National Health Service

Debate between Hywel Williams and Andy Burnham

Wednesday 21st January 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House notes comments from leading experts that the NHS is under unprecedented levels of pressure and that this is putting patient care at risk; further notes that attendances at hospital A&E departments increased by 60,000 in the last four years of the previous Government and 600,000 in the first four years of the current Government; believes that this is linked to decisions taken by this Government, including cuts to adult social care, the abolition of NHS Direct, the closure of almost one in four walk-in centres and removing the GP access guarantee; and calls on the Government to match the Labour Party’s plans to raise an extra £2.5 billion a year for the NHS, funded by measures including a tax on properties worth over £2 million, to help ease the current pressure and ensure that the NHS is fit for the future.

We have called this debate today to see if we can establish a shared analysis across the House of the causes of the current crisis in accident and emergency departments, and from that, shared solutions. I hope we can all agree that the staff of the national health service and of the ambulance service are working wonders in the most trying circumstances, and that it behoves all of us to put forward our ideas today to relieve the pressure on them, but more importantly, to reduce the risks that too many patients are facing right now.

As I have said to the Secretary of State before, things cannot carry on as they are. As the British Medical Association said last week,

“these ongoing challenges are placing patient care and safety at risk.”

Very poorly people are waiting hours for ambulances to arrive, hours to be seen in A and E, and hours on trolleys in corridors, and too many elderly people are then being held on hospital wards, trapped for days, weeks, even months or, in one case that I will come to later, a full calendar year.

[Hywel Williams (Arfon) (PC)]

Can the right hon. Gentleman establish for the benefit of the House whether the figure quoted in his motion applies to England and Wales or to England only?

[Andy Burnham]

I am not sure which figure the hon. Gentleman is referring to, but the figures in the motion apply to England. I will say more about them in a moment.

The stories of failure keep coming. Today we read that a 38-year-old man in Bristol died of meningitis after an ambulance took four hours to arrive. This is by no means an isolated example. The response time target for the most serious calls has been missed for the past six months in a row. We need to hear today what the Secretary of State is doing about this. Rather than work to improve response times, the only proposal we have heard so far is to allow a pilot relaxing response time standards. There will be two pilots, one in the south-west and one in London. London, as the right hon. Gentleman knows, is the worst-performing ambulance service in the country right now, and we hear today that the chief executive of London ambulance service, Ann Radmore, has resigned. The Secretary of State will need to explain to us today why it makes sense, in the middle of a difficult winter, to run an experiment in the most troubled ambulance service in the country.

Mental Health (Approval Functions) Bill

Debate between Hywel Williams and Andy Burnham

Tuesday 30th October 2012 Commons Chamber

[Andy Burnham]

I thank the Secretary of State for his intervention. We understand that these are urgent matters, and I am sure that he is receiving briefings from the Department, but I think that there is a sense among Opposition Members that that is not good enough, and that he should have been here to answer the questions that were asked. We appreciate that he will be winding up the debate, but I hope he will take careful note of all the questions that are asked, and will give every Member present the fullest possible answer.

First things first: let us begin with the detail. I think it would help the House to know more about the extent of the checks that have been carried out on the 4,000 to 5,000 cases involved. The very fact that the number remains vague suggests that there has not yet been a thorough case-by-case review. Does the Minister—or, indeed, the Secretary of State—agree that it is essential to conduct such a review, and to put a precise number on the extent of the problem? I asked yesterday whether the Department could tell us how many of the people concerned were in high-security hospitals. I think that that is an important aspect of the issue, and I should be grateful if the information could be given to us at some point this afternoon. Without detailed case-by-case checks, how can we be sure that this procedural defect was the only technical irregularity in the process that was operating in the four SHAs concerned? We need to be reassured that there are no further problems that will need to be corrected at a later date.

That brings me to another question that was not answered yesterday. Families of the people involved will have heard yesterday’s news, and will no doubt have been unsettled by it. Does the Secretary of State agree that it is important for the Government to make arrangements, urgently, for direct communication to take place with the families who have been directly affected so that the issue can be explained to them more fully, and in isolation from some media coverage that may not give them the reassurance and support that they seek? Have such arrangements been made, and has any facility been provided enabling questions to be answered so that people can be given that reassurance and support?

That, in turn, brings me to another important point. If the Government were to leave a vacuum in terms of advice and communication, it could of course be filled by less scrupulous elements of the legal profession seeking to initiate compensation claims. We have already read warnings today that efforts may be made to encourage patients to sue for £500 or £600 a day, the amount that a prisoner would receive in compensation for unlawful detention. I am sure the Secretary of State agrees that any such activities would be highly unsettling, and would amount to the potential exploitation of vulnerable people. I hope he will join me in sending the clearest of messages to the legal profession that that would not be at all welcome. On the other hand, we would not want to see any curtailment of individuals’ legitimate right to challenge the decisions made affecting their liberty as a result of the Bill.

[Hywel Williams]

I am glad that the right hon. Gentleman has made that second point. The fact that some people are litigious, possibly as a result of their condition—of which that is a notorious aspect—should not detract from their right to pursue a case if they wish to do so.

[Andy Burnham]

That is a good point. So many cases are involved that challenges may have already been in progress before this technical problem arose. There may have been complaints about the nature of the decision-making process, the number of professionals involved, or any matter relating to the process by which the decision was made.

I hope that it will reassure the hon. Gentleman to learn that I have been given access to Government lawyers—the Secretary of State promised that yesterday, and I am grateful to him for arranging it—and I have been assured that the Bill will not wipe away an individual’s right to issue a legal challenge on a different point of process. That is a fundamentally important point, and I am glad that the hon. Gentleman has given me an opportunity to put it on the record. We would certainly not support the Bill if it were intended to wipe away an individual’s rights retrospectively, and I am sure that the hon. Gentleman would not either. We are grateful for that reassurance from the Government.

Along with the urgent steps that are being taken to correct the legal position, we need a review of how this came about in the first place. If it had happened in a single SHA, the explanation might have been easier to ascertain and understand, but the fact that it happened in four SHAs points to a more widespread issue of concern. It raises the question whether the problem arose from historical practice among clinicians and NHS bodies in the four regions concerned, or whether a piece of Department of Health guidance that was circulated in the past may have been responsible. I hope that the Minister or the Secretary of State will be able to enlighten the House further.

We want the Harris review—which I support—to cover all the technical issues surrounding mental health, so that the House and the public can be absolutely certain that no other technical failures or breaches of regulation have been identified. Let me make two appeals to the Secretary of State. First, I ask him to consider widening the remit of the review, and ensuring that in future it can take the broadest possible view of arrangements for sections under the Mental Health Act 1983. Secondly, I ask for the review to be conducted as swiftly as possible, so that it can inform the current reorganisation of the NHS.

It seems to me that the crux of the issue is the interrelationship between the 1983 Act and the potential for reorganisations of the NHS to disturb important existing arrangements and procedures for the carrying out of these essential public functions. That is the crux of the matter. I accept that a problem may have arisen as a result of the introduction of SHAs and PCTs in 2003, and we will have to wait and see whether that was the case. Regardless of the answer to that, however, the Government still have to face a relevant and current issue: they have to be absolutely sure that the changes they are proposing—and which the Opposition continue to believe are unnecessary and highly disruptive to an NHS that is functioning well for the vast majority of people—will not run the risk of causing further confusion.

We have not had anywhere near enough clarity from the Secretary of State—or his predecessor, the right hon. Member for South Cambridgeshire (Mr Lansley), who has just left the Chamber—on how some of the essential functions of NHS bodies to do with safeguarding and public protection are to be handled in the new NHS structure. Many months have passed since the publication of the Government’s first White Paper, yet there are still doubts in the minds of clinicians and others practitioners on the ground. That is an indictment, and shows the confusion the reorganisation has created. We are seeing the emergence of myriad new bodies in the NHS whose functions are not yet fully understood or specified by the Government. This crowded landscape has the potential to cause for further uncertainty. I therefore today ask for more clarity on this matter.

As things currently stand, what will the NHS arrangements be for sectioning people under the mental health provisions to be introduced from April 2013? I do not yet know with confidence what those arrangements are, and if I do not know there is a good chance that the wider public and many people working in the NHS have no idea. The Government need to answer these questions.

There is a further specific question the Department needs to answer, and it goes to the heart of the issues under discussion. I am sure I heard the Secretary of State say yesterday that the secondary approval function that SHAs are meant to carry out will come back to the Department of Health following the Government’s current reorganisation of the NHS.

--- Later in debate ---

[Andy Burnham]

My hon. Friend makes a very important point, and we have the seen the beginning of the kind of campaign he advocates with the work of the Time to Change group. There has also been incredible bravery from individuals such as the cricketer Marcus Trescothick, who spoke out very publicly about the difficulties he had faced, and just a few weeks ago in this House we witnessed some incredibly powerful contributions from Members on both sides of the Chamber: for the first time Members spoke personally and publicly about the difficulties they faced.

I think a change is under way, therefore. People who have been suffering alone will take great heart and encouragement from these developments. We are beginning to challenge the last taboo—the last form of acceptable discrimination in our society—but that does not come a moment too soon. My feeling is that Parliament is finally waking up to the full scale of the mental health challenge we face. A Bill before us at the moment will outlaw the discrimination that exists whereby somebody who has suffered a serious mental breakdown is unable to be a Member of Parliament, a company director, a juror or a school governor. It is so important to remove that discrimination from the statute book because it sends a message that recovery is not possible, and that if someone has a serious mental breakdown there is no possibility of their coming back and playing a full part in our society. The further problem with that legislation is that it prevents those people from being in leadership positions in those organisations—in schools, in Parliament and in companies—where they could develop a better understanding of mental health and what policies need to be put in place to support people who may experience those problems.

[Hywel Williams]

Does the right hon. Gentleman share my concern, and that of organisations such as Mind, that the rate of compulsory detention seems to be growing, as does the rate of detention in police cells?

[Andy Burnham]

We need to look carefully at those trends. I remember the moment when my thinking about mental health changed. It came when I was Secretary of State for Health and I received the Bradley report on mental ill health in the criminal justice system. I recall the moment when I read the statistic that seven out of 10 young people in the system have some form of undiagnosed or untreated mental health problem. My jaw dropped and at that moment I realised that we were seriously failing many thousands of people by failing to give them the support they needed when they needed it, and so they went into detention and down a path of failing to fulfil their potential. That is a terrible indictment of our life today. In addition, the level of prescribing of anti-depressants has almost doubled over the past decade. We are issuing almost 40 million prescriptions for anti-depressants, which suggests to me that insufficient alternatives to medication are available in our communities and people are being given very old-fashioned, outdated interventions by the authorities which are not meeting their needs. That is why we cannot allow this complacency any more and why we need a modern approach to good mental health care.