Public Health: Coronavirus Regulations

Kevin Hollinrake Excerpts

Tuesday 13th October 2020 Commons Chamber

[Matt Hancock]

Yes. The introduction of the three-level system means that, in some areas where the local area has been working so effectively to get the curve flattened, as in the west midlands, under the leadership of Andy Street—there has been a rise in the past few days of data, but essentially a huge amount of progress has been made—changes have had to be made. However, I will absolutely recommit to working with Andy Street, who is an incredibly effective voice for the west midlands, to make sure that what we can do together can best deliver to control the virus in the west midlands. I pay tribute to my right hon. Friend, who makes the case on this so effectively, because protecting our economy and protecting our health are not alternatives. We must act and keep the virus under control to protect lives and livelihoods. I strongly believe that every one of us, young or old, has the ability to suppress the virus through the actions we take and the best way to protect the vulnerable, support the NHS and protect the economy is to get the rate of transmission down.

I turn to the steps we are taking to do that and, therefore, the instruments before the House today. Yesterday, the Prime Minister provided an update on the measures we are taking, which centre on three local covid alert levels in England.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

The rate of transmission varies significantly within the eight different districts of North Yorkshire. When we are looking at putting different areas into different tiers, can we look at that by district rather than at county level?

[Matt Hancock]

Yes, absolutely, and I will go further than that: we look at this at sub-district level, if that is appropriate. In High Peak we put four wards into level 2 and the rest of the wards stayed in level 1. So we are prepared to look at the sub-district level if that is appropriate. Some districts within North Yorkshire have individual outbreaks in individual institutions that we are managing, and we should not mistake that for general community transmission and therefore put those areas into a higher level than is necessary. I am happy to go through the local epidemiology from near Thirsk that affects my hon. Friend’s constituency.

In a sense, that brings us to the point of these local covid alert levels. These are the first statutory instruments to be debated under our commitment to consult Parliament on significant national measures that have effect in the whole of England or are UK-wide and, wherever possible, to hold votes before the regulations come into force. That is what we are doing today.

Local action has proved to be one of our most important lines of defence. Where firm action has been taken—for instance in Leicester, or in Bolton, where we flattened the curve—our local approach has inevitably produced different sets of rules in different parts of the country, as my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell) set out. We have already moved towards simpler national rules that are centred on the rule of six, and we are now acting to simplify and standardise the rules at a local level.

The regulations set out three levels of alert: medium, high and very high. The medium alert level, which will cover most of the country, will consist of the current national measures. This includes the rule of six and the closure of hospitality at 10 pm. The high alert level reflects the interventions in many local areas at the moment and that aims to reduce household-to-household transmission by preventing social mixing between different households indoors, with the rule of six outdoors. That is super-simple: no household mixing socially indoors and the rule of six outdoors.

The very high alert level will apply where transmission rates are rising most rapidly and where the NHS will soon be under unbearable pressure without further restrictions. In those areas the Government will set a baseline of prohibiting social mixing, while allowing households to mix in public outdoor spaces, because that is where the risk of transmission is lowest, as long as the rule of six is followed. That baseline is set out in the very high alert level regulations being considered today. Pubs and bars will be closed, and we will advise against travel into and out of very high-risk areas.

We also offer a package of support for individuals, businesses and councils. That includes more support for local test and trace, which many have asked for, more funding for local enforcement and the offer of help from the armed services, as well as the job support scheme announced by the Chancellor. That is best done as a team effort and, wherever possible, we want to build local support on the ground before we introduce these measures. So in each area we will work with local government leaders on the extra measures that need to be taken. We do not rule out further restrictions in the hospitality, leisure, entertainment, or personal care sectors, but retail, schools and universities will remain open.

Social Distancing: 2 Metre Rule

Kevin Hollinrake Excerpts

Monday 15th June 2020 Commons Chamber

[Edward Argar]

Before I answer, may I put on the record on behalf of myself and my hon. Friends our very best wishes to the hon. Member for East Dunbartonshire (Amy Callaghan) for a swift and full recovery? I hope that the hon. Member for Central Ayrshire (Dr Whitford) will be able to convey our sentiments to her when they speak. The hon. Member for East Dunbartonshire is a member not just of the SNP family but of the family of this House, and we all wish her well.

The hon. Member for Central Ayrshire is well versed in these issues and is an eminent clinician in her own right. We have made it clear that the 2 metre rule taken in isolation is not the only factor. She is right to highlight the broader context: it is not just about distance, but about duration of contact, how close that contact was, and whether measures were in place to mitigate that, be it screens or other measures. She is absolutely right and, we must always remember that this is not a binary question—it is not just the 2 metre rule, or the distance rule, and nothing else. We must look at it in the round, as the Chancellor and, I believe, the First Minister of Scotland, rightly said. That is exactly what this review will be doing—looking at all those factors in the round, to come up with appropriate scientific and economic advice to the Prime Minister and Ministers so that they can make a balanced decision.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

The Minister is absolutely right that the evidence is changing daily and that we have a menu of options to deal with the transmission of covid. Increasingly, face coverings look effective. Would it not be worth relaxing some measures, such as the 2 metre rule, which make the pubs and restaurants in Thirsk and Malton and every other constituency financially unviable, and tightening up in other areas, such as requiring the compulsory wearing of face coverings in shops, and in pubs and restaurants when moving to and from a table?

[Edward Argar]

My hon. Friend makes a very good point and, as ever, a gentle but clear plug for his constituency encouraging people, when it is safe to do so, to come and enjoy those businesses and that hospitality. He is right to do so, because I—like every other Member of this House, I am sure—have spoken to restauranteurs and those in the hospitality industry and pubs, who are all very clear about the impact that this has on the operation of their business. We are incredibly sensitive to that, but it comes down to making an appropriate judgment on the scientific evidence, balancing economic impact and keeping the disease under control. He is right to allude to other measures within that package or menu of options, which will of course be taken into consideration in the review.

Covid-19 Response

Kevin Hollinrake Excerpts

Wednesday 22nd April 2020 Commons Chamber

[Matt Hancock]

I am terribly sorry, I do not recognise those reports at all. There is no impact at all from Brexit on our coronavirus response. The good news is that thousands of nurses and other clinicians have come back into service since the crisis started.

[Kevin Hollinrake (Thirsk and Malton) (Con) [V]]

Daniel Falush, a professor of infectious diseases based in Shanghai, points to the fact that part of China’s successful efforts to control the virus was immediate quarantining: people go to a clinic, they are tested immediately, they wait for the results—it is a 15-minute test—and, if the test is positive, they are quarantined there and then. Will the Health Secretary consider that as we open up our economy, because it has the potential for significant mitigation of the chances of a second wave of the virus?

[Matt Hancock]

Well, of course we look at all options. Under the test, track and trace strand, the policy advice on how people should isolate if they test positive is an important part of that. That advice is in place, but of course test, track and trace also relies on self-isolation to ensure that it is implemented properly. Test, track and trace is about finding out who needs to take action—they then need to take the action set out.

Covid-19 Update

Kevin Hollinrake Excerpts

Tuesday 24th March 2020 Commons Chamber

[Matt Hancock]

I will raise that question and make sure that the appropriate guidance is put on gov.uk.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

The Secretary of State is doing an excellent job and is being incredibly responsive, despite what I appreciate must be the huge volume of correspondence coming into his inbox. He is damned if he does and damned if he doesn’t. However, there is confusion about whether people should be going to work or not. From both a health and an economic perspective, as a business owner, I would much rather have a short, sharp shock, with everything closed down for 30 days to get this disease under control and allow the Secretary of State to get his testing and tracking in place and defeat it.

[Matt Hancock]

I agree with what my hon. Friend has said—and not just the first bit—but I repeat what I said in my statement. I want to be clear that, where people absolutely cannot work from home, they can still go to work. Indeed, it is important that they do so to keep the country running.

Oral Answers to Questions

Kevin Hollinrake Excerpts

Tuesday 10th March 2020 Commons Chamber

[Helen Whately]

We have the NHS visa, which applies to the whole United Kingdom. The Migration Advisory Committee has been clear that UK immigration policy must benefit the whole UK, and Scotland benefits from its own shortage occupation list, which will continue to exist.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

Does my hon. Friend agree that a German-style system of social insurance for adult social care would relieve the burden and reduce the requirement for overseas workers, by allowing a loved one, a neighbour or a friend to provide that care and be properly remunerated for it?

Social Care

Kevin Hollinrake Excerpts

Tuesday 25th February 2020 Commons Chamber

[Barbara Keeley]

I absolutely agree with my hon. Friend. The only way that we will see real change is if the Government put in funding to provide the housing and support needed for those people currently trapped in inappropriate institutions. I first raised this issue with the Secretary of State in October 2018, citing the case of a young autistic woman called Bethany. It took 14 months before Bethany was moved out of a seclusion cell and into a more supported environment. Now we have, as my hon. Friend has said, the Equalities and Human Rights Commission launching a legal challenge against the Department for its failure to move those 2,200 autistic people and people with learning disabilities out of those inappropriate units.

We must see action on this issue, because it is a national scandal. We need to see reform so that more people can get the care they need, rather than being left to struggle on alone. Even when people are able to access publicly funded care, there is no guarantee that it will be of acceptable quality. Last year, one in six social care services was rated by the Care Quality Commission as “inadequate” or “requires improvement”. That can mean care homes that are so unclean that residents are at risk of picking up infections. It can mean home care agencies that have not even carried out basic checks on their staff, or home care staff being so rushed that they do not have the time to take off their coats during a visit.

Twenty per cent of councils in England and Wales still commission 15-minute care visits. That is clearly not long enough to provide care. It is not long enough to get to know someone and support them to do the things that they want to do.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

A German style system of social insurance would allow somebody who is defined as needing social care to draw down a certain amount of money which they could then use to pay to a relative, a loved one, or a neighbour who understands that person best and who can care for them best. Is that not a sensible basis for a cross-party discussion, between the Opposition and the Government, about whether a German style social insurance system could solve this problem?

[Barbara Keeley]

I thank the hon. Gentleman for making that point; he does make it on every occasion that we debate this subject, so I congratulate him on doing so again. However, the person he needs to be directing his comments about cross-party talks to is sitting on the Government Front Bench. I am hopeful that the Secretary of State is going to tell us what he is going to do about cross-party talks, because those 15-minute visits are really not good enough.

NHS Funding Bill

Kevin Hollinrake Excerpts

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

[Jonathan Ashworth]

It is unacceptable, and sadly it is happening constantly in the English NHS. Of course, on certain performance targets there is improvement in Wales; there is no improvement on any performance targets when it comes to A&E or electives in the English NHS. I welcome the hon. Lady to her place and she is right to raise that issue, but I hope she will also raise with the Secretary of State his poor leadership on performance data for the English NHS.

The long-term plan rightly calls for more investment in areas of the NHS that have been neglected for many years, particularly mental health services, community health services and primary care. We endorse the approach outlined in the long-term plan. Mental illness represents around 23% of the total disease burden, but only 11% of NHS England’s budget. Mental health patients are some of the most let down by the decade of decline in the NHS. We regularly read heartbreaking reports in the newspapers of patients forced to wait up to 112 days for talking-therapy treatments, when we know that people are supposed to get an improving access to psychological therapies appointment in six weeks. We regularly read of the shortage of mental health beds, which means that too many people—often young people—are sent hundreds of miles across the country. They are often young people in desperate circumstances, sent away from their family and friends, often receiving ineffective care in poor-quality private providers. The rationing of care for children in particularly desperate circumstances has seen more than 130,000 referrals to specialist services turned down, despite those children showing signs of eating disorders, self-harm or abuse. It is totally unacceptable.

The long-term plan calls for increased investment in mental health services, which we welcome. Had we won the general election, we would have gone further and invested more to deliver parity of esteem for physical and mental health, and we would have legislated to ensure health and wellbeing in all policies with a future generations wellbeing Act. None the less, we welcome the ambition in the long-term plan to increase the proportion spent on mental health. In the past 10 years, under intense financial pressures because of underfunding and austerity in the NHS, commissioners have had to raid budgets, especially child and adolescent mental health services budgets, to fund the wider NHS. In the past 10 years, mental health services have often lost out because of financial pressures in the system so, if such an amendment would be in scope, we will seek to amend the Bill to ensure guarantees for mental health funding and that mental health funding can be ring-fenced. We will also seek look to ensure that there is a framework of accountability, under which the Secretary of State would come to the House, perhaps once a year, to update it on mental health funding and where it is being spent.

We endorse the increased funding for mental health, community services and GP services at a faster rate. If the Government are genuinely committed to that, and if at the same time the NHS is to live within its 3.3% uplift, that means that by definition less money will remain for growth in funding for the acute sector. The Secretary of State will need to moderate the rate of growth in acute demand, because if he cannot, there is a risk that either the money that he is allocating to mental health services will be diverted back to hospitals, as has happened in the past 10 years, or waiting times will have to increase and A&E performance will have to worsen ever further.

The problem is that the Secretary of State will not be able to drive up performance and moderate need without a fully funded plan for the whole of the health and social care sector. That is why the Bill is fundamentally inadequate. When in June 2018 the previous Secretary of State, the right hon. Member for South West Surrey (Jeremy Hunt), came to the House to outline the funding settlement, he quite rightly said that he would not be able to fix the various problems facing the NHS if that did not happen alongside a funded staffing plan, a funded multi-year capital plan and a funded social care plan. The previous Secretary of State was correct. The problem with the Bill is that, as the Secretary of State conceded, it excludes key areas of health spending, such as public health; health visiting; the training of doctors and nurses; the capital budgets to build and maintain hospitals; and the capital budgets for community health facilities. That is before we even get on to social care funding, which is another issue that has in effect been kicked into the long grass by the Secretary of State.

We all know that public health services are crucial services that keep people well, prevent ill health and keep people out of hospital. A year ago, the Secretary of State would do interviews to tell us that public health and prevention was his big, No. 1 priority. I remember his interview in The Sunday Times in which he said that he had ordered the behavioural insights team to target those who are obese, smokers and people who drink to excess. He said he would “not rule out” using social media to target people to change their ways. Pregnant smokers would get emails to encourage them to stop smoking. This is my favourite; this is what he actually said—well, it is quoted in the article:

“Those in hospital with ailments related to alcohol abuse will be targeted for a ‘stern talking to’”.

That is what he said on prevention a year ago. What did we get instead? We got more cuts to smoking cessation services, more cuts to alcohol addiction services, and more cuts to drug misuse services. That is what we have had in the past 12 months, because budgets have been cut as part of the wider £870 million cut to the public health grants. The Secretary of State did not mention public health in his remarks. We still do not know what the public health allocations will be for this year. He is asking the House to legislate for a funding allocation that the previous Secretary of State outlined to the House 18 months ago. He cannot even tell us the public health allocations beyond the next three months. That just reveals what a ridiculous political stunt this Bill is.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

In his earlier remarks, the hon. Gentleman mentioned social care. He will be aware that the Health and Social Care and the Housing, Communities and Local Government Committees recommended in a joint report a range of options, one of which was a social insurance premium. Will he agree to cross-party talks, and does he think that all those different options laid out in that report should remain on the table for discussion?

[Jonathan Ashworth]

I am grateful to the hon. Gentleman for his intervention. He is a considered authority on these matters, and I appreciate the spirit in which he has made his intervention. We are not convinced that a social insurance model will work. In those countries where there is a social insurance model—I think in Germany and in Japan—they have largely been building on a social insurance model for their healthcare delivery. In Japan—I may be wrong on this, and I will correct the record if I am wrong—there is a taxation element as well.

We believe that there is a degree of political consensus on the future funding of adult social care. We agree with the House of Lords Committee, which includes people such as Michael Forsyth and Norman Lamont, that we need a form of free adult social care paid for by taxation. There is a version of it in Scotland and in Northern Ireland. We believe that, if the Government are prepared to talk to us on those terms, we could find political consensus, but at the moment the Secretary of State stands outside that political consensus.

[Kevin Hollinrake]

The hon. Gentleman makes some interesting points, but is it not the case that the best way forward is not to have a precondition about the subject of those talks, and that we should simply have a cross-party discussion? In that way, he can find out more of the detail behind the Japanese system, which he says he is lacking. Why does he need to make preconditions to those talks?

[Jonathan Ashworth]

The Government have no proposals whatsoever. They have been talking about bringing forward a social care plan for years now. As I have said before in the House, Members are more likely to see the Secretary of State riding Shergar at Newmarket than see a social care plan. The truth is that, if the Government want to put forward some proposals, we will always be happy to talk to them. We are clear that taxation is the best way to fund adult social care, and that we need a version of free personal adult social care. That is what we have put in our manifesto, and that is what the House of Lords has proposed, and, as I have pointed out, there are some very Thatcherite Tories on that Committee in the House of Lords—they are by no means red in tooth and claw socialists. They have looked at all these different options and came to the conclusion that a taxation-funded system is the best way to go, but, of course, we are prepared to have discussions. I am grateful to the hon. Gentleman for the way in which he put his question. He is a very thoughtful figure in the House and he has done a lot of work on this matter, and Members on both sides of the House appreciate that.

As I was saying, the Secretary of State cannot tell us the allocations for public health budgets beyond the next three months. We have talked about capital, but we still do not have a multi-year capital settlement. We still do not know whether the Secretary of State will rule out the capital to revenue transfers that have taken place over the past 10 years. If we can find an amendment in scope, we will put it down to rule out capital to revenue transfers. If he agrees that capital to revenue transfers are not in the interests of our hospitals that desperately need to deal with their repair backlog, I hope that he will support such an amendment.

The Bill does not provide a proper costed plan for the workforce. There is nothing in the Bill on training budgets, when every single trust chief executive reports that understaffing is their biggest challenge, and a hindrance to delivering safe care. The numbers employed by trusts over the past decade have grown at half the rate of 2000, and this is at a time of increasing need. As I have said, with vacancies numbering more than 100,000, the situation across the NHS is chronic. Staff shortages mean overcrowded wards, lengthening queues in A&E, cancelled operations and exhausted, burned-out staff with low morale who feel that they must do more with less. Perhaps we should not be surprised that the numbers leaving the NHS citing bad work-life balance has trebled under this Government.

In these circumstances, the Government expect to retain 19,000 nurses and recruit an additional 31,000, although they are not actually bringing back a full bursary to do so. At the same time, vacancies for nursing today stand at about 44,000, so the Government are hardly going to resolve the crisis in nurse vacancies that our trusts are facing. Not only have the Government failed to train enough nurses, they have not dealt with the taxation changes affecting doctors. On diagnostics, one in 10 posts are vacant in England, so if the Government are to meet their promise to diagnose three in four cancers at an early stage by 2028, we need to see significant growth in the NHS cancer workforce as well. We have no funded workforce plan, even though it was promised by the Government when they announced these funding allocations back in summer 2018.

This all matters, because the NHS will simply not be turned around without the investment in public health that is needed, without recruiting the extra staff that are needed, without modernising buildings and equipment and without fixing our broken social care service. The Secretary of State will not be able to improve performance across the NHS and level up health outcomes while the Government continue to pursue their austerity agenda.

We have seen a decade of cuts, which has seen child poverty rising—it is set to rise to record levels—increasing rough sleeping on our streets, insecure work becoming the norm, poor quality housing becoming commonplace, local services being cut back and closed, and an increase in air pollution. All of these things determine the health of our constituents.

Austerity means that the advances in life expectancy that we have come to expect since the second world war have begun to stall. Infant mortality rates have increased three years in a row. The last time that that happened was during the second world war. We are seeing increasing mortality rates for those in their 40s—so-called deaths of despair from suicide, drug overdose, and alcohol abuse—and the gap between the health of the richest and the health of the poorest getting wider and wider. Not only have we seen in this decade of austerity widening inequalities in health outcomes, but we are now seeing widening inequalities in access to health services—the poorest wait longer in A&E, the poorest wait longer for a GP appointment because there are fewer GPs in poorer areas, the poorest have fewer hip replacements, and the poorest are less likely to recover from mental ill health.

Oral Answers to Questions

Kevin Hollinrake Excerpts

Tuesday 29th October 2019 Commons Chamber

[Mr Speaker]

I ask Members for one-sentence questions from now on.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

Does the Health Secretary agree with the joint report produced by the Housing, Communities and Local Government Committee and the Health and Social Care Committee that the best way to fund adult social care is through a social care premium?

[Matt Hancock]

The joint report was excellent.

Social Care Funding

Kevin Hollinrake Excerpts

Tuesday 1st October 2019 Westminster Hall

[Sir Vince Cable (Twickenham) (LD)]

I beg to move,

That this House has considered social care funding.

I should like to introduce a discussion on the funding of social care and narrow that to adult social care and the specific areas covered in the admirable Library briefing around the Green Paper in its absence.

It is a relief to debate something that is not about Brexit, although there is probably some indirect connection. Attempts have been made to blame the delays on Brexit, but the Secretary of State was candid enough to acknowledge that deep-seated disagreements going back 20 years explain why we are at an impasse on the basic principles.

There are a couple of contradictions or paradoxes that we must try to unravel. We all say that the only way forward is to have an all-party consensus, but at the same time the issue is increasingly weaponised. We all say that this is an incredibly urgent problem, but it stays for longer and longer in the long grass. Until we get to the root of those problems, we are not going to make any headway.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

Will the right hon. Member give way?

[Sir Vince Cable]

Will the hon. Gentleman wait a moment? I will happily take interventions in a few minutes.

At the root of this—and trying to be generous to all parties—is a lot of public misunderstanding. This is a complex subject. To take just one point, half of the adult social care budget is not about old people; it is for younger adults. The public fundamentally misunderstand the nature of the means test—most people do not realise it exists until they encounter it. Consequently, people are frightened when they see proposals that are characterised on one side as a death tax and on the other as a dementia tax, apparently unaware that we have a death tax and a dementia tax now.

I cannot in my short contribution solve such a fundamentally difficult problem that has been going on so long, but we need to try to disentangle issues that are fundamentally different. My primary concern is social care—how we support people in the community so they can function with a proper life, preferably at home, outside of hospital.

A totally different set of problems—wealth, property and inheritance—leads to a lot of the emotional angst caused by what is sometimes called catastrophe risk: people landed with financial obligations as a result of having long-term personal care and the expense of £50,000 a year or whatever in a residential home. However, that is about wealth, distribution and assets. It has nothing to do with health and we have to try to separate the two.

--- Later in debate ---

[Kevin Hollinrake]

I am grateful to the right hon. Gentleman for giving way. I am also grateful for the opportunity to discuss this matter on a cross-party basis. He mentioned a cross-party consensus earlier. Is he aware of last year’s joint report by the Health and Social Care Committee and the Communities and Local Government Committee on the future funding of social care? That report came to a cross-party consensus on how we can move forward, and one of the solutions was a social care premium.

[Sir Vince Cable]

Yes, there is a lot of joint thinking. We have the joint House of Commons Committees, and my hon. Friend the Member for Totnes (Dr Wollaston), as Chair, was critically involved in that. There is also a very good piece of work by the House of Lords, and the considerable brains of Lord Lawson and Lord Darling contributed to a cross-party consensus. A lot of think-tanking is going on in the vacuum created by the Government’s non-publication. There is no shortage of ideas, but we need to be clear what the problem is—and it is a very serious one.

--- Later in debate ---

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I appreciate the opportunity to talk about something other than Brexit, and to talk constructively, to have a proper debate on the facts, to look at each other’s positions and, I hope, to try to find a middle way. I think it was Lord Tebbit who said that politics was about shooting the crocodile nearest the boat. This crocodile is about to swallow the whole boat. There are three big, ticking time- bombs, all connected to demographics: pensions, healthcare and social care. According to the Office for Budget Responsibility, our national debt is about 80% of GDP. By 2060, unless we look at this issue strategically and change our taxes dramatically, our debt-to-GDP ratio will be 280%. This is not something that we can just put a sticking plaster over and hope it will be okay.

I do not mean to be critical of the Opposition’s policies, but they are moving down the road of free personal care. The difficulty with that is the question of its affordability. We have to understand the sheer scale of the problem. Perhaps, once they do, they will still have the same perspective. Another point is that there is no such thing as “free”, of course. If something is free, it is funded by the taxpayer. Taxes would have to go up significantly to do what is being suggested. The right hon. Member for Twickenham (Sir Vince Cable) talked about putting a penny on income tax, which will raise about £5.5 billion, but he acknowledges that the gap will already be about £8 billion in three or four years’ time. The scale of the problem is huge, and it will simply grow, so we need to look at the facts behind it.

The Health and Social Care Committee and the Communities and Local Government Committee held a constructive inquiry into all those issues and came up with a German-style social insurance premium. I felt that was the most sustainable, simple and scalable option that tackled the future as well as the past.

Germany introduced the system in 1995 and has already revised the level of contributions once. Since 2005, it has increased the percentage of total take from the premium by 56%, at a time when our resources have been decreasing. That shows that this can work on a cross-party basis. It is a simple system based on a percentage of somebody’s income. It is not actually put on national insurance, which I would not advocate, because we would go back, in a future Budget, to arguing about who could put the most on national insurance and who could spend the most on it.

It is an independent system in which people are categorised according to need, so it is possible to calculate exactly how much needs to be raised. In future, we can come to a cross-party agreement about by how much we need to increase the premium, because we will have to increase it. Everybody pays a small amount from their income—not just their salary, so it is for retired people as well. It is also mandatory, which tackles the insurance problem, because the insurance market will not work unless there is universal cover, and it is handled by not-for-profit insurance companies.

The key element in the system is that, when someone is categorised as needing care, they can pay for provision, ask their local authority or provider to give them care, or draw down the money and pay it to a relative or neighbour, so they get care from the people who care for them most and understand them best. That also helps to tackle the staffing element. If we have a system where everybody pays something, nobody has to give everything.

[Several hon. Members rose—]

--- Later in debate ---

[Barbara Keeley]

My hon. Friend is absolutely right. For people with dementia and learning disabilities, seeing a familiar face every day can be crucial.

We cannot allow this crisis to continue. We must see action to ensure that everyone is able to access the care that they need to live with dignity. That is why Labour has announced that we would introduce free personal care for all older people who need it and expand such provision to working-age adults as soon as possible. That would end the scandal of people having to sell their home to pay for basic care. We will fund social care in the only fair, sustainable and understandable way—through general taxation. That is how we fund our NHS and our schools, and it is how Labour will fund our national care service.

Before we can build this new system, we must also repair the damage caused by years of budget cuts. We will invest £8 billion in more care packages, in improved training and in better community support. The apprenticeship levy is not enough for training; skills for care should be better funded.

[Kevin Hollinrake]

Will the hon. Lady give way?

[Barbara Keeley]

I do not have time.

A few months ago, we pledged £350 million a year for community resources, aimed specifically at helping to bring autistic people and those with learning disabilities out of in-patient units—over 2,000 of them—in which they are trapped. It is a scandal that we do not have the social care and community resources that are needed to prevent people being trapped in abusive care. Time and again, the reason given for people being in those units is that there is no resource in the community. My hon. Friend the Member for Plymouth, Sutton and Devonport has spoken about the burden that falls on social care authorities if they end up with a very expensive case. We have to get round that.

We can fix the crisis in social care only by properly funding the system, as the Labour plans will do. Two years after the Conservatives’ disastrous 2017 manifesto plans, which were later dropped, we are still waiting to hear what they will do. The Government’s promised Green Paper has been delayed and delayed, and now it looks to many—including many in this Chamber—as if it has been dropped altogether. The hon. Member for St Ives (Derek Thomas) mentioned how embarrassing that was. It is not just embarrassing; people lose hope waiting for the care they need.

A cap on care costs, which would stop people facing catastrophic costs, and for which we legislated, was ditched by the Government in December 2017. I am sorry to say that instead the Government have provided only small, one-off cash injections—sticking plasters—rather than the long-term funding settlement that social care needs. Will the Minister tell us where the Government’s proposals on social care are? If the Government want to resolve the crisis that their funding cuts have created, as I hope they do, why have they constantly kicked social care funding reform into the long grass? It is time for a solution to the crisis that this Government have created. Labour Members have pledged a way to solve the crisis, which in itself gives hope to many people who need social care.

Suicide Risk Assessment Tools in the NHS

Kevin Hollinrake Excerpts

Wednesday 4th September 2019 Westminster Hall

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I beg to move,

That this House has considered the use of suicide risk assessment tools in the NHS.

It is a pleasure to serve under your chairmanship, Sir Christopher.

According to a detailed study carried out by Manchester University, in one year alone 636 people who were deemed by clinicians to be at low or no immediate risk of suicide went on to take their lives within the next three months. Of course, 636 is just a fleeting fact, one of myriad statistics about the NHS that we can cite every minute of the day, but every one of those 636 deaths is a tragedy—it is a brother, a friend, a partner, a child. One of those 636 people whose lives were lost in that year was the son of two of my constituents, a young man called Andrew Bellerby.

It may break the heart of any parent in this Chamber to see this photograph of young Andrew in his blazer as he went to school some years earlier. As one who proudly took my own children to their new school only this week, it is shocking to think that at some point one might lose one’s child in such circumstances. On 10 July 2015, many years after the photograph was taken, and in the same year as the study that I just mentioned, Andrew took his own life. The loss of Andrew’s life and the devastating impact that it had on his loved ones was, in all likelihood, totally needless. According to an expert witness who represented the Bellerby family, on a balance of probabilities Andrew would be alive today had the NHS trust that was entrusted with his care looked after him properly.

At this point, I would like to play tribute to Andrew’s family, particularly his father, Richard Bellerby. I understand that Richard’s brother is with us today in the Public Gallery; Richard could not be here himself, but I think that he is watching this debate via a parliamentary link. It was only due to his tireless efforts, his determination and his commitment to make sure that others do not suffer the same fate that we are debating this issue today.

Not only did the Bellerby family have to cope with unimaginable grief and loss, but they then had to fight a two-year battle with the Sheffield Health and Social Care NHS Foundation Trust to establish the truth. The truth, which the trust finally and begrudgingly apologised for, was that there had been a simple but fatal series of errors. Andrew’s state of mind was assessed by untrained nurses using an assessment tool—a checklist, for want of a better word—that was not fit for purpose. As a direct consequence, they made an incorrect diagnosis, without even taking into account his past behaviour.

[Jim Shannon (Strangford) (DUP)]

First of all, I congratulate the hon. Gentleman on bringing this matter forward. In Northern Ireland, the figure for suicide is 20% higher than for the rest of the United Kingdom. Does he agree that it has come to the point that all frontline medical staff, from pharmacists to treatment room nurses, should be trained in appropriate suicide risk assessment, especially taking into consideration the high rate of suicide across the whole of the United Kingdom, and in particular in Northern Ireland?

[Kevin Hollinrake]

The hon. Gentleman is absolutely right. That is one key component of three: training nurses; using a proper, validated tool; and taking into account the past behaviour of the individual and the context of the situation. None of those three things was in place for Andrew. As a consequence, 48 hours after being admitted to hospital in an ambulance, Andrew took his own life.

[Liz Twist (Blaydon) (Lab)]

Will the hon. Gentleman give way?

[Kevin Hollinrake]

I am happy to give way to the chair of the all-party parliamentary group on suicide and self-harm prevention.

[Liz Twist]

The hon. Gentleman is raising a very serious issue. I am grateful to Samaritans for a briefing on it ahead of this debate. It is absolutely clear that these risk assessment tools are not in themselves complete. They must be supported by consideration of the context, including previous history, and by a professional assessment of what is happening. Does he agree that it is absolutely essential that all trusts ensure that that happens?

[Kevin Hollinrake]

I entirely agree with the hon. Lady. I know that the Bellerby family would very much like to meet the Minister here today—the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries)—to see what can be done to make sure these situations do not happen again, and I think they would be very pleased to meet the hon. Lady, too, because I know that she does tremendous work in the all-party parliamentary group.

[Hugh Gaffney (Coatbridge, Chryston and Bellshill) (Lab)]

Will the hon. Gentleman give way?

[Kevin Hollinrake]

I am happy to give way again and then I will make some progress.

[Hugh Gaffney]

I will just add my point, from Scotland. In emergency departments, the staff have not been trained up to the level that we are hearing about today. Suicide is a big risk, especially among young people, and all we are asking for is that people look at this situation and give emergency staff the proper tools and training. If that had happened before, Andrew would be with us today.

[Kevin Hollinrake]

The hon. Gentleman is absolutely right and I am grateful to him for his very kind contribution. I know that Andrew’s family will also be grateful to him.

The fact is that the Sheffield trust had been treating Andrew for many years; it knew him well and knew that he was a serious suicide risk, yet none of this was taken into account when he was admitted to hospital for that fateful final time. The untrained nurses carried out the assessment using a crisis triage rating scale, CTRS, and deemed Andrew fit to be discharged. They rated Andrew 14 on a scale of zero to 15, where 15 means that there is no serious or immediate risk of suicide, despite the fact that Andrew had a history of suicide attempts and also threatened to jump out of a fifth floor window while he was being assessed.

The insult to fatal injury in this case is that Mr Richard Bellerby has had to fight for justice and answers for years. He describes the trust’s role in this process as a campaign of dirty tricks—dirty tricks, denial and deceit. In February 2018, the trust finally admitted its wrongdoing, apologised and agreed to settle out of court, but before doing so it had persistently and gratuitously maintained that it was not at fault. For instance, the trust had said that it had an expert witness whose opinion was that whatever the trust would or could have done, Andrew would still have taken his own life. However, the trust refused to supply that expert witness’s evidence and it appears that such an expert never even existed.

The inquest established that the trust was guilty of missing numerous opportunities to provide help. The trust’s own internal investigation revealed that the nurses who had seen Andrew had no training in this area, which directly contravenes national guidelines. At the inquest, there was an embarrassing blame game between Andrew’s GP and the trust, with each pointing the finger at the other. As Mr Bellerby has said, it was like musicians in an orchestra playing from a different sheet of music, with no conductor.

There appears to be a complete lack of accountability; nobody has been properly held to account for these errors. The trust admitted in its internal investigation that it had failed to carry out adequate risk assessments. In Richard Bellerby’s profession, which is construction, failure to carry out proper risk assessment or failure to train people properly can lead to a charge of criminal responsibility for manslaughter in the event of a fatality.

Instead of being open and honest about the circumstances surrounding Andrew’s death, the trust only corresponded when it was forced do so. There were no responses to Mr Bellerby’s letters unless they were sent by recorded delivery, and even then the only responses came from corporate affairs managers rather than from clinicians, and they still failed to provide answers. The trust has not even responded to my letters, other than to send a holding response. I wrote to the trust on 28 January asking for answers to questions and I chased things up on 6 March, but there was still no full response. When the trust finally agreed to meet Andrew’s father, Mr Bellerby, it was of course a meeting with the corporate affairs director. When Mr Bellerby insisted on a clinician being present, the meeting was cancelled.

The trust refused simple requests for information, such as how long the nurses who saw Andrew had worked at the trust and what their qualifications were. The two-year battle cost the NHS around £40,000 just to reimburse the Bellerby family’s legal costs, in addition to any costs that the trust itself and NHS Resolution would have incurred. The total bill is likely to be in excess of £100,000—all for £9,000 in compensation. Critically, there was no compassion, no condolences and no remorse. Instead, there was contempt, denial and disregard.

To say the Bellerby family won is a travesty. They lost their son, a grandson, a brother, but they did defeat the trust. With the help of their solicitors, Irwin Mitchell, whose efforts were instrumental to their success, they won their case, they received their grudging apology and the trust has now stopped using the CTRS. All the family wanted was recognition of the failures and an apology. Given that, everything could have been sorted on day one. Instead the family had to fight against our own bureaucracy. It beggars belief that we tolerate a system that behaves in this manner.

Surprisingly, given the facts of the case and its role in the two-year cover-up of the truth, NHS Resolutions agrees with having a position of openness. In its 2018 report, “Learning from suicide-related claims”, it states:

“Where compensation is due it should be given willingly and in a timely manner to prevent further distress and suffering to distraught families.”

It is time we lived up to those fine words.

The Bellerby family have worked closely with Manchester University on the inquiry I mentioned earlier, which is called, “The assessment of clinical risk in mental health services”. It has helped to establish the extent of the problem of inappropriate use of suicide risk assessment tools in the NHS and the figure of 636 deaths per annum. It has also established that today, 33 out of 85 trusts use a tool that has not been independently validated and 29% of trusts use it with untrained staff. The national inquiry into safety in mental health recently raised issues of the

“inconsistency across mental health trusts in the length and content of risk assessment tools”

and a

“variation in how tools are used and examples of use contrary to national guidelines”.

Everyone seems to agree that the incorrect use of such tools is wholly wrong. Mental health charity Mind is clear that the Government should standardise tools across the service, improve training and support in their usage and follow-up within 48 hours with those who have received assessments. The Royal College of Psychiatrists said that we should

“move away from a risk assessment model to a risk reduction model”.

I know the Minister will be appalled by the full details of the case and will be determined to help drive change in the system, and I have some questions for her. What has changed since Andrew’s death? Specifically, what action will she take to ensure that mental health trusts are only using risk assessment tools that have been independently validated as safe? What action is she taking to ensure that staff in mental health services receive training in risk assessment? What action is being taken to support staff to be able to talk to people about suicidal thoughts? Will she implement a process so that the Care Quality Commission or another body can check that best practice is adopted? Will she commit to an ambition for zero suicides among all those under the care of mental health services? Will she look at the behaviour of the trust and drive through a new policy of openness and honesty in our health services? Finally, will she meet me and my constituents to hear Andrew’s story and possible solutions at first hand, to ensure that Andrew did not die in vain?

--- Later in debate ---

[Ms Dorries]

I am afraid I must disappoint the hon. Gentleman. This is my third day in, and I have not yet had a chance to discuss Northern Ireland in detail, but as a result of his intervention I will ensure that we do that, and it will be on tomorrow’s agenda.

The letter that NHS England sent out highlights the report from the University of Manchester on “The assessment of clinical risk in mental health services”, and asks trusts to ensure that their risk assessment policies reflect the latest evidence from the university, as well as best practice. I am pleased that NHS England and NHS Improvement have committed to working with trusts to improve risk assessment and safety planning as part of future quality and safety work on crisis care and suicide prevention.

My hon. Friend the Member for Thirsk and Malton asked specifically about the role of the Care Quality Commission in ensuring that trusts are adopting best practice in respect of risk management processes. The CQC has assured me that risk management processes are a key feature of every CQC inspection. I hope that that assurance from the CQC, along with the letter that NHS England sent out this week, will go some way to reassure my hon. Friend.

[Kevin Hollinrake]

I am sure that the work that the Minister has already done to raise the issue with trusts is very positive news for the family. On the basis that people do not do what is expected but what is inspected, it is good to hear that some processes are already in place in the CQC. Will new processes be added? Presumably checks were happening when the situation occurred, so we need something else to ensure that best practice is properly adopted.

[Ms Dorries]

If I may continue my speech, I hope that I can reassure my hon. Friend on that point.

The Government are committed to a culture of openness, honesty and transparency in the NHS. The legal duty of candour means that trusts need to be open and transparent with patients or their families when something appears to have caused, or could lead to, significant harm. Trusts could face action from the CQC if they are seen to be failing to comply with that duty. I think that some good news will come out later in the year that will hopefully reassure my hon. Friend regarding a new culture that will develop within the NHS to encourage staff and clinicians to be more open about incidents as they happen, so that they share information and we can learn from such incidents.

Our national learning from deaths policy has introduced a more standardised approach to the way that trusts review, investigate and learn from deaths. The national guidance on learning from deaths, published in 2017, is about supporting trusts to become more willing to admit to and learn from mistakes, so that they reduce risks to future patients and prevent tragedies from happening in the first place. The guidance is clear that trusts must engage meaningfully and sensitively with bereaved families and carers as part of that process. I hope that, as a result of those measures, what the Bellerby family went through in 2015 will never be experienced by another family. To support our national policy, the CQC has strengthened its assessment of learning from deaths by trusts.

I will talk about what we are doing to reduce suicides across the NHS more widely. People in contact with mental health services account for around a third of all suicides in England, and arguably some of the more preventable ones. The overall suicide rate among people in contact with mental health services has reduced significantly over the last decade, but numbers remain too high. We must not lose sight of the fact that nobody under the care of NHS services should ever lose their life as a result of suicide. At the start of 2018, we therefore launched a zero suicide ambition, starting with mental health in-patients, but asking the NHS to be more ambitious and look to expand it to include all mental health patients.