Oral Answers to Questions

Justin Madders Excerpts

Tuesday 10th March 2020 Commons Chamber

[Helen Whately]

The salary threshold for people coming to work in the NHS in the roles that my hon. Friend mentioned are linked to NHS pay bands, and applicants will have more than enough points to apply under the new immigration system. We are working with NHS employers to encourage international applicants. I thank my hon. Friend for giving me the opportunity once again to dispel any myths in this area.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

The Minister will have to try a bit harder, because the Chartered Society of Physiotherapy is certainly very concerned that its positions are not going to be covered. Others, such as care assistants, are also below the salary threshold. We are talking about vital roles. There are 100,000 vacancies across the NHS, so will the Minister go back to the Home Office and ask staff to look at the detail of these proposals so that they do not make the NHS staffing crisis any worse than it already is?

[Helen Whately]

The NHS visa is in place. There are also plans in place to ensure that we have international recruitment alongside investment in a home-grown workforce, and that we increase retention rates and the number of returners to provide the NHS with the staff it needs.

Lesbian, Bisexual and Trans Women’s Health Inequalities

Justin Madders Excerpts

Tuesday 10th March 2020 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I am pleased to be responding to this debate, which falls near the beginning of LBT Women’s Health Week. The theme of this year’s week is visibility, so this debate itself provides an important opportunity to raise awareness of the health inequalities that affect women in LGBTQ+ communities. I know that the other place debated these issues as recently as last week, but as the hon. Member for Reigate (Crispin Blunt) said, this is the first time that these issues have been specifically discussed in this Chamber. The week provides an opportunity for communities, practitioners, local government, health and social care providers and commissioners of services, as well as ourselves in this place, to take a close look at what progress has been made in improving the health and wellbeing of all women in our communities and supporting them to take action, because, as we have heard in the debate today, there are some excellent examples of good practice and progress around the country but more needs to be done to support LBTQ+ women.

The hon. Member for Livingston (Hannah Bardell) opened the debate and said she hoped it would be conducted with respect and integrity, and I believe it has been. As always, she conducted herself with respect and integrity, and she spoke with great openness and sincerity about her own experiences, which I hope will prove an inspiration to others. I was particularly impressed by the humility she showed in recognising that her own position and privilege might have made it easier for her to come out than it would be for other people to do so, but I am sure it was still not an easy thing to do.

The hon. Lady spoke about the mental health challenges facing people and also issues in accessing healthcare. She gave us the staggering fact from a survey in Scotland that about half of all trans people have considered taking their own life. That was particularly worrying and concerning, and should cause us all to think about what more we can do. The personal testimonies she gave were extremely powerful and put many of the figures that we have heard today into a much more personal and meaningful context.

The hon. Member for Reigate was absolutely right to say that equality in law is not the same as equality in outcome, and he highlighted some of the findings from the Women and Equalities Committee report, which I will return to shortly. He was also right to highlight some of the initiatives that have been successful and also some of the areas where we need to do more.

It was a pleasure to hear from my hon. Friend the Member for Sheffield, Hallam (Olivia Blake); it was the first time I have heard her speak in the Chamber. She shone a spotlight on an area we do not talk about very much: the social care sector and some of the bullying and discrimination that is happening there. It is certainly the case that, as she said, much more education and training is needed. My hon. Friend was also right to say that the approach to health and care needs to be much more holistic to take account of the needs of the individual; she got the tone absolutely right in making that point.

The hon. Member for Runnymede and Weybridge (Dr Spencer) gave a very thoughtful speech, and one point I took from what he said was that we need a lot more data and research in these areas to really understand the issues that we are dealing with. The hon. Member for North Down (Stephen Farry) spoke very powerfully and movingly about the progress that has been made in Northern Ireland, but also about some of the challenges that are still faced there.

As we have heard during the debate, there are higher rates of poor mental health, misinformation about sexual health, difficulties in accessing healthcare, and experiences of discrimination, harassment and domestic abuse. There are multiple barriers facing LBTQ+ women that prevent them from having a healthy and happy life, and that is simply because of who they are.

Several Members mentioned Stonewall’s 2018 report, “LGBT in Britain”, and we must use that as a touchstone for what to do in future. It found a worryingly high rate of mental health issues suffered by LBT women. The report itself told of harrowing experiences of discrimination and harassment in daily life, rejection by family and friends and people being subjected to hate crimes just because of who they were. These things clearly all have a devastating impact on a person’s mental health.

Over a quarter of lesbians and 42% of bisexual women report having a long-term mental health condition, with bisexual women being four times more likely to have long-term mental health problems than straight women, and 28% of bisexual women and 40% of lesbians said they deliberately harmed themselves in the last year, compared with 6% of adults in general. The fact that incidents of self-harm are over four times greater for bisexual women and twice the rate for lesbians than for the general population should give us all cause to think about the difficulties these communities are facing. Some 19.2% of lesbian women and 30.5% of bisexual women also reported having an eating disorder. Despite the clear levels of need we have talked about, the 2018 national LGBT survey found that when it comes to accessing mental health care, about 50% of LGBQ women and 53% of trans women found accessing those services “not easy” or “not easy at all”. The LGB&T Partnership also found that lesbians, at 25%, and bi women, at 32%, are more likely to describe themselves as having fair or poor health than heterosexual women, at 21%. Studies have shown that lesbian and bisexual women also have higher risks of obesity and cardiovascular disease. Two national patient surveys in England found that the prevalence of all cancers is higher in lesbians, at 4.4%, and bisexual women, at 4.2%, than heterosexual women, at 3.6%. In terms of sexual health, less than half of lesbian and bisexual women have ever been screened for sexually transmitted infections, but half of those who have were found to have had an STI.

Despite the clear advice from Public Health England that all women aged 25 to 49 should be screened for cervical cancer, there are conflicting messages still from health professionals which mean that lesbian and bi women are much less likely to attend their cervical screening appointments, with one in five lesbian and bisexual women reporting having been told by a healthcare professional that they were not at risk of cervical cancer. Overall, lesbian and bisexual women are up to 10 times less likely to have had a cervical screening test in the past three years than heterosexual women, yet bisexual women are more than twice as likely to have cervical cancer than heterosexual women.

The picture for breast cancer screening is a little more positive, with four in five lesbians over the age of 50 having attended their breast screening invitation, which is a similar figure to that for heterosexual women. But trans women taking oestrogen may be at increased risk of breast cancer and may not be routinely invited for screening, particularly if the gender marker on their records is “male”. Macmillan also found that many breast health awareness messages are delivered to women when they attend clinics for contraception or cervical screening, meaning lesbian and bisexual women and trans men with breast tissue may be less aware.

There are serious concerns that poor access and poor experiences contribute to poorer health outcomes. The National LGB&T Partnership tells us that 8.1% of lesbians, 5.9% of bisexual and 15.4% of trans women experienced inappropriate questions because of their sexuality when accessing healthcare. In its report, Stonewall found that discrimination, both experienced and expected, can deter LGBT women from accessing healthcare when they need it, with one respondent saying:

“Medical professionals are not that good with lesbians. I don’t go to the GP very often because they’re not familiar with lesbian issues usually.”

That is disappointing to hear, because I often stand at this Dispatch Box and praise our wonderful NHS staff. We all know that they do a tremendous job under increasing pressure, but, as this report shows, while most health and social care staff do their best to deliver the best possible care, the fact that one in seven LGBT people avoids seeking healthcare for fear of discrimination shows that there are training issues. I will address those issues a little later.

A Women and Equalities Committee report in 2016 found that trans women face lengthy delays to accessing gender identity services, averaging a two to three-year wait. That is a very long time considering the constitutional target for referral to treatment is 18 weeks. That ought to be addressed as a matter of urgency. The 2018 national LGBT survey found that a quarter of trans women felt their specific needs in relation to their gender identity were ignored or not taken into account when accessing healthcare. Three in five trans people said they have experienced a lack of understanding of specific trans health needs by healthcare staff

The evidence is clear that there is a need for action to reduce health inequalities. Providing the best possible, high quality healthcare does mean delivering care without prejudice. It also requires an understanding of specific health needs and an understanding of the challenges particular communities face. Following the 2017 national LGBT survey, the Government’s Equalities Office produced an LGBT action plan in 2018 which, included more than 75 commitments across a whole range of areas. With regards to health there were commitments to

“ensure that LGBT people’s needs are at the heart of the National Health Service”,

including appointing a national adviser to provide leadership on reducing the health inequalities that LGBT people face, enhancement of fertility services for LGBT people, improving mental healthcare and improving the way gender identity services work for adults.

In the annual progress report for 2018-19, which was presented to Parliament, I know that some progress on those recommendations was made. The National LGBT health adviser was appointed and a funded programme to trial new approaches to tackling LGBT health inequalities was launched.

The Government said that it was their intention to deliver the remainder of the commitments from the action plan over the next three years. Will the Minister update us on how those plans are going along? In particular, the Government’s stated priorities for action are: looking at ways to improve the mental healthcare for LGBT people, developing a plan to reduce suicides among the LGBT population, and the transformation of adult gender identity services. There was also a pledge that NHS England would fund the Royal College of Physicians to develop the United Kingdom’s first accredited training course in gender medicine, which will begin accepting recruits shortly. I am not sure whether the progress report for 2019-20 has been published yet, but perhaps the Minister can update us on that and on what progress is being made and when the next report is due.

As we heard, in October last year, the Women and Equalities Committee published a report on health and social care in LGBT communities following its inquiry, which called for evidence on how well policy makers and service providers were taking into account the health and social care needs of LGBT communities. It received over 100 written submissions and heard oral evidence from people about their experiences, as well as community groups, advocacy organisations, policy experts, local authorities, public service providers and politicians.

As we heard, the report found that unsurprisingly, there are many significant health inequalities for LGBT communities and that they face numerous barriers in accessing health and social care. We are yet to see the Government’s response to the Committee’s report. While I appreciate that it was published just prior to Dissolution, it would be useful if the Minister indicated when the Government’s response to that will be provided.

There are many recommendations in the report—23 in total—and I will not talk about them all today, but I would like to draw one or two to the House’s attention. I agree with the report, Stonewall and the National LGB&T Partnership that monitoring both sexual orientation and gender identity is far too important to be left as an aspiration rather than a concrete goal. If monitoring remains optional, health disparities will continue and remain hidden across services if they choose not to implement it. I believe that all providers must implement sexual orientation and trans status monitoring alongside training for frontline staff to collect the data, so that as with all personal data, information on sexual orientation and trans status is collected and recorded sensitively.

The Committee also recommended that sexual orientation monitoring should be made mandatory across all NHS and state social care providers by October this year and that service providers that fail to implement it should face fines equivalent to those for not monitoring ethnicity. It also recommended that gender identity monitoring work should be accelerated with a view to creating a standard by the end of 2019 and then rolled out on a mandatory basis to the whole NHS and state social care providers by the end of the year. We know that one of the roles of the national adviser is to advise the Government on the implementation of sexual orientation monitoring across the NHS. Will the Minister update us on what progress has been made in implementing the plans and whether the recommendations will be completed in the timeframe set out?

The Committee’s report recommends that all NHS and social care providers should ensure that all staff understand their legal responsibility to deliver services that are inclusive of LGBT people. We have touched on the fact that training will play an important role, and I agree with the Committee that those responsible for the education and training of health and social care professionals should treat training on LGBT needs as being as integral as any other training.

I support Stonewall’s call for all health and social care staff to receive LGBT-inclusive training on meeting the needs of LGBT people throughout their careers. Again, given that one of the national adviser’s specified roles is to improve healthcare professionals’ awareness of LGBT issues, will the Minister update us on what plans the Government have to improve and enhance ongoing training on these issues so that services are inclusive?

The Committee also recommended that the Government should consult on ways in which effective knowledge and understanding of unacceptable discriminatory practices and the Equality Act 2010 could be ensured among the highest range of health providers. Again, will the Minister advise the House whether there has been any progress on that?

Finally, the report made several recommendations regarding the importance of leadership on this issue from the Department of Health and Social Care and NHS England. It is clear that if we are to see the improvements that we need, all local health and social care organisations must actively consider the needs of their LGBT women, as required by the public sector equality duty. I support the Committee’s recommendations that this should be mandated directly from the Department and NHS England as part of commissioning requirements and as a prerequisite for receiving funding. As the hon. Member for Reigate said, the Department and NHS England should work together to create an inclusive commissioning toolkit that health commissioners can use to spread best practice in commissioning inclusive services, and any bids found to be lacking should be passed on to the EHRC for enforcement action.

I also agree with the Committee and the hon. Member that we need joined-up working across the whole of Government. As we know, the Government Equalities Office has the lead on the LGBT issues and the action plan, which includes healthcare, but it is separate from and not included in the NHS long-term plan. This issue was raised in the other place last week, but the response was not particularly helpful. Does the Minister agree that the response implied that all responsibility for LGBT healthcare lay with the GEO and that this is something we need to reconsider?

The Committee also recommends that NHS England and the GEO work together to produce the next LGBT action plan update and be a signatory to it. Will the Government take forward that very practical and sensible recommendation? On leadership, can the Minister provide any assurances that there will be continued funding for the national advisor for LGBT health beyond the end of this month, as they are needed to drive forward the inclusion agenda throughout health and social care? It would be a welcome signal from the Government that they are determined to give this issue the importance it deserves.

Nursing Workforce Shortage: England

Justin Madders Excerpts

Tuesday 3rd March 2020 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to see you in the Chair, Ms McDonagh. I congratulate my hon. Friend the Member for Bedford (Mohammad Yasin) on having secured this important debate, and on the thoughtful and knowledgeable speech he has given about the challenges currently facing the nursing workforce. He made some very interesting points: the reference to nurses being there at our birth, at our death and throughout our lives was an important and moving reference to how much we all rely on nurses. He mentioned the 10.7% nursing vacancy rate in his region, which is a staggering statistic; there are actually some variations within that, because the vacancy rate for mental health is even higher, at 15.3%. Those huge variations across disciplines need to be addressed by the Government.

My hon. Friend also referred to the RCN’s survey of its members, in which a staggering 95% of nurses said that patient dignity is compromised and 92% felt worried that patients may be receiving unsafe care. That should be a red-light warning for us all about what is going on in our NHS. What he said about the professional attitude and sense of duty that nurses feel was particularly important: when a nurse is at the end of their shift but sees something that needs to be done, they carry on. They are professional, but they carry the impact of that with them, and we have been relying on their good will to keep the NHS going for far too long. Finally, my hon. Friend referred to this being the year of the nurse and the midwife, and was absolutely right to say that we should celebrate this diverse and dynamic profession.

We heard from the hon. Member for Strangford (Jim Shannon), as we often do in these debates, who gave his own perspective from Northern Ireland. He referred to the recent dispute there, and it was clear from what he said that the concern was as much about working practices as it was about pay. He was right to say that workforce challenges there are often mirrored here. The hon. Gentleman also referred to a worrying increase in the agency bill in Northern Ireland, which may well be partly related to the greater flexibility that agency work can sometimes provide to nurses. That is something we need to reflect on when we consider working practices.

As always, it was a pleasure to hear from my hon. Friend the Member for Gower (Tonia Antoniazzi), who I congratulate on her appointment as chair of the all-party parliamentary group on cancer. She was right to highlight patients’ concerns that they are not getting the care they need, the reason for which is inextricably linked with the staffing shortfall. She was also right that it is vital that the full people plan be published as soon as possible, and to raise the concern that the plan will not include the funding it needs to meet our ambitions. Only last month, the Government introduced the NHS Funding Bill 2019-21, so we already have the parameters for funding the healthcare system over the next three to four years. Really, it should have been the other way around; we should have established what the staffing need was before we put a financial envelope around it.

My hon. Friend also referred to the excellent Macmillan report, “Voices from the frontline”, and the concerns it expresses about the lack of ability to access continuing professional development. She highlighted the impact on retention caused by cuts to the CPD budget, and the report’s references to many nurses feeling that their current workloads are unmanageable. My hon. Friend has said that we are on the edge of a full-blown crisis; I could not agree more.

I pay tribute to the 1.9 million or so dedicated and hard-working people who work across both the health and the social care sectors; it is always an honour to speak up on their behalf. Our NHS is built on its staff, and in particular our nurses and midwives who, as we have heard, go the extra mile day in and day out, despite too often finding themselves under intolerable levels of pressure. It is a damning indictment of this Government’s record that despite this being the 37th debate in this place over the past three years on workforce shortages in health and care settings, there is still no plan to address this crisis. It is not over-dramatising matters to describe it as an existential crisis, because following nearly a decade of mismanagement and underfunding, we are facing a very real recruitment and retention crisis in the NHS. Years of pay restraint, cuts to training budgets and growing pressures have left us with a chronic shortage of over 100,000 staff.

Those shortages affect patient care every single day. They manifest themselves in the NHS performance data, which month after month show hospitals with the worst performance data on record. That will not change unless the workforce shortages are acknowledged and addressed. The proportion of people being seen within four hours in A&Es is the lowest on record, and the number of people waiting four hours or more on hospital trolleys is the highest on record, as is the number of people waiting 12 hours to be admitted and the total number of people on the waiting list in England. Targets for patients to receive treatment within 18 weeks have not been met for four years now, and there is no sign that that situation will improve any time soon.

The Government need to take seriously the growing gap between the number of nursing staff and the number of people who need healthcare. As we know, the Royal College of Nursing estimates that there are about 43,000 nursing vacancies in the NHS in England alone and warns that the nursing shortfall will rise to almost 48,000 by 2023 and a mind-boggling 108,000 by the end of the decade. That is a staggering figure. To put that in context, it is more than every man, woman and child living in the Minister’s constituency—picture that. That is how much of a shortfall we could face by the end of the decade, if action is not taken.

The effect of staffing shortfalls on patients must never be underestimated, but they also have an effect on staff. NHS staff are consistently asked to take on additional responsibilities, to work harder, to do more intense shifts and to take on excessive numbers of patients. All the surveys show the effect that that has on them. It is worrying, but not surprising, that only a quarter of respondents to the NHS staff survey published last month agreed that there were enough staff for them to do their job, and that more than two thirds per week worked additional unpaid overtime. As we heard, higher numbers of emergency care nurses—more than nine in 10—are worried that patient dignity is being compromised and that patients may be receiving unsafe care.

I am sure that all hon. Members were moved by the testimony that my hon. Friend the Member for Bedford quoted. No one, patient or staff, should be in that situation. The testimony used the word “dignity” repeatedly, which should cause us to reflect on the situation that we are putting people in. I am sure that we would not want that for our family.

Staff are working in a high-pressure environment without adequate resources or support, which not only puts patients at risk but damages the mental health of staff and leads to low morale, poor wellbeing and a poor work-life balance. It is no surprise that conditions are becoming intolerable for some staff. More than 40% of NHS staff were unwell as a result of work-related stress in the last year—that is an unsustainable figure.

An analysis of NHS Digital data finds that more than 200,000 nurses have left the NHS since 2010-11; there has been a 55% increase in voluntary resignations from the NHS with staff citing a poor work-life balance as the primary reason; and the number of voluntary resignations for health reasons has increased threefold in the past 10 years. It is no wonder that the recent “Interim NHS People Plan” states that hard-pressed staff are “overstretched” and admits that people no longer want to work in the NHS. It is our pride and joy. People should positively want to go to work every day full of joy about what they are delivering for the people of this country, but the pressure is becoming too great.

It is damning that we still have no funded workforce plan, despite the Government’s promise of one when the funding settlement was first announced in summer 2018. We also still have no framework that sets out the roles, responsibilities and accountabilities for workforce supply and planning.

As has been mentioned, last month’s NHS Funding Bill was an opportunity for the Government to show their commitment and set out plans for a proper costed strategy for the workforce but, frankly, it was a publicity stunt. Despite every trust chief executive reporting that understaffing is their biggest challenge and a hindrance to delivering safe care, there was nothing in the Bill on protecting and enhancing training budgets. I acknowledge that staffing shortages are the responsibility of multiple decision-makers across all levels of the health and social care system, but ultimately, they are outside the control of frontline staff and trusts. The Government need to act to ensure that there are enough skilled staff to ensure safe and effective care.

The standards of protection and safety that are rightly expected by staff and enshrined in the NHS constitution appear to have been abandoned by the Government. Things have become so bad that NHS England has recommended that the Government review

“whether national responsibilities and duties in relation to workforce functions are sufficiently clear.”

The public are concerned and want action too. In a recent YouGov poll, 80% of respondents in England agreed that

“the Government should have a legal responsibility to ensure there are enough nursing staff to meet the country’s needs”.

The Royal College of Nursing, other royal colleges and health organisations are all calling on the Government to take action to ensure clear workforce accountability in law. Unfortunately, there has been a continued failure of leadership to bring forward the required legislation to guarantee and enshrine safe staffing levels in the NHS in England. That has left us lagging behind Scotland and Wales, which have already established explicit accountability for workforce provision.

It is vital that, as the royal colleges are calling for, an NHS long-term plan Bill for England sets out a framework of explicit roles, responsibilities and accountabilities for workforce supply and planning, through all levels of decision-making. Like other hon. Members, I am keen to see the detail of the Bill and whether it will contain the long-awaited commitment to safe staffing, in addition to a bold and fully funded workforce strategy. I welcome the Minister to her place; perhaps she will indicate when that Bill might be introduced when she responds.

The election promise of 50,000 more nurses in five years is all well and good, but without a plan for how that will be delivered and maintained in the long term it is pie in the sky. As it is British Pie Week, I cannot think of a more apposite metaphor. We all know that that figure does not stand up to even the most cursory inspection. It is not 50,000 extra nurses, but the retention of 19,000 existing nurses and the recruitment of an additional 31,000. As has already been clearly set out, retention is a huge challenge that the Government are failing on.

The Minister will no doubt tell us there has been an increase in the number of nursing staff in the last year. Of course, in such desperate times, any increase is welcome, but as my hon. Friend the Member for Bedford said, it is a miniscule 0.4%. Let us be honest: the scale and pace of the increase is not happening fast enough. There are also concerns that the figures do not reflect what is really happening on the ground, because they were taken at the optimum time to capture the new registrations before the impact of annual departures is felt.

The Government’s failure to train enough nurses will not be reversed by the recent announcement of maintenance grants for nursing students, as the grants will cover only living costs, not tuition fees. Many student nurses are slightly older and may have family responsibilities, yet the sum on offer from the Government to support them through their training is slightly less than £100 a week.

Evidence shows that, since the Government scrapped the bursary scheme in 2016, applications to study nursing have dropped by 25% in England. As we and many others repeatedly warned at the time, that was bound to happen. Adequate funding for nursing students is crucial to attract more people to study nursing. I hope, again, that the Government listen to us when we say that the U-turn is only partial and not enough to undo the damage done. It is still the case that the prospect of accruing large debts is a huge disincentive for those who want to train in nursing, especially prospective mature students who may already shoulder debt from a previous degree in another subject.

With Labour’s analysis showing that the first cohort of students who started their nursing degrees in 2017 will graduate with £1 billion in tuition fee debt, everything possible must be done to remove the financial burden for prospective students. If the Government are serious about recruiting more nurses, they need to match our commitment to bring back the nursing bursary in full, including the abolition of tuition fees.

I agree with my hon. Friend the Member for Bedford that the new maintenance grants must be increased to cover actual living costs. Given that the Government have admitted the error of their ways in removing the bursary in 2016, I hope that the Minister will set out whether any maintenance loan debt incurred by students between 2017 and 2019 will be written off.

I cannot end without mentioning immigration. The NHS plans to increase the international recruitment of nurses to reduce workforce pressures, but, at the same time, the Government are planning to raise the health surcharge that those staff have to pay. Unison and the RCN are calling for nursing staff to be exempt from the immigration health surcharge. Those staff already make their contribution to the NHS by working in it. Alongside their colleagues, they often go beyond their contractual hours to keep the service from crumbling under the pressure. It is indefensible to continue to apply the surcharge to them.

The RCN also calls for nursing to remain on the shortage occupation list and for nurses to be exempt from the salary threshold when the points-based immigration system comes into force. Given the challenges outlined today, could the Minister set out when responding what representations she has made to the Home Office about bolstering the workforce and ending the uncertainty and red tape in international recruitment? Nursing is a global recruitment market, and a challenging one at that. If the Government’s workforce strategy is over-reliant on international recruitment, it will fail, particularly when barriers are put in the way of recruitment. The myriad of reasons that have been set out about failing to improve retention rates will not lead us to a better place.

Maternity Services: East Kent

Justin Madders Excerpts

Thursday 13th February 2020 Commons Chamber

[Ms Dorries]

I thank my right hon. Friend for his comments and suggestions. In response to his call for an independent inquiry, last night I asked my officials to look into sending the independent Healthcare Safety Investigation Branch back in to do a deep dive into historical and existing cases at the trust. I want to reiterate that the trust is a safe place for any woman who is pregnant or giving birth. We have some of the very best people and clinicians working in that trust right now.

I would just like to add that NHS England and NHS Improvement are themselves commissioning an independent review into East Kent maternity services, so my right hon. Friend’s question has been answered. That is the news I have just been given. We are taking this situation very seriously. We will publish the findings of the HSIB and CQC reports in due course, because we take this matter—I personally take this matter—very seriously.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

Our thoughts go out to all the families, including the family of Harry Richford, who have endured unimaginable heartbreak because of avoidable and preventable failings at the trust. Harry Richford was aged just seven days when he died. His death was described by the coroner as “wholly avoidable”. This was a wholly avoidable tragedy and not, as the trust originally said, “expected”. After Harry died, the trust refused to refer the case to the coroner and it was only the persistence of the family that led to the inquiry.

The trust will now receive special support to help turn things around, but can the Minister outline exactly what that support will be, by whom and where the funding is coming from? Why has it taken us so long to get to this point? It was reported earlier this month that despite evidence in a report by the Royal College of Obstetricians and Gynaecologists back in February 2016, the same mistakes were made in subsequent years. We need an explanation for why those warnings four years ago were allowed to go unnoticed and unaddressed. I understand that the trust will not be put into special measures and it seems that the chief executive and the medical director will be staying in post. However, given the trust’s failure to deal with those identified failings at the first opportunity, there must surely be questions about the local leadership. Can the Minister outline whether anyone in the trust will be held personally accountable?

Once again, we are unfortunately hearing about another tragedy where the culture has exacerbated the pain suffered by the family: denial, obfuscation and a staggering lack of transparency. Why is it that these issues only come to light because of the persistence and bravery of the affected families? We need to create a culture within the NHS where safety concerns can be raised by trained staff at all levels, free from fear so that issues are dealt with quickly. Perhaps the biggest concern we have is that we do not know the true number of avoidable maternity deaths at the trust.

I would like to join Harry’s family and other Members in calling for a full independent inquiry. I understand that the HSIB deep dive will address matters to some extent, but I do not think it is the full transparent inquiry that the parents deserve and demand.

[Ms Dorries]

I thank the hon. Gentleman for his collaborative tone on this issue. I think he may have missed my last comment, which was that NHS England and NHS Improvement will be commissioning an independent inquiry. That has been decided this morning, so that will happen.

On the hon. Gentleman’s first question about what is happening to support the trust now, NHS Improvement is in there. As I said, the chief midwife, Jacqueline Dunkley-Bent, has sent in some of the best midwives, obstetricians and neonatologists in the country from outstanding trusts to support the trust. They are having twice-daily huddles on the wards, which is where multi- disciplinary teams get together and discuss on an ongoing and regular basis what is happening on the wards, what disciplines are involved and what measures are being taken. We have fresh eyes looking at the cartography that measures foetal heart rates and contractions. We have a second pair of eyes reading those cartography read-outs, so it is not just down to one midwife.

A huge amount of support has gone into the trust. As I said, it is today a safe place for anyone to give birth. We are also asking HSIB to go in to do that deep dive to look at historical issues. Whether that will continue in light of the fact that NHS England is commissioning an independent inquiry is something I need to find out when I leave the Chamber. However, I want to reassure the hon. Gentleman and everybody that this is an issue that I take very, very seriously.

Babies bring joy and happiness when they arrive, and every family—every mother, every father and, indeed, every grandparent—is entitled to know that when they or their relative is in hospital, the delivery will happen in a safe environment, with the very best care. I can say that that is the case at East Kent now, and I—we all—will strive to make sure that it is the case at every hospital.

Historical Stillbirth Burials and Cremations

Justin Madders Excerpts

Thursday 6th February 2020 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I do not normally start with warm words about a Minister’s speech, but what we have just heard shows great empathy for and insight into an incredibly difficult subject. I thank her for her introduction.

I express our sincere condolences to all parents who have not only suffered the loss of a baby or infant but have been denied the opportunity to grieve when their child was buried or cremated in an undisclosed place or when they did not receive their child’s ashes following the cremation. That should never have happened—it was wrong—and I am sure all Members on both sides of the House will wish to join me in extending our sympathy and full support to all those bereaved parents who found themselves in that totally unacceptable situation.

Each year, thousands of people sadly experience the loss of a baby in pregnancy, soon after birth or in infancy, and the feeling of loss and isolation can be overwhelming for bereaved parents. Nothing can remove that pain and grief, of course, but we know from evidence that good bereavement care can make a very real difference to the experience of parents and families at such a tragic time, which is why what we have heard already today has been so powerful.

Not so long ago, things were very different for parents who lost a baby during pregnancy or shortly after birth. Indeed, as we have heard, many hospital staff had to quickly remove the baby, and the parents were sent home to try again. Fortunately, this is not something everyone has to think about, but the law is clear on what must now happen to babies who are stillborn after 24 weeks of pregnancy or who die in infancy: they must be buried or cremated, and cemeteries and crematoriums must keep records of those burials and cremations.

Before the mid-1980s, it was often hospitals that took care of funeral arrangements for stillborn babies and for babies who died shortly after birth, and we know that parents were often not consulted or involved in those funeral arrangements. We can all see now that that was not the right approach.

The bodies of the babies were cremated, buried or put in a communal plot. In some cases, the bodies were placed in a coffin with a woman who had also recently passed away. Shockingly, information was not shared with either family in that situation. Many parents were not told what happened to their baby’s body when they were buried or cremated.

If the baby had been cremated, not all parents received their baby’s ashes. Some parents were wrongly told that there would be no ashes, and in some cases when ashes were recovered, they were disposed of without the parents’ knowledge. Again, we all now find that shocking, and it is extremely hard to fathom why it was allowed to be the practice at the time.

At this juncture, I echo the Minister’s tribute to my hon. Friend the Member for Swansea East (Carolyn Harris) for calling the Government to account and securing this debate. She has been a tireless campaigner for bereaved parents and, of course, she brings her own deeply moving personal experience to this place. She articulates why this is such an important issue in a way that only those who have suffered personal tragedy can and do. She is entirely right to demand help and support to enable the parents of stillborn babies to trace their graves so that they can finally commemorate their loss. It is only right that we do all we can do to support these bereaved parents, having failed them in the past.

I also want to commend all the brave individuals and families who first brought these issues to light, and those who have taken part in inquiries and consultations, sharing their own painful experiences, which we know would have been difficult, to ensure that lessons are learned and that no other families have to go through what they have gone through. I should also mention those who have worked selflessly and tirelessly to help bereaved families to trace their lost babies, as we are grateful for their efforts and extend our gratitude to them. I think we all agree that these people should never have been put in that position.

Thankfully, since the 1980s there have been significant and positive changes in the way those families are now treated. There is a much greater understanding that the care bereaved families receive from healthcare and other professionals following the loss of a child can have long-lasting effects. Indeed, the need for psychological support following pregnancy loss and stillbirth is recognised in the National Institute for Health and Care Excellence guidance, the “Better Births” report, the maternity transformation programme and the NHS long-term plan. All those documents rightly highlight the need to improve perinatal mental health care. However, we must ensure that those plans translate into action and that the needs of bereaved parents are explicitly addressed in quality standards, national guidance, training for healthcare professionals and guidance for local services. It is important that all parents who experience pregnancy and baby loss and need specialist psychological support can access it in a timely fashion.

We know that, unfortunately, good practice is not consistent across the board and we need to aim to ensure that it is. Too often, people who experience a psychiatric illness after their loss do not receive the support they need. Most mental health support is available only to mothers and is focused on women who are pregnant or have already lost their baby. As discussed in the annual baby loss debates, we urge the Government to develop a national standard, with guidance.

[Mark Tami (Alyn and Deeside) (Lab)]

We all agree that the woman, and indeed the whole family, should receive that psychological support if they need it, but just saying it does not mean that this help is getting to the people it should be reaching. In many cases, people find it almost impossible to get that support.

[Justin Madders]

I thank my right hon. Friend for his intervention, as he raises the very point: the support is not consistent across the piece. We rightly raise that issue when we discuss these matters, because we need better support, better funding and better delivery of these specialist services. As he says, this is a difficult issue and support is needed at the right time.

[Dame Diana Johnson (Kingston upon Hull North) (Lab)]

I am pleased to hear what our Front Bencher is saying about this important subject, but I want to develop this point about mental health support. For families who have suffered and do not know where their baby’s ashes have been strewn, asking the local council to make inquiries, as happened in Shrewsbury with the Emstrey inquiry, goes some way to seeing whether there are answers to the questions they still have. Will the shadow Minister commit his support to local authorities that want to carry out these independent inquiries, to give whatever closure they can to families by trying to get the information they seek?

[Justin Madders]

I thank my hon. Friend for her intervention. I know about the work she has been doing in Hull. She has articulated in the past why it is clearly important for such inquiries to take place and how it is the most effective way for families to achieve closure on these difficult issues. I am certainly in support of what she says.

The availability of talking therapies for bereaved parents is not how it should be. Nearly nine out of 10 clinical commissioning groups do not currently commission talking therapies specifically for parents, and where the services do exist they are usually only for mothers. We need to do better than that. Of course, I acknowledge that there is much good practice out there, but Members will know that it is often reliant on charitable grants and third parties. That is one of the main reasons why provision is patchy and at risk from wider funding decisions. I therefore ask the Minister to undertake a review of the current provision, including an evaluation of the models of best practice. Will she ensure that parents and professionals are involved in that exercise? The Minister was absolutely right to identify that when she talked about the culture in the past.

We also need to acknowledge that although the culture today has definitely improved, it is still not where we would like it to be. As we know, most of the time those whose loved one has been involved in a tragedy in the health service just want to know why it has happened and how it can be prevented from happening again. The former Health Secretary, the right hon. Member for South West Surrey (Jeremy Hunt), has on several occasions addressed the need for us to move away from a blame culture and towards a learning culture, so that when things go wrong there is proper analysis of why things have happened and we understand how we can prevent those things from happening again.

Only this week, I have heard from a constituent who has lost a lot of faith in the system in terms of getting to the truth about what happened to one of their family. They commented that the trust seemed to spend more money on lawyers than on actually uncovering the truth, and that should not be happening. We need to move away from the defensive culture that we see on occasions. I hope that we can look at that issue, possibly through the Select Committee, because there is still a temptation for trusts to lawyer-up at the first sign of concern. Most of the time, parents and family members want answers.

Back in October we heard that the Healthcare Safety Investigation Branch annual report would share some of the learning about the more than 1,500 individual cases in which something has gone wrong in one trust. I hope that report will be available shortly. I think the quote was that it was going to be available in “early 2020”, so when she responds will the Minister update us as to when we can expect to see it?

Finally, although we rightly focus on the families in this debate, we must also not forget the impact on staff, some of whom will regularly have to deal with tragedies. The Minister set out clearly what that looks like. It is important that their voice is heard in this debate as well.

--- Later in debate ---

[Justin Madders]

With the leave of the House, Madam Deputy Speaker, I would like to sum up the debate. It has been, as these debates often are, very moving and very thought-provoking.

We heard first from the right hon. Member for South Holland and The Deepings (Sir John Hayes), who made a very fair point about whether more can be done with local authorities, in particular, in respect of public funerals. There are clearly issues about the capacity in local authorities to take on extra responsibilities, but some of the issues that he raised are really matters of sensitivity and appropriateness, rather than funding. I am sure that we can do more on that. He also made the very fair point that counselling needs to be available quickly and to the whole family. He was right to raise the issue of paternal concern, which a number of Members talked about. He also talked about the impact on grandparents, which can also be overlooked.

The hon. Member for North Ayrshire and Arran (Patricia Gibson), who has spoken very movingly on these issues on a number of occasions, also picked up on the need for support for fathers. She rightly paid tribute to Sands, which does a great deal of work in this area. She articulated particularly well the differences between parents’ experiences now and the experiences they would have had in previous decades. That contrast is stark and, in many ways, heartbreaking.

The hon. Member for East Worthing and Shoreham (Tim Loughton) spoke about the importance of the personal experiences of Members in this place and how, over recent years, that has helped to bring about change. We have heard again today personal experiences that cannot do anything other than bring about more change. He made an important point about the need for bereavement leave. I pay tribute to him for the work that he has done and the changes that he has already sought and brought about. He is right about the pre-24-week birth review. I think that needs to be resolved. As he says, it is an anomaly that does need sorting.

Of course, we could not help but be deeply moved by the contribution from my hon. Friend the Member for Swansea East (Carolyn Harris). She was incredibly brave to talk about her sister and, indeed, her own son in the way that she did. She spoke very powerfully about how hard it would have been for her mother to deal with, first, the initial tragedy with her own child and then how that was repeated with her grandchild. The whole House will send its best wishes to my hon. Friend, and a huge amount of support and respect for the way that she has brought these issues forward, which we know will have been incredibly difficult.

I join my hon. Friend in paying tribute to the work done by Paula Jackson in helping bereaved families. But she is also right to say that it should not have to be down to people like Paula—that surely more can be done to get this information to the families, who should not have to fight to get what should be theirs as of right. As she said, we really do need to get more done to make sure that families do have that opportunity to say their final goodbyes.

My hon. Friend the Member for Kingston upon Hull North (Dame Diana Johnson) paid tribute to Sands, to the Lullaby Trust, and to the all-party parliamentary group on baby loss, which has led the way on this over the past few years. It is now the fourth time that she has raised the case of her constituents Mike and Tina Trowhill and their little boy William. She took us through the tremendous efforts that she has gone to, on their behalf, to get to the truth about what happened to their baby’s ashes. The comparison that she makes between what Hull City Council did and what happened in the Emstrey inquiry is a valid one. I am sure that the persistence that she has shown so far will eventually lead to the full independent inquiry that the families clearly deserve.

It is fitting that we have had this debate today, on Time to Talk Day, because we have learned over the years that it is important to talk about these things. The more we talk about them, the more we understand and the more we can improve and change things for the better. It is through learning from personal experiences that areas such as this can see the changes that we will all see the benefit of in the long run.

NHS Funding Bill

Justin Madders Excerpts

Legislative Grand Committee & 3rd reading: House of Commons & Legislative Grand Committee: House of Commons & Programme motion: House of Commons & 3rd reading & Programme motion
Tuesday 4th February 2020 Commons Chamber

[The First Deputy Chairman of Ways and Means (Dame Rosie Winterton)]

I remind hon. Members that if there is a Division only Members representing constituencies in England may vote.

Clause 1

Funding Settlement for the health service in England

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I beg to move amendment 2, page 1, line 10, at end insert—

“(1A) The amount spent on mental health services in each financial year set out in the table must be set out in a statement laid before the House of Commons by the Secretary of State no later than 30 June in each year.

(1B) The statement in subsection (1A) must be accompanied by a statement on the Secretary of State’s plans to achieve parity of esteem in mental health services.”

This amendment would require the Secretary of State to report annually on the amount actually spent on mental health services, and on the Secretary of State’s plans to achieve parity of esteem in mental health services.

[The First Deputy Chairman]

With this it will be convenient to discuss the following:

Amendment 1, page 1, line 14, at end insert—

“(2A) For each year in the table in subsection (1), the Secretary of State must specify the amount of the allotment that is for mental health services.”

This amendment requires the Secretary of State to specify the amount to be spent each year on mental health services.

Amendment 5, page 1, line 14, at end insert—

“(2A) For each year in the table in subsection (1), the Secretary of State must specify the amount of the allotment that is for training for staff to improve maternity safety and care for mothers and babies.”

This amendment would require the Secretary of State to specify the amount to be spent each year on improving maternity safety and care for mothers and babies.

Amendment 3, page 1, line 18, at end insert—

“and that the sums set out in the table are not permitted to be augmented by or composed of any virements from NHS capital budgets.”

This amendment would stop the Secretary of State meeting the NHS England allotment for resource spending by using funds from NHS capital budgets.

Clauses 1 and 2 stand part.

New clause 1—Annual report on mental health spending—

“The Secretary of State must lay before the House of Commons an annual statement of the outturn of NHS England spending on mental health services no later than six months after the end of each financial year, beginning with the year ending 31 March 2020 and up to and including the year ending 31 March 2024.”

This new clause requires the Secretary of State to report each year on the actual level of spending on mental health services.

New clause 2—Annual Report on Child and Adolescent Mental Health Services spending—

“(1) The Secretary of State must lay before the House of Commons an annual statement of the outturn of NHS England spending on Child and Adolescent Mental Health Service (CAMHS) no later than six months after the end of each financial year, beginning with the year ending 31 March 2020 and up to and including the year ending 31 March 2024.

(2) The annual statement from subsection (1) must report figures on—

(a) CAMHS expenditure per head,

(b) the percentage of the annual NHS England budget allotted to CAMHS, and

(c) the percentage of the annual mental health budget allotted to CAMHS.

(3) The figures in subsection (2) must be broken down by standard regional units in England or by such territories as the Secretary of State considers appropriate.

(4) Each statement under subsection (1) must include an assessment by the Secretary of State on whether expenditure on CAMHS has met the aims of the NHS Long Term Plan.”

This new clause would require the Secretary of State to report each year on the actual level of spending on CAMHS. It requires figures to be broken down by regional units and for the Secretary of State to include an assessment of whether expenditure on CAMHS is meeting the aims of the NHS Long Term Plan.

New clause 3—Allocation of funding—

“The Secretary of State must lay a report before the House of Commons no later than 31 July each year setting out how much in percentage and in cash terms in relation to the amounts set out at section 1(1) has been spent on mental health services in the most recent year ended on 31 March.”

This new clause would require the Secretary of State to report annually on the amount and proportion of NHS England spending devoted to mental health services.

New clause 4—Annual statement on performance—

“The Secretary of State must make a statement to the House of Commons no later than 31 March each year setting out—

(a) whether in the Secretary of State’s opinion the amount specified in section 1(1) for the following financial year is sufficient to meet the performance targets set out in the NHS constitution, and

(b) if in the Secretary of State’s opinion the amount specified in section 1(1) for the following financial year is not sufficient to meet the performance targets set out in the NHS constitution, what steps Secretary of State is taking to ensure that those targets are met.”

This new clause would require the Secretary of State to report annually on whether the allotment to the health service specified in section 1(1) year is sufficient to meet the performance targets set out in the NHS Constitution and, if not, what steps Secretary of State is taking to ensure that those targets are met.

New clause 5—Inflation—

“(1) The Secretary of State must make a statement to the House of Commons in the event that the annual rate of inflation as set out in the Consumer Prices Index is greater than 3.3% in any six months out of twelve after the date on which this Act is passed.

(2) The statement under subsection (1) must specify whether, and by how much, the allotments to the health service in England set out will exceed the amount specified in the table in section 1(1).”

This new clause would require the Secretary of State to make a statement on the impact of inflation above a certain rate on the allotments to NHS England.

New clause 9—Annual parity of esteem report: spending on mental health and mental illness—

“Within six weeks of the end of each financial year specified in the table, the Secretary of State must lay before each House of Parliament a report on the ways in which the allotment made to NHS England for that financial year contributed to the promotion in England of a comprehensive health service designed to secure improvement—

(a) in the mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of mental illness.”

This new clause would require the Secretary of State for Health and Social Care to make an annual statement on how the funding received by mental health services that year from the overall annual allotment has contributed to the improvement of mental health and the prevention, diagnosis and treatment of mental illness.

New clause 11—Annual review of adequacy of allotment to NHS England—

“The Secretary of State must lay before each House of Parliament within 14 days of the Treasury laying the annual main estimate for the Department of Health and Social Care an assessment of the extent to which changes in the costs of pharmaceutical treatments, medical devices and service delivery since the date on which this Act is passed have affected the health outcomes in England achieved as a result of the amounts in the table in section 1 of this Act allotted to NHS England.”

This new clause would require the Secretary of State to publish an annual assessment of the impact of changes in the costs of pharmaceutical treatments, medical devices and service delivery on the expected outcomes from the allotted amounts under this Act.

[Justin Madders]

It is a pleasure to see you in the Chair, Dame Rosie. In my speech I will address amendment 2 and, as we are dealing with everything in one go, the other amendments and new clauses submitted in my name and the names of my right hon. Friends.

It seems that Members across the House are anxious that the Government’s laudable aims on parity of esteem for mental health services are given some legislative teeth. The NHS long-term plan rightly calls for more investment in mental health services to give mental health the same priority as physical health. That is the right approach and it is one that we support. However, as we can see by the amendments that have been tabled today, there is scepticism about how that will actually be delivered. Investment in mental health services has been seriously neglected in recent years and mental health patients are some of the people who have been most let down by the Government in the last decade.

No doubt we will hear from those on the Government Benches that mental health spending is increasing, and that the funding set out in the Bill will benefit mental health services, but the reality is that on this Government’s watch, we have seen a mental health crisis emerge. We are not getting the investment at the level required and services are simply unable to keep pace with demand. As a consequence, the number of people living with serious mental health problems is rising. Patients are unable to access vital psychological therapies within six weeks and often have to wait over 100 days for talking therapy treatments. Thousands of mental health patients continue to be sent hundreds of miles from home, because their local NHS does not have the beds or the staff to provide the care they need. These are often young people in desperate circumstances being sent away from their family and friends—their support network, as it were—and that to me sounds a long way away from parity of esteem. We know that adults in need of help with eating disorders are waiting more than three years for treatment, while hospital admissions for eating disorders increase year on year. The number of people living with serious mental health problems is continuing to rise and suicide levels are at their highest since 2002.

Even against this awful backdrop, however, it is children’s mental health services that are suffering most from the chronic lack of funding. Children’s mental health services account for just 8% of total mental health spending, and the Government’s continual failure to prioritise children’s mental health has led to services for children effectively being rationed. We know that on average, children and young people visit their GP three times before they get a referral for specialist assessment. They then have to wait more than six months for treatment to start. Suicidal children as young as 12 are having to wait more than two weeks for beds in mental health units to start treatment, despite the obvious risk to their lives.

Three out of four children with mental health conditions do not get the support they need. With over 130,000 referrals to specialist services turned down, despite children showing signs of eating disorders, self-harm or abuse, the problem has become so bad that some children and families are being told by their GPs to pretend that their mental health problem is worse than it is to make sure they get the help they need. Four hundred thousand children and young people with mental health conditions are not receiving any professional help at all—400,000. That is a scandalous figure. We know that mental health conditions in adults often begin in childhood, so it is not only an outrageous dereliction of duty to our young people; it will also end up costing the NHS and society far more in the long run.

[Pete Wishart (Perth and North Perthshire) (SNP)]

I do not want to detain the hon. Gentleman too long, because he is making a very good speech and very important points, but I just wonder whether he has any views about the setting of this debate in the Legislative Grand Committee, the de facto English Parliament. SNP Members are excluded from voting in this debate and excluded from tabling any amendments, yet the Bill will have a fundamental impact on the health funding of Scotland through Barnett consequentials. I am interested in his views on that process, so will he say something about them? Can we have Labour support, so that this nonsense stops and we go back to one class of MP in this House where everybody can participate equally?

[Justin Madders]

I thank the hon. Gentleman for his intervention. I understand his frustration absolutely. I think he has a very fair point, Dame Rosie, that because of the Barnett consequentials there is a role for SNP Members—indeed, all Scottish and Welsh Members—in this debate. Clearly, that is a separate issue to the whole English votes for English laws process, but the fact is clear that on the face of the Bill there are Barnett consequentials, which mean that the devolved nations ought to have a say.

It is really no wonder, given the background I have just set out, that children are reaching a crisis point before getting the support they need, and that the number of children attending accident and emergency for their mental health in a situation of crisis is increasing year on year. That is not inevitable. With real investment, we could reverse the trend of long waits, rationed treatment and inadequate care if we allocated more of the NHS budget to mental health. As we know, mental health illnesses represent 23% of the total disease burden on the NHS, but just 11% of the NHS England budget. That is a long way off the parity of esteem that we all seek to achieve.

We know that the Government plan to put in an extra £2.3 billion a year by 2023-24, but that is not enough. The Institute for Public Policy Research has said that to achieve parity of esteem for mental health services, funding for those services needs to grow by 5.5% on average not just next year, but over the next decade. The NHS plans to spend £12.2 billion on mental health funding in 2019, but the IPPR estimates that that needs to reach 16.1 billion by 2023-24 alone.

Of course, we support the increased funding for mental health in the Bill, but we know the NHS has to live within the 3.3% uplift provided under the Bill. The Institute for Fiscal Studies, the Health Foundation, NHS providers, the British Medical Association and many of the royal colleges say that health expenditure should rise across the board by 3.4% just to maintain current standards of care. By definition, there will actually be less money for funding in other areas. That means there is a risk of further raids on the mental health budget. In previous years, money allocated to mental health services, particularly children and adolescent mental health services, has been diverted back to hospitals to deal with the crisis there.

Labour would have done what was desperately needed. We would have put in an extra £1.6 billion a year immediately into mental health services, ring-fenced mental health budgets and more than doubled spending on children’s mental health. That is why we are seeking to amend the Bill to ensure mental health services do not lose out because of other financial pressures in the system. We are calling on the Government to ensure that guarantees for mental health funding are protected by ring-fencing mental health funding. We also seek to require the Secretary of State to come to the House annually to report on the amounts and proportion of funding allocated to mental health services, and on their plans to achieve parity of esteem for mental health services.

On the Labour Benches we are not convinced that mental health is a priority for this Government, despite what they say. They may want to position themselves as the party of the NHS, but as long as they continue to neglect mental health and push services deeper into crisis, they will not come near that aim. We intend to push amendment 2 to a Division, because we want to hold the Government to account. We want transparency on mental health spending and we want a clear road map from the Secretary of State on how he intends to make parity of esteem a reality.

[Gareth Thomas (Harrow West) (Lab/Co-op)]

I wonder if I could raise with my hon. Friend an example that I think makes his point, which is the state of NHS finances in north-west London, in particular of the acute hospital that serves my constituents, Northwick Park Hospital, and the clinical commissioning group. Both the trust and the CCG are over £30 million in deficit. As a result, they have cut back on community mental health services and, indeed, on a range of other things. Unless there is parity of esteem and unless there is a significantly higher funding boost for the NHS in north-west London than that currently being suggested by the Conservative party, I fear that mental health services, as he so rightly says, are likely to be cut even further.

[Justin Madders]

My hon. Friend sets out very clearly the challenge that the Government face from the debt situation in the NHS. Both in-year deficits and total debt to Government have not been addressed adequately or taken into account in the Bill and that is clearly of huge concern.

Amendment 5 deals with patient safety, which should be front and centre in the NHS. When things go wrong, as they sadly do from time to time, it can have tragic consequences for patients and their loved ones. When three in four baby deaths and injuries are preventable with different care, it seems particularly tragic when things go wrong during birth, leaving families devastated by the loss of a child or having to cope with the long-term impact. There have been many things over the years that I have disagreed with the previous Secretary of State—the right hon. Member for South West Surrey (Jeremy Hunt)—about, but on Second Reading he raised the important issue of maternity safety training, calling on the current Health Secretary to reinstate the maternity safety fund. We absolutely agree with him on that, which is why we have tabled amendment 5.

Improved maternal health is one of four priority areas in the long-term plan for care quality and improved outcomes, and it includes action to achieve 50% reductions in stillbirth, maternal mortality, neonatal mortality and serious brain injury by the middle of the decade. As a party, we have pledged to legislate for safe staffing and to increase funding for NHS staff training, including reinstating the maternity training fund to help to improve maternity safety in our hospitals. The leaked interim report of the Ockenden review last year exposed widespread failures in maternity care at Shrewsbury and Telford hospital trusts and demonstrated, sadly, that Morecambe Bay was not a one-off.

An evaluation of maternity safety training from 2016 found that it had made a difference and improved patient safety, yet it was still axed. Just two years later, the “Mind the Gap” report found that fewer than 8% of trusts were providing all training elements and care needs in the “Saving Babies’ Lives” bundle and called for the maternity safety training fund to be immediately reinstated to address, as it said, the

“clear…inadequate funding for training”.

Given the clear evidence of the need for the training fund’s reinstatement, I very much regret that it is not within the scope of the Bill for us to submit an amendment to include its reinstatement. However, with the amendment we seek to put a greater spotlight on the issue, and hopefully, that will require the Government to set out how much they are spending on improving maternity safety and care for mothers and babies each year in order for them to demonstrate their commitment to improving maternity and foetal safety. I believe that that will enable us to judge and evaluate their commitment to those aims.

[Alex Cunningham (Stockton North) (Lab)]

It is not within the Bill’s scope to press the Government on the need to have funding restored to smoking cessation services so that they can have multimedia campaigns to reduce smoking in pregnancy and smoking generally. Does my hon. Friend agree that it is a shame that the Government cannot address that at this time?

--- Later in debate ---

[Justin Madders]

My hon. Friend is absolutely right: it is a matter of some regret that public health has not been included in the Bill. As we have said repeatedly, we have to look at the health system in the round and include public health and, of course, social care. We cannot deal with those matters in isolation and I believe that it was a mistake for the Government to restrict the Bill in this way.

Despite the many tragedies that we know about in maternity care, it is worth restating that we still have fantastic midwives and fantastic maternity care in this country. That is to be celebrated, but we also need to ensure that when things go wrong—when there are failures and safety issues—we address them and lessons are learned so that no more families have to experience such tragedies.

Amendment 3 is about genuinely giving trusts the certainty that the Bill only purports to do, as well as beginning to tackle the appalling maintenance backlog that has arisen on the Government’s watch. As we know, trusts are around £14 billion in debt to the Government and are currently predicting a £571 million in-year deficit. That is a truly shocking and unsustainable situation. Only short-term fixes have prevented the situation from getting even worse. Such fixes are a symptom of structural long-term underfunding, and like most short-term fixes they create bigger problems further down the road.

We have been absolutely clear that the funding settlement proposed in the Bill is inadequate and that it will not be enough to keep up with demand. As I said, that analysis is shared by just about every major health expert, including the Institute for Fiscal Studies, the Health Foundation, most royal colleges and NHS providers, and the BMA.

--- Later in debate ---

[Gareth Thomas]

In support of the case that my hon. Friend is making, I again mention Northwick Park Hospital, which serves my constituents. It has a huge maintenance backlog. Since the cancellation of the Government’s “Shaping a Healthier Future” NHS reform plan for north-west London in June last year—that programme of reform had been going on for seven years —there has also been no replacement money identified for investment in intensive treatment beds, an extra 30 of which are needed to help to tackle some of the problems in A&E at Northwick Park Hospital.

[Justin Madders]

My hon. Friend is again showing what an assiduous and determined constituency MP he is. He might want to look at the NHS providers’ report today, which sets out some of the challenges from the lack of a long-term capital investment programme. As we have heard, including from him and in relation to other various examples around the country, this is not just about a lick of paint, but about really vital work that impacts on patient care.

[Alex Cunningham]

When my hon. Friend talks about capital, I think of the hospital that was cancelled for my constituency by the Tory-Lib Dem Government 10 years ago. Does he share my opinion that when it comes to the capital programme and NHS funding, the Government should consider the life expectancy in different areas? In my constituency, it is 14 years lower than in the Prime Minister’s constituency, so I desperately need a new hospital for my area.

[Justin Madders]

I am sure that if my hon. Friend continues with his determined campaign, he will see that hospital appear. His point about health inequalities is really important. It is absolutely scandalous that we see such disparity in this country, and we want to see further and more determined action from the Government on that.

Patients ultimately pay for the increasing backlog. Between 2017-18 and 2018-19, there was a 25% increase in clinical service incidents. These incidents are caused by estate and infrastructure failure that leads to clinical services being delayed, cancelled or otherwise interfered with.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

The hon. Gentleman is making some very fair points about the importance of investing in hospital infrastructure. A number of years ago, we were promised a paperless NHS, but the reality today is very different. In fact, NHS IT infrastructure is creaking at the seams. There has been a complete failure to invest adequately in that infrastructure, which is compromising patient care. Far too many staff hours are lost on IT systems that are not fit for purpose. Will he join me in urging the Government to take that issue very seriously, because it is about improving patient care as well as improving productivity and better using staff time?

[Justin Madders]

The hon. Gentleman makes an important point. We have all heard horror stories of workers in the health service having to turn on seven or eight different computer systems and use fax machines and pagers— there were so many fax machines in the NHS I used to think the previous Health Secretary was sponsored by Rank Xerox. It is a serious point though. If we are to improve patient outcomes, we will need to move with the times and get the benefits of technological improvements.

[Mark Tami (Alyn and Deeside) (Lab)]

My hon. Friend will agree on the importance of the Countess of Chester Hospital to his area and mine. It is quite a unique hospital, in that it was built to serve the people of Deeside in north Wales as well as Chester and the surrounding area, so is it not strange that, although many in my area rely on it, I will not be allowed to vote on the Bill today?

[Justin Madders]

My hon. Friend makes a pertinent point. Both my parents are residents of north Wales but on occasion use the Countess of Chester Hospital. This process does not take account of the reality on the ground. As I said before, the fact that there will be Barnett consequentials from the Bill suggests that we have made a serious error in not allowing those from the devolved nations to vote on it.

We know what some trusts have told us about the lack of capital investment and what that means on the frontline: Morecambe Bay has said it has “unsuitable” environments for safe clinical care that have led to the closure of its day case theatre; the Queen Elizabeth Hospital in King’s Lynn has warned of a direct risk to life and patient safety from the roof falling in; and at the Royal Derby Hospital, a failing emergency buzzer system in the children’s ward means that staff would be unable to warn colleagues if something went seriously wrong. That is not acceptable.

The capital maintenance backlog will not be addressed unless the Government take note of what NHS Providers says in the report that came out this morning. It talks about the need for the NHS to have a multi-year capital settlement and a commitment from the Government to bringing the NHS capital budget in line with those in comparable economies, which would allow the NHS to pay for essential maintenance work and invest in long-term transformational capital projects of the kind we have touched on. One of our criticisms of the Bill is that capital allocations have not been included in the figures in clause 1, so in order to protect those allocations we have tabled amendment 3, which we hope to push to a vote, to stop the Government’s continual sticking-plaster approach.

I move now to performance targets and our new clause 4. We all know about the record investment and record patient satisfaction levels that the last Labour Government bequeathed to the Conservatives, but another part of their legacy was the NHS constitution, introduced as part of a 10-year plan to provide the highest quality of care and services for patients in England. It included a clear statement of accountability, transparency and responsibility, and standards of care for accessing treatment. These are the figures we often trade across the Dispatch Box.

Only last month, across this very Dispatch Box, the Prime Minister gave us assurances on performance. He said:

“We will get those waiting lists down”—[Official Report, 15 January 2020; Vol. 669, c. 1015.]

We would all like to see that, but we should remind ourselves of the Government’s sorry record: the target for 95% of patients being seen within four hours in A&E has not been met since July 2015; the target for 92% of people on the waiting list to be waiting fewer than 18 weeks for treatment has not been met since February 2016; the target for 1% of patients waiting for more than six weeks for a diagnostic test has not been met since November 2013; and the NHS has not met the 62-day standard for urgent referrals for suspected cancer treatment since December 2015. I fail to see how the Prime Minister can drive down waiting lists when the level health expenditure he is proposing is not enough to meet existing demand.

[Alun Cairns (Vale of Glamorgan) (Con)]

I note the statistics the hon. Member has shared with the House, but how do they compare to the outcomes that my constituents in Wales face? I would suggest they fare much worse.

[Justin Madders]

Across the piece, some areas in Wales are actually performing better than areas in England. The direction of travel is the right one. If the right hon. Member is so interested in the performance in Wales, he should stand for the Welsh Assembly; he will have the opportunity to do so in the not-too-distant future. I am sure he was aware when he stood for this place that health was a devolved issue.

[Gareth Thomas]

I want to raise again the example of Northwick Park Hospital, which serves my constituents. It has not met the four-hour A&E target since August 2015. One of the latest issues responsible for the increasing pressure on waiting times at Northwick Park is the closure of our walk-in services, which were one of the great reforms of the previous Labour Government. Alexandra Avenue, which served my constituency, closed in November 2018, and Belmont health centre, which served the constituency of Harrow East, closed in November 2019. The last walk-in service in the London Borough of Harrow, the Pinn medical centre, which currently is in the constituency of the hon. Member for Ruislip, Northwood and Pinner (David Simmonds), is also due to close, and yet it is increasingly difficult to get an answer to a request for a meeting to discuss that closure with Ministers or the chief executive of NHS England.

[Justin Madders]

There has to be a correlation between the number of closures my hon. Friend is seeing and his CCG’s debts, which he was referring to earlier. The pressure on frontline services is making these decisions, which it is more and more likely can only impact on performance. I hope that when the Minister responds he will be able to give him the satisfaction of at least a meeting to discuss the issue further.

The funding in the Bill is insufficient to reverse the decline in recent years, let alone deliver the aspirations set out in the long-term plan. It is not just the opinion of Her Majesty’s Opposition that the performance targets cannot be met; NHS England has also made it clear that the core treatment targets cannot be met because of the funding settlement imposed by the Government. And who loses out month after month when performance targets are missed? It is patients. Whether for pre-planned surgery, cancer treatment, diagnostic tests or emergency care, our constituents are waiting longer and longer, often in pain and distress, to access the health services they need. The figures do not lie.

We must remember that the figures are also real people. They are real people stuck on waiting lists: the total number of people on waiting lists in England is now 4.41 million, which is the highest since records began, and up from 4.1 million, when the right hon. Member for West Suffolk first became the Secretary of State. They are real people waiting for treatment: the target to treat 92% of patients within 18 weeks has not been met for four years—not since February 2016—and obviously has never been met by the current Secretary of State. They are real people waiting for cancer treatment: the Prime Minister himself agreed last month that it was unacceptable that the target for treating cancer patients within 62 days of urgent GP referrals had not been met for five years. That is five years of failure. They are people waiting on hospital trolleys: the number of people waiting four hours or more on hospital trolleys reached 98,452 last December, which is not only a 65% increase on the same point the previous year, but the highest on record.

As we heard on Second Reading, the failure to meet these targets has real consequences. Research from the Royal College of Emergency Medicine shows that almost 5,000 patients have died in the past three years because they spent so long on a trolley waiting for a bed in an overcrowded hospital. As we have said several times during our consideration of the Bill, the true increase in funding is about 4.1%—I will not list again all the bodies that agree with that figure—yet the money in the Bill will not be enough.

This is all before last week’s news about the Chancellor looking for 5% savings in all Departments, including this one. That might not affect the figures in the Bill, but there might be cuts across the wider Department that do have a knock-on impact on service delivery. Let us take a look at A&E. There is increased demand on our A&E services, for many reasons, including the years of cuts to social care, but that is not covered in the Bill. Will the 5% cut come from there—if it does, more and more people will be forced into A&E by a collapsing social care system—or from public health, as we have heard previously, which would inevitably store up problems in the short and longer term?

None of this can be said to be likely to have no impact on performance targets, which for too long have been treated as a poor relation by this Government. The Government have widely ignored them, to the extent that they are spending more time dreaming up ways to get rid of them than to meet them. We say that patients deserve better. We will push the new clause to a vote, because we believe it is clear that the Secretary of State will not be able to drive down waiting lists or drive up performance with the level of health expenditure that he proposes to enshrine in law.

Rather than presenting the Bill as a panacea, let us ensure that the Secretary of State and the Prime Minister are held to account for the promises that they make, and that the Secretary of State comes to this place every year to tell us whether, in the Government’s opinion, the funding allocated for that year will be sufficient to meet those performance targets. If it is not, the Government must set out what they are going to do about it. It is simply not good enough to continue, year after year, to have a Government who treat the targets as an inconvenience. If those standards are to mean anything to patients, and if the Government are serious about persuading us that they mean something to them as well, they will have to come here every single year and tell us, unambiguously and with reference to the funding package for this year, how they intend to meet those targets.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Is that not the most critical weakness in the Bill? Given that inflation is expected to rise after Brexit, the figures for 2023-24 are just guesswork. There should be a commitment to £20 billion by that year, in real terms.

[Justin Madders]

There are indeed many weaknesses in the Bill, which, given that it is so short, is quite an achievement on the Government’s part. That is the point of the new clause. We cannot say with any certainty what the rate of inflation will be in a few years’ time. It is important for funding that is seen as adequate now—at least by Conservative Members, if by no one else—not to be downgraded further as a result of economic turbulence. We have had no guarantees that a different economic picture will change the Government’s stance. Indeed, when on Second Reading we sought assurances that the NHS would still receive the real-terms increases envisaged in the Bill should inflation run at unforeseen levels in the future, no commitments were forthcoming. When pressed by my hon. Friend the Member for Nottingham South (Lilian Greenwood), the Secretary of State could not give the cast-iron commitments that are needed by those delivering the services. Even if this is an unsatisfactory settlement, they deserve some certainty that the sums involved will not be eroded by spikes in inflation.

As the Secretary of State said on Second Reading,

“The crucial thing in this Bill is the certainty.”—[Official Report, 27 January 2020; Vol. 670, c. 560.]

We are not sure whether he meant certain failure, because we know that the sums set out in the Bill are not enough to keep up with demand, but the new clause seeks to ensure that the NHS is, at least to some extent, insulated against unforeseen economic shocks. It would act as a safety net in the event that inflation ran above 3.3% for more than six months in any 12-month period. It also requires a statement from the Secretary of State about whether any additional funds will be made available to supplement the sums set out in the Bill. That would at least provide some clarity and certainty about whether there will be any real-terms reduction in funding as a result of a sustained rise in inflation.

Let me finally say a little about new clause 11, and the adequacy of the allotment to NHS England. As I have already made clear, the Bill sets NHS expenditure for the next four years at a level that is not sufficient to put the NHS on a sustainable footing or to improve performance. That is why we are seeking to ensure that the impact of unforeseen changes in the costs of pharmaceutical treatments, medical devices and services—possibly as a result of our leaving the European Union, or of the trade deals that we sign—are reviewed by the Government so that adequate funds are available to meet any uplift, and so that there is no negative impact on health outcomes. Much has been said about the possibilities in new trading arrangements, but not enough about the risks, of which this is only one.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 28th January 2020 Commons Chamber

[Edward Argar]

I remind the hon. Gentleman that Bradford treated more people in A&E this winter than in any previous one, and although he may have omitted to do so, I want to pay tribute to and thank the staff at Bradford for that work. The Conservative party is the party that is investing in our NHS, our A&Es and our staff, and the hon. Gentleman should welcome that.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I think it is time that we shook this Government out of their complacency. On their watch, the four-hour A&E waiting target has never been met, and performance is getting worse each month. It is no wonder they are putting so much effort into getting rid of it. We agree with the president of the Royal College of Emergency Medicine, who said:

“Rather than focus on ways around the target, we need to get back to the business of delivering on it.”

Does the Minister agree?

[Edward Argar]

First, 1.7 million more people are being seen within the four-hour target now than before 2010. I hope that the shadow Minister will acknowledge that that reflects the significant increase in demand due to the number of people going through the system. He talks about the review of standards. That is a clinically-led review, and I am sure he would want to let those clinicians lead it. We will see what it reports and will consider its recommendations when they come back to us. In the meantime, we are getting on with investing in our NHS, and improving services.

NHS Funding Bill

Justin Madders Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

We have had many Back-Bench contributions today, including from the right hon. Member for South West Surrey (Jeremy Hunt), my hon. Friends the Members for Nottingham South (Lilian Greenwood), for Mitcham and Morden (Siobhain McDonagh), for Feltham and Heston (Seema Malhotra), for Easington (Grahame Morris), and for Rhondda (Chris Bryant), and the hon. Members for Newton Abbot (Anne Marie Morris), for Darlington (Peter Gibson), for Ashfield (Lee Anderson), for Kirkcaldy and Cowdenbeath (Neale Hanvey), for Dover (Mrs Elphicke), for St Ives (Derek Thomas), for Birmingham, Northfield (Gary Sambrook), for Banbury (Victoria Prentis), for Carshalton and Wallington (Elliot Colburn), for West Aberdeenshire and Kincardine (Andrew Bowie), for Ipswich (Tom Hunt), for Waveney (Peter Aldous), for Watford (Dean Russell), for Bishop Auckland (Dehenna Davison), for South Thanet (Craig Mackinlay), for Stoke-on-Trent Central (Jo Gideon), for Northampton South (Andrew Lewer), for Stoke-on-Trent North (Jonathan Gullis), for South Dorset (Richard Drax), for North Dorset (Simon Hoare), for Isle of Wight (Bob Seely) and for Crawley (Henry Smith). As you would expect, Mr Speaker, time constraints mean that I will not be able to go through each of those contributions, but there are a few that I would like to pick up.

My hon. Friend the Member for Nottingham South expressed her concern that the Bill was more about presentation and substance, and she is absolutely right. She also said, as did several Members, that we need a sustainable long-term settlement for social care, and we will return to that later. My hon. Friend the Member for Feltham and Heston rightly pointed out that the real-term size of the capital budget is less than it was in 2010 and that there have been five raids on it in recent years. She neatly moved on from that to the need for a new health centre in her constituency.

Once again, my hon. Friend the Member for Easington made a compelling case for more funding for radiotherapy, and he is right to highlight the low survival rates for certain types of cancer and the need for more specialist staff in this area. My hon. Friend the Member for Rhondda also pointed out our poor record on cancer outcomes. Although, as he said, we are improving on survival rates, the gap between us and the best-performing countries is not narrowing. Both he and my hon. Friend the Member for Easington pointed out our huge shortages in radiologists.

It was startling to hear from my hon. Friend the Member for Rhondda that only 3% of pathology labs currently have enough staff. He took us through a list of specialisms in which the NHS has huge vacancy rates. There is no doubt that the workforce challenge is a huge challenge for the NHS.

My hon. Friend the Member for Mitcham and Morden is right to highlight the scandal of growing health inequalities in this country. We do not talk enough about that, and it will be interesting to hear the Minister’s answers to her important questions.

The right hon. Member for South West Surrey gave a very thoughtful speech, but I wish he had been candid enough to admit that the NHS did not always have the funding it needed when he was Secretary of State. He is right that we need an equivalent plan for social care, without which this funding will not do the trick.

The hon. Member for Newton Abbot made some interesting points. She asked about the assumptions behind the underlying figures and how we know whether they are right. She also made an interesting suggestion about an annual report, to which we may return in Committee.

We have heard three excellent maiden speeches tonight. The hon. Member for Darlington spoke with great passion and sincerity about his constituency, which he clearly knows well. If he does half as good a job as his predecessor, Jenny Chapman, he will be able to consider himself a success.

The maiden speech of the hon. Member for Ashfield was characterised by a great sense of humour. I agree with him that talent is spread evenly across this country but opportunity is not. His predecessor, Gloria De Piero, would agree with that, too.

The hon. Member for Kirkcaldy and Cowdenbeath made a compelling, powerful and hugely impressive maiden speech. He will have a lot of contributions to make in the years to come.

As my hon. Friend the Member for Leicester South (Jonathan Ashworth) said, this Bill could not demonstrate more clearly the Government’s lack of commitment to the NHS. I did not think it possible to get so much wrong in such a short Bill, but somehow the Government have managed it.

What is wrong with the Bill? First, after a decade of austerity, any increase in funding is positive, but the song and dance being made about this Bill could lead people to think the funding settlement will restore the NHS’s fortunes and put an end to the dismal record of failure we have heard about this evening. We know the money on offer simply will not be enough.

The Health Foundation has said:

“Investing in and modernising the health service as set out in the NHS long term plan requires around 4.1% a year”.

This settlement falls well below that. It is around 25% short of that 4.1%, which we should remind ourselves is not an outrageous, unrealistic figure but was the long-term average funding for the NHS prior to 2010. That matters, because every year we sell ourselves short is another year that the mountain gets a little bit higher to climb.

We will not even stand still on these figures. The awful performance targets we have heard about this evening could actually get worse, because the committed increase of 3.1% falls short of what the IFS and a host of other experts have said is needed just to maintain current levels of performance. The Government are setting out on a course of action that they know will, in the long run, lead to more misery for patients. The NHS deserves more ambition than we are seeing here. Let us be clear that the NHS is in crisis, and this is not the solution. Committing funds that will not even maintain the status quo is simply not good enough.

Secondly, the Bill is based on a set of inflation assumptions that even Mystic Meg would find hard to predict. That is an issue, because there is no commitment in the Bill to preserving the current real-terms increases should there be a sharp rise in inflation. We hope that does not happen but, of course, if it does come to pass, this inadequate settlement will become even worse. I note that when the Secretary of State was given the opportunity to provide reassurance, he pointedly failed to do so. We will need to return to that.

Thirdly, the Bill does not help the Government’s aim, which we support, of achieving parity of esteem for mental health. As we know, mental health equates to 23% of demand but takes up only 11% of the budget—that is a long way off parity of esteem. We know that the Government plan to put an extra £2.3 billion a year into mental health by 2023-24, but that is not enough, and of course there is a risk that there will be further raids on the mental health budget, such as we have seen in previous years. Given those raids, it is not surprising that more than half of mental health professionals say that they are too busy to provide the level of care they would like to give to their patients. When the number of staff working in mental health services has fallen by nearly 8,000, despite demand rising, we know that it is not good enough. We need to see a commitment to ring-fencing in this Bill.

Fourthly, the Bill does not address existing NHS debt. As we know, trusts are about £14 billion in debt to the Government and, as we have heard, it is only short-term fixes that have stopped the situation getting worse. It is not clear what assumptions have been made about existing provider debt in these figures, and it would be a crying shame if much of this extra money being heralded by the Government as being for use in the NHS actually ended up going back to the Government in debt repayments.

The final issue is that the Bill looks at matters in isolation. If we are really going to get the NHS back to the level it was the last time Labour was in government, funding settlements should be looked at in the round, and that means including capital, training and public health as part of the picture. We know that the NHS capital budget is lower today in real terms than it was a decade ago and that the maintenance backlog has spiralled out of control, topping £6.5 billion. We have all heard the stories of ward ceilings falling in and of sewage pipes bursting, with the consequent delays to treatment. If this settlement is as good as the Government clearly think it is, surely they also need to fix the roof while the sun is shining.

Of course there is also concern about public health, which is excluded from the Bill, in an incredibly short-sighted decision. I know that Members will not need to be reminded of the savage cuts this Government have made in public health over the past decade—about £870 million in real-terms funding reductions. We are not going to solve the long-term challenges this country and the NHS faces if we do not prioritise prevention in this Bill, but it contains no commitment to funding in that area at all.

Another puzzling omission relates to the training budget. As we have heard many times tonight, workforce is one of the greatest challenges we have in the NHS, with more than 100,000 vacancies and huge pressures on workforce retention. We have 44,000 nursing vacancies, falling numbers of GPs, and professional associations such as the Royal College of Nursing, the Royal College of Physicians and the British Medical Association urging the Government to tackle unsafe staffing. There is plenty more we can do on that. There is a critical need for investment in the workforce, yet the training budget is apparently outside the scope of this Bill. That matters because the last Health Secretary was forced to scrap the nurse bursary, which exacerbated the workforce crisis, because the then Chancellor whipped a billion pounds out of Health Education England budgets. There is nothing in this Bill to prevent that sort of thing happening again.

It is a bit ironic that although there is a degree of consensus that we need greater integration in health and social care, this Government do not seem to be able, within this Bill, to join up existing NHS budgets, let alone integrate them with social care. A number of Members have referred to social care tonight, so let us remind ourselves of what the Health Foundation recently said:

“No plan for the NHS will work while social care remains the Cinderella service. Long overdue action on social care is needed to.. .reduce the pressures on the NHS.”

The NHS Confederation put it more succinctly:

“you can only fix the NHS if you fix social care”.

That is the gaping hole in the middle of these plans, so let us sort out social care as soon as possible.

In conclusion, the Bill fails to deliver the investment our NHS needs. It does not invest enough in cash terms; it has a paucity of ambition; it applies only to revenue and not to capital investment, training or other areas of spending; it does not account for inflation; and vital spending is not ring-fenced. We will not be opposing the Bill; we are not going to fall into the rather obvious trap the Government have laid for us, but we will hold them to account over their continued failure to properly fund the NHS and the adult social care system. Patients and staff deserve better than this.

Baby Loss Awareness Week

Justin Madders Excerpts

Tuesday 8th October 2019 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a privilege to follow the hon. Member for Eddisbury (Antoinette Sandbach), who speaks from personal experience on this matter. Every year, she identifies the main issues that we still need to improve on. She is absolutely right to talk about the evaluation that shows where things are getting better, but it is also fair to say that the good practice is not consistently felt across the board, and that is what we need to aim for. She also spoke about the need to change the culture, which is really important. The right hon. Member for South West Surrey (Mr Hunt) also referred to that, and I welcome him to the Back Benches—I know that we had our disagreements as Front Benchers, but on this issue, there was a great deal of unanimity, and that is the spirit that we should carry forward. Both spoke about the need to change the culture and the length of time that that will take, but that is absolutely the right approach, because with all tragedies in the health service, most of the time people just want to know why something happened and how it can be stopped from happening again. The more that we can move away from the blame culture and get into a proper analysis of why things have happened and how we can prevent them from happening in future, the better the experience will be for everyone.

When I first spoke in a baby loss awareness debate back in 2016, I expressed the hope that this would become an annual fixture, and I am pleased to see that we have managed to do that despite the unpredictable timing of Parliament at the moment. This gives us a real opportunity to take stock of where we are and hopefully to set some benchmarks for future progress, because, as we know, every year there are thousands of tragedies. Tommy’s estimates that a quarter of pregnancies end in miscarriage. The Ectopic Pregnancy Trust tells us that one in 80 pregnancies is ectopic and Sands tells us, as we have heard, that 15 babies are stillborn or die shortly after birth every day. Those charities are just some of the 60-plus charities that collaborate to support this extremely important week. I echo the comments of hon. Members who have praised their work in this vital area, not just how they support people who have experienced their own personal tragedies, but how they work across the board to secure better outcomes for everyone. They not only raise awareness of baby loss, but work with health professionals to improve services and bereavement care and, critically, to reduce the number of preventable deaths.

Like others, I want to focus on bereaved parents and mental health support. As we all know from meeting bereaved parents, the feelings of loss and isolation are understandably overwhelming, and nothing can take away from that, but that does not mean that we cannot do more to ensure that the right care and support are in place at the right time so that those people can come to terms with their loss as best they can. We know from the evidence that good bereavement care can make a difference to parents and families and their experiences at this tragic time.

The sooner we can support more healthcare professionals in delivering good-quality care, the better. I welcome the roll-out of the pathway, but I urge the Government to redouble their efforts to ensure that all trusts and health boards adopt the pathway and ensure that all our healthcare professionals feel properly equipped to deal with bereaved parents, so that everyone across the board gets the correct and best level of support, which is what they truly deserve.

Not all bereaved parents will develop a mental health problem, but we must ensure that those who do can access specialist psychological support, that they can access it as soon as possible and at a time and place that is right for them, and of course that it is freely available to them. Sadly, as we know, not all parents can do that at the moment. Parents have told me that they are often not aware of the services available. Many leave hospital with no information about where they can seek support. Some are given information but then find that the support is not available for them at the time they need it—because of course there is a waiting list.

A survey by Sands earlier this year found that nearly two thirds of bereaved parents felt that, although they needed specialist psychological services, they could not access them on the NHS. This is equally a challenge for those who seek bereavement counselling for adult deaths, urgent referrals for which can take up to six months to process, which is far too long, I think we would all agree. In the words of one mother who contacted me:

“we weren’t offered any specialist help in terms of bereavement support. I visited my GP on a number of occasions and was advised I could see a counsellor but there was a waiting list. I was prescribed antidepressants which I refused to take as I was grieving, I wasn’t depressed”.

Many listening to this debate will recognise that experience. I hope we can learn that it is vital that the right support and treatments are available at the right time.

A new report from the Baby Loss Awareness Alliance reveals that nearly nine out of 10 clinical commissioning groups do not commission talking therapies specifically for parents, and where the services do exist, they are mostly for mothers only, meaning that the needs of fathers are often overlooked, as the hon. Member for Colchester (Will Quince) has spoken about in the past.

There is of course much good practice out there, but it is sometimes reliant on charitable grants and third parties, meaning that the provision is patchy and at risk from wider funding decisions. I therefore support a call for a review of the current provision, including an evaluation of the models of best practice, involving parents and professionals in those conversations. We know that the need for psychological support following pregnancy loss and stillbirth is recognised in the NICE guidance and that the “Better Births” report, the maternity transformation programme and the NHS long-term plan all highlight the need to improve perinatal mental health care. These plans must translate into action to ensure that the needs of bereaved parents are explicitly addressed in quality standards and national guidance, in the training for the relevant healthcare professionals and in guidance and support for local services.

Beyond the major transformational strategies we have been talking about, we can also make simple, small changes that will make a difference to parents’ experiences. In the words of another constituent after her own bereavement:

“That moment, I know myself, stays with you as much as the birth and most of us end up bumping into other new parents carrying their bundles home on the way out. I feel a support worker or midwife could do with walking the parents out, helping the transition into the hands of family or friends go more smoothly would be extremely beneficial. Most of us are left with not even so much as a leaflet of where to turn to in crisis. Most of us haven’t had a follow up with a midwife or healthcare professional even though we have given birth and these unfortunate administrative errors occur far too often. I suppose support is the key issue.”

Those comments show that some simple, straightforward things can be done that need not cost the earth or require massive national strategies, but actually just need a bit more thought and organisation. I think we can all recognise the difficulty that that mother must have experienced.

Having participated in debates on this subject over the last three years, I know that Members have shown a great deal of personal courage by speaking about their own experiences. Three years on, we have shown that the message is going out to people that they are not alone. I pay tribute to my hon. Friends the Members for Lewisham, Deptford (Vicky Foxcroft) and for Washington and Sunderland West (Mrs Hodgson), and to the hon. Members for Eddisbury, for Colchester and for Banbury (Victoria Prentis), for their work and for the way in which they have spoken about their own experiences. That contributes greatly to increasing awareness of Baby Loss Awareness Week, which has itself led to some local groups getting together. Next Tuesday my constituents will take part in the Wave of Light outside Ellesmere Port civic hall, which I think is a very good way of encouraging more people to come and talk about what they have been through. The more people who engage in that dialogue, the better.

I should like to be with those constituents next week, but I suspect that I shall be here, although my thoughts will be with them. I think that what we can show them today is that when the House puts its mind to it, we can work across parties and make things better for our constituents. Anyone who has heard the debate today will understand why it is so important that we do that.

Health Infrastructure Plan

Justin Madders Excerpts

Monday 30th September 2019 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

The two Budgets in 2017 allocated some £3.9 billion for estates planning and also to tackle the huge maintenance backlog that has been allowed to mushroom under the Government. As of now, how much of that allocation from 2017 has been spent, and how much of it has been announced in today’s statement?

[Edward Argar]

I am happy to tell the hon. Gentleman that the announcements we are making today are for new money.