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.

NHS Winter Crisis

Helen Hayes Excerpts

Wednesday 10th January 2018 Commons Chamber

[Jonathan Ashworth]

My hon. Friend speaks eloquently about the pressures on her local hospital. She will also be aware of how foolhardy it would have been to close the Eastham walk-in centre on the Wirral, as was proposed because there were not enough staff at Arrowe Park Hospital. Fortunately, because of her campaigns and those of my hon. Friends the Members for Wirral South (Alison McGovern) and for Wirral West (Margaret Greenwood), the Eastham walk-in centre has been saved. That is because of Labour MPs working in their constituencies.

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

King’s College Hospital NHS Foundation Trust in my constituency, one of the largest trusts in the country, has recently been taken into financial special measures. Does my hon. Friend agree that the failure of King’s is a canary in a coalmine for the NHS, and must be a wake-up call for the Government on the level of resource that our outstanding NHS staff need so that they can deliver for patients? Will he join me in calling on the Health Secretary to ensure that King’s emerges from financial special measures with the additional funding it needs to deliver safe, effective, world-leading care for patients?

[Jonathan Ashworth]

I am grateful to my hon. Friend for raising this issue. She has been a passionate defender of King’s, speaking out in this House on numerous occasions. Before Christmas, we saw the resignation of Lord Kerslake as the chair of King’s, when he spoke out about the real pressures facing our NHS, which were dismissed at the Dispatch Box by the then Minister when we had a debate in this House.

King’s College Hospital Foundation Trust

Helen Hayes Excerpts

Tuesday 12th December 2017 Commons Chamber

[Mr Dunne]

What is particularly disappointing about King’s is that it does have a cost improvement programme, but regrettably, it has not been able to keep to it. It is particularly surprising that, as recently as October, the senior leadership team indicated that they were on track to meet their deficit, which palpably, as we now realise, was not the case.

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

King’s College Hospital is in my constituency, and I can tell the Minister that the roots of this current financial crisis go back to 2013, with the collapse of the South London Healthcare NHS Trust and the decision to incorporate two additional hospitals, which were failing in their services, into the King’s trust without adequate funding to support that decision. This has been followed by year-on-year, real-terms revenue cuts and next-to-zero capital funding, while demand and need in our community is going up all the time. Instead of scapegoating a well-respected public servant, will the Minister listen to his wake-up call and look again at holding a full review of the finances for King’s College Hospital, and will he give the trust the resources it needs, so that the exceptional doctors and nurses who work for it can deliver the care and treatment that patients need and deserve?

[Mr Dunne]

I share the hon. Lady’s support for the clinicians and professionals working in her trust, who are doing the best job they can in admittedly challenging circumstances. I do not accept her characterisation of a lack of capital provided to King’s. I have been there myself and seen some of the building work going on. I am happy to look at the circumstances surrounding what happened in 2013, but they are not as relevant to today’s situation as the way the trust’s financial management has deteriorated in recent months.

Mental Health Units (Use of Force) Bill

Helen Hayes Excerpts

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

[Oliver Dowden]

I thank the hon. Lady for her intervention. I know that she, like me, greatly values the work of our public sector workers. With respect, I was seeking to respond to interventions from other Opposition Members, and if they will refrain from making political interventions, I will happily refrain from rebutting them.

The root of this can be traced back to my constituency of Hertsmere, which I proudly represent and in which I was born and grew up. I remember the way in which mental health was treated during my childhood. We are on the edge of London, and London was historically surrounded by very large mental health institutions. In my own constituency, we had facilities such as the very large hospitals at Harperbury and Shenley. In many ways, those institutions had a positive ethos. I am fortunate to represent many mental health nurses who worked in those institutions and who still live in the constituency, and there was certainly a positive ethos of rehabilitation and providing a safe, calm space for people. However, the flipside of that was a tendency to put people in those institutions, shut them away and never think about the problem again. It is absolutely right that, under successive Governments, we have sought to change that approach. We now mainstream mental health problems, certainly in my own constituency and I am sure in many others.

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

I believe it is important for the hon. Gentleman to acknowledge that there are still far too many young people with autism and learning disability living for the long term in hospitals. Does he acknowledge that that problem is related to the resources available for their care and how those resources are spent? I believe that we need a shift towards properly resourced community settings for people with autism and learning disability, who really should not be in hospital for the long term.

[Oliver Dowden]

The hon. Lady makes an important point. The closer to the community the treatment can be given, the better the treatment will be. I see this with my own constituents. If they are having to travel long distances, particularly with younger children, to access mental health care facilities, that can only add to the disruption in their lives. However, I believe that a journey is taking place in all of this, and I am glad that the Government are addressing the need for that journey.

The experience of many of us is that mental health is now delivered at the primary care level. From speaking to GPs in my constituency, I know that they are now on the frontline of the process. What is the answer? The first thing is to ensure that we have parity of treatment between mental and physical health. A broken limb is a serious injury and the patient is patched up and treated properly—no one doubts that they have had an injury. However, it has been the case for too long that if people have a mental health condition, it is not immediately treated with the same seriousness, and there is a sense that the person concerned has to prove that they have a problem in the first place.

Social Care

Helen Hayes Excerpts

Wednesday 16th November 2016 Commons Chamber

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

I want to pay tribute to the careworkers across the country who will be spending today and every day looking after vulnerable adults in their homes and in residential settings. The work they do is hard—often impossibly hard in the current context. On too many occasions, they are paid very little, and they are often provided with little training to equip them for their work.

I am a member of the Communities and Local Government Committee, which is undertaking an inquiry on adult social care. The Committee is yet to report, but, for my part, I think that much of the evidence we have seen and heard to date is damning. The proportion of GDP we spend on social care is falling at a time when need and demand are rising and will continue to rise. That is being felt in a system that is barely able to cope.

The Committee has heard evidence from local authorities that are having care contracts handed back by providers that cannot make them work, with careworkers facing impossible case loads. We have seen evidence of negligent providers, with owners paying themselves six-figure salaries while failing to provide even the most basic standards of care.

Last month, I attended the launch of the CQC’s “State of Care” report. David Behan, the chief executive of the CQC, spoke about how he and his team had agonised over whether to use the phrase “tipping point” in relation to social care, but, in the end, they decided that it was an accurate description for the state of the care sector. While there is much good practice and high- quality care, structural problems in the sector and with the resourcing of care are leading to more and more care being provided on a basis that is simply not sustainable. As that happens, the scope for error and neglect, and for vulnerable people to be let down, is growing.

The Government’s approach to funding social care simply is not working. While take-up of the 2% social care council tax precept is high, many local authorities have told the Committee that the funds raised simply do not cover the shortfall left by the cuts to their budget in preceding years—still less the cost of the national living wage, and still less the increase in demand. The back-loading of the better care fund to the later years of the current Parliament is not working. I asked a local government Minister earlier this year whether he thought that that back-loading created a risk that smaller care home providers would exit the sector in the short term, leading to a loss of capacity at a time when demand is growing. He assured me that that would not be the case, but we are now seeing evidence that that is exactly what is happening. Often, local authority funding does not cover the full cost of providing care, and there is no slack in the system to provide the investment needed to improve facilities and performance where necessary, so many providers are simply moving out of the market.

I recently visited a care home in my constituency that is provided by a small charity and is rated good by the CQC. The manager told me that, time and again, what the local authority agrees to pay does not meet the full cost of the care provided by the care home, and that it regularly subsidises residents from its reserves. That situation is completely untenable in the long term. I am very concerned that, by the time the increase in the better care fund is available in 2019-20, many small providers will have found the financial strain too much to bear, and that there will be a significant drop in capacity at the precise time when we will need capacity to meet growing need.

The quality of our care sector matters so much, because the way in which we look after our most vulnerable residents is a mark of our civilisation, and because the need to care for frail and elderly relatives is an issue for every single family in the country at some time in their lives. Our social care system is not delivering the quality of care or the dignity and compassion that our vulnerable residents need. Neither is it delivering sufficient support for our unpaid carers, whether that is due to a lack of respite provision or to the difficulties that too many carers face in obtaining the assessment of their own needs, which is their statutory right. The underfunding of adult social care is, in turn, having an enormous impact on our NHS through avoidable hospital admissions and delayed discharge, and there is also the mental health impact of loneliness and isolation.

The Government must act now to address the state of our care system. We need more funding for social care—that cannot be denied—and I call on the Government urgently to bring forward the increase in the better care fund. We need a commitment to training for care staff and to fair terms and conditions, and I call on the Government to adopt the Unison ethical care charter as the standard for care across the country, because we know that better paid, better qualified and fairly treated carers also provide better standards of care. We need a fully integrated system that recognises the benefits and savings that can come from ensuring that vulnerable adults are well cared for and supported to live independently and remain active for longer. We also need support for unpaid carers, who save the taxpayer billions of pounds by providing care that would otherwise need to be provided by the state. Cuts in respite care, a lack of mental health support and inadequate carers’ assessments are a false economy, and the Government need to support carers to do their vital work without being pushed to breaking point.

I hope that the Minister will respond to the debate by confirming emergency measures to address the crisis and a wholesale review of the care sector so that it can be established on a fit-for-purpose, sustainable footing for the future. I also hope that the Chancellor will use the autumn statement to introduce proposals for the sustainable funding of social care, to relieve the burden on our NHS and, most importantly, to enable all our vulnerable adults to live well supported, with dignity, for the whole of their lives.

Young People’s Mental Health

Helen Hayes Excerpts

Thursday 27th October 2016 Commons Chamber

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

I beg to move,

That this House notes the recommendations of the Youth Select Committee report of November 2015 on Young People’s Mental Health; endorses the findings of that report on the need for more support from the Government for mental health services for young people; acknowledges steps taken by the Government, since its response of January 2016 to that report, with regard to some of its recommendations; and calls on the Government to set out what further progress has been made since its response and what its plans are further to improve mental health services for young people.

The motion concerns the report of the Youth Select Committee on young people’s mental health and the Government’s response to that report. I am grateful to the Backbench Business Committee for allocating time for the debate, the application for which was supported by more than 50 members from across the House, and to the hon. Member for South Cambridgeshire (Heidi Allen) for co-sponsoring the debate.

I start by paying tribute to the many health professionals and voluntary sector organisations working in mental health services for young people, the teachers and teaching assistants who support young people with mental health difficulties in classrooms every day of the week and the youth workers seeking to support our young people in many different ways. This debate is not about the commitment of those who work tirelessly to support our young people but about the resources and the framework within which they are working, which affect our collective ability to deliver the outcomes we need.

The Youth Select Committee report on young people’s mental health was published in 2015, as a consequence of more than 90,000 young people voting for the subject of mental health in the 2014 Make Your Mark ballot. It is an exceptionally important piece of work because it is a report on mental health by young people, about young people. Since I was elected last year, I have been struck by how often young people’s mental health issues have been raised with me; whether by individual constituents struggling to access the support that they or their children need, doctors in my local accident and emergency department or teachers in our local schools. The issue is raised very frequently, and no one thinks the current situation is even close to being acceptable.

I pay tribute to the Youth Select Committee for its excellent, rigorous report and clear recommendations, which fall into three areas: funding and the state of services; a role for education; and awareness, stigma and digital culture. The report concludes that mental health services are significantly underfunded, and young people’s mental health services even more so, and that the challenge posed today by young people’s mental health is unprecedented. It highlights significant problems in accessing services, particularly in relation to first contact through GPs, and raises the urgent need for every young person in the UK to leave school with a good understanding and awareness of mental health, empowered and equipped to look after their own mental health.

[Mr Kevan Jones (North Durham) (Lab)]

Does my hon. Friend agree that some of the issues on access that are raised by this very good report could apply equally to adult services, so there is clearly a read-across between the two?

[Helen Hayes]

My hon. Friend is absolutely right to say that, although today we are debating young people’s mental health, many of the same issues apply to mental health services across the board for all members of our communities.

The Government published a response to the Youth Select Committee report in January 2016. That response was, on the whole, disappointing. It referred mainly to work that the Government were already doing rather than the additional work that they and other agencies clearly need to do. Most disappointing of all, the response rejected the key recommendation that statutory levels of attainment in mental health education should be introduced for all young people. I welcome the fact that the Government have subsequently announced some additional funding for young people’s mental health, but I remain very concerned about the current state of mental health services for our young people and the resourcing of those services.

I will focus, therefore, on the current state of services, and what I believe to be evidence of a crisis that is growing, not diminishing, and demands a response far bolder and more comprehensive than that which the Government are currently offering. I will also return to the conclusions of the Youth Select Committee report.

One in four of us will experience mental ill health in any given year. That means that mental health is something that affects every one of us. All of us have a friend or family member who has mental ill health, and many of us will experience mental ill health ourselves. I have known close friends and family members who have suffered from severe anxiety that impacted on their daily lives, clinical depression and eating disorders. There are few worse feelings than the worry for a loved one who seems unreachable in the pit of depression, except perhaps the worry when that loved one is a child. All any of us wants for our own children and the young people we represent is that they grow up happy, healthy and resilient to the stresses and strains of our world. Watching a precious child struggle with clinical depression, severe anxiety or an eating disorder is absolutely devastating.

According to NHS statistics, around one in 10 children and young people has a diagnosable mental health condition; that is around three students in a typical classroom. Many more young people do not have a diagnosable condition but experience a period of mental ill health or emotional distress during their childhood or adolescence. The Government’s own measures of children’s wellbeing found that almost one in four children showed some evidence of mental ill health. Half of mental health problems are established by the age of 14 and three quarters by the age of 24.

Shockingly, suicide is the most common cause of death for boys aged between five and 19, and the second-most common for girls of that age, after traffic accidents. A recent survey by Girlguiding found that 69% of girls aged seven to 21 feel that they are not good enough. It is thought that around one in eight young people self-harm between the ages of 11 and 16.

[Ms Karen Buck (Westminster North) (Lab)]

I know that my hon. Friend also has concerns, which a number of us share, about serious youth violence. Does she agree with me that mental ill health is now understood to be a key trigger in gang and serious youth violence, and that this deserves a serious and concentrated focus from within the health service and the Government? There is some very good practice out there. It is, sadly, nothing like widely available enough to help us deal with this problem.

[Helen Hayes]

My hon. Friend makes a very powerful and important point. This is an issue that affects both our constituencies to a significant degree.

Only 0.7% of NHS funding is spent on young people’s mental health and only 16% of that funding is spent on early intervention. The Royal College of Psychiatrists also reports that additional funding the Government have committed to young people’s mental health is not getting to the frontline. Responses to a recent freedom of information request from my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) revealed that although the Secretary of State made a commitment that the proportion of funding for mental health services should be increasing everywhere this year, and this is desperately needed, 57 of the country’s clinical commissioning groups are actually reducing the proportion of funding for mental health services.

The charity YoungMinds reports that three quarters of young people with mental health problems may not get access to the treatment they need. Child and adolescent mental health services, on average, turn away nearly a quarter of children referred to them for treatment by concerned parents, GPs, teachers and others. That finding is supported by evidence from the Association of Colleges, which reports that, of 127 colleges responding to a survey, many reported real difficulties referring students on to health services in times of crisis, with 61% of respondents reporting that their relationship as a college with local mental health services is only “fair” or “not very good/non-existent”. The thresholds for support are going up at precisely a time at which demand for services is increasing. This has the potential to create a ticking time bomb of mental ill health for the future.

The average waiting times for all CAMHS providers was six months for a first appointment and almost 10 months for the start of treatment; and an investigation by Pulse recently found that three in five referrals from GPs to CAMHS are being batted back to primary care without any access to specialist support. When early intervention is not available, it is very often schools and colleges that end up dealing with the consequences, and they are woefully under-resourced to do so. A recent survey by the National Association of Head Teachers found that only a third of primary schools have access to a school-based counsellor, and that of those who do have access, 59% have a counsellor on the school site for one day a week or less.

[Helen Whately (Faversham and Mid Kent) (Con)]

I commend the hon. Lady for securing this debate on this very important subject, which often comes up in my constituency work. She makes a point about schools struggling to find support. That is certainly something I have experienced in my constituency, so I want to reiterate the point that primary and secondary schools know they have children who could really benefit from more specialist support and it is very hard for them to access it.

[Helen Hayes]

I agree with the hon. Lady completely. As we focus on prevention and early intervention, we need to think about early intervention in terms of age, as well as the stage of mental ill health.

As a consequence of the lack of early intervention support, the number of young people attending A&E because of a psychiatric condition has more than doubled since 2010. I have spoken to many doctors who tell me that when this happens and a seriously unwell young person presents at A&E needing a CAMHS in-patient bed, they frequently wait a very long time—sometimes days—for a bed to be identified. Often that bed is hundreds of miles away from home. One south London hospital has provided me with data that show a 37% year-on-year increase in the number of under-16s being seen in A&E with a mental health condition, and a 193% year-on-year increase in the number of those children being admitted to an in-patient bed.

[Mr Kevan Jones]

Does my hon. Friend agree that while there is a shortage of beds, another issue, particularly in cities such as London, is poor quality housing? In cases where individuals could perhaps have been treated at home and in the community, that treatment cannot be delivered because of the lack of proper housing.

[Helen Hayes]

My hon. Friend is right. There are multiple causes and contributory factors to mental ill health, and multiple contributory factors that present obstacles to addressing that and providing the treatment people need, where they need it. Housing is certainly one of them.

In London, 69 young people from Lambeth, Lewisham, Southwark and Croydon were unable to receive in-patient care in the South London and Maudsley Trust. Of those, 45 were sent out of London for their care. This issue, of seriously unwell young people being sent a long distance away from home to access in-patient care, needs to stop. It is distressing for families, it stops young people receiving the maximum possible support from family and friends to help them recover, and it makes them more vulnerable. When young people are admitted to a CAMHS in-patient unit, very often the service is not what it should be. The Care Quality Commission found that 62% of CAMHS in-patient wards and units were inadequate or required improvement.

The goal of parity of esteem for mental and physical health was introduced into the Health and Social Care Act 2012 via an amendment by Labour peers, and was a landmark in the way that mental health services are considered. However, we only need to think for a moment about what our response would be if some of the statistics on young people’s mental health related to a physical condition to realise just how far away we are from the stated objective of parity of esteem being realised. Just imagine if 75% of people with a bacterial infection struggled to get access to treatment; if almost a quarter of referrals for cataracts were turned away; if people with a chest infection were routinely forced to wait until they had pneumonia before any help was provided; or those with a broken leg were forced to wait for days in A&E only to be sent to a hospital hundreds of miles away to be treated. It would be a national scandal. The state of our mental health services, particularly those for young people, is a national scandal: it just is not being recognised as such. Words alone cannot achieve parity of esteem; the Government must start to act differently.

What action, then, is necessary to transform mental health services for our young people? I want to return now to the conclusions of the Youth Select Committee report. The Royal College of Psychiatrists highlights three recommendations in the report, which it believes are key. First, the Government must increase funding for young people’s mental health services and ensure that this funding is ring-fenced to guarantee that the money “reaches the ground” to CAMHS. There is particular concern at the moment about the introduction of sustainability and transformation plans across the NHS, and the resourcing implications of those plans. The Royal College of Psychiatrists recommends that the Government introduce ring-fenced funding for CAMHS and rejects any sustainability and transformation plans that do not clearly set out a plan to improve children’s mental health services in their area. I hope the Minister will commit to that today.

Secondly, health services must pursue co-production, in which young people themselves are involved in the process of formulating policy to improve CAMHS. Research shows that where young people have a clear voice in service design, the end result much better reflects the real needs of the patients.

Thirdly, the Government must focus on improving mental health education in schools, with the aim of ensuring that young people leave school with not only an understanding of mental health, but an understanding of how to help their own mental wellbeing. This recommendation was made by the Youth Select Committee and it is supported by the Education Committee, the National Association of Head Teachers and other teaching unions, the United Nations and many others. The Government have introduced new lesson plans for the personal, social, health and economic curriculum, but there is a broad consensus across the health and education sectors that the role of mental health education in developing resilience, preventing mental ill health and safeguarding young people is so important that it should not be left to chance, and that along with sex and relationships education it should be a compulsory part of the curriculum. I hope the Government will reflect on the urgency of the situation and the consensus around the need for compulsory education, and will make a commitment to introduce it.

The Youth Select Committee report made many other practical recommendations, including the introduction of regional commissioning, the development of an app to provide mental health advice and support, and the introduction of plans to support students through periods of exam stress. I would welcome an update from the Minister on the progress that is being made to deliver these excellent ideas.

Finally, we know that one of the greatest barriers to delivering the mental health support and services that our young people need has always been the stigma that surrounds mental health. I want to pay tribute to a brilliant piece of work that was recently published by the YMCA in partnership with the NHS. Called “I Am Whole”, the research sought to identify the extent and impact of mental health stigma and included the finding that three quarters of the young people spoken to believe that people experiencing difficulties with their mental health are treated negatively as a result of stigma. The project also sought to address stigma directly by publishing a series of stories from young people about their experiences of mental health difficulties. These make for very challenging and moving reading.

Before I close, I want to read a quotation from the foreword to “I Am Whole”, from Connie, aged 22:

“Having mental health difficulties is like being trapped inside a thousand invisible prisons. There are a thousand reasons that as a young person you are driven deeper into that colossal void. Not only isolated by the struggles you’re facing mentally, but further enveloped in a thick, suffocating darkness. The darkness descends, comprised of a tangled web of myths, harmful language, misconceptions and misunderstandings. This is stigma. It is time for these myths to be dispelled, the web broken and the isolation to end. It is time for us to be free to talk about our mental health difficulties openly, so that we can access the services we need. Once the conversation begins, you promote understanding for others and break down misconceptions people hold…It is like being stood in the dark, untangling parts of that web until the sun’s warmth breaks through…the light reaches your eyes, and you look around to see you are not alone.”

When we talk about young people’s mental health, we are talking about the wellbeing of our precious children, about their health and happiness, about the resilience of the next generation and about the ability of young people to fulfil their potential and be everything they can be. We are talking about the ways to stop more families living with the heartbreak of a young person with mental ill health and about ways to stop more families suffering the devastation of a loss to suicide. There are few things more important than this and it is time the Government got it right.

--- Later in debate ---

[Tim Loughton]

I do agree. Believe it or not, my hon. Friend is older than me and was in the year above me at school. He has aged rather better than me, but then he has not been in the House quite as long as I have. He is right about the dynamics of the stresses and strains in those days. How children communicate has also changed. For example, one of my daughters once put in her request for supper by text message from her bedroom to my wife and me in the kitchen—supper’s off! In an age when communicating has never been easier with email, social media, mobile device, tablet or whatever, the irony is that face-to-face communication between human beings has never been more rare or remote. Therein lies part of the problem. Communication between children and parents does not happen as regularly, and the fault lies with the parents as much as the children. Some people cannot talk frankly about the real pressures, strains and stresses on our children and about grooming, sex matters or drugs. In my hon. Friend’s day and my day, we perhaps talked more to our parents or other family members.

I will now pick out a few points from the report—I know that other hon. Members want to speak. We have reached a point at which one in 10 school-age children will have some form of mental disorder, and the age at which that happens is getting younger. Some 340,000 five to 10-year-olds have a form of mental disorder. If it is not detected early and acted on, it just festers and gets worse. Too often, the only immediate response if someone gets access to a clinician is the chemical cosh of drugs, which is in many cases inappropriate for younger children. Talking therapy, for example, might be more appropriate, but we increasingly find that when people have to wait weeks or months for them a call has to be made between waiting longer or giving some form of antidepressant.

The report flags up the big issue of the transition from childhood to adulthood. Nothing changes physically or mentally when someone receives an 18th birthday card from their Member of Parliament. The last thing that an 18-year-old needs if they are going through the stresses of mental health is to have a completely new process and system to deal with because they have suddenly become an adult even though their condition has not changed. There is a particular issue around children in care, who too often used to leave at the age of 16. Fortunately, we now have a new scheme, which I was proud to have piloted at the Department for Education, based on staying put, allowing for a longer lead-in time. Every child is different and different children will be ready to go into the big wide world at different ages. The report contains some good examples of best transition practice. Southampton general hospital has a 0 to 25 age range for its “Ready Steady Go” scheme, under which every person is treated differently—people have different “go” ages.

Turning to the report’s recommendation about GP training, it is right, certainly for younger children, that GPs will be the first port of call for clinical services. Training for GPs to deal with younger people’s mental health problems is not good. Young people may need a lot of confidence to go along to see a GP with a parent or whomever, and there must be a clear understanding of how to tease the best out of children, so we need better guidance. As the hon. Member for Dulwich and West Norwood mentioned earlier, young people should absolutely be in on the genesis of that guidance.

Another recommendation that we have heard a lot about relates to what happens in schools. The hon. Member for Dulwich and West Norwood quoted the National Association of Head Teachers briefing, which states:

“When children do not meet CAMHS thresholds, schools often become responsible for children’s mental health.”

In too many cases, they are ill-equipped to do so. We are dealing with potentially one in 10—three in a class of 30—children suffering from some diagnosable mental health disorder, and the chief medical officer says that three quarters of them will receive no treatment at all. That will obviously have an impact on the child, but there will be an impact on the class as well and it is very much in the school’s interest to do something about that.

We need better teacher training so that they are able to identify the signs that point towards a mental illness. They also need better awareness of where to signpost children to get the treatment that they require. They should also be able to talk about things more generally in class. We can argue whether PSHE should be compulsory—I have some sympathy with that—and whether mental health should be a formal part of it, but it must be done in an environment in which young people will feel engaged. It should not be just another lesson, but a place where they feel free to talk openly, to absorb and to learn.

[Helen Hayes]

The point about the proposal that mental health education should become compulsory is simply that its presence on the curriculum is too important to be left to chance. I entirely agree with the hon. Gentleman that it should be undertaken in a way that is engaging and effective at educating young people, but does he agree that whether it happens at all should not be left to chance?

--- Later in debate ---

[Helen Hayes]

I very much thank the 10 Back Benchers, the Opposition Front Benchers and the Minister for taking the time to be in the House to contribute to this debate. It has been an excellent debate, with some very powerful speeches. Members have acknowledged the scale of the crisis in young people’s mental health, very effectively represented those of their constituents who face mental health issues, brought to bear their direct experience in this field and called on the Government to take a different approach. We have discussed many statistics, and they paint a picture of a heartbreaking reality for young people and families across this country. Many Members have also highlighted the false economies involved in failing to invest properly in young people’s mental health, with the additional costs to the health service, local authorities, the criminal justice system and, indeed, to human beings themselves.

Many Members have paid tribute to the work of the British Youth Parliament, and I want to add my voice to those saying that the work of the Youth Parliament should be debated in Government time. We must continue to build the institution of the Youth Parliament as the voice of young people in our democratic process. It is right and proper that it should be given such a status. The debate has, on the whole, been very consensual, and it has shown the House at its best. I hope that Members on both sides of the House have communicated to the British Youth Parliament, the Youth Select Committee and young people across this country the seriousness with which we take this issue.

I very much welcome the Minister’s response, and her commitment to address this issue and to deliver a step change in young people’s mental health. She is right to point out that this will require resources, leadership and work across Departments. She mentioned work with the Department for Education, but work with the Department for Communities and Local Government will also be very important. As the Minister also has responsibility for public health, she will know the extent to which public health expenditure is so challenged at the moment. We heard from several Members during the debate about the impact of such cuts on mental health and as a direct consequence of them. I welcome her response, but it must be backed up by action, following through and delivering on those commitments.

I hope all Members from both sides of the House who have contributed to this debate will join me in holding the Government to account on delivering the step change we need to protect our vulnerable young people and on delivering a framework of support that will help them to be resilient, confident and healthy as they grow into adulthood.

Question put and agreed to.

Resolved,

That this House notes the recommendations of the Youth Select Committee report of November 2015 on Young People’s Mental Health; endorses the findings of that report on the need for more support from the Government for mental health services for young people; acknowledges steps taken by the Government, since its response of January 2016 to that report, with regard to some of its recommendations; and calls on the Government to set out what further progress has been made since its response and what its plans are further to improve mental health services for young people.

NHS Commissioning (Pre-Exposure Prophylaxis)

Helen Hayes Excerpts

Tuesday 7th June 2016 Commons Chamber

[Jane Ellison]

My hon. Friend is right to recognise that PrEP has potential. It is, in fact, being used in some places internationally. The point I was making was that there is no simple, one-size-fits-all solution. Different countries have different challenges. For example, the level of HIV prevalence and the services available to manage that prevalence, and to manage testing, are very different in different countries. That forms different landscapes into which PrEP might fit. To give an example from Africa, PrEP was licensed last year, and it will be available for sex workers in selected sites. HIV prevalence among female sex workers is estimated to be just under 60% in South Africa. There are different contexts in which PrEP is being taken forward, and that is just one of them.

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

Local authorities’ public health budgets are being stretched to breaking point, and this is arguably one of the false economies of this Government’s approach, in terms of its impact. Does the Minister agree that in the context of such stretched budgets, the implication that local authorities should fund PrEP is simply unworkable, and will she make it clear that her position is that NHS England is the natural commissioner of PrEP?

[Jane Ellison]

I have been very clear about NHS England’s position, and I have said that no decision has yet been made about commissioning. I do not accept the hon. Lady’s challenge about spending on public health. We have committed to spend £16 billion over the next five years on the public health grant. In addition to that, we have committed more than £1 billion this year alone in the section 7A agreement and £300 million on vaccines that we buy in the Department of Health, plus system-wide leadership through things such as the sugary drinks levy and the forthcoming childhood obesity strategy. All in all, this is the radical upgrade in prevention that was talked about in the NHS “Five Year Forward View”.

Defending Public Services

Helen Hayes Excerpts

Monday 23rd May 2016 Commons Chamber

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

It is a pleasure to follow the hon. Member for Dudley South (Mike Wood), who spoke with passion about the NHS, a theme to which I will return. There can be no denying that the legislative programme outlined in the Gracious Speech is thin and aimed at preserving Tory party unity in the run-up to the EU referendum rather than at tackling head on the issues that the country faces, which is a great pity. This evening, I will concentrate on an issue affecting many of my constituents that was almost entirely absent from the Gracious Speech: the appalling state of mental health provision, and emergency provision in particular, across the country.

Our NHS currently faces an unprecedented financial crisis. Under Labour in 2009-10, the NHS reported a surplus of £2 billion. In the last financial year, the NHS in England reported a record deficit of £2.45 billion. It was the worst ever performance in the history of the NHS and worse than that predicted by NHS England. The deficit is kept from being significantly higher only by a series of creative accounting steps taken in a vain attempt to reduce the number of negative press reports about such disastrous performance.

This week, my family has again been profoundly grateful for the NHS. My mother, who spent many years working in the NHS, was admitted a week last Sunday after attending A&E. She was admitted at the weekend, but there was no absence of either diagnostic tests or expert healthcare at any level of the NHS. I am grateful to the dedicated staff who cared for her, and I am glad to say that she was discharged today. Over the past week, my family have seen NHS staff stretched to the limit, including nurses working 12-hour shifts without time for a break. My mother was not in the correct ward for the condition from which she was suffering, but an overspill patient on another ward, because no beds were available. She was admitted with a physical illness, but of all the pressures caused by the financial crisis facing our NHS it is mental health provision that is one of the biggest casualties.

Since May 2010, clinical commissioning groups across the country have reduced the amount spent on mental health, and we are seeing the consequences. In my constituency, for example, funding for first episode psychosis treatment has seen huge cuts and the number of mental health in-patient beds has been reduced, meaning that people in need of mental health care are in many cases left waiting for extended periods, either at home unable to cope or all too often in A&E. My constituency is served by King’s College hospital, a leading teaching hospital, and the Maudsley, a world-leading psychiatric hospital. Yet despite that combination of exceptional skills, expertise and facilities, the provision for mental health patients in A&E is simply not good enough. Despite the previous Labour Government setting aside funds for a dedicated waiting and assessment area for patients with mental health needs in A&E, it is yet to be delivered. On far too many occasions, patients attending A&E and requiring admission are unable to access a bed, because patients on the wards have yet to be discharged due to a lack of social care provision when they leave hospital.

I welcome the additional spending, although it is limited, on mental health that was announced in the Budget for tackling eating disorders, improving perinatal mental health services and providing mental health liaison services in every A&E, and the Government’s stated ambition of parity of esteem for mental and physical health. But much of the funding has previously been announced, and the overall budget assumes, incorrectly, that NHS trusts, including mental health trusts, will be able to attain unachievable levels of efficiency savings—the failure to do so being one of the main causes of the £2.45 billion deficit the NHS in England currently faces.

The commissioning of in-patient beds for child and adolescent mental health services within England is a national disgrace. Young people in urgent need are shuttled from one end of the country to another as a matter of routine. On the same day as a young person from Liverpool was placed on a ward in London, a young person from my constituency in London was admitted to a ward in Liverpool. No one would think it acceptable for a patient in cardiac arrest to be sent from London to Liverpool, and we should not accept a young person in mental health crisis being moved around the country in this way. Too many young people find themselves in hospitals dozens of miles from home, thus increasing their vulnerability, inhibiting the support that family and friends are able to provide to aid their recovery, and complicating their discharge planning.

The shortage of tier 4 CAMHS beds also means that young people frequently find themselves waiting in A&E for unacceptably long periods—often days at a time. We must see this for the scandal it is; we would not regard it as acceptable for a young person with a broken leg to spend days in A&E with only the most basic triage care, and it is just as unacceptable for someone with a mental health crisis to have to do that. The first step in achieving parity of esteem for mental health is to acknowledge these failures for the scandal that they are.

In my constituency, as across too many parts of the country, there is also an unacceptable shortage of places of safety for people who are detained under section 136 of the Mental Health Act 1983. That shortage delays the help that people who are desperately unwell urgently need. It is clear that there is too little co-ordination of the planning of the provision of places of safety, with police services, A&E departments and mental health services failing to work together to address the need. In London, the Metropolitan police have taken welcome steps to work towards eliminating the use of police cells as a place of safety for people in a mental health crisis who have committed no crime, but, without adequate multi-agency planning, this unilateral decision has exacerbated the pressure on A&E, resulting in situations where NHS staff are responsible for detaining patients and keeping them safe without having the required resources or an appropriate environment in which to do so.

One of the most shocking illustrations of the lack of parity of esteem between mental health and physical health is life expectancy: people suffering from serious mental illnesses such as schizophrenia or bipolar disorder can have a life expectancy 10 to 15 years lower than the UK average. Many mental health patients are dying early from heart attack, stroke and cancer rather than any cause linked directly to their mental health. Suicide is now the leading cause of death for men aged 18 to 49, with close to 5,000 people tragically taking their own lives in 2014. The recent Mental Health Taskforce report recommended the creation of local, area-based, multi-agency prevention plans, with a particular focus on high-risk locations and supporting high-risk groups. I urge the Government to implement the recommendations in full.

Our mental health services are failing too many people. One in four of us will suffer from mental ill health at some time each year, and all of us will know someone close to us who suffers from mental ill health. We are falling very far short of achieving parity of esteem for mental health. I find it astonishing that the Government do not seem to recognise this for the urgent priority that it is, and have failed to include any measures to address it in the Gracious Speech. The absence of significant measures in the Queen’s Speech to tackle these important issues speaks volumes about the priorities of this Government and how out of touch they are with the day-to-day needs and concerns of so many of the people I represent.

World Autism Awareness Week

Helen Hayes Excerpts

Thursday 28th April 2016 Commons Chamber

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

I am grateful for the opportunity to speak in the debate, and I too pay tribute to the right hon. Member for Chesham and Amersham (Mrs Gillan) for securing it and for her long-standing commitment and hard work on this issue.

Over the past year, I have been contacted by several parents of children with autism—parents who are proud of their children’s abilities and who, like any parent, simply want their children to receive the support they need to live the best life possible.

I have been contacted by enough parents to be able to see what some of the problems and challenges are—they are many, and they cut across different areas of public sector responsibility. I have represented parents of autistic children who are struggling to get a diagnosis for their son or daughter, which is a significant problem. Just as worrying, however, are the families whose child has a diagnosis but who are still struggling to secure the additional resources and support they need, whether that is support in the classroom, transport to get to and from school, help to access housing that is appropriate to their needs, or help with the welfare system or healthcare.

Across the public sector, there is a lack of understanding of autism and its impact on families. Families face stigma and stereotyping. The complexity of autism is not understood, and that results in parents facing weekly and sometimes daily battles on behalf of their children, just to secure the basics.

Earlier this year, I was privileged to meet Isabelle and Robin Garnett, whose 15-year-old son Matthew has autism. Isabelle came to see me at my surgery to tell me about the terrible experiences Matthew was having because of his mental health needs. I would like to focus today on the particular problems of people with autism who also have mental health needs.

Last summer, Matthew Garnett’s behaviour and level of distress deteriorated, and his family were finding it more and more difficult to cope. Eventually, Matthew assaulted his father, resulting in his parents calling the police—an absolutely heart-breaking situation for any family. Matthew was sectioned under the Mental Health Act and taken to a psychiatric intensive care unit in Woking, many miles from his south London home.

Psychiatric intensive care units are for short-term assessment; they are designed to diagnose a patient and to determine the treatment and support they need, and then to make an onward referral within six to eight weeks. Matthew’s doctors quickly identified that the most appropriate place for him was a unit at St Andrew’s, Northampton. St Andrew’s accepted the referral, but to Isabelle and Robin’s great distress, Matthew remained in Woking for a further six months, moving to Northampton only after a persistent campaign by his family, and after I had repeatedly raised the case in Parliament and with the Minister.

I am grateful to the Minister for meeting me and Matthew’s family, for recognising the extent of their suffering and the many serious issues with Matthew’s care, and for initiating a review of his case. I look forward to seeing the results of the review and to discussing it with the Minister.

One of the most troubling aspects of Matthew Garnett’s situation was the absolute absence of autism awareness or specialism from the care he received while he was in Woking for six months. There was no recognition of his need for routine and structure, of the impact of his diet on his condition or of the detrimental impact of too much screen time on his mood and level of anxiety. As a consequence, his physical and mental condition deteriorated while he was in Woking. He gained weight, became more withdrawn and broke his wrist; his social skills and reading ability regressed; and he became more anxious and frightened.

Matthew’s parents launched a brave campaign to get him the treatment he needed. In doing so, they engaged with many other parents of children with autism and mental health needs. Working with the National Autistic Society, they launched a questionnaire for parents of children with autism and mental health needs. Within a few days, more than 800 parents had filled out the questionnaire, and the results are very troubling. Almost half the respondents said that, prior to their child being admitted to hospital, they had received no support in the community for autism or mental health needs. Some 85% of those whose child had been admitted to hospital said they had received no autism-specific support. Almost half said they did not feel consulted about, or involved in, decisions about their child’s care when they were in hospital. Finally, 61% said that, after their child was discharged, no arrangements at all were made for suitable support back in the community.

Children with autism, and their parents and carers, deserve better than this. While I am grateful to the Minister for his engagement with Matthew Garnett’s family to date, I urge him to pick up the wider set of issues and challenges in the mental health care system and across other areas of the public sector and to ensure we have a fairer deal for families who face these daily, heart-breaking struggles and appropriate resourcing of the support they need.

Mental Health Taskforce

Helen Hayes Excerpts

Tuesday 23rd February 2016 Commons Chamber

[Alistair Burt]

My hon. Friend makes a good point. GPs are often contacted first when a problem is developing, as I know from my contacts with the British Medical Association and with the Royal College of General Practitioners, which was also very interested in the taskforce report. Those organisations want to ensure that doctors have enough training, because training levels tend to vary according to interest. I know that all GPs are concerned about the matter and want to ensure that they have the skills. Equally, they need to know that they can then refer to the right place. That is what the increased support for both emergency and community services is all about. It is to ensure that there are proper pathways so that people do not get stuck at any particular stage.

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

My 15-year-old constituent Matthew Garnett, who has autism, has spent the past six months in a psychiatric intensive care unit 30 miles from home. The unit does not have the specialism to meet Matthew’s needs and he has deteriorated significantly. The specialist bed that Matthew needs is in Northampton, where Matthew’s family have been told there are five young people who are ready for discharge but whose ongoing care cannot be arranged. Clearly, there is a crisis in mental healthcare for children and adolescents. When will the Minister bring a plan to the House to address that, and will he intervene to secure the bed that Matthew Garnett so desperately needs?

[Alistair Burt]

I thank the hon. Lady for her question. If she wants to make a particular approach on that case, I am ready to listen.

[Helen Hayes]

I have already done that.

[Alistair Burt]

It is already in the works. Okay, thank you. Let me say a couple of things with regard to specialist care. First, even though we want most young people to have access to care close to home, there will always be some specialist care that will require out-of-area treatment—perhaps those are the circumstances to which the hon. Lady is referring. It is then a question of getting the place.

That issue emphasises why it is so important to have the community care available. We need to be able to discharge patients and put in place a proper care package. That is precisely what the taskforce considered and made recommendations on. That work is already ongoing. As my time in office has shown me, there are variations in practice in different places. Discharges are handled better in some areas than in others. The practice of the best must become the practice for all. Everything must be done to ensure that people are treated in the appropriate place at the appropriate time, and keeping people in hospital unnecessarily is not what anyone wants. That work is already going on, and I will make sure that the hon. Lady gets an answer to her particular question.