Coronavirus

Janet Daby Excerpts

Wednesday 11th March 2020 Commons Chamber

[Matt Hancock]

I have heard some of the noises off. I merely encourage everybody to base their decisions and judgments on science, rather than politics.

[Janet Daby (Lewisham East) (Lab)]

I thank the Health Secretary for his continued updates to the House. The partner of a constituent of mine suffers from cystic fibrosis and other related illnesses and requires daily treatment that includes cleansing—alcohol wipes, gels and so on—but because of the panic buying in some shops they have been unable to purchase these items, which could result in serious health issues for them. Are there any other measures the Government can put in place, working with supermarkets, to manage this?

[Matt Hancock]

Yes, absolutely; this is really important. We have some supplies of these sorts of things, in the supply chains and, in some cases, within the shops themselves, and we are working with the shops to ensure availability of things that can be critical to people’s care. We are working on that with DEFRA, the NHS and within the Department, particularly in relation to pharmacies, to make sure we get the right kit to the people who need it.

Health Inequalities

Janet Daby Excerpts

Wednesday 4th March 2020 Commons Chamber

[Janet Daby (Lewisham East) (Lab)]

It is a pleasure to follow the hon. Member for Bury North (James Daly) and to hear his suggestions on how to reduce health inequalities.

Professor Marmot’s recent review on health inequalities since 2010 has highlighted how the Government’s decade of austerity has taken its toll on aspects of people’s lives. In particular, the report highlights: rising child poverty; the closure of children’s centres; declines in education funding; zero-hours contracts; increasing insecurity in work; the housing crisis; a rise in homelessness; an increase in the number of beggars on the street; people not having enough money to lead a healthy lifestyle; and more and more people turning to food banks. If those outcomes are not bad enough, things are even worse for our minority ethnic population, and that area is my focus in this speech.

Ethnicity has not been a consistent focus of health inequalities policy; very few policies have been targeted at minority groups. Two factors affecting the action—or the lack of it—on ethnic health inequalities are the availability of data on ethnicity and the legal obligations on racial equality. For example, data on ethnicity is not collected when a death is registered, so it is not possible to calculate life expectancy estimates. Having that data on ethnic groups in our health statistics would be an important aid to researchers, who would then be able to investigate differences in health. Education for our health professionals is also most important if we want to address health inequalities and to enable those professionals to feel that practical steps can be taken to help to reduce the inequalities. For example, sickle cell disorder affects some of my diverse community in Lewisham East, but not enough research has been done on it, and not enough time has been spent on evaluating the preventive measures and how to reduce people’s risk of having a sickle cell crisis. Clearly much more needs to be done to understand the disorder and how it disproportionately affects a section of our diverse population in the UK.

Many health professionals would agree that there is a desperate requirement to increase training on sickle cell disorder, as well as diversity training in the General Medical Council, the General Pharmaceutical Council and the Nursing & Midwifery Council, in order to address these needs. The Marmot review makes one thing clear: the effects of austerity are reducing quality of life and, in some cases, they are taking life.

NHS Funding Bill

Janet Daby Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Matt Hancock]

I need to make some progress.

Let me turn to what is happening on top of the funding in the Bill. The revenue budget does not cover the budgets for training and for infrastructure investment, so the increase in the training budget and the money for new infrastructure will be in addition to the £33.9 billion for the core day-to-day running costs. We made clear in the manifesto that we would have more nurses in the NHS—50,000 more—and I am delighted that the latest figures, released last week, show an increase of 7,832 over the last year,

[Janet Daby (Lewisham East) (Lab)]

rose—

[Matt Hancock]

If the hon. Lady wants to welcome that increase of over 7,000, she is more than welcome to do so.

[Janet Daby]

I thank the Secretary of State for giving way, and of course I welcome more nurses in our NHS. Why wouldn’t I? My mum was a nurse in the NHS. However, I want to ask the Secretary of State about the increase for the recruitment and retention of mental health nurses, and whether he will agree to ring-fence new mental health funding to ensure that it goes to the Department to which it is meant to go.

[Matt Hancock]

I can guarantee that the mental health funding will be ring-fenced; and I want us, from the House, to pay tribute to the hon. Lady’s mum.

We are going to have more nurses, and I am delighted that we already have a record number of registered nurses, a record number of midwives, a record number of nursing associates and a record number of nurses in training. If the current trends continue, 36,000 nurses will join the NHS each year from the domestic and overseas workforce, which means that we will have more than 140,000 new nurses by 2024. However, we need more nurses now, and we will have 50,000 more by the end of this Parliament. That is a critical manifesto commitment on which we intend to deliver.

We need the right number of nurses and we need them to have the right skills, with nursing increasingly becoming a highly skilled as well as a caring role. From September this year, we will give every student nurse a training grant worth at least £5,000 to support them in their studies and ensure recruitment and retention. We are also expanding the routes into nursing with more nursing associates and nursing apprenticeships, making it easier to climb the ladder to become a fully registered nurse, and prioritising the care of our nursing staff to encourage more of them to stay in the NHS.

Of course, that training grant will also apply to midwives, paramedics, dieticians and all allied health professionals. Too often, the media use “doctors and nurses” as shorthand, and sometimes, if I am honest, we do that in this House, too. We should instead recognise the essential contribution of our allied health professionals, without whom our NHS family is incomplete and on whom our increasing move to multidisciplinary teams depends. This £2 billion training package is in addition to the funding contained in this Bill.

Finally, as well as revenue and training, the NHS also needs more money for infrastructure. On that point, I will give way to the hon. Member for Rhondda (Chris Bryant).

--- Later in debate ---

[Jonathan Ashworth]

My hon. Friend speaks movingly about the situation in her local trust. Of course, St George’s is one of the trusts that has a high maintenance backlog of around £99 million. The reason why hospitals such as St George’s have maintenance backlogs, which mean that they cannot get the flow through the hospital that is needed so that my hon. Friend’s constituents are treated on time, is because capital budgets have been raided repeatedly. The underfunding of the NHS has been such that NHS chiefs have had to shift money from capital budgets into the day-to-day running of the NHS. That is what Tory austerity has done to our NHS. That is what Tory austerity means for my hon. Friend’s constituents.

[Janet Daby]

Does my hon. Friend agree that we have a crisis in respect of mental health nurses, who are not being recruited and supported in the way in which they should be? Not only is that putting strain on the mental health nurses who are there, but it will affect patient care as well.

[Jonathan Ashworth]

My hon. Friend is absolutely right. Of course, we are short of 44,000 nurses across the whole national health service. One of the most damaging policy decisions that George Osborne made—probably another of the Secretary of State’s ideas—was to cut nurse training places in 2011 and get rid of the training bursary. The Government say that they will bring back a grant, but they are not going to go the whole hog, are they? They are not going to get rid of tuition fees. They still expect people to train to be nurses and build up huge debts, because the nature of the training that they have to go through means that they will not be able to take a job on the side. I do not believe that is the way we should recruit nurses for the future; we should bring back the whole bursary for nurses, midwives and allied health professionals.

Mental Health Act 1983

Janet Daby Excerpts

Thursday 25th July 2019 Westminster Hall

[Neil Coyle]

That is very much what I will be coming on to and what I hope we will hear more from the Minister on; it was the subject of an independent review.

I was talking about the prevalence of mental health conditions in Southwark and people I have seen at constituency surgeries. These statistics for Southwark are from the South London and Maudsley NHS Foundation Trust, which is my local mental health trust. Close to 4,000 people have what it defines as a serious mental illness; that does not include things such as dementia. Almost 48,000 people are currently experiencing a common mental health condition. Across the borough, 22,000 people have both a mental health condition and a long-term physical condition. And almost 4,000 children in Southwark have a mental health condition.

[Janet Daby (Lewisham East) (Lab)]

I thank my hon. Friend for making a speech that is very powerful and very personal. The number of mental health nurses in England has fallen by 6,000 in the past 10 years. Does he agree that we need the correct number of staff, and staff with the correct expertise, to meet the needs of the service in supporting people with mental health issues?

[Neil Coyle]

I absolutely agree and will come on to some of those figures.

I referred to the children in Southwark who have mental health conditions. The NHS’s overall target for ensuring that children and adolescents can access mental health treatment is just 35%. That is remarkably low, and I hope the Minister will have something to say about it today. In the meantime, while that is the national standard, Southwark’s Labour council has set an ambition to ensure that 100% of children and adolescents can have access to mental health care. As part of that commitment, the council has made £2 million available for local schools to support the emotional wellbeing and mental health of pupils. It is also developing a mental health hub service for young people. That is in partnership with—jointly funded by—the local clinical commissioning group.

As I have said, I think that my personal experience has given me an additional strength in working with local people and families who are affected by these issues, but being open about my family experience does not mean that I have not seen discrimination or stigma at first hand. I was about 10 or 11 when I said to a friend at school that Mum had schizophrenia and he asked whether that meant I had two mums. That was a surprising reply, but obviously there was a lot of confusion then about what schizophrenia actually was. Some of it is still out there.

Sadly, one thing that remains is the perception that people with schizophrenia are somehow more dangerous. Actually, mum’s experience and that of many people with schizophrenia is that they are more likely to be targeted, because their erratic behaviour when they are unwell can draw the attention of others, who might target them for robbery and other offences.

--- Later in debate ---

[Neil Coyle]

Certainly, there is insufficient support for a whole range of people. We have sadly seen a roll-back of support, independence of choice and control in a number of areas, including social care support, health services and direct benefits for some disabled people, particularly in the past nine years.

The extensive powers, which I described, were used to detain 50,000 people last year—a 47% increase in the past decade. The only other people detained in this country are those in criminal custody. Those citizens have safeguards to protect them from going to jail, but we do not have the same safe standards of support and safeguards for mental health care. Those who commit a criminal offence have a police investigation, the CPS evidence threshold, a trial, the right of appeal and advocacy throughout, but for the 50,000 detained under the Mental Health Act few such safeguards exist, despite the deprivation of liberty, choice and control.

We can turn this situation around. The independent review of the Mental Health Act, chaired by Professor Sir Simon Wessely, recommended that four principles be written into a revised Act. First, it recommended that choice and autonomy, even for someone detained under the Act, must be respected, enabled and enhanced wherever possible. Secondly, it recommended that the compulsory powers contained within the Act should be exercised in the least restrictive way possible. Thirdly, it recommended that services and treatments should be of therapeutic benefit and delivered with a view to minimising the need for Mental Health Act powers to be used. Fourthly, it recommended that the individual must be respected, and that care and treatment must be provided in a manner that treats them accordingly.

I seek the Minister’s views on those principles being incorporated in forthcoming plans. If those four principles had existed when my mum was detained—she has been sectioned more times in my lifetime than I can remember—I would have had more reassurance that her needs, rights and wishes would have been the starting point for the care and treatment she received. Sadly, that was not the case.

This is the first debate to be held on the Mental Health Act since that review was published, which is astonishing, given the level of use of the powers in the Act and the level of support for reform. The review made 154 recommendations. The Government accepted two immediately and agreed to publish a White Paper by the end of this year to bring forward full legislation. I welcome that; there is no one who does not want to see that. However, given the paralysis caused by Brexit, and the new Prime Minister and Cabinet, can the Minister confirm that that timetable has not slipped?

[Janet Daby]

Does my hon. Friend agree that a new mental health Act must prioritise children and young people? The statistics relating to young people are cause for concern.

[Neil Coyle]

It certainly should, but we should not have to wait for new legislation—some measures can be taken before that. Given that the White Paper is due by the end of the year, legislation many not come soon enough to help some of those young people who are experiencing problems now.

I hope the Minister will indicate that the Government’s rhetoric on parity of care will be matched by action on preventing the need for detention. Sadly, all the evidence points in the other direction. Parity of care—the requirement to treat mental and physical health equally—was enshrined in law in 2012 and became part of the NHS constitution in 2015. Although mental health accounts for 28% of the overall disease burden, as the NHS terms it, it received just 13% of NHS funding, according to the Centre for Mental Health. In cash terms, the King’s Fund has shown that between 2012 and 2017, funding for acute and specialist hospitals grew by almost 17%, while that for mental health trusts grew by just over 5.5%.

The Royal College of Psychiatrists has found that, taking into account inflation, the real-terms income of mental health trusts across the UK has fallen since 2011. It says that 62% of mental health trusts in England reported a lower income at the end of 2016-17 than in 2011-12. Sadly, only one trust experienced a rise in funding in all five financial years. The Royal College of Psychiatrists has also reported that mental health trusts received £105 million less in 2016-17 than in 2011-12, at today’s prices. There is no parity of funding, even though the Government are legally committed to it.

The 40% rise in detention over the past decade has come at the same time as a loss of overnight beds—between 2010 and 2017, the figure went down from more than 25,000 to less than 20,000—and a 15% decrease in the number of mental health nursing posts. Demand is rising as a result of detentions, but the number of staff has diminished and there is also less space available. The Care Quality Commission, which regulates mental health services, has reported that previously preventable admissions are now not being prevented because of cuts to less restrictive alternatives, such as community mental health services. There has also been an increase in the number of people with at-risk factors when it comes to detention, such as social exclusion and untreated drug or alcohol misuse.

Clearly, it is not in someone’s best interest to be detained if that is avoidable. A breakdown of mental health and behaviour can be deeply damaging for individuals, and their families and loved ones, but detention is extremely costly, especially compared with drug and alcohol treatment services or other interventions and support in the community. The average cost of each detention is estimated to be just over £18,000. The 50,000 detentions over the past year cost an estimated £900 million. That money could have gone so much further in earlier interventions to prevent detention.

Of course, there are also costs to how people are identified or present themselves in crises that result in detention. Sometimes they are homeless. I know the Minister has done a lot of work on that. We have met on several occasions and I know that she views homelessness as a public health issue—an issue that overlaps with the topic of this debate. Homelessness as a result of mental ill health increases physical health issues, which result in costs to the NHS.

Sometimes people in crisis are identified by the police. The last time my mum was sectioned—I think it was in 2016—she had had a car accident in which she hit a bollard. No one was injured, but she was prosecuted for the accident. My family and I—including my sister Alex, who I know is watching—had sought help for mum. We knew that she was becoming unwell and that she was not taking her medication, and we tried in advance to alert people to her need for support and to get her back on track, but that did not happen. She had agreed to plead guilty when the case went to court—she was guilty; she hit the bollard and no one else was responsible—but when she was asked how she would plead, she said that she could not be guilty because she had been wearing blue that day. Of course, that made no sense to anyone and resulted in the ordering of a psychiatric assessment, which was a pathway back into mental health care.

That was not necessary. Police and court involvement cause unnecessary cost to the taxpayer. If earlier interventions had occurred at the request of family members, that could have been avoided. I ask those hon. Members who have not been out with their local police and emergency responders to please do so. The last time I did it in Southwark, the police responded to a surprising number of 999 calls that involved someone with a mental health condition. That is not just anecdotal evidence; it is backed up by national statistics.

Troublingly, police statistics show an increased use of section 136 of the Act. That power is used by the police exclusively to remove

“mentally disordered persons without a warrant.”

Between 2015-16 and 2017-18, the use of that power in Southwark doubled, from 60 detentions to 121. That number fell slightly last year, but the shocking overall rise shows the price of underfunded mental health services, with the police often picking up the pieces in situations that should be handled by healthcare specialists and community interventions. Of course there will be some who are unknown to services, but most are not, and there are some who present with issues relating to suicide. Tackling the majority of cases upstream should be the target. I hope the Minister will state how that will be done through a White Paper or new legislation.

I welcome the previous Prime Minister’s commitment to end the use of police cells to detain people who are experiencing mental ill health. I hope that that commitment will continue under the new Government, because a police cell is no place for someone who is experiencing a mental health crisis. Although there has been a 95% fall in the use of cells and custody facilities since 2011, in the latest figures from 2016-17 they still accounted for almost 4% of detentions. I hope that the Minister will set out when the Government expect the number of people going through the system to be zero.

The point that I am trying to ram home is that overreliance on sectioning and detention can be bad for the individual and their families, but also for the taxpayer. We can do better than that. It is not just a matter of the loss of liberty; the Care Quality Commission has also sounded the alarm over risks for people when they are detained, including compulsory treatment and sexual assault. It reports that almost one fifth of patient records—double the proportion in the previous year’s study—

“showed no evidence of consideration of the least restrictive options for care.”

It also stated:

“We have seen limited or no improvement in the key concerns we have raised in previous years.”

That is the regulator saying, “Not only have we identified the problem this year, but we told you about it in previous years, and still no improvement has been made.” Its evidence shows that 1,120 sexual safety reports were made in a three-month period in 2017, of which 457 were about sexual assault or harassment of patients or staff. Some of our most vulnerable citizens are at risk of sexual assault while they are detained under the state’s powers. That is an absolutely appalling record in any civilised society.

These problems all undermine mental health treatment and use of the Act and make it no surprise that research commissioned by the Mental Health Alliance shows that individual experiences of being detained under the Act are far from positive. It surveyed more than 8,000 people, and the majority of respondents who had been detained did not believe that the Mental Health Act sufficiently protected them from inhuman or degrading treatment. Some 61% of respondents who had been detained disagreed with the statement, “People are currently treated with dignity when detained”, as did 41% of mental health professionals. The unity behind the case for reform and true parity of care could not be clearer. I hope that the Minister will cover those issues and confirm more of what the Government aim to put in their Bill when it appears, including human rights provisions.

At the Disability Rights Commission in 2004-05, I helped to bring organisations of and for disabled people together behind the principles that were then put in the Mental Health Act 2005:

“A person must be assumed to have capacity unless it is established that he lacks capacity.

A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.

A person is not to be treated as unable to make a decision merely because he makes an unwise decision is made.”

Our right to make bad decisions is enshrined in legislation. I apologise to any smokers present, but they make a bad choice every time they light a cigarette, and arguably the Conservative party has chosen badly in selecting the right hon. Member for Uxbridge and South Ruislip (Boris Johnson). The fourth and fifth principles are:

“An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.

Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.”

We have precedent in legislation, and we need to support that approach again in reforming the Mental Health Act, with a resolute belief in patient-centred care, with as much choice, control and dignity as is humanly possible.

People’s experiences of being detained vary wildly. It cannot be right that some people are treated worse simply because the place where they become unwell does not have access to the right level of support. We need more standardised access to care, and more standardised care when it has to be provided. I recognise that detention cannot always be avoided, and that it has welcome results when people come out better than when they went in, but even when it is necessary, it must be done better—and there are ways to do that.

Advance decisions were one of the review’s two recommendations that the Government accepted. It is crucial that patients be involved in planning their care as much as possible. The Care Quality Commission’s research shows that under the current legislation, a staggering one in five patients detained have no input whatever in their care plans. It examined the plans in place for those patients and found that most of them were of poor quality, lacked planning and had no evidence of patients’ consent to treatment when they were admitted to hospital. Introducing advance choice documents so that people can set out their wishes about future care and treatment, and giving them more legal weight than they have under the current system, would help to solve that problem and improve care for thousands of people.

I will give a quick practical example for anyone who needs it. Medication for schizophrenia has improved dramatically. Some of the medication that mum used to take would cause regular, sustained vomiting, which caused teeth loss and worse. Different treatments are available. If she were sectioned and put back on that medication, knowing the side effects, it would obviously make the treatment worse for her. I hope that the Minister will give a strong indication about the Government’s plans for advance decisions and the ability to make choices that can improve the treatments available.

When a person is detained under the Act, they have a “nearest relative” who has certain rights to be involved in their care. Many family members and patients value the fact that relatives are given a statutory role, but that relative is chosen from an outdated hierarchal list that is based on age, rather than on the views of the individuals involved or on whether they have a good relationship. The Government accepted that recommendation from the review. I hope that the Minister will have more to say about that today—[Interruption]—and less about stopping Brexit, which is the chant outside that may have been caught on the microphones.

Those who are detained under the Act have effectively no legal say over their treatment and no automatic right to advocacy in the event of their detention. The fact that such rights are not enshrined in the legislation illustrate that reform is badly needed. Establishing a right to an advocate for all mental health in-patients, whether voluntary or detained, without having to ask for one, would also radically improve care, as would the statutory inclusion of a patient’s advance wishes in their treatment plan. I hope that the Minister will give an indication on that matter today as well.

I will cut down the bit of my speech about resources, because they have already been mentioned and I know that other hon. Members want to speak. However, cuts have had serious implications, including for the distances that people, including children, have to travel for treatment: they are often taken hundreds of miles away from their friends, family and community. That cannot be acceptable. Wider cuts to council budgets and the public health agenda have also had an impact, and my constituency has experienced the knock-on effects. We lost an organisation called CoolTan Arts, which used to provide creative and employment support for many disadvantaged people with mental health conditions.

My very real fear is that the bad old days have crept back. For too long, Ministers have ignored the problems. There have been cuts to services, and we are seeing more ill-trained or morale-sapped staff; an overuse of agency crews; rising use of detention, which locks the problem away out of sight; and compulsion rather than empowerment. That must change. The new Prime Minister must listen to what is said in this debate; I hope he will. The White Paper that has been promised must be delivered and must reflect the spirit and ambition of the independent review.

New legislation must also be passed to update the Act. It is not just about getting a better piece of legislation; more importantly, it is about better treatment for the thousands of people with mental health conditions and their families up and down the country. There is cross-party support for this work: 49 colleagues have signed early-day motion 1242, which

“calls on the Government to reform the Mental Health Act…during this Parliament”.

There is appetite in the Commons for that reform, so I hope it will be delivered.

We have a window of opportunity to improve thousands of people’s lives. I hope that the Minister and the new Cabinet and Government will take it.

NHS Long-Term Plan: Implementation

Janet Daby Excerpts

Monday 1st July 2019 Commons Chamber

[Matt Hancock]

Yes, I am looking forward to that legislation being introduced. The work that my hon. Friend’s Select Committee—the Joint Committee on the Draft Health Service Safety Investigations Bill—did in the prelegislative scrutiny was incredibly important. The HSIB Bill promises to improve patient safety, which is an important part of the agenda, and I look forward to its being brought forward to the House.

[Janet Daby (Lewisham East) (Lab)]

I have recently become the vice-chair of the all-party parliamentary group on sickle cell and thalassaemia. Sickle cell is very much a hidden disability which is lifelong. Some people take up to five medications a day, which is very costly. If they have a relapse, they can be hospitalised, but it is more cost-effective and preventive to have free prescriptions than to end up in hospital. Will the Secretary of State review the matter and do what is both best for those patients and in the public interest?

[Matt Hancock]

I will certainly look at the matter. When I was on a night shift with a London ambulance crew, we attended a patient who suffered from sickle cell, and it was horrific to see the degree of pain that they were in. I have therefore seen at first hand exactly how horrific the condition can be and I will look into the hon. Lady’s suggestion.

Cystic Fibrosis Drugs: Orkambi

Janet Daby Excerpts

Monday 10th June 2019 Westminster Hall

[Janet Daby (Lewisham East) (Lab)]

I thank the hon. Gentleman for giving us such a comprehensive overview of cystic fibrosis. A constituent of mine, Joanne, has contacted me regarding her daughter Lauren, who suffers from cystic fibrosis. Access to treatments such as Orkambi, which has already been mentioned, would be absolutely crucial to managing hers and so many other people’s conditions in our country. Hon. Members might know that 16 May marks a year since the Prime Minister called for a speedy resolution to this issue. Does the hon. Gentleman agree that we need to hear the actions that the Government can take, and are taking, to open up access to these lifesaving treatments for people such as Lauren in my constituency?

[Paul Scully]

One of the reasons why NICE was set up in the first place was to take politics out of drug development. We need to ensure that we have the balance right between the Government intervening and the clinicians—the people who can make their assessments without political interference—making their decision. None the less, we clearly must have a view.

One of the things that some people have suggested—I think it was intimated in an earlier intervention—is Crown use of patents, to allow the use of generic drugs and effectively remove patents from pharmaceutical companies. Obviously, that is in extremis. There is an inherent problem with the potential lack of investment in future research, should we start taking away patents from private companies.

Mental Capacity (Amendment) Bill [Lords]

Janet Daby Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

[Chris Bryant]

I think the hon. Gentleman has just read, in some weird way, what I was about to say—he has a very special mental capacity of his own if he is able to read my notes from that distance. He is absolutely right, however, and I do not want to drive a coach and horses through the Bill at all. I fully accept that there is a requirement for some elements of it.

I have an anxiety about the pace at which the Bill is going. It is a shame that the code is not yet available, because it would significantly affect how we viewed some of the issues that we are talking about today. All the things in my amendments should probably be in the code, rather than on the face of the Bill—that is what the Minister said to me yesterday, and I should have given her a much harder time, by the way—but why do we not have the code now? We are not going to have it before the Bill receives its Third Reading, and I think that is a mistake. It is not as though we have lots of wonderful business to be getting through.

[Janet Daby (Lewisham East) (Lab)]

A young person in my constituency has contacted me—she has a disability and works for a disabled people’s organisation called Inclusion London—to raise concerns about the speed at which the Bill is going through Parliament. There is a sense of it being rushed through without adequate consultation, which it needs, and with little regard for the people who are likely to be affected by it. Does my hon. Friend agree?

[Chris Bryant]

Yes, I do have that anxiety. I want to be a bit critical of the Government on that, because this is a two-year Session of Parliament and there is no reason why this could not have been done in a proper way. I am slightly conscious that there is not a great deal of time left today, however, so I am keen to bring my remarks to a close.

--- Later in debate ---

[Barbara Keeley]

We should not be in this position of having less than two hours on Report. This Bill has been rushed. We were in the same position on Second Reading, and it is absolutely unacceptable for such an important Bill to be rushed through as it has been today. I spoke to the Minister about this yesterday. She could have chosen to bring the Bill back on a different day, and I am sorry that she has not.

I am every bit as concerned about this Bill as I was on Second Reading. It remains deeply flawed. It weakens the current safeguards for people who lack capacity, and we have not even had a clear answer to the question that the hon. Member for Totnes (Dr Wollaston) just asked about the current backlog of DoLS applications. It is not clear how that will be cleared.

The Minister said at the start of Committee that she would work constructively with other parties on this Bill, but that has not been reflected in our experience. She has dismissed many of the serious concerns raised both by Opposition Members and by the many charities and representative groups outside the House with an interest in the Bill.

I said in Committee that our amendments were the bare minimum required to ensure that the Bill is fit for purpose. The Government rejected all our amendments in Committee, and, despite some movement on one or two issues since, the Bill retains the majority of the significant flaws it contained on Second Reading. It is sad that, having been through all the stages, this is where we are.

We have tabled further amendments to address some of the glaring holes that remain in the Bill, and I thank all the stakeholders who have helped us, including the Alzheimer’s Society, VoiceAbility, Mencap and Lucy Series. Without these amendments, we simply do not believe that the Bill is fit for purpose, and we oppose it progressing further.

[Janet Daby]

Does my hon. Friend agree that the Bill should be paused until the draft code of practice is ready?

Nursing: Higher Education Investment

Janet Daby Excerpts

Wednesday 21st November 2018 Westminster Hall

[Janet Daby (Lewisham East) (Lab)]

My mother is a retired nurse from the Windrush generation and my sister is in the nursing profession having studied midwifery and having been a health visitor. I value their contribution, and many other contributions, to health and social care in this country. I have some insight and understanding of the challenges that underfunding brings.

Health and social care in England is short of registered nurses. The NHS in England is missing nearly 42,000 nurses —it is estimated that, without significant funding and policy intervention by 2023, the figure will rise to almost 48,000. That is a conservative estimate drawn directly from the system-held data and should be seen as a public interest issue.

This serious underfunding for Royal College student nurses is a crisis in England and action must be taken to address it. England is now the only country in the UK without some form of bursary for the nursing degree. The First Minister of Scotland recently announced that the bursary for nursing and midwifery students in Scotland would rise to £10,000 by the academic year 2020-21. We in England are failing in that respect.

On 31 October, the Secretary of State for Health and Social Care publicly committed to investing in nursing education, stating that nursing students must

“get the support they need to complete their training so they can serve in our NHS. That is something we will specifically address in the long-term plan for the NHS”.

[Sandy Martin (Ipswich) (Lab)]

Does my hon. Friend agree that the important point is that the nursing course demands full-time study? Someone cannot do a part-time job while they are taking a nursing course. Unfortunately, because of the lack of maintenance grant, in most other areas of higher education students have to do part-time jobs in order to keep themselves alive, but it is not an option for nurses.

[Janet Daby]

I absolutely agree with my hon. Friend and I will address that crucial issue.

What I need to know, and what student nurses, potential student nurses and England need to know, is this: when will we see the long-term plan to promote the sustainability of the NHS and when will the Government take it seriously? I ask because the number of applicants from England aged 18 decreased by 12% between 2016 and 2018, while the number of applications from those aged 25 and above from England fell by 40% in the same period. Furthermore, a decline in the number of mature students affects specialist areas of nursing such as learning disability and mental health.

In all areas of nursing, not having enough nurses means that the safety of care is a concern—it could become fundamentally unsafe. Frontline staff are compromised, and people seeking to access health and care services are not able to receive the quality of care that they need.

Nursing students spend 50% of their time in clinical practice and—as mentioned by my hon. Friend the Member for Ipswich (Sandy Martin)—nursing courses run longer than many other degrees, which means that nursing students have no opportunity to take on part-time work to supplement their income. They deserve support that recognises the exceptional nature of nursing and we need to invest in their future. If we do that, we would also be investing in our NHS and, indeed, in England.

It is clear that student nurses work long hours, which demands much from them. This can be physically, mentally and in many cases emotionally draining. It is particularly difficult when a student nurse witnesses, for example, a newborn baby dying on a paediatric ward, or when they are caring for terminally ill patients or those with complex mental health needs. If the Government consider that training and the NHS worthy of recognition, when will they properly invest in student nursing careers?

I have been lobbied considerably. My local hospital is overstretched for health and care professionals, including for doctors and nurses. It seeks to recruit from overseas but, in the context of Brexit, the growth of the domestic workforce will be ever more important. The Government and NHS England must invest at least £1 billion a year in nursing, through higher education, as part of their long-term plan for the NHS in England.

Finally, I endorse and praise the work of the “Fund Our Future” campaign and I thank my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) for securing this debate.

--- Later in debate ---

[Stephen Hammond]

Of course it is important. As my hon. Friend will know, as Members, and particularly as Ministers, we get all sorts of briefings, which are very helpful and contain lots of numbers, but not real-life experience.

My hon. Friend the Member for Henley (John Howell) talked about the experience of nurses at his hospital. He made the point quite powerfully that there are several common issues that we need to address, but several other issues that are not necessarily common to every experience. It is right that we consider the issues they raise.

[Janet Daby]

One of my constituents who is a student nurse has been to see me. She is struggling with her student nursing loans. She has two children, and she was literally in tears while telling me her stories about how difficult it is for her—the Student Loans Company is demanding the money back. She is working and has children, and cannot afford to pay back those loans. Does the Minister think that situation is tenable?

[Stephen Hammond]

I will talk about that issue in more depth later, but if the hon. Lady wishes to write to me, I will look at her constituent’s case. I will point out that the learning support fund already offers a number of opportunities, including child dependants allowance, travel costs and an exceptional hardship allowance. I hope her constituent knows about and is taking advantage of those opportunities.

The hon. Member for Ellesmere Port and Neston (Justin Madders) asked whether the Government will publish an update on the impact of the reforms. That is currently being worked on with education and health organisations and stakeholders. We will look at the most appropriate way of making sure that, following receipt of the proposals by the RCN, and in the context of the long-term plan and the chapter on workforce planning, the higher education funding review takes place and feeds into that update. We will set that position out in due course—I dare say that the hon. Gentleman and I will debate it in due course as well.

My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) described what an excellent training scheme should look like, which was very helpful and powerful. My hon. Friend’s experience as a clinician is invaluable, and hopefully my speech will address a number of the points that she raised. I listened carefully to the asks of my hon. Friend the Member for Chelmsford (Vicky Ford). Some are in my power and some are not, but she made a point about mature students, and the Government recognise that the number of mature student applications has dropped across the wider higher education sector as well as in nursing. We are working with organisations in the sector to see how we can attract more mature students and whether specific funding can be targeted more effectively towards those students via the learning support fund.

It does not really need saying that, at the national level, the Government understand how important nurses are. We are committed to making sure that the nursing workforce are properly supported and funded. In her contribution, the hon. Member for Wolverhampton South West made the point that funding to the NHS is increasing: by 2023-24, it will receive £20.5 billion a year more than it currently does, and the Government expect the long-term plan to set out a strategy for the NHS to ensure a sustainable supply of nurses, rolling that supply across the whole range of pathways. We expect NHS England to clearly set out its commitment to the nursing workforce in the long-term plan, and ensure that there is a clear way for that plan to be implemented. A number of significant interventions are already in place to boost the supply of nurses, including training more nurses, offering new routes and enhancing reward packages. As my hon. Friend the Member for Sleaford and North Hykeham pointed out, there are over 11,900 more nurses on our wards than there were in May 2010.

However, the Government, and I as the new Minister for Health, should never be complacent, so I will set out a few other things that I regard as priorities. Our priority is to get more nurses on to our wards. As has been referred to, the education funding reforms, which moved student nurse funding into the student loans system, were introduced to unlock the cap that constrained the number of pre-registration nursing training places. Those reforms allow more students to gain access to nurse degree training courses. We have announced funding for 5,000 more clinical training places to make sure that those placements can be put in place. We have also increased midwifery training places by more than 3,000 over the next four years, and in 2017, there were 22,575 acceptances—the second-largest number since nursing became a degree-only profession.

It is also important to note that the loans system gives more cash when compared with the bursary system—effectively, up to 25% more. A mature student with two children will receive up to an extra £7,500 a year. I recognise that a number of other things need to be, and should be, put in place and known about more widely. The Government have also targeted support for healthcare students on courses through the learning support fund, which provides additional non-repayable grants. Up to £1,000 is available for eligible students in childcare allowances and hardship funding provisions. None of that, of course, was available under the bursary scheme. More nurses are in training, and the Government are working with Health Education England and the university sector to ensure that students continue to apply for nursing courses up to the end of clearing this year. I am pleased to say that, this year, we have seen a 6% increase in the number of 18-year-olds applying for courses and being accepted.

As an hon. Friend pointed out, there continues to be strong demand, specifically for younger people. I have made the point that we need to address the issues faced by more mature students who wish to enter, or re-enter, the profession. That should be a key priority in the long-term plan. The Government, and I as the new Minister, recognise that we need to do much more to continue to encourage people to apply for nursing courses, particularly more mature students. Therefore, my officials are actively engaging with the Royal College of Nursing, the Council of Deans of Health, and Universities UK—all of those organisations have a role to play. The Government will be consulting on the detailed proposals on future funding for higher education that the RCN has put forward today. I said this earlier, but I want to recommit and make it clear that we regard those as serious proposals, and will be writing to the RCN to engage on those proposals. We will start that work straightaway.

Budget Resolutions

Janet Daby Excerpts

Tuesday 30th October 2018 Commons Chamber

[Naz Shah (Bradford West) (Lab)]

I was really shocked when the hon. Member for Mid Norfolk (George Freeman) said that there is weariness. It was Halloween yesterday, and that Budget was damn scary, never mind wearying. As for asking public sector workers to tighten their belts, it was not about tightening their belts—it was about going and accessing food banks. That is what that Budget was about, and what the Government continue to be about.

I sat here yesterday listening attentively to the Chancellor delivering his Budget. I was not holding my breath given this Government’s track record on breaking their promises, but I am ever an optimist, so I still sat here in hope: hoping, on behalf of my constituents of Bradford West, for this Government to deliver on their all-singing and—dare I say it?—all-dancing “end of austerity” Budget. Alas, even the Chancellor’s self-deprecating humour could not mask the reality of yet more broken promises.

No doubt we will hear from many colleagues, as we have heard before, about what this Budget really means and how it has failed to redress the balance and the crisis in the health and social care sector, with no end in sight under the Conservatives. But for now I want to talk about young people, and particularly their mental health. That is not only because I come from the great city of Bradford, which will have the youngest population in the whole of Europe by 2020, but because, as a former chair of a large mental health charity and a former NHS commissioner, I have an acute understanding of the realities that this Government continue to fail to grasp. They fail to listen to charities such as Barnardo’s, which has warned the Government that they are sleepwalking into a crisis.

Throughout this country we have seen a huge increase in the number of young people, in particular, suffering from mental health issues. Just a few weeks ago in my constituency, I met George Zito. George and his colleagues work to provide positive mental health training across schools in Bradford. George explained to me that 8,500 young people across Bradford have been diagnosed with mental health disorders, but the number with lower-level concerns is estimated to be at least double that. Implementing mental health specialist departments in every large NHS A&E is one way of tackling the crisis in mental health at the last stage, but we cannot afford to provide just last-minute crisis rescue for people’s mental health disorders, as the Government are currently doing with their Brexit negotiations.

When 50% of mental health problems are established by the age of 14, and 75% by the age of 24, making young people’s mental health a priority allows us to prevent future life problems for a whole generation. The Children’s Society has expressed concern that the Government’s plans for improving children’s mental health more generally are moving too slowly. With only one in four children being reached by school-based mental health teams in the next five years, there was nothing in the Budget to address that. My hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) mentioned earlier that is extremely disappointing that the Government did not put extra resource into schools to provide counsellors who can effectively tackle low levels of wellbeing and support children with poor mental health.

The reality on the ground is that people like George Zito from my constituency will not get the resources they need, and little will be done to help reach young people with mental health issues in their schools. With this Budget, the two-year waiting times for young people trying to see a specialist counsellor for issues to do with mental health will remain to a large extent in Bradford West. The Chancellor decided it was okay to trick the young in my constituency facing issues with mental health while his Budget could treat the wealthiest, who are 14 times more likely to benefit from it than the poor.

Between 2012 and 2016, this Government’s cuts led to a loss of 600 youth centres, 3,500 youth workers, and 140,000 youth centre places for young people. This Budget does nothing at all to resolve the loss of those services. It not only neglects young people’s need for direct access to mental health counsellors in their schools but, given the minimal youth services available, leaves them with little or no face-to-face support. Although I sincerely welcome the Chancellor’s cash injection of £2 billion, which has been referred to on more than a few occasions, I am afraid that it just does not cut it for my constituents, or for young people up and down the country. The Institute for Public Policy Research suggests that almost £4.1 billion is the actual figure needed to meet the necessary provision of mental health services.

[Janet Daby (Lewisham East) (Lab)]

In situations where there are no beds in acute mental health wards, public funds are being used to pay for private beds in private hospitals. Does my hon. Friend think that that is a good use of public funds?

[Naz Shah]

I absolutely share those concerns about that expenditure when we are not investing in the infrastructure we need. What we heard yesterday, and more of today, was sticking plaster options—those are the only solutions that this Government have come up with. That is one thing that the Conservatives are absolutely the masters of—saying, “We are investing £2 billion, but actually we stripped you of £5 billion the week before.” It just cannot work like that.

My concerns remain as valid as they were before the Chancellor stood up yesterday and delivered his Halloween frighteners, because the truth remains that once again this Government are using their mastery of applying sticking plasters to try to hold together a wound that they have inflicted and that, quite frankly, is not healing. The tricks in his bag were exactly those, delivered by the Chancellor on behalf of a Tory Government who are now a master of disguise. Yesterday, the Chancellor liked to refer to himself as Fiscal Phil. Although it may be humorous for the Chancellor to half-pronounce his name, it is catastrophic for this whole country when his Budget does not even half halt austerity, half provide the provision needed for mental health services, or go halfway towards providing the parity of esteem that his own Government have been promising.

With the Chancellor suggesting that he will put an emergency Budget before Parliament in the event of a no-deal Brexit, a few things come to mind. Is the Minister willing to provide assurances that the extra funding for mental health will not be swallowed up, that there will not be cuts, and that the Prime Minister’s failure to negotiate a Brexit deal will not mean collateral damage for those suffering the most?

Finally, I want to talk about the investment in the public sector leadership academy, which the hon. Member for Mid Norfolk mentioned. I concur: I absolutely value that investment. However, the problem is that it is those very public sector leaders who are having to deal with austerity. For example, there is the former chair of Solace in Doncaster, who has written an article about it. In Northamptonshire, the Tory council is having to go through bankruptcy. There is nothing wrong with the people involved as leaders. What is wrong is the cards that they are dealt in having to cut services and make decisions every single day of the week about whether a woman is not going to get a bed for the night following domestic violence, a child is not going to get a CAMHS referral, or a child is going to take home a begging letter from their school because there is not enough funding and it cannot afford food. That is the reality of austerity, and it needs to stop now.

Social Care Funding

Janet Daby Excerpts

Wednesday 17th October 2018 Commons Chamber

[Matt Hancock]

I will come on to the proposed funding reforms. My hon. Friend is right that there is support for reform across the House, but there is support for different types of reform in different parts of the House. I respect the shadow Opposition spokeswoman, but it would help if she could bring more clarity to the Opposition’s position, updating the proposal that they put forward in 2010, which I will come on to in some detail. That will help if they want to genuinely contribute to this debate.

Of course, social care is not only a challenge of old age. The number of people of working age with care needs is also growing. Many of us in this House will know the pain and difficulty of helping a loved one who needs constant care or faces dementia. Such pressures bring long-term challenges, and we must ensure that both the NHS and our social care system can respond to the challenges we face.

[Janet Daby (Lewisham East) (Lab)]

There is an acute nursing shortage in this country. According to the CQC, nursing homes may need to re-register as residential homes, possibly due to the difficulty in recruiting enough nurses, which would have disastrous consequences for some of the country’s most vulnerable old people. With the looming prospect that Brexit will further restrict our ability to recruit nurses from Europe with the necessary skills and talent, does the Secretary of State agree that he needs to do everything he can to ensure that the nursing home sector does not collapse?