National Health Service

Gerald Kaufman Excerpts

Wednesday 21st January 2015 Commons Chamber

[Alan Johnson]

The right hon. and learned Gentleman knows, because we have debated this before—I will come on to some of the history—that the big difference between what he and other Governments did during the 1980s and what we did is the single tariff. They competed on price. We had a single tariff that meant that, wherever that operation took place, it was paid for at the same rate.

With that top-down reorganisation that we could see from space, all the Conservative party’s efforts to convince the public that they could be trusted with the stewardship of the NHS were thrown into disarray at a stroke. The fact that the NHS tops the list of public concerns as we approach a general election can be traced to that self-inflicted wound.

The Conservative party leader’s efforts to detoxify the Tory brand vis-à-vis the NHS could be described as an attempt to return to the consensus that existed prior to the 1980s. The great historian of the NHS, Rudolf Klein, says that following its contentious birth there followed 35 years when the NHS was “cocooned in consensus”. That changed in 1982, when the Thatcher Government’s internal think-tank, the Central Policy Review Staff, produced a paper with the option of replacing the NHS, a tax-financed health service, with a system of private insurance. This option—the right hon. and learned Member for Rushcliffe (Mr Clarke) will probably remember this—was, incidentally, presented to Ministers not by the Secretary of State for Health but by the Chancellor of the Exchequer. It was defeated thanks to the efforts of Norman—now Lord—Fowler, but it expressed for the first time the idea that a tax-funded NHS was wrong and broke that 35-year consensus.

From that moment, through weird and wonderful ideas, right up to 2005 when Conservatives Members stood on the platform of the ridiculous patient passport, their policy has been about taking money out of the NHS and changing the very principles of the service. I could not describe it better—I think there would be agreement on this—than the great American clinician and health care expert, Donald Berwick, who I believe the Secretary of State has used during his time in office as an adviser. He describes the NHS as

“one of the truly astounding endeavours of modern times”

and, in a wonderful phrase, as

“a towering bridge - between the rhetoric of justice and the fact of justice.”

This ideological battle is not over. Indeed, it has just been joined by the ultra-Thatcherite leader of UKIP. The hon. Member for St Ives (Andrew George) is no longer in his place, but he was perhaps right in thinking that we should get back to a consensus on the NHS.

We could raise relevant arguments about many aspects of the NHS. Indeed, my colleagues in Hull and I are talking to the Secretary of State about some issues central to Hull. However, in this speech I do not want to talk about clinical health or the successes of the NHS. I want to talk about one of its failures. At the tenth anniversary of the NHS in 1958, there was a debate in this Chamber. Nye Bevan, the great architect of the NHS who was mentioned earlier, stood up and said what a great success it had been, but that the failure had been mental health. He spoke, using the language of the time, of the disgraceful conditions in our mental hospitals. Of course, there has been a huge improvement since 1958, but it remains a fact that mental health is a poor relation of the NHS, and children and adolescent mental health is a poor relation of that poor relation.

I would like to cite three awful statistics published by the Office for National Statistics. First, 10% of children between the ages of five and 16—or to put it another way, three in every class—experience mental health problems. The second disgraceful statistic is that that figure rises to 60% when applied to children in care. The final disgraceful statistic is that 95% of imprisoned young offenders have a mental health disorder. Many of those young offenders should not be in prison at all. I have raised the case on the Floor of the House of my constituent, Vince Morgan, a young man with a severe psychotic illness who committed suicide in a prison cell having been failed by every single organisation and authority that was meant to help him. Section 136 of the Mental Health Act 1983 is still being used to incarcerate children, mainly as a result of the failure to provide sufficient in-patient tier 4 child and adolescent mental health services facilities.

Forgive me for being parochial, but this is a crucial issue in our area. In Hull and East Riding, we were served well by an in-patient unit called West End for 20 years. When NHS England assumed responsibility for tier 4 services as a result of the changes from the reorganisation—all other tiers being the responsibility of the local clinical commissioning groups—it changed the specifications for tier 4 units, saying that they had to be open seven days a week, 24 hours a day. There was no consultation with anyone. This was done in March 2013. As West End was open only from Monday to Friday, with children spending the weekends at home—a regular feature of CAMHS treatment—the unit was closed. The option of extending the provision, so that it was a seven-day service, was never offered. Parents of children who had benefited from this important part of the NHS had no input whatever in a decision made by a huge quango that had no local accountability and no local presence. So much for the glib slogan, “No decision about me without me”.

I raised this issue in the Chamber on 23 October. The Minister of State, Department of Health, the right hon. Member for North Norfolk (Norman Lamb), who is in his place, gave me a sympathetic response. I am convinced that he cares deeply about the problems of mental health, but he appears to be entirely powerless to do anything about them. Since then, there has been a review of tier 4 services by NHS England, which, as the Health Committee has said:

“does not provide a conclusive answer on the reasons for the current problems, nor on whether there are sufficient beds”.

In addition, that Health Committee report, published in November, pointed out that NHS England had

“presided over a system which has resulted in children being sent hundreds of miles to access care.”

There has been no resolution on this issue in Hull and East Riding, or in other parts of the country, such as Devon and Cornwall. We have a foundation trust provider that recognises the problem and has identified a site for a new seven-day in-patient service, but the commissioner at NHS England has yet to commission. The CCGs are powerless. The acute trust often has to open its adult wards to children.

Let me tell the House what this means to the victims of such failure—to the children who were once so well served by the West End unit. Maisie Shaw is a 13-year-old who has had serious mental health problems since her father died two years ago. Her mother, Sally, is a teacher. Clearly, children need to be close to their family when they are undergoing treatment. Family involvement is a crucial aspect of their recovery. In December, Maisie took an overdose after breaking into a locked medication box at her home in Hessle. As it was a Saturday, there were no CAMHS staff on duty and, of course, no in-patient facility. She was taken to Hull royal infirmary on Saturday and cared for in a locked ward at the maternity hospital, with a 24-hour guard until Monday morning. She was sent to Stafford, which is almost 200 miles away, and then to Sheffield, which involves a round-trip of 120 miles by her family to visit her. As part of her treatment, she will be home at weekends, but when her mother asked what help would be available for this very disturbed child if there was an emergency, she was told to ring 999.

The subject of my debate in October 2013 was Beth Hopper, who is now 15. Beth’s mother, Kathy, is a staff nurse for the NHS. Beth is an extremely intelligent girl who has, according to her school, huge academic potential. She suffered a severe mental breakdown at the age of 11 and spent nine months at the West End unit, which opened at weekends specifically to tend to her needs. Kathy believes that the unit saved her daughter’s life. Since West End closed, Beth has been sent away 19 times. She has been to Cheadle, 103 miles away. She has been to Liverpool. She has been to Warrington. She has been Nottingham. She has been Widnes. Of course, while there is no argument that to travel further for more expert care is a factor in physical health, it is rarely the case with mental health, particularly when the patient is a child. Indeed, Maisie and Beth’s clinicians in Hull often have to travel to care for her in these distant locations, thus adding to the cost of that care. It is no exaggeration to say that the condition of Beth and Maisie is actually being made worse by this treatment. It is truly scandalous.

So that Beth’s voice is heard in this debate, I will read out a letter that she sent to her mother the other week. She wrote this:

“I really just don’t know what to do or what I want, or what is best for me anymore.”

Forgive her grammar.

“I aren’t happy here. I am happy at home, but I am scared that things might go like they were before. I just want normality. I want to have the chance to be a kid for once, before it is too late. I feel as though nobody is listening to me. I am so isolated here I am scared to join the groups and don’t want to make new friends anyway. I want my old friends, who I miss.”

We need to hear these children’s voices.

[Sir Gerald Kaufman (Manchester, Gorton) (Lab)]

I am listening with sympathy and concern to the case histories that my right hon. Friend is describing. He might be surprised to learn that a constituent of mine with mental health problems was sent to Hull, without any consultation with his family.

[Alan Johnson]

It could not have been a CAMHS service, because we have no tier 4 service available in Hull.

I have cited two long-standing cases from my average-sized constituency, but I have recently heard about another case—that of Jordan Hatfield, a 15-year-old who, last May, took 45 paracetamol tablets in an attempt to end her own life. She spent six days on a medical ward and has been in Cheadle for the past week. Her mother does not drive and has small children, so it is impossible for her to visit. My colleagues in east and north Hull, and across the East Riding, will have other examples, because, as the Select Committee and NHS England, in its obscure way, pointed out, there is a lack of services in this huge swathe of eastern England.

On the wider question of mental health, we will not achieve parity of esteem by cutting funding. NHS trusts providing mental health care have lost £250 million of funding since 2012—the first fall in a decade. In addition, as my right hon. Friend the shadow Secretary of State pointed out, two thirds of local authorities have reduced their CAMHS budgets since 2010, while more than three quarters of adults who access mental health services had a diagnosable disorder before they were 18, yet only 6% of the decreasing mental health budget is spent on under-18s.

The report of the taskforce on mental health in society, commissioned by my right hon. Friend the Leader of the Opposition, and published on Monday, has much to recommend it, particularly the right to mental health treatment in the NHS constitution; expansion of the enormously successfully IAPT—improving access to psychological treatment—programme; and the introduction of waiting-time standards for access to CAMHS. These are good ideas, and they need to be put into practice, regardless of which parties are in government. However, somebody needs to get a grip of this issue now. We cannot go on letting our children down in this horrendous way.

--- Later in debate ---

[Sir Gerald Kaufman (Manchester, Gorton) (Lab)]

The national health service is, without doubt, the most precious asset this country possesses. It was created by a Labour Government against, as we should recall at all times, the votes of the Conservative party in this House of Commons.

The Minister who created the national health service was Aneurin Bevan. He did so by immense negotiation, including with the British Medical Association, which he got on board to support and participate in it. As well as having administrative abilities and abilities of persuasion, Nye Bevan was the greatest orator I have ever heard. I met him on a number of occasions and heard him speak. I remember one speech that he made at Labour party conference when a Conservative Government were in power, in which he said of a Minister, “The Marquess of Salisbury has an ancient lineage. It is almost as old as the Poor Law itself.” Nye Bevan would be horrified that in far too many ways, the national health service has descended to Poor Law levels.

Margaret Thatcher said:

“The National Health Service is safe in our hands.”

This Government’s hands are throttling the national health service. Under this Government, the NHS has had an extremely costly reorganisation that cost £3 billion and provided no benefit at all.

A recent survey of GP services—we all rely on our GPs; heaven knows that I would not be standing here today had it not been for my GP referring me to the national health service—showed that ratings have declined for every aspect of trying to see a GP, including opening hours, waiting for an appointment, and waiting in the surgery. Looking at causes, it pointed out that general practice has had its funding reduced over the past five years, and it is five years since this Government came to power. Too often, the system is blocked by bureaucracy that prevents it from operating effectively at the point of use.

Like other hon. Members, no doubt, I get a constant stream of letters on this issue from constituents, and this morning I received a letter from a constituent about his son:

“I have a son…who has psoriasis and he has had this for up to a year now. He has been putting up with it, but it has come to the stage now that it’s unbearable. It’s all over his body including his private parts too. He had to finish work due to that. He can’t sit down with it…He is not sleeping at night. He is bleeding all the time. He can’t go out. He is always in his bedroom…he is in pain day and night.”

My constituent’s GP referred him as an urgent patient to a local hospital, and he has an appointment for 28 March. He is going through hell, and he will go through two more months of hell before he is seen, let alone treated.

Again and again we get such cases. There was a recent debate and meeting about blood diseases. I have a constituent who has a blood disease. He has HIV and is making no progress at all. It is heartbreaking to read such letters, but it is far more heartbreaking to live through such a situation than it is to read about it or even try to help.

The situation is not only affecting the patients, or in some cases would-be patients. Without the essential contribution of NHS workers the service could not function, but they are being victimised. This year, 60% of NHS workers will get no cost of living pay increase at all. They have had a two-year pay freeze, followed by a 1% pay rise. National health service workers’ pay has fallen by 12% to 15% in real terms since this Government came to office.

As a result of the shortage of funds available to the national health service, very bizarre things happen. I want to draw the Minister’s attention to something that is happening in my constituency and ask him to look into it. I have no great confidence that I will get any response, because at recent Health questions I raised two cases and was told by the Minister that they would be looked into. That was the last I heard from the Department of Health on the subject.

I describe this situation because it is not only a major health issue, but a major community issue. Currently, there is no landing site available in Manchester for helicopter ambulances for either the Royal Manchester adult major trauma centre or the Manchester children’s hospital paediatric major trauma centre. There is a lack of money to provide a landing ground for air ambulance centres to do their vital work—heaven knows I praise them for it—so there is a plan to have a landing site in a park in my constituency.

Friends of Birchfields Park, the organisation of local residents that looks after the park, had a meeting on Saturday. I promised them that I would raise it in the debate. There will be a landing site in the park, but it is a small park and part of it will be lost. It will be used something like every three days, so there will be disruption the whole time. Apart from the disruption in the park, the site is next to two schools, one of which is extremely near to the proposed landing area. It is a heavily populated area. A ground ambulance must go the site to pick up the patients who are landed, which will affect traffic on an extremely busy road.

One of the most odd things of all is the effect on the park’s nature. Those responsible for suggesting that landing site say:

“The majority of wildlife will evacuate the area proximate to the aircraft due to the noise and displacement of air and downwash during landing and take-off.”

Apart from the affect on the wild creatures, which share this planet with us and ought to have as many rights as we have, the thousands of people who live in the area will be affected. I am not in any way belittling the air ambulance service—it is vital, essential and dedicated—but it is extraordinary that it will be reduced to using Birchfields park as a landing site because it does not have the money to create its own.

All hon. Members pay tribute to the national health service. As I have said, heaven knows I have a greater duty than most in the House to thank the NHS for what it has done. Everybody needs it. It is just about the only service in this country apart from education that absolutely everybody needs. It ought to be given priority, but it has been severely damaged by the Government. That is accepted by the electorate. Every opinion survey shows that the Government are blamed for what is happening to the NHS, and that the electorate are worried about it. Roll on 7 May.