Transforming Care Programme

Helen Hayes Excerpts

Thursday 5th July 2018 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I am grateful to the Backbench Business Committee for allocating time for the debate and to the right hon. Member for North Norfolk (Norman Lamb) for securing it. I am also grateful for his commitment to this issue over many years. It is a pleasure to follow the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan). I am grateful, too, for her deep commitment to, and knowledge of, the subject of autism.

The treatment of residents at Winterbourne View was a national disgrace. That any human being should be subjected to such terrifying physical and emotional abuse in their own home setting is utterly abhorrent, and that those people should be among the most vulnerable and least able to speak out or defend themselves simply defies belief. The way in which we treat our most vulnerable residents is a mark of our civilisation, and Winterbourne View was a failure of the most basic measure of human decency. It was therefore absolutely right that the public outcry that followed Winterbourne View led to a firm commitment from the Government and to the transforming care programme.

However, the transforming care programme has failed to live up to its name. It has not substantially transformed the care and support that many people with autism and/or a learning disability are receiving. There are still far too many people living in hospitals such as Winterbourne View instead of homes. There are still far too many examples of families who have to fight each week to ensure their relatives’ safety and security, and even the basics of care, and too many people are still not receiving the support they need to live healthy, secure and fulfilled lives. We are now eight months away from the end of the transforming care programme and urgent action is needed to deliver a genuine transformation in the quality of care for thousands of people living with learning disability and autism in the UK.

In December 2012, 3,400 people were in NHS-funded learning disability in-patient beds, with around 1,200 in assessment and treatment units. The original Department of Health report following Winterbourne View found that the main reason for referral was the management of a crisis, suggesting that the failure in service provision had often started long before the person was admitted to hospital. The failure often involved a lack of support in other areas of health, social care and education provision, often leading to behaviour and mental health deteriorating over time and then reaching a crisis point. The report’s conclusion suggested six key changes, and I want to restate them because, in the experience of too many of my constituents, those changes have not yet been implemented or become a reality.

The first recommendation was that the information made available by councils, health bodies and care providers should be transparent and of good quality. The second was that community-based mental health services should offer assertive outreach, 24-hour crisis resolution and general support. The third recommendation was that small-scale residential care should be available to those in greatest need. The fourth was that employment or daytime activities should be offered. The fifth was that health and social care commissioners should start to plan from day one of admission to in-patient services for the move back to the community. The final recommendation was that the Care Quality Commission should monitor whether services are meeting essential standards, take enforcement action if a provider is not compliant, and monitor the operation of the Mental Health Act 1983.

Those recommendations bring me to the case of my constituent Matthew Garnett. Matthew’s mother Isabelle is in the Public Gallery today, and I am grateful to the Minister for taking the time to meet me and Isabelle recently. I have spoken of Matthew’s situation in the Chamber several times, but I make no apologies for raising it again today because his case illustrates exactly how little progress has been made in implementing the Department of Health’s original recommendations in response to Winterbourne View.

Matthew is approaching his 18th birthday. He is a tall young man whose absolute passion is football, particularly Liverpool FC. Matthew has autism. I first met Matthew’s mum at the start of 2016 when she came to my surgery following a deterioration in Matthew’s mental health and behaviour at home. Matthew had been admitted to a mental health unit under section. At that time, Matthew’s parents were concerned that the assessment unit that he was in had no specialism in autism and that he had been there for far too long without appropriate clinical support. They had been recommended a hospital in Northampton, St Andrew’s, as a place with the right expertise for Matthew to be able to get well and come home. I supported their battle to get access to a bed for Matthew at St Andrew’s, and we celebrated when he was allocated a bed.

After Matthew had been at St Andrew’s for just a few weeks, his parents came to see me again. They were concerned that Matthew seemed to be taking part in very few activities, that he was losing weight, that he had become more withdrawn and that they had noticed signs of anxiety in his behaviour. They were concerned that there was no discharge plan and that staff seemed reluctant even to talk about one. Matthew’s situation deteriorated rapidly at St Andrew’s. He suffered a broken wrist and bruising. His parents found excrement in his shoes. He lost a catastrophic amount of weight. His parents became gravely concerned that he would die, so we fought again. They found alternative community-based provision not far from the hospital. They contacted Alderwood, which the right hon. Member for North Norfolk has already mentioned, and discovered that it had a place for Matthew, so he moved in.

Matthew is now flourishing. He volunteers at the local football club and in the village where his home is located. He takes part in a wide range of activities—from film nights to canoeing and trips to the seaside—and he is able to play and watch lots of football. Matthew is well and living life to the full. The care and support he is receiving costs considerably less than the £12,000 a week spent by the NHS on a private hospital bed in which his health was deteriorating and from which there was no plan to discharge him.

[Norman Lamb]

The hon. Lady is making a powerful case. Does she agree that the Care Quality Commission should do far more to challenge how these units often define themselves as specialist units? The care given to Matthew and Fouzia at St Andrew’s in Northampton was very far from specialist; it was inappropriate and it damaged them massively.

[Helen Hayes]

I thank the right hon. Gentleman for his intervention. I also visited St Andrew’s and, when I returned, I looked at how it was advertising its services and compared that with what I saw. I would go so far as to say that, in any consumer environment, a good case could be made that St Andrew’s was contravening the Trade Descriptions Act 1968 in how it was advertising itself, given the expertise the staff actually had in relation to autism. In my view, that is certainly a matter for the CQC.

Matthew’s case is important, because it demonstrates clearly that all the failures that led to Winterbourne View are still possible. Matthew’s family did not receive the support they needed for Matthew at any stage prior to his admission to hospital. It was that lack of support that led to his behaviour deteriorating in the first place. There was no assertive outreach or 24-hour crisis resolution support; there was just the local police force when things got too much. That was four years after the Department of Health report on Winterbourne View.

The small-scale residential setting in which Matthew is now living is brilliant, but there is far too little of that type of provision and none of it close to home. Matthew’s parents live in my south London constituency, and Matthew is currently living in Northamptonshire. I met the providers of his care at Alderwood, and they told me that what they provide is easily scalable. It is about training staff in effective communication techniques, paying staff properly and providing a good career structure so that providers can retain a stable team, and being able to access funding for the places they provide. It is not rocket science. It just needs a proper commitment to invest in settings that deliver the best possible care.

At St Andrew’s, Matthew was not participating in any meaningful activities on a day-to-day basis; the emphasis was on managing and containing his behaviour through medication rather than engaging him in recovery. In his new home at Alderwood, Matthew is on very low levels of medication. He takes part in meaningful activities that add value to his life and make a real contribution to his community on a daily basis.

There was no discharge planning while Matthew was at St Andrew’s. In fact, his parents were told they were being far too optimistic even to raise discharge with his clinicians. St Andrew’s is a private hospital that is largely funded by the NHS. The Government must look seriously and urgently at the perverse incentives at work in a system that is so reliant on the private sector because of the lack of NHS provision. Private hospitals currently have no incentive to discharge when they are being paid a rate of £12,000 a week by the NHS.

There was very little scrutiny of the effectiveness of the treatment Matthew was receiving in return for such large amounts of NHS funding, and no regard was given to the concerns of his family, who had to fight to get a second opinion, which was itself dismissed by staff at St Andrew’s.

Transforming care can never be fully implemented while such perverse incentives apply and while profit-making organisations are relied on to substitute for a lack of proper funding for NHS and social care provision. Private hospitals too often remain holding pens for patients, rather than the secure and supported homes that they need. No learning disabled or autistic person should be living in a hospital for the long term. We need homes not hospitals.

Too many of my constituents whose family members, including children, have a learning disability and/or autism still tell me that when they express concerns about the care their loved one is receiving, their views are not taken seriously and they have to battle to have their concerns addressed. Again, we cannot begin to see a system that delivers the care that vulnerable people need without proper processes for accountability through which family members can raise concerns.

I am concerned about the Government’s tracking of the progress of the implementation of transforming care. In response to a written question tabled by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), the Minister for Care highlighted, in her answer on 4 June, the plan to decommission 900 beds in mental health hospitals. Assuring transformation data provides figures on the number of people with learning disabilities and/or autism admitted and discharged. In the 2017-18 period, there were 330 more discharges than admissions, but it should be noted that that applies not to individual people, but to the individual instance of an admission or discharge, so there is no way to tell to what extent some people are caught in a revolving door. The dataset does not directly identify whether an admission is from the community or a transfer from another hospital setting. Similarly, the data does not directly identify whether the end of an episode of care is a discharge to the community or a transfer to another hospital setting. Thus, although 330 discharges might sound like progress, the Department of Health and Social Care has not so far provided figures for individual cases. In the light of the target of closing 900 beds, this cannot be seen in any way as a victory for either the Government or, more importantly, those vulnerable individuals whom transforming care is intended to safeguard.

I am also concerned that the Government's focus for the final few months of transforming care is far too much on hospital bed closures. Bed closures should be a consequence of the provision of properly funded, high-quality community settings, and the by-product of achieving better outcomes for people currently in long-term hospital provision. Instead, the Government continually refer to bed closures as the headline target and measure for transforming care. Without high-quality, properly resourced alternative provision, bed closures, in themselves, will simply result in further pressures on the NHS, as people who are discharged without sufficient support will end up readmitted, via A&E, to a situation where fewer in-patient beds are available. It is almost impossible to find any meaningful data on the funding and level of community provision for people with autism and learning disabilities, and I urge the Government to switch their focus from bed closures to community provision for the final eight months of transforming care in its current form.

I also want to highlight the regulatory gap that still exists. A constituent contacted me recently on behalf of her brother, who is an adult with autism living in a supported housing provision, paid for through his personal budget. He needs a high level of support and his personal budget is considerable, but his sister has raised concerns about his treatment in the community provision over a period of months. The provision involves a high level of care, but is technically supported housing, which means that it is not regulated by the CQC. The recent report by the Housing, Communities and Local Government Committee and the Work and Pensions Committee on supported housing highlighted this gap in regulation and called on the Government to take action to address it, and I want to do so again today. There is great urgency that we make progress on transforming care, but discharging vulnerable people from hospital into settings that are not regulated creates a risk that they will be failed yet again.

Finally, I wish to highlight the wider gap in awareness and support, particularly in the area of autism. In schools and in the NHS, the experience of far too many of my constituents is that the support needed so that autistic people, particularly children, are able to thrive is simply not there. This continued failure to properly equip teachers and healthcare professionals to understand autism and the support that their students and patients need has long-term consequences through an increased level of care that people need later in life and an increased likelihood of crisis. I urge the Minister to work with her colleagues, particularly those in the Department for Education, to accelerate and bring forward training in autism for teachers, and not just new teachers coming through the education system now but existing teachers who are working day in, day out, without the knowledge that they need to serve autistic students well.

There is no way around the fact that the transforming care programme has failed significantly to date. We need a renewed focus on care and support for people with learning disabilities and autism. In every community throughout the country they should be living well, close to family and friends and properly supported, not locked away receiving over-medicalised care, with no one monitoring how effective that care is or what the public purse receives by way of high-quality provision in return for the expenditure. We need homes not hospitals, and we need everybody living with autism and a learning disability in this country to be able to live life to the full, with dignity, in community settings that are close to home.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call Ronnie Cowan.

--- Later in debate ---

[Caroline Dinenage]

I am very glad the right hon. Gentleman said that because as part of the Department of Health and Social Care legacy scheme we are providing £70,000 in this year for that sort of intermediate and reablement provision which Share Lives would come under. We should definitely be investing more in that.

I take very seriously the right hon. Gentleman’s point on conflicts of interest. We have to look at that very carefully, because it might imply that any clinician would be conflicted in making a clinical decision because they are employed by a trust. Providers are monitored by the CQC and doctors are of course subject to extremely rigorous professional registration, but I take what he says very seriously and I will look more closely at his concerns. I am very happy to meet him to discuss this issue further if he would like me to do so.

The right hon. Gentleman spoke about pooling resources. There are now formal mechanisms for that to take place, such as section 75 and the ways in which CCGs and local authorities can work together. That is the point of having transforming care partnerships’ commissioners working together.

The right hon. Gentleman spoke about the exclusion of families from decisions. That really upsets me and it really should not happen. There are legal duties, under the Mental Capacity Act 2005 and the Mental Health Act 2007, to have independent mental health advocates. I would be very keen to speak to him further about what more we can do to make sure that the legislation is having the desired effect.

My right hon. Friend the Member for Chesham and Amersham knows I am a massive fan of hers. She has probably done more to further the cause of individuals with autism and their families than anybody else in the history of this building. She spoke with great knowledge about autism and was absolutely right to point out that transforming care is not only about learning disabilities but people with autism. In Think Autism, the adult autism strategy, we set a programme of action across Government to support autistic people to lead fulfilling and independent lives where possible. We have recently refreshed the governance arrangements that will achieve greater traction and delivery of the required outcomes, better supporting autistic people to live healthy independent lives and participate in their local communities.

My right hon. Friend spoke about autism care pathways. NHS England is developing a framework of adult community mental health services which will include care for adults with comorbid neurodevelopmental disorders and/or learning disabilities, rather than the pathways planned and set out in the “Five Year Forward View” implementation plan. NHS England’s care pathway programme has evolved to take account of the current operational context and expert service user advice. The pathway is linear about discrete episodes of care, so is more appropriate for specific interventions undertaken by specialist teams.

My right hon. Friend spoke about the barriers that autistic people face in accessing mental health services. Trusts should already be ensuring that services are accessible to people with autism and that they have made reasonable adjustments to care pathways to ensure that people with learning disabilities and autism can access the highly personalised care and achieve the equality of outcome that we all want.

The hon. Member for Dulwich and West Norwood spoke about her constituent, Matthew Garnett. It was a great pleasure to meet the hon. Lady and Matthew’s mum, Isabelle, recently. I was very shocked to hear of Matthew’s experience and deeply upset to see the pictures of him at his lowest ebb, when he was suffering from the neglect that she spoke of. It was very distressing. I am pleased that the NHS is learning from this. The Marsh review into Matthew’s care has helped to shape a much more focused approach to the needs of children and young people who are at risk of slipping into the sort of crisis that she mentioned. The operational delivery group allows stakeholders, including young people, to shape policy.

[Helen Hayes]

The right hon. Member for North Norfolk (Norman Lamb) raised the issue of St Andrew’s in Northampton having been able to expand so significantly with the benefit of NHS funding—I cannot remember the exact percentage, but the percentage of funding that comes from the NHS for St Andrew’s is up in the eighties and nineties. Does she agree that this is not the right model and will she commit to looking at limiting the further expansion of private in-patient beds, when they are not what is needed for treating young people with autism and learning disability?

[Caroline Dinenage]

We can certainly look at what the hon. Lady suggests. I am pleased that the operational delivery group, which I just mentioned, allows stakeholders to shape policy and it is really good news that Isabelle Garnett, Matthew’s mum, is a major contributor to this and liaises with NHS England directly on its programme around children either in hospital or at risk of being admitted.

The right hon. Member for North Norfolk asked why the evaluation was cancelled. As he knows, an evaluation sponsored by NHS England is already under way, and the Department, having invited bids for its evaluation, was not satisfied that the proposals received were what was needed. That does not mean that we are not absolutely determined to critically review progress, particularly working with stakeholders and users.

The right hon. Gentleman spoke about the “No voice unheard, no right ignored” Green Paper. Although I am always ready to bow to his incredible knowledge in this field, it is not entirely true to say that the Green Paper went unheeded. Some of the recommendations were overtaken by changes in Government policy, and indeed, in Governments, but we have taken forward work such as the named social worker pilot and a review of the Mental Health Act. We have asked Professor Sir Simon Wessely, the chair of the independent review, to listen to people with direct experience of the Mental Health Act and this, of course, includes autistic people and their carers. He published his interim report to update the Government on his progress, which sets out specific issues that we must explore to look at how we can improve the scope of the Act.

The hon. Member for Dulwich and West Norwood also spoke about training for teachers in autism. The Department for Education has funded training and support for teachers through the Autism Education Trust. That is in early years, schools and further education, and so far, 175,000 staff have been trained.

Department of Health and Social Care and Ministry of Housing, Communities and Local Government

Helen Hayes Excerpts

Monday 2nd July 2018 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

It is a pleasure to follow the hon. Member for Mid Worcestershire (Nigel Huddleston) and to speak in the estimates day debate to mark the 70th anniversary of our NHS—the most remarkable achievement of a Labour Government to provide free healthcare for all, free at the point of delivery.

I want to speak about King’s College Hospital—a major teaching hospital, tertiary referral hospital, and local district and general hospital in my constituency. There is a strong bond between local residents and King’s. I am proud that my mum worked at King’s as an occupational therapist for 10 years. Like so many local residents, I owe a personal debt of gratitude to the tremendously hard-working staff at the hospital. I was a surgical in-patient at King’s in my 20s, gave birth to both of my daughters there in my 30s, and have subsequently been an out-patient. My family rely on the A&E to be there when we need it. As we celebrate the 70th anniversary of the NHS, I pay tribute to the staff at King’s for their skill and professionalism, commitment and dedication, care and compassion.

King’s went through very challenging times during the 1980s and ’90s, but was completely transformed by Labour’s investment and NHS reforms. By 2010, the hospital had achieved a balanced budget every year and was meeting all its major targets. Since 2010, however, King’s has faced very significant and substantial challenges, driven principally by chronic underfunding and an enforced decision in 2013 to take on the management of Princess Royal University Hospital and Orpington Hospital when South London Healthcare NHS Trust failed. King’s now finds itself in special financial measures, with an annual deficit of £140 million.

While there are some areas where the trust can make improvements—and I know that staff are working as hard as they can to do so—many of the problems that it faces are outside its control. The Government’s funding model rewards elective surgery and penalises emergency work. King’s has a regional trauma centre and a stroke centre. It is one of a small number of London hospitals with a helipad. It has a busy accident and emergency unit and will soon open a new critical care unit. These specialisms save lives daily, but the funding model does not recognise this work. As a result, the hospital is grossly underfunded, even though London needs centres of emergency excellence such as King’s—no more so than during the Westminster and London Bridge terror attacks and the Grenfell Tower fire last year, when the team at King’s were at the forefront of the emergency life-saving response.

Last year the Government refused to allocate sustainability and transformation funding to King’s, in contrast to many other hospitals, resulting in the hospital’s already challenged financial situation becoming significantly worse. In the context of a spiralling financial decline, the Government then decided to fine King’s for not achieving its already impossible financial control targets—even though it was the Government’s failure to provide adequate funding that led to the inability to meet these targets in the first place. Since King’s has been in special financial measures, the trust has been charged penal rates of interest on the money it has had to borrow to tackle the deficit it faces.

King’s does not have access to the capital funding it needs to undertake routine buildings maintenance and to invest in the infrastructure it needs to be able to be as efficient as possible. The Government love to recommend efficiency improvements. At King’s, efficiencies can be delivered if the buildings and outdated equipment are fit for purpose for the needs of patients in the 21st century. Both King’s and Maudsley Hospital across the road urgently need more funding to meet mental health needs in our communities. Too many local residents are ending up in mental health crisis because early intervention is not there, and too many of those patients spend far too long—often days at a time—waiting in accident and emergency at King’s for the mental health support that they need.

I raise these issues today because while any additional funding for the NHS is welcome, the problems at King’s cannot and will not be solved by 3.5% a year for five years. King’s needs new funding now to overcome its current challenges. It needs an end to the perverse policies of financial penalties for failing to meet impossible targets. It needs urgent capital funding to enable the Denmark Hill site in my constituency to be fit for purpose to meet patient needs. It needs revenue funding to enable it to recruit and retain the staff that it needs to run the hospital.

It is an appalling and unacceptable fact that as we mark the 70th anniversary of the NHS this week, one of the biggest teaching and research hospitals in the country, with such world-class life-saving and enhancing expertise, is in such a perilous financial state. This must be stopped. We owe it to the staff; we owe it to the patients. There is no way around the need for additional funding now. I call on the Government to acknowledge this challenge—to acknowledge the impossibility of the current situation at King’s with the current financial settlement and to step in to provide the funding it so desperately needs.

Adult Social Care: Long-term Funding

Helen Hayes Excerpts

Thursday 28th June 2018 Commons Chamber

[Mr Betts]

It is about getting a well-paid, well-trained workforce. NHS staff who do a similar job get paid about 29% more. I am not saying they are well paid, but clearly social care staff are not well paid. That funding gap has to be addressed and people have to be properly paid. The Committees signed up to the Unison charter for the workforce in social care.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I congratulate my hon. Friend and the hon. Member for Totnes (Dr Wollaston) on their leadership on this issue. The inquiry’s report provides incontrovertible evidence of the crisis facing social care funding. I particularly welcome the recommendation that social care should be provided to those who need it free at the point of delivery, and the very practical recommendations for raising the additional funding we so urgently need. I come to the House from a meeting of supported housing providers, which provide housing for older people in my constituency and elsewhere in Southwark. All highlighted to me the increasing numbers of referrals they receive from older people who are being made homeless and suffering problems in the private rented sector. This problem is growing. The report highlights the importance of housing for the delivery of a sustainable social care system and I wonder whether my hon. Friend might just say a little bit about that now.

[Mr Betts]

Absolutely. Most people receive care in their own home. The Committee’s report on housing for older people looked at the nature of the home. It showed the importance of the warmth of the home and the ability to get around the home—trip hazards and so on. Means-testing for the disability facilities grant relates to means-testing for care provision and other benefits, so they need to be properly integrated. Another recommendation in the report was that where means tests exist, they need to be joined up together.

Mental Health Units (Use of Force) Bill (Third sitting)

Helen Hayes Excerpts

Wednesday 25th April 2018 Public Bill Committees

[Jackie Doyle-Price]

The hon. Lady makes some excellent points, and in the run-up to the Bill, we discussed some of those wider issues. It is incredibly sad that undercover reporting has, on occasion, shown such bad abuse. The fact that there is a camera will affect people’s behaviour in a positive way, although perhaps it is sad that we need to rely on that. We must, however, balance that with the need for privacy, and we can have further discussion on that. However, I see no reason why we would not have cameras in communal areas, for example. We will discuss the provisions in the Bill with organisations such as the College of Policing, and that will enable a discussion to take place with providers about where it is appropriate to have cameras. I am sure we will return to that issue.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I rise briefly to support my hon. Friend the Member for Liverpool, Wavertree and the potential exploration of the use of cameras in secure mental health settings. I have worked on behalf of a constituent with autism who was detained at St Andrew’s, which is a private mental health facility in Northampton, and I have got to know other families who had children in that facility who did not have an extensive capacity to communicate for themselves. Those families had grave concerns about the use of force and their children’s treatment more widely, which manifested itself in aspects of their behaviour—they became withdrawn and fearful, and there were some physical signs as well. The families were unable to say, however, that detention had taken place, and there is a case to be made for the kind of transparency that the use of cameras would bring, perhaps in rooms where detention and the use of force are more likely to take place—

[The Chair]

Order. Interventions really should be brief.

Cancer Treatment

Helen Hayes Excerpts

Thursday 19th April 2018 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I congratulate my hon. Friend the Member for Croydon Central (Sarah Jones) on securing this important debate, and I am grateful to the Backbench Business Committee for allowing it time. It is a pleasure to follow the right hon. Member for Old Bexley and Sidcup (James Brokenshire), who so powerfully shared his own experience of cancer and cancer treatment.

I pay tribute to my friend and predecessor as MP for Dulwich and West Norwood, Baroness Tessa Jowell of Brixton, who has inspired this debate. When I was selected as the Labour party candidate for the 2015 election after Tessa had announced that she was stepping down, four words seemed to come instantly to everyone’s lips as I went around the constituency speaking to people: “big shoes to fill”. They certainly were.

As a constituency MP, Tessa helped and supported countless individuals and families facing the most difficult of circumstances with compassion and tenacity. My strong memory of my first experiences of doorstep campaigning in the constituency is of how many people offered, unprompted, their gratitude that Tessa had helped them, often going above and beyond the call of duty. More than that, Tessa worked to deliver lasting change for our communities in Dulwich and West Norwood, by campaigning to secure investment to deliver not one, not two, but five brilliant new schools in the constituency. As a Labour Minister, she established the Sure Start programme, which was the fruit of her lifelong passion for supporting parents and babies to address disadvantage early and to enable every child to thrive. Sure Start centres made a difference across the country, including in Dulwich and West Norwood, where they are still highly valued by parents and carers. Through sheer inspirational determination, Tessa also delivered the greatest celebration of London and Londoners that we have ever known—the 2012 Olympics.

Across everything she did as our MP, Tessa established a clear and principled way of doing politics, based on listening to, engaging with and responding to the concerns of local residents; identifying and working on the issues that matter to all of us and that bring people together; using the currency of personal stories, compassion and kindness rather than trading in statistics and cheap political shots; and, most of all, seeking to empower people and to tackle disadvantage and adversity head-on. It is therefore no surprise to Tessa’s many friends in Parliament, in Dulwich and West Norwood, across London and beyond that she is now using the very difficult personal circumstances of her brain tumour diagnosis to work to make a difference for other people in the same circumstances. It is no surprise, but it is remarkable in a situation where many of us would be focused only on our immediate loved ones, and it is extremely brave.

My own family knows the pain of brain tumour diagnosis. In 1983, at the age of 66, just a year after he had retired from his career as a bus driver and spent his life savings on a small house with an indoor toilet and a garden where he could grow his beloved dahlias, my grandfather George Hayes died from a brain tumour. Seven years later, in a situation so statistically rare that doctors had to be persuaded to take her symptoms seriously, my grandmother, George’s wife Olive, also passed away from a brain tumour, at the age of 71. We know as a family the fear and anxiety that such a serious diagnosis brings, the hopelessness of finding that there is very little that can be done, and the pain of watching loved ones deteriorate and lose capacity at the hands of such a cruel disease.

My first thought when I learned the horrible news of Tessa’s diagnosis was of grandparents George and Olive, and my second thought was that the treatment and prognosis for brain tumours must be much better now than it was then. I looked up the statistics, and was shocked to find that, although brain tumour survival rates have doubled since the 1970s, it is only from 6% to 14% compared with a 10-year survival rate of 50% across all types of cancer in the UK. Brain tumours kill more children and adults under the age of 40 than any other cancer, yet just 1% of the national spend on cancer research has been allocated to brain tumour research. As a consequence of this lack of funding, there is a shortage of drugs, and patient participation in clinical trials for brain tumour patients is extremely low—just 6.4% of adults compared with 61.4% for leukaemia. The survival rates for brain tumour patients after one year are less than 40%; after five years, less than 20%; and after 10 years, just 14%. Time is short for patients and their families.

Tessa has rightly called for more funding for research into treating brain tumours, but she has importantly also called for a more flexible approach to participation in adaptive trials. Such trials allow patients who have a diagnosis that without a breakthrough treatment will certainly be terminal to add new drugs to their treatment plan, or to switch between new medications in a trial rather than having to wait sequentially for each trial to conclude. They are really important. It is also important that better ways are found to share the data from brain tumour patients in order that it can be used for research. This is what most brain tumour patients want, and it is what most members of the public would want, faced with an illness that cannot be cured. Our experience and our data should be used to try to improve the prognosis for others in future.

Tessa has also called for improvements in the way that treatment is provided to brain tumour patients and the wider environment of care. There is still too much variation across the country in diagnosis, referral-to-treatment times, access to specialists and clinical trials, and palliative care for those who need it. We have in this country exemplary services in all of these areas, but they are not available to every patient. That must change. Everyone with brain tumour symptoms should be diagnosed as early as possible; be referred to a specialist centre with access to the most up-to-date surgical techniques and drug therapies; and have access to the very best support services, including counselling as well as physio and occupational therapy. If and when the time sadly comes, everyone should have access to the gold standard of palliative care, which exists in some parts of the country but which is currently not available everywhere.

I welcome the Secretary of State’s engagement with Tessa’s campaign for better research, access to clinical trials, treatment and care, along with the work of the brain tumour Task And Finish Group, Brain Tumour Research and others, but we must make change happen. It is our commitment, Tessa, and my promise on behalf of all those who love you in Dulwich and West Norwood that, collectively, we will take on your campaign, and that your vision of people living better lives for longer with cancer, and with brain tumours in particular, will become a reality.

[Hon. Members]

Hear, hear!

Autism

Helen Hayes Excerpts

Thursday 29th March 2018 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I am pleased to be able to contribute to this important debate. I thank the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan) for securing it, and for all her work in Parliament over many years on behalf of autistic people.

My engagement with autism comes through the many constituents who have contacted me since my election in 2015, through the experiences of friends with autistic children, and through the especially harrowing case of my constituent Matthew Garnett. I first met Matthew’s mother Isabelle in February 2016, when she came to my surgery. Isabelle told me that that Matthew, who was then 15, had been sectioned after a crisis in which he had attacked his father at home. He had been admitted to a psychiatric intensive care unit at Cygnet hospital in Woking, a private unit designed for assessment, diagnosis and onward transfer in which patients should stay for no longer than six weeks, but where Matthew had been for several months. The unit had no specialism in autism, and it has subsequently been closed after the Care Quality Commission found serious failings.

Matthew’s family, in their desperation to see him moved from Woking, had identified St Andrew’s hospital in Northampton as a specialist unit that appeared to have the expertise to meet his needs. I helped them to secure a place there. Soon after Matthew’s move to St Andrew’s, his parents began to express serious concerns about the treatment that he was receiving. There was little evidence that he was participating in any therapeutic or educational activities, he seemed distressed and withdrawn and, most worryingly, he had started to lose weight extremely quickly. When I visited him in St Andrew’s with his family, I was shocked at both the condition he was in, and the attitude and behaviour of some of the senior clinical staff whom I met. The subsequent complaints that his parents and I made, combined with a “Dispatches” documentary on his case and those of others at St Andrew’s, led to investigations, including one by the General Medical Council. I understand that some changes have now been implemented there.

Matthew’s family again identified an alternative provision for their son: Alderwood, also based in Northampton. This time, things worked out well. Matthew is living in supported housing with other young people. He is well and thriving, taking minimal medication, volunteering at the local football club, and participating in his local community. This could not be more different from the time that he spent in hospital, held under section.

I raise Matthew’s case again today because there is still unfinished business arising from it, and because although, thankfully, Matthew is now well and thriving, the experiences that he and his family have had resonate in many different ways with the experiences of autistic people up and down the country, including many of my other constituents.

For too many families, there is a constant struggle to access support. The then Minister responsible for mental health, the right hon. Member for North East Bedfordshire (Alistair Burt), commissioned a review of Matthew’s case from Dr Michael Marsh, and the report was published in June 2016. It catalogues a constant struggle on the part of Matthew’s family with every public service with which they had interacted since he was two years old to secure the support that he needed.

As other Members have said, there is a lack of expertise and understanding of autism across health and education services. I have heard from many parents that the experience of their autistic children in education is only as good as the expertise that any given teacher has in any given year. The hon. Member for Berwick-upon-Tweed (Mrs Trevelyan) spoke of her son’s experience of one particular teacher. The support given to autistic children in school should not depend on accident—on the experience of a given teacher.

In particular, there is a lack of understanding of the relationship between anxiety and behaviour in autistic children. Disciplinary measures do not work if a child’s behaviour results from that child’s being scared or anxious. Such measures will only traumatise children further in those circumstances. I echo what others have said today: not only do we need training for new teachers coming through the system, but we urgently need additional training for existing teachers. They need to learn what autism is and how best to support autistic children in their classrooms.

There is a lack of funding for assessment, diagnosis and SEND support. Too many families are waiting too long for assessment and diagnosis. I have heard many head teachers say that even when families have a diagnosis, it is often still insufficient to draw down the additional support that is needed because of constraints on resources. This is a false economy for families. If we fail children in the education system by failing to give them the support that they need, we condemn them to a life of struggle, often to mental ill health, and often to interactions with the criminal justice system. Moreover, that will certainly lead to much more public sector expenditure in a negative rather than a positive way.

Too many avoidable crises are experienced by people with autism, and that brings me to the importance of community provision. I recently visited a centre called Lifelong Family Links. It is in a neighbouring constituency, but supports many of my constituents with autism. It is a day school and after-school club for young people with autism. It runs on a shoestring, and is now at risk of closure because of funding cuts. The families there to whom I spoke told me that many of their children would be in the criminal justice system—and, in one case, a foster placement would have broken down—without the support provided by Lifelong Family Links.

Again, it is a false economy when in the current atmosphere of austerity we are unable to provide the tiny amounts for what community-based services provide—they deliver so much. There is too much hospitalisation of young people with autism, and that is often in the private sector, with very little scrutiny of the effectiveness of the care and treatment that is provided. Matthew’s private hospital bed cost £12,000 a week of NHS money for care that was making his health worse, and I support Matthew’s parents’ campaign for homes not hospitals for autistic young people.

I wrote to the Minister responsible for mental health and inequalities when she was new in post, and then again in November 2017 to request a meeting to review Matthew’s case and the lessons that can be learned from it, but a meeting has not been forthcoming. I therefore want to end by asking the Minister for Care, who is on the Front Bench today, if she will agree to meet me and Matthew’s family so that we can ensure that the suffering that he experienced was not in vain, and we can deliver the change we need for families with autistic children across the country.

Mental Health Units (Use of Force) Bill (First sitting)

Helen Hayes Excerpts

Committee Debate: 1st sitting: House of Commons
Wednesday 28th March 2018 Public Bill Committees

[Mr Reed]

These amendments are to the clause relating to improving training for staff working in mental health units before they are able to use force of any description against patients. It is clearly better for patient safety that any staff administering force should be properly trained, but it is worth noting that it is also important for staff safety that they are properly trained before they engage in administering force to patients.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I commend my hon. Friend for introducing the Bill. On the need for training, I want to flag my experience of young patients with autism being held in secure psychiatric units. In my experience, there is a lack of expertise and training across the board for staff treating young people with autism, so they fail to understand that much challenging behaviour arises from the intense levels of anxiety experienced by young people with autism. In such circumstances, the use of force further compounds that anxiety, and indeed traumatises those young people. I ask the Minister whether, when laying down guidance to accompany the Bill, specific regard will be given to the lack of training and understanding of autism within our mental health services?

[Mr Reed]

I am grateful to my hon. Friend for making that important point and I look forward to hearing the Minister’s comment. That point has been made to me by many service users and advocacy groups, including Rethink Mental Illness, YoungMinds and others.

Many of the approaches outlined in the Bill ought to be applied more widely for people who experience mental ill health in many other circumstances. I hope that the Government’s ongoing review into mental health will do that. I hope that some of the principles in the Bill will take us forward and allow that review, when it reports back, to make a bigger impact than it perhaps might have made otherwise.

Moving back to the principles of training in general, the Bill includes provisions on training to recognise the Equality Act 2010 and de-escalation techniques that reduce the need for force to be used in any circumstances. The amendment will also strengthen the requirement for trauma-informed care. It is important to include in the Bill that staff are trained in the impact of further traumatising patients, whose mental ill health may have already been exacerbated by forms of trauma.

I am informed by Agenda that more than 50% of female patients in mental health units have experienced physical or sexual abuse by men, which in most cases contributes significantly to their mental ill health. After those experiences, being forcibly restrained—generally by groups of men—can further traumatise those women and make their mental health conditions even worse, so it is very important that staff are fully aware and trained in the risks of re-traumatising patients who have already been traumatised.

It is also important that training takes full account of the risks of unlawful discrimination regarding race. Dame Elish Angiolini’s report last year into deaths and serious incidents in police custody found that:

“The stereotyping of young Black men as ‘dangerous, violent and volatile’ is a longstanding trope that is ingrained in the minds of many in our society.”

We only have to look at pictures of the faces of people who have died in state custody, including in mental health custody, to see how severe the risk of unconscious bias in the system is. A much higher proportion of those faces will be of young black men than the proportion present in the population as a whole. In order to ensure that staff will not be acting out of prejudice against people who enter a publicly funded health service for treatment on equal terms with everyone else, it is important that staff are trained to be fully aware of the risks of unconscious bias and racism in that service.

Putting anti-discrimination training into legislation is a move towards ending such unlawful discrimination, as is the overall aim of the Bill, and towards exposing the use of force to much closer scrutiny by standardising data recording across the whole country, so that it is possible to compare performance in mental health units on the same basis in different parts of the country. That is not currently possible, and it is a loophole that was pointed to by Dame Elish Angiolini in her report. I am pleased that the Bill will close the loophole.

Crucially, staff must also be trained in the use of techniques to avoid or reduce the use of force—essentially de-escalation. That makes the situation safer for everyone involved. It is critical that anything that might trigger behaviours in a patient that could lead to their being restrained should be avoided, if at all possible, so that the use of force can be minimised.

Amendment 86 sets out a revised duty on the responsible person to ensure that training is provided for staff in mental health units. Amendment 87 sets out when training should be provided to staff. It should be provided as soon as the provision comes into force, and there should be refresher training at regular intervals. That will build the institutional knowledge needed to ensure that force will only ever be used as a genuine last resort.

Leaving the EU: NHS

Helen Hayes Excerpts

Thursday 22nd March 2018 Westminster Hall

[Mr Ben Bradshaw (Exeter) (Lab)]

I beg to move,

That this House has considered the effect on the NHS of the UK leaving the EU.

It is a great pleasure to serve under your chairmanship, Mr Stringer. I thank the Backbench Business Committee for supporting the debate and the thousands of our constituents all over the country who pressed for it.

The debate is very timely. We are hopefully on the brink of a formal agreement on a transition deal, which will, over the next few months, very much set the scene for the vital negotiations on our long-term future relationship with the rest of the EU. It is also extremely timely given yesterday’s publication of the Health and Social Care Committee’s second report on the impact of Brexit on our health and social care system. I thank my colleagues on the Committee for the work they put in and all the individuals and organisations that provided us with invaluable evidence.

As you will remember, Mr Stringer, the NHS featured prominently in the EU referendum campaign. We well remember the famous—or infamous—bus that was taken around the country promising £350 million extra for the NHS if we left the EU. Most commentators, and several leave campaigners themselves, have credited that since discredited claim with taking the leave campaign over the line. Our health and social care systems also face one of the most significant impacts from Brexit, so it is absolutely right and imperative that Parliament has the time to focus on and debate the subject before final decisions are taken.

The headlines from our Committee report from yesterday are that, if Brexit goes wrong and there is no deal, or if we have too hard a Brexit, the results will be extremely damaging for patients; our health and social care services; Britain’s important and successful pharmaceutical industry; the supply and costs of medicines and vital medical equipment; our world-renowned scientific research base; the status of EU staff, who help to keep our health and social care services running; and UK nationals living or working on the continent, including British retirees, who depend on reciprocal arrangements to access healthcare.

It is fair to say that the majority of our Committee would rather we were not leaving the EU at all, or that, if we do, we stay in the single market and customs union. That was the near unanimous preference of all our witnesses, whether patients groups; charities; doctors, nurses and their representatives; the drugs companies, which do such vital work to develop and make available life-saving therapies and contribute so much to our economy; the manufacturers of vital medical equipment such as radioisotopes, which are used in the treatment of cancer; and our world-renowned medical research centres.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I thank my right hon. Friend for bringing this debate to the Chamber today. As many Members will know, my predecessor Baroness Tessa Jowell is campaigning, in the face of the cancer that she is dealing with, for greater international research and access to dynamic trials and new treatments for patients suffering from brain tumours. Does my right hon. Friend agree that Brexit puts at risk exactly that kind of international collaboration—that access to data sharing and to international scientific research—that patients suffering from brain tumours and many other conditions need to see move forward, not backwards? This is a grave threat from Brexit.

[Graham Stringer (in the Chair)]

Before I call Ben Bradshaw, let me say that we have sufficient time, given the number of people who want to speak, but may I please ask that interventions are to the point and brief?

Oral Answers to Questions

Helen Hayes Excerpts

Tuesday 6th February 2018 Commons Chamber

[Mr Hunt]

I am well aware of the pressures at Kettering. It is a very busy hospital, and it has undergone a number of changes of management. However, I can reassure my hon. Friend that a big improvement package is there to support it and that we want to take it out of special measures as soon as possible.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

The previous chair of King's College Hospital NHS Foundation Trust resigned because he had concluded that the funding provided for King’s had placed the trust in an impossible position. The current interim chair has said that the proportion of GDP spent on health and social care needs to rise to match that in other European countries if our NHS is to be sustainable. When will the Secretary of State heed the warning cries and commit the funding that King’s and, more widely, our NHS need in order to deliver care to our constituents?

[Mr Hunt]

We spend 9.9% of our GDP on health. The European Union spends 15%, and the richer EU countries spend 9.6%—slightly less than us, on average. We are able to spend more because this Government put the economy back on its feet.

King’s College Hospital

Helen Hayes Excerpts

Tuesday 16th January 2018 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

The good news for our next speaker is that she has an extra 10 minutes for her debate, because we can move straight on.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I beg to move,

That this House has considered King’s College Hospital finances.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am pleased to have secured this debate on the finances at the King’s College Hospital NHS Foundation Trust, which I have been seeking for some months. It has been clear to me that the trust has been heading towards a crisis, which came to a head shortly before Christmas, when NHS Improvement took the trust into financial special measures. The debate is therefore timely.

To date, the Government have responded to the crisis at King’s as if the problem has arisen suddenly in the short term. I want to use this debate today to set out clearly the causes of the problems at King’s, which can be traced back to 2010 and 2013. I also want to ask the Minister to take seriously the complexity of the current situation at King’s and to take action now to allow it to stabilise and rebuild. There is ample evidence of a crisis across the whole of our NHS this winter, and I want to emphasise that the situation at King’s is a warning sign for the NHS that the Government must heed.

My relationship with King’s goes back 20 years. I have been a surgical patient and an out-patient at the hospital. I gave birth to my children there. Both were delivered by the same amazing midwife, whose name we chose as a middle name for our second daughter. My mum worked at King’s for 10 years until she retired. The situation at King’s is as personal and as important to me and my family as it is to tens of thousands of my constituents.

King’s is an extraordinary hospital. As a major teaching and research hospital, it undertakes world-leading work across more specialisms than any other hospital, including liver transplants, maxillofacial surgery, foetal medicine, neurosurgery, neonatal intensive care, cardiology and sexual health. As a major trauma centre, the emergency department saves the lives of critically ill and injured patients every single day. The work of its trauma surgeons is pioneering. Together with the specialist nurses, anaesthetists and other clinical staff, they were at the frontline of treating critically injured victims of the Westminster and London Bridge terror attacks and the Grenfell Tower fire.

In south London, we are enormously proud of King’s specialisms and its major trauma centre, but it is also our district and general hospital, where people have antenatal scans, give birth, have their appendix removed, have hips and knees replaced, have broken limbs fixed, have cataracts removed, recover from strokes, and receive help to manage diabetes, sickle cell disease and many other health conditions. King’s has a very special place in our community. I pay tribute to the extraordinary skill, commitment, dedication and care of the 15,000 staff at King’s. I have spoken to many staff in recent weeks. All of them, including the consultant with 32 years of experience I met yesterday, say that things have never been tougher. I want to put on the record my gratitude for everything they continue to do.

My constituents are desperately concerned about the plight the hospital currently faces. King’s has been on a journey over the past 20 years. Back in 1998, when I was an in-patient, it was a struggling, failing hospital, where patients were treated in overcrowded conditions and waited on trolleys in accident and emergency. Years of Labour investment transformed it, so that by 2010 it was meeting all of its main clinical targets, had recruited many more staff, and was consistently achieving a small financial surplus each year.

I am concerned that, despite the incredibly hard work of the brilliant staff at King’s College Hospital, that journey has come full circle—the days that we thought had been left behind at King’s have now returned. The hospital is regularly more than 100% full, with meeting rooms and storage space being used for beds; it has been consistently failing to meet the four-hour waiting time target in A&E, or the 18-week referral-to-treatment target; and it is not meeting its key cancer targets.

I want to be absolutely clear with the Minister that the causes of the problems at King’s have roots that go back to events in 2010 and 2013, which could have been predicted by the Government and Monitor, and which absolutely should have been prevented. I draw the Minister’s attention to four key issues. First, the rate of funding increase for the NHS was significantly cut from 2010, from 3% to 4% under the previous Labour Governments to 1% under the Tory-Lib Dem coalition Government. There was therefore no way that the funding was ever going to keep pace with inflation, let alone increases in drug and treatment costs and increasing demand. The fact that we are all living longer is a positive thing, but since older people use health services far more than younger groups in the population, it creates an entirely foreseeable increase in the need for health services. That can be managed and minimised when good-quality social care is available to everyone who needs it, but over the same period £6 billion has been taken out of social care. At the Princess Royal University Hospital, which is part of the King’s trust, 20% of older patients are clinically fit for discharge but have nowhere to go—a direct example of the extra burdens that the Government’s inadequate approach to social care is having on the NHS. The false economy cuts are simply adding to the pressures in our NHS, as people who should be able to maintain their health at home with good support end up requiring acute care.

The second key issue affecting King’s is a result of the 2013 decision for it to take on two hospitals—the Princess Royal University Hospital and Orpington Hospital—from the failing South London Healthcare Trust. Following that decision, the Government and Monitor should have insisted on a review period to ensure that the new expanded trust had the right level of support and resources to run the hospitals, but they did not do so. From that moment on, the finances of the new trust deteriorated rapidly. The situation at the Princess Royal was far more complex than anticipated, but there was no review of funding in the light of new and more detailed information about the level of investment required. That 2013 decision fundamentally destabilised the finances of the trust.

The third issue is the challenge of the competing responsibilities of emergency care, including the trauma centre and elective surgery. The King’s trauma centre generates its own demand, which increases year on year, but the funding for emergency medicine is by way of a block grant. There is no increase in funding that is in any way responsive to that demand. It cannot be right that, when King’s staff step up to the plate in response to terror attacks or the Grenfell Tower fire, there is no additional funding to cover the costs of the additional work. Elective surgery is paid for by procedure, so when the demands of emergency admissions, whether because of an increase in flu cases, or a major incident, force elective operations to be cancelled, there is loss of income in addition to an increase in costs. That creates knock-on financial consequences for the trust as a whole.

Fourthly, the limited capital funding since 2010 has meant that staff at King’s have not been able to plan strategically for the facilities the hospital needs to cope with increasing demand. The King’s College Hospital site at Denmark Hill is very constrained for a major hospital, and it has been developed piecemeal over many years. Large parts of the hospital estate are no longer fit for purpose, and additional ward space is urgently needed. King’s will open a new state-of-the-art critical care unit later this year, the largest in the country, but the trust has not been able to expand its general ward capacity, which will potentially result in additional pressures as patients leaving critical care compete with emergency admissions and elective surgery patients for insufficient beds.

The four challenges I have described have been evident for some time, but the Government’s approach, rather than to undertake a review of the finances and agree a sustainable funding settlement, has been to set more and more unrealistic targets for financial savings; to refuse King’s the sustainability and transformation funding that other hospitals have been awarded; and to fine King’s for being in a challenging financial situation.

Since 2015, at the behest of Monitor and later NHS Improvement, vast sums of money that could have been spent on patient care have been spent on management consultants. At one stage the trust was paying a single firm of management consultants more than £1 million pounds a month. The trust has been asked to make punishing savings when it has no control over the demand for its services or some of its costs, but the management consultants have not been judged on their ability to deliver sustainable, lasting improvements—theirs has been a one-way street of throwing good money after bad.

It is absolutely the case that the Government have known about the financial situation at King’s for some considerable time, yet on top of an already unmanageable financial situation, the Government proposed completely unrealistic control totals, in essence setting the hospital an unachievable target for making savings, then punishing it with financial penalties for failing to do so. Since last year, King’s has been under enhanced regulatory oversight by NHS Improvement, technically a similar situation to being in financial special measures, with NHSI staff permanently in the hospital and a high level of scrutiny.

Over the past three years King’s has made savings of more than £200 million, more than twice the average level of savings of trusts across the country over that same period. King’s has done that while maintaining standards of care that are on the whole very good. The Government have known about the financial situation at King’s for three years, the Government have been directly involved with the situation at King’s, and the Government are culpable, yet instead of taking responsibility for the situation and acting to ensure that King’s has the resources it needs, the Government have required King’s to do the impossible and punished the trust when it has been unable to deliver.

The Government must now take responsibility for the situation and ensure that the King’s College Hospital NHS Foundation Trust is not allowed to fail any further. I therefore ask the Minister to do the following: to undertake a full review of the finances at King’s, starting with an analysis of what is required to deliver safe and effective care across all areas of treatment and responsibility; to make a commitment that financial special measures will not mean just forcing through the proposed control totals, which simply cannot be met without jeopardising patient care; to guarantee that there will be no threat to any of the services provided at King’s on which my constituents and residents in the wider south London and the south-east area rely; to agree a capital funding settlement to enable King’s master plan for Denmark Hill to be implemented, so as to deliver the space and facilities the hospital needs now and for the future; to guarantee that financial special measures will not mean an increase in the interest rate that King’s is charged on its deficit; and to revise the funding formula so that King’s is not hit financially when it steps up to respond to major incidents and London-wide emergencies.

I will end with this: King’s is a special trust and some attributes of it are unique, but the pressures and challenges it faces can be found in NHS hospitals up and down the country. Until the Government recognise that and choose to make a long-term commitment to fund the NHS to provide the services our ageing population needs and to stop the outflow of NHS funds into private profits, our NHS is not safe in their hands.

[Several hon. Members rose—]

--- Later in debate ---

[Stephen Barclay]

Indeed, I am happy to give consideration to the point my hon. Friend makes, although if one looks at the deficit for this year, which I will come on to in my remarks, one will see that the bulk of the deficit is not from the Princess Royal but from the other sites, so it does not pertain to the 2013 decision. I will come on to that more fully as I develop the case.

I will also say to the right hon. and learned Member for Camberwell and Peckham (Ms Harman), who recognised that the staff at King’s want to deliver, that I agree with her on that point. It is not about apportioning blame to those members of staff. Indeed, the financial special measures are about giving additional assistance to King’s to address those points, rather than seeking to blame them. I think there is a shared desire from both sides of the House to get the right outcome for King’s. I am very happy to agree with her on that.

It is a fact that King’s is a challenged organisation. We are putting a lot of effort into supporting it. King’s is receiving substantial financial support from the Department. The trust has received more than £100 million of support to maintain frontline services, the second-highest level of support to any individual trust across England. Placing King’s in special measures for financial reasons is a regulatory action to bring about swift improvement and address the trust’s financial challenges. NHSI is working with the trust to undertake a rapid review and agree a financial recovery plan.

Under the financial special measures programme, the trust will receive extra help and oversight, with the appointment of a financial improvement director. The organisation will also be required to draw up and deliver a plan to improve its finances, which NHSI will closely monitor. That will include support from peer providers where appropriate. On top of those special measures, NHS Improvement has also appointed Ian Smith as a new and experienced interim chair for King’s, to take control of the organisation’s position. He was appointed, as I am sure the hon. Member for Dulwich and West Norwood is aware, on 21 December and took up that role with immediate effect.

It is a fact that some profound financial issues at the trust need to be addressed. The trust agreed a budget deficit of £38.8 million in May 2017, yet just five months after the board had agreed that deficit it submitted a re-forecast deficit of £70.6 million, and a further two months later, in December 2017, the trust informed NHS Improvement that its current mid-case projection had worsened again to around £92 million. So, an agreed board position of a deficit of £38.8 million had within seven months gone up to a deficit of £92 million. That is really at the heart of this. When measured, that level of deterioration is an outlier, which is why the chief financial officer and chief operating officer both resigned in November 2017, and the chair resigned, as hon. Members have pointed out, in December 2017.

When announcing the financial special measures, Ian Dalton, the chief executive of NHSI, noted of other hospitals that

“none has shown the sheer scale and pace of the deterioration at King’s. It is not acceptable for individual organisations to run up such significant deficits when the majority of the sector is working extremely hard to hit their financial plans, and in many cases have made real progress.”

[Helen Hayes]

The extent of the financial challenge facing King’s is well documented, and I recognise the figures that the Minister quotes. However, he has not yet recognised the extent of financial savings that King’s was already making. It is not an organisation that had been resisting the need to make savings; it has been making, on average, double the level of savings of any other trust in the country. That points to a situation in which the level of resource afforded to the trust is simply not enough to deliver the day-to-day responsibilities of keeping patients safe. Will the Minister recognise the extent of the effort that has gone into saving significant amounts of money out of the trust’s finances?

[Stephen Barclay]

I am happy to recognise the hon. Lady’s point that significant savings have been made. However, the regulators found that there had been an over-reliance on non-recurring savings, rather than on delivering the cost improvement programme. For example, King’s has the highest cleaning costs per square metre, at £71, compared with the median of £41 per square metre. Indeed, in her remarks the hon. Lady talked about the cost of bringing in consultants such as McKinsey, which the King’s board itself brought in. The concern is the slow pace at which those cost savings and efficiencies have been delivered on the back of those reports.

The trust has also been in breach of its licence for financial governance since April 2015. That followed an investigation by Monitor in March 2015 after the trust was unable to resolve long-standing problems at the Princess Royal University Hospital, which it took over, as Members have pointed out, in October 2013. As part of Monitor’s enforcement action, the trust was required to produce and implement an effective short-term recovery plan and a longer-term plan to ensure that patient services were improved and that they were provided in a sustainable way for the future.

The trust does not routinely report its financial performance by site, but analysis shows that the trust confirms that the losses by service are across many services and across both main sites. As I remarked in my opening, while the deficits at the Princess Royal are proportionally, as a percentage, higher than at Denmark Hill, in absolute terms the majority of the deficit is at Denmark Hill. That speaks to the point raised by my hon. Friend the Member for Central Suffolk and North Ipswich, who is not in his place, about the legacy from the Princess Royal.

The trust also faces a number of other challenges. King’s has not met the referral to treatment standard—RTT—since January 2015, at which point the board took a decision to suspend its performance data reporting. The trust resumed reporting of the RTT performance data again in March 2016. Following the deterioration in performance throughout 2016-17, NHSI undertook an investigation into the RTT governance and the drivers of the deterioration, which was completed in July 2017. An action plan based on recommendations from that investigation was subsequently developed by the trust and agreed by NHSI. Again, while the hon. Member for Dulwich and West Norwood says that this is a sudden, late intervention by the Government, a chronology of action and support can be shown.

Taken together, these challenges are the reason why NHSI has invested a lot of time and effort in supporting the organisation. It has provided a member of staff on secondment to the trust for two days per week to support the delivery of the action plan and to strengthen governance around RTT performance and reporting. Delivery against the action plan is monitored by NHSI through its formal monthly provider oversight meetings with the trust, and it is working closely with the trust to agree an appropriate timeframe for the sustainable return to compliance.

King’s has received more than £350 million-worth of working capital since 2015-16, and was also successful in securing a £47 million capital loan in April 2017 relating to Windsor Walk. Along with other trusts, King’s has also benefited from £21 million of public dividend capital funding since 2013, covering many central programmes including cyber security and digital care. In the last three years, King’s has invested in new capital assets in excess of the level needed just to maintain their asset base and above the average across all foundation trusts and NHS trusts.

The Department of Health commissioned Deloitte to review the trust special administrator’s analysis of the split of South London’s deficit, pertaining to when the Princess Royal came within the trust, and to provide an updated view of the split of the forecast out-turn deficit for 2013-14. Its assessment of the Princess Royal University Hospital’s share of the deficit for the full year was approximately £22 million. The trust reported deficits in the three subsequent years, despite significant other integration cost and bridging support revenues. It brought in PwC in the autumn of 2014, and appointed a turnaround director to initiate a financial recovery plan process. The trust then had McKinsey in during 2016-17 to drive a transformation programme, which has been very slow to yield the significant benefits that were promised.

The trust has been subject to enhanced financial oversight since March 2017, which includes the following support from NHSI: a senior financial adviser embedded at the trust; monthly financial oversight meetings with NHSI; participation in the financial improvement wave 2 programme; and, since April 2017, the trust has also received dedicated support from NHSI’s transformation and turnaround team as part of its enhanced financial oversight. More recently, in 2017-18, the trust has had external support from PwC, Ward 20/20, and Bailey & Moore. We need to be clear about what has caused the recent problems at King’s, including its recent rapid deterioration, and what has not, but it is not a lack of support and consultancy.

The argument that the cause of King’s problems can be found in the merger with Princess Royal, which several Members raised as a contributory factor behind the subject of the debate, does not stand up to scrutiny. In October 2013, King’s College Hospital Foundation Trust completed a transaction to acquire Princess Royal University Hospital and Orpington Hospital on the back of the trust special administrator’s recommendations regarding South London Healthcare Trust. The trust also took over responsibility for additional services at Beckenham Beacon, Sevenoaks Hospital and Queen Mary’s Hospital, Sidcup.

In the summer of 2013, King’s presented a five-year integration plan that showed small net surpluses of £2 million to £4 million in each year from 2013-14 onwards. The plan was assessed to be of medium risk by Monitor’s assessment team, but was none the less plausible thanks to generous support funding agreed by the Department of Health and NHS England at the time. The trust’s current financial problems reflect, as I said earlier, a continued overreliance on non-recurring savings, instead of delivering recurring benefits through cost improvement programmes and especially a failure to improve medical productivity at both the Denmark Hill and Princess Royal sites.

Model Hospital data, which is available to the trust, suggests that the trust has significant opportunities for efficiencies in areas such as orthopaedics. NHSI is supporting the trust to develop its cost improvement plan programme for 2018-19, which includes developing schemes based on validating those potential opportunities.

While there is never a single cause in such cases, and while we have acknowledged the pressures being felt across the system, the clear conclusion to draw from the evidence is that King’s was an outlier in financial terms and had lost its grip of its finances in recent months. I spoke with the trust’s chief executive yesterday and he acknowledged that there had been a serious problem with the trust’s financial planning process. Defects in the way the trust’s plan was put together eroded the regulator’s confidence in the trust, and it is for that reason that the trust has entered into special measures for its finances. The financial special measures regime has a proven track record of success in supporting trusts, as shown with North Bristol NHS Trust, which recently exited the special measures regime.

In losing control of its finances in the way that it has, King’s has effectively taxed others in the NHS, which is why it is right that NHSI took action in the way that it did. This organisation got itself into a very bad financial position and now needs a great deal of help and support. As the right hon. and learned Member for Camberwell and Peckham set out, we can agree on both sides of the House that King’s needs support. It is for that reason that the regulator has intervened to put it into special measures.

[Helen Hayes]

I thank the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who is not in his place, for bringing his experience to the debate. I am pleased that, having looked at the issue in some considerable detail when he was a Minister, he recognises, as the Minister seems not to, the problems that the merger of King’s with the Princess Royal and Orpington Hospital has caused for the trust.

The fact of the matter remains that the trust’s finances were stable and it was performing well on every measure until that merger took place. It has never been the same since. The combination of the drop-off in the increase of funding year on year, which has affected the finances at Denmark Hill and the organisation’s resilience to carry across costs to the Princess Royal and Orpington, with the irresponsible lack of a review mechanism for the funding settlement post-merger has, in my view, played a major role in destabilising the finances.

I thank my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), who has been a formidable champion for King’s for more than 35 years. She knows very well from direct experience exactly how bad things have been in the past at Denmark Hill, and how close we are to seeing once again those terrible circumstances of patients waiting far too long in A&E to receive the treatment they need so badly.

In summing up, I want to highlight two points on which I disagree with the Minister’s analysis. First, notwithstanding the support that the Government are putting in, they maintain a punishing approach to the finances of NHS trusts that are in financial difficulty. A system for funding our NHS that takes a trust that is already under financial strain, fines it and charges it additional interest for failing to meet impossible targets is a system that makes no sense at all. A system for funding our NHS that funds on a block grant basis emergency admissions, the volume of which hospitals have no control over, and then cancels elective operations, which deliver the revenue into our hospitals when pressures come through the front door of accident and emergency, is a system that makes no sense. The Minister has not addressed that conflict and the perversity in the funding system for the NHS.

Finally, I urge the Minister to consider very carefully the need for substantial capital investment in King’s at Denmark Hill. I am concerned that when staff at King’s hear talk about failures in efficiencies, and when the Minister talks about the failure to improve medical productivity, the inference is that staff are somehow not working hard enough.

[Stephen Barclay]

To clarify, that is absolutely not the point. The point is about billing and how rotas are managed. It is not about whether staff are working hard or not. We very much recognise that they are.

[Helen Hayes]

I am grateful for that clarification, but that needs to be communicated very clearly to staff, who are feeling the pressure of this crisis. When we talk about efficiencies at King’s, they are in a lack of buildings, ward capacity and fit-for-purpose facilities to deliver when facing the challenges that are coming through its front door every single day. That matter urgently needs to be addressed as part of this turnaround process.

Question put and agreed to.

Resolved,

That this House has considered King’s College Hospital finances.