside schools to spot such problems earlier and we are going to introduce a waiting time target for CAMHS appointments.

Mental Health Units (Use of Force) Bill

Edward Argar Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[Edward Argar (Charnwood) (Con)]

Like other hon. Members, I pay tribute to the work of the hon. Member for Croydon North (Mr Reed) in bringing forward this Bill. As someone who was lucky enough to get drawn in the private Members’ Bill ballot last year, I know that luck plays a part but, more importantly, so does passion. He has shown that in talking very movingly today about his constituent and what has motivated him to take forward this important Bill. I think his constituents will rightly be very proud of the work he is doing on it.

I very much welcome and support the Bill. I know from my casework and more generally that it will be welcomed in my constituency and more broadly across the country. The tone in which this debate has been conducted reflects very well on our proceedings in the House today, as does the fact that on such an important issue, hon. Members who wish to speak are having the opportunity to do so. Our constituents would expect no less. They would expect all of us who wish to speak to have the opportunity to put our views on the record about this important issue.

As the shadow Minister made clear, this Bill is about transparency and accountability. It is also about changing attitudes, and about risk. Most importantly, it is focused on making the processes involved in our treatment of those who are detained in mental health units more people-centric. As my hon. Friend the Member for Richmond (Yorks) (Rishi Sunak) said, the circumstances that can lead to someone being detained in a mental health unit could happen to anyone. Mental ill health can happen to anyone, and it is important that we remember that. We are talking about people at their most vulnerable in these situations. As my hon. Friend the Member for Hertsmere (Oliver Dowden) pointed out, we are very good as a society at understanding physical ill health because we can see it, but less good at understanding mental ill health because it is more intangible and much harder to see. The hon. Member for Croydon North said that this is about compassion, not cruelty. At times, given the nature of the circumstances, restraint may be needed at a moment of crisis, but it must be applied in the right way and it must be minimal. We must always focus on dealing with such incidents in the right way and doing what we can to assist people in their recovery.

It is important that we highlight—as hon. Members have done, most recently my hon. Friend the Member for Wells (James Heappey)—the debt of gratitude that we owe to all those working in the emergency services, including in the mental health setting, for the incredibly difficult job they do with an amazing degree of professionalism, compassion and care. In that context, I very much welcome clause 5, with its emphasis on the provision of training. This is about protecting and supporting not just those who are detained in mental health units, but those who may have to intervene in applying restraint. The hon. Member for Stroud (Dr Drew) referred to the need for those workers not only to be trained at the induction stage but to have the training refreshed throughout their careers. That is an important point.

This Bill is about reducing the use of restraint where possible, but, as I said, it is also about risk. Too often in our society, be it in the private sector or in the public sector, there is an understandable desire to eliminate risk. The reality is that that simply cannot be done. Instead, we must seek to understand and mitigate risk, and ensure that that understanding drives the right behaviours. The data that the Bill will provide, the transparency it brings, and the understanding of how restraint operates in these settings will all feed into a better understanding of risk that will hopefully improve the way in which we treat those detained in mental health units. Of course, as the hon. Member for Croydon North made clear, this is about justice. In the tragic cases—I hope they are few in number, but they do occur—in which someone dies, it is important that the evidence exists to facilitate justice for that person and to ensure that we learn the lessons of the incident.

Finally—conscious of the importance of giving all who wish to speak the opportunity to do so, because that is what our constituents would expect—I turn to the point about changing attitudes. Attitudes to mental health in this country are changing, but there is still a long way to go. Every time we talk about mental health in this Chamber, we help to change attitudes and reduce any stigma attached to mental ill health. It is right that we continue to do so. We are on a journey, on which this welcome Bill is a hugely important step. A similar step will be the review that is under way of the Mental Health Act. The legislation may be of its time, but it is certainly not fit for our time. In that context, in addition to what we are discussing today, we must seek to create a mental healthcare system of which we can be proud, and which is fit for the 21st century. It is a pleasure to support the Bill.

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

I completely agree with the hon. Lady that that is a very important issue. It is particularly important because people with mental health conditions need regular visits from their friends and family to help them to get over a crisis. Indeed, their chances of getting discharged and being able to go home are much higher when they are nearer home. She will be aware that we have a commitment to eliminate all out-of-area placements for children by 2020, and we are making big efforts with adults as well.

[Edward Argar (Charnwood) (Con)]

T4. Leicester and Leicestershire MPs, irrespective of party and led by the hon. Member for Leicester West (Liz Kendall), are united with local people, patients and medical professionals in opposition to NHS England’s badly thought out and, frankly, wrong proposals to close Glenfield hospital’s children’s heart unit. Can my right hon. Friend reassure me that he continues to appreciate the strength of feeling on this issue and that he will ensure that the eventual decision reflects the responses received to the consultation?

[The Minister of State, Department of Health (Mr Philip Dunne)]

My hon. Friend and other Leicestershire MPs have made their views very clear to me. I hosted a number of them, from both sides of the House, to discuss this issue. He is aware that the public consultation on congenital heart disease services continues until 17 July. Obviously, we will take all the comments made into account when we come to the conclusions from that report.

NHS Funding

Edward Argar Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

I am happy to visit the hon. Gentleman’s local hospital, as I have been concerned about it for some time. I know that things have been particularly challenging there in the wake of what happened in neighbouring Mid Staffs, which has created its own pressures on the hospital. I also know that its staff work extremely hard in very challenging circumstances, so, yes, I will visit that hospital.

[Edward Argar (Charnwood) (Con)]

Does my right hon. Friend agree that achieving improvements in public health comes down not simply to the amount of money spent by the Government on it, but to a range of factors, including how it is spent, regulation, education and individuals’ choices?

[Mr Hunt]

I absolutely agree with that. This House should be very proud of the fact that, according to the UN, when it comes to public health this is the fifth healthiest country on the planet—after Iceland, Andorra, Singapore and Sweden, if my memory serves me correctly. That is a record we want to continue.

Community Pharmacy in 2016-17 and Beyond

Edward Argar Excerpts

1st reading: House of Commons
Thursday 20th October 2016 Commons Chamber

[David Mowat]

I am not sure that takes us forward, but it is right to say that spending NHS money on payments of £25,000 to many pharmacies within half a mile of one other is the wrong way to spend money when we need more in cancer drugs funds, in GP surgeries and in accident and emergency—that is what we need to be doing.

[Edward Argar (Charnwood) (Con)]

A large number of rural villages and small towns in my constituency are served by individual local pharmacies, which play an important role in the community. I welcome the Minister’s comments about the access scheme. Will he reassure me that small pharmacies in rural areas such as mine will be among those to benefit from the access protections he has outlined?

[David Mowat]

Yes, I can reassure my hon. Friend on that. Indeed, I can make the specific point that the 25% that make up the largest pharmacies will not be in the access scheme; it is directed more at smaller pharmacies.

Glenfield Hospital Children’s Heart Surgery Unit

Edward Argar Excerpts

Wednesday 19th October 2016 Westminster Hall

[Liz Kendall]

My hon. Friend is absolutely right. We have to think about people’s needs in the round—the need for high-quality surgery; ongoing care and support; and, critically, help for those families for whom this is a terrible, frightening and ongoing experience. Making the east midlands the only place without a heart surgery unit does not make sense.

It does not have to be this way. In its own standards, NHS England says:

“Networks will need to establish systems to ensure that referrals…between centres are managed in such a way as to ensure that each clinician is able to achieve their numbers”.

Its own standards say that people need to work together so that everyone can achieve the best. However, at the moment NHS England is not developing the work. I am a long-standing champion of patient choice, but the current proposals deny choice to patients from across the country who use Glenfield children’s heart surgery unit on an ongoing basis.

[Edward Argar (Charnwood) (Con)]

I pay tribute to the hon. Lady for securing this important debate. The Glenfield children’s heart unit is vital not only to my constituents but, as she said, to people across the east midlands and beyond. She has alluded to the significant progress that the hospital has made in just the past year in driving up the number of referrals and operations. That significant progress gives me confidence that it is on track to meet its target. Will she join me in urging the Minister to press NHS England to pause, look at the excellent clinical outcomes and the progress on increasing referral numbers, and think again, to keep this hugely important children’s heart unit open?

[Liz Kendall]

The hon. Gentleman makes an extremely important point. The clinicians at the unit and the hospital bosses have striven continually to improve patient care. They are not complacent for a second. They bust a gut to keep making improvements. Those improvements will, I am sure, be recognised and acknowledged by the 58 patients in the hon. Gentleman’s constituency who are receiving continuing care at Glenfield. He is right to say that NHS England needs to look in detail at the improvements that have been and are being made. When NHS England came to the centre in September—I was more than a little disappointed that it had not made a visit before it launched its proposals to close the unit—it found that some of its perceptions were wrong.

One important standard for improving care is co-locating—bringing together, in other words—the different children’s services, which includes not just surgery but other heart support, paediatric intensive care and wider services available to children. NHS England initially marked Glenfield down for not having plans to co-locate services. I am afraid that that was completely and utterly wrong. On coming to the centre it discovered that there are indeed such plans. I would like the Minister to confirm that University Hospitals of Leicester trust has plans to complete the co-location of all the services before April 2019, and has secured all the capital budget necessary to build its new children’s services hospital. To put all that at risk when the hospital is trying to improve services would be a big mistake.

Finally, I want to discuss the impact on other services in Leicester and the region of closing the children’s heart surgery unit. It is extremely important. As I said earlier, NHS England has itself said that it would not put forward proposals to close the unit unless it had done a risk assessment of the costs and benefits, including the knock-on effect on other services. It has not yet done that. I am concerned about two services in particular. Glenfield has a world-leading extracorporeal membrane oxygenation service. Essentially, if someone has a weak heart and needs surgery on it, ECMO enables oxygen to be pumped back into the blood during the operation. Glenfield’s is only the second ECMO service in the world to treat more than 2,000 patients. It conducts 50% of the entire ECMO activity in the UK. It also has the country’s only national patient transport service enabling people who need ECMO to be transferred swiftly from anywhere in the country to Glenfield. The huge benefits of that service were seen during recent flu crises.