Decriminalisation of Abortion

Heidi Allen Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Jackie Doyle-Price]

Yes, absolutely. I would be delighted to meet the hon. Lady about her report. That there is difficulty in getting agreement comes as no surprise to me but, given the intentions of the people behind it, having that discussion would be useful. Yes, I have heard concerns expressed about skills levels, in particular to perform late-stage terminations, which are incredibly dangerous, as she is aware. I will endeavour to take that forward with the relevant bodies.

[Heidi Allen (South Cambridgeshire) (Ind)]

I sense that the Minister is genuinely trying to help. There is some irony in that we have been trying for so long to amend legislation in Northern Ireland to reflect what we have here, but now it has gone the other way—in the absence of any Executive, with the repeal of sections 58 and 59, Northern Ireland will in fact have more modernised legislation than we have. May I ask her explicitly what she thinks—personally, I suspect—would be the most effective tool to modernise abortion law right across the UK, which the majority of Members want?

[Jackie Doyle-Price]

That is a difficult question to answer given that the matter is now completely devolved. In respect of England and Wales, I think that the most effective method would be to revisit the Abortion Act, which is itself an amendment to the Offences Against the Person Act providing an exemption for women making that choice in those circumstances. My personal view—the Government do not have a view on such matters of conscience—is that, after 50 years, the Abortion Act does not reflect medical practice today, and therefore restricts the choices of women and their ability to exercise those choices in the safest way.

Cambridgeshire and Peterborough CCG: Funding Pressures

Heidi Allen Excerpts

Tuesday 11th June 2019 Westminster Hall

[Heidi Allen (South Cambridgeshire) (Ind)]

I beg to move,

That this House has considered Cambridgeshire and Peterborough CCG funding pressures.

I start by thanking the Backbench Business Committee for granting me this short debate and you, Mr Hollobone, for chairing it. I also thank the Minister for his time.

I represent South Cambridgeshire, which is a largely rural constituency, although it also contains part of Cambridge, which is the fastest growing city in the UK: it grew on average by 7% every single year from 2010 to 2015, and since then has continued growing beyond the national average. There is no doubt that the economy, which is spun out of Cambridge University, is world class. It is equally no surprise, therefore, that the Government are keen to connect us with Oxford, another world-leading, rapidly growing city. Beyond the exceptional levels of growth that we are already experiencing, the Oxford-to-Cambridge expressway and rail line will create a further 1 million homes, so how can it be that the health funding allocated to our clinical commissioning group is based on an assumption that we are growing more slowly than the rest of the UK?

The NHS funding formula has determined that our population is growing at 0.1% below the England average, when in reality growth across the whole county has been 0.6% above the England average over the past four years. That difference matters. In population terms, the Office for National Statistics, from which the NHS draws its calculations, predicts that our population will be 988,000 by 2021, while our known and planned housing growth means our population will in fact be 1,022,000. That is known housing growth, before we even consider the additional housing that will come from the Cambridge to Oxford project.

I must tell the Minister that that is not all. The money we receive per head of population is also significantly lower than it should be. In fact, all our neighbouring CCGs are better funded than we are. In Cambridgeshire and Peterborough, we receive £1,125 per capita, as compared with £1,244 in Bedfordshire, £1,288 in West Suffolk and a staggering £1,497 in Norfolk. How does the Minister consider that to be fair, when we have one of the greatest and fastest growing ageing populations and severe areas of deprivation in Fenland and some of the Cambridge city wards? Those issues of unfair per capita funding and incorrect growth forecasting have the compound effect of making us the third-lowest funded CCG in the country.

On top of that, we have been given a £55 million savings target for this year alone, which amounts to 4.5% of our entire budget. We have an allocation uplift of 5.67%, or £66.7 million, but we are already committed to nationally mandated costs of £70 million, so the numbers just do not add up. In simple terms, despite our growth, we have less money to fund health services for the people of Cambridgeshire and Peterborough in 2019-20 than we did in 2018-19, and that is set to get worse.

[Daniel Zeichner (Cambridge) (Lab)]

The hon. Lady is making a very important speech. I would like to underline that final fact. It feels very much like the situation with our schools, where the Government tell us that we have more money, but teachers and headteachers tell us that we do not. I would like to underline her crucial point: we have less money to fund health services in 2019-20 than in 2018-19. I hope the Minister will be able to explain why.

[Heidi Allen]

The hon. Gentleman, who is my neighbour, is absolutely right. Everyone knows that Cambridge and the surrounding region are growing, yet somehow we are expected to manage on less and less money every year.

Let us bring some colour and real life to the situation. The provision of in vitro fertilisation, of any number of cycles, is totally under question. Hearing aids for those with moderate hearing loss, and community diagnostics, such as ultrasound services, might go, as might vasectomies. The CCG has to reduce its spend on services outside of hospitals by £33 million this year. That means, speaking plainly, significant cuts to community care—everything we are trying to do to stop people from being admitted into hospital, which we know is the most expensive form of care. Every single one of our major out-of-hospital care services is under review.

The Minister will be familiar with a CCG’s “distance from target”, which is how far away a CCG is from what the NHS would consider the fair funding position to be. I can tell him that that will deteriorate yet further to 3.71% by 2019-20 from an already unacceptable gap of 3.5% in 2018-19. That position is simply unsustainable. The goalposts are being moved further and further away. In monetary terms, it means that we are underfunded by £43 million this year. If nothing changes, over the next five years we will be underfunded by £200 million. Our CCG has just agreed the 2019-20 financial plan with NHS England. That agreed plan will show a deficit of £192 million. That just cannot continue. I cannot believe for one minute that the Minister would be content with such a depleted health service.

What are the Minister’s views on what he can do specifically to correct the flawed growth forecasting? How will he address our significantly lower funding per capita? Will he tell me why the problems have not been addressed in the five-year funding allocation? I would appreciate a commitment to an early review of the funding allocation and extra intermediate emergency funding. At this rate, we are going to be cutting just about everything. If that funding is not available, I sincerely ask the Minister to explain exactly how my CCG and its providers are expected to close that deficit gap. Without cutting more health services for my constituents in South Cambridgeshire and for people across the whole Cambridgeshire and Peterborough area, I do not see how the CCG can make ends meet.

[The Minister for Health (Stephen Hammond)]

It is a pleasure, as ever, to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for South Cambridgeshire (Heidi Allen) for bringing forward this debate. I know there are not many Members in the Chamber, but that should not in any way undermine or take away from the importance of this debate, which is clearly of great interest to her. She spoke powerfully about the problems that the CCG has had.

I recognise right at the outset that Cambridgeshire and Peterborough CCG has faced a number of difficult, interlocking and historical factors. The historically low funding settlement is obviously taking time to rise to target—there is a commitment to rise to target over time, which I will come on to in greater depth in a moment—and that has combined, as she rightly points out, with the fast rate of population growth across the area, which has put additional demands on the CCG.

I and the Government recognise that the CCG receives less per person than its neighbouring CCGs. As the hon. Lady rightly pointed out, it gets £119 per person less than its neighbouring CCG in Bedfordshire. Although it is moving towards target—as she rightly points out, it is 3.7% below target this year—that figure reflects some of the historical funding patterns. It does not reflect the allocation formula change that the NHS is working to resolve.

The hon. Lady and the hon. Member for Cambridge (Daniel Zeichner) pointed out the growth levels. She is right that Cambridge and Peterborough have seen substantial population growth in recent years, and that growth has been 0.6% above the England average over the past four years. Inevitably, that growth—plus the potential growth from the Oxford-to-Cambridge expressway, which will put more housing along the corridor—will clearly cause additional pressures.

The hon. Lady asked for a commitment from me. I can say that NHS England is committed to bringing all CCGs up to target as soon as possible, while also ensuring that all CCGs receive some additional funding this year. As a result, the CCG has received an additional 2.5% per capita growth in 2018-19, and will receive a further 5% per capita growth in 2019-20. That will bring the CCG funding up to £1.1 billion for 2019, which is below target but moving up. As I think the hon. Lady said, it was previously some 5% away from the target; it is now 3.7% away from the target. Our commitment is to bring all CCGs up to the target as soon as possible.

The hon. Lady will not be surprised to hear me say that it is, of course, a matter for NHS England to allocate funding to CCGs, and that process has been evolving. It might be helpful if I briefly set out how that happens. NHS England must ensure that funding is equitable and fair, taking into account the three main drivers of healthcare demand: population growth, deprivation and an ageing population. As a point of principle, CCG allocations are based on equal access for equal need and reducing health inequalities.

As the hon. Lady pointed out, a complex national formula supports the allocation of resources, and historically that has caused some distortions. That formula is developed by the Advisory Committee on Resource Allocation, known as ACRA, which is an independent body of experts, supported by the population projections of the Office for National Statistics.

The hon. Lady cited some population predictions, which I think come from the Cambridge Research Group as opposed to the Office for National Statistics. She will therefore understand that, although I accept that those numbers are shared locally, Ministers and the NHS have to rely on the independent and academically rigorous body. Otherwise, it could easily be perceived that we were using a local think-tank’s population growth estimates to privilege one group over another.

[Heidi Allen]

Am I allowed to intervene?

[Mr Philip Hollobone (in the Chair)]

Order. You are allowed to rise at any moment, but the Minister does not have to accept your intervention.

[Heidi Allen]

Thank you, Mr Hollobone. Forgive me—I have not led a Westminster Hall debate before. I accept all that the Minister has said, and it is a difficult matter, but the statistics are flawed. The Minister said that he accepts that the growth is 0.6% above the England average; the Office for National Statistics is working on its being 0.1% below. Something is therefore going a little astray.

[Stephen Hammond]

I am sorry—either I did not make myself clear, or the hon. Lady misheard me. I said that the population growth was 0.6% above the England average over the last four years. The number that she cited of the growth being below the average is from ONS predictions for the next two or three years.

[Heidi Allen]

Forgive me if I am mistaken, but I thought I heard the Minister agree that the growth was in fact 0.6% above the England average. If it is, why on earth are we working on the ONS figures that it is 0.1% below the England average?

[Stephen Hammond]

This is prejudging the tennis season, in that we can go backwards and forwards, but let me say for the record that if I misled the hon. Lady I apologise wholeheartedly. I agreed that the population growth of the Cambridge and Peterborough CCG area has been 0.6% above the England average over the last four years; I did not intend to suggest that it is expected to be 0.6% above the England average for the next one, two or three years. I think the ONS number that she cited is one that we recognise; however, as I said, the numbers that she produced from the Cambridge Research Group are different from those of the ONS.

This year, ACRA has recommended a wide-ranging set of changes to the formula, to ensure fairness across the country. In the case of Cambridgeshire and Peterborough CCG, that has led to an increase in NHS England’s estimate of what the fair share of resources should be. That is mainly due to the mental health and learning disability service estimate and the market forces factor.

Changes have also been made to the way population data is used. ACRA now uses the annual average registered list for the most recent year, rather than the size of the list at the time of allocations, to allocate resources on a per capita basis. That change will inevitably benefit Cambridgeshire and Peterborough CCG because it will reflect more recent population growth. The change is obviously also intended better to reflect cyclical patterns in areas with large numbers of seasonal workers or large student populations.

ACRA also now uses specific data regarding age and gender population projections produced by the ONS, so that if population growth in an area is disproportionately in a younger or older population, which will obviously affect the relative need, that will now be reflected in the new way that NHS England calculates the allocations. As I said earlier, the formula changes will more accurately reflect population growth, deprivation and the structure of the population over the next few years.

[Heidi Allen]

I appreciate the sincerity, and my CCG knows that NHS England intends to improve the formula to make it more representative. However, a question remains, and it is the same question that the hon. Member for Cambridge (Daniel Zeichner) referred to regarding education: what happens in the meantime? Our CCG is talking about significantly cutting community services. That will affect elderly care in the community. That will stop vasectomies. It may take IVF treatment away altogether, as we are at just one round at the moment. Although I appreciate that NHS England is an enormous machine and improving the health formula will take some time, what do I say to my constituents whose health services are being cut while we wait?

[Stephen Hammond]

I will say two things to the hon. Lady. First, the reflection of the formula and the increase in the money is coming through this year and next year. We have spoken about the additional per capita funding that is coming through.

[Stephen Hammond]

All I have are the percentage increases in additional per capita funding for 2018-19 and 2019-20. I will seek inspiration to confirm the absolute totals, and if that inspiration reaches me while I am still on my feet, obviously I will relay it to the hon. Gentleman. If not, I am happy to confirm that I will write to him.

My point is that the NHS England allocation is based on the ACRA assessment and on the change in the funding formula. The hon. Member for South Cambridgeshire and the hon. Member for Cambridge rightly point out that, historically, the funding of their CCG has not been equivalent to that of local areas. That historical funding disparity is being improved, and is moving back towards the target of funding for CCGs over the next two or three years. I pointed out that last year there was a funding increase of 2.7%, and there will be one of more than 5% this year.

[Heidi Allen]

While the Minister’s inspiration is working diligently on the back row behind him, may I ask to be included in that? If we do not have time now, perhaps the Minister could come back to us. He is right that some additional funding has been provided to the CCG, but more than that amount is in mandated national programmes over which it has no control, so how much extra will the CCG receive for core services—not for something that has been put on it from a national point of view?

[Stephen Hammond]

The hon. Lady will know that some of those core mandated services are providing core services as well. I am happy for the hon. Member for Cambridge to correct me, but my understanding is that an additional £8.5 million will go into the CCG. If he wishes to write to me with his figures, I will happily source those numbers for him. However, I have just received inspiration from somewhere, for which I am very grateful, and I can confirm that that is the number.

Access to Orkambi

Heidi Allen Excerpts

Tuesday 17th July 2018 Commons Chamber

[Mr Lewis]

I entirely agree—my hon. Friend makes absolutely the right point. When there is an incomplete assessment in looking at value for money versus outcomes, that will lead to flawed decisions that are incredibly difficult to justify. We have a mismatch between the basis on which NICE is expected to make these decisions and appropriate processes. Instead of everybody hinting, “Yes, of course there’s a need to review NICE—of course that would be a good thing”, we would like to hear from the Minister a timescale as part of the response to the specific issue of Orkambi in terms of NICE’s roles and responsibilities.

[Heidi Allen (South Cambridgeshire) (Con)]

Now is an opportunity because we have a new Secretary of State. I have already contacted him about this issue. The way that NICE is making its decisions is affecting not only drugs like Orkambi but an awful lot of drugs that people in our constituencies desperately need. Does the hon. Gentleman agree that now is absolutely the right time to grasp this situation on Orkambi and challenge NICE about its decision-making criteria? Let us change the way it is looking at the value of quality of life and do that urgently, using Orkambi as a starting point.

[Mr Lewis]

I entirely agree. It is always very important, when a new Minister begins a role, that they have a very clear sense of a positive agenda on which they want to achieve change. This will be a very appropriate issue for the new Secretary of State to adopt and to drive forward.

Oral Answers to Questions

Heidi Allen Excerpts

Tuesday 19th June 2018 Commons Chamber

[Mr Speaker]

And that advice will be proffered on a very large number of occasions in this Chamber until the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan) gets what she seeks—I think I can say that with not just confidence, but certainty.

[Heidi Allen (South Cambridgeshire) (Con)]

15. What steps his Department is taking to support NHS foundation trusts to tackle shortages in clinical staff.

[The Minister for Health (Stephen Barclay)]

The workforce strategy we are bringing forward will include investment and an expansion in the number of medical schools— five new medical schools—alongside those 1,500 new doctor places.

[Heidi Allen]

I had wanted to ask the Secretary of State to get behind exempting nurses and doctors from the tier 2 visa process, but I do not need to do that; I just have to thank him for his support in doing that. Instead, for his next challenge, will he commit to looking again at the pensions cap, which I fear might be one reason some senior NHS professionals and doctors are retiring sooner than they might otherwise do?

[Stephen Barclay]

I am grateful for my hon. Friend’s support on tier 2 visas. She will be aware that clinicians who reach the £1 million lifetime allowance limit can expect a pension of about £44,000, payable at age 60, increasing with inflation, plus a tax-free lump sum of about £132,000. Although these are ultimately issues for the Treasury, it is important that we ensure that tax allowances, two thirds of which go to higher-rate taxpayers, are fair to other taxpayers.

GP Indemnity Costs: England

Heidi Allen Excerpts

Wednesday 15th March 2017 Westminster Hall

[David Mowat]

The two consultations will take 12 weeks. In a sense, my hon. Friend’s question is false. I do not think there will ever be a final solution because we are trying to reconcile two powerful forces: the need for access to justice and equity for people damaged through negligence and the need to be fair to our NHS. There will always be issues that evolve. The discount rate, for example, which we have talked about during the debate, will vary depending on where interest rates move in the months ahead.

We are talking about something that will always have to be kept under review. There will not be a final solution, but the two consultations that I mentioned will make a material difference and I am keen that we should make progress on them as soon as we are able to.

[Heidi Allen (South Cambridgeshire) (Con)]

I appreciate the Minister’s giving way, particularly as I was late arriving for the debate, and so may have missed some key points. Building on the point made by my hon. Friend the Member for Cheltenham (Alex Chalk), of course I welcome the Government’s interventions, the consultation, the winter scheme and extra money for GPs to cope with inflationary pressures. The problem is that the costs are already so high.

Addenbrooke’s hospital in my constituency is losing trainee doctors, who are put off by the cost. Older doctors are retiring early. Doctors are thinking twice about going into specialisms because there is perhaps a higher associated risk. Is there nothing else that we can do? Hospitals have Crown indemnity. Could we consider that for GPs? Could we extend it to them, as an alternative idea?

[David Mowat]

Those are all fair points, but in the GP forward view we have said that GPs will not bear the cost of increased indemnity—the Government will; and that is a commitment that we are holding to. The increased costs incurred last year are being paid through the GP contract, following the discussions that we have had with the BMA, and the cost of that to the Government for this year is £33 million. That is a commitment that will go into the future.

However, my hon. Friend the Member for South Cambridgeshire (Heidi Allen) makes a fair point that in a country with a shortage of GPs, where we are trying to recruit a further 5,000 doctors to work in general practice by 2020, we need to make the profession attractive. We are trying to do that, and there are different ways to do it. Indemnity is just part of it. To answer her point, I would say that this year the number of medical students going into GP training is the highest ever achieved. Something over 3,000 are going into the training, and we need them all. I responded to a debate here yesterday about a shortage of GPs in Essex. Frankly there are shortages everywhere; we understand that.

In a sense, I share the frustration of my hon. Friends the Members for South Cambridgeshire and for Cheltenham and the feeling “Why can’t we just fix this?” The answer is that there are legal rights that we cannot just take away; we cannot say that it will just not be possible to sue the NHS in future. That is not the system in the country that we live in. However, we need to do moderate, sensible things to bear down on costs, so that we spend a greater proportion of NHS money on doctors than on lawyers. All of us in the Chamber would agree on that.

Social Care

Heidi Allen Excerpts

Wednesday 16th November 2016 Commons Chamber

[Heidi Allen (South Cambridgeshire) (Con)]

The motion is wide ranging because when we talk about social care, we are talking about the needs of older people, the disabled and their carers. In my constituency, we have one of the fastest-growing ageing populations in the country, so I understand only too well the pressures placed on my hospital, Addenbrooke’s, when elderly patients cannot be discharged.

My county council, NHS trusts and CCG are well aware of these challenges and are working well together as a team to see what transformation is possible to break the cycle, just as the Secretary of State recommended. However, I know that although they are determined and very capable, they are not miracle workers. As local authority budgets are reduced and we are rightly asking for better value for taxpayer money, it is inevitable that the pace of change will be variable across the country, and my worry is that the standard of care may suffer while that transformation occurs.

I believe that our care providers have the potential to transform. The question is whether they can do so swiftly enough and whether they can do it without a short, fast boost of additional funding to release them from the unrelenting pressure so they can find the head room to manage and make change.

Many of the issues that we face in the care sector apply equally to the disabled and to the elderly. Supporting the vulnerable is a moral and political priority, so for those who cannot help themselves, including the 1.5 million people living with a disability in the UK, we must help our care providers adapt. I shall focus on the disabled, as we have heard a lot about the elderly today.

Our growing and ageing population means that the current terms for the delivery of these vital services are no longer sustainable. Many providers have nowhere left to turn and are withdrawing from services that help those most in need. I have visited such a provider in my constituency, Voyage Care, which delivers 24-hour support to adults with significant disabilities. The care staff are the most humbling and dedicated human beings I have ever met. I am so proud to have them looking after my constituents, but they cannot continue to deliver a service on local authority rates that are frozen year after year. Fortunately, this year I have managed to help them secure a very small uplift, just enough to keep their heads above water, but throw in rural geography, a higher national minimum wage, changes to payments for sleep-in shifts, and a likely reduction in the number of keen eastern European carers coming here, and we start to run out of options.

The Government’s transforming care programme sets out a clear vision for ensuring people with learning disabilities receive the right level of high quality care in their local communities to support them in living as independently as possible. We have some great tools at our disposal to facilitate pathways into independence and employment, such as Access to Work, so let us get smart about this. By supporting this community transition, we generate not only life chances but economic activity. Some 45% of young disabled people want their social care support to help them find and stay in work, but their care package does not include such support.

The debate must also draw attention to supporting our carers. I immediately thought of Alan, one of my constituents, who looks after his mum, Marion, who has very progressed Alzheimer’s, in one of my villages. He has dedicated his adult life to looking after her, but he needs a break, too. I know he has just about managed, but that is through huge personal and financial sacrifice. The value of the care that carers such as Alan provide is about £132 billion—almost equivalent to the UK’s total health care annual spend—so this little debate, Alan, is for you and your mum, Marion.

In financial terms, the Government have rightly allocated money via the better care fund, but we really cannot wait until the end of the Parliament—we need to do all we can to bring that money forward now. The precept is not enough; even if every council out there had taken up that offer, it would have generated £380 million, not the £1 billion shortfall. So we need to bring that better care funding forward, and it will provide an immediate uplift to councils so that they can pay care workers an appropriate wage. However, we should also be looking closely at how care is given, based on time spent, not tasks—and that means proper time, because I want to see an end to these 15-minute slots. Our country is more civilised than that, and cutting corners now means more costs later.

It is not enough for the Opposition to simply demand more money. The complexity of these issues and the current economic climate mean it is simply not good enough to make such demands without offering solutions. To transform the social care landscape, we need to be as brave as those care providers we are asking to work in a new way. As the right hon. Member for Leigh (Andy Burnham) so eloquently put it, we need to work together to come up with new ideas, so let us get smart. We need to fund areas based on their proportion of older and disabled residents, not on deprivation, as the funding model currently does. We need to ensure—legislating if necessary—that councils, the NHS and CCGs pool their money and resources. The key to unlocking a new model of social care, as we have heard loud and clear today, is to make a team effort. Those in my area are working in partnership, but the Government need to set up a health and social care commission to pull these work streams together. Health and social care are entwined, but, currently, the decision-making and budget priorities are not.

The Care Quality Commission said the system has reached a “tipping point”, with providers starting to hand contracts back. I have seen it in my own county—it is true. So let us work together as a team and come up with a brand-new plan for social care in the 21st century.

Mental Health Taskforce Report

Heidi Allen Excerpts

Wednesday 13th April 2016 Westminster Hall

[James Morris]

My hon. Friend is absolutely right. We need to support people with depression back into work. The report makes a number of recommendations, which he may be aware of, on the use of strategies such as individual placement and support to get people with mental health problems back into work.

The report also talks a lot about data, which underpin our decisions about where we should focus our efforts on mental health. It refers to a “black hole” of data and calls for a “transparency revolution” in mental health. As I said earlier, for a long time—probably 20 years or more—we have not been collecting sufficiently robust data about what is actually going on in mental health services. We need better data on what is going on to have a firm basis on which to understand what is working, what is not working and what is going on at local and national level. Recommendation 50 in the report—this pertains to what my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) said about accountability—is at the heart of the implementation challenges that we face. It states:

“The Department of Health and NHS England should require CCGs to publish data on levels of mental health spend in their Annual Report and Accounts, by condition and per capita, including for children and Adolescent Mental Health Services, from 2017/18 onwards. They should require CCGs to report on investment in mental health to demonstrate the commitment that commissioners must continue to increase investment in mental health services each year at a level which at least matches their overall allocation”

of funding. That goes to the heart of our data challenge.

For too long, mental health services have not been properly resourced because we do not have an effective data set on what is actually happening in the NHS or, as the report highlights, an effective model in the NHS for paying for mental health services. They tend to be commissioned on what is called a block contract basis, which often has the effect of focusing on the delivery of a low-cost service, rather than on quality outcomes. We certainly do not have a model of care that focuses on an individual care pathway or a cure for an individual patient.

We need a different model of payment for mental health services in the NHS that focuses on quality and outcomes and reflects our aspiration, which is written into the NHS’s operating mandate, for parity of esteem—the integration of physical and mental health. How can we express that aspiration? To give an example, if I suffer from diabetes and a serious mental health problem, my treatment in the national health service is effectively split in two: there is a physical health pathway, which is paid for in one way, and a mental health pathway, which is paid for in another way. I believe that we need to move towards a payment-by-activity model in the NHS that does not discriminate between physical and mental health. That will certainly not happen overnight, but the report goes some way towards arguing for it in recommendation 47, which states:

“NHS England and NHS Improvement should together lead on costing, developing and introducing a revised payment system by 2017/18 to drive the whole system to improve outcomes”.

[Heidi Allen (South Cambridgeshire) (Con)]

Does my hon. Friend think it is right that we have a separate payment model for mental health, or should physical and mental health be treated together? Separating them could cause the very division that we are trying to lose.

[James Morris]

That is precisely what I am arguing for. Over time, we need to move to a model that does not discriminate between mental and physical health, with integrated payment reflecting the fact that there are a lot of conditions and a lot of comorbidity. Getting the payment system right in the NHS is fundamental to everything about the aspiration for parity of esteem. “Parity of esteem” is an interesting set of words, which can be interpreted to mean that we want a culture change or a system change—all of which is right—but to achieve it we need to change the payment model for how services are commissioned and purchased in the NHS.

Mental Health

Heidi Allen Excerpts

Wednesday 9th December 2015 Commons Chamber

[Heidi Allen (South Cambridgeshire) (Con)]

If I may, Madam Deputy Speaker, I would like to ask you to cast your mind back to the summer. As a new MP, I was sitting on the grass on a Sunday reading through my casework. There were many of the usual items of correspondence on housing, planning and so on, and then a letter, and a moment I will never forget. It was from a constituent, Steve Mallen, telling me about the tragic suicide of his 18-year-old son—a brilliant, gifted young man with grade 8 piano, straight A*s at A-level, and a place reserved at Cambridge University. Ten months ago today, Edward Mallen took his own life in front of a train. “Mental health”—they are not dirty words. We all have a state of mental health, just as we all have a state of physical health. We have good days and we have bad days. We all have them, every one of us. For most of us, the good days follow the bad days and overcome them, but tragically this did not happen for Edward.

Today I want to talk about what we in this Chamber can do to make sure that there are no more Edwards. Members will know that I want this House to work together to resolve problems, not to point fingers at failure. So I urge those in all parts of the House to recognise the good work that has been done so far and to commit, from this day, to working together to achieve more. I believe that we are building on the foundations laid by the tremendous work of Norman Lamb and the Health and Social Care Act 2012. We have seen investment of £1.25 billion to help deliver the Future in Mind Initiative, the appointment of Sam Gyimah, and the appointment of Natasha Devon as the Department for Education’s first schools mental health champion—and boy, what a fireball she is! Only this week, we had the announcement of a £3 million pilot programme to support mental health leaders in schools across the country. Given that 10% of children under 16 have a clinically diagnosable mental health problem, and 75% of all mental illness predates higher education, we are focusing on the right things.

Prevention is far better than a cure, because by the time a cure comes, families, communities and the wider economy have been devastated. Ask Steve Mallen, his family and the village of Meldreth, because they know. We could argue all day about whether the Government are spending enough on the cure, but I do not want us to do that.

[Norman Lamb]

The hon. Lady is making a passionate case, particularly in relation to the tragic case of her constituent. Does she agree that we need to get the whole of the NHS to sign up to a commitment to a zero suicide ambition? That is not about setting a target, but about changing the culture so that everyone focuses on saving lives.

[Heidi Allen]

That is fundamental and there should be no alternative. The right hon. Gentleman is absolutely right.

Nobody doubts the need to improve mental health care or the fact that money does not grow on trees. Investment is increasing, but I fear that the scale of the problem is far greater than any Government cheque book. It is so much bigger than that, but the good news is that we are capable of being bigger than that, too. Let us cast aside party politics and make this our issue, not just the Government’s issue.

In South Cambridgeshire, we are pooling together the resources of schools, world-leading academics, mental health charities, business, local authorities, politicians and parents—everyone—to do things differently. With Steve and the memory of his son, Edward, at the helm, we want to roll out a timetabled early intervention and prevention programme in every single one of our schools. We are trialling and developing it, and in March next year we will launch it at an international conference in Cambridge, which Alistair Burt has kindly committed to attend.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. The hon. Lady must refer to Members by their constituency name. Twice now she has referred to people by their names. It is simply not done in this Chamber.

[Heidi Allen]

Forgive me, Madam Deputy Speaker—I was genuinely unaware of that.

I have no doubt of the personal dedication of our Ministers, for they have proved it to me and, more importantly, to Steve Mallen. If Members are undertaking similar work in their constituencies, or if they want to join our project, I urge them to talk to me. If we have learned one thing about mental health, it is that we need to talk about it. The answer is simply not about cash; it is about partnership working, and I urge every Member of this House to join in this fight together. Let us take the responsibility.

[Several hon. Members rose—]

Oral Answers to Questions

Heidi Allen Excerpts

Tuesday 17th November 2015 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

The hon. Gentleman will be aware of my earlier answers to other questions. A wide range of aspects of the public health work that this Government are taking forward attack that very issue—the inequality of outcomes for some communities. I gave examples earlier, including the family nurse partnership and the troubled families programme, which has a health aspect to it. More widely, the universal health visiting programme, which has just moved into commissioning by local government, contains significant elements that were designed exactly to support poorer families and disadvantaged communities.

[Heidi Allen (South Cambridgeshire) (Con)]

For the avoidance of doubt, will the Secretary of State please repeat again that he will enter into completely open-minded, non-preconditional negotiations with the British Medical Association? The public need to see that we are approaching this matter with an open mind.

[Mr Hunt]

I am happy to confirm that we are willing to talk about absolutely anything with the BMA to avoid a dispute that would be very damaging to patients. We do, of course, reserve the right to implement our manifesto commitment to seven-day reforms if we fail to make progress in the negotiations, but at this time, in the interests of patients, the right thing to do is sit round the table and talk rather than refusing to negotiate and going ahead with the strikes.

Oral Answers to Questions

Heidi Allen Excerpts

Tuesday 7th July 2015 Commons Chamber

[Alistair Burt]

As has been discussed extensively during this Question Time, the Secretary of State has announced a programme that will include increasing the numbers training to be GPs, improving not only the recruitment but the retention of GPs, and work to make general practice more attractive to those who are worried about that. With all these measures, we will do our best to boost the position of general practice within an expanded primary care system in future, and I hope we can meet the concerns of the hon. Gentleman and his constituents.

[Heidi Allen (South Cambridgeshire) (Con)]

T7. This is a request really: will the Secretary of State please meet me and GPs from the surgery in Cambourne—which we could call a new town—who are significantly underfunded? The funding model does not work for them; they are at breaking point, and they need your help.

[Mr Speaker]

They do not need my help, but they might need that of the Minister.