Health Visitors (England)

Karen Lee Excerpts

Wednesday 23rd October 2019 Westminster Hall

[Tim Loughton]

That is a serious point; my hon. Friend is absolutely right. Health inequalities are still a big problem in this country, and those professionals on the ground, not least health visitors, are the first to come face to face with them and have the practical means, in many cases, to do something about them.

[Karen Lee (Lincoln) (Lab)]

Will the hon. Gentleman give way?

[Tim Loughton]

I am happy to take interventions, but it will mean that hon. Members will have to make shorter speeches, as I am sure Mr Bone will point out.

[Karen Lee]

The Royal College of Nursing’s briefing for the debate says that the number of health visitors with caseloads of more than 500 children rose from 12% to 21% between 2015 and 2017, so it will have risen even more in the two years that have elapsed since. The caseload is really worrying, in terms of people being missed.

[Tim Loughton]

The hon. Lady pre-empts a point I was going to make on page 5 of my notes, so I will take that bit out.

Unlike some other public service professionals, health visitors are non-stigmatising and usually welcomed over the threshold into homes, enabling them to give early advice and support to prevent later problems, encourage healthier choices, detect problems early and, in some cases, act as an early warning safeguarding alarm. Often when social workers are the ones to knock on the door, it may be too late, and that professional has a completely different sort of relationship with the family.

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[Karen Lee (Lincoln) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bone. I congratulate the hon. Member for East Worthing and Shoreham (Tim Loughton) on securing this vital debate. The role of the health visitor is important to our local communities. The health visiting service provides the vital support that young children and their families need to ensure that every child has the best start in life. Health visitors address cross-departmental priorities for children and give a voice to young children living with adversity, who can in some cases be invisible to other services. The health visiting service provides an important safety net for infants and young children who are at particularly high risk of having their needs missed, as they are not visible in the same way as children who are accessing an early years setting or are at school.

Early intervention is vital for children and their families and an effective health visitor service is a proven way to improve health outcomes and reduce inequalities. However, in January 2019, the Royal College of Paediatrics and Child Health raised serious concerns about widening child health inequalities, highlighting that:

“Universal early years services continue to bear the brunt of cuts to public health services”.

In Lincoln, 28% of children live in poverty. Health visitors are desperately needed to ensure that those children receive the support they deserve. In 2015, the commissioning of health visitors was transferred from the NHS to local government—a bad move in my view—and that has resulted in a negative impact on the working conditions of local health visitors and the capacity of the service delivered to my constituents, as the funding is not ring-fenced. I am deeply worried by the steps that Lincolnshire County Council has taken to divide the health visitor role, and I was proud to support the health visitor strike against the proposed changes.

The changes will divide the health visitor role into two different job descriptions, which will create a flawed career progression scheme that restricts health visitor career progression. All health visitors undertake the same training, and upon qualification they are all expected to carry out every facet of their role on a daily basis. It is my understanding that there is no rationale to explain why one health visitor would be demoted to a junior job description while another continued at the same level. It is a fact that fully qualified top band 6s are leaving or have left—many with years of experience—due to a reduction in their status and an enforced three-year pay freeze. We are losing an important skilled workforce who are invaluable to our community. As a qualified nurse, I have to say that nurses and healthcare professionals do not go on strike without a really good reason.

Analysis undertaken by Unite shows that those held back from progression due to the changes will lose a substantial sum annually in comparison with the NHS pay structure. I am concerned that the reforms are not being undertaken in the best interests of the health visitor service, but rather as a mechanism to deskill the service in order to reduce pay. Financial efficiency must come second to the wellbeing of our local communities. It risks the long-term social benefits created by investing in our children’s future at a crucial early stage. Will the Minister make representations to Lincolnshire County Council—please do not push it to one side and say it is a local government issue—to prevent the downgrading of the health visitor role? It is important in my constituency of Lincoln, and I hope I am being heard. It is important that Lincolnshire County Council recognises health visitors’ professionalism and importance to our community and rewards them accordingly.

Social Care Funding

Karen Lee Excerpts

Tuesday 1st October 2019 Westminster Hall

[Sir Vince Cable]

I will come to that point later and to the heart of what I understand to be the Labour proposal—on free personal care—in not too polemical a way. It presents opportunities but also serious problems.

We have the growth in demand, the hidden costs, and the burden on local authorities. It is easy to score political points, and I will put my hand up immediately: after the financial crisis I was part of the Government and we cut—in real terms—per capita spending in this area by about 11%. It did not start then. The number of people with so-called moderate needs who were excluded in the previous five years rose from 50% to 75%. It is an old problem as well as a new one, and we are all faced with the challenge of how to finance local authorities. If local authorities are underfunded, we all know the problem gets passed back to hospitals in delayed discharge.

There is the problem of the labour force. It is horrendous. Until I saw the figures, I had not realised just how bad it is. There is an annual turnover of 450,000 care workers for a mixture of reasons, a lot of it to do with pay and conditions. We currently have 100,000 vacancies, and there is the potential for stricter immigration controls, which would create even more vacancies and make them even more difficult to manage. The business model for the companies involved, partly in residential care but also in domiciliary care, is just not viable; as I understand it, four of the leading providers are now up for sale and one is in administration.

The problem, as we all recognise from our constituencies, is that there is a two-tier system: on the one hand, luxurious and comfortable homes for those who do not need to worry about money, but on the other crumbling homes with minimal standards, overseas workers on minimum pay, and a nasty smell of urine—we have all seen them. An intermediate level of care that is attractive and affordable is simply not available.

Those are the problems, as I think we all recognise, but the question is: what can be done? As has been mentioned, a wide variety of brains in and outside this place have been contributing and thinking about it; one of the unintended benefits of the Government’s delay has been that others have filled the vacuum with ideas. The most useful ideas that I encountered seemed to be from organisations such as the Health Foundation and the King’s Fund, which have no political axe to grind that I am aware of. They suggest that rather than trying to deal with all these complicated problems together, we should deal with them in sequence, starting with those that are more manageable. Essentially, they suggest that there are four stages to dealing with them, which I will briefly canter through.

First, we should identify what we need to do simply to stabilise the present position, unsatisfactory though it is, because there is a real danger of going even further backwards as a result of lack of resource. The King’s Fund identifies a need for an extra £1.5 billion by 2021 and £6 billion by 2030 simply to keep the system at its present level, unsatisfactory though it is. I hope we can all agree that that is the absolute minimum that we should aim for.

The second level up is improvement. As the King’s Fund identifies it, that means going back to the standards that prevailed in 2009-10, although they were unsatisfactory even then, and filling in some of the holes in availability of social care. It costs that at approximately £8 billion a year, rising to £10 billion after five years—a significant sum. My party, including colleagues present, has come with up with one suggestion: creating a ring-fenced fund based on a penny in every pound of income tax. That would raise £6.5 billion, which would get us most of the way there. I do not want to be doctrinaire about the best way of doing this, but I hope that there can be some understanding that that contribution, which is very limited in terms of public funding, could get us back to a more acceptable standard. People have different views about which taxes we should use and how we should ring-fence the money, but that seems to me to be the minimum level of ambition—and it could happen without legislation if the parties agreed that we should proceed in that way.

We then get on to the more difficult level, which relates to charging. One thing that has come through to me from reading the various think-tank reports is the growing interest in the idea of free personal care in the Scottish model. I confess that I have always been sceptical about it—I have the traditional economist’s scepticism of free things—but its proponents note two practical attractions that have nothing to do with ideology or party thinking: it aligns social care and healthcare, if we are going to integrate the two systems, and it brings in a lot of people who are currently excluded from social care provision, so that they are more likely to stay at home rather than going into hospital. It has potential benefits as well as costs.

[Karen Lee (Lincoln) (Lab)]

I am an ex-nurse. Does the right hon. Gentleman agree that it is right to offset the costs of social care against what we would save the NHS? I regularly had eight patients, and probably three of them would be medically fit for discharge and did not want to sit in a bed, although they had to do so. When we consider the cost, we must also balance that issue.

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[Karen Lee (Lincoln) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Charles. I will start by talking a little about my experience as a nurse on an in-patient cardiac ward and the number of times we saw delayed discharges. Delayed discharges happened when a patient was medically fit for discharge, had had all their assessments, had received physio and had seen the occupational therapist, and we knew what they needed, but because there was no social care provision, they could not go. Dr Andrews or Dr Kelly would tell them on a Friday afternoon that they could go home, and I used to think, “I’m going to be the one who tells them that they can’t.” Patients really hated that. There was also a cost to it; in cardiology—an acute setting—people would be waiting for a cardiac bed. We might have to choose to outlie that patient in a non-specialty area. We just did not have the beds. It was a constant juggling act.

I was really pleased to hear the announcement last week at the Labour party conference about the national care service; it will play a huge part in relieving the pressures on the NHS. Our NHS is in crisis; the Conservative party will say that it is not, but I still meet my friends for supper once a month, and it is. Part of that crisis is the fact that we have so many people sitting in beds, waiting for social care.

If people get decent social care in their homes when they are discharged, they will not bounce back into hospital so quickly, because there will be someone going into their home every day and keeping an eye on them. I know this from my experience with my mum. If someone is keeping an eye on them, they get to a doctor more quickly, and they are not as acutely ill when they are readmitted, as they very often ultimately are.

Elderly people face significant challenges these days in accessing a general practitioner. The GP service in Skellingthorpe, a village near me, is to be shut; it will be really hard for elderly people there to get to a GP, so they will just get more and more ill before they get to hospital.

Another important point is that when people need increased support, it should be provided by staff who are properly trained, paid and valued. Someone mentioned staff on low wages earlier. I will not utter the dreaded B-word, but when that happens, how will we provide social care, given that none of the staff we are talking about earn £30,000 a year? Labour has come up with a way. Last week, we said that people who earn over £80,000 will pay a little bit more in tax. Surely it is right that the wealthiest in society pay a little bit towards keeping the most vulnerable people safe; I know that does not go down too well with some people, but I think that that is only fair. It is also good to hear that undervalued carers who are struggling will get proper financial support in line with jobseeker’s allowance. We will introduce a cap on care costs for catastrophic illness.

I agree with everything said by my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy). I have a little grandson—I say little; he is 13 —who has Down’s syndrome, and one of the worries of my life has been what will happen to him when we are gone. It is really important that people with learning difficulties are provided for. I completely agree with my right hon. Friend the Member for Twickenham (Sir Vince Cable); Joe used to go to all sorts of little clubs and things like that, and they have all gone. Things are really basic now. All that is viewed as a commodity. It is as though we do not care about people; it is all about how much things cost. I am sorry, I think my disgust for that view is probably apparent.

Providing social care for an increasing elderly population, as well as many others across our society, is one of the biggest challenges facing us. I am really pleased that my right hon. Friend the Member for Twickenham brought forward this debate. It is really important that we talk about the issue cross-party, because it is a problem that we all face, and we need to come up with answers.

Oral Answers to Questions

Karen Lee Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Stephen Hammond]

The hon. Lady will know that the Government are putting more cash and more money into the NHS than at any other time in its history. There will be £33.9 billion extra going in by 2023-24.

[Karen Lee (Lincoln) (Lab)]

10. What recent estimate he has made of the number of NHS workforce vacancies.

[The Secretary of State for Health and Social Care (Matt Hancock)]

Question 10 is about workforce vacancies, and I can tell the House that one workforce vacancy has just been filled, because Boris Johnson has just been elected as the leader of the Conservative party.

The NHS employs more staff now than at any time in its 70-year history, with significant growth in newly qualified staff from 2012. Our full people plan will help to tackle these issues for the long term.

[Karen Lee]

Words are all well and good, but it is actions that actually count, and the Government are not creating a health service that supports its workforce. The striking health visitors in Lincolnshire have each lost more than £2,000 a year since they were transferred from the NHS to the Conservative-controlled county council and many have had their professional status downgraded. Does the Secretary of State agree that rather than shifting the responsibility for cuts to health services on to local government, the NHS should deliver fully resourced healthcare services and pay its staff properly?

[Matt Hancock]

The NHS is delivering healthcare services and it is paying its staff properly. It is working with local authorities to deliver the best possible health services right across the country. We absolutely need to recruit more people to the NHS and we are recruiting more people to the NHS.

NHS Workforce: England

Karen Lee Excerpts

Wednesday 17th July 2019 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I congratulate the hon. Member for Wolverhampton South West (Eleanor Smith) on securing this debate on an issue that she and I have discussed—her office is near mine in Norman Shaw North—and both care deeply about.

I am glad to see the Minister in his place. He knows my constituency well and understands the challenge of getting to it. In fact, he was the first MP ever to visit me in the heady days before 2010, when I stood as a parliamentary candidate because I thought that coming to Parliament would be a great way of changing the world. I have since learned that that is probably not the case.

The credit should really sit with the people who work in the NHS. In particular, I pay tribute and send my thanks to those who work in West Cornwall Hospital in Penzance, Helston Community Hospital—or cottage hospital, for those of us who grew up there—and other places where NHS staff and others do a fantastic job in really difficult situations, as we have heard. They make sure that people who arrive for whatever reason get the best possible care.

I was keen to take part in the debate because I recognise that things need to be done. We must take responsibility for the way things are at the moment, and although I understand what the legal responsibility is and the reason for the debate, I want to understand a bit more about the solutions, too. I have never thought that all the solutions can be created, thought up or delivered here in Westminster or in any Government Department. Although real progress in integration and improving services on the ground needs to be enabled through legislation, support and encouragement, people in health and social care in Cornwall have got together and worked extremely hard for many years to deliver a system in which pathways and integration are much better than when I welcomed the Minister off the train.

One problem of many is the workforce, which is undoubtedly a challenge. There is also no doubt that the NHS 10-year plan is a fantastic document, but it depends heavily on workforce. I know that the Minister will agree and will want to ensure that we have people in place. We may not participate in this Chamber, but across Parliament, the bunfight, debate and arguments about the NHS go on, and have been taken up by people in local campaigns and the media. That has created an environment in which people choose not to nurse or do anything else in the NHS because they are misinformed. I know of lots of people who would have gone into or considered going into nursing or social care, but will not do so because the NHS is a political hot potato.

[Karen Lee (Lincoln) (Lab)]

On the hon. Gentleman’s point about people not joining the NHS to nurse, the lack of bursary is a significant issue. If someone wants to train, the bursary is really important.

[Derek Thomas]

I am addressing the point the hon. Member for Wolverhampton South West made about the importance of working cross-party, as we will in this Chamber. I will come to the bursary later.

Actually, I will come to that part of my speech now as the hon. Member for Lincoln (Karen Lee) has mentioned it. I was one of the MPs who signed a cross-party letter requesting a royal commission for the 70th year of the NHS, because I believe that although we do not have all the solutions, we should set the tone. That would help to open the door of opportunity for those who work in the NHS. I will come to the bursary, which I have already raised with the Minister; I asked him to look in particular at the impact on mature students. Podiatry in Plymouth, for example, will not be taught from September onwards. In the south west, where the incidences of diabetes and other vascular problems are significant, we need podiatrists, so that is a major problem. The reason given is that most people who go into podiatry do it later on in their careers, and one of the challenges arising from the removal of the bursary and introduction of student loans—I voted for that and regret doing so—is that those who take out the loan immediately lose all welfare and can no longer get housing benefit.

For someone with a young family who wants to study, the student loan, or the grant available for mature students, is just not enough. The Minister is aware of my view because I have raised it before, and there is work to do on that. It is not about financial incentives; it is about making it affordable for people to go and do a fantastic job. As the hon. Member for Wolverhampton South West rightly said, some people bring so much to health and social care and we need to ensure that we take away every possible barrier without creating unintended consequences. I am sure that the Minister will be pleased to address that point later.

I will talk briefly about how Cornwall is responding. I have been very keen to see what we can do in Cornwall to make sure that people can turn up, get training and work and train on the job. For people in Cornwall, most opportunities for training are outside the area, but as we know, people who go into some professions, including in the NHS, tend to stay where they train. That has always been a problem for Cornwall, which has struggled to recruit the people we need. We have set up a health and care academy using the apprenticeship levy. The academy can offer people training and jobs as healthcare assistants. There, they can do 12 hours per week working and studying through the Open University, and will become qualified nurses after four years. As they are already settled in the area and have family there, they are very likely to work for the NHS for the rest of their careers.

That is really positive, but there are some challenges and I have met the Minister to talk about them. One of the challenges is that for hospitals—in this case Royal Cornwall Hospital—to provide that kind of support, they need extra cash. It is not just about the apprenticeship levy, which they want to use and not repay, but about staffing 100 nurses and 100 healthcare assistants at a time, and providing pastoral support and other elements that come with training up staff on a ward or in a hospital. An added pressure is that for a hospital without the staff that it needs, really excellent healthcare assistants are no substitute for fully qualified nurses with a wealth of experience.

There is a problem in this place. I am a skilled craftsman in the building trade but I have put my tools away, despite the desperate need for skilled craftsmen in Cornwall. In this Chamber and across the House, we have lots of GPs and talented nurses. For some reason, we decided to pitch up here instead of continuing in our valuable jobs. I think that we are part of the problem. I am not suggesting that we should all pack up and go home, although we might get more done if we did, so we should consider it.

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[Karen Lee (Lincoln) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Moon. I thank my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) for securing this important debate.

I will start by talking about my lived experience of staff shortages in the NHS. I worked as a nurse from 2003 until 2017, when I entered Parliament. For the majority of that time, I worked on an in-patient cardiac unit at Lincoln County Hospital. Today, I want to paint a picture of a nurse’s working day and how difficult that becomes when we have staff shortages. First, however, I pay tribute to all the staff at Lincoln County Hospital—not just the nurses, but all the staff—and to NHS staff who deliver our healthcare right across this country in local communities and in hospitals.

I keep in touch with my former colleagues and still hear at first hand how staff shortages affect them—some stories are quite scary. As an MP over the past two years, I have witnessed an awful lot of patronising pats on the back. I exclude today’s debate from that, but we often hear from Members how wonderful our NHS staff are, and yet that does nothing to address staff shortages or to make their working conditions any better. That is what they want; they do not want patronising pats on the back. The 40,000 nursing vacancies are evidence of that stark truth.

As a nurse, when I went on shift, I would be allocated eight cardiac patients. They would have been treated for heart failure, recently had a heart attack or been waiting for an angiogram, or perhaps they were being treated for endocarditis, which is a serious infection of the heart. The staffing was meant to ensure that a single nurse took either the male or the female team, with an extra nurse working between the two sides to support the multitude of tasks that delivering good patient care means. In reality, we often did not get that third nurse, and had to manage without. Some shifts felt like a marathon combined with a sprint—I kid you not, Mrs Moon, it really was that bad. I did love it though.

The medical management of my group of patients would be varied. Many patients were diabetics, meaning that we had to check blood sugars, four times a day for some and twice for others. If four or five out of eight of a nurse’s patients were diabetics, that was quite a task. We could even get something called “sliding scale”, which meant we had to check them every two hours. Sometimes, honestly, we just chased our tail the whole day.

Many patients needed intravenous antibiotics, which were really time-consuming to prepare, even more so if a patient had a line, a Hickman or a PIC—a peripherally inserted central catheter—because it had to be done aseptically; it just took ages, and the nurse was running around the whole time. As well as that, staffing was routinely topped up with bank or agency staff. I am not knocking them, because we would not have managed without them, but they were not allowed to do IVs, so when we had agency staff on the other side of ward, to be honest we would end up doing quite a proportion of their work as well. That made it really difficult.

Many patients were prescribed controlled drugs, so first thing in the morning, at 8 o’clock, we might have had two or three CDs to do—but trying to get someone else to check the CD was a nightmare. There were just not enough hands on deck, which meant that people were sat waiting in pain for analgesia when they had gone all night and were due that dose. Sometimes a patient needed a blood transfusion, which was a really tricky process. They had to be monitored the whole time, but, again, that was done for one person and there were eight patients, so the nurse was running around all the time. It felt unsafe and the nurse felt really bad because they wanted to deliver good, safe patient care.

A patient might be close to death and need to be monitored, because the nurse could tell visually whether they were in pain, but there were seven others to look after. The relatives wanted someone to sit and talk to them, which of course the nurse wanted to do, but they did not have the time. In addition, there were other tasks such as changing dressings, monitoring pressure areas, and speaking to social workers, physiotherapists and occupational therapists about assessments, as well as discharging patients. The doctor might say to a patient, “You can go home today”, but the nurse had seven others to look after. All the patient wanted was for the nurse to do their paperwork and get their meds from the pharmacy. They sat waiting impatiently and the nurse felt bad because the patient could not go home. When the nurse eventually got them out, another patient was straight into their bed and the admission paperwork had to be done. The tasks were endless, but that was the job. We did it and we loved it, but we have to have enough staff to do it properly.

No nurse can deliver care without the healthcare support workers, so this is not only about nurses. The housekeepers make the tea but because the nurses do not have time to sit and talk to the patients and their families, the nurse goes to the housekeeper at the end of a shift and says, “Has anybody told you anything that I need to know?” It is team work. If there are not enough staff to carry out the different roles, staff simply burn out and cannot deliver the care that patients need. Towards the end of my nursing career, in the two years before I came to Parliament, I worked in out-patient clinics because I thought it might be a little easier, but it was not. It never is, but I was starting to get burn-out and I did not want that to happen because I loved the job too much.

We used to work 12.5 hour shifts. We would start a day shift at seven in the morning. At about half nine, if we were lucky, we got a cup of tea, but we literally had only five minutes. At around two o’clock we got our lunch. We had half an hour and we were meant to have another break at teatime, but we never, ever got it because we were running around trying to finish all our jobs, chasing our tails and trying to get everything done. So we would have a break of about half an hour in twelve and a half hours. Then, just when we thought we were going home, it would turn out that the bank staff, the agency staff, had not turned up and we could not simply say, “I am off home.” We had to wait until somebody had been found somewhere else in the hospital and somebody was moved from a different ward. Then the handover took half an hour. Instead of going home at half seven or eight o’clock, it could be nine o’clock and we would be back again at seven the next morning. People simply burn out.

Working in our NHS is incredibly hard work in whatever role. It is not well paid, and in places such as Lincoln a few years ago when we had the pay freeze, it was suddenly decided that a consultation would be held and we were asked, “Do you think you ought pay for staff parking?” Of course, everyone said no, so what happened? We all had to start paying for staff parking: £15 a month for staff nurses who had not had a rise in years. It absolutely made us feel undervalued, and that is not acceptable. I am not surprised that people are leaving the profession.

I want to talk now about the crisis in our NHS and about some of the steps we must take as parliamentarians to address it. There are more than 100,000 vacancies in our NHS, including 40,000 nursing vacancies. The “Interim NHS People Plan”, released last month, acknowledges that

“shortages in nursing are the single biggest and most urgent we need to address.”

I agree with that, but there are many other things we need to address, too. It is true that 80% of shifts from over 40,000 nursing vacancies are covered by expensive bank and agency staff, which highlights the false economy of austerity. It makes no sense financially. I will say this again and again: the removal of the nursing bursary in effect means that nurses are not training. I know I will get the answer back about how wonderful nursing apprenticeships are and how other wonderful things will happen, but the stark truth is that nurses are not training. So the NHS long-term plan and the talk about all the extra places for nurses is pie in the sky if we have not got the nurses training. It will simply not happen.

I am particularly concerned that applications from mature students have decreased by 39%. People no longer have the support that I had when I trained as a mature student. I was 39 when I started my training. The RCN is calling for the Secretary of State for Health and Social Care to be accountable to Parliament for making sure that there are enough health and care staff with the right skills in the right place at the right time to care for patients, based on population needs now and in future. Support for that must be, as my hon. Friend the Member for Wolverhampton South West said, cross-party if it is to happen. This or any future Government must ensure a credible, costed workforce strategy. Our healthcare workers must feel confident of delivering the very best care, and our patients must feel happy with the care they receive. A worn-out and demoralised workforce is not what the patients or any of us want to see.

Patients watch nursing staff doing their best to look after them. Some of them used to say to me, “Do you ever stop and take a breath?”, and I would jokingly say, “No, but I still don’t get thin, do I?” They have to wait their turn longer than they should for the care that they need, and that is not what we want to see. So I really hope that the Minister is genuinely listening and does not give me the usual answers: “We have got apprentices and we have got this and we are doing that, and all this money is going in, so we will get lots of nurses and it will all be all right in five years’ time.” I want someone to take notice and listen to me as an ex-nurse and make sure that hardworking NHS staff will be equipped to deliver the care that is both safe and effective for them and for their patients.

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[Stephen Hammond]

The hon. Lady will know that the CQC regime puts directives in place if staffing levels are not there. The local providers are then forced to address those issues. The accountability is there.

Beyond this issue, several hon. Members talked about exactly what we are doing now. There was recognition that the Government have put in place the long-term plan and the people plan. Any reading of those will see that our overarching plan for the health service looking forward recognises explicitly that getting the workforce supply right is key. That is therefore an important part of the long-term plan, which sets out the vital strategic framework to ensure that in the next 10 years the NHS will have the staff it needs. Nurses and doctors will have the time they need to care, work in a supportive culture and allow them to provide the expert, compassionate care to which they are committed.

Hon. Members rightly said that that will not be for this Government; it may well be for the Government beyond. However, the long-term plan rightly recognises by its very nature that what we need to put in place today must continue through the next 10 years to ensure that we have the staffing levels we need.

[Karen Lee]

A number of us mentioned the nursing bursary. The long-term plan talks about extra places for nurses, but if nurses are not being trained—the evidence shows that numbers have dropped by about 25% to 30% —clearly we cannot have them in place. I seek the Minister’s comments on reinstating a nursing bursary so that mature students and other students can afford to train.

[Stephen Hammond]

I will come to the number of nurses in training and related issues in a moment, to address the hon. Lady’s comments.

Associated with the long-term plan is the people plan, which clearly recognises, to reference what I said about Health Education England, the significant role of that organisation in securing the NHS workforce for the future. That is why my right hon. Friend the Secretary of State for Health and Social Care commissioned Baroness Harding, the chair of NHS Improvement, to work alongside and closely with Sir David Behan, the chair of HEE, to develop the workforce implementation plan. The interim people plan published in June set out the actions needed to change positively the culture and leadership of the NHS, making it the best place to work, which addresses the issues rightly raised about recruitment and retention.

The people plan commits to developing a new operating model for the workforce that ensures that activities happen at the optimal level, whether in individual organisations, local healthcare systems, regionally or nationally, with roles and responsibilities being clear.

On NHS workforce supply, hon. Members talked about demand for nursing and midwifery courses. The latest available evidence shows that we are starting to see a substantial rise. Data published only last week showed a 4.5% increase in applicants compared to 2018, with that being the second increase in as many years. To build on that, to ensure that we increase the pipeline of nurses coming into the profession, the Department has worked with NHS England to ensure that funding is available for up to 5,000 additional clinical placements for nursing degrees in England. The chief nursing officer for England has led work to identify and accelerate the availability of such clinical placements. It is vital that universities ensure that they take up offers and provide placements to ensure that places are filled at the end of this year’s recruitment cycle. That can happen.

Healthcare: East Midlands

Karen Lee Excerpts

Tuesday 30th April 2019 Westminster Hall

[Karen Lee (Lincoln) (Lab)]

I beg to move,

That this House has considered provision of local healthcare in the East Midlands.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am glad to have secured this crucial debate, which gives me and my east midlands colleagues a great opportunity to highlight the healthcare crisis in our constituencies, our region and across the country. I must stress in everything I say that I do not blame the hard-working and dedicated staff for any of it; the fault lies fairly and squarely with Government cuts. Our constituents deserve better than the past decade of under- funding, which has created a postcode lottery in local healthcare. It has had particularly detrimental implications for my constituency of Lincoln: local healthcare centres have been forced to shut, more general practitioners’ services are at risk of closure in the coming months, and local hospitals are in need of considerable funding and support.

Our healthcare infrastructure in the surrounding region of Lincolnshire has also been put under considerable pressure over the past nine years. In July last year, the chief inspector of hospitals recommended that United Lincolnshire Hospitals NHS Trust, which has a deficit estimated at £80 million, should remain in special measures. The latest figures show that the trust missed its A&E waiting time target by 32% and has not met the national standard since September 2014.

The east midlands reflects the national picture of a health service in crisis. The Government have spent nine years running down the NHS by imposing the biggest funding squeeze in its history, with massive cuts to public health services. Social care has been slashed by £7 billion since 2010. Our NHS is short of 100,000 staff, including 41,000 nurses and nearly 10,000 doctors. That has had a detrimental knock-on effect on performance: waiting lists are at 4.3 million, more than 500,000 patients are waiting more than 18 weeks for treatment, and 2.5 million people are waiting for more than four hours in A&E. That is a crisis.

It is clear that the underfunding, privatisation and inadequate staffing of our health service has had a devastating effect on healthcare provision in Lincoln and the east midlands. Government decisions have had terrible consequences for people who need care in the areas that I and many of my colleagues represent. That is typified by the recent announcement that the highly relied-on Skellingthorpe surgery may close.

For those who do not know it, Skellingthorpe is a beautiful village in my constituency. Its doctors surgery provides healthcare to more than 8,000 patients, many of whom are local residents. The national patient survey found that 81.9% of the surgery’s patients felt that their overall experience was good or very good. The Glebe Practice, which runs the surgery, is in the process of proposing its closure to the clinical commissioning group, and the practice’s patients are centralised in its Saxilby surgery. I acknowledge that there are pressures on the service—there could not fail to be, given the Government’s cuts—and that the practice is struggling to recruit clinicians, so centralising its service in Saxilby allows it to maintain quality in one surgery. However, centralising the service restricts my constituents’ access to care. They have told me that it is already very difficult to book a timely GP appointment there.

As many other hon. Members will know from their own constituencies, rural areas are often inaccessible because of limited transport links. If the Glebe Practice’s plan to transfer patients to its Saxilby practice is agreed to, it will mean patients having to travel on public transport—remember, not everybody can drive or has a car—or walk for 90 minutes from the Skellingthorpe surgery. Even the closest surgery is about a 40-minute walk away. Imagine elderly people having to walk for 40 minutes!

This is a shocking downgrade of my Skellingthorpe constituents’ access to care. The proposed alternatives do not offer an acceptable journey length to patients who are in need of health services. Many patients may struggle with mobility issues because of age or illness, while others may not be able to afford to travel other than by public transport.

[Ruth George (High Peak) (Lab)]

My hon. Friend is making an excellent speech that sets out the challenges to healthcare in rural areas such as Lincolnshire. Just this week, the wound service in one of our local clinics in High Peak has shut. Elderly patients with open wounds are having to travel for four hours each way, on three buses, to access the clinic that they are supposed to go to. Does my hon. Friend agree that that is absolutely unacceptable?

[Karen Lee]

Yes, I do. I hope that everybody in this Chamber would agree that that is really unacceptable.

Rather than reducing access to one-to-one healthcare, we should be outlining how we can help groups such as the Glebe Practice by implementing effective national programmes that incentivise recruitment in rural areas. There is a major workforce crisis: as a report co-authored by the Nuffield Trust, the King’s Fund and the Health Foundation has found, the NHS could be short of 7,000 GPs within five years. Rural areas will be the first to be hit. As access to GP services in the east midlands is reduced, I urge the Minister to take action to address the staffing crisis.

Before the surgery closes, Lincolnshire West CCG intends to hold a public consultation—but the people of Lincoln have been there before, very recently. Lincoln’s walk-in centre on Monks Road closed last year after an allegedly meaningful public consultation, 94% of respondents to which were opposed to the closure. Protests were held outside Lincoln County Hospital and along the high street. Both Conservative-led Lincolnshire County Council and Labour-controlled City of Lincoln Council formally objected to the closure, as did I, but not a bit of notice was taken—the centre was still closed. The justification was similar to the one being given now for the Skellingthorpe closure: we were told that there would be sufficient alternative provision to ensure the same level of care. After researching that claim, we found that no substitution would come anywhere near the accessibility of the walk-in centre, so I am afraid that my constituents’ faith in any local consultation is pretty limited.

Appointment-only slots will not meet the needs of my constituents who rely on short-notice, timely access to care. Inevitably, they will only add to the pressure on the overworked A&E department at Lincoln County Hospital and East Midlands ambulance service.

I am very concerned that a trend is emerging: the implementation of cuts to healthcare services, in direct opposition to local people’s wishes and needs. It is deeply worrying that CCGs are not listening to residents’ concerns before closing local health services. I completely acknowledge that there have been sustained budgetary pressures on the healthcare system over the past nine years, and that it is the CCGs that are expected to deliver large-scale cuts, but in a transparent health governance system we cannot allow cuts to be rubber-stamped against such clear local opposition.

I ask the Minister to consider these cases and contact me to provide substantial reasoning to explain why another closure in my constituency is considered acceptable. The information that I and my constituents have been afforded has led us to the opinion that neither the walk-in centre nor the Skellingthorpe surgery should have been considered for closure. I am sorry, Minister, but passing the buck to the CCG is not good enough for my constituents.

It is not just local GP practices and health centres that have been put under debilitating pressure over the past decade. In my constituency, Lincoln County Hospital serves the city of Lincoln and the north Lincolnshire area. Due to funding and staffing pressures, the latest Care Quality Commission inspection has found that Lincoln County Hospital is below the national standard and requires improvement. It is important to stress that, as is the case in hospitals throughout the UK, this substandard performance is in no way the fault of the dedicated and hard-working staff. I speak from experience: when I was a nurse there, we often used to stay up to an hour late. In theory we got our time back, but in practice we did not.

The staff give a lot—it is not their fault. I worked as a nurse at Lincoln County Hospital for 14 years and I know how much energy and care all the staff, from porters to doctors, put into their challenging work. That is supported by the CQC report, which concluded that the hospital requires improvement in four out of five areas: safety, effectiveness, responsiveness and management. The only area rated as good was the caring nature of the hospital. As the report states repeatedly:

“Patients were treated with compassion, dignity and respect.”

I pay credit to the hard-working staff for that, but they are being let down by a Government who have consistently neglected our health services. I have been through their cuts myself.

The inspection found that nurse staffing numbers were often insufficient to keep people protected from avoidable harm and that the hospital relied heavily on agency and locum staff. I know that at first hand: my friends who are still nurses there tell me that that is true even now. Most worrying was the fact that adequate levels of nurses were observed on only four of the 28 days that the CQC reviewed. It is hardly surprising that there are such drastic staffing shortages. Since 2010, there has been a 19% real-terms fall in weekly earnings for full-time nurses. Nursing degree applications have dropped by one third since the Government scrapped nursing bursaries, without which I would not have been able to train. I go on and on about the nursing bursary, and I will not stop. We need to bring it back; we will not have enough nurses until we do.

The Health Foundation has also found that the number of nurses quitting because of a poor work-life balance almost tripled between 2011 and 2018. Our NHS staff should be celebrated and supported. Their kindness and commitment should not be taken advantage of by a Government who strip away the security of their profession. Lincoln County Hospital demonstrates the devastating way in which avoidable staffing shortages affect vulnerable patients in our communities.

The CQC report also found that patients could not always access care and treatment in a timely way. Waiting times were worse than the England average and did not meet the national standard. Some 60% of ambulance handovers were delayed by 30 minutes or more, and 47% of patients in A&E waited longer than the recommended 15 minutes to be triaged. I went out with an ambulance crew about a year ago, and I saw that at first hand.

That shows how hard-working, committed NHS staff in Lincoln are being put under intolerable pressure by decisions made in Whitehall. That is not unique to Lincoln. In July last year, England’s chief inspector of hospitals recommended that United Hospitals Lincolnshire NHS Trust should remain in special measures after visits to Lincoln County Hospital, Pilgrim Hospital, County Hospital Louth and Grantham and District Hospital. Pilgrim Hospital in Boston, which serves my constituents, is a particularly worrying case. It received an overall rating of “inadequate” in this year’s CQC inspection. The report found that there was no allocated corridor nurse. Corridor nurse—really? Should people be in corridors on trolleys? One nurse was caring for up to 21 patients at one time. When I was a nurse, the average was about six or eight. On a bad day, if someone did not come in, it could be 10 or 12, but 21—really?

It is clear that at the local, regional and national level, healthcare provision is not working. Vulnerable people who need care in Lincoln, the east midlands and across the UK have a right to access the health provision that they need. That requires a properly funded and staffed NHS service, from local GPs to county hospitals. Although I welcome the Government’s planned funding increase for the NHS, most health experts agree that it is barely enough to keep the NHS afloat, let alone reverse nine years of severe funding cuts. Areas such as Lincoln and the east midlands need and deserve much more than a plan that will barely keep afloat a system operating on a shoestring budget.

As someone whose job used to be to provide local healthcare, I am lifted by the fact that everyone can access healthcare as a human right in this country, but that universal right is threatened by policies that do not enable an effective health service in which everyone can access care based on their need, not on the austere policy decisions of the Government of the day.

[Several hon. Members rose—]

--- Later in debate ---

[Karen Lee]

I thank all those who have contributed to this excellent debate. Some comments have reflected the fact that healthcare remains something of a postcode lottery. In some areas we hear that everything is positive and good, but that is not always the case where I live. Travelling long distances to access a GP is not positive for someone who is ill, and that is not what my Skellingthorpe constituents want. That is not about an emotional attachment; it is a practical consideration. The concern in Lincoln is that nothing is opening, it is all closing.

The hon. Member for Strangford (Jim Shannon) spoke about suicide and mental health and I agree that we need ring-fenced funding for mental health care. My hon. Friend the Member for High Peak (Ruth George) spoke about problems delivering healthcare in rural settings, and people travelling long distances to access care. My Skellingthorpe constituents are not looking forward to that, should they lose their GP services.

Motion lapsed (Standing Order No. 10(6)).

World Cancer Day

Karen Lee Excerpts

Wednesday 30th January 2019 Westminster Hall

[John Lamont]

I could not agree more. There is an awareness issue. Often, when people develop some symptoms that they are unsure of, they are nervous about going to the doctor. People need to be encouraged to step forward and go to their GP, to ensure that if there is an opportunity to get an early diagnosis, that is achieved, because the results are clearly much more positive if that is the case.

That is why we have early diagnosis targets across the UK, and why it is so serious that in Scotland, more than 20% of patients are waiting for longer than the six-week standard for diagnostic tests. Too many people are waiting too long for treatment. NHS boards north of the border are meant to take no more than two months to start treatment, but that target is being missed for every type of cancer. In some health boards, one in five patients did not meet that target. I am sure we have all received emails from patients who are faced with an agonising wait for treatment, knowing that they have cancer. While the missed targets are by no means unique to Scotland, I hope that we can all come together here—Scottish National party colleagues included—to call on the Scottish Government to make clear that that needs to get better.

I should also be interested to hear the Minister’s views on whether any consideration has been given to reviewing treatment target times with a view to introducing faster treatment targets for certain types of cancer. It strikes me as odd that across the UK our targets are the same for all cancers, regardless of type.

One significant reason for the time taken to diagnose and treat is problems to do with workforce. Demand for tests is only going to increase, due to a growing and ageing population, but we already do not have enough staff in a range of areas.

[Karen Lee (Lincoln) (Lab)]

Does the hon. Gentleman agree with me on the impact of no longer having nursing bursaries? When I was a nurse, I had a nursing bursary. I could not have trained without that. We really must bring back the bursary. It is all right saying, “We have all these vacancies and we are going to have all these nurses,” but if people do not train, we will not have the people to fill those vacancies.

[John Lamont]

I am grateful to the hon. Lady for making that point. There is a range of options that we need to consider. I recently met my local NHS health board, and I meet a number of my GPs frequently. There are vacancies in all different parts of the health service, and we need to consider how we get more people in to do the jobs that we need. There is a particular challenge in my constituency—many rural communities do not have enough GPs or get enough nurses. Bursaries may be part of that. There are a range of things that we need to do, and that the Scottish Government and the UK Government can do, to address those issues.

For example, there is a 10% vacancy rate for radiology consultants across Scotland. One in five of the current workforce are expected to retire over the next five years. So, yes, there are challenges just now, but there are future challenges coming down the line.

--- Later in debate ---

[Karen Lee (Lincoln) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I will keep my speech fairly brief. I speak as an ex-nurse who worked in gynaecology outpatient clinics every Tuesday morning and as a mum whose daughter died of breast cancer at just 35. She was not overweight and she did not smoke—sometimes it is just the luck of the draw, sadly.

I will make a few short points, but the most important is that although we talk about a lot of issues related to cancer, we need to consider the people—the patients with families and lives. It is not just a disease in the abstract; it affects people. That should make us determined that, austerity or no austerity, those people should get the very best treatment possible.

We must ensure that we have the best screenings processes, because everybody knows that early detection means more positive outcomes. We need to put an end to people not being called for mammograms or waiting 12 weeks for the result of a smear test, as they do where I live—surely we can do better than that. If people have a positive diagnosis, treatment must be prompt. There should be no geographical inequalities in access to care or to a clinical nurse specialist, whether for the psychological or physical manifestations of disease.

That level of treatment should be there and everybody should be able to access it, but that is just not happening. I work with a lot of cancer groups because of my experience, and it really is not equal out there. As for surgery—fancy going into hospital and having the surgery cancelled! That is what happened to a constituent of mine. It is stressful enough going in, never mind having it cancelled and then having to go back. I spoke to another constituent recently who could not access a particular drug. People just should not have those battles; the disease is enough of a battle in itself.

If a patient is lucky enough to be successfully treated, it is vital that they can access regular follow-ups as necessary. I am a patron of Westminster Health Forum and we had a day last summer when we looked at cancer treatment in the round. One of the things we talked about was having Skype sessions instead of cancer patients having to trail all the way to a hospital and sit around. Because there are not enough nurses or doctors—I speak from experience—appointments are often an hour or an hour and a half behind. People spend hours and hours sitting around when they could have had a Skype session. That is not for every patient, but some can do it. It is about looking at what is most appropriate for that patient.

We must ensure that patient experience surveys are completed so that we know what is happening to patients and can collate that and act on it. If the disease progresses, we must ensure psychological support and medical treatment are as good as they can be. There should not be variations in end of life care. There are not enough nurses in our NHS. We have nurses in hospitals at the end of life, and we have nurses in out-patient clinics. They are a vital part of the treatment. We have lots of vacancies and apprenticeships are not being taken up at the rate that was hoped for. We need nursing bursaries back. It is not just me and Labour politicians who are saying that; the Royal College of Nursing is saying that, too. We need more nurses and more radiologists, and to get that we need bursaries.

Patients should not have to struggle with the benefits system. My hon. Friend the Member for High Peak (Ruth George) talked about filling out a form. I remember the film “I, Daniel Blake” was shown recently and a very thoughtless person—a senior politician—put something on social media saying, “It is just a film, you know.” Actually, it is what people are going through. What was said was shameful, and I do not think any apology was ever forthcoming.

Recently, I had a constituent whose husband died of cancer. He should have been on a very high level of benefits at the end, but his benefits were messed up. She tried to claim them after his death because she had to borrow money to bury him. My office fought and fought for several weeks, and we got that backdated money, but if we had not done that, she would have not got it. She would still be paying money back for that funeral, and that is shameful.

As politicians, I think we have the best of intentions, and I mean everyone in every party, but it is important that those intentions and words are matched by effective actions that ensure that people get the treatment they deserve.

Appropriate ME Treatment

Karen Lee Excerpts

Thursday 24th January 2019 Commons Chamber

[Karen Lee (Lincoln) (Lab)]

How do I follow that? I congratulate the hon. Member for Glasgow North West (Carol Monaghan) on securing this important debate. Last year I was invited by a group of ME patients in Lincoln to a screening of “Unrest”, Jennifer Brea’s deeply moving and personal documentary. The film really opened my eyes to the bravery and resilience that people living with ME display on a daily basis. Over the past week, many constituents have contacted my office to encourage me to attend this debate. Hearing at first hand from people in Lincoln about the complex difficulties that people with ME encounter really underlined for me the need to provide more support at national and local level.

ME is a disease that poses unique difficulties for those who suffer from it. We are all aware of its fluctuating and sometimes invisible symptoms, which have fuelled an unjust and debilitating stigma around the disease. That stigma is institutionalised in the fabric of ME medical research, healthcare provision and our welfare system. When it comes to treatment, most people do not have access to adequate care and support, and there is an almost total lack of appropriate secondary services. Many primary care professionals receive minimal training on ME—I did not get a lot of training on this when I was a nurse—and are therefore occasionally prone to holding stigmatising and misinformed opinions about the illness. It is clear that more training is required, not only for healthcare professionals but for welfare assessors. Welfare assessors frequently have insufficient understanding of ME and therefore often fail to assess claimants accurately. I heard that a lot at the film screening.

It is completely unacceptable that people suffering from ME are, through no fault of their own, even more harshly exposed to the cruelties of Tory welfare cuts and the disastrous roll-out of universal credit. This Government must consider properly funding research into ME to better understand the condition. It is crucial that we all work towards eradicating the stigma of ME and improve routes to diagnosis, care and treatment. It is also crucial that all Members across this House recognise that that can only be achieved with adequate resources. I hope that today the Minister will give us a real commitment to do this, and not just warm but empty words.

--- Later in debate ---

[Carol Monaghan]

I thank all Members who have stayed behind once again on a Thursday afternoon, particularly the Members who sponsored the debate, and especially the right hon. Member for Loughborough (Nicky Morgan) and the hon. Member for Ceredigion (Ben Lake). I also thank the ME community for their lobbying and presence here today in the Gallery, and the Backbench Business Committee for granting the debate. We had some very clear asks for the Minister, which he has responded to in part. On the question of medical research, I am sure that many researchers will have heard what he said. However, it is notable that although there is some excellent biomedical research going on just now, it is being funded by charities, and not by the Government. The Government need to take this seriously.

Question put and agreed to.

Resolved,

That this House calls on the Government to provide increased funding for biomedical research for the diagnosis and treatment of ME; supports the suspension of Graded Exercise Therapy and Cognitive Behaviour Therapy as means of treatment; supports updated training of GPs and medical professionals to ensure that they are equipped with clear guidance on the diagnosis of ME and appropriate management advice to reflect international consensus on best practice; and is concerned about the current trends of subjecting ME families to unjustified child protection procedures.

[Karen Lee]

On a point of order, Madam Deputy Speaker. I did actually mention the film “Unrest”, and I am sure that Hansard will bear me out on that. My constituents would never forgive me if I did not point that out.

Mental Health First Aid in the Workplace

Karen Lee Excerpts

Thursday 17th January 2019 Commons Chamber

[Chris Stephens (Glasgow South West) (SNP)]

Let me first praise the hon. Member for Liverpool, Wavertree (Luciana Berger) for securing the debate and for making an excellent speech. Let me also congratulate her, because she may well be the first person to have a motion passed in the House this week: every other motion seems to have been voted down.

I want to talk about some of my personal experiences. Before I came to this place, I was a trade union activist. When dealing with mental health issues, I had to remind employers of the provisions of the Equality Act 2010 and reasonable adjustments, and to make them understand the nature of a particular condition and what can happen as a result of it. I used to encourage managers to ensure that first aiders were aware that someone might have such a condition. In particular, they needed to know if an employee was taking a specific medication because of the possible side effects. Medication can have an impact on behaviour and performance.

The hon. Member for Dagenham and Rainham (Jon Cruddas) produced some shocking statistics on issues such as dismissal. In my view, much of that is due to aggressive management policies on attendance, not just in the private sector but in the public sector. When someone has been absent for a certain number of days, that can trigger an interview leading to the removal of sick pay or other forms of disciplinary action. That makes people go into what has been referred to as presenteeism. People also feel that, because they have been off for a certain number of days, if they are off another day, they will get the treatment. If we are going to have attendance management policies, they should be based on facts; they should not be aggressive and done just on the basis of trigger points.

I associate myself with the remarks by the right hon. Member for North Norfolk (Norman Lamb) about bullying. Bullying and harassment in the workplace is an issue and impacts on people’s mental health. So I strongly support the motion’s proposals to ensure that first aiders have adequate training. That is very much encouraged in trade unionised workplaces. I know hon. Members across the House will agree with me that trade unions play a vital role in trade unionised workplaces, ensuring that an employee with a mental health condition is looked after and given the proper support and that employers understand their conditions. This reminds me that one of the favourite books in the Glasgow Unison office was the “MIMS” book, which explained every piece of medication and their side effects. It was used as a tool to explain to employers the behaviour of those on medication or with a mental health condition and other problems that can arise, and to explain how to address those in a way that was fair and appropriate.

The hon. Member for Strangford (Jim Shannon) encouraged me to promote the health service in Scotland and the 10-year mental health strategy, and I will talk briefly about that. Between January and June last year, there were a number of courses. There were 43 one-day courses on healthy workplaces for NHS managers, and 552 people were trained. There was training for trainers; 28 people are now delivering more courses. There were eight workshops on resilience and wellbeing; 97 people were trained on that. There were also three managers’ competency workshops; 36 people were trained on that.

In Scotland there is a 10-year mental health strategy. It seems to be working. Out of 40 actions, 13 are complete and 26 are progressing and ongoing. These training programmes are vital, as the hon. Gentleman said. The workplace training programmes deal with topics such as surviving the pressures of work-related stress, managing organisational stress and getting the Health and Safety Executive on board with those arrangements.

There is an opportunity for the UK Government to look at their good work plan as well in relation to ensuring that mental health issues in the workplace are dealt with appropriately. Issues to do with insecure work are not yet being tackled by the Government. That can have a real impact on someone’s mental health and wellbeing. There are issues about how the DWP deals with some of these issues, which I hope the Government will look at. For example, someone who refuses a zero-hours contract job could be sanctioned under universal credit, but if someone is on a legacy benefit they would not be sanctioned. The pressures of the DWP system of benefit conditionality can often be punitive.

[Karen Lee (Lincoln) (Lab)]

I often get letters from people on zero-hours contracts. They might, for argument’s sake, get up at 5 o’clock in the morning and spend an hour cycling to a job only to find out there is not a day’s work for them. That puts them under such stress and causes so much more anxiety, and pressures their mental health. Does the hon. Gentleman agree that this is just one of the drawbacks of zero-hours contracts? We hear such a lot about how wonderful it is that everybody is in work, but if we scratch the surface we see it is not actually quite that simple.

[Chris Stephens]

I strongly agree. I do not know if the hon. Lady has had the opportunity to look at the Workers (Definition and Rights) Bill, which I have introduced and deals with some of those issues. People on zero-hours contracts or working parents turn up at work with an expectation that they are going to be working for a certain amount of hours—four, perhaps—and are told they will instead be working for eight hours and then have to deal with childcare; or they turn up and, as the hon. Lady said, find they are not required that day. That must have an impact on someone’s mental health and wellbeing.

I ask the Government to look at the punitive measures in terms of benefit conditionality. That is also a recipe for people to be recycled into unsuitable, potentially exploitative work just to avoid a sanction.

I support the motion. I ask the Government to look at these issues about the clear and direct impact on the mental health of workers and possibly changing some policies in that regard. I thank all Members who have spoken so far for their excellent contributions.

Oral Answers to Questions

Karen Lee Excerpts

Tuesday 15th January 2019 Commons Chamber

[Matt Hancock]

Yes, I would love to do that. I will raise it with Mike Richards, who is running a review of the future of screening services. I am sure that the whole House will want to join me in congratulating my hon. Friend on her forthcoming use of maternity services in the NHS.

[Karen Lee (Lincoln) (Lab)]

7. What recent assessment he has made of trends in the staffing levels of registered nurses in hospitals.

[The Minister for Health (Stephen Hammond)]

Our policies have allowed the NHS to recruit over 13,400 more nurses into all wards since 2010. Additionally, we have increased the number of available nurse training places, offering new routes into the profession and encouraging those who have left nursing to return to practice, alongside retaining more of the staff that we have now.

With your permission, Mr Speaker, I was so enthusiastic about the number of extra staff in the national health service, I might have inadvertently misled my hon. Friend the Member for Banbury (Victoria Prentis): it is 500 obs and gynae doctors since 2010.

[Mr Speaker]

In calling the hon. Member for Lincoln, I congratulate her on her birthday.

[Karen Lee]

You are very kind, Mr Speaker. The latest Care Quality Commission report on Lincoln County Hospital found sufficient nursing staff on only four of the 28 days reviewed and a heavy reliance on agency staff. As people know, I was a cardiac nurse for 12 years, and I can tell the House that agency nurses are expensive and create extra work—often they cannot do IVs and they are not familiar with paperwork, so the regular nurses end up doing half their jobs for them. Will the Secretary of State explain to the House why the NHS long-term plan has no policy on effectively tackling understaffing and no mention of reinstating the nursing bursary, which enabled nurses like me to train?

[Stephen Hammond]

The hon. Lady is right: we want to see more nurses in the NHS. That is why we have provided funding to increase nurse training places by 25% and why the long-term plan will have a detailed workforce implementation plan. She talked about the bursary, but since that was replaced nurses on current training schemes are typically 25% better off. Alongside that, additional funds support learning.

HIV and World AIDS Day

Karen Lee Excerpts

Thursday 29th November 2018 Commons Chamber

[Lloyd Russell-Moyle]

I thank my hon. Friend for that. He is right to say that my name will help those people, and it might appear in tomorrow’s newspapers as a result of my being the first MP to declare themselves HIV-positive in this Chamber and the second, after only Chris Smith, to openly live with HIV as an MP.

[Karen Lee (Lincoln) (Lab)]

I just want to say what a typical gesture of my hon. Friend this is and how proud of him we all are.

[Lloyd Russell-Moyle]

Perhaps foolishly, to gauge what the public reaction might be like, I went on social media to read some of the comments on recent HIV news stories. One does not have to scroll down far to find comments like:

“Anyone with HIV who has sex should be tried for murder”,

or

“fags getting what they deserve”,

or “disgusting lifestyle choice”. Now, most of the people behind such comments will be homophobes who are weaponising HIV to attack LGBT people. If it was not HIV, they would find something else, because they are haters and they are not pleasant people.

But HIV stigma is not just a symptom of homophobes. Even the most well-meaning people can perpetuate HIV stigma. It takes many shapes. It can be believing that HIV and AIDS are always associated with a death sentence. It can be thinking that HIV is transmitted only through sex. It is thinking that HIV infections are the result of some personal or moral fault. It can be believing inaccurate information about how HIV is transmitted, which in turn creates irrational behaviour and misconceptions about personal risk.

Before I was diagnosed, I myself perpetuated some of those stigmas, so it is not without judgment that I ask people to reflect; it is a genuine ask that we begin to think, talk and act differently when it comes to HIV. That is even harder when there is a taboo about talking about sex, which means that stigma is often compounded, thereby creating a more risky environment because people do not seek the treatment that they need.

The Sussex Beacon in my constituency is one of only two residential care facilities in the country for people living with HIV. It originally started as a hospice in the 1990s, when three to four people died there each week. Fortunately, end-of-life care is now a rare occurrence at the Beacon, and today most of its support services are utilised by people with HIV from marginalised groups who face a big stigma. Older people diagnosed late, women, black and ethnic minorities—all these groups are disproportionately affected by stigma and rely on the good work of the Sussex Beacon and other charities like it. But their funding is being reduced.

Yesterday, I was lucky enough to get a photo with Stiggy the Stigmasaurus at the Martin Fisher Foundation, as part of the foundation’s campaign to make HIV stigma history. I hope that Members who could not be there yesterday will be able to join me in that pledge going forward. Stigma causes a treatable disease to become life-threatening, because of the impact on an individual’s mental health and their access to medication. No person diagnosed with HIV today should feel any less able than anyone else to thrive and enjoy life because of their status.

Stigma is not just a UK problem; it is a global one. Fifteen years ago, 200,000 people around the world were receiving treatment for HIV. Today, the number is 22 million, but we still have 15 million more who need access to regular medicine.