NHS (Five Year Forward View)

Lord Beamish Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

I am happy to do so. We have made good progress during this Parliament, increasing by 10% the proportion of people with dementia who receive a diagnosis. This is not just about getting a diagnosis, however; it is the care and support that people get when the diagnosis is made that really matter. That is the reason for giving the diagnosis. Let me characterise the change that we want to see for people with dementia over the next few years. When someone gets a diagnosis, we want to wrap around them all the care and support that they and their family need to help them to live healthily and happily at home for as long as possible, so that they do not get admitted to hospital in an emergency or need to go into residential care until the very last moment. Of course that will cost the NHS less, but it is also far better for the individual concerned.

[Mr Kevan Jones (North Durham) (Lab)]

The Secretary of State talks about party politics, but he cannot get away from the fact that the number of mental health beds in this country has dropped by 1,500 on his watch. We have heard about the scandal in Devon last week, and my hon. Friend the Member for Hampstead and Kilburn (Glenda Jackson) has told the House how some patients have to travel up to 200 miles to access an emergency bed. What is the Secretary of State going to do to deliver those beds where the mental health patients who are in crisis actually need them, which is close to their homes?

[Mr Hunt]

I agree with the hon. Gentleman that we need to address the issue of availability of mental health beds for crisis care, but we also need to recognise that the model of care for people with mental health needs is changing. We think that it is much better to avoid long-term institutionalisation if we possibly can, and that is why there has been a process of reduction in the number of beds. That happened under the Labour Government as well. If he wants to know what I am doing, I will tell him. I am part of the Government who are delivering a strong economy, which means we can put more money into the NHS.

NHS Services (Access)

Lord Beamish Excerpts

Wednesday 15th October 2014 Commons Chamber

[Andy Burnham]

I am afraid that the hon. Gentleman is wrong, because I mentioned the cuts to mental health services earlier in answer to my hon. Friend the Member for Warrington North (Helen Jones). The talking therapies he mentioned were introduced by the previous Government —indeed by me—and in some places they are not being cut, which I am pleased about, but in others they are. The letter I referred to from the royal colleges and other organisations talked about a crisis in mental health. They say that people are being ferried hundreds of miles to find emergency beds. That is the reality on this Government’s watch. I think that a little less complacency and a little more focus on these problems would not go amiss.

[Mr Kevan Jones (North Durham) (Lab)]

My right hon. Friend should be congratulated, along with my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson), who brought in the IAPT—improving access to psychological therapies—programme. It was a revolutionary system for dealing with access to mental health services. Is not it the case that this Government, even though they obviously think that there are votes in championing mental health, are cutting not only the number of in-patient beds, but the mental health budget across the country?

[Andy Burnham]

My hon. Friend is right. We heard the commitment that the Deputy Prime Minister gave last week, and I am sure that he means it, but people will ask why they have not done anything about it in this Parliament. It is lip service. We introduced talking therapies and many other things. The key point is that they cut it faster than they cut the rest of the NHS. Worse still, they introduced a tariff decision this year that will cut it even further and make the problems even worse. It was Labour that proposed parity of esteem between mental and physical health in law. The Government accepted it, but they have done absolutely nothing about it.

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[Mr Kevan Jones (North Durham) (Lab)]

I wish to discuss the crisis in the North East ambulance service. To do this, I will give some of the examples I have come across and others that have been backed up by the police and other agencies. But first I must pay tribute to the hard work of the staff of the ambulance service. It is not their fault they are under pressure; they are dedicated individuals who wish to do their best for my constituents and others in the north-east.

I wish to give two of many examples—other north-east parliamentary colleagues have complaints as well. The first comes from Carole Hampson, who lives in Quaking Houses, in my constituency. On 20 June, her son Christopher rang 111, the non-emergency number, because his 10-month-old son had drunk bleach. He was told, “No problem. We’ll get an ambulance to you straightaway. Don’t do anything.” An hour later, an ambulance had still not turned up. His mother then rang back and said, “Forget it. I’m taking him in a car.” The pressure and worry for both him and his grandmother must have been tremendous. Luckily, the youngster was fine. On 4 July, she again rang the ambulance service because her son was critically ill with a diabetes-related condition. She rang 999 and the operator said, “Is he still conscious?” She said, “Yes”. The operator said, “Okay, we’ll get there as soon as possible.” An hour and 20 minutes later, an ambulance turned up.

It is not just Carole Hampson’s family who have been affected. On 11 July, she was driving through Stanley in my constituency when she saw an old gentleman fall into the road and break his head on the pavement. The police arrived and she and other bystanders came by. She rang 999 for an ambulance. While they were waiting—for 30-odd minutes—blue light ambulances were going past. The police rang the ambulance service, but no response was forthcoming. In the end, the police took the old gentleman home, where an ambulance later attended. I have another constituent, who I will not name because I have not asked her permission, whose husband had an angina attack. She rang her GP, who recommended she ring 999. The operator said, “We’ll get a paramedic to you”, which she did, but three hours later the ambulance arrived to take him to hospital.

It is not just individual constituents saying there is a crisis in the North East ambulance service; there is evidence from the police. Over a six-month period this year, there were 675 incidents in which the police had to step in following the failure of ambulances to attend. I shall give just a few examples. On 2 September, the police attended a road traffic accident and asked for an ambulance to attend. Thirty minutes later, an ambulance arrived.

On 5 September, the police requested an ambulance because an individual had been assaulted and had waited 75 minutes for an ambulance to attend. On 7 September, the police transported to hospital a male patient with head injuries because the North East ambulance controller said that no ambulance was available and that there were 39 outstanding instances. On 19 September, the police requested an ambulance to attend a female patient with severe facial injuries; an hour and a half later an ambulance had not attended, so the family had to take care of the individual themselves. On 20 September, the ambulance controller told the local police that the ambulance service was in a critical situation. This needs sorting out.

There are two problems facing the NHS North East ambulance service. One is A and E. Ambulances are backing up at A and E. The other day, an ambulance driver told me that he had been directed from Chester-le-Street to Carlisle on the other side of the country. Then there is the 111 service brought in by this Government, which is failing. The system is not being managed by professionals with any background. It is a tick-box system that is leading to instances in which ambulances that are not needed have been sent out, clogging up the system. This service is in crisis, and what is the North East ambulance service that is responsible for it going to do? It is carrying out a review. It has appointed Deloitte to carry out a review into its operation, but my constituents do not want management consultants to sort it out.

[Mike Kane (Wythenshawe and Sale East) (Lab)]

I thank my hon. Friend for giving way and compliment him on his excellent contribution. Does he agree that this situation is being exacerbated where we are privatising ambulance services? That is what happened in Greater Manchester where in the last year alone, half the journeys failed to get patients to their appointments on time.

[Mr Jones]

That is right. This is what is picking up the slack.

My constituents do not want management consultants to sort the problems out; they want health care professionals to do so. If we in the north-east do not do something about this soon, people are going to die. Because of what is happening, people do not accept this system. The delays are causing a huge amount of angst to individuals and are putting huge pressure on other services such as the police and fire and rescue. In desperate situations, where people in road traffic and other accidents need urgent medical care, they are unable to get it. It is a failure in 2014 that my constituents and those of other north-east Members cannot get basic medical care.

I ask the Minister—I see he is busy talking at the moment and I would like him to pay attention—urgently to intervene in the North East ambulance service because it faces a critical situation. Management consultants are not the answer, and I have no faith in the management to sort this out, as has been said by other emergency services, local authorities and their own staff. Unless there is some central direction and intervention to put this right, people’s lives in the north-east of England will be lost.

Health

Lord Beamish Excerpts

Monday 9th June 2014 Commons Chamber

[Richard Benyon (Newbury) (Con)]

It is a great pleasure, but a daunting prospect, to follow the right hon. Member for Cynon Valley (Ann Clwyd), who is a model of dignity for the House and has shared some truly horrific experiences with us. I want to talk mainly about public health, but before I do so, I should like to raise an issue that is not unrelated to what the right hon. Lady has mentioned.

I have been fascinated by the fact that the Mid Staffs issue has not resonated as a major concern with the vast majority of people in this country. Perhaps I missed it; perhaps it is there just under the radar. To me, it should be seared on our collective conscience as a nation. If 1,200 had wrongfully died, say, in police custody or in some other area of direct Government responsibility, there would be crowds of people out on the streets. Yet this was a collective failure and a national failure. Irrespective of what has been said in certain journals by certain Members, this was not a local issue, but a national one in which neglect, incompetence and something called cognitive dissonance was allowed to fester—and people died in large numbers.

We rightly revere the NHS. As with my hon. Friend the Member for Mid Worcestershire (Sir Peter Luff), I have had recent experience of a close relative being treated in the NHS, and I have nothing but praise for the staff who treated him. Where there is failure, and when people are treated in the sort of way mentioned by the right hon. Lady and dignity and care fall by the wayside, we have to act. I believe that the implementation of the Francis report is a major step on that road. I applaud the Secretary of State for his determined approach to put patients first, by putting in place measures, individuals and safeguards so that Mid-Staffs does not happen again.

As I said, I want to talk about public health, which I believe is so important to how we are going to be able in the long run to afford a national health service. So much of that is about diverting people away from needing it. It is also about addressing inequalities. I have worked hard with other Members to make sure, for example, that rural areas are not left aside. When I was the Minister with responsibility for rural affairs, my hon. Friend the Member for Beverley and Holderness (Mr Stuart) raised the issue of stroke treatments in his constituency. It is, of course, much quicker and easier for a stroke therapy consultant to spend all their time in Hull, dealing with many more cases in one day, rather than getting out into the rural areas. Addressing those health inequalities is now, however, for the first time a statutory requirement. That is a major step forward. It does not just involve national bodies such as NHS England and Public Health England; local care commissioning groups and local authorities are ensuring that inequalities are addressed.

[Mr Kevan Jones (North Durham) (Lab)]

I agree with the hon. Gentleman that there is a specific need in rural communities. Does he support the Government’s action in taking need out of the assessment for public health funding, which has meant that areas such as mine in the north-east have lost funds that have been redistributed to wealthier areas in the south?

[Richard Benyon]

I do not know what happens in the hon. Gentleman’s part of the north-east, but I can tell him that there is now a real drive to deal with the problems in the constituency of my hon. Friend the Member for Beverley and Holderness. My hon. Friend felt that his constituents were getting a raw deal under the old system, and there is now a statutory requirement for that to be addressed.

The new responsibility for public health means a great deal to us as constituency Members. The West Berkshire health and wellbeing board, ably led by Councillor Marcus Franks, is taking the initiative locally, not just dealing with massively important issues such as reducing smoking but encouraging, through a partnership approach, lateral thinking and the tackling of disease and illness before they happen. We must ensure that that happens at local level as a result of legislation that has been introduced in the past.

I was pleased to be one of the authors of the natural environment White Paper. We worked closely with the Department of Health, with the aim of helping people to understand the healing benefits of nature and the great outdoors. Initiatives such as Walking for Health have created a virtuous circle. Improved health has led to greater companionship and less isolation, and organisations such as the University of the Third Age have improved the quality of life for lonely and, in some cases, elderly people—and, of course, there is the additional benefit of a lower health care bill for the taxpayer. All that is crucial to our objective of diverting people from health services.

About 20 years ago, a health service manager said to me, “The trouble is—from my point of view—that clever people keep inventing expensive new cures which we have to fund. People survive longer as a result, and that means yet more costs, because they will need the NHS at a later stage.” I think that he was being light-hearted, but it was probably just a half-joke. His point was this: if we, as a society, are to be able to afford the NHS that we want in the future, whichever party is in government, we must continue to divert people from it by keeping them healthier. The lateral thinking to which I referred earlier has never been more important.

I applaud the housing association that, working with its local health and wellbeing board, identified a large number of elderly people who were being admitted to hospital following accidents in the home. Simply employing a handyman to do some work in their sheltered accommodation resulted in a reduction in the number of injuries, particularly serious injuries such as broken hips, from which many people do not recover.

Another initiative in my area is “brushing for health”. Good oral health is vital, and my local health and wellbeing board has launched a programme involving Sure Start and other children’s centres, encouraging children to adopt diets that are lower in sugar and to brush their teeth more regularly, and ensuring that they will have access to a dentist. Promoting that initiative will mean that less national health dentistry will be required in the future.

On Saturday, I was delighted to launch the Newbury dementia action alliance. We know that 800,000 people in this country are living with dementia, and that it is costing the country £23 billion a year. It is great to hear that the G7 world leaders are getting together and making dealing with dementia one of their priorities, but what does that mean in our constituencies? It means, at local level, stimulating the minds of dementia sufferers, supporting their carers, ensuring that healthy living is part of the norm and involving organisations such as the fire service and the police.

That was a very quick canter around the importance of public health. I am running out of time, but let me end by saying that when we talk about health, we must not just talk about the important factors that surround the core of the national health service. We need to prevent people from becoming ill in the first place, and that is why the Government’s concentration on public health is so welcome. There is, of course, much more to be done, but a very important change has been made.

Oral Answers to Questions

Lord Beamish Excerpts

Tuesday 25th February 2014 Commons Chamber

[Norman Lamb]

I thank my hon. Friend for his question. Indeed, I share the concerns that he raises, and I have recently met my hon. Friend the Minister responsible for benefits specifically because I have those concerns. There needs to be much closer working between mental health services and the benefits system locally.

[Mr Kevan Jones (North Durham) (Lab)]

The Minister knows that early intervention therapy or talking therapies can relieve pressure not only in access to beds, but in helping individuals. He has just told the House that he will look at assessments of waiting times. Will he tell the House exactly what force or lever he will have to ensure that local trusts implement such targets?

[Norman Lamb]

I think it was a big mistake to leave out mental health when the 18-week maximum waiting time limit was introduced for physical health services. To me, that is inexplicable, so I am determined to correct it: from next year, there will be waiting times standards for mental health. Indeed, when the Care Quality Commission inspects and regulates providers, it will ensure that those access standards are met, in the same way as applies for physical health.

Managing Risk in the NHS

Lord Beamish Excerpts

Wednesday 17th July 2013 Commons Chamber

[Andy Burnham]

He seriously expects us to believe it? Why are we being told that those responsible were representatives of Conservative Central Office? [Interruption.] Yes, that is what is being said. The Secretary of State should go back and check his facts. If he does not have control of his advisers, it will not be the first time, will it? We have heard this before, have we not? “I do not know what the advisers are doing.”

The “my adviser is out of control” defence may have worked for the Secretary of State once, but it will not work for him twice. He must take responsibility for his own advisers, and for the advisers at Conservative headquarters. We were told explicitly that that is where the briefings came from, and the Secretary of State owes the House a full answer. He owes it to the House to put that on the record. [Interruption.] I will not put the name in the public domain, but I have a name. I will send it to the Secretary of State immediately after the debate, and he must come straight back to me, having asked that person whether or not he briefed the press. If the Secretary of State agrees to that, let us leave it there. I have a name, and I will put it to him straight after the debate. He must take responsibility.

[Mr Kevan Jones (North Durham) (Lab)]

If there was no organised briefing over the weekend, there must have been a coming together of some extraordinary fiction. The Keogh report itself states:

“It is important to understand that mortality in… NHS hospitals has been falling over the last decade: overall mortality has fallen by…30%”.

Keogh says that that is an improvement, even given

“the increasing complexity of patients being treated”.

Those who read the headlines, and the spin from the Conservative party, would not think that our investment over 13 years had made any difference to mortality rates.

[Andy Burnham]

My hon. Friend has made an extremely important point. The conclusion to which he has referred may well have been missed by many people up and down the country yesterday, but it is worth repeating and putting centre stage in today’s debate, because the Government certainly will not make any reference to it.

NHS hospitals in England, including the 14 covered by the review, have reduced mortality by 30% in recent years. That is an incredible achievement, which we should surely be celebrating. Of course the NHS is not perfect. It does fail people, and when it does, we are truly sorry for the effect on their families. The fact is, however, that the NHS and its hospitals have improved over the past decade, and that needs to be repeated and repeated to counter the scare stories that are emanating from the Conservatives and the fears that they are stoking among people about going into hospital.

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[Frank Dobson (Holborn and St Pancras) (Lab)]

I do not wish to get involved in great party turmoil on this matter, but it seems to me that a characteristic of any health care system is whether it is entirely devoted to managing risk. When people are ill or injured, their lives and health are at risk, and it is also possible that any treatment they may be offered will itself be risky.

The principal problem faced by doctors, nurses and midwives is that of uncertainty, and they want to give the right diagnosis. It is statistically true, for example, that the average GP will be confronted by 1.5 patients who are suffering from meningitis in a 35-year career, yet we expect them to make the right diagnosis. It is difficult. If the GP has made the right diagnosis—I am not necessarily talking just about meningitis—we expect them to come up with the right treatment, which involves another judgment and a great deal of uncertainty. Even if the diagnosis and choice of treatment are right, it may be that the treatment will, for one reason or another, go wrong.

Nevertheless, within the national health service, most people, most of the time and in most places, get very good treatment. Over the past 15 or 16 years, there has been a big reduction in mortality in hospitals, a big improvement in people’s recovery from treatment for a serious illness, and we have been catching up with some countries that had a better record than us. Despite all the criticism, general satisfaction with the national health service remains high. If people are asked what they think of the national health service, about 60% say it is pretty good. If they are asked how the NHS treated them or a member of their family, the percentage of those who are satisfied is usually in the high 80s or low 90s. Any political party or political leader would love that sort of satisfaction rating.

People working in the NHS have very demanding jobs and they need help in doing those jobs. The first thing we must do is try not to make their lives more difficult than they are already. We should ensure, for instance, that they are not in a decrepit hospital without enough beds and that the equipment they have is reliable.

[Mr Kevan Jones]

Does my right hon. Friend agree that one of the achievements of the previous Labour Government was the capital investment we put into hospitals? In 1997, for example, the hospital in my constituency was housed in the old workhouse, and we now have a brand-new hospital thanks to Labour. That has made a difference not just to patient care but to the working environment of the people we are asking to care for those patients.

[Frank Dobson]

That is certainly the case and applies to many parts of the country, including areas represented by Government Members.

I do not think any hospital has had more money spent on it than University College hospital in my constituency, the rebuilding of which, I freely admit, was authorised when I was Secretary of State. I understand that it is the hospital in this country from which one is least likely to come out dead. It is a good place that has modern and reliable equipment and is not, generally speaking, short of staff. It is quite clear that staff shortages in parts of the country have endangered the standard of care provided.

People’s pay and conditions are also important. The Cavendish report, produced only last week by a journalist for The Daily Telegraph, Ms Cavendish, stated that she regarded the pay and conditions of large numbers of people providing services outside hospitals to people who need them as disgraceful, shocking and a condemnation of our society. She is quite right.

One thing concerns me most, however. I remember when I first became Secretary of State for Health being telephoned by a very good friend who was then a professor in the medical school at Nottingham and said—I shall have to bowdlerise this—“For Lord’s sake, leave us alone. Do not reorganise; do not distract people from their usual jobs.” That is what too many Governments have done, including this one, but I do not want to go ranting on about it.

One thing I want to talk about is not mentioned very often. It became fashionable to say that the money must follow the patient and that we did not want to hand over big lumps of money to hospitals and other parts of the health service as that did not provide the right incentives. The only trouble is that as a result NHS transaction costs went up from 4p in the pound to what is estimated now to be between 12p to 15p in the pound. That is a lot of money—about £8 billion, £9 billion or £10 billion extra, just because of the new method of funding. If we want to release funds to help people who are being treated in the health service and who want to be treated there, to provide the buildings, equipment and staff, and to encourage the staff, we must think about the money being squandered on transaction costs. Unless we do something about that, it will only get worse under the new system.

Tobacco Packaging

Lord Beamish Excerpts

Friday 12th July 2013 Commons Chamber

[Anna Soubry]

I agree.

[Mr Kevan Jones (North Durham) (Lab)]

It is a first for this Government to determine policy by waiting to see what the Australians do. What time period will there be for the consultation? Has the Minister’s position on this issue, and that of her colleague the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), changed?

[Anna Soubry]

I have absolutely no problem whatsoever with waiting to see what happens with the introduction of the legislation in Australia. The hon. Gentleman knows that the aim of standardised packaging is to dissuade young people from taking it up.

[Mr Jones]

How long?

[Anna Soubry]

I am answering the hon. Gentleman’s first question first, after which I will move on to the next one. That is the aim of the introduction of standardised packaging. If a good experiment is up and running that will produce evidence, what could be a more sensible thing for Government to do? As to the length of time, I cannot answer that question, because we have to wait and see the evidence as it emerges. I thought that we might see some sort of change quite quickly in Australia, but we have not seen it yet; I am surprised about that. I am afraid it is a case of “How long is a piece of string?” We have to wait and see how the evidence emerges.

Health and Care Services

Lord Beamish Excerpts

Wednesday 3rd July 2013 Commons Chamber

[Grahame M. Morris]

That is an excellent point. I am sure that Members across the Chamber will have experience of that. On Friday gone, we had a crisis meeting of the county MPs and senior politicians in my local authority area of County Durham to determine how to cope with a further tranche of cuts. The situation is becoming serious. It is said that the allocations have been ring-fenced, but the local authorities’ discretionary spend is all being absorbed into social care and expenditure for children and the elderly, and there is very little room for manoeuvre.

[Mr Kevan Jones (North Durham) (Lab)]

Will my hon. Friend give way?

[Grahame M. Morris]

I will give way to my hon. Friend.

[Grahame M. Morris]

Okay—

[Mr Jones]

Will my hon. Friend give way?

[Grahame M. Morris]

Am I allowed to give way to my hon. Friend, Madam Deputy Speaker?

[Grahame M. Morris]

With all due respect, Madam Deputy Speaker, I know that my hon. Friend was at the same meeting as me on Friday, and he will probably have a relevant point to make about that, so if you do not mind, I will give way to him.

[Mr Jones]

With respect to the Deputy Speaker, the point I wanted to make was that at the meeting last Friday we were told that Durham county council has to take £210 million out of its budget. Does my hon. Friend think that areas such as ours, which has a growing elderly population, will face more pressure than some others?

[Grahame M. Morris]

Absolutely. The pressures are becoming intolerable. Some of our great northern cities, such as Liverpool and Middlesbrough, seem to be shouldering a disproportionate share of the cuts, and it is a difficult task to try to balance the budgets and deliver the services that people require. There has been a discussion about whether the councils are in a position even to deliver their statutory requirements.

As the right hon. Member for Charnwood said, the NHS has been set productivity targets of 4% per year, as the Government seek to make savings of £20 billion over the lifetime of this Parliament. As the report identifies, the Government believe that those savings can be made in part by prioritising competition over co-operation. I find that questionable, and we need a cost-benefit analysis of the consequences in regard to the value for money of outsourcing. There has been a lot of criticism of PFI schemes, and questions have been asked about whether they provide value for money for the public purse. To date, efficiencies have largely been achieved by freezing staff salaries and cutting the tariffs paid to NHS providers. Neither of those is sustainable, and both fail to meet the spirit, if not the letter, of the Nicholson challenge.

There are signs of falling morale in the NHS, and that is due in no small part to the Government’s attacks on pay, pensions and conditions of service. It is not helpful that Ministers seek to blame NHS staff for problems caused by the Government’s cuts and reforms. These are not the innovative changes that we need to see from a restructured NHS. In the main, we are seeing the picking of low-hanging fruit. Some of the cuts are rash and damaging, and they are being made to satisfy the Government’s need for cuts across the board.

I understand that the current Secretary of State for Health has joined his predecessor in receiving a vote of no confidence from the health care professionals at the British Medical Association conference. I only hope that the next Secretary of State for Health will seek to work with health care professionals, not against them.

The NHS Confederation’s survey of NHS chief executives indicated that 74% of respondents believed that the NHS’s financial situation was either the worst they had ever seen or “very serious”. Despite the Government’s claim to have ring-fenced funding, which has been called into question, NHS executives are not confident that the situation they face is good for their organisations or their patients, with 85% expecting things to get worse in the next fiscal year.

There is no doubt—the figures are there in the report—that the NHS is facing the biggest financial challenge for a generation, as a result of unprecedented demographic changes, an increasing demand for health and care services, co-morbidities, and people living longer with chronic illnesses such as diabetes and dementia. The Nuffield Trust has warned that, unless we improve the way in which services are delivered, growing care needs will result in a shortfall of up to £29 billion a year in NHS funding by 2020.

The NHS faces new challenges in the 21st century. The last Labour Government corrected the chronic under-investment following 18 years of the previous Conservative Government. Investment in the NHS trebled under Labour. We built more than 100 new hospitals, replaced much of the ageing infrastructure, and developed the new walk-in centres, primary care centres and a new generation of modern community hospitals. There were extended GP opening hours, and more doctors and nurses than ever before.

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[Priti Patel (Witham) (Con)]

I welcome today’s debate and I, too, want to pay tribute to my right hon. Friend the Member for Charnwood (Mr Dorrell) for his comments. He clearly made some strong and valid points about expectations of the NHS and the required pre-requisite of expectation management. Yes, the debate is about funding and finance, but it is also about some of the significant challenges we face as a society and a country because of our changing demographics and our ageing population.

I pay tribute to the Government for prioritising investment in the NHS and in health and social care and for committing to increase spending on the NHS and health to more than £115 billion for the next comprehensive spending review period. I also welcome the measures they have introduced to focus resources on the front line and in particular to clamp down on NHS bureaucracy—my hon. Friend the Minister will know my views on that. I believe that the importance of making £20 billion of bureaucratic and efficiency savings should not be underestimated.

As we have heard, increasing demand on services requires more spending, but targeted specifically at the front line. In my constituency, a scandalous deficit in health care provision built up while Labour was in power as resources were soaked up by NHS bureaucracy. Across the former East of England strategic health authority, the number of senior managers doubled between 1997 and 2009 from 1,300 to 2,700.

[Mr Kevan Jones]

Does the hon. Lady think that there has been any sense whatever in the top-down reorganisation? I know that in many areas managers have taken large redundancy payments from primary care trusts only to be re-employed weeks later by GP commissioning groups.

[Priti Patel]

The answer to the hon. Gentleman’s question is yes. In the east of England, and certainly in Essex, there have been significant changes. The change to the structure has been specifically welcomed because resources are now going to the front line, which, for my constituents, is the most important thing.

The numbers of administrators and managers grew vastly in the PCTs that used to cover my constituency. I am afraid that we did not have one PCT—we had several. The number of managers and senior managers at the Mid Essex primary care trust and its predecessor trust increased tenfold from 10 to 102, while at the North Essex primary care trust the number went up from 25 to 84. By the time the Labour party was kicked out of office by the British public, the proportion of administrative staff had risen to one third, and between those two PCTs something like £25 million was spent on management costs alone—money that could have been much better spent on providing front-line services to my constituents and to constituents elsewhere in Essex and across the eastern region.

Although bureaucracy increased, health service provision in Witham town suffered as NHS managers completely neglected the area in favour of spending money elsewhere. As a result, Witham town’s GP surgeries are bursting at the seams. Almost 30,000 patients are registered across four practices with just 13.5 full-time equivalent GPs. That means that there are 2,200 patients registered per GP, nearly 50% more than the national average of 1,500 patients per GP.

My constituents report that they are struggling to register with a GP and are facing insufferable delays in getting appointments. One wrote to me, saying:

“Two doctors’ surgeries in Witham have refused to take me on, because the books are closed for new patients.”

Another said that they

“waited 12 days for an appointment with my GP. In the end, I was diagnosed with appendicitis.”

Unfortunately there will only be more such cases, exacerbated not just by our changing demographics but by housing growth, which creates greater pressures on existing practices. On Witham’s Maltings Lane estate, 1,700 new homes will be built, increasing the local population by more than 4,000. Other sites have been identified for development over the next decade, quite rightly bringing new homes and affordable homes to my constituents.

When Labour was in power, opportunities to bring in new medical facilities through section 106 agreements and other funding arrangements were completely spurned by the PCT managers, who neglected and ignored the situation and the strains of a growing population in the community. New GP practices could have been opened and new facilities to provide treatments and assessments could have been brought in to save my constituents from travelling to Chelmsford, Colchester or even Braintree, which involves considerable distances. That demonstrates how patients in my constituency were not being put first. It was bureaucracy that was being put first by the army of bureaucrats in charge of running the local NHS in my part of Essex at that time.

The Minister will understand the legacy of problems left to the town. I also pay tribute to him—like the Secretary of State, he has received a fair amount of correspondence and is well aware of the issues. One of the biggest challenges for the NHS today, with the increased investment that it has, quite rightly, received from the Government, is ensuring that the savings in bureaucracy that this Government are making are reinvested in providing new local health care services in Witham in particular. I hope that my hon. Friend will give a commitment to support our local efforts to increase health care provision in Witham, to ensure that my constituents of today and those of tomorrow, gained through new housing growth in particular, receive and benefit from a 21st century health care service.

With more money than ever being invested in the NHS, it is essential that those who are responsible for spending decisions and run our local NHS are also held to account. Accountability and transparency are key. We in the east of England have had from our ambulance trust the worst ambulance service in the country. It was run by a board of non-executive directors who failed to provide the trust with the leadership, skills and expertise required to address endless shortcomings and delays in ambulances attending to patients. Lives were put at risk, but despite the failures, a damning governance review and a “failing” report from the Care Quality Commission, the board bit the bullet and resigned only last Friday morning, following substantial pressure from MPs in the east of the region, including my hon. Friend the Minister, and a Westminster Hall debate last week. The situation was shameful and scandalous, because the board refused to go until the pressure became too much for them.

None of us can avoid the need for accountability and transparency. We have seen in Mid Staffordshire with the Francis review, in Cumbria, in the East of England with our ambulance trust, and now with the Tameside hospital trust—I think the chief executive resigned this afternoon—what can happen when NHS managers and directors get it wrong. They have to be accountable for their failures. Transparency is required. I recognise that the Government are taking this seriously and hope that at the end of the debate my hon. Friend the Minister will give details of steps that will be taken to remove failing directors and managers and, importantly, to replace them with people who have the skills and capabilities to put patients first and to deliver value for money. A huge amount of taxpayers’ money is used to pay for the NHS. It is only right and proper that all of us, including the public, should feel confident that the money is being well spent.

[Dr Phillip Lee (Bracknell) (Con)]

The nature of this debate is such that one can talk about anything to do with the NHS, be it local or national, in the context of the estimates of costs. The figures in the documents are immense—£1 billion here, £50 billion there; perhaps we need to plant some money trees in this country—and will only increase, as we all know. It has been interesting to listen to Members on both sides of the House this afternoon. Everybody accepts that demands are rising. Obesity is increasing—26% of adults are obese and the proportion is rising—and our population is ageing, so that by 2030 almost 25% of the population will be over 60. On top of that, there are advances in medical technology and the costs thereof to deal with—today’s cancer drugs can cost upwards of £5,000, £6,000 or £7,000 per month per patient.

Given those demands and costs, maintaining the current service will inevitably become nigh on impossible. I sense, even in the Chamber, and certainly outside it, that the public are beginning to realise that. I will say a few words about that before going local and discussing some of the things I have been suggesting in my region, and “region” is the key word here, rather than constituency.

The figures are really quite shocking. It has been suggested that by 2025 around 25% of the NHS budget will be spent on type 1 and type 2 diabetes alone. Only this morning a colleague told me that he had been diagnosed with type 2 diabetes. It affects all groups in society. Around 21% of the population smoke and around 28% of the adult male population drink too much—the figure is about 20% for women.

The number of prescriptions in 2009 was 886 million. The total cost of the NHS drugs budget in 2009 was between £13 billion and £14 billion, and it increases by £600 million each year. We are getting cleverer at inventing new drugs and classes of drugs, so I suspect that those costs will continue to increase, because it is human nature for someone to want the very best drug, the drug that will cure their cancer or extend their life.

Cases of dementia are set to double over the next 10 years, which will have a profound impact on health and social care. There will be a huge impact on the economy, as families will increasingly have to spend more time looking after the vulnerable, rather than going to work. The ramifications are immense.

I have detected some recognition in the Chamber today, particularly from my right hon. Friend the Member for Charnwood (Mr Dorrell), that there needs to be some cross-party agreement on this. I suspect that we will be arguing over the next 10 to 15 years about how we pay for health care. I have been brave enough to suggest that relying solely on general taxation to fund health care is not practical in the medium to long term. It is difficult politics—trust me, I saw my Twitter account explode at that point—but I think that we are likely to have a debate on that, and an argument, across the House, and that is as it should be.

However, where we should not disagree is about the way health care is structured in this country. I think that for both parties—it is a plague on both houses—the introduction of the market into hospital health care and the use of private finance initiative contracts, particularly over the past 10 years, has made it extremely difficult to reconfigure hospitals in certain parts of the country, which is unfortunate.

I have also heard that the introduction of competition law and its possible implications with regard to reconfiguration is also looming large in the national health service. Government Front Benchers might want to look at that, because I am persuaded—I have spoken about this on many occasions—that in future we will need fewer acute hospitals but more community hospitals. The majority of care will increasingly be offered closer to home, or indeed in the home, but the clever stuff, such as the life-saving stuff shown in the television series that the BBC is currently broadcasting on Thursdays, cannot and will not be offered in the number of district general hospitals that we currently have. Anybody who thinks that it can be does not understand. I suggest that it is increasingly becoming good politics to save lives, not to defend the indefensible, and I think that Members on both sides of the House should reflect on that.

One example from that television series was a nasty accident involving a head-on collision 30 minutes north of Addenbrooke’s hospital. The injured did not go to the local hospital, which had recently opened, because it could not care for them; they went 30 minutes down the road to be treated at Addenbrooke’s. In other words, a hospital that had been built in the past few years was already not fit for purpose. We should reflect on that.

Reconfiguration is essential, and it has been shown—not least in respect of London stroke services—to save lives and improve care. That should be replicated across the country.

[Mr Kevan Jones]

The hon. Gentleman is speaking a lot of sense. The stroke unit in the north of County Durham has just been specialised, and the results are already showing the benefits, although in parts of the region there was a lot of opposition to the move.

Does the hon. Gentleman think that long-term health should be managed not only by doctors but by pharmacists and others, who can play a key role?

[Dr Lee]

I am pleased that services are improving in County Durham; as the hon. Gentleman knows, I have family roots in his part of the world that go back centuries. I am not persuaded of the role of pharmacies, although I am persuaded of the role of pharmacists. I distinguish between the two because I personally think that all GP surgeries should be dispensing drugs. I do not see why the taxpayer should be subsidising pharmacies.

It is no surprise to me that Boots was the biggest ever private equity buy-out in the history of British industry, given that the taxpayer is outside the front door: “Come here for your amoxicillin, and while you’re here you can get your shampoo, conditioner and royal jelly.” I am not convinced about the role of pharmacies in the longer term; pharmacists most certainly have a role and should be included. Community pharmacists should be checking drugs, particularly when patients have polypharmacy—when they have a multitude of medications, another pair of eyes is always appropriate.

To return to the reconfiguration, in my locality we have a number of district general hospitals. Historically, Bracknell itself has been under-served by acute services since it was created in the late ’50s or early ’60s. We have seen services diminish in the area for a variety of reasons and under Governments of both parties, and we are sensitive about that.

Before I was elected as Member of Parliament for Bracknell—I stress that it was before I was elected—I suggested as part of my campaign that we needed to close hospitals in the area and consolidate to improve clinical outcomes. I am not aware that my result at the election was adversely impacted by that. Having worked in the area as a GP for a number of years and looked after 50,000 patients, I guess that people trusted what I was saying, and I recognise that.

I was trying to argue that we could consolidate acute services on a single site and improve community hospital services in appropriate locations around the region. I stress the word “appropriate”, as the problem is often that, for a variety of legacy reasons, hospitals are in inappropriate locations. They are not often on motorways, but on land bequeathed before the war. In my part of the world, the Astor family bequeathed the land for Heatherwood hospital. The local farmer outside Slough bequeathed some land because his daughter was looked after well. People thought, “Okay, we’ll build a hospital in the middle of a farm field nowhere near the population that it seeks to serve.”

There is a legacy problem. There is some need to close and relocate, while in some parts current locations can be enhanced. In my locality, there is the problem with Heatherwood hospital. I must put on the record something bizarre that frustrates me. It is “blue on blue”; if I was in a defence debate, it would be called friendly fire. The Royal Borough of Windsor and Maidenhead has called for a judicial review of the relocation of a minor injuries unit just three miles down the road, would you believe, to Bracknell—an urban centre in a better location and away from a place opposite the Royal Ascot racecourse. That judicial review will delay the move and cost money. I find that baffling and bizarre. It is evidence of the problem that I guess all colleagues of both political colours experience in local politics with regard to health care and trying to change services for the improvement of clinical outcomes, because it is not about cost, although obviously that is a factor, but about improving clinical outcomes. That frustrates me, and I will certainly be dealing with it robustly in local terms. At the moment, it is in the best interests of the general public to have fewer acute hospitals.

Mental Health

Lord Beamish Excerpts

Thursday 16th May 2013 Commons Chamber

[Mrs Moon]

I am very aware of that research; the point I was about to make comes from it. The problem is that we often use the police as our first line in dealing with people with mental health problems, but they are not trained and equipped to carry out that role and function. We must do something about that. Otherwise, the person with the mental health problems is often dealt with as a disruptive element, and treated as if they are someone violent and aggressive, rather than someone who has a mental health problem. We must deal with that problem.

Words and anecdotes can be dangerous, particularly in the military. Research was published this week by the Defence Analytical Services and Advice agency on Falkland veterans. It found that 95 veterans had taken their own lives since the end of the conflict. That figure is lower than previously assumed, although each death is a tragedy for the individual and family involved. The research showed that, of the 26,000 mobilised, 255 died in conflict and 95 took their own lives, but 455 died of cancer. We sometimes forget that our armed forces community has problems we need to address that are not necessarily mental health problems.

[Mr Kevan Jones (North Durham) (Lab)]

I agree totally with my hon. Friend that each of those 95 people taking their own lives is an individual and family tragedy. My problem is that, in opposition, the Conservatives, including the Prime Minister, took the figure used prior to the research and quoted it freely, like confetti, to try to discredit what the Labour Government were doing for veterans’ mental health.

[Mrs Moon]

I tracked that figure back and found that it initially came from a story in the Daily Mail. That is how currency becomes fact.

[Mr Jones]

It was repeated by the Conservatives.

[Mrs Moon]

The repeating of such figures is the dangerous part as it places the perception in people’s minds. More dangerously, it goes into the minds of veterans, who then think, “I have served. I will have a mental health problem and post-traumatic stress disorder,” when the opposite is true. It is incumbent on all hon. Members to ensure that our work and the facts we share come from academically proven research. A study by Lord Ashcroft suggested that 92% of the public believe that all veterans will have a mental health problem, but research suggests that the opposite is true—that 90% do well.

We have had a 15-year report from the King’s Centre for Military Health Research, but we need a 20-year report showing the impact of the draw-down from Afghanistan and the increased numbers of veterans in the community.

In this debate on mental health, words can be dangerous—they can harm and create impressions in vulnerable minds. They can make people believe they have a problem they do not have, or that they have a problem that they can survive and grow from. Military mental health is robust. The transition to civilian life, alcohol misuse and reservists are risks that we must take seriously and tackle. The MOD will need to work more closely with the Department of Health. As people leave the armed forces and become civilians, civilian society organisations need to be equipped and ready to help. As civilians, we face the same problems together.

--- Later in debate ---

[Mr Kevan Jones (North Durham) (Lab)]

It is a pleasure to follow the hon. Member for Broxbourne (Mr Walker), whom I would call my hon. Friend.

I congratulate the Backbench Business Committee and the sponsors of this debate. Remarkably, this is the second debate on this subject in less than a year. I think we should have one every year in order to raise issues that affect many in the House and many of our constituents. Our last debate was on 14 June 2012, when I spoke about my depression and the hon. Member for Broxbourne spoke about his struggle with mental illness. We were both a little wary about what the reaction would be, but it has been nothing but positive, to the extent that he and I have become the Eric and Ernie of the mental health conference circuit. I leave it to you, Madam Deputy Speaker, and the House to discern which of us is Eric and which is Ernie. I have received well over 1,000 e-mails and letters, and I think one was negative, but so what? As I said last time, if people did not like me before I spoke last year, they are not going to like me now.

The most remarkable thing for me is that some people I thought I knew well have told me about their own mental illness. I want to pick out three. I will not name any individuals, and I pick them out only to demonstrate that mental illness and depression are equal opportunity conditions. It is not determined by social status, education or what someone does in life. The first was a chief executive of a large council whom I have know for many years. If she was here today, hon. Members would think her a confident and forthright individual, but speaking to her after the debate, I learned that she suffered terribly from post-natal depression.

The second person was the chief officer for a large European defence company. I am sure that some people in the House have met him several times. He is the last person hon. Members might think suffered from mental illness but, as he explained to me, 10 years ago he suffered from a bad bout of depression. The third person, remarkably, is a retired general I know. Others in the House will know him. I will not mention his name, but again he is not someone we might think suffered from mental illness. I pick out those three to demonstrate my point. These are not weak individuals or failures in life, but confident individuals, and had they not told me, I would not have known, and neither would anyone else, apart from their immediate families.

I want to give another example. I was on Chester-le-Street in my constituency one Saturday morning. I was walking down the street and a lady, perhaps in her late 50s, early 60s, came up to me and said, “Mr Jones, can I thank you for what you said on mental illness?” I said, “Thanks very much.” She said, “I’m a recovering alcoholic who had 10 years of depression, but now, with the proper support, I am leading a good, constructive family life.” Normally, if I had walked past her in the street, I would not have thought that this well-dressed, middle-class lady had suffered from mental illness. That reinforced the point that unlike a broken leg, for example, we cannot see mental illness. Every day we pass people in the street or working with people—people we might know very well—who have suffered from mental illness or who has a family member who has suffered from it.

[Ian Austin]

What my hon. Friend is saying illustrates how important the speeches that he and the hon. Member for Broxbourne (Mr Walker) made were. The key point is that despite the number of sufferers who battle against these problems at some point in their lives, there is still a huge amount of stigma attached to them. That is why debates such as this are so important. On his point about health, it is quite right that the Government and public health organisations do so much on smoking, weight loss and reducing alcohol intake to improve health and well-being, but why does he think so little is said publicly, or by health organisations generally, to raise the problems of mental health?

[Mr Jones]

That is our great challenge, and not just for the present Government. We did a lot in the last Government to recognise the problem. I pay particular tribute to my right hon. Friend the Member for Leigh (Andy Burnham), who championed IAPT—improving access to psychological therapies—services, for example, but part of the problem is cultural. We do not talk about these issues in this country. I think that is changing—I will come to the stigma in a minute—but for anyone who has suffered from a mental illness or who has a family member who has, there is a sense of shame. There should not be, but there is a sense in which talking about it means that those people are failures, when I would argue the opposite. In many cases it is a sign of strength. With the right support, people can function normally, work perfectly normally and have a perfectly happy and productive family life.

[Yasmin Qureshi]

I congratulate my hon. Friend on being brave and speaking about his situation—as I congratulate the hon. Member for Broxbourne (Mr Walker) on speaking about his—and on highlighting the issue. There is a stigma attached to it, and we should discuss it more. My hon. Friend said that the lady who approached him said that she was able to recover after she was given support. Does he agree that some mental health treatments are often quite costly? There is a funding issue, so should we not also encourage the Government to ensure proper funding for services across the country for everyone who may have problems?

[Mr Jones]

We need to explode the myth that the problem is funding. I do not think it is; I think it is where the funding is spent—a point raised earlier. Indeed, funding that is properly spent on early interventions for people with mental health issues will save the NHS money in the long term, not cost it.

[Mrs Moon]

There is an issue with the interaction of mental health and alcohol. I repeatedly had texts from a dear friend of mine who is a minister in the Church. He had severe depression and was self-medicating with alcohol. His family and the police would repeatedly take him to mental health services, which would turn him away, because they said he had been drinking. He was drinking because he needed their services and could not access them. We have to ensure that mental health services cannot turn away people who have been drinking, but hold them until they are no longer under the influence of alcohol and then ensure that they access the services they need. The link between alcohol and mental health has to be explored and tackled.

[Madam Deputy Speaker (Dawn Primarolo)]

Before the hon. Member for North Durham (Mr Jones) continues, let me say that interventions are becoming speeches in their own right, when they are supposed to be brief and pertinent to the point that has just been made. If we could return to that, perhaps it would help the flow of the debate.

[Mr Jones]

It is a statement of fact that people with mental illness will self-medicate, and alcohol is the most easily available drug. I am surprised by what my hon. Friend describes. If services are taking that approach to people, that is wrong. Her point is also linked to the bigger debate about access to alcohol.

Let me return to the issue of stigma, which my hon. Friend the Member for Dudley North (Ian Austin) raised. He quite rightly said that we do not talk about it, but we are making some progress. I thank Mind, Time to Change, Rethink and the Royal College of Psychiatrists for doing a great job of raising the issue and tackling the stigma. We should remember that it is not just the individuals with mental illness who suffer, but family members too. Earlier my hon. Friend the Member for Ashfield (Gloria De Piero) mentioned her own family. A lot of families suffer in silence because they think there is no one to turn to. In many cases, they think they have failed in some way or wonder where they can get help. It is not uncommon—I have come across a lot of these cases—for carers to end up suffering from mental illness themselves because of the daily pressures on them.

The hon. Member for Broxbourne raised the issue of schizophrenia. I pay tribute to the Schizophrenia Commission, which reported towards the end of last year. It looked not only at services for schizophrenia, but at the stigma attached to. Again, the popular image in the media is that someone suffering from schizophrenia is potentially the mad axeman or woman next door who will come and kick the door in, when nothing could be further from the truth. When we describe people’s conditions, there is an onus on us all to describe them properly, because there are people suffering from schizophrenia who, with proper treatment and support, can function quite normally.

I also pay tribute to the hon. Member for Croydon Central (Gavin Barwell), who introduced the Mental Health (Discrimination) (No. 2) Act 2013—a good use of a private Member’s Bill. Like my friend the hon. Member for Broxbourne, I also pay tribute to Lord Stevenson, not only for championing the Bill through the other place, but for the work he does with his new charity. Did that legislation help in itself? Yes, it did, because it sent a clear signal that we were starting to take discrimination more seriously. Will it change things overnight? No, I do not think it will, but the more we talk about the stigma, the better people can address it.

I have been criticised—we see this occasionally in some newspapers—by people who say, “Well, it’s okay for famous film stars or even MPs to say they’ve suffered from mental illness,” as though it is somehow an easy thing to do, but I can tell Members now that it is not. I would like us to reach a position where people generally are talking about mental illness, so that if people are suffering in a workplace, they can open up to their colleagues. I should point out—not just to people in this Chamber, but to those in the wider audience—that most people who are suffering from a mental illness would be very surprised by the reaction if they told people. However, it is a big step, and I know personally that it is a very difficult one to take.

One of the best examples of that was from a Channel 4 programme that I appeared on after I spoke last year—I pay tribute to Channel 4 for its work to raise awareness of the stigma around mental illness. The programme had the great title of “Mad Confessions” and was presented by a very mad individual called Ruby Wax. By chance, it happened to include one of my constituents, Derek Muir, who suffered from depression. The programme started with him talking about his depression—he had been off work for a number of months and lives in Edmondsley in my constituency. At the end of the programme they got all his colleagues together in a room and he told them. It was the first they had known about it, but the reaction was very positive and supportive. That is the point we need to get to. Sometimes it is a big step for people suffering from mental illness or depression to admit what is seen as a frailty—although it is not. The strength is in opening up and asking for help.

One area that we need to do more work in is getting mental health policies in the workplace right. I pay tribute to BT and Dr Paul Litchfield for their policies, which have buy-in not just at the level of personnel managers, but from the board downwards. They are not only talking about getting people to talk to one another and open up about mental illness, but trying to be supportive of people with mental illness. When I was at a seminar with Paul last year, somebody asked him, “Why has BT done this? Is it just to tick the social responsibility box?” He said no. Indeed, the board was quite clear: the policy makes economic sense for BT. The message we need to get across to more and more employers is: “Why write off people who are valuable to your business, just because they happen to suffer from a mental illness?” BT is to be congratulated, and I certainly congratulate the board and Paul on their work in this area.

[John Glen]

The hon. Gentleman is making a typically brilliant speech on this subject. Will he also focus on what we could change in regard to education in our schools? For many, laying the foundations of understanding at an earlier stage, prior to the workplace, would be very effective in creating better outcomes and helping all those young people who have to witness mental health problems among adults.

[Mr Jones]

The hon. Gentleman makes a very good point: schools are important in this regard, and it is important to get young people to talk about the issue. I have a fantastic charity in my constituency called If U Care Share, run by Shirley Smith. It was created following the tragic circumstances in which Shirley’s 19-year-old son hanged himself. Her organisation goes into schools, youth groups and football clubs—Shirley is working with the Football Association and others—to get people talking about their emotions. We need to get more of that kind of work going.

The workplace is important. Although he is not in the Chair at the moment, I want to pay tribute to Mr Speaker, as well as to the House of Commons Commission. Following our last debate on this issue, they earmarked some funding for our own mental health in this place. Dr Ira Madan, the head of the unit across the road that MPs and staff can access, has told me that that was valuable in that it allowed her to assist Members with mental illness, and that there had been an uptake of the services since the money was made available. I would recommend that anyone who wants to go and have a chat with her should do so, as she is a very good and open individual. We must give credit to Mr Speaker and the Commission for that funding, because that was not an easy decision to make, especially as he was getting criticism from certain newspapers for giving special treatment to MPs. It is not special treatment; it is a vital service. Unfortunately, it is still not open to many MPs because of the stigma that surrounds mental illness.

[Norman Lamb]

I pay tribute to the hon. Gentleman for the incredible contribution that he has made to this subject over the past year or so. It was encouraging to hear what he said about Mr Speaker’s actions, and I want to alert him to the fact that I am trying to get every Government Department to sign up to Time to Change, so that they can all make the commitment to be an exemplar. If we are talking about what employers in the private sector should do, it seems to me that we should be taking the lead here.

[Mr Jones]

I have spoken at a few events with the Minister, and I want to thank him for his interest in, and understanding of, this subject. Getting Government Departments signed up to Time to Change would be a very good move, and he should please ask if he requires any assistance from me.

I want to talk about an issue that affects many of our constituents—namely, the work capability test and the ongoing issue with the company Atos. Is work good for people’s mental health? Yes, it is. Should people be in work if they can work? Yes, they should, with the right support. The problem with the work capability test, however, is that it is still not looking at people with mental illness with any sympathy or understanding.

I believe that individuals with long-term mental illnesses should be taken out of the current work stream, and that there should be a dedicated system for dealing with such people. I am not saying that we should write them all off and leave them at home without making any assessment, but we cannot continue with the present ludicrous system in which they are assessed by the same people who assess claimants with bad backs and other injuries. There are assessors with no expertise at all in mental illness. The assessment process is leading to some people’s conditions being made worse, and, in some cases, to people taking their own lives. One of my constituents has taken an overdose because of the trauma of being asked to attend an interview.

[Jeremy Corbyn]

My hon. Friend is making an excellent point. Does he think it would be better if, instead of calling people with mental health conditions in for an interview, Atos simply sought medical reports on them and then considered setting up an interview with a suitably qualified examiner? Would that not be better than the production line that Atos operates at the moment?

[Mr Jones]

My hon. Friend makes a good point. The starting point should be the medical history of those individuals. Someone at the Department for Work and Pensions has said that it is not possible to identify such individuals, but that is complete nonsense. The process my hon. Friend has just suggested should be the starting point.

Professor Harrington’s review of the process put forward the idea of mental function champions. The Government spun that idea out a bit, as though it was the big answer to the problem, and I actually fell for it at the beginning, thinking that those people would be the ones who would carry out the assessments. That was not the case, however; they are there to give advice to the Atos assessors. We still have assessors with no mental health qualifications.

Representatives of the charity Mental Health Matters, a good advocacy charity in the north-east, have just met Atos to ask about the champions, and a number of questions have been raised. Atos would not tell them how the champions were recruited, and there is no indication that they need any formal qualifications. I understand that they are given a two-day Atos in-service training course, but they do not interact with any of the royal colleges or other outside bodies. Remarkably, they are also not accountable to the DWP. I put it to the Minister that he needs to tell the DWP that this must be looked at again. The process is not only causing a lot of heartache and difficulty for many of our constituents; it is actually not a good use of public money. People are failing the tests and going to appeal. At least one of my constituents has been affected in that way. They sometimes go through the process and end up in a residential hospital for a month, which must cost more than the amount of benefit that might have been saved.

We also need tailor-made programmes for people with mental illness. We should consider a separate work stream that could include voluntary work, given that many people with mental illness find the transition back into work through voluntary work easier than being thrown straight back in. We also need a pool of employers who understand and are sympathetic towards people with mental illness. There is an idea that such people can just join the normal job market and that employers will just accept that they might not turn up for work for a day or a week because they are not feeling well, but that is not the case. Those people will not keep their jobs for very long.

[Nic Dakin (Scunthorpe) (Lab)]

I was at a recent meeting of the Mind support group in Scunthorpe, and I was concerned to hear people saying that they were anxious about taking on voluntary work because of the impact it could have on their benefits and their access to other services. Does my hon. Friend think that that issue needs to be looked at?

[Mr Jones]

Yes, it does. If there were a separate work stream for those individuals, of which the voluntary sector was a part, we could use the voluntary sector to get people back into the world of work. I agree with my hon. Friend, however, that they should not be penalised for doing so through loss of benefits.

I also want to talk about the old issue of the NHS reorganisation. It provides some great opportunities for doing things differently, and there should be an opportunity for local providers to bring in the third sector. I have one problem with that, however. I am president of the local Mind, which has just received a contract to provide certain services, and the process it has to go through is very difficult. I am not suggesting for a minute that such organisations should not be performance managed, because there are some large contracts involved, but we need an easier system for applying for the contracts. We also need to ensure that when bodies are competing for the contracts, people can access the services.

Another area of concern is the increased waiting lists for IAPT services. I know that the world has changed since 1 April, and people who lobby on behalf of mental health services are going to have to change their lobbying tactics. It is important to ensure that commissioning groups have an understanding of mental illness and of the importance of IAPT services.

If we look at the Royal College’s report, we find that people are going through the system saying they are quite happy when they get a diagnosis, but are then told they might have to wait up to a year for a talking therapy—that is just no good. What we need—again, this will save the NHS and the economy money—is a quick service such as the IAPT service. I know from people in my own constituency and others who have written to me that the wait is totally unacceptable. If we want to make this work, we have to make sure we have a joined-up service and that people who want a diagnosis get the support they need quickly. Otherwise, people will be stuck in this no man’s land between diagnosis and treatment.

Another area on which the new organisation needs to focus is local government. Local government now has an important role in health care through health education and protection. The Royal College of Psychiatrists is working with councils on a project to have champions at the local level. It is important for local councils to have councillors or chief officers who can champion the need for mental health services locally.

I welcome the debate. It is important to talk about these subjects, and the more we do, the better. To adopt an old BT phrase, “We need to talk”. If we talk about it—whether it be in schools, the workplace or here—we will erase the stigma of mental illness. That has to be the goal: mental illness being treated just like any other long-term condition. People should not be afraid of admitting to it and should not feel that they cannot be helped. We also need to recognise that in many cases—including, I have to say, my own—it can be strength rather than a weakness.

--- Later in debate ---

[Jeremy Corbyn (Islington North) (Lab)]

Like all the other Members who have spoken, I welcome the debate. It is important for us to have it, and I hope that it will become an annual event. It is a way of reducing the stigma that is attached to mental illness, increasing understanding of it, and also, quite correctly, holding the Government to account on how their policies develop.

There is still an enormous amount of discrimination against people who have suffered from some kind of mental illness or breakdown, or have spent time in a long-stay institution. Like all discrimination, it is incredibly wasteful of resources, because it means that those people cannot contribute to society in the way that we want, and as a result we all lose out.

I want to raise two points. The first relates to local experiences, and the second to national policies. My borough has an image as being relatively wealthy and high-achieving, and there are certainly some wealthy and high-achieving people in it. Islington council, however, undertook an interesting exercise: it set up a fairness commission to examine the quality of the delivery of public services to everyone in the borough, with the aim of ensuring that the purpose of the council’s policies, including health policies, was to reduce inequality.

According to a briefing that the council gave me before the debate, it is estimated that in my borough

“30,000 adults experience depression or anxiety disorders in any one week…. Mental ill health among 5 to 17 year olds is estimated to be 36% higher…than the national average”.

The briefing states that more than one in eight children are

“experiencing mental health problems at any one time.”

It also states:

“The suicide rate is… 8 per 100,000…second highest in London”,

and broadly

“similar to the national average”.

Physical ill health is often related to mental health problems. According to the briefing,

“Poor mental health was found in 43% of all Islington patients who died of cardiovascular disease before the age of 75. As people live longer, there are an increasing number of people with dementia, although Islington has a relatively smaller number of older people”—

only 9% of the population. Islington has a 70%—higher than average—rate of diagnosis of dementia. Increasingly, as others have pointed out, people who care for adults with mental health problems are much older people who find it extremely difficult to cope. Those carers need more support, so that they are better able to look after people who are becoming more and more dependent.

Both my local council, in its study, and the Mental Health Trust draw attention to the enormous over-representation of people from black and minority ethnic communities in the context of diagnosis and, in particular, the context of long-stay institutions. We should ask whether there is, in fact, a higher level of prevalence, or whether there is a perception that it is somehow OK to put black and minority ethnic people into long-stay institutions, whereas it would not be OK in the case of other people.

Indeed, I urge Members to visit long-stay institutions and talk to people resident in them. I get the impression some of them have had very difficult lives and very little support, and that they have led very isolated existences. I also get the impression that many of them have very few friends and very little representation, and whereas those who come from a fairly stable family background with a series of understanding relatives are able to get representation and often win their cases where there has been a section order, others do not get the same quality of representation and consequently do not win any tribunal cases.

In an earlier speech, I made an intervention about the role of the voluntary sector in dealing with mental health conditions. As I have pointed out, my borough has considerable problems in dealing with mental health, but we have a number of very good local organisations that often deal with mental health issues in an innovative and supportive way, and are often very successful. Nafsiyat, an intercultural therapy centre based in Finsbury Park which was founded by the late Jafar Kareem, was groundbreaking in its ideas of looking at the cultural background and ensuring culturally appropriate treatment of people with mental illness, for example by making sure there are people who speak the necessary languages and understand something of the specific cultural background. The Maya Centre, which particularly relates to women, does much of the same work, as does ICAP or Immigrant Counselling and Psychotherapy, a counselling and psychotherapy centre originally founded by people in the Irish community that now deals with a much wider community.

We also have a considerable refugee population. A very good group called Room to Heal deals with people who have achieved asylum status in this country. They have often been through the most dreadful experiences of torture, which are frequently dealt with in a community way. People meet regularly and do things together, such as gardening and taking trips. Many of them improve a great deal and get through the terrible traumas they have suffered. I find it very interesting talking to people from different countries all around the world who have all experienced torture in one form or another and who have benefited from these activities. We also have the Refugee Therapy Centre and the Women’s Therapy Centre, which also provide therapy on a culturally sensitive basis. Finally, we have the Holloway Neighbourhood Group stress project.

These are all valuable groups, and they all depend on contracts obtained either from the local health authority or neighbouring health authorities. All of them spend a great deal of time filling in forms in order to gain what are often relatively small sums of money for relatively short-term contracts. Health authorities must value these organisations and look to use them. We should give out the message that we recognise that the voluntary sector has a very important complementary role to play in supporting statutory services in the treatment of mental illness. I do not see them as competitors or rivals; I see them as complementary.

[Mr Kevan Jones]

I agree with what my hon. Friend says about the smaller contracts these organisations get and the bureaucracy they have to deal with. Does he agree that some of them could bid for larger contracts to provide services as well, but the bureaucracy and financial hurdles involved in bids for such contracts make it very difficult for them to do so?

[Jeremy Corbyn]

I agree. The bureaucracy involved and the skewing of the contract culture frequently means voluntary organisations that have a tradition of the voluntary provision of services—often in an effective and innovative way, as I have described—are debarred by the contracting process. Instead, very large private sector medical companies come in to privatise those services and run them in a profit-related way, rather than the voluntary sector, which is motivated not by profit, but by the care of the individuals. I urge Ministers to look very carefully at how services are contracted out to the private sector, which is motivated by profit, as opposed to voluntary sector organisations, which often have a very good record in looking after people who need help and support.

We must also recognise that if we are to deal with mental illness problems in any community, there must be a level of understanding that goes wider than just what GPs, hospital doctors and the statutory services do. There is the question of signposting. I pay tribute to local organisations—voluntary groups, churches, mosques —that understand the situation and help signpost people into getting help and support, because many people in our society with some degree of mental illness get no support whatever. This debate may well help us to understand that that is needed.

We must also recognise that there is a cost involved. The cost to health budgets of dealing with mental health is very high. Unfortunately, the policy of community care for the mentally ill has often resulted in lack of care, and in deep isolation and serious problems for the individuals concerned.

I recall a debate in the House in 1986. The Select Committee on Health was looking in an interesting and critical way at the closing down of large asylums and long-stay institutions, such as Friern Barnet and Napsbury, that existed all around London, and, indeed, all around the country. The Committee warned that community care should not be seen as a cheap option, saying it should instead be seen as an opportunity, but as one requiring comprehensive support, support workers and care.

I am sure all MPs have talked at their surgeries with neighbours of those with mental health problems who have come to complain about noise and inappropriate behaviour. Many of them say to me they are sympathetic to the plight of the individual, and recognise there is a lack of support. We should not see community care as the cheap option. It is an option that can be followed, but a great deal of support is also required to carry it through.

[Mr Kevan Jones]

Does my hon. Friend also agree that under the new NHS structure, local councils will have to do a lot more in terms of understanding the needs of people with mental health conditions?

--- Later in debate ---

[John Pugh (Southport) (LD)]

I apologise to the House for not having been here at the start of the debate. I was in the Finance Bill Committee, and unfortunately I cannot be in two places at the same time. I also apologise for missing the introductory speech by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow). I pay tribute to everything he has done to put mental health on Parliament’s agenda.

It is unquestionably the case that Parliament has got its act into gear on this. I refer to Parliament rather than the Government or the Opposition because this is genuinely an all-party matter. Last night I went to a very encouraging event, which other hon. Members attended, run by the Alzheimer’s Society. The Minister was there, as was the shadow Secretary of State, a Conservative Minister, and my right hon. Friend the Member for Sutton and Cheam, and they spoke with their customary eloquence. In fact, to be fair, there were not very many Members there. I think that other people were detained with matters that had something to do with Europe. However, all of us who were there would have to acknowledge that no matter how eloquently the Minister or the shadow Minister spoke, the most impressive speech was by a very feisty medical lady who had Alzheimer’s and discussed the importance of talking about her condition and people talking to her about it.

That emphasises the fact that there is a blurred division between people who have mental problems, allegedly, and those who appear not to have them. There genuinely is not a clear distinction, other than at the extremes. If we were asked who here has perfect mental health, we would not necessarily all volunteer with alacrity, any more than we would if someone asked who has perfect physical health. It is rather like the Bible saying that the person who is without sin has to step forward. We would not say that because we acknowledge that we all have our own peculiarities and weaknesses and are not as mentally robust as we would always wish to be.

I was made aware of that the other day when I went to an event organised by Liverpool Personal Service Society, which is a well-established charity. The event was a memory day for elderly people in which it invited me to participate. The old ladies and old men were passing round objects that came from their youth, and music was being played in the background that also came from their youth. The environment was made to look almost like a 1950s drawing room. I was very struck by what it did for them. It was like the events organised by football clubs such as Everton and my own local football club in Southport, which bring old men together to talk about teams long since vanished and the glories of the past.

I picked up on two important features of that occasion. First, it was undoubtedly beneficial to the people concerned, who have dementia. Secondly, it is not in any way onerous for anybody else to participate in it. It is incredible fun. It is really enjoyable to hear these people talking about things that are now obsolete, like cigarette cases, nylons of the kind that people had in the war, or EPs—things that we no longer have and that our children do not even understand. That brings it home to us that memory is very relative. There is no magic cut-off point between a memory lapse that may afflict us at any time—

[Mr Kevan Jones]

Nick Clegg knows all about that.

[John Pugh]

We are presumably talking about unintentional memory lapses—senior moments that may afflict any of us.

There is no absolute cut-off point between mildly obsessive behaviour and obsessive compulsive disorder, between mood swings and genuine bipolar conditions, or even between irrational fears of which everybody is sometimes a victim and some of the conditions we would call paranoia. There is a continuum; it is, to some extent, a matter of degree. It is even possible, apparently, to have hallucinations without having schizophrenia. Delusions are not unique to asylums; there are many victims in this place. There is nothing especially rational about clever, civilised people gathering here every Wednesday at 12 o’clock just to shout at one another.

There are two aspects to addressing the stigma of mental health. One of those is to persuade people that this can happen to anyone, including MPs. That is very important. The other job is to persuade the public that mental health is not an either/or, black/white distinction. I recognise that there are conditions such as serious neurological malfunctions, deterioration of the brain, and so on. Affective disorders can be evident in people classified as being well and also in people classified as being unwell with mental health issues. What determines the classification is not only the severity of the condition—the extent to which the person is down one continuum or another—but the capacity of society to deal with the condition and the ability of the person to cope within society with the condition. The cultural comparison made by the hon. Member for Bolton South East (Yasmin Qureshi) is useful in this context. The mental health of a society and the mental health of individuals are intertwined, and one is the index of the other. I wonder whether, when we talk in this place about producing a prosperous society or economic growth, or doing something about social mobility or social inequality, we ask ourselves sufficiently whether we are doing enough to make society a happy place for us all to live in.

Let me add one other point with which I think you, Madam Deputy Speaker, will be au fait. Community treatment orders were a bone of contention throughout the passage of the Mental Capacity Act 2005, when I served on the Bill Committee. We have to review that issue, and the Minister needs to make a response. I think that we made the right decision, but that depends on whether the Act is understood and implemented properly. There is a genuine case, particularly given some of the variations, for trying to see whether we have got it right.

--- Later in debate ---

[Norman Lamb]

I am grateful to the hon. Gentleman for his intervention. I was going to mention his contribution, even though I was not present to hear it, for which I apologise. As a Member of Parliament, concerns have been raised with me about the suitability of those tests for people with mental health problems, and I was going to suggest that I should talk to the appropriate Minister at the DWP. I am of course happy to do that. Someone else made the point that this is not a question of not addressing the need to help people get back into work. Work is particularly important in relation to people suffering from mental ill health, and the idea that we should simply leave them undisturbed and out of work for the rest of their lives is totally wrong. The way in which we handle this is incredibly important, however, and if we have more to learn in that regard, we should be prepared to learn the lessons.

[Mr Kevan Jones]

I made the point in my speech that work was good for people with mental illness. The problem is that the present system is inefficient and costly, and that it is creating absolute agony for many people. I know that the Minister has a great understanding of, and a deep passion for, the subject of mental health, and I urge him to put pressure on the DWP to change the system. We are not asking that people should be excluded completely from work capability tests; we are just asking for the system to be changed.

[Norman Lamb]

I am grateful to the hon. Gentleman for reminding me that he, too, had made that point. I knew that someone else had talked about it, but I could not remember who it was. I take his point; I have heard it.

My hon. Friend the Member for Southport (John Pugh) made a thoughtful speech in which he talked about reminiscences. Oh! He has gone! Even though it pains me, as a Norwich City supporter, to talk about Everton, it appears that Everton and even Southport have done some very good work in these areas. My hon. Friend talked about a continuum of mental health. That was a good point, well made. He also mentioned community treatment orders and the need to look at how they are working. I will certainly reflect on that.

My hon. Friend the Member for Battersea (Jane Ellison) made a powerful contribution about the mental health aspects of female genital mutilation, a most horrific experience suffered by so many young girls. I really pay tribute to her for the work that she has done on that issue. The fact that there are 66,000 females in this country who have suffered this assault was an extremely striking point.

The hon. Member for Finchley and Golders Green (Mike Freer) talked about waiting times for access to treatment. He asked if he could gently challenge the Minister—I appreciated that approach. On the mandate for the NHS Commissioning Board, NHS England has been very clear that we expect it to assess the scale of the problem of access, including for IAPT. Other Members have raised the question of whether we are meeting the IAPT programme’s four-week target. We want the NHS Commissioning Board to assess the scale of the problem with a view to setting access standards.

One of the big problems relating to what I regard as the institutional bias against mental health is that on one side of the equation we have the 18-week maximum waiting time for physical health, which is a very powerful political driver of where the money goes, yet we have nothing equivalent for mental health on the other side. That, to me, is a lack of parity of esteem. For people with mental health problems, early access is particularly important to ensure that their condition can be halted, if possible, and the deterioration stopped. The hon. Member for Finchley and Golders Green made a good point there, and he also rightly talked about the importance of consistency and continuity of care.

I want to mention four of the most important things that this Government are doing to create the environment and incentives for improving mental health across the system as a whole. The first is the Health and Social Care Act 2012, which creates a “parity of esteem” so that mental and physical health share the same importance, as we have discussed this afternoon. Changing the law is just the start, but it sends a clear signal—that mental health is important, and that the health and care system can and must play a leading role in changing attitudes across society as a whole.

Secondly, there is the mandate the Secretary of State has issued to NHS England. It shows the importance we have ascribed to mental health and makes it clear where improvements are needed. The mandate makes clear our overarching goal—that mental health must have equal priority with physical health across all aspects of NHS work. In particular, we have highlighted the need to close the gap in outcomes between people with mental illness and the population as a whole, as well as the absolute imperative to ensure that people can access the services they need when they need them. Neither of these facets of good mental health treatment is entirely up to scratch at the moment. I think we all recognise that.

Immigrants (NHS Treatment)

Lord Beamish Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

Yes it is. We are always likely to pay out more than we receive under that scheme because we have a number of pensioners who decide to retire to slightly sunnier climes and there is a cost to the UK under EU treaty law with those decisions. My hon. Friend is right to point out that just as inadequate as our failure to charge people from outside the EU when we should is our failure to collect money from inside the EU when we are able to, and we must also look at that.

[Mr Kevan Jones (North Durham) (Lab)]

The Secretary of State has clarified the Prime Minister’s figure of £20 million, but he used inflammatory language to my hon. Friend the Member for Bolsover (Mr Skinner) about health tourists clogging up A and Es. He claims that £200 million could be the tip of the iceberg, but if he does not know the figure is that not the worst example of dog-whistle politics?

[Mr Hunt]

If we do not know the figure, is not the right thing to do to find it out and sort out the problem, unlike what the hon. Gentleman’s party did during 13 years in office?

Suicide Prevention

Lord Beamish Excerpts

Wednesday 6th February 2013 Commons Chamber

[Mr Nigel Dodds (Belfast North) (DUP)]

I am pleased to follow the hon. Member for Pudsey (Stuart Andrew), who spoke about the impact that suicide can have. He mentioned a memory of his school days. In preparing for this debate, I, too, reflected on my first acquaintance with suicide. At school one day, we discovered that a chap in my class in the third year had died by suicide. I experienced feelings of absolute bewilderment and shock that someone who had been with us only the previous day—playing a normal role in school and taking part in normal activities—was gone from us. I remember racking my brains and feeling totally bewildered. What had caused it? Were we missing something? That vivid memory, which will never leave me, had an enormous impact on me.

Just today, a friend of mine related to me the sad news of the death by suicide overnight of a mutual acquaintance, and again those feelings of shock and bewilderment came back. I am sure that every hon. Member can relate to this issue in some shape or form. I know that some have experienced personal loss through death by suicide. It is very painful, but it is right that we talk about it, so I am glad of this opportunity to say a few words. Only by highlighting this issue of suicide and talking about its causes and what prompts people to take their own lives can we in some way help others not to go down this path. We need to talk about what we can do in government and society and through working with voluntary community groups to help these vulnerable people.

I want to talk from my perspective as the Member for Belfast North, which has been mentioned a number of times. It has one of the highest suicide rates of any part of the United Kingdom, with 25.2 deaths per 100,000 in the period 2006 to 2011. In the last five-year period for which we have figures, from 2007, that figure crept up to 25.9 per 100,000. As has been said, only the constituency of Belfast West has a higher rate. Those rates are high for Northern Ireland, which has high rates compared with the rest of the United Kingdom. I therefore know about this issue from my constituency surgeries, as well as from meetings with the Minister of Health in Northern Ireland, Edwin Poots, from delegations that I have led of families bereaved by suicide and from my work with groups such as PIPS, which my hon. Friend the Member for South Antrim (Dr McCrea) mentioned—I commend him on his excellent speech in introducing this debate—and others that do such tremendous work in Belfast North. They include Lighthouse, FASA—the Forum for Action on Substance Abuse—and many other charities and Churches.

Those working in such organisations do enormously dedicated work in difficult circumstances, often volunteering and bearing a great emotional burden every day, as they cope with young people, middle-aged people and older people who are going through difficult times, as well as counselling and helping in a practical way families who have been bereaved. This work takes a great toll on the volunteers and others working in such organisations. I commend them publicly for the work they do on behalf of us all.

[Mr Kevan Jones (North Durham) (Lab)]

I have similar organisations in my constituency doing the kind of work the right hon. Gentleman describes. One of the questions they are asked by many relatives is: “What did we do wrong?”, which is a very difficult issue to deal with.

[Mr Dodds]

The hon. Gentleman is absolutely right. When I speak to people working in those organisations, I am told that this issue comes up time and time again. It is very difficult to give answers to families who are struggling to cope with the nature of the passing of their loved one. Often it is hard to find any answer that can satisfy—it is just not possible to do that—but in the long run, the work these organisations do provides enormous consolation, help and support. The work of the Samaritans has been mentioned. The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) mentioned Papyrus, and there are many, many others. It is right to put on record our tremendous debt to such organisations and the people who do such tremendous work.

The new suicide prevention strategy, which was launched in September 2012 here in England and Wales, is excellent. The chair of the advisory group, Professor Appleby, who has been mentioned, has said:

“Suicide does not have one cause—many factors combine to produce an individual tragedy.”

Therefore,

“Prevention too must be broad—communities, families and front-line services all have a vital role.”

That is absolutely right, and that is why our motion today talks about government, community and society—all of us—working together to try to prevent suicide. The Samaritans chief executive, Catherine Johnstone, has made an important point—I suppose this sums up what we are trying to get at today—which is that

“suicide can be prevented by making sure people get support when they need it, how they need it and where they need it.”

We know that that is very difficult and complicated to put into practice, because as has been said—the hon. Member for Bridgend (Mrs Moon) mentioned this and the Minister reiterated it—75% of those who die by suicide were not known by, or in contact with, social services. This is not just a simple matter of saying that it is about people who are having mental health problems and who are known to the various agencies; that is often not the case at all.

As I have said, we have a particular problem in Northern Ireland, where death by suicide has gone up by 100% in less than 15 years. Some 300 people each year are dying by suicide in the Province, with men three times more likely to die in that way than females. I shall discuss some of the reasons for men being more prone to taking their lives and for their reticence in coming forward.

The hon. Member for North Down (Lady Hermon) asked the Minister a question about the amount of money that was being spent. I am glad to say that the Department of Health, Social Services and Public Safety in Northern Ireland has spent £32 million over the past six years on suicide prevention under the Protect Life strategy. That money has been extremely helpful, and it has been well spent on helping some of the groups that I have mentioned.

Of course, money can do only so much, because of the broad range of reasons that lie behind suicide. I will not go over all the issues that have been mentioned, but I will deal with one or two of them. As well as social isolation, there is the problem of drug misuse, which my hon. Friend the Member for East Antrim (Sammy Wilson) mentioned. In Rathcool and elsewhere in my constituency, good work is being done to try to reach young people with drug problems and to counter those problems. We are finding that a lot of young men—again, it is particularly young men—who get themselves into that situation end up attempting to commit suicide or actually dying by suicide. Problems with alcohol abuse are also a factor.

I also want to draw attention to a piece of research recently carried out by Mike Tomlinson of the school of sociology at Queen’s university. The key finding of his study entitled “War, peace and suicide: the case of Northern Ireland” was that

“the cohort of children and young people who grew up in the worst years of violence…have the highest and most rapidly increasing suicide rates”.

Those generations were the most acculturated to division and conflict, and to externalised expressions of aggression. The report continues:

“The transition to peace means that externalized aggression is no longer socially approved. It becomes internalized instead.”

My constituency of Belfast North probably suffered more than any other constituency in Northern Ireland—that could be true of Belfast West as well, but I can speak only for my constituency—during the period euphemistically known as the troubles. That was a heinous, horrible period of our history, with its violence, blood-letting, murder and mayhem. Today in Belfast North, and in Belfast West, we are still paying the price for that period of violence and bloodshed. Young men and women are still dying, as are middle-aged men and women, as a result of the troubles in Northern Ireland. Nowadays, they are dying not as a result of murders committed by paramilitaries, but as a direct result of the troubles because, having been brought up in a culture of violence, they cannot cope in this period of relative peace.

--- Later in debate ---

[Mr Kevan Jones (North Durham) (Lab)]

I congratulate the Democratic Unionist party on securing this debate. It is a privilege to follow a very moving speech by the hon. Member for Foyle (Mark Durkan).

The right hon. Member for Belfast North (Mr Dodds) is right to say that the reasons for suicide are complex. The question that most families usually ask is: why? My constituency has a great organisation called If U Care Share, which was set up by Shirley Smith, whose 19-year-old son, Daniel, hanged himself a few years ago, having not showed any of the signs referred to by the right hon. Gentleman. He was, the family thought, a perfectly happy, contented teenager. The family then wondered what they could do. They set up If U Care Share, and Shirley, her husband, Dean, and their children, Ben and Matthew, go into schools to talk to young people about suicide and people’s feelings. People should not be ashamed to open up and talk about their feelings. They also work with youth clubs and the Football Association to get their message across.

The hon. Member for Pudsey (Stuart Andrew) noted how the highest number of suicides seem to be among men, and the hon. Member for Upper Bann (David Simpson) mentioned the figure of 6,000. I have just looked up the figure and it is about 4,500 who are actually men. As the hon. Member for Pudsey has said, mental health is not an issue that we talk about. I might sound like a broken record, but we need to keep talking about mental health.

Today’s debate is good because, as the hon. Member for Foyle has said, we are talking about one of the great last taboos. The more we talk about mental health and the effect of suicide—not just on the individual and the lost opportunities for them and their family, but on society—the better we can draw up the systems to help.

There is nothing wrong about talking about mental health, or about people admitting that they need help. As the right hon. Member for Belfast North has said, that is the big step that needs to be taken in most cases. We need to get the message across, not only to young people, but to everyone, that if they are in distress they need to ask for help. In my area, the statistics show that an older generation of men in their 30s and 40s are committing suicide. A reason for that might be the issue of the economic role of men in society, which has been mentioned. Unless we talk about it and put it on the national agenda, we will continue to come up against these issues.

I have just one point to make. We need to join up the services, because the roles of the voluntary sector and the NHS are vital. GP commissioning could have great benefits, but it also brings great risks. I fear that when GPs commission services, mental health services might again be seen as the poor relation. We need a joined-up approach if we are to prevent the tragic losses that are now at a level which most people would say is unacceptable.

I will finish by saying—again, I will sound like a broken record—that the more we speak about these issues, the better it is, because it will help young people and others who are in distress to take the major step of getting the help that is there if they only ask for it.

[Mr Deputy Speaker (Mr Nigel Evans)]

To resume his seat no later than 5.45, I call Mr Jim Shannon.