Helen Morgan
Main Page: Helen Morgan (Liberal Democrat - North Shropshire)Department Debates - View all Helen Morgan's debates with the Department of Health and Social Care
(1 month, 2 weeks ago)
Commons ChamberI have tabled several amendments to the Bill, but I will hopefully keep my remarks focused so there is a good opportunity for other Members to make their speeches.
The Bill should be about fixing the front and back doors of the NHS. It offers the opportunity to bring in tangible changes for patients to address pressing problems and introduce desperately needed improvements to patient safety and experience. The primary care and social care crisis, in particular, are millstones around the neck of the NHS. But instead of addressing them, the Bill has focused on a top-down reorganisation, which risks diverting time and money away from those pressing issues, and it gives sweeping powers to the Secretary of State, which is not in itself without risk.
The Liberal Democrats would instead have put social care and general practice at the heart of the Bill—a move that would represent real reform of the health service. In particular, new clauses 54 and 56 tabled by my hon. Friend the Member for Mid Sussex (Alison Bennett) would together transform the rights of family carers through guaranteed respite care and reform of the carer’s allowance. They would put free personal care, and an end to catastrophic care costs, at the heart of social care reform.
New clause 53, tabled by my hon. Friend the Member for Epsom and Ewell (Helen Maguire), would ensure that everyone can see a GP within seven days, or 24 hours if urgent, and amendment 17 would introduce a primary care investment standard. Although general practice is the core of a patient’s relationship with the NHS, it has seen its funding decline as a share of NHS spending. Less than 10% of the NHS budget is spent on primary care, although that is estimated to constitute 90% of a patient’s direct experience with the NHS. A primary care investment standard would help to reverse that trend. Dentistry is another area of primary care that has been neglected, leading to dental deserts and dangerous DIY dentistry. New clause 18 would introduce a scheme to end dental deserts, and guarantee appointments for children and those most in need.
New clause 82 refers to the family mental health pathway, but from diagnosis right through to treatment and, tragically for some, bereavement, mental health support for families cannot be an afterthought and must be a statutory proactive duty. Does the hon. Lady agree that the Government and the Minister should take that on board?
I broadly agree with the hon. Gentleman, and I am about to come to mental health. It is right to modernise the NHS and end some of the duplication that we see between NHS England and the Department of Health and Social Care, but the way it has been handled has been chaotic. It has been combined with 50% cuts to ICB budgets, unfunded redundancy payments, and chaos through the system. I was alarmed to read the report in The Times at the weekend about advice to the Secretary of State that the changes envisaged under the Bill are impossible to implement, given that the staff of NHS England are on different pay scales to those in the Department. Given those significant hurdles, I hope that in her closing remarks the Minister can provide some reassurance that abolishing NHS England in the way the Bill envisages is achievable.
We are particularly concerned that the functions of the Secretary of State under these reforms open the door to political capture, which is a huge risk given the unstable political climate we live in. Amendment 16 would create a firewall between the Secretary of State and operational decisions. These new powers are particularly worrying in the context of patient safety issues created by the Bill, which we will discuss in more detail tomorrow.
Beyond the Department, the Bill is complacent on taking seriously the vulnerability of our NHS to foreign interference and its implications for national security. That is why we tabled new clauses 2 to 5, which recognise and address the role of the NHS as part of our sovereignty, and the sensitivity of patient data. New clause 17 would require scrutiny in the House of the arrangement between the United States of America and the United Kingdom on pharmaceutical pricing. That deal, forced on us by Donald Trump with no say from the British people, will hike medicine prices in the coming years by billions of pounds, and deserves parliamentary scrutiny. All those shortcomings of the Bill attest to the fact that the NHS already spends far too much time and money responding to failure, rather than improving the safety and quality of services in the first place.
Gideon Amos (Taunton and Wellington) (LD)
On safety, does my hon. Friend agree about the gravity of the national maternity review, which found that Musgrove Park hospital was the “most challenging” estate in the country? If it is the most challenging estate in the country, does my hon. Friend agree that that needs to be addressed sooner than 2033, so that mums get better treatment sooner than the 2040s? That is unacceptable if it is the most challenging estate in the country.
Crumbling estates are a big part of the problem across the whole NHS and in maternity, and my hon. Friend is right to highlight the state of his own local hospital and advocate for its quick remediation. Amendment 10, which I am sure my hon. Friend the Member for Winchester (Dr Chambers) will outline in more detail, would reintroduce the mental health investment standard. That is a crucial investment to avoid failures further down the line if interventions are not made for patients early on.
Nowhere is the cost of failure more obvious than in maternity—a devastating scandal which, despite many recent reviews, still deserves far more attention. Our amendments to make our maternity services finally safe for mothers and babies will therefore be the main focus of my remarks today. I thank the Minister for her constructive engagement with me on new clause 1, and the commitment that she made at the Dispatch Box today to table relevant amendments when the Bill reaches the other place, and to put that maternity commissioner in place. I am grateful to her for the discussions we have had, and the constructive approach she has taken both with me and with the many campaigners on the issue beyond this place. In the light of that, I will not be pushing new clause 1 to a vote.
I have seen up close the human costs of failures in our maternity system. Four years ago the Ockenden review found that over 200 babies and nine mothers in my community had died needlessly in Shrewsbury and Telford due to failures in maternity care. That has been devastating for my community, and we have heard since then that the situation was not isolated. There have been terrible stories from families around the country, most recently following the review into services in Nottingham. New clause 6 would introduce a scheme to ensure that every maternity unit in the country is rated “good” or “outstanding” by the Care Quality Commission. That new clause is essential if we are to meaningfully address the crisis in our maternity services and show families that lessons have been learned not just locally but nationally.
The Liberal Democrat maternity rescue package would require an estimated £600 million a year to bring safety in maternity units up to standard, investing in safe staffing and listening to mothers. The Government already spend £1.3 billion a year—more than double the cost of the package—on maternity negligence payments, so introducing that reset is a no-brainer. Rather than spending a fortune compensating for failure and heartbreak, the NHS should be getting it right in the first place. Recently we have seen the consequences of safety failures, with lack of staffing causing North Devon’s maternity unit to close, forcing women to take a 50 mile trip if they go into labour. My hon. Friend the Member for North Devon (Ian Roome), whose constituency has been hit hard by that news, has tabled new clause 66 to guarantee safe staffing levels and access to a maternity unit within 45 minutes.
While on women’s health, I also want to highlight new clauses 11 and 12. Earlier this year I wrote to the Equality and Human Rights Commission to highlight the stark inequality in research and investment in women’s health, with a huge gap in investment, governance and reporting mechanisms between women’s and men’s health strategies. The new clauses would set up an inquiry into women’s health outcomes, and ensure that average waiting times for women’s health conditions do not exceed the average waiting times for wider elective treatments.
The crisis in our maternity care is a national shame and reveals a systemic neglect of the safety of women and their babies over many years. However, that is indicative of even wider concerns for patient safety, which I urge the Secretary of State to address in the Bill, and which we will discuss in more detail tomorrow. If the Government are serious about using the Bill to improve our NHS, they must invest time and money in the front and back doors of the NHS rather than structural reorganisations. The safety of staff and patients must be at the centre of those changes, and I urge the Minister to consider the amendments tabled by me and my Liberal Democrat colleagues, which would improve the Bill to achieve just that.
Daniel Francis (Bexleyheath and Crayford) (Lab)
I rise to speak to amendment 32 and new clause 39 tabled in my name, which seek to address the problems facing community equipment and wheelchair services across the country. I declare my interest as chair of the all-party parliamentary groups for wheelchair users and for access to disability equipment. As the parent of a wheelchair user, I know just how important getting such services right is for disabled people and their families, and the consequences and long-term impacts when it goes wrong.
Evidence gathered for an inquiry by the APPG for access to disability equipment last year found that one in three equipment users who responded to our inquiry are waiting a significant time for equipment, with one in five waiting over two months, and 55% stating that they do not have the equipment they need for their long-term needs. At a time when we are rightly focused on reducing waiting lists and improving patient flow, it makes little sense for somebody to remain in a hospital bed simply because the equipment they need to return home has not arrived. Some 74% of professionals and equipment providers report that patients experienced delayed hospital discharge because essential equipment was not available at home, increasing pressure on hospital beds and placing further strain on services. The current system is fragmented, inconsistent and lacks sufficient accountability and national oversight.
My amendments would introduce two things that the system lacks: a clear expectation of how long people would wait, with clear, set timelines and accountability when things go wrong, and they would ensure that patients have a clear pathway for hospital discharge. Amendment 32 would require ICBs to provide community equipment and wheelchair services within 18 weeks of the date that a person is assessed. I know from experience of my daughter’s case when she was eight that the 18-week deadline was missed on two occasions, and she was without an adequate wheelchair for 21 months. These issues simply shunt costs to elsewhere in the NHS. The APPG for wheelchair users heard evidence from consultants within the NHS about the quality of assessment, interventions and aftercare. We heard that delays led to children receiving a wheelchair that was no longer fit for purpose by the time they received it. The following are quotes that we heard:
“There is the additional care to consider as well. Poor equipment provision leads to pressure sores, increasing scoliosis, all of which have a wider impact on the sector.”
“In terms of inequity of care, when asked for information it is always the same eight or 10 ICBs who respond. The ones who don’t, are probably the ones we should worry about.”
“There is a level of bureaucracy in the NHS that stops things happening. Disability is not considered as important as other things in health parameters.”
The data available shows that the wheelchair deadline is being missed by many ICBs, and 29% of ICBs are not meeting the target of providing over 25% of wheelchairs in 18 weeks.