NHS Funding Bill

Elliot Colburn Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Derek Thomas (St Ives) (Con)]

It is a great honour and privilege to speak about the NHS, which is a fantastic institution. There is no one in this building who has not had some experience of the NHS in some form or another. As I was particularly reminded during the election, the truth is that, in most cases, people’s experience is fantastic—they are treated in a timely, effective and caring way. It is always good to commend the work that many people do in our NHS. However, I heard about the experiences that my hon. Friend the Member for Dover (Mrs Elphicke) referred to; in Cornwall, we have had similar experiences, which cause considerable strain on families and the NHS in the area.

I welcome the NHS funding commitment in the Bill, and the fact that it is here to deliver our NHS 10-year plan. It provides the certainty that the NHS and all who work in it need in order to make their own plans. However, as others have already said, it is essential for us to get this right. I hear of countless instances in which NHS care and treatment have been excellent, beyond expectations and timely, but there are two areas in which patients in Cornwall—particularly children and vulnerable people—are being failed by the current provision. Those areas, which are especially relevant to the NHS workforce plan, are the diagnosis and treatment of children, young people and adults with autism, and the shortage of NHS dental appointments.

My heart goes out to the parents and families of children who have autism. They love and care for their children with every ounce of their bodies, but they often have to fight, fight, fight for a diagnosis, for access to adequate support and therapies, and for an understanding of what autism is and what impact a lack of that understanding has on their children’s development. In the past few weeks I have met several parents who are in crisis because they cannot obtain a diagnosis, an education, health and care plan, or adequate support for their children at school, and have little or no access to child and adolescent mental health services.

As I prepared for the debate, I was encouraged to read that the National Autistic Society was looking to the NHS 10-year plan to address, finally, the fact that people wait for many months—even years—for an autism diagnosis, the poor support for autistic people’s mental health, and the insufficient understanding of that learning disability or condition. It is great that the long-term plan recognises the autism diagnosis crisis and announces the NHS’s intention to reduce waiting times, but it would be good to hear from the Minister how the NHS plans to achieve that, and what progress is being made.

[Elliot Colburn (Carshalton and Wallington) (Con)]

In my local borough of Sutton, the council has received a damning Ofsted report on its services for children with special educational needs, and parents have formed a crisis education, health and care plan group. Does my hon. Friend agree that councils should work with their local NHS trusts to ensure that there is early diagnosis and that problems do not develop into something far worse?

[Derek Thomas]

That is exactly the commitment made by the NHS plan: early diagnosis, followed by proper, wraparound support from not only the NHS but local authorities. The potential gains are significant. The opportunity to transform thousands of lives, reduce pressure on our schools and unlock the potential of people who have autism is there to be had, and I urge the Department to step up its work in that regard.

The response to a question that I asked last March was that NHS England had a legal duty to commission national health service primary care dental services to meet local needs, but the truth—and NHS England accepts it—is that that is not the case in Cornwall. The six of us who represent Cornwall constituencies have worked closely on this. We have been told that NHS England is working with local commissioners to investigate how widespread the problem is and is keeping it under active review, but there is a shortage of NHS dentists in west Cornwall—indeed, throughout Cornwall—and it is not a new problem. The waiting list was two years on average in 2015, and remains roughly the same now. The number of units of dental activity has increased from roughly 80,000 to roughly 90,000, but the average number of people having to wait is lower than the national average. About 50% of adults are not seeing an NHS dentist, and about 60% of children have not seen one in the last 12 months.

Having spoken to NHS dentists, I know that children and their families are likely to take better care of their teeth and to have healthier diets if they have a regular relationship with their dentists. My primary concern, which I believe is becoming a critical problem in Cornwall and other rural areas, is the inability of children, from a very early age, and vulnerable adults to obtain NHS dental appointments, which both groups have reported to me.

When my colleagues and I met representatives of NHS England last year, they explained the difficulties that were being experienced, describing recruitment and retention in areas such as west Cornwall as a key concern. The NHS has made it clear that dentists in Devon and Cornwall are increasingly unable to meet their contracts. Funding for NHS dentistry in Devon and Cornwall was being returned to NHS England. That suggests that commissioned capacity is sufficient, and that funding is not the primary issue. The key difficulty reported by practices is the recruitment and retention of dentists.

We in Cornwall are fortunate to have a dental college in Truro where residents can have access to treatment. It is based at the Peninsula Dentist School, part of Plymouth University, where graduates learn their skills for careers in dentistry. However, students who are training to be dentists often return to their home towns afterwards, citing poor transport, high housing costs and a lack of opportunities in the south-west as reasons for not staying in the area.

As I have said, the Cornwall MPs have been working together closely, and I pay particular credit to our former colleague Sarah Newton, who led the way. However, it is unclear what progress is being made in ensuring that we care for the teeth of our young and vulnerable people so that they can avoid the many problems that would otherwise have to be picked up by the NHS in the future. May I take this opportunity to request a review of NHS dental provision, and an urgent exploration of what is needed to recruit and retain dentists, especially in rural areas such as west Cornwall?

The 10-year plan clearly sets out, among other things, its intention to integrate care and prevent healthcare problems from arising later. Getting diagnosis and care for people with autism right, and providing the dental treatment that people need, would help to deliver in that respect, and to reduce demand both now and in the future.

[Munira Wilson (Twickenham) (LD)]

Along with my Liberal Democrat colleagues, I naturally welcome all commitments to additional expenditure on the NHS, and we will not be opposing the Bill. The questions that need to be addressed, which other Members have touched on, are whether the minimum expenditure enshrined in the Bill is sufficient, and why the Government have singled out NHS England’s revenue budget for protection without also prioritising other extremely important areas of the Department’s budget, which have a huge impact on revenue expenditure, such as public health, capital investment, workforce development and, of course, social care.

The NHS has been chronically underfunded for a number of years. As we have already heard from many other Members, our healthcare system in England is in crisis. We have a crisis in waiting times, a workforce crisis and an infrastructure crisis. However, the funding committed in the Bill will enable the NHS only to stand still in the coming years, maintaining the level of service that it currently provides. Those crises will continue. As we have heard, in real terms the additional £34 billion equates to only £20.5 billion when adjusted for inflation, and that equates approximately to a 3.3% increase every year. As we have also heard, many respected commentators and NHS leaders have said that some 4% extra a year is needed to transform services.

I fear that the hon. Member for Nottingham South (Lilian Greenwood) did not receive a response to her excellent intervention when she asked the Secretary of State what assurances the Government would provide that, should the rate of inflation increase owing to unforeseen circumstances—or, indeed, owing to Brexit, which, unfortunately, we face at the end of this week—the promised real-terms increase in NHS spending would be protected.

The crises to which I have referred are clearly epitomised in the challenges faced by NHS mental health services. The mental health system has experienced decades of underfunding and neglect, resulting in services and facilities that are all too often substandard and sometimes dangerous. Mental illness represents up to 23% of the total burden of ill health in the UK, but only 11% of NHS England’s budget. In terms of waiting times, the most mentally unwell are often left waiting the longest for treatment. I am particularly concerned that children and young people are being especially let down. We know that 81% of trust leaders say that they are unable to meet demand for community CAMHS, and only three in 10 young people with a mental health problem were able to access specialist services in 2017-18. In my own constituency, Off The Record, an excellent local charity that does sterling work to support young people with mental health problems, is often told by users of its service that access to local CAMHS is possible only if they are suicidal when they present themselves. That cannot be right.

The Secretary of State has given assurances today on his commitments to increase mental health and CAMHS spending, but we know that this is not always getting through to the frontline in an equal way. There is a lot of variability across the country and we need proper, accountable public tracking of expenditure to ensure that every area across the country can—[Interruption.] The Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries), is mouthing at me, but if she looks at Mind’s analysis of the variability of mental health spending across parts of the country, she will see that there is huge variability. We need to track it publicly to ensure that that priority investment is getting through. We have heard much from the Government about levelling up, and I hope that Ministers will accept that mental health, and CAMHS in particular, needs to be a priority area for levelling up.

[Elliot Colburn]

I am grateful to my south-west London colleague for giving way. She makes a passionate case for mental health spending. Will she join me in welcoming the Trailblazer programme that has been launched in schools in her borough and mine in south-west London? It puts mental health support workers into our local schools to help the children she has rightly identified.

[Munira Wilson]

I thank the hon. Member for his intervention, and I completely agree that we need more support for our children and young people, not only in schools but in universities for students who are suffering mental health crises.

On the workforce crisis, we know that there are more than 100,000 vacancies across NHS trusts in England. I met a nurse on the doorstep in my constituency during the election campaign who works at West Middlesex Hospital. She was in tears because of the strain that she and her colleagues are under in that hospital. Workforce is arguably the largest risk to the delivery and implementation of the NHS long-term plan, yet the funding in the Bill does not include education and training. Again, we heard assurances from the Secretary of State that money would be forthcoming for this, but it is not guaranteed. That leads me to wonder whether this is not a priority area, and whether it could be cut, should spending come under pressure in other areas.

The mental health workforce has experienced little growth over the past decade. Gaps are often filled with temporary staff, which is not only expensive but undermines continuity of care and relationships. A recent survey by the British Medical Association revealed that four in 10 mental health staff found their workload either unmanageable or mostly unmanageable. If we are to achieve the laudable mental health ambitions in the long-term plan, we need to see substantial investment in expanding the mental health workforce.

The crisis in NHS infrastructure is acute and growing. The budget in the Bill does not commit to addressing the need in capital spending, either in buildings or in technology. The NHS’s annual capital budget is now less than its entire £6.49 billion maintenance backlog, which is growing at 10% per annum. That means that leaky roofs, broken boilers, ligature points in mental health facilities and outdated technology cannot be repaired or updated. The Wessely review described the mental health estate as some of the worst the NHS has, which is impacting on the quality of care. The review showed how dilapidated buildings and poor facilities are hindering treatment and recovery for patients. Will the Government use the 2020 Budget to set out a major multi-year capital investment programme to modernise the mental health estate in particular?

The Bill is fine as far as it goes, but frankly it does not go very far. If we want to progress from the status quo and truly transform our NHS services, the real-terms increase needs to be around the 4% mark that many respected commentators have called for, and we need a more holistic approach across the whole departmental budget, not just in selected areas. We heard from the hon. Member for Central Ayrshire (Dr Whitford) about the huge cuts in public health grants to local authorities, and my fear is that public health spending could be cut further, as it sits outside the protected budget on the face of the Bill. That would be a false economy that puts further pressure on NHS budgets. And of course, until a solution to the social care crisis is in sight, the NHS will continue to shoulder the costs of inadequate social care provision.

This Bill is an opportunity to put mental health services on an equal footing with physical health in order to deliver true parity of esteem. I hope the Government will provide more guarantees that mental health, and CAMHS in particular, will not be overlooked, and that guaranteed funding will get through to the frontline. Liberal Democrats will be supporting what is largely a symbolic gesture in the Bill—a political gimmick to write into law what the public were promised more than a year ago. Is this a Government who trust themselves so little that they have to legislate to keep their promises?

--- Later in debate ---

[Elliot Colburn (Carshalton and Wallington) (Con)]

I begin by declaring an interest, as I recently worked in the NHS—[Hon. Members: “Hear, hear!”] Thank you very much.

We have heard passionate speeches about some of the benefits that will come about in our national health service as a result of this additional investment, and I will focus on the improvement to the NHS estate. This additional investment will build new hospitals and improve existing ones.

My constituency of Carshalton and Wallington is home to St Helier Hospital, which is older than the NHS itself—it is over 80 years old. Many battles have been fought over the decades to prevent partial downgrading or even total closure, which has been dangled in front of St Helier for so long. Thanks to the Conservatives in government, however, we now have £500 million-worth of investment going into our local NHS trust, and I thank my hon. Friends the Members for Sutton and Cheam (Paul Scully), for Reigate (Crispin Blunt) and for Wimbledon (Stephen Hammond) and my right hon. Friend the Member for Epsom and Ewell (Chris Grayling) for their work before my arrival in this place and for supporting me since I got here in campaigning for the same.

This investment represents the long-term future of St Helier Hospital, and it has, in fact, already begun with more than £100 million having been pumped in to do things such as doubling the size of the accident and emergency department and to build a brand-new renal unit, which really is world class. I invite Health Ministers to come to visit the new renal unit at St Helier. It really is fantastic.

Perhaps most excitingly, this investment means we will have a brand-new third hospital within the catchment area of Epsom and St Helier University Hospitals NHS Trust. That means that, for the first time, we have a plan for local healthcare that means people will not have to travel to Croydon or Tooting to access the healthcare they need when they are most vulnerable.

The investment will also mean that over half of the hospital estate covered by Epsom and St Helier that is currently too dangerous to be used to provide healthcare can be brought back into use, which means we will no longer hear stories of people having to pull beds away from the walls because the walls are either damp or leaking. It also means we will not have stories of ambulances being used to transport patients from the back of St Helier to the front because the lifts are too small for a modern hospital bed.

Most importantly, the investment means we will have not one, not two but three local hospitals providing world-class healthcare to local patients. The consultation on the site of that third hospital has just launched, and it is open until 1 April, so I encourage all residents of Merton, Sutton and Surrey to have their say—I have a copy of it here for video reference. Residents should log on to improvinghealthcaretogether.org.uk to have their say about where they want the exciting future of our healthcare provision to be located.

This is about more than just St Helier. I have worked in the NHS before, and this Bill presents an opportunity to accelerate progress in delivering the NHS long-term plan. It will provide the NHS with the funding, staffing and infrastructure it needs to deliver better patient outcomes, which of course must be the primary driver to future-proof our NHS. This investment must also go hand in hand with a change of healthcare delivery in this country, and I am delighted to see the commitment from the Health Front-Bench team on things such as social prescribing, empowering local pharmacies and prevention. All this and more will mean that our NHS will be better equipped to tackle the healthcare challenges of the future, particularly the scourges of illnesses such as dementia and cancer, levelling up mental health investment and continuing to provide excellent care for all of us, when and where we need it.

[Several hon. Members rose—]