Health and Social Care Bill

Jonathan Reynolds Excerpts

Tuesday 13th March 2012 Commons Chamber

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I will speak in favour of the Government dropping this truly awful piece of legislation.

Before I do so, I will say a few words about my constituent, Dr Kailash Chand, who began the e-petition against the Bill, which has reached 174,000 signatures. Kailash has been a GP in my area for 27 years. He has been awarded an OBE for his work and in 2009 he was named north-west GP of the year. He has dedicated his life to public health. At times he has spoken out against Government policy, whoever has been in charge. His motivation in creating the e-petition was solely his love for and belief in the NHS. We should be grateful for such public servants. I am delighted that he is here to listen to this debate.

[Mr Simon Burns]

So that everyone fully understands the background, will the hon. Gentleman confirm that this same doctor wants to be a Labour MP, has been appointed by the leader of the Labour party to review Labour party policy on older people, and has worked for the right hon. Member for Wentworth and Dearne (John Healey) in a research capacity?

[Jonathan Reynolds]

The Government are just not willing to listen to the people who will be affected by the Bill. Kailash is not alone in opposing it. If I read out the name of every organisation that opposes the Bill, I would run out of time.

[Mr Burns]

Will the hon. Gentleman give way?

[Jonathan Reynolds]

No, sit down and listen for once.

It is clear that the majority of non-biased, objective opinion is against the Bill proceeding. Never in the field of public policy have so many opposed so much and been listened to so little.

Should the Government not be asking themselves this: if the Health Secretary cannot convince the people who he wants to devolve power to, and if the Deputy Prime Minister cannot convince his own party members to support the Bill, maybe—just maybe—there is not that much going for it? The Health Secretary cannot even visit an NHS hospital, so low has his reputation sunk.

As has been said, the people who oppose the Bill, whether the royal colleges or Opposition Members, do not oppose all reform. Of course, NHS services will have to change over time, particularly in the provision of specialist services. The Labour Government introduced reforms, which used the private sector to the advantage of the NHS. The Bill does the opposite and uses the NHS for the benefit of the private sector. The problem is not reform, but these reforms. To say that anyone who opposes the Bill is against all reform is crass and simplistic.

Let us please put an end to the nonsense that the reforms are just an evolutionary approach following what has happened in the past. If that were the case, would there be an unprecedented groundswell of opinion against them? Once the Bill is passed, the primary care trusts and the strategic health authorities will be gone, and clinical commissioning consortia will be responsible for the whole NHS budget. Local authorities will take public health, and Monitor and the NHS Commissioning Board, not the Department of Health, will be responsible for the health system. That is a fundamental, top-down restructuring of the NHS, and no one wants it.

To justify that revolution, the Government started by rubbishing the success of the NHS. It began with the cancer survival rates and carried on from there, and every time the Government’s case has been knocked down. The King’s Fund, the respected health think-tank, in its review of NHS performance since 1997, clearly showed dramatic falls in waiting times; lower infant mortality; increased life expectancy across every social group; cancer deaths steadily declining; infection rates down, and in mental health services, access to specialist help, which is considered among the best in Europe. Again, I put it to the Government that they have no justification for the revolution that the Bill brings about.

The Government’s other justification has been that the NHS has too many managers, yet their reforms create a structure so confusing that, when an organogram of the new structure was published, it became a viral hit on the internet because it looked so ludicrous. What do the experts in the King’s Fund say about this? The myths section about the Bill on its website says:

“If anything, our analysis seems to suggest that the NHS, particularly given the complexity of health care, is under-rather than over-managed”.

[Lyn Brown (West Ham) (Lab)]

During the Bill’s passage, it has struck me just how vulnerable my constituents will be to doctors who are not as good as many of those who currently serve them well. One of our opportunities in Newham with a decent PCT was to deal with doctors who did not provide the right care. Is my hon. Friend , like me, concerned about the vulnerability of many of our constituents if the Bill is passed?

[Jonathan Reynolds]

I agree with my hon. Friend. If the Bill is passed, perhaps one of the biggest changes will be to the relationship between doctor and patient. Every time a patient is not referred for some sort of specialist treatment, they will wonder whether that is on clinical grounds or because their GP has one eye on the budget. Whatever the basis for those fears, GPs will be in a difficult position, and because NICE guidance will no longer be compulsory, the problem will be compounded when people compare their experience with that of others, using the internet or other means.

However, the most worrying aspect derives from the stories that we hear from parts of the country where individual GPs might have a financial interest in the services that they now commission. Such a relationship would not only destroy the trust at the heart of the system, but provide perverse incentives for how it might develop in future.

[Mr Jim Cunningham (Coventry South) (Lab)]

Government Members have said that the Government will spend an extra £12.5 billion on the NHS. Yet University hospital in Coventry must make further cuts of £28 million this year. The Government boast about the increase in the number of doctors, but it takes seven years to train a doctor. Who, therefore, was responsible for training those doctors? The Labour Government.

[Jonathan Reynolds]

My hon. Friend is, as ever, correct. He knows that the problem that all parts of the health service face is that they have been given money to justify claims from Ministers to Parliament, but they must ring-fence some of it to pay for the reorganisation—£16 million in the case of my PCT.

The story of the Bill is the story of British politics at its absolute worst. We have a weak and unpopular measure, opposed by nearly everyone, pushed through by two out-of-touch party leaders because they are worried that they will look weak if they perform a U-turn. Even worse, whatever Government Members might say, we all know that, had the Downing street operation been up to speed from the beginning of this Government—if, for instance, they had had a policy team in the centre of Government—the Bill would never have got through. After all, why, after spending so much time and so much money convincing the public that they could trust the Tories on the NHS, and after making a commitment that there would not be a further top-down reorganisation of the NHS, have the Government embarked on a deeply unpopular and unwanted top-down reorganisation of the NHS? The Bill has confirmed every swing voter’s nagging fear—you simply cannot trust the Tories on the NHS.

We have the Bill for two reasons: the vanity of the Secretary of State for Health and the naivety of the Prime Minister. Neither is a good enough reason for proceeding. It is time to drop the Bill.

Oral Answers to Questions

Jonathan Reynolds Excerpts

Tuesday 7th June 2011 Commons Chamber

[Mr Lansley]

Through the listening exercise and in response to the report of the NHS Future Forum, which we hope to see shortly, we hope to be able further to strengthen the principles of the Bill and its implementation of the White Paper, so that patients can share in decisions about their care and access the services that give them the best quality. That includes, in many instances, patients having access to a choice of providers as well.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

T5. Doctors, nurses and PCT staff in my area tell me that the Government’s pausing of the health reforms has had no impact whatever on the ground, and that implementation of the Health and Social Care Bill is proceeding just as it was before. Does the Secretary of State believe that that is wrong—and if not, does it not mean that this whole consultation period is an absolute farce?

[Mr Lansley]

No, not at all. We were very clear—indeed, I was clear to the House on 4 April when I announced the pause to listen, to reflect on and improve the Bill—that it was specifically related to achieving in the legislation the necessary support for the many changes happening across the NHS. It cannot be right, however, that people across the NHS who are engaging in delivering improved care, redesigning clinical pathways—or designing clinical services to deliver the best outcomes for patients—should be told to stop making those positive changes. They are engaging with those positive changes and we are not preventing them from doing so.

Oral Answers to Questions

Jonathan Reynolds Excerpts

Tuesday 26th April 2011 Commons Chamber

[Mr Burns]

Yes, absolutely.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

16. What amendments he plans to table to the Health and Social Care Bill.

[The Secretary of State for Health (Mr Andrew Lansley)]

As I told the House on 4 April, we are taking the opportunity presented by a natural break in the legislative process to pause, listen, reflect and improve our plans for modernisation of the health service. We will consider what amendments are required in the light of this.

[Jonathan Reynolds]

The Health and Social Care Bill is undoubtedly one of the most controversial pieces of legislation being proposed by the coalition. May I push the Secretary of State a little further on some of the answers that he has given my hon. Friends and ask him exactly how he will ensure adequate parliamentary time to scrutinise the amendments that he will bring forward?

[Mr Lansley]

I am not sure that I necessarily subscribe to the hon. Gentleman’s premise. This issue is important and it warrants the kind of attention that we are giving to it, and there is an opportunity to listen, reflect and improve the Bill because we want to ensure that we can thereby strengthen the NHS. On strengthening the NHS, I am surprised that the hon. Gentleman did not take the opportunity to refer to the £12.9 million increase in the budget for Tameside and Glossop PCT this year—something that Labour would not have offered. The truth is that we are going to strengthen the NHS through the Health and Social Care Bill, as we are strengthening it through our commitment to the priorities of the NHS.

--- Later in debate ---

[Mr Lansley]

I should make it clear that the review is being led by the Joint Committee of Primary Care Trusts, not by the Department of Health, and that it is being conducted by an independent team who are employing an independent consultative process. My colleagues and I have made no decisions so far, but we will expect all the points made by the hon. Gentleman and others throughout the country about paediatric cardiac surgery to be taken fully into account in the consultation.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

T4. The Secretary of State will be aware that, according to the quarterly monitoring report from the King’s Fund, waiting times have hit a three-year high. Does he accept that that is a direct result of his actions, particularly the abolition of the centrally managed target in June last year?

[Mr Lansley]

I can tell the hon. Gentleman that waiting times in the NHS are stable. The average waiting time for patients who are admitted to hospital is nine weeks, and the average waiting time for out-patients is three and a half weeks. I think that people in the NHS might reasonably say that it is not fair to cite February 2011, when patients waiting for elective operations could not be admitted because critical care beds were occupied in the immediate wake of a severe winter and the largest flu outbreak since 1999.

NHS (Public Satisfaction)

Jonathan Reynolds Excerpts

Wednesday 30th March 2011 Westminster Hall

[Emily Thornberry]

Before the Division, I was talking about the way in which the former Bullingdon boy and shadowy ex-adviser to Lord Lamont was transformed by his seeming commitment to the national health service. People wanted to believe that he wanted to protect public services. When the Prime Minister summed up his priorities as N-H-S, people wanted to give him the benefit of the doubt.

Before the last election, the Conservatives made two promises about the NHS. First, they promised to increase spending year on year. Secondly, in November 2009, the Prime Minister told the Royal College of Pathologists:

“With the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS.”

They have broken both those promises. Although we have heard them claim that the Secretary of State for Health talked about his proposals on a wet Wednesday afternoon in Wimbledon, the people do not believe it; they were not there to hear it, they do not believe that they voted for it, and they certainly did not vote for it when they voted for the Liberal Democrats, because they believed that they were voting for elected primary care trusts when they voted Lib Dem.

The Conservatives are taking a huge risk by undermining the NHS. Nigel Lawson has said that the NHS is

“the closest thing the English have to a religion”.

People meddle with it at their peril. Going into battle with it, as the Government have done, will be toxic for them.

The Conservatives are at long last realising that they have made a profound mistake, but it is too late, because people know that introducing competition into the heart of the national health service is completely at odds with the NHS ethos of equality and co-operation. That the Conservatives are doing all this without a mandate from the people makes it even worse. Their reforms are causing profound unease among health workers and the public.

The Conservatives are so desperate to cover up and to counter opposition that they have been trying to manipulate public opinion with false statistics. To hear the Prime Minister claim that we are behind the rest of Europe on heart disease and cancer was appalling. He was corrected by Professor John Appleby, who has already been quoted. It is simply inaccurate not to put into the mix the fact that the UK had the biggest fall in heart-attack deaths between 1980 and 2006 of any European country. At that rate, we will have one of the lowest death rates for heart disease. It is a similar story for lung cancer and breast cancer—two of the other main killers. That is, of course, as long as standards continue to improve and the NHS is not distracted by things such as a major reorganisation of the entire NHS.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I am grateful to my hon. Friend for putting on the record some of the real health outcomes in this country. The hon. Member for Southport (John Pugh) summed it up when he said that even if those health outcomes were not improving, there is no causal link between that area and the reforms that the Government propose; does my hon. Friend the Member for Islington South and Finsbury (Emily Thornberry) agree?

[Emily Thornberry]

That is right. It is a little like saying, “There are some difficulties with the national health service, so let’s change it,” without looking to see whether those changes will actually attack the problems. None of us says that the national health service is perfect. More things need to be done, but instead of building on our achievements, the Government are undermining the national health service by taking it by the ankles, turning it upside down and shaking it hard. People do not support them in doing that. Some people even heard the Prime Minister say on the “Today” programme that the national health service was second-rate. However, the penny has finally dropped for the Conservatives and they realise that they are not bringing public opinion with them when they seek to undermine the national health service in this way, so instead they have tried to suppress the information that proves that there is huge public support for our NHS as it is now, fundamentally. That is the story of what has been happening in the last few days.

To begin with, we have the unedifying spectacle of the Secretary of State saying that he will not give out certain information about what the public feel about the national health service. Then he discovers that in fact it has been given out. It is wrong of the Conservatives to suppress information about what the public think about the national health service—information that the public have paid for. It shows what their views are, and gives us a baseline before this forthcoming major trauma for the NHS. Then the Secretary of State says, “Actually, I’ve made a mistake. I gave out the information in any event.” That is the other big concern about the present Government. Not only are their reforms fundamentally driven by their ideology, but they are incompetent. There is much criticism of that.

The bottom and top of it is this: the Conservative party can do whatever they want with statistics. They can spin as they wish with whatever they want. They can say black is white until they are red—or blue—in the face, but the truth will out. The truth is that the public love their NHS. Labour gave the Government the national health service on trust. They should work on what we have achieved and tackle any outstanding problems. My hon. Friend the Member for Easington gave me this quote because he did not have time to use it, but it needs to be said as often as possible. Bevan said:

“The NHS will last as long as there are folk left with the faith to fight for it.”

The NHS does have folk willing to fight for it.

Health and Social Care Bill

Jonathan Reynolds Excerpts

Monday 31st January 2011 Commons Chamber

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

As we have already heard today, the public love the NHS. and they are right to do so. Of course it is not universally perfect; of course there are times when it does need reform; but it is still something of which we are right to be proud, and we should not be proud of it just from a moral standpoint.

As economists of many different political persuasions have shown, a centrally funded NHS is a far more efficient way of providing a system of health care than the imperfect market of a system of health insurance. We need only look to America, where, until the recent reforms, more than half all personal bankruptcies were caused by people who were unable to meet their medical bills, to recognise how decent and effective our system of health care really is.

That brings me to the main point that I want to make. In my view, these proposals do not represent an evolution in the NHS reforms of the last Government. The principal goal of the Bill—to transfer commissioning from PCTs to GPs—is, in fact, a dangerous gamble with one of the country’s most-prized institutions. Bringing GPs closer to decision-making did not require the wholesale dissolution of PCTs and the transfer of their responsibility to GPs. When the Government promised no further top-down reorganisation, they should have meant it, because this reorganisation is ill judged and ill advised, as is spending the £3 billion that it will cost. However, now that they have embarked on this revolution, they should be aware of what has come about as a result of it.

Throughout the country, there is a pressure cooker of discontent in the primary care sector as PCTs struggle to balance their budgets and hand over what, on paper, will appear to be their stable financial footing. In order to do that, many have already implemented restrictions on procedures, described in the jargon as “procedures of limited clinical value”. I assure Ministers that they are not of limited value to people who are suffering and in need of care. In a number of areas, PCTs have asked GPs to suspend all but urgent referrals to secondary care. This prompts us to ask what kind of health service GPs will be inheriting. Patients are suffering now as a result of the actions of this Secretary of State.

I also fear that the commissioning of specialised services will create a real gap. For all the faults that some may ascribe to them, PCTs ensured equity for those who, if commissioning had been done on a smaller scale, would have struggled to have had their voices heard. There is a real question of scope here. Many GPs simply do not have sufficient sight of some types of work to commission effectively. The provision of mental health services is a particular concern. As ever with this Government, it seems that the most vulnerable will be most at risk.

If GPs really are better placed to commission services on behalf of patients, why were there shortages of flu vaccines this winter? GPs were responsible for ordering those vital supplies. They had the medical records of the people in their areas; they had the information that they needed in order to make effective provision. In my area it was the local PCT that remedied the situation, but who will be there to do that in future? GPs already have to balance financial and medical considerations. Have they really proved that they can do so effectively?

Finally, we must look at what exactly GPs will be expected to do and how they will go about doing it. In all the contracts they award, someone will have to monitor financial and clinical governance. That requires expertise, which GPs will have to buy in. Who will evaluate the tenders for services and deal with contractual issues? That will require yet more expertise to be brought in. Once we consider all that PCTs do across a wide geographical area, we see that GP consortia doing the same thing over a smaller area will result in an army of consultants, private companies and ex-PCT staff being contracted in by the consortia. We will, in effect, have the expense of PCTs as they work on the same things as now, but without the accountability and economies of scale currently enjoyed. Alternatively, GP consortia might achieve these economies of scale, but they will do so by ceasing to be the community-based practices with which we are all familiar. They will become faceless corporate entities, where doctors will be salaried members of staff with no connection to a specific practice or locality. That might be the Government’s intention, but it is not an evolutionary change to the NHS.

I do not wish to be entirely negative, because there are parts of the Bill—these do not deal with changes to commissioning—that I have to be more positive about. I welcome the ongoing commitment to patient choice, as I have never believed those who say that the public do not want to choose which NHS facilities they wish to use. As with other public services, the NHS must reflect the autonomy people now expect to be able to exercise over their own lives. I also welcome a stronger role for local government in scrutinising health outcomes in their area, provided that that is a real power, not a symbolic one, entailing the ability to force changes when outcomes are not good enough.

However, those are small consolations when we consider a Bill that risks the very future of the NHS as we know it. This is a poor Bill, which has been rushed out without scrutiny and which lacks a democratic mandate. It is not so much a hand grenade thrown into the national health service, as a commercial demolition designed to break the NHS as we know it in order to serve a set of interests which are—

[Stephen Lloyd]

Will the hon. Gentleman give way?

[Jonathan Reynolds]

I am not going to give way. Other hon. Members wish to get involved in this debate and it is a disgrace that we have only one day to discuss this.

This Bill will break the NHS to serve a set of interests that are not those of NHS patients, not those of NHS staff and not those of my constituents. It is for those reasons that I shall vote against it today.

Oral Answers to Questions

Jonathan Reynolds Excerpts

Tuesday 7th December 2010 Commons Chamber

[Mr Burns]

I suggest that the hon. Gentleman studies the response given earlier by my right hon. Friend the Secretary of State to the right hon. Member for Exeter (Mr Bradshaw). By concentrating resources and reforming the system to improve outcomes, we will provide enhanced health care for all our constituents in England.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

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

[The Secretary of State for Health (Mr Andrew Lansley)]

My responsibility is to lead the NHS in delivering improved health outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities and to lead the reform of adult social care, which supports and protects vulnerable people.

[Jonathan Reynolds]

The Secretary of State will be aware that primary care trusts across the country are being asked to cut between 35% and 50% from their management costs. This inevitably leads to job losses, but can he confirm that he is confident that the jobs being lost as a result of this policy are purely management roles and that there are no losses of jobs that combine some management role with front-line clinical responsibilities?

[Mr Lansley]

We have been very clear that we are asking the whole of the NHS administration—we are applying the same discipline inside the Department, to arm’s length bodies and across the whole of government—to secure a reduction by a third of real-terms administration costs over four years. In the NHS in particular, I am looking for a reduction in management costs of 45% in cash terms. By that, I mean specifically the costs of managers and senior managers. By definition, that does not include clinical staffing.

NHS Reorganisation

Jonathan Reynolds Excerpts

Wednesday 17th November 2010 Commons Chamber

[Yasmin Qureshi]

I entirely agree with my hon. Friend. She and I have almost adjoining constituencies, and many of the issues and problems of her constituents are very similar to those in my area. When we were in power, £345 million was set aside for disabled children, for respite and all-night breaks. All of those children will now suffer because the White Paper makes no mention of funding for disabled children after March 2011. Yet, we have £3 billion to pay for reorganisation. On 2 November 2009, the Prime Minister, then Leader of the Opposition, told the Royal College of Pathologists that under the Conservatives, there would be no more restructuring of the NHS.

On 20 May, the coalition Government said:

“We will stop the top-down reorganisations of the NHS that got in the way of patient care.”

What are they doing? They are carrying out exactly that reorganisation. If the Government want to make some real improvements to the NHS, the principle of “no decision about me without me” should be considered. The Health Secretary should reconsider the NHS reorganisation and try to think of a better way to use that money for patients.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

My hon. Friend says that the reorganisation is ideologically driven. Is not it the case that when one intends to spend up to £3 billion, one needs an evidence base and proof that that spending—whatever it is on—will be money well spent? As my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) said, there have been no trial programmes or pathfinders. The money could be spent without a shred of evidence that it will make one bit of difference.

[Yasmin Qureshi]

I agree. I was about to discuss the impact of the reforms, with GP consortiums replacing PCTs. We know that there will be huge differences in the arrangements for health care in different areas. With the formation of up to 500 GP consortiums, all free to set their own priorities, a highly visible two-tier service will develop. Patients will be forced to move GPs or be reallocated to another area to get the care that they need.

The financial success of each consortium will also affect the service that patients receive. It will influence the type of care provided and how long it lasts. Some patients who need hospital treatment will inevitably be told by their GP, “Sorry, you’ll have to wait until next year.” Evidence has shown that making providers compete for patients and providing more choice to patients has done little to improve quality. Most people who are offered a choice of hospitals opt for their local provider. Choice may be important, but for patients, it comes below the quality, speed and accessibility of care.

The proposals do not make it clear whether the patients of the commissioning GP do the choosing. However, the GPs’ new contract will have a powerful incentive to hit commissioning targets. How, therefore, do patients know whether they are being prescribed the best or just the cheapest treatment going?

Again, there is no evidence to show that the restructuring would reduce the bureaucratic load. Hospitals alone will have at least three times the number of commissioners with whom to communicate and contract. Five hundred GP consortiums, each with its own set-up and administrative costs, will replace the current 150 PCTs. Huge differences in the arrangements for health care will emerge between areas. A postcode lottery will develop.

--- Later in debate ---

[Mr Steve Brine (Winchester) (Con)]

I shall be brief as I know that many hon. Members wish to speak. I am pleased to speak in the debate as someone who is about to see rather a lot of our national health service. My wife and I are due literally any day now—some may say tomorrow—to have our second child at the Royal Hampshire county hospital in Winchester, so all, including my Whips, will forgive me if I miss the Adjournment debate tonight.

Perhaps I am a little biased, but the Royal Hampshire in my constituency is in many ways the sort of institution that I see as the cornerstone of our national health service. It is a classic district general hospital, with a full service, and maternity and A and E departments at its heart. Elderly care services are first rate and infection rates are among the lowest in the NHS. We have a neonatal baby care unit, for which many similar sized institutions would give their right arm, and a bustling out-patients unit. Of course, the hospital would like to do more, but it sits at the heart of the community in Winchester and the surrounding areas because it is continually strengthened by the fact that the people who work there—the nurses, the midwives, the consultants and the cleaners—live in and around the city of Winchester. Of course, the NHS is more than its physical hospital buildings, but I view the Government’s equity and excellence White Paper in the context of institutions such as the Royal Hampshire and the locally connected NHS services that cluster around it.

My local NHS trust will undergo many changes in the coming years as it prepares, with its partners, to make the gear change to foundation status. That is absolutely right in my view to liberate our NHS. As I have often said to my trust and to the people I represent, I am not hung up on the name at the top of the wage slip for individual employees of the NHS in Winchester or anywhere else; I am merely concerned about the services that the NHS in Winchester offers the people I represent. I suspect that no hon. Member would disagree with that.

Equally, I am concerned about protecting the services in the financial context in which we find ourselves and the enormous national debts under which we labour. I am proud that my right hon. Friend the Prime Minister put the NHS at the heart of his programme for government. He must have been watching closely because I did the same in Winchester. I am especially proud to be elected as a new member of the new Government, who made the political choice—it is a choice; we did not have to do it—to protect health spending in the recently announced spending round. I know that Labour Members do not believe that and that at every turn they will try to rubbish it, as we have seen from part of the motion’s wording today. I guess that part of me, were I in their position, would do the same. It must really rankle. There is a new coalition Government, led by a Conservative Prime Minister, who are pledged to protect the NHS and put it at their heart. I am proud of that.

[Jonathan Reynolds]

Does the hon. Gentleman think that the terrible cuts that our local authorities will face in adult social care and other core services will absorb the ring-fenced money for health simply because they will not be able to provide in future the sort of services that they currently provide?

[Mr Brine]

No, there is absolutely no reason for them to do that. My right hon. Friend the Secretary of State for Communities and Local Government will make an announcement on council funding, but the Secretary of State for Health has already announced in the comprehensive spending review that the Government have allocated moneys for social care.

I know that the Labour party will try to rubbish our proposals, and that is their choice. My point is this: the people I represent do not care much about how the NHS is structured, but they care a great deal about ensuring that their NHS is there when they need it. They pays their money, and they expect the NHS to be there when they need it, free at the point of use. That is the cornerstone of what we are proposing.

I am very happy to defend outcome-focused, GP-led commissioning for my constituents. Every health care system in the world worthy of the name has the GP-patient relationship at its heart, and our proposals for GP consortiums seek to strengthen that for the sake of all the people we represent. Why on earth would we propose anything different? GP consortiums are an enormous opportunity for the NHS, and the perfect way to further the “no decision about me without me” agenda that is so important. I do not think that that is glib, as an Opposition Member said earlier. It is about rejecting the “Like it or lump it—this is the service you’re going to get” view that we have heard for far too long in our health service.

[Mr Brine]

I am sorry I gave way; I expected something else. I do not think for one minute that it is glib. We are not suggesting that every single patient will be involved in every single element of their care, but how could anybody disagree with “no decision about me without me”?

GP consortiums are an opportunity for the health service finally to realise one of its original aims—the sophisticated management and prevention of illness through the intelligent use of the patient list. That is still a largely untapped resource in our national health service.

GPs I speak to are up for their new role in commissioning for their patients. Of course they have questions—it would be strange if they did not—but they are not calling, as the Opposition’s motion is, for us to ditch our plans because things have got difficult and they have a fear of change. The Opposition cannot have it both ways. They support our plans for more GP involvement in patient care, but call plans for GP consortiums inefficient and secretive.

I see my job as a Member of Parliament as being an important link in helping GPs to answer some of those questions about consortiums that are coming down the line. I know that my right hon. Friend the Secretary of State has met groups of GPs in other areas of the country, and I ask him today to check his inbox because an invitation from me is coming his way.

As we know, following the establishment of GP consortiums, primary care trusts will no longer have NHS commissioning functions. It would be nonsense to create GP consortiums and keep two other tiers of management commissioning alongside them. Investment in the NHS has not been matched by reform. Yes, we will protect NHS investment, but our reform agenda builds on the best of the reform process over the previous 20 years. An Opposition Member said that we reject everything that went on under the previous Government, but of course we do not. We have made that very clear. These proposals build on Labour Government measures such as practice-based commissioning and NHS foundation trusts, and rightly so.

I sometimes hear it said—I heard it put to my right hon. Friend the Secretary of State yesterday morning on the “Today” programme—that the Government’s health policy was a bit of a surprise to everybody. I do not know why that would be. I mentioned earlier that the Health Secretary visited the Royal Hampshire county hospital. That was in May 2008, and he discussed the policy with people there then. He will remember the visit.

[Jonathan Reynolds]

Will the hon. Gentleman give way?

[Mr Brine]

No, I want to finish my remarks. My right hon. Friend will remember discussing with those professionals his ideas, which were published. He referred to those ideas in 2006, and they eventually made it through to our manifesto and the coalition agreement. They certainly should not have been a surprise to anyone who was watching.

I know that my colleagues will all be speaking to their PCTs and strategic health authorities, as am I. I have had a positive dialogue with NHS Hampshire in the months since I was elected, and I pay tribute to its chief executive who takes the responsible view that her job is to ensure that the NHS in Hampshire has what she calls a safe landing and a smooth transition to GP consortiums.

On public health and local accountability, as we know, a key part of the coalition plans for health involve the transfer of public health to local authorities, who will employ a director of public health. I know that these directors will be responsible for health improvement using a ring-fenced public health budget according to the needs of the local population, and I warmly welcome the move. However, I sound a note of caution about local authorities leading in public health. I urge Ministers, perhaps through partnership-working with the Local Government Association, to ensure that councillors are taken into every single step of the process and that sufficient training is given. I know that the cult of the amateur has held sway in many parts of our public service, but this is one area in which we need to support locally elected representatives as much as possible.

As co-chair of the all-party group on breast cancer, it would be remiss of me not to mention the very real concerns that we have about access to specialist nurses in the NHS, which traditionally have been an easy target for cuts. That must not happen under the new arrangements. It would be a false economy for any GP consortium to do that.

The coalition plans for health reform are not a gamble; nor are they ideological. They are about recognising that we live in the shadow of appalling national debts, and we remember where they came from. Protecting the front line, pushing power down to the local level and dealing with the national debt crisis are what “Equity and excellence” is all about, and that is why I will not be supporting the motion.

Child and Adolescent Mental Health Services

Jonathan Reynolds Excerpts

Wednesday 7th July 2010 Westminster Hall

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I appreciate having been able to secure the debate. I thank the Minister and shadow Minister for their attendance, and am grateful to the other MPs present. A lot of people watching the debate on the Parliament website might not be aware that we all had a late night last night, debating the finer points of the Finance Bill, so I am grateful to hon. Members for turning up. I also thank the National Autistic Society for providing me with statistical information. I remind the Chamber that I have declared an interest in the subject of the debate, as the parent of a child with autism.

I want to discuss the experience of many families with autism; their feedback on the support provided by child and adolescent mental health services, or CAMHS; and problems of communication, misdiagnosis and the training of CAMHS professionals. I will then make the case for more specialist autism support and ask the Minister a number of questions.

Autism is a serious, lifelong, disabling condition that affects how a person communicates with and relates to other people. It is a spectrum disorder that affects each individual differently. Some people with autism can lead independent and fulfilling lives with little support, while others need specialist support throughout their lives.

People with autism have said that, to them, the world is a mass of people, places and events of which they struggle to make sense, and which can cause them considerable anxiety. In particular, understanding and relating to other people and taking part in everyday family and social life may be harder for them, while other people appear to know intuitively how to communicate and interact with each other. Approximately one child in 100 has autism.

Autism is not a mental health problem, but a recent study by Professors Simonoff and Charman found that 71% of children with autism have a co-occurring mental health problem, and 40% have two or more. Such problems include serious conditions such as depression, anxiety disorders and obsessive-compulsive disorder, which can be debilitating without the right support. Seven out of 10 children with autism develop such conditions, which is far too high a figure. However, with the right support from people who understand autism, such children can have mental health as good as any other child’s. Unfortunately, that support is often unavailable in our society.

Children with autism find it difficult to understand the world around them. They may not understand social cues and expectations or be able to identify patterns and routines in their lives. Help with understanding what to do in different situations or what happens next in a sequence of events, or with coping with changes in routine, can make a big difference, but without such support, children with autism can become anxious or frustrated.

Children with autism are also less likely than other children to have strong social relationships. One Office for National Statistics study found that 42% of children with autism had no friends, compared to 1% of other children. Children with autism may act in unusual ways, or may try to fit in with their peers in socially inappropriate ways. Other children may ridicule or bully them as a result.

Difficulties at school and elsewhere may affect the self-esteem of children with autism. An inability to express their feelings can lead to escalating emotions or leave them unable to deal with experiences such as loss or grief. A supportive educational setting that works for the child, in partnership with mental health services, can be crucial to maintaining emotional well-being and preventing mental health problems from developing, yet the NAS found that 34% of parents said that a delay in accessing the right support at school had had a negative impact on their child’s mental health, and that half of children with autism are not in the kind of school that their parents believe would best suit them. Awareness and consideration among the general public also play a part. Whether in shops and restaurants, on public transport or in the park, children with autism and their parents can face intolerance and lack of understanding that can cause considerable stress and anxiety.

It does not have to be like that. Most of those difficulties can be overcome with the right support for children with autism and their families. Children with autism can live happy, healthy, fulfilled lives, do well at school and reach their full potential. Everyone in society must take some responsibility for making that happen.

I intend to concentrate on the support that children with autism and their families receive when mental health problems develop. According to Government-commissioned research conducted by the university of Durham, one child in every 10 who accesses child and adolescent mental health services has an autism spectrum disorder. That amounts to more than 10,000 children a year. Such children are often extremely vulnerable and in dire need of support that works for them. Another ONS study for the Government found that 25% of children with autism either self-harm or have suicidal thoughts. Their families are desperate for skilled help that can improve their children’s mental health and quality of life.

The NAS has been carrying out in-depth research on the subject since last summer, as problems with CAMHS were being mentioned consistently through its helpline and regional offices. When NAS members were surveyed on the organisation’s campaigning priorities, 99% rated improving CAMHS as either important or very important. The NAS held focus groups with parents and one-to-one interviews with children who had experienced CAMHS, followed by a mass survey of parents. It also visited several CAMHS sites and spoke to professionals and clinical directors.

Through its research, the NAS has found that, sadly, most children with autism and mental health problems are not getting the service that they need from CAMHS. According to the NAS survey, CAMHS fails to improve the mental health of two thirds of children with autism. We must improve on that.

One young woman said of her experiences as a nine-year-old accessing CAMHS that

“when I went in to the meeting I was miserable and depressed. When I came out I was suicidal. I was trying to throw myself out of my windows and hang myself… It took me several years to recover and I didn’t ever want anything to do with them.”

The NAS consistently heard from professionals, parents and children that, despite the huge proportion of children with autism in the system, understanding of autism among professionals is generally poor. Only half of parents feel that CAMHS staff have a good understanding of autism, and fewer than half think that CAMHS staff know how to communicate properly with their child.

To work successfully with a child with autism, a CAMHS professional must have a good understanding of autism. Autism is a communication difficulty, so the professional must generally adapt how they communicate, which requires a good understanding of autism. With respect to some children, that involves speaking more clearly and directly, while others have limited or no verbal communication and may need visual cues to help them to make sense of and communicate their feelings. A child with autism is likely to take longer than other children to trust the professional and communicate openly.

Professionals may also have to adapt their explanations to be less abstract or hypothetical and relate more directly to the specifics of the child’s situation. For example, if a professional works with a child with autism to deal with a certain situation in a classroom setting, the child will usually struggle to generalise, applying the same techniques at home or on the school bus. The professional will have to work through each situation in turn, which is not necessary for other children.

Children with autism can also struggle to explain difficulties that they are not currently experiencing. One child said:

“They need to be there when things happen, because when I went to see the doctor at our local CAMHS I never felt bad and couldn’t talk about what had been hard because it wasn’t happening then”.

When professionals are given the time and training to get to know the child and their family, understand the child’s autism and how they communicate best, and adapt their approach accordingly, outcomes are greatly improved. However, a professional who does not understand autism is unlikely to make such adjustments, leading to a breakdown in communication and making effective intervention extremely difficult.

When a child with autism also has a mental health problem, it is crucial that the right support is provided for the right diagnosis. If a child is wrongly assessed, the wrong support will inevitably follow. Practitioners who do not have a good understanding of autism can misdiagnose children as a result, leading to inappropriate or unsuitable interventions. Without a sound working knowledge of autism, some behaviours that are common in children with autism can easily be interpreted as mental health problems. For example, autism-related personal obsessions, rituals and routines can lead to a false diagnosis of OCD. Peculiarities and fads about what a child eats can come across as an eating disorder. Sleeping difficulties or an aversion to human touch can wrongly lead to suspicions of abuse-related trauma.

The NAS found that some children who had been diagnosed with autism were wrongly undiagnosed by a professional who was convinced that their behaviour was symptomatic of a different condition. Other children’s mental health conditions were overshadowed by their autism, when professionals were unable to distinguish the symptoms of mental health problems from autism-related behaviours: if the CAMHS team focused on autism, mental health issues were ignored. Some parents said that the professionals they met considered conditions such as anxiety disorders inevitable and unavoidable side-effects of autism, rather than as the separate, treatable conditions that they are.

Many of the professionals told the NAS that they wanted more opportunities for professional training and development, so that they and their colleagues would be better able to work with children with autism and mental health problems. Many children with autism receive either inappropriate support or no support at all because the right support simply does not exist in their area. Some CAMHS professionals told the NAS that their waiting lists for children with autism were much longer than those for children without autism, and that, because so few staff had autism training, the vast majority lacked the skills to treat children with autism, so those children were left waiting for the handful of staff with sufficient autism expertise.

[Charlotte Leslie (Bristol North West) (Con)]

As chair of the all-party group on autism, I congratulate the hon. Gentleman on securing this debate on an immensely important subject. The NAS has done fantastic work raising these issues with colleagues. What training did CAMHS staff receive under the previous Government and does he think it was adequate? If not, what improvements might be made?

[Jonathan Reynolds]

I am grateful to the hon. Lady for her intervention, and I acknowledge her work and expertise in this field. I approach this subject primarily as a parent, so I am happy to say that more needs to be done. I am not making this a party political issue between this Government and the previous one. I am trying to highlight the issue and, I hope, move forward together, across the House.

I wish to identify some good practice relating to the hon. Lady’s question. Dudley primary care trust operates an autism clinic that focuses on diagnosis and assessment, and has the specialist expertise to assess complex autism cases. The clinic takes a “broad apprenticeship” approach to training new staff, which gives them the opportunity to observe specialists and more experienced clinicians assessing children from behind a one-way mirror.

After new staff have watched several assessments, they progress to shadowing colleagues and then to taking the lead with children with autism, with support from a specialist. Finally, they are able to work alone and train new starters themselves. They learn through practical experience, rather than theory. The clinic also shares its expertise more widely and trains external agencies. For instance, it trained a group of specialist autism teachers and key workers to provide social skills training to children, meaning that social skills training could continue once a child had left CAMHS, making it far more effective than if it had been delivered once and then discontinued.

There is clear evidence that a good understanding of autism is vital to delivering an effective service to the high number of children with autism in the CAMHS system. All professionals working in CAMHS must have their training needs relating to autism recognised and addressed. In “Fulfilling and rewarding lives”, the Government’s recently published strategy for adults with autism, there is a commitment for

“all NHS practitioners”

to

“be able to identify potential signs of autism, so they can refer for clinical diagnosis if necessary… but more importantly so they can understand how to adapt their behaviour, and particularly their communication, when a patient either has been diagnosed with autism or displays these signs.”

The same strategy commits the Government to working with the General Medical Council and various professional bodies

“to improve the quality of autism awareness training in their curricula.”

What action do the Government intend to take to ensure that the NHS training objectives made in the autism strategy, “Fulfilling and rewarding lives”, are met, so that all CAMHS practitioners receive some basic training in autism?

[Dr John Pugh (Southport) (LD)]

The hon. Gentleman has made two distinct points so far: that mental health problems can be masked by autism so that a person who really has mental health problems may be seen only as having autism, and that autistic behaviour can be misdiagnosed as a mental health issue. Surely that is a very tricky situation for any diagnostician to be in.

[Jonathan Reynolds]

Yes, it is difficult. To be clear, my point is that the prevalence and frequency of co-occurring mental health problems with autism require CAMHS professionals to have specialist training. Without that support, there can be misdiagnosis, which can lead to the situation that the hon. Gentleman referred to.

Does the Minister agree that, given the high proportion of children with autism who access CAMHS, all CAMHS professionals should receive some autism training?

I have explained how a basic knowledge of autism among all CAMHS staff is essential to ensuring that appropriate interventions are delivered to children with autism, but that alone is not enough. Providing mental health support to a child with autism is a specialist skill. Research has found that when an autism specialist has been involved in the support of a child, the outcomes and service satisfaction both improve dramatically.

The NAS found that parents who reported that their child had received support from a professional specialising in autism were twice as likely as those whose children had not to agree that CAMHS had improved their child’s mental health. They were also four times as likely to say that a good understanding of autism by mental health professionals had positively influenced their child’s mental health. However, only two in five parents say that their child has had such support.

[Mr John Leech (Manchester, Withington) (LD)]

I congratulate the hon. Gentleman on securing the debate. As a parent of an autistic child, does he support the idea that children on the autistic spectrum should be educated in special schools, or are such children better off in mainstream schools?

[Jonathan Reynolds]

Speaking as a parent, we must recognise that this is a spectrum disorder. Therefore, children with autism are in different situations and have different symptoms, and each requires a response particular to them. Generalisations of the kind that the hon. Gentleman asks about cannot be made. Each parent and professional would, in respect of the support that they had, have to make the decision based on what was best for that particular child.

The professionals who spoke to the NAS stressed the importance of specialist autism expertise when dealing with a child with autism and mental health problems. They explained how in many cases a specific skill-set is required to treat these children and that without that specialist knowledge it can be very difficult to effect any real improvement. They felt that specialist expertise was often required to get a real understanding of how the child’s mental health problems related to their autism, and how they would need to adapt the interventions they provided to take account of the child’s autism.

Although basic autism knowledge will help a professional to communicate better with the child and understand better why the child displays certain behaviours or symptoms, greater expertise is often needed to make a positive difference to the child’s mental health. That is because many therapies and interventions rely on thought processes and communication techniques that do not make sense to children with autism, and only skilful adaptation from a specialist can make them relevant and useful. Children with autism often will not gain any benefit from treatment that is applied in the standard way. Indeed, such treatment can make things worse.

Again, we should recognise good practice where it exists. West Berkshire has a social communication team that provides home and community-based assessment and intervention for young people with complex diagnostic issues or needs that cannot be met by local services. That team works with children with autism and a co-occurring mental health disorder. It takes a multidisciplinary approach, incorporating speech and language therapists, two clinical psychologists and a psychiatrist. The team is also part of a wider multidisciplinary group that provides services for children with autism in west Berkshire. The team recognises the need to adapt therapies to account for autism. Psychologists divide their time between diagnosis and follow-up appointments, and provide behavioural and mental health interventions.

[Pat Glass (North West Durham) (Lab)]

I have worked in this area for many years, with many children and CAMHS services. I have found across the country that there is massive inconsistency in the quality of CAMHS services, but there is absolute consistency in the lack of those services for children. Quality is variable throughout the country. Although the services that my hon. Friend is talking about are at the upper end of the scale, for many children they simply do not exist.

[Jonathan Reynolds]

I am tremendously grateful to my hon. Friend for her intervention. She has great expertise in this and other matters, and in another capacity was responsible for the education system that I went through. I hope that I am not letting her down.

Following on from that, as so many children who access CAMHS have autism, what action will the Government take to ensure that specialist autism support is available to all children with autism and mental health problems? To take up what my hon. Friend has said, I think we would all agree that one matter that always arises when we talk to parents and campaigners is the inconsistency in service delivery across the country. For every example of innovative or positive practice, there are often many examples of children with autism and mental health problems facing inadequate or non-existent provision.

Local commissioners are supposed to plan services based on the needs of the local population, but it seems that in many instances commissioners are unaware of either the number of children with autism and mental health problems in their area, or that those children need specific support from people who understand autism, or both. When commissioners fail to recognise and address the needs of children with autism and mental health problems, those extremely vulnerable children and their families do not receive the support that they need. Commissioning is a local exercise, but there is no doubt that direction from the Government at national level can make a huge difference to what is commissioned.

Previous Government directives—for example, the national indicators, Care Quality Commission inspections and the national service framework for children—have instructed commissioners to prioritise specific areas of CAMHS, such as age-appropriate in-patient wards for teenagers, early intervention services, and services for children with a learning disability. Those directives drive commissioning in those areas, and lead to greater availability of services and greater consistency across the country.

The National Autistic Society has provided strong evidence that CAMHS are failing children with autism, and that results for such children can be greatly improved by improving autism understanding and specialisms within CAMHS. We know that only 10% of CAMHS provide targeted support to children with autism. Surely, there is a strong argument for the Government to prioritise the commissioning of services for children with autism.

Ten thousand children with autism access CAMHS each year. Given that the mental health of two thirds of children with autism is not improved by the support that they receive, that is a huge waste of NHS resources when we can ill afford such a waste. Furthermore, when children with autism receive services that do not work for them, or receive no support because none is available, their problems escalate and become more complex. Not only does that mean that it is much harder for families to cope; it means that, ultimately, those children are much more expensive for the NHS to treat. A relatively short period of appropriate therapy from an autism specialist at an early stage could prevent a child from needing a long stretch in an expensive in-patient unit.

If commissioners were given more guidance and direction to help them to commission the right services for children with autism in the first instance, we could stop wasting money and stop wasting lives. What action will the Government take at national level to ensure that the right services for children with autism are commissioned locally across the country?

[Several hon. Members]

rose—