NHS Bursaries

Jeff Smith Excerpts

Wednesday 4th May 2016 Commons Chamber

[Jeff Smith (Manchester, Withington) (Lab)]

It is a great pleasure to follow the hon. Member for Totnes (Dr Wollaston), as I have a lot of respect for her. Indeed, she commands respect across the House, and it is important that we listen to her views. It is also important that we listen to the views of others, including those of her colleague the hon. Member for Lewes (Maria Caulfield), who said:

“Speaking as a nurse, I would struggle to undertake my nurse training given the proposed changes to the bursary scheme.”—[Official Report, 5 January 2016; Vol. 604, c. 15.]

Clearly, the changes have not been thought through.

As a south Manchester MP, I am very proud to represent a large number of Manchester University students, including many of our nurses and midwives of the future. Indeed, the School of Nursing, Midwifery and Social Work at the university was the first institution in England to offer a nursing course, and it remains one of the top 10 universities in the world to study that same degree today. For the 2,000 students currently studying there, as well as for those weighing up their future with healthcare education in mind, the proposals on student bursaries will do nothing to instil any confidence that the Government understand the perspective of student nurses or potential student nurses.

I want to use my brief remarks to raise two main points. The first is the disappointing lack of consultation with organisations such as the Royal College of Nursing, and the second is the effect that this policy will have on potential students and patient care. Ensuring that access to these professions remains fair, that their funding is sustainable and that the Government consult experts from the sector are vital factors in securing the interests and the confidence of future healthcare professionals. Those roles are the lifeblood of our national health service, and we all have a stake in their future.

One big concern that we have consistently raised is the Government’s reluctance to engage with stakeholders. We have heard from charities, representative organisations, and think-tanks that the evidence base for these proposals is at best uncertain, and at worst non-existent. The very real fear is that the proposals will reduce the numbers of people entering nursing studies. Even the 12-week consultation that the Minister was lauding earlier takes the form of a technical questionnaire on the implementation of the proposals rather than a real consultation on the substantive policy.

[Richard Graham]

On consultation with stakeholders and so on, does the hon. Gentleman agree that when a hospital such as the Gloucestershire Royal shows strong support for the concept of nursing associates and wants to run a pilot project for them, we have to assume that it sees real value in those associates in terms of providing good nursing for its patients and my constituents, and that that must be as telling as anything in a formal consultation?

[Jeff Smith]

I thank the hon. Gentleman for his intervention. Parliamentary questions have shown that the Department of Health failed to consult the Royal College of Midwives, the Royal College of Nursing and Unison before the policy was announced in the autumn statement last year. It is not just the Labour party that is worried about this, but the Royal College of Midwives, the Royal College of Nursing, the College of Podiatry, the Royal College of Speech and Language Therapists and the NHS Pay Review Body, as well as Members across the House. It is little surprise, then, that the result fails to understand the unique characteristics of the sector and the hard-working professionals that work in it. This is a process that has been driven by short-term financial savings at the cost of tackling the big questions of how we adequately fund our NHS for the decades to come.

What about the effect of this policy on the nurses and midwives of the future? At the centre of any policy on healthcare education must be the students themselves. In this case, they are diverse: older than most—the average age is 28—and overwhelmingly female. There are greater numbers from black and minority ethnic backgrounds. We should not forget that completing a degree necessitates 2,300 hours of clinical practice over three years. Any legislation that we need to design to encourage students in the future and to guarantee high-quality care for patients must recognise those types of people. They are people like Katie, a nurse in my constituency, who wrote to me about her concerns about the prospect of debt. She said:

“It is particularly worrying for mature students, many of whom have dependants, and it could deter them from joining the profession altogether. I can relate to this as three of my close colleagues are mature students and have stated on multiple occasions that, without the bursary, nursing school would not have been an option. Student nurses are not like other students: 50% of their time is spent on unpaid clinical placements in hospitals and in the community and there are simply not the same opportunities for part-time work as other students. I could not have completed this course without the bursary. Studying nursing requires participation in extra-curricular activities. This is in line with a recent national initiative: revalidation…Therefore, finding time for part-time work becomes very difficult, and many of my friends have been turned away from part-time jobs as our weekly schedules, working shifts and time for completing university work are often sporadic. The bursary covers my rent and without that I would not be able to support myself and nor would my family.”

We need to take such views on board when looking at a new policy.

[Rebecca Long Bailey (Salford and Eccles) (Lab)]

Research from the House of Commons has shown that of the net savings made to the Treasury through measures taken by this Government since 2010, 86% will have come from women. Does my hon. Friend agree that these proposals are no different from those we have seen in the junior doctors’ contract dispute, and that they will adversely affect women rather than men?

[Jeff Smith]

My hon. Friend makes a very important point. It is important to remember that, and to think about how the prospect of paying off more than £100,000 worth of debt affects the calculation of a mature student looking to study a second time to become a mental health nurse. It is important to think about how a lone parent, who is hoping to become a midwife, might feel the pressure of £59,000 of repayments when considering the future of their family—that is the latest estimate of debt from the Royal College of Midwives.

It is important to wonder how a nursing student, taking part in a 48-week extended course, is expected to find part-time work to make their studies viable. Not only is the Government’s evidence base desperately weak, but research by the Higher Education Funding Council for England tells us that poorer students, lone parents and BME students—the demographics of many of the people attracted to nursing—are disproportionately dissuaded from applying to university by the prospect of large debts.

The policy fails on two fronts. The refusal to engage with experts in the field has led to a misguided policy that makes healthcare education the privilege of those who can afford decades of debt. It fails to ensure fair and equal access to healthcare education. Secondly, there is a real danger that this policy will fail to achieve its own aim of attracting future students. Everyone in health who knows about these issues will acknowledge the shortages of nurses, midwives and other health professionals, but moving the burden of payment to students is widely seen as a mistake. Deterring potential candidates by promising a lifetime of repayments immediately on graduation cannot be the answer.

I conclude by joining the calls of the Royal College of Midwives and the Royal College of Nursing for the Government to rethink the proposals and to scrap the NHS bursary. We need a thorough and inclusive consultation process so that those with experience of the system are able to contribute properly. I ask Ministers to ensure that future students at Manchester University’s School of Nursing, Midwifery and Social Work are not forced to bear the burden of a Government unwilling to listen. The Royal College of Nursing has said that the Government have not thought hard enough about the risks. Now is the time to do so.

BMA (Contract Negotiations)

Jeff Smith Excerpts

Monday 21st March 2016 Westminster Hall

[Helen Jones]

My hon. Friend is quite right, and I will come on to that point later. There are staff shortages in the NHS that the contract may well make worse.

In the end, as in any dispute, the issues can be resolved only by negotiation, and in truth the two sides are not all that far apart. Huge progress was made when Sir David Dalton was brought into the talks, but there are still outstanding issues to be resolved. For instance, the Government trumpet a 13.5% increase in basic pay. What they do not say is that that increase will be paid for by cuts elsewhere. For example, payments that are made as a reward for length of service will go. I have yet to hear from the Government their assessment of what impact that change will have on retaining staff in the NHS, or how it will work for members of staff who take time out, whether for academic study—we need doctors who are both academics and good clinicians—or for maternity leave. What will happen to women who work part time, and so on? If we lose a number of women doctors in the NHS, the service will be in a great deal of difficulty.

Guaranteed pay rates when people change specialties are also going. In the past, if someone changed specialty later on in their career, their pay was guaranteed. That will not be the case any more. That change is bound to have an effect on recruitment in areas where we are already short of doctors, and I have seen no real impact assessment of that yet.

Of course, the big issue for many doctors is the change to standard time and premium time. The Government are increasing standard time from 60 hours a week to 90 hours a week. In the past, doctors were paid extra for working between 7 pm and 7 am, and for working at weekends. Standard time will now increase to run to 9 pm on weekdays and 5 pm on Saturdays. Doctors who work more than one in four weekends will get a premium payment. It is difficult to work out the effect of that change on individual doctors; it depends on how many weekends they work now, what their specialty is and so on.

The Government’s pay guarantee lasts for only three years, and given the Secretary of State’s remarks, junior doctors fear that the change is a back-door way of introducing longer hours. It certainly makes it cheaper to roster doctors at weekends. The Government say they will fine hospitals that roster people for more than a certain number of hours, but the doctors say that offer is not good enough. That is not an unbridgeable gap; it could be resolved. However, the result of what has happened and the Secretary of State’s comments is distrust and suspicion among doctors about what his real motives are. That is combined with a disastrous drop in morale in the NHS. The latest NHS staff survey shows that the percentage of junior doctors reporting stress has risen from 20% to 35% in five years. The proportion of staff saying that they feel pressurised to come into work when they are ill has gone up from 16% to a whopping 44%.

That loss of good will and drop in morale matters, because NHS staff are known for going the extra mile, working longer than they are paid for and doing things they do not have to do. That extends from the consultants who come in on their day off to see certain patients to the nurses and support staff who bring in a birthday card for an elderly person who has got no one else. I well remember that when my son was born, I was there for three shifts in the maternity department. After he was born, the registrar from the first shift came back to see me, to check that I was all right and to see whether I had had a boy or a girl. It is impossible to put a price on such things, and the Government risk losing all that and doing huge damage to the NHS if they do not solve the dispute.

[Jeff Smith (Manchester, Withington) (Lab)]

Will my hon. Friend give way?

[Helen Jones]

Yes, I will give way once more.

[Jeff Smith]

I am grateful to my hon. Friend. I met a group of junior doctors recently. For the first time, many of them are considering going abroad to work. None of them want to, but they are so demoralised by this Government’s actions that they are considering it. One of them told me how much she loved her job, but she said, “I would never let my daughter train as a junior doctor.” Does my hon. Friend agree that if the Government carry on down this route, we will not have a junior doctor workforce to rely on?

[Helen Jones]

My hon. Friend is right. That is an awful and sad thing to hear from people who are dedicated to the NHS, but yes, there has been a huge increase in the numbers of junior doctors thinking of moving abroad.

The answer is not the imposition of a contract, it is to get back into negotiations. It is about funding for weekend working, not just for doctors and nurses but for the lab staff, the diagnostic staff and the support staff that we need. It is about valuing the staff and showing that they are valued, because many junior doctors believe that the Secretary of State undervalues their work and has sought to undermine patients’ trust by implying that they are responsible for a number of deaths. That really needs to be corrected.

I have a message for the Secretary of State today: you get real. You are a member of Her Majesty’s Government —a senior Minister. Take responsibility. Yes, we need to get the BMA around the negotiating table again, but you need to make an offer that brings it there. You need to make that offer, because you are the person in charge.

It is already clear, in fact, that it is possible to improve weekend working without the new contract. There are trusts that have done that—Salford Royal is one example, as my hon. Friend the Member for Manchester, Withington (Jeff Smith) will know. There is also a rumour that the Department is close to a deal with consultants that will not require the proposed changes. Perhaps the Minister will tell us whether that is true.

To continue my message to the Secretary of State: man up. Admit that you got things wrong. Admit that you mishandled this. Make a gesture and get people back around the negotiating table. If you do not, it is not only the junior doctors who will hold you responsible. The public will hold you responsible as well—in fact, they already do.

When polls ask who is to blame for the dispute, the overwhelming answer is that it is the Government. That is not surprising, is it? If a member of the public is asked, “Who do you trust most, this nice doctor in your local hospital or Jeremy Hunt?”, it is not a difficult decision for them to make. It is time for the Government to stop heading down this road, before we end up with disastrous consequences. It is time for them to get people back around the table, because if they do not the NHS will suffer incredible damage, not simply through doctors leaving but through the loss of their good will. Both the staff of the NHS and the public in this country deserve better.

Junior Doctors Contracts

Jeff Smith Excerpts

Thursday 11th February 2016 Commons Chamber

[Mr Hunt]

It is because an agreement cannot be reached that we have to take the measures that we are taking today. The bits of the new contract to which the hon. Gentleman draws attention are the bits that will have the biggest impact on the morale of junior doctors, because we are saying that we do not think it is right for hospitals to ask them to work five nights in a row or to work six or seven long days in a row. We are putting that right in the new contract. That will lead to less tired doctors and better care for patients.

[Jeff Smith (Manchester, Withington) (Lab)]

I met a large group of junior doctors in my constituency to discuss the new contract. They were highly professional and totally committed to the NHS, but for the first time some of them were considering working abroad. One of them told me that, although she loved her job, she would never let her daughter train as a junior doctor now. Does that not demonstrate that the low morale—the despair, frankly—and the likely flight of junior doctors as a consequence of imposition is a huge threat to the future of our NHS?

[Mr Hunt]

The biggest threat to morale for doctors is not being able to deliver the care that they came into the profession to deliver. That is why we are sorting out a proper seven-day NHS, particularly for junior doctors who work in A&E departments at weekends, where they often do not have the support they would get during the week and do not have as many consultants around as there would normally be. That is what we are trying to put right. I appreciate that it is very difficult when the counter-party in the dispute does not want to negotiate, but in the end Governments have to decide what is right for patients and what is right for the service, as well as what is right for doctors.

Mental Health

Jeff Smith Excerpts

Wednesday 9th December 2015 Commons Chamber

[Jeff Smith (Manchester, Withington) (Lab)]

I want to make some brief remarks in support of the motion and, just as importantly, to welcome the opportunity to talk about this issue. I do so as someone who, like many Members of this House, and many millions of people across the country, has had my life affected by mental ill health. I grew up in a home where a very close family member suffered from severe depression and had a number of breakdowns. I experienced how it affected the whole family over many years, and not just individual suffering, but the effect on everyday family life of regular hospitalisation and the need for other family members to be home carers. Like most of us probably, I have a number of friends who have been affected by mental ill health, and some years ago a close friend committed suicide as a result of her depression.

I have my own personal experience of mental ill health. Like other Members of the House—I think that there are probably a number of us—I have suffered from depression. As a result of these depressive episodes, I know how it feels to be unable to function normally, or to perform even the most basic everyday tasks, because the weight of the depression is so overwhelming. I know how debilitating depression and other mental ill health can be. It is quite difficult to explain to people who have not experienced that just how debilitating it can be.

I am really heartened that mental health is increasingly being not only recognised, but acknowledged and spoken about. People increasingly accept that it is an illness that should be without stigma or taboo. The more that mental health is discussed, the clearer it becomes that it is something that affects people in huge numbers from all walks of life, all backgrounds and all ages. More and more I think my experience is not unusual.

As a councillor for many years before coming to this House in May, I noticed an increase over the years in the number of people coming to advice surgeries with serious mental health problems. Most of us will have stories about how constituents with mental health problems have been failed by the system. We need to treat those people with more sensitivity and understanding. It is the right thing to do not only for the individual, but for society and the economy.

[Rehman Chishti]

With regard to addressing constituents’ needs, the hon. Gentleman might have seen that I have a private Member’s Bill on perinatal mental healthcare. The aim is that mothers should be able to get that healthcare at that most vulnerable time within a reasonable distance from home—75 miles—because at the moment we have a postcode lottery on where they can get it.

[Jeff Smith]

That is a very important issue, and I thank the hon. Gentleman for bringing forward his private Member’s Bill.

A person recently came to my surgery who had some very difficult personal circumstances that left them unable to work due to mental health issues. They were told by an official at the jobcentre that in order to maintain their benefits they were required to take part in telephone counselling, without reference to their GP. That turned out to be an extremely detrimental experience. It brought up episodes from the past that meant that my constituent was set back in their recovery and is now even further away from the ability to regain confidence and rejoin the workforce.

Because of my personal experience, I understand how depressive illness can blight the life of an individual, but it blights our society too. It is difficult to measure the cost of mental ill health to society, but it clearly runs into several billion pounds each year. That is why cuts to mental health services, particularly preventive services, are a false economy, as the Secretary of State acknowledged in his very good words earlier. We are all seeing the effects of the cuts to social care budgets, to wider council support budgets, and to mental health trust budgets. That is a bad thing at a time when demand is growing and we can finally acknowledge the need for concerted action to tackle this issue, and that is why I am supporting this motion.

I have experienced how medication and physical treatment can make a difference—medication worked for me—but I know that psychological therapy can also make a big difference. It is illogical that the right to one of those can be enshrined in the NHS constitution but not the other. We are making progress on parity of esteem, as I think we can all acknowledge across the House. We now need to go beyond that ambition and that rhetoric and match it with action.

Hospital Services (South Manchester)

Jeff Smith Excerpts

Tuesday 8th September 2015 Westminster Hall

[Jeff Smith (Manchester, Withington) (Lab)]

Thank you, Mr Hollobone, for the opportunity to take part in today’s debate. It is a pleasure to serve under your chairmanship for the first time. I echo other hon. Members’ congratulations to my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) on securing the debate.

I will be brief because I do not want to repeat other hon. Members’ comments about Healthier Together, but I agree with a number of concerns raised about the process. The consultation was less than ideal and I think we all agree that the model needs review to ensure that we deliver the highest quality services for patients. I also agree that there was a strong case for awarding Wythenshawe the fourth specialist status. The high quality of the services at that hospital has already been outlined and the transport connectivity, especially given the new developments of the Metrolink line and the relief road, makes it the best option.

Like other Members here, I was disappointed by the decision not to award the fourth specialist status to Wythenshawe. What is key now is for the assurances that we have been given in relation to the existing specialisms to be robust, and for those services to be protected. I visited Wythenshawe hospital over the summer and saw for myself some of the absolutely excellent, world-leading specialist heart and vascular care provided there. What I took away from that visit more than anything was how much some of that excellent specialist provision relied on high-quality general surgery support. I agree that it is vital that we do not lose those connections and that expertise.

Having expressed disappointment about the process and the outcome of the consultation and decision making, we should not be blind to the opportunities that we now have in healthcare in Greater Manchester, particularly south Manchester. Co-operation, not competition, needs to be the future for our NHS. That is what lies behind the principles of Healthier Together, which we agree with, and the plans for devolution of health funding and organisation to Greater Manchester.

[Angela Rayner]

I congratulate the hon. Member for Altrincham and Sale West (Mr Brady) and my hon. Friends the Members for Wythenshawe and Sale East (Mike Kane) and for Stretford and Urmston (Kate Green) on making a compelling case, which I hope the Minister listens to.

Does my hon. Friend the Member for Manchester, Withington (Jeff Smith) agree that when we are looking at devolution and the reconfiguration of health across Greater Manchester, the evidence shows overwhelmingly that public opinion will be undermined if we rush ahead with a proposal that is clearly not good for the people of Greater Manchester? People have genuine concerns that we will not achieve the fantastic things that we could by looking at reconfiguration of health. We must consider pausing the situation and listen to the general population of Greater Manchester, giving them a voice in this process which they feel they have not had so far.

[Jeff Smith]

My hon. Friend makes an excellent point. Clearly, Wythenshawe was the public choice for a specialist hospital.

On working together, which I was just talking about, there is clearly a growing and improved relationship between Wythenshawe and the Manchester Royal Infirmary. Some people see that as a concern, but I think that it is very much to be welcomed and we need to see it as an opportunity.

In south Manchester, we have the opportunity to be an exemplar of partnership working. We have two fine hospitals in Wythenshawe and the MRI, which are on either side of my constituency. My constituency also houses the excellent—and, I believe, underused—facilities at Withington community hospital, which was established under the last Labour Government. I look forward to an expanded role for Withington community hospital in health provision in south Manchester, supporting the two major hospitals and providing joined-up services for all our communities.

We have an opportunity to use Withington community hospital to integrate community services, primary care, secondary care and mental health support, with health services and social care services working together for the benefit of all the community in Manchester Withington and the whole of south Manchester. I urge everyone involved to make the most of that opportunity to expand and improve services at Withington community hospital.

I agree with many comments that hon. Members have made about the Healthier Together process, but I welcome the opportunity to use all those hospital resources together—to use Withington as a thriving community hospital to improve health outcomes for people in south Manchester.

[Mr Philip Hollobone (in the Chair)]

Before I call the Front Benchers, I should say that we are going to have the pleasure of hearing Mike Kane sum up the debate for three minutes at the end. I would be grateful if the Front Benchers would be kind enough to leave him enough time to do that and if he would be kind enough to leave me 30 seconds at the very end to put the motion to the Chamber.