Mental Health

John Howell Excerpts

Wednesday 9th December 2015 Commons Chamber

[John Howell (Henley) (Con)]

I want to consider mental health in the justice system, and will draw my remarks quite widely to include the police. I am very pleased that we have made progress in this area. In my county at least, police cars are no longer used to transport mental health patients; ambulances are used instead.

NHS England has been charged with developing better healthcare services for people in the criminal justice system, and the National Institute for Health and Care Excellence has also been asked to develop guidelines on improving mental health for those in prison. The need is to identify those who have mental health problems and to support them, as the Government have recognised. The choice is for the prisoner either to have support for their mental health issues as they move along the criminal justice pathway, or to be diverted into treatment—or, indeed, social care. The integration of social care and the NHS can contribute a lot to that process.

The service provided to prisoners needs to be consistent across the UK, and I was pleased to hear the Secretary of State’s remarks on the involvement of the King’s Fund in that. There is a great need for prisoners to have the same access as non-prisoners to mental health services. It is also necessary to ensure continuity of treatment across the prison estate and through to the non-prison environment. That continuity is crucial to the provision of better facilities for those prisoners with mental health issues.

That takes us back to the crisis care concordat and the need for good access to support. Prisoners need to know that their problems are genuinely taken seriously, and that they can get help when they need it. That could help tackle the issue of the huge number of men who commit suicide, which my right hon. Friend the Member for North Somerset (Dr Fox) has mentioned. That has to be acknowledged.

I congratulate the Government on the progress they have made, and on recognising the need for parity between mental and physical health services. I am also extremely grateful for the £600 million of additional funding for mental health that the Chancellor put into the system in the recent autumn statement and spending review. The Royal College of Psychiatrists was also pleased with that commitment, and said that it was good news.

Junior Doctors Contract

John Howell Excerpts

Monday 30th November 2015 Commons Chamber

[Mr Hunt]

I am afraid the hon. Gentleman is, as ever, completely wrong. First of all, I have not denigrated junior doctors. I have spent a lot of time praising their absolutely vital contribution as the backbone of the NHS. Secondly, I have not conflated routine services with mortality rates. In fact, I have done specifically the opposite. In answer to the hon. Member for Central Ayrshire (Dr Whitford), I confirmed that we are talking about urgent and emergency care and making sure that services are consistently delivered for urgent and emergency care across the week. That is our priority and that does link to mortality rates.

[John Howell (Henley) (Con)]

As the chairman of the alternative dispute resolution all-party group, may I confirm that it is always right to identify common ground before going into a negotiation at ACAS? I do not think that anyone should underestimate the amount of common ground that the Secretary of State has achieved in getting the ACAS talks going. What will it now take to get the BMA to call off the strike?

[Mr Hunt]

My hon. Friend is absolutely right. What is the common ground between the Government and junior doctors? We want to make sure they are working safe hours; we do not want to cut their pay; we want safer services for patients; and we want to make sure that the many junior doctors who do work weekends get proper consultant support and training opportunities at weekends as well as during the week. I think that that is enough on which to come to a deal.

Cities and Local Government Devolution [Lords] Bill

John Howell Excerpts

Wednesday 21st October 2015 Commons Chamber

[Alistair Burt]

I take the hon. Gentleman’s point. I am not sure, however, that we can be more prescriptive on the face of the Bill. The hon. Gentleman is describing the process by which an area says, “We think that, in addition to the functions already devolved, other things need to be devolved to help local health services work together”, but it is difficult to envisage the circumstances in which NHS England would say, “Well, no you can’t”. At the moment, most are working collectively in any case, so this is a matter for local decision making and agreement between the parties involved. I do not think we can say more than that directly in the Bill at this stage. The whole process of devolution will fall into disrepair if there is continual conflict between an area that says, “Look, we think we can do this”, and a central authority that says, “No, you can’t, there’s no point in that given the process we are going through”. The provision of safeguards is about ensuring that NHS England can be confident of devolving powers, because ultimately the regulatory powers and the safeguards should ensure that patients and constituents are protected by national standards remaining the same. That is how I envisage it working.

[John Howell (Henley) (Con)]

My right hon. Friend has talked a great deal about the safeguarding of NHS provision. Can he reassure me that the social care element will be protected by the same level of safeguards?

[Alistair Burt]

Yes, in that the regulatory powers of the CQC and the safeguarding inspection regime will be retained for the social care element that is covered by a devolution deal. Again, the whole point is to give as much flexibility as possible to areas that want to exercise their powers to deliver services differently, with the reassurance that there will no compromise in relation to key standards—not that that would be wished for in a local area, and not that it would be anticipated by any of the devolving powers.

Following discussions with Greater Manchester and other local areas, we are now taking the opportunity to make available further options in legislation for combined authorities and local authorities to work together with clinical commissioning groups and NHS England across a wider area—such as Greater Manchester—to improve the integration of services. Those options will sit alongside the powers provided by the Bill to devolve a range of powers and functions that are currently exercised by Whitehall departments or bodies such as NHS England to a combined authority or a local authority. Crucially, wherever responsibility for NHS functions is delegated or shared in this way, accountability will remain with the original function holder, whether that is NHS England or a CCG. The original NHS function holder will continue to be accountable via the existing mechanisms for oversight, which ultimately go to the Secretary of State, who retains ministerial responsibility to Parliament for the provision of the health service.

GP Services

John Howell Excerpts

Thursday 5th February 2015 Commons Chamber

[John Howell (Henley) (Con)]

It is a great pleasure to follow the hon. Member for Halton (Derek Twigg). I congratulate him on securing this debate, which highlights a very important subject.

Over the past few months, I have had discussions with GP practices across my constituency. I have had a number of meetings with GPs, usually during their lunch hour, and we have covered a wide range of topics, some relating to the new hospital being built in Henley as a re-provision of the old one, and some relating to the individual situation of GPs. These discussions arose out of my speaking to a conference of GP practice managers. It is important to stress the crucial role of managers in running GPs’ practices. There was a lot of agreement between myself and the right hon. Member for Oxford East (Mr Smith) about how the health service is organised. My meetings with GPs have also come about as a result of talking to patient groups.

GPs are excited at the possibility of providing a range of services, through new methods, in the hospital in Henley, and are very much part of the discussion with the CCG on this. There is a real possibility of an emergency multidisciplinary unit there.

When talking to GPs, I have raised the subject of access to GPs and services. In my constituency, access is not an issue. If people need urgent appointments, GPs will make themselves available. People can ring for an appointment and be given one very quickly. I have found that to be the case with my own surgery, for example, and I applaud the dedication and the willingness to work in co-operation that have been shown by GPs in these circumstances. Sometimes, though, if people ask to see a specific GP urgently, that may not be possible, but these are small practices where there is good communication and discussion of medical issues between the limited number of doctors there. Access does become a problem when practices are essentially outposts of another practice. This occurs in the north of my constituency in a village called Chinnor, where the practices are outposts of practices across the border in Princes Risborough. Managing that can create certain problems for GPs.

The major problem put to me by GPs is patient expectations. I would not want to limit patients’ genuine expectation of good service provided in a timely manner, but we expect things without a wait, so the issue is the expectation, rather than the GP’s availability.

[Michael Fabricant (Lichfield) (Con)]

Does my hon. Friend agree that another problem facing GPs and the NHS in general is patients who make appointments with GPs and consultants and do not turn up?

[John Howell]

If my hon. Friend will give me a chance, I will come to that very point, which is one that I discussed with GPs and patient groups.

There is also the expectation of what a GP can do. The number of visits per patient may be up, which is increasing demand, but the causes, according to GPs, are, first, the desire for an instant cure. People are not giving minor ailments time to heal themselves, but expect medicine on tap for everything. Thus going to a GP as soon as symptoms occur is part of the expectation. Secondly, people are motivated to see their GP by advertisements listing symptoms and encouraging people to go to a GP if they have them.

[Liz McInnes (Heywood and Middleton) (Lab)]

rose—

[Duncan Hames (Chippenham) (LD)]

rose—

[John Howell]

I give way to the hon. Member for Heywood and Middleton (Liz McInnes).

[Liz McInnes]

The hon. Gentleman talks about patient expectations, but in the Heywood, Middleton and Rochdale CCG, which serves my constituency, 16% of patients report that they are unable even to speak to somebody to get an appointment. I do not think it is an unreasonable expectation that patients should be able to contact somebody who can get them an appointment with a GP.

[John Howell]

I will give way to the hon. Member for Chippenham (Duncan Hames) and then respond to both interventions.

[Duncan Hames]

I do not find fault with the patients, but does the hon. Gentleman agree that a significant difference between the funding patterns for primary and secondary care is that in secondary care the more treatment provided and the more patients seen, the more funding provided by commissioners to the provider, yet the same pattern, where funding is proportionate to the amount of activity undertaken, is not typically seen in what we ask of general practice?

--- Later in debate ---

[John Howell]

I will talk a bit about funding later. I say to the hon. Member for Heywood and Middleton that we are trying to put together a picture on the basis of individual constituencies. It is no use taking an overall, theoretical picture and then trying to work out what is happening in individual constituencies; it has to be done the other way around, by individual constituencies saying what is happening with them. I am setting out precisely the situation in my constituency.

[Richard Graham (Gloucester) (Con)]

On that point, in Gloucester we had exactly the same problem that Members have referred to, so our clinical commissioning group managed to arrange funding for 300 additional hours in GP surgeries a week, which is proving very effective. That is the sort of thing that can be done locally by using the budget creatively. Does my hon. Friend agree that others might be able to explore that?

[John Howell]

I agree that that is a very good local initiative that could be spread across general practice.

Let me give the House an example. I happened to be visiting a surgery one afternoon, so I asked the staff what the problem with access was. I was told that a good example was a lady who had come in that morning to have her plaster changed. I imaged plaster being removed from a suppurating wound, but it was actually a small plaster on her hand. She was told to go away. I think that is an abuse of a GP practice by a patient.

[Mr Bellingham]

Will my hon. Friend consider the role of pharmacies in providing more cover and more care, for example for the type of complaint he has just mentioned? Surely those people should be going to their local pharmacy, rather than their GP practice.

[John Howell]

I completely agree. If I manage to get through my speech, I will say a few words about that.

The way forward is for patients to take responsibility for their own health, but there is a basic education point that stands in the way. I have a minor condition that requires my blood pressure to be monitored. I do that myself at home, and then send the results remotely to the surgery. We then have a conversation about it remotely, hopefully by e-mail. It is ironic that the internet is increasingly used by the over-50s, but the view of GPs providing a public service stands in the way of, and even contradicts, the over-50s being able to use the internet to achieve that result.

[Mr Simon Burns]

Is there not also a problem with some patients using the internet to self-diagnose, as there can sometimes be unpleasantness and arguments when GPs do not agree?

[John Howell]

That risk does exist, but I am talking about a treatment regime that I have agreed with my local practice, and this is the best way of dealing with it.

I have discussed the impact of no-shows with local practices. No-shows can affect surgeries by denying appointments that are the equivalent of up to one doctor each week. We looked with patient groups at various ways of dealing with that, including a ring-back system that allows surgeries to send text messages to remind patients not to forget an appointment the following day. What is missing, though, is an ability for the patient to ring back and say, “Yes, I’m coming”, or “No, I’m not coming.” I understand that the scheme that was going to put that in place centrally has been cancelled, and I ask the Minister to look at that carefully. Some practices use no-shows positively as a potential indication of symptoms; if someone is a consistent no-show, that might be a sign of dementia or something else. When I discussed charging for no-shows with patient groups, there was great hostility to this, tempered by the admission that it was administratively impossible and raised too many issues about access to services.

The hon. Member for Halton talked about the role of GPs in planning locally. I have asked about this in my area, where a whole lot of places are going for neighbourhood plans. I fully support them in doing that. It is the first time that communities have had the ability to determine where houses will go—and, indeed, what they will look like, because there is a very important design element. When I asked GPs what role they had in the neighbourhood planning process, the answer, basically, was none at all; they had not participated in the discussions. I sent them back to have those discussions with the people putting the neighbourhood plan together. This cannot be left to the CCG to determine for GP practices; GP practices have to do it themselves. The risk is that if they do not have their wish-list regarding what is to be done, they will lose out in the allocation of community infrastructure levy money that will eventually come through.

[Mr Prisk]

On the development of local plans, in east Hertfordshire and elsewhere, the problem is that our rather nice, but historical and inadequate, premises restrain the ability of practices to provide modern facilities. Is that my hon. Friend’s experience of the local planning process in his constituency?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. May I make a suggestion? The Speaker suggested a time limit of about 10 minutes, and the hon. Gentleman has now had 13 minutes. I hope there will not be too many more interventions, and that the hon. Gentleman is coming to the end of his speech.

[John Howell]

Thank you, Mr Deputy Speaker. I am coming to the end, but let me respond to my hon. Friend’s intervention. It depends on where the practice is and what its buildings are like. Some are quite modern, and one would not want to change their facilities. Even those practices may need to add an extra surgery, if the village is going to grow by several thousand people, so they need to plan for where it will go and for the doctor that will use it.

The trend in the population has been towards more elderly patients and more patients with long-term, chronic or multiple conditions. That leads to an increase in the number of patients per year. There is no doubt that the age profile is having an impact. The Government’s allocation of a named doctor to a patient is useful for the co-ordination of services, even though in an emergency the patient may not be able to see that doctor on the day when they require them.

Yes, there is a need for money to be provided for GP services, but this is possible only if we have a strong economy. The Government have evened out the payments between practices so that they do similar things in similar parts of the country and there are not wide variations between them. That has to be the right way to go. It also has to be right to increase the strength of the economy in order to provide these services.

Residential Home Closures

John Howell Excerpts

Thursday 10th July 2014 Commons Chamber

[Michael Ellis (Northampton North) (Con)]

I congratulate the hon. Member for Luton South (Gavin Shuker) on securing this debate. I am grateful to him, and to you, Madam Deputy Speaker, for permitting me to contribute to this important Adjournment debate, as the regular proceedings do not normally allow for that. The hon. Gentleman spoke very well and advocated his position very effectively. I agree with much of what he said.

I admire Scope, as I am sure the hon. Member for Luton South does. It is an excellent charity and its staff do wonderful work. They clearly care about the people in their charge, for whom they are duty bound to care. Hampton House, in my constituency, should not close. It should not close for the very reason that it is not an institution, but a home for more than a dozen people. We are told that this is not about economics, Government policy or local authority decisions; it is a policy shift. There has been a decision to move away from a residential setting to more of a care home setting. This may well work in many cases—the hon. Gentleman alluded to them—especially for those who are disabled who are entering this kind of care arrangement, but it does not work, and is not working, for those who have lived in Hampton House in my constituency for literally decades, and in one case nearly four decades.

In the very short time allowed to me in this instance, I want to put on record my suggestion that we work with Scope to find an alternative to its proposal to close Hampton House, and ask it please to look again and please think again. Those who have lived there for decades are firmly wedded to its atmosphere, staff and ambience—to everything about a home—as you or I, Madam Deputy Speaker, would be. There must be alternatives.

[John Howell (Henley) (Con)]

The point is that the sense of community is being destroyed. Whatever arrangement we come to with Scope, we have to find a way of keeping that sense of community for the people who want to keep it.

Patient Safety

John Howell Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

Yes, I can. My hon. Friend’s local trust is in special measures, and the decision on whether a trust should come out of special measures is no longer one for the Secretary of State; it is made independently by the chief inspector of hospitals. I hope that we have created incentives for system leaders to solve these problems, because if they do not, the chief inspector will simply not decide that the trust can be taken out of special measures.

[John Howell (Henley) (Con)]

I join my hon. Friend the Member for Wycombe (Steve Baker) in praising the improvements that have taken place in Buckinghamshire Healthcare NHS Trust, which has come out of special measures, and which affects part of my constituency. Are not those improvements a very good example of the way in which we are summoning up the political courage to tackle such trusts, particularly when they have experienced high death rates in the past?

[Mr Hunt]

I hope that they are. I think that in the end we shall be judged on how successful we are in turning around hospitals in special measures. Last week I met Anne Eden, the chief executive of Buckinghamshire Healthcare. I think she has done an excellent job in extremely difficult circumstances, but I know she would agree that there is still much work to be done. Taking hospitals out of special measures is the first step, but ultimately we must reassure the public that when there are problems, we shall be on their side and try to sort those problems out.

Oral Answers to Questions

John Howell Excerpts

Tuesday 1st April 2014 Commons Chamber

[Henry Smith (Crawley) (Con)]

11. What recent steps he has taken to improve maternity care.

[John Howell (Henley) (Con)]

14. What recent steps he has taken to improve maternity care.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

We have made improving maternity services so that women have a named midwife responsible for ensuring personalised maternity care the key objective in our mandate to NHS England. Since May 2010 the number of full-time equivalent midwives increased by more than 1,500, and over the past two years I have set up a £35 million capital investment fund, which has already seen improvements to more than 100 maternity units.

--- Later in debate ---

[Dr Poulter]

I would be delighted to do so. As my hon. Friend knows, I have a particular knowledge of his local hospital trust. It was a very short-sighted decision by the previous Government to downgrade and effectively close Crawley hospital, given the demographic pressures there. There is a good case for a midwifery-led maternity unit. Under this Government we are seeing the numbers of those increase. I would be happy to meet him to discuss these matters further.

[John Howell]

I welcome the increased number of midwives, but what are the Government doing to support women who suffer from post-natal depression?

[Dr Poulter]

My hon. Friend makes an important point. We were talking earlier about improving parity of esteem between mental and physical health. When we came to power, only 50% of maternity units had specialist perinatal mental health support, and we will make sure, through the mandate to Health Education England, that by 2017 all maternity units have specialist perinatal mental health support. That is something that this Government will be very proud of.

Oral Answers to Questions

John Howell Excerpts

Tuesday 14th January 2014 Commons Chamber

[Mr Hunt]

I think the figures the hon. Gentleman is talking about are efficiencies and not actual cuts. [Laughter.] Well, Members should look at the figures carefully. If they are the figures from the Association of Directors of Adult Social Services, that is what they will find. If the hon. Gentleman looks more specifically at the figures related to delayed discharges, he will find that, year on year, the number attributable to the social care system went down by 50,000 bed days in the last year.

[John Howell (Henley) (Con)]

One of the principal ways of promoting the health and well-being of older people in my constituency would be a rapid sign-off for the rebuild of the Townsland hospital complex. I recognise that the decision lies with NHS Property Services, but will the Secretary of State join me in using whatever influence we have to put pressure on it to get a move on?

[Mr Hunt]

I have spoken to my hon. Friend about the scheme, which sounds excellent. Obviously we want to encourage it, while working within the correct processes. The Under-Secretary of State for Health, my hon. Friend for Central Suffolk and North Ipswich (Dr Poulter), has agreed to meet him to do all we can to speed it along.

Mental Health Act 1983

John Howell Excerpts

Monday 29th October 2012 Commons Chamber

[Mr Hunt]

I shall try to give my hon. Friend that information later.

[John Howell (Henley) (Con)]

Does the Secretary of State agree that speed is of the essence in the provision of clarity, and will he accept our congratulations on having moved with such commendable speed?

[Mr Hunt]

I am grateful to my hon. Friend for saying that, but I think that we should extend our gratitude to the Opposition on this occasion. It is possible to move with speed only when there is cross-party co-operation, and I think that everyone has recognised the seriousness of the situation.

Life Sciences

John Howell Excerpts

Monday 5th December 2011 Commons Chamber

[Mr Lansley]

I will gladly do so. As the right hon. Gentleman knows, the designation of an academic health science centre in Manchester has supported many developments. We want to go further. In today’s life sciences strategy, we are making it clear that not only do we want to maintain the academic health science centre designation as a world-class designation for comprehensive research centres, but we want to go further and ensure that such centres are used to diffuse and spread innovation across the NHS more effectively. Next spring, we will set out how we will enable academic health science networks to be designated. That will happen during 2012-13. I will happily look at the circumstances in south Manchester and at how this matter will apply there. I hope that partnerships will be forged between the NHS, universities and the private sector of the kind that he and I know will be successful.

[John Howell (Henley) (Con)]

Does my right hon. Friend agree that there is a world of difference between streamlining regulation, to use his phrase, and the picture of the indiscriminate abolishment of regulation that the Opposition tried to create? Such streamlining is essential to cut the time from invention to adoption.

[Mr Lansley]

I am clear, and I know that my hon. Friend agrees, that we must ensure that the regulatory processes are effective and that the medicines that are available in this country are of the necessary quality, safe and effective. However, we must not allow the delays that are inherent in some of these processes to prevent information from being provided on the basis of which clinicians, with the active, informed consent of patients, can access what they regard as potentially effective medicines. In the overall context of patient safety, we do patients a serious disservice if we know that there is a potentially effective medicine available and do not give them the first possible opportunity to access it.