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?