Oral Answers to Questions

John Pugh Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Dunne]

My hon. Friend is right to point out that the Opposition constantly complain about the cost of the PFI programmes that they themselves initiated. The Government are making large efforts to support trusts in dealing with the PFI legacy. We are giving the seven trusts worst affected by PFI schemes access to a £1.5 billion support fund over a 25-year period. In 2014 alone, trusts negotiated savings worth over £250 million on their contracts.

[John Pugh (Southport) (LD)]

21. On the subject of financial liabilities, what assessment has the Department made of the potential effect of changes to the discount rate on the amount of compensation paid out by the NHS Litigation Authority?

[Mr Dunne]

The Department is urgently undertaking work to understand what the impact on the NHS will be. There have been regular meetings with the NHS Litigation Authority since the announcement. The Government will adjust the NHSLA’s budget to meet the additional costs associated with the change in the discount rate.

Oral Answers to Questions

John Pugh Excerpts

Tuesday 7th February 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

My hon. Friend is right to say that we now publish one-year survival rates for every CCG in the country, and I agree that that is a beacon of light and a transformative step. It also shows differences of more than 10% between the best and the worst, which is unacceptable. The transparency itself will bring improvement, but we have also recently established 16 cancer alliances, whose sole job is to roll out best practice and investigate and bear down on poor performance.

[John Pugh (Southport) (LD)]

T4. Will the Minister update the House about NHS litigations, which rocketed to £1.4 billion last year? Are they anything like under control?

[Mr Hunt]

The hon. Gentleman is absolutely right; this issue is a very big concern. The only way, in the long run, to reduce those litigation costs is to have safer care. That is why the Government have prioritised safety in everything we do.

Accident and Emergency Services: Merseyside and Cheshire

John Pugh Excerpts

Tuesday 22nd November 2016 Westminster Hall

[John Pugh (Southport) (LD)]

I beg to move,

That this House has considered accident and emergency services in Merseyside and Cheshire.

It is a pleasure to serve under your chairmanship, Sir Roger, and a pleasure to see the Minister in his place. We spent many a happy hour on the Public Accounts Committee in years gone by, and I have great respect for him. I am sure he will give due consideration to what I say.

The debate title is a slight misnomer, however, because it was intended to entice other colleagues from the Cheshire and Merseyside region. Sadly, they have not taken the bait, perhaps because of the limited time available, so I will talk largely and almost exclusively about my own patch.

Southport is a large seaside town on the Lancashire coast, with one of the most elderly populations in the UK. I have to point that out, because for some reason I am often confused with the Member for Stockport and I am referred to as such. Southport, however, is nothing like Stockport. Southport is a seaside town and has one district general hospital on a split site with Ormskirk. The accident and emergency provision, though, is split by age between the two sites, which is a bone of contention in Southport.

For the purpose of the sustainability and transformation review, Southport was grouped with other hospitals ringing Liverpool, including those in Aintree, St Helens, Whiston and Warrington. Southport has recently had a poor Care Quality Commission report on its A&E department and an equally poor review of its surgery. It has responded positively with further investment of £600,000 into the A&E department, so that now, according to the stats—I checked this with the chief executive only this week—it has one of the best-performing A&E departments in the north-west.

That might have been the end of the story, because the CQC report dates from some time back and because of the improvements, but for suppressed drafts of the Cheshire and Lancashire sustainability and transformation review that have been leaked. The leak showed a number of things, including a possible downgrading of Southport A&E and of other A&E departments in the area—the hon. Member for Macclesfield (David Rutley) is now in the Chamber, and his is one of the areas affected, as we have discussed—as part of a cost-saving exercise.

That is not the first time that the suggestion has been made apropos of Southport, but the Minister knows from his own experience in Ludlow how politically explosive such suggestions can be and have been. He will also appreciate that those suggestions are sometimes entirely simplistic and often linked to another further bright suggestion that people come up with, which is to close down wards. The consultants charged with balancing the books, and often deferred to by the national health service, might come up with the brilliant suggestion that the best thing to be done with a loss-making hospital is to get it to do less—to stop admitting people to A&E, and finding space for them in wards, and therefore to close down A&E and shut down a few wards.

The Cheshire and Merseyside sustainability and transformation plan proposals were reneged on somewhat in the final draft, so they fell short of actually advocating downgrades. However, that is not to say that that is not in mind as an ultimate objective.

[David Rutley (Macclesfield) (Con)]

I congratulate the hon. Gentleman on securing the debate. Like him, I am concerned about the proposals set out in the STP and, with regards to east Cheshire, the document actually sets out that options being considered include downgrading from an A&E to an urgent care centre in Macclesfield. There needs to be greater transparency about the options and a frank conversation with people. There is already a Macclesfield petition signed by 8,000 people opposing any downgrading of A&E services in our area.

[John Pugh]

There is also a petition in Southport, and I am sure there will be petitions wherever in the country this sort of thing happens. As the hon. Gentleman suggests, the ownership of the sustainability and transformation reviews is wholly unclear. No one quite knows who writes the plans, or how they are agreed, and few democratically elected bodies or people, or patients, have any kind of input. In fact, the Liverpool local authorities wrote in some indignation to the authors of the report to ask, “How can we be involved? It alleges in your report that we are involved, but we do not appear to be.” Furthermore, no one quite knows why the hospitals have been grouped as they are.

Southport hospital is in a particularly unfortunate position, because it has changed its chair recently and suspended its chief executive over a period of a year, so it is unclear to me how Southport and Ormskirk’s views could have been represented in any review. Roadshows were organised by the clinical commissioning groups to talk about the financial plight of the local NHS and things that need to be done, and I have attended some of them, but they spend all their time talking about things such as savings on prescriptions and none on the big league stuff that is agreed and discussed in NHS boardrooms. There is absolutely no transparency, and I am sure hon. Members share in my cynicism. We await the real cost-saving proposals—or, in some cases, the empire-building proposals that are often disguised by blather about clinical efficiency and safety, which come almost after the event.

I speak with some cynicism, because I am a veteran of such carryings-on. I regret all the back-stage manoeuvres and, in particular, that no one has been around to champion my local hospital in the review. There is a good case for keeping our A&E—elderly people throughout the country are the major clients of A&E, for obvious reasons.

[Jim Shannon (Strangford) (DUP)]

The debate is clearly about Merseyside, but the issues for accident and emergency are the same everywhere in the United Kingdom, including in Northern Ireland. Does the hon. Gentleman share my concern about A&E being on the frontline of the NHS, so that is where the spend clearly needs to be? Does he also share my concern about Government policies to close some pharmacies, with their role, which will push many minor ailments to A&E, creating even more problems?

--- Later in debate ---

[John Pugh]

Precisely. I am going on to some brief analysis of the problems of A&E, but it is certainly the line in the sand that we must defend.

Elderly people are obviously the major clients for A&E, and Southport by any analysis has an enormous number—a very high percentage—of people who will require A&E. Moreover, as the ambulance service says, and as the hospital will confirm, when people arrive at A&E these days they are iller than ever before. The reason for that is that access to GPs and to social care is worsening—social care has suffered extensive cuts, and has done so in my area, and is struggling.

To make matters worse, one reason for A&E throughput being a little slow is that, more than ever, people going to A&E are not being turned around and sent home, but need to be admitted, so beds are needed for them, although previous reports recommended ward closures in Southport hospital. Furthermore, discharging people from existing wards is a slower process, because social services are, frankly, struggling. The system is getting logjammed, with ambulances at one end and people not being discharged at the other.

To add to the problem is a matter that the hon. Member for West Lancashire (Rosie Cooper) will wish to bring up: the CCGs have taken the community care contract off Southport hospital, where I thought it was well placed, and given it to two organisations new to the field. How that is supposed to help integration, I do not know.

[Rosie Cooper (West Lancashire) (Lab)]

There is a serious problem in West Lancashire and the Southport conurbation. The local population has been excluded from all these decision-making processes. There is a serious need for the NHS bosses to explain what they mean by “downgrading”, as their perception of A&E can vary quite significantly from my community’s understanding. Simply sharing information without any explanation leads to anxiety and serious distress about the future of health services. I come back to the point that the hon. Gentleman has just been making: in the face of the fact that it will destabilise the hospital, the CCG—that is the local GPs—has just awarded the contract for urgent and community services to Virgin Care, which has no real track record. We do not have a real assessment of what is going on, and my constituents are being put at risk.

[John Pugh]

I thank the hon. Lady for that clarification and amplification. There really is a problem with integration, and I do not know how that will be better solved by bringing more organisations—particularly untried organisations—into the fray.

We are all exasperated by watching people make a hash of things and create rather than solve problems. CCGs are neither accountable nor always reasonable, and frankly sometimes have their own agendas. They are often tough on hospitals but less so on GPs. They are of course GP-led organisations, which is a weakness in how they are structured. I have a letter from the biggest surgery in my patch complaining about abuse received by receptionists. Hon. Members will be able to guess what that abuse is about. It is not excusable, but the rationale for that abuse is that people are having real difficulty making appointments in a timely and effective way, and as a result they are going to A&E, sometimes in desperation. Surveys that I have done over time have shown GP access to be as much of an issue in my constituency as A&E waiting times. As the hon. Lady just said, NHS bosses collectively are either deliberately or accidentally causing the destabilisation and unbalancing of provision in the area, and no one can stop them.

[Margaret Greenwood (Wirral West) (Lab)]

I thank the hon. Gentleman for being so generous. Does he share my concern that the STP for Cheshire and Merseyside talks of

“leaving the work at STP to focus on creating a framework to support development of”

accountable care organisations? ACOs are generally associated with insurance-based systems such as those that exist in the US. Does he share my concern that that fragmentation is to do with breaking up the national health service?

[John Pugh]

I am not sure whether that is the deliberate intent, but that is certainly a possible result.

[Rosie Cooper]

CCGs are nominally accountable to the Secretary of State or NHS England. Will the Minister address who actually guarantees that CCGs will provide really good service? The incompetent CCG in Liverpool that presided over the unholy mess at Liverpool Community Health NHS Trust has been allowed to preside over future services and new contracts in Liverpool. It is the same incompetent organisation. How is that okay?

[John Pugh]

The hon. Lady reinforces the point that I was going to make next. No one in the NHS locally is in a position to bang heads together and say, “Hang on, what do the public actually want or expect here?” The CCGs speak to NHS England and the Secretary of State. They are the decision makers. It seems to me that one of the coalition Government’s biggest mistakes was abolishing the regional strategic arms of the NHS—the bodies accountable for integrating and making things work together and making services across an area work effectively. Instead, we have groups of special interests—the big providers on one side and wholly unaccountable CCGs on the other—and, frankly, a recipe for chaos.

[Margaret Greenwood]

On accountability, does the hon. Gentleman share my concern—I would welcome a response from the Minister on this point—that the Health and Social Care Act 2012 took away the Secretary of State’s duty to provide and secure a national health service in England? That is one of that Act’s key flaws.

[John Pugh]

There was actually an attempt to make clear in that legislation where responsibility lay. I am very familiar with that debate and do not want to re-engage with it at the moment.

There is an absence of a genuine force for integration at a local level. We all know that there are institutions in any local environment that will be shored up at all costs, regardless of the clinical benefits to the population. Like the banks, a big private finance initiative such as the Royal Liverpool hospital will never be allowed to fail, because when PFIs fail, they revert to the Government’s books. Such services therefore tend to attract neighbouring services, whether or not it is a good idea for those neighbouring services to be attracted and regardless of the practicalities or the patients.

To come to some sort of conclusion, without a 24/7 A&E in Southport and all that follows from that—a great deal follows from that in terms of what other services may then go—people will suffer longer and more anxious journeys. I shudder to think what would happen if there were an incident at a big event in Southport, such as the flower show, the air show or the musical fireworks, and we did not have a 24/7 A&E. For better or worse, Southport is on the periphery of Merseyside and the hospital is also used by large parts of Lancashire. Southport straddles the boundary between Sefton and West Lancashire. The local hospital trust has to interact with two CCGs that face different ways. As it stands, the hospital is massively convenient for patients but inconvenient for those who like symmetry in the NHS. Precisely because of that, we are in constant danger of being overlooked and not championed, which is why Sefton Council recently passed a motion drawing attention to its concerns, particularly about the A&E.

Hon. Members will have gathered that I do not have entire confidence in the transformation process. None of us will say that we are not aware of the need to work more smartly and in a more integrated fashion to make the health pound work a lot harder, but the record will show that this is not the first time that I and the hon. Member for West Lancashire have brought the affairs of this hospital and this health service patch to the House’s attention. I fought off a previous attempt to get rid of our A&E when that was mooted by consultants on the usual ground that if the NHS ceases to do anything, it will cease to cost anything. The public have campaigned vigorously for an urgent care centre in Southport, and a succession of Ministers have been lobbied in this place about that plan, only for it to be scuppered by behind-the-scenes NHS politics. I have no reason to feel any confidence at all in this process—not when I see the hospital trust itself make a complete hash of whistleblowing charges against senior management and protract the process through its own simple incompetence.

[Rosie Cooper]

rose—

[John Pugh]

The hon. Member for West Lancashire is positively bursting to get in.

[Rosie Cooper]

Does the hon. Gentleman agree that STPs are in danger of becoming a managerial exercise in contingency and risk planning, where the NHS speaks to itself? Several years ago, in the Health Committee, I put to Bruce Keogh the charge that where we were going, there would be 30-plus trauma centres in this country and every A&E would be downgraded. With STPs, the NHS is talking to itself, not the communities it serves, and it will come up with that very same plan. I can see that happening in front of me right now.

--- Later in debate ---

[John Pugh]

Thank you, Sir Roger. We are on the home straight now. The trust that we are talking about has been under the management of a series of interims over the past year. That has not helped its affairs. Why should the people of Southport suffer? We have been poorly served—not by the doctors, the nurses and the hard-working staff, but by the NHS high command. People are angry. If they are to be repaid for their anger by having further services taken off them, that anger will simply come the Government’s way, to the Secretary of State who will make any final decisions.

I want to make a plea. Let us not have another NHS stitch-up on any patch, where MPs, councils, local people, patients and all the access issues provoked by these arrangements normally are ignored. Let us not have a fait accompli that suits special interests that is covered over at the last minute with a veneer of clinical justification. Let us have local decision making that is not a sham or a pretence, but is genuine local decision making. Lord Lansley had a frequent saying in many a debate on health—I am not a great fan of his, but the saying bears repetition—which was, “Nothing about me, without me.” We have had lots done to us with the health service on our patch, but it has always been without any genuine involvement of the population or their representatives. I make a plea to the Minister that he tries to correct that or to reassure me that this time it ain’t gonna happen.

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a great pleasure, as always, to serve under your chairmanship, Sir Roger. I congratulate the hon. Member for Southport (John Pugh) on securing the debate. He referenced the fact that we served together on the Public Accounts Committee many years ago in the early days of my parliamentary career, and I have therefore long understood his forensic approach to matters affecting his constituency. He has shown that again today with his characterisation of the health needs of Southport. It is good to see a number of neighbouring MPs joining this short debate. They share a common interest in guaranteeing high-quality health services for their local residents. We in the Department of Health obviously share that interest.

I have listened carefully to the concerns the hon. Gentleman has expressed about A&E services in particular in the local area. He and other Members have touched on wider health issues, and I will try to address some of those in the few moments I have today. I am particularly aware of the concerns he concluded with about the potential of the sustainability and transformation plan proposals for the area, which include urgent care among many other things. I will touch on that in my remarks.

We all recognise the increasing pressures in the NHS, particularly as we move into winter. I am sure all Members would acknowledge the hard work and dedication of those providing high-quality services across the NHS, including in Southport, which the hon. Gentleman referred to. The NHS cannot stand still, however, and services need to change to continue to meet patient need and patient expectation. Nationally, there were some 1.95 million attendances at A&E departments in September, compared with around 1.86 million in September 2015—an increase of 4.9% in only 12 months. Some 1.77 million patients were admitted, transferred or discharged within four hours, compared with 1.73 million a year ago—an increase of 1.85%. I give the House those statistics to point out that the NHS is seeing and treating more people within its targets than ever before. In Merseyside and Cheshire, that means that more than 2,400 more patients were transferred, admitted or discharged within four hours of arrival this September as compared with last September.

Turning specifically to the Southport and Ormskirk Hospital NHS Trust, there are clearly performance matters that need to be addressed. Although its A&E performance does not meet the national 95% target, at 91.5% it is above the national average of 90.6%. As the hon. Gentleman said, its current A&E performance is relatively better than that elsewhere. However, the CQC report that he touched on, which was published last week, rated the A&E department as “inadequate” for safety and “requires improvement” for all other fields apart from caring. Although that may be based on work done some months ago, I am sure he would agree that it is unacceptable. The trust needs to improve its performance for the people of Southport.

[John Pugh]

The Minister is making an important point. The argument about the CQC inspections is to some extent related to what the CQC inspects. If it is inspecting an A&E department—I hope I made this clear in my speech—the CQC often has to bear in mind the fact that it is not an isolated unit. A&E works in conjunction with adult social care, the ambulance service and so on. Getting snapshots of a poorly performing department without taking into account the background and the other arrangements in and around A&E can give a false picture of where the problem lies.

[Mr Dunne]

I am not going to get into a prolonged debate about the CQC report, but it rates the entire trust as “requires improvement”. We have confidence in the overall reporting, and looking at A&E in that context reflects an accurate impression of the current status of the trust. For example, three of the trust’s seven A&E consultant posts are filled by locums or agency staff. That mix of staffing is not sustainable for any A&E department. I am aware that the trust and its commissioners are looking to address that.

Several hon. Members referred in interventions on the hon. Member for Southport to the NHS sustainability and transformation plans. I emphasise to the House that STPs are collaborative plans designed to help local organisations deliver on the “Five Year Forward View”. They are formed by CCGs, providers and local authorities working together in an area to develop a plan. Some have also involved other stakeholders who will be affected by changes in their area and can contribute to improvements. The true test will be whether a revised healthcare system really improves matters for patients.

We are still at an early stage in the process. The local NHS describes the plan for Cheshire and Merseyside as a plan for a plan at this stage. I will not therefore pass judgement today on the STP process or the content of the Cheshire and Merseyside STP. I am not in a position to do so. I do not know the local position as well as the local clinicians who have drawn up the plan; no one in Westminster or Whitehall does. Local clinicians must ensure that they involve the public and patients—and Members, as the hon. Gentleman called for in his closing remarks—and explain what they think is best for each local area. I reject the charge that the plan will not involve the local communities; it absolutely needs to involve local communities to be taken forward. It is a central tenet of the approval of the plans that there is public engagement.

Oral Answers to Questions

John Pugh Excerpts

Tuesday 10th May 2016 Commons Chamber

[John Pugh (Southport) (LD)]

5. What plans he has to reduce agency staffing expenditure in the NHS.

[The Secretary of State for Health (Mr Jeremy Hunt)]

We have taken tough measures to control unsustainable spending on agency staff, which cost the NHS more than £3 billion last year. Overall agency spend is now falling and we expect to save the NHS at least £1 billion this year as a result.

[John Pugh]

I thank the Secretary of State for his answer. I do not share his optimism. Is not the real problem the shortage of permanent staff and the budgetary constraints on the acute sector? Most of them are now below establishment.

[Mr Hunt]

I think the hon. Gentleman is right that we have historically not trained enough staff to work in the NHS and been over-optimistic about the staff needs. That is why, in this Parliament, we will be training over 11,000 more doctors as a result of the spending review, and 40,000 more nurses.

NHS and Social Care Commission

John Pugh Excerpts

Thursday 28th January 2016 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I thank the right hon. Member for North Norfolk (Norman Lamb) and pay tribute to him, particularly for his work as a Minister in the coalition Government and for his personal commitment to mental health services. I welcome his call for real focus and cross-party agreement on this long-standing problem. We need that if we are to solve the problem and create a health and social care service that is fit for purpose for the next century.

I would sound one note of caution. I am very relieved that the right hon. Gentleman is not calling for a royal commission, as there is no shortage of commissions in this place. We are just a year from the Barker commission, the highly respected independent commission set up by the King’s Fund, which very clearly laid out the problems we face and suggested a number of options. Hard choices will have to be made if we are to raise the share of our GDP that we spend on health and social care to 11%, which I know many Members would support.

We know the options. The difficulty is a political one. I question whether we need a commission, and would ask whether we do not in fact need a commitment from the leaders of all political parties in England to come together to look at the proposals seriously, and get away from the endless bickering in this place about the choices before us and the pretence that this is somehow not going to happen. Unless we make such changes, we will have to start thinking rapidly about plan B as an alternative. What will be the consequences for all our constituents if we fail to reach a political agreement about the challenges we face?

[John Pugh (Southport) (LD)]

If I understand the hon. Lady correctly, she supports a commitment, but not a commission, but would a commission not be a sign of such a commitment?

[Dr Wollaston]

In this place, we sometimes push issues into commissions, which debate them endlessly and come to no agreement. I would say the urgency of this issue demands that the leaders of all political parties sit down together and agree.

Oral Answers to Questions

John Pugh Excerpts

Tuesday 5th January 2016 Commons Chamber

[Alistair Burt]

My hon. Friend is absolutely right. I have talked more than once at this Dispatch Box about the variation in performance on different issues around the country. Two or three things will help. On funding and resources, there is a better tracking system to make sure that money that goes into children and young persons’ mental health services will be spent appropriately. More money is going into that. Equally, a children and young persons’ mental health improvement team is working across the national health service to make sure that those variations are evened out so that good practice in the best areas becomes the practice of all.

[John Pugh (Southport) (LD)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Yesterday evening the British Medical Association regrettably decided to walk away from the talks on a new junior doctors’ contract and announced plans for strike action. We had made significant progress in negotiations on 15 of the 16 areas of concern, including doctors’ hours and patient safety, and will now do everything we can to make sure that patients are safe. We promised the British people we would deliver truly seven-day services and, with study after study telling us that hospitals have higher mortality rates than should be expected at weekends, no change is not an option.

[John Pugh]

I thank the Secretary of State for that response. He will recall the 3 million lives telehealth programme. Since then, it has all gone rather quiet on telehealth. What is the Government’s current strategy on telehealth and what pump-priming funding is there for it?

[Mr Hunt]

I thank the hon. Gentleman for his consistent interest in telehealth. The technology landscape has changed significantly since the 3 million lives programme was launched in 2012. We are absolutely committed to it, but we do not want to isolate a few individuals who we think would particularly benefit from it, because we think everyone could benefit from being able to talk to their GP via video conferencing or whatever. The plans we will announce for technology in the next few months will show how we can roll it out to an even wider audience.

Oral Answers to Questions

John Pugh Excerpts

Tuesday 17th November 2015 Commons Chamber

[George Freeman]

My hon. Friend makes a great point. I pay tribute to Congenica, a small company in Cambridge that is doing extraordinary work. I recently went to open Illumina’s global research and development headquarters, which is a £160-million commitment. As well as the significant investment in technology and research in the UK, NHS England is leading genomic medicine across the UK, not just in the Oxford-Cambridge-London triangle, but through 11 genomic medicine centres across the country, which are bringing genomic diagnostics to the benefit of us all.

[John Pugh (Southport) (LD)]

The Minister will know of the case of one-year-old Layla Richards, who was saved from leukaemia by genome editing at Great Ormond Street hospital. What specific help does he give for such hands-on pioneering work?

[George Freeman]

The hon. Gentleman makes an excellent point. Genome editing is the latest in a suite of technologies that is rapidly emerging in genomics. Through the Genomics England programme, we are actively supporting those tools and intermediate technologies, and through the accelerated access review that I have launched, we are looking to harness those breakthroughs to support new treatments and new flexibilities for the National Institute for Health and Care Excellence and NHS England on targeted treatments.

NHS Reform

John Pugh Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for his passionate support for that trust through a very difficult period. I also thank him for giving us perhaps the single biggest insight into how to transform a hospital in difficulty: according to all the measures, the most important single thing is to engage with staff. If staff feel supported and listened to, the result is safer care for patients and better outcomes. That is something they have done in East Lancashire, and it is something that many other hospitals could learn from.

[John Pugh (Southport) (LD)]

Many current failures in care are caused by poor integration of services, not the failure of a specific service. What, in the proposals announced, addresses that problem?

Oral Answers to Questions

John Pugh Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Ben Gummer]

May I, too, welcome my hon. Friend to her seat. I was aware of the tragic death of her father, so she will be pleased to know that we are already collating information on SSIs resulting from orthopaedic surgery. That is done by Public Health England and the information is available from NHS England as a set of statistics. We are looking at what else we can do to include indicators on SSIs for other procedures.

[John Pugh (Southport) (LD)]

T10. May I invite Ministers to comment on the recent statement by the Academy of Medical Royal Colleges that the Government’s anti-obesity strategy is“failing to have a significant impact”and that there is a“huge crisis waiting to happen”?

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

The Government is quite clear, as was the coalition Government, that tackling obesity is one of the great challenges of our time for the whole of the developed world, not just this country. We are looking at a comprehensive strategy right across all aspects of Government, including local government and so on. We will address that and rise to the challenge. Everyone has a part to play, including, as has been said during this Question Time, industry and, of course, families themselves.

Child and Adolescent Mental Health Services

John Pugh Excerpts

Tuesday 3rd March 2015 Commons Chamber

[John Pugh (Southport) (LD)]

I will certainly observe that time limit, Madam Deputy Speaker, and I congratulate the hon. Member for Totnes (Dr Wollaston) on the report from the Health Committee, which was interesting and important reading.

I want to make a few remarks about adolescents. If we had to be reincarnated, I doubt that anyone in this room would choose to be reincarnated as an adolescent. They are neither fish nor fowl; they are attached to one family but dominated by their peers. They are going through new states of mind and body, which are exciting and disturbing in equal measure. They are no longer a child but are not quite an adult. They are advancing in knowledge and understanding, but hormonally and emotionally confused. It is probably the most difficult stage of anybody’s life to negotiate, and I believe it is quite hard to be genuinely and consistently happy. In a society without clear norms and rites of passage, it is probably doubly difficult.

Should we therefore be surprised that adult mental illness is on the rise—the hon. Lady called it an alarming rise—or does that indicate that we are in a pathogenic, sick-making society? Are we simply getting better at diagnosis, or are we applying clinical language to describe the mood swings of adolescents, which are more normal than we like to believe?

I find the figure of one in 10 surprising, although there are undoubtedly some troubled youngsters out there who will not get back on track or lead a normal life without extensive help. There are those in the early stage of psychosis or in the grip of a debilitating neurosis, or the depressively suicidal—I know a fair deal about that. As hon. Members have said, it is crucial that good services exist for such people, and nobody would disagree that diagnosis should be early and treatment sensitive and effective. I applaud—as does everybody—the new commitment and resources, the drive for parity of esteem, people speaking out and so on.

However, I have one problem with the current enlightened mindset and what I call the myth of the normal. Probably no one here would claim to be in perfect physical health—at least not for long—and we generally cope with the ailments, aches and pains of ordinary life, seeking help only when something dramatic happens or our own immune system cannot cope. I do not see why that should not apply to our perspective and our take on mental health. It is not a black or white issue—it is not an either/or. The world does not divide into those who have mental health issues and those who do not; there are simply those whose lives have been disabled by their mental health issues, and others who, by and large, have coped.

Many years ago I used to teach adolescents about mental health in a Bootle comprehensive school, which was my own idea. I used to discuss the issue as a spectrum, and I hoped to encourage a degree of sensitivity. Children in the playground badly misuse mental health vocabulary. They call one another “psycho”, “mong”, “retard” and so on—the school yard can be an awfully cruel place. As part of our course we went to visit an old-fashioned mental hospital called Winwick in Rainhill. It was a large, relatively benign, caring and good institution of its kind—I had previously worked in a less good institution, Oakwood hospital in Maidstone. I basically wanted the children to understand what mental ill health was like, and for them to have a deeper sensitivity towards it. I vividly recall one episode in a corridor. An elderly and somewhat confused old lady approached the party. She was happy to see young faces reminiscent of her grandchildren. The boys—tough Bootle lads—backed away in fear. They did not know what to do or how they were expected to react. At that stage, I thought I had clearly failed to get something across. We are still failing to get quite a lot of things across. We have a myth of the normal and believe that the world divides into the sane and the insane, the normal and the well, and those with issues and those without.

That is still going strong. The House of Commons applauds with all the enthusiasm of a revivalist meeting when someone owns up to having mental illness, and we pat ourselves on the back for being enlightened. However, when a prominent Member of the House has a memory lapse on TV, which was a mental failing—he said it was an age thing—we scream like banshees, “Bill, Bill, Bill!” at Prime Minister’s questions. That is not a fine example of an atmosphere conducive to good mental health. It is worse than the school yard, but it will be repeated again at 12 noon tomorrow.

The terrifying thing about adolescent mental illness is that the individuals will never have had anything like it happen to them before. There is no frame of reference for what they are going through—it is all new. For them, as they grow up, a chasm opens up between those who can hack life and the small minority who cannot. The dread is that they are doomed to be in the latter category more or less for ever. That is the underlying and horrible fear. Successful peers will surround their failing selves. Their fear is that there will be future adults and future casualties, the copers and the failures.

Those young people buy, as do big chunks of society, into the myth of the normal—the belief that mental illness and frailty is not on a spectrum like physical illness, or something that touches everyone to some extent, but something abnormal, unusual, permanently blighting and for keeps. The truth is that mental illness is not that. Unless we get that across, we will make matters a whole lot worse.