Perinatal Mental Illness

Kevin Hollinrake Excerpts

Thursday 19th July 2018 Westminster Hall

[Dr Williams]

I thank my hon. Friend for raising that point. I will refer to it later in my speech. I think the pressure on GP services that she has identified is one reason, but there are some other reasons to do with training and perhaps resources.

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

I thank the hon. Gentleman for bringing forward this important debate. To support his case, I will describe the case of Libby Binks, a very brave constituent who came to my surgery. She described how she went through the six-week check without any consideration being given to her wellbeing, despite the fact that she was clearly in distress and had post-natal depression. A health visitor came in at a later stage and filled in a questionnaire with her, which clearly showed she had post-natal depression, but nothing whatever happened until her child’s first birthday. Does the hon. Gentleman agree that we need to make more of that six-week check in particular, to ensure that the mother’s wellbeing, as well as the child’s, is taken into consideration?

[Dr Williams]

I thank the hon. Gentleman for relating the experience of his constituent, which is, sadly, shared by too many other women. Of course, there are many dedicated health professionals who do identify mental health problems, but too many women say that they slipped through the net.

I will talk about why perinatal mental health problems are so important for a child. The first 1,001 days of a child’s life, from conception to the age of two, are absolutely crucial to their social, emotional and cognitive development. Put simply, those 1,001 days are when a brain is built and shaped. During that time, 1 million new neuronal connections are made every second in that child’s brain. When the environment the child experiences, whether inside or outside the womb, is happy, relaxed and stimulating, he or she learns and develops those connections in the brain. The baby grows and adapts in a positive environment.

However, many of the symptoms of mental health problems do not provide that ideal environment. Stress raises the level of cortisol, which can cross the placenta and affect a foetus. When someone is severely depressed, perhaps they do not smile, so a baby does not see the warmth, the love and the reciprocation that they need from their mother. When someone is anxious or has an obsessive compulsive disorder, a baby sees, learns and repeats actions from the environment they are experiencing from birth. They learn to behave like their mother.

A mum’s mental health problem can have such a significant effect on a baby that academics describe it as an adverse childhood experience. Adverse childhood experiences, or ACEs, are stressful events that occur in childhood.

--- Later in debate ---

[Dr Williams]

I thank my hon. Friend for her intervention. I have avoided, as much as I can, talking about money in the debate—not all of this is about money, but there are many opportunities to make a massive difference. If we can draw a direct link between a mum’s experiencing mental health problems and the damage that that may do to her child—it increases the child’s chance of developing health problems and even of being involved in crime later in life—there are certainly opportunities to invest to save.

We must not forget, either, that perinatal mental illness has serious consequences for the mother. Suicide is the leading cause of direct maternal deaths occurring within a year after the end of pregnancy in the UK. It is at least possible that if an effective six-week check were in place, some of those deaths would be prevented. Of course, this is, as many hon. Members have said, a complex issue. Diagnosis and treatment are complex, but in addition some health services undoubtedly do not give women the care that they need. Women feel that they are still being dismissed, stigmatised and ignored. However, we should not blame the individual GPs and health professionals who carry out the checks; we should look to change the guidance, the system and the structure in place.

From its research, the NCT has made three recommendations. The first is to fund the six-week maternal post-natal check so that GP surgeries have the time and resources to give every new mother a full appointment for the maternal check. At the moment, although the check focusing on the baby is contracted for and there is funding available for it, there is no requirement for a six-week check on mothers. Checks on mothers, if they are done, are often compressed into the baby’s check, so conversations about mental health may be rushed or sidelined completely.

A constituent got in touch after I said that I was going to speak in this debate. Her response was surprising. She said:

“After the birth of my first child, I suffered terribly with post-natal anxiety—something I didn’t even know was a thing. I don’t remember anyone ever picking up on how I was feeling and no one ever really asked.

Then after the birth of my second child I believe I was depressed. When he was born I didn’t feel anything which then made me feel guilty”—

a common theme—

“and I struggled to bond with him over the first year.”

She then said:

“I believe I met you”—

meaning me, because I was working as a GP in the constituency at the time—

“at my six-week check with him and I remember you asking how I was feeling. After telling you I think I may have needed to”

get some extra help

“for more therapy, you agreed it was a good idea and told me to come back”

for follow-up. She continued:

“I think women need to know where they can go for help and what signs to look out for. I was too scared to tell anyone that I didn’t feel any bond with my son because I think there’s still such a stigma around mental ill health.

I do think the idea of a separate appointment for the mother would be a good idea and more signposting to support groups, how to self-refer, confidential information and advice.”

That experience with my patient, who is now my constituent, demonstrates the value of making time to identify and explore perinatal mental health issues. It might be argued that GPs should be doing that anyway, even if it is not contracted for. I would respond by saying that some are and some are not. GPs do many things that are not in their contract. But the only way of getting true national coverage and the time needed to do a proper job is to resource it.

[Kevin Hollinrake]

The hon. Gentleman will be aware that £365 million has been set aside for perinatal mental health services. He is not too far away from North Yorkshire himself, and North Yorkshire has just secured £23 million of that to help with perinatal mental health services for new and expectant mothers.

[Dr Williams]

I do give credit to the Government for making investments in this area of provision. We started from quite a low baseline. There has been significant investment. Too many women are still missing out on these specialist services; the coverage throughout the country is patchy, but I acknowledge that things are improving. However, if we are not identifying half the women with perinatal mental health problems, that is a significant problem in itself.

The investment required to identify problems through the six-week check is estimated by the NCT to be about £20 million a year. That is a very small amount in the grand scheme of the NHS’s budget, but it could make a huge difference to many new mothers. Secondly, in addition to the funding for the six-week check, the NCT recommends improved guidance for GPs on best practice on mental health, specifying a separate appointment for the maternal six-week check and the best methods of encouraging disclosure of maternal mental health problems.

A separate check involving supportive, open and encouraging questioning would provide an opportunity for women to come forward with any problem that they may be having. It might also help to eliminate some of the feelings of stigma or shame; 60% of women said that they felt embarrassed, ashamed or worried about being judged. Just because it is in a GP’s contract does not mean that a doctor has to do the work; with the right training in place, it can just as effectively be undertaken by a practice nurse or other suitably qualified healthcare professional. What is important is that it forms part of the ongoing relationship that a new mother has with her GP practice.

The third NCT recommendation covers NHS investment in and facilitation of GP education. It is important that GPs are trained to recognise the symptoms of post-natal depression and differentiate them from “the baby blues”, which resolve on their own; and it is crucial that mothers are reassured and valued, not dismissed.

These three relatively straightforward measures—a contractual obligation, guidance, and training—could make a huge difference to many women’s and children’s lives. They could eliminate some of the preventable problems encountered by women suffering from perinatal mental illness. The average cost to society of one case of perinatal depression is estimated at £74,000. With an already overstretched NHS under immense pressure, these measures could alleviate some of the stresses placed, later, on mental health services; they will inevitably have to deal with the consequences of undiagnosed and untreated perinatal mental health problems.

With this debate, we are already raising awareness and challenging some of the stigma surrounding perinatal mental health, but we also have a unique opportunity to do something practical to address the problem. Negotiations for the new GP contract begin in September, and by holding this debate today, we want to gain wider support for these important recommendations to be included in the new contract.

There are many other areas of perinatal mental health that I hope we get the chance to explore in this debate. We have already discussed the availability of specialist perinatal mental health services. I hope that we also talk about the variable access to psychological therapies, which are excellent in some parts of the country; in other parts of the country, women struggle to access those services, too. I am very grateful to the other hon. Members who have come today to speak and contribute.

I consider myself to be a fortunate father, one whose experience of parenting has so far been very positive. Many parents are not so lucky. When I hear the heartbreaking stories of women whose post-natal depression has blighted their and their family’s experience of parenthood, I am reminded of just how fortunate I have been. I am also acutely aware of how damaging it will be to wider society over the longer term if we do not improve the way in which we handle this issue. We need to bring the hidden half of these women out of hiding. Post-natal mental illness is not just a problem for new mums. If we fail to tackle it, we risk failing the next generation of children, too.

Adult Social Care: Long-term Funding

Kevin Hollinrake Excerpts

Thursday 28th June 2018 Commons Chamber

[Mr Betts]

I completely agree with my right hon. Friend. The fundamental question is: if we can do it, why can’t they? We have done the difficult part. We have set out a framework. Those on the Government Front Bench may not want to accept every detailed element of it, but it is there to work from. It should mean that we ought to be able to get to a consensus and an agreement about what should be done in a much shorter period of time than the years the Government were perhaps initially contemplating.

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

I thank both Chairs for the very constructive nature of the inquiry and the discussions around it, which have led to the report. We need to depoliticise this issue—that is critical—and I believe we have done that in the report. Does the hon. Gentleman agree that one of the most important parts of the report is not just the money it would raise, but how it would be delivered? Individuals who are in receipt of care can direct the payments to their loved ones, the people who know them best and can give them the best possible care. That care being delivered by the people who understand them best and love them the most will strengthen the social fabric of our communities.

[Mr Betts]

Yes, I completely agree. I could not refer to every specific recommendation in my statement. The hon. Gentleman is referring to paragraph 78 of the report, where it states that instead of care being delivered to people, they could receive a cash payment so their family members could do it in a way that suits them best.

Oral Answers to Questions

Kevin Hollinrake Excerpts

Tuesday 19th June 2018 Commons Chamber

[Mr Speaker]

We have been so brief that we must now include Mr Hollinrake.

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

Thank you, Mr Speaker. Probably the most important recommendation in the new O’Neill review into antimicrobial resistance was the requirement for diagnostics prior to the prescription of antibiotics by 2020. Will the Minister update the House on progress towards that goal, and will he agree to meet me and colleagues, including Lord O’Neill, to discuss the establishment of an antibiotic diagnostics fund?

[Steve Brine]

Yes, the Government’s response to Lord O’Neill’s review in 2016 set out new ambitions building on existing progress, including ensuring that tests on epidemiological data are used to support clinical decision making and delivering high-quality diagnostics in the NHS in support of our other ambitions. My hon. Friend is right to raise this issue, and I am happy to meet him.

NHS Outsourcing and Privatisation

Kevin Hollinrake Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Jonathan Ashworth]

Given that Mr Deputy Speaker has just castigated me, let me make a little progress. Hopefully, I will be able to take more interventions towards the end of my remarks.

Underfunding and lack of capacity have driven more and more—

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

rose—

[Jonathan Ashworth]

Mr Deputy Speaker has asked me to make a bit of progress, so let me do so.

Underfunding and lack of capacity have driven more and more NHS purchasing from the private sector. We have seen beds lost in NHS hospitals, which are then increasingly forced to use the private sector. Spending on elective treatments outsourced to the private sector rose from £241 million in 2015-16 to £381 million in 2016-17. In many instances—from mental health provision and detox services for those suffering from substance misuse, to routine elective operations—we often see a poor quality of service in the private sector. The House does not have to take my word for it; the Secretary of State himself intervened recently to demand that the private sector gets its house in order. These risks have been known for years, since the Paterson scandal, and I note that the Government are not proposing to legislate.

Oral Answers to Questions

Kevin Hollinrake Excerpts

Tuesday 8th May 2018 Commons Chamber

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

Lambert Hospital in Thirsk was bequeathed to the town by Sara Lambert in 1890, and was closed via the back door by South Tees Hospitals NHS Foundation Trust last year. NHS Property Services is planning a sell-off to the highest bidder, despite the fair offer that is on the table from the local authority which could include provision for community use such as public health advice. Does my right hon. Friend agree that there are times when value to the public might outweigh the requirement to maximise a price?

[Mr Hunt]

I have spoken to my hon. Friend about this matter, and he speaks powerfully about the community interest in this particular transaction. We have listened carefully to what he has said, and will continue to do so before a decision is made.

Breast Cancer Screening

Kevin Hollinrake Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

My right hon. Friend speaks extremely wisely. We have the Touch, Look, Check campaign, and it is important that we see screening as just one important part of the battle against breast cancer, but it is no substitute for many of the other things that really matter.

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

I thank my right hon. Friend for his statement and for his tone. This was clearly a failure not only of IT, but of quality assurance, so will he commission a review of quality assurance right across the health service to ensure that it is as effective as it should be?

[Mr Hunt]

My hon. Friend may well be right that we need to do that, but what I would like to do first is to see the outcome of this review, what the lessons are and what precisely it says about the quality assurance that applied in this case, and then make a judgment about the implications for the rest of the NHS.

Social Care

Kevin Hollinrake Excerpts

Wednesday 25th April 2018 Commons Chamber

[John Grogan (Keighley) (Lab)]

It is a great pleasure to follow the detailed analysis of my hon. Friend the Member for Warrington South (Faisal Rashid). As a Yorkshire MP, it is always good to follow a Member from the other side of the Pennines—it is early season yet, Mr Deputy Speaker, but particularly when Yorkshire is at the top of the county championship and Lancashire is at the bottom.

I want to take up two points directly from the seven principles that the Secretary of State outlined when he talked about the Green Paper in March. One of them is about a valued workforce, which many hon. Members have spoken about, and the other is about a sustainable funding mechanism for the future.

Every morning in the villages and towns of Airedale and Wharfedale—some of which I am lucky to represent—very early, before the commuters have got up and even thought of going into the great cities of Bradford and Leeds, another workforce have just finished their night shift and are getting the first buses and trains into those cities, where they live. They have the characteristics of the social care workforce, who number about 1.4 million in our country. They are a massive workforce. About 80% are women and 80%—the overwhelming majority—are British, with 11% coming from outside the European economic area and about 5% from within it. There is a massive turnover in the social care workforce, as Unison has illustrated, with more than one in three care workers in care homes leaving their job in the course of the year. It is higher in domiciliary care.

Members on both sides of the House have talked about valuing these workers more. They are undervalued, underpaid and in many cases undertrained. The right hon. Member for Ashford (Damian Green) and particularly my hon. Friend the Member for Leicester West (Liz Kendall) talked about building a consensus, so that in the future we value more this extremely important workforce, who look after the most vulnerable people in our society at the time they need it most.

I have a couple of suggestions for the Government. It was good to hear from my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) that a Labour Government would abolish 15-minute care—the idea that social care workers have to provide for the most intimate needs in 15 minutes, tick a few boxes and then rush off to the next appointment. It makes me proud to be a Labour MP that we are committed to ending that sort of thing and to paying people properly.

There are things the Government could do, and some are little things. I notice that there is an advisory council on the Green Paper. The great and the good are on that advisory council, but it would be good to have a figure from the workforce on it. I remember the Prime Minister speaking on the steps of Downing Street about involving the workforce more. Unison is a union you can do business with, and it would be good to have an additional person from the unions on that council. The Library’s list does not indicate that there is any such person on it at the moment.

If there ever was an industry crying out for a sectoral council, with the Government, the trade unions and the industry, to improve skills and the quality of the workforce, it surely is the care industry. Those are just a couple of ideas.

My hon. Friend the Member for Leicester West spoke passionately about the need to get consensus on a long-term funding model that all parties can agree on. I would stop talking about a “dementia tax”, and the bargain would be that the Conservatives would not talk about a “death tax”. We have used both those terms in the last 10 years, and I agree that they have not particularly enhanced our politics.

The letter from Members of all parties suggested raising and hypothecating national insurance. I would like to keep on the table the idea of an increase in inheritance tax, which the now Mayor of Manchester mentioned in the latter days of the Labour Government. Only 4% of people currently pay inheritance tax. It raises £5 billion. It is a potential way of achieving intergenerational fairness. A national insurance rise at the moment would hit many workers whose real incomes have been cut in recent years, so we should consider the option of raising inheritance tax. I think that many people in our society who are lucky enough to own their own home would accept that bargain—a guarantee that they could pass on the bulk of their estate to members of their family or to any good causes they wanted to support, in return for which I think they would be prepared to pay an additional inheritance tax.

The hon. Member for Central Ayrshire (Dr Whitford) reminded us that one in four of us will end our days in a care home, but of course we do not know which of us that will be. We have to face up to the fact that, under the current system, those of us who are lucky enough to own our own home would lose most of it, if we were in a care home for a prolonged period. I see that as a life tax, rather than a death tax.

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

rose—

[John Grogan]

I of course give way to my Yorkshire colleague.

[Kevin Hollinrake]

The hon. Gentleman talks about one in four of us ending up in a care home, but we do not know which of us that will be. Does that lead him to conclude that we should pool the risk through social insurance, as they have done very successfully in Germany, having moved in 1995 from a local authority-funded scheme to a social insurance scheme, which also has great community benefits?

[John Grogan]

I certainly agree that we have to pool risk, but it has to involve everyone in society, from the poor to the rich, so that whatever our circumstances we get the care we need in those days.

We heard a lot from the hon. Member for North Cornwall (Scott Mann) and other hon. Members about the potential of technology. That is a worthwhile point to make. Age UK has provided all hon. Members with the number of elderly people in our constituencies who need care. For example, in Keighley there are 3,500 long-term disabled people and 16,000 people with long-term illnesses. One way of helping them is through telemedicine from Airedale General Hospital. Even when the “beast from the east” was raging at its worst, people in Keighley, Airedale and the dales, even in remote areas, could still have tests and get treatment via broadband. That kept them out of hospital, even in the depths of winter.

This has been a great debate and I look forward to the Green Paper—may it come sooner, rather than later.

--- Later in debate ---

[Laura Smith (Crewe and Nantwich) (Lab)]

It is an honour to follow my hon. Friend the Member for Stretford and Urmston (Kate Green).

Four weeks ago today, one of my constituents from the village of Hough attended Parliament to speak at Age UK’s parliamentary reception. We meet some people in life whom we will never forget. Joyce Yoxall is one of those people. Those who came to the event will remember her harrowing account of life as an unpaid carer. I was as moved then as I was when I first visited Joyce at her home to discuss the problems she is having with our social care system. Joyce’s husband David suffered a stroke in 2014. Since then, she has been forced to stop the care that David should be entitled to because of its high cost and poor quality. She talked about crippling care costs and how she felt she had been “let down”. I had to fight back the tears as she spoke about being mentally and physically exhausted, and how she dare not think of the year ahead.

Joyce has literally become the face of hundreds of thousands of people—and maybe more—who are in a similar situation by featuring on the front cover of Age UK’s aptly named report, “Why call it care when nobody cares?” The report is the result of 127 interviews regarding the quality of social care that people have experienced. I encourage anybody who has not read the report to do so.

The reason I started by talking about Joyce and David is that I want to remind everybody of the heartbreaking human reality behind the statistics I will refer to later. Let us start by reminding ourselves why those like Joyce might feel let down. As has been mentioned, a growing and ageing population is placing ever more demand on the social care sector, but that should not come as a surprise to anybody who has been living in the real world for at least some of the time in the past few decades.

Almost eight years ago, the Dilnot commission was set up by David Cameron’s coalition Government, tasked with making recommendations for changes to the funding of care. It published its recommendations in 2011, including a more generous means-testing threshold and a cap on care costs. That sounded promising, but after another general election the Government announced that the measures would be delayed until April 2020 and, at around the same time, closed the independent living fund. Then the Government promised to publish a Green Paper in the summer of 2017, but along came yet another general election, during which the current Prime Minister threatened to introduce a dementia tax.

Since then, we have had an autumn Budget in which the Chancellor failed even to mention social care, let alone provide adequate funding. We have seen the Department for Health and Social Care’s single departmental plan, which failed to mention the social care workforce. More recently, we had the spring statement, and still there is no lifeline for those with care needs or their families or carers.

We know that at some point, hopefully before the summer recess, the Government will publish their Green Paper on social care for older people, but we do not yet know when any proposals will be implemented after the consultation. To make matters worse, the Green Paper will not cover care for younger adults, which accounts for almost half of all council spending on adult social care.

[Kevin Hollinrake]

Will the hon. Lady give way?

[Laura Smith]

No.

There has been one missed opportunity after another—delay, delay, delay. Meanwhile, local councils, which are responsible for delivering social care, are seeing their budgets slashed, and one care home after another is placed in special measures or forced to close. What is the result? Research published recently by BMJ Open links cuts to adult social care and health spending to nearly 120,000 excess deaths in England since 2010.

The Care Act 2014 has been about as useful as a chocolate fireguard against a backdrop of inadequate funding and insufficient resources. The legislation has done nothing to protect the 1.2 million older people whose care needs are not being met. Our system clearly places more emphasis on councils setting balanced budgets to an ever-reducing bottom line than it does on making sure that all its residents’ care needs are met.

[Kevin Hollinrake]

Will the hon. Lady give way?

[Laura Smith]

No.

Cuts have consequences: I refer to my constituent’s words—that she

“dare not think of the year ahead.”

I do not blame my constituents for having little faith. The past eight years have been nothing but empty promises and never-ending cuts. Fully integrated health and social care would be a good start, but that does not go nearly far enough. We need a whole new approach to disability and ageing based on a commitment to the social model of disability that permeates every aspect of Government.

For example, our social care system needs to be aligned with an appropriate welfare policy and housing strategy, so that we remove as many barriers to disabled people as possible. Access to services should be on the basis of need and not affordability. I wholeheartedly agree that pumping more money into a broken system is no long-term solution.

[Kevin Hollinrake]

Will the hon. Lady give way?

[Laura Smith]

I have waited a long time to speak and I am going to carry on.

We need to stop viewing social care as a cost or a burden and instead see it as a wealth creator. Penny-pinching has proved to be a false economy when it comes to social care. It undermines the ability to take preventive action that not only is morally and ethically the right thing to do, but saves money in the long run by reducing the demand on our NHS. We also need to stop neglecting our 1.5 million workers in social care and build a more highly skilled and better-paid workforce. Finally, we need to address the failings of privatised adult social care, as outlined in the 2016 report by the Centre for Health and the Public Interest. Without any real debate, market values have penetrated areas where they do not belong and social care is perhaps the worst example of this. We cannot keep burying our heads in the sand and letting the crisis escalate.

There is no excuse for the Government’s inaction. The CQC warned us last year that social care was reaching a “tipping point”. This was after the Prime Minister had herself acknowledged that our system is broken. This cruel, callous Conservative Government have turned their back on older people and disabled people up and down this country. They have also repeatedly let down the social care workforce and the invisible army of unpaid carers.

[Kevin Hollinrake]

Will the hon. Lady give way?

[Laura Smith]

No.

We need a Government who put people before profits. Until then, I fear that we will be left with the same fragmented, failing system that is letting our constituents down daily.

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

We have had a very wide-ranging debate with 16 Back-Bench contributions. I pay tribute to my hon. Friends the Members for Redcar (Anna Turley), for Luton North (Kelvin Hopkins), for Weaver Vale (Mike Amesbury), for Leicester West (Liz Kendall), for Blaydon (Liz Twist), for Warrington South (Faisal Rashid), for Keighley (John Grogan), for Stretford and Urmston (Kate Green), for Crewe and Nantwich (Laura Smith) and for Bedford (Mohammad Yasin) for their passionate, powerful and well-informed contributions. I also thank the right hon. Member for Ashford (Damian Green), and the hon. Members for North Cornwall (Scott Mann), for South West Bedfordshire (Andrew Selous), for Cheadle (Mary Robinson), for Solihull (Julian Knight) and for Redditch (Rachel Maclean) for their contributions. We might not always see eye to eye, but there is consensus that we have to fix the problem in adult social care, although how we go about that will always be up for debate.

[Kevin Hollinrake]

Is the hon. Gentleman aware of the very constructive cross-party, collegiate visit of the Communities and Local Government Committee to Germany, where we looked at its social insurance scheme, which could provide the perfect, sustainable and scalable solution to the adult social care conundrum?

[Andrew Gwynne]

The Government need to decide their position, but there are examples across the world of how adult social care can be funded. We need to make sure we get a system that works for England.

I also pay tribute to the workforce and carers. They do not just need platitudes from us in the House; they need the Government and politicians on their side.

This is the second time we have had to call an Opposition day debate on this issue, following the Government’s lack of action on social care. In our debate last October, there was broad agreement across the House, as there has been more or less today, that reform of social care was a priority, but here we are, six months later, and little has changed. Last month, we heard the Secretary of State for Health and Social Care tell the British Association of Social Workers that he accepted his share of responsibility for the lack of progress since the Conservatives entered government in 2010.

The social care Green Paper, due this summer, has faced substantial delays. We need a commitment from the Government that it will not be delayed any further. There is only so much longer that the sector can wait. Let us remember that in January there was hope that the Government would place an extra focus on social care after the Department of Health was rebranded, but then, shortly afterwards, in what sounded like a tribute act to the Prime Minister, the Secretary of State for Housing, Communities and Local Government told a packed LGA conference—I was there—that

“nothing has changed, nothing has changed”.

Confusion still reigns, and it is true: nothing has changed. This confusion means that 1.2 million people are being denied the support they need.

Let us look at what the cuts mean. According to its director of adult care, social care provision in Northamptonshire County Council—a Conservative council —is

“on the verge of being unsafe”

as a result of the cuts. That council has effectively been the first in England to declare insolvency. According to the director, the additional funds in the local government finance settlement will have “little impact” on the county’s problems, and I fear that that is right, but the Minister will be aware of the widespread fear that what has happened in Northamptonshire could happen again elsewhere. Mark McLaughlin, who was appointed from the Department for Environment, Food and Rural Affairs in December to oversee Northamptonshire’s finances, has warned that all top-tier local authorities will soon face similar issues. Then, only last week, we heard that Worcestershire County Council, the Conservative-run local authority in the constituency of the Secretary of State for Housing, Communities and Local Government, had buried a report expressing urgent concern after rising costs, including the cost of adult social care, had forced the council to use more than half its reserves in the past five years. The Chartered Institute of Public Finance and Accountancy expects the growth in demand to result in a budget deficit of £60.1 million by 2020-21.

Privatisation of NHS Services

Kevin Hollinrake Excerpts

Monday 23rd April 2018 Westminster Hall

[Graham P. Jones (Hyndburn) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Graham. I thank my hon. Friend the Member for Hartlepool (Mike Hill) for introducing the petition and the petitioners for instigating a very worthwhile debate.

I will speak briefly, because I know that many Members want to speak, about fragmentation, accountability, privatisation, and how the NHS in Lancashire is going backwards. We will hear from across the United Kingdom —or certainly England—about the fragmentation of the NHS. It is not providing the services that patients expect.

The Health and Social Care Act was introduced in 2012. It was a top-down reorganisation, although it was promised that it would not be, that cost £3 billion and has caused chaos in Lancashire. That was a promise made by David Cameron that he broke. It has fragmented the NHS: we have lost accountability, we have opened the door to privatisation and we have reintroduced the purchaser-provider competition, which has been mentioned. In the 1990s, that was implemented in social care—it failed, and there was a U-turn.

In Lancashire, we have the high-profile case of Virgin Care’s £104 million contract signed by the Conservative Lancashire County Council, which has been blocked by a High Court judge for reasons of “considerable cost and disruption.” We are seeing the fragmentation of our NHS through the desire to privatise and move towards the purchaser-provider model. There has also been the removal of the Lancashire Care NHS Foundation Trust from Calderstones. The trust has been involved in taking up contracts and being relieved of contracts. The Walton jail mental health service unit is in crisis. It is an important service because we are trying to tackle the issue of mental ill health, yet there is a significant problem at Walton jail. Lancashire Care NHS Foundation Trust picked up the contract from somebody else, but it is struggling; it is underfunded, and the provider keeps changing. That fragmentation is having an impact on those who require these services.

At Calderstones, there was a very large mental health unit on the fringes of my constituency—in fact, it was just inside the constituency of the hon. Member for Ribble Valley (Mr Evans). The unit was rebuilt in 2007, costing £11 million, to provide a cutting-edge mental health service. It was rated “good” by the Care Quality Commission, but it was closed in 2016. How can the £11 million Calderstones unit, which was rated good and moving towards outstanding, be closed in this age and only nine years after that refurbishment? Calderstones Partnership NHS Foundation Trust itself will cease to exist, to be replaced by the Mersey Care NHS Foundation Trust, which will provide services. One service provider is being swapped for another. We are not getting continuity, and there are problems in NHS services, particularly mental health services, in my area.

The public want to say no to the Health and Social Care Act—they do not like these changes. GPs were told that they would hold budgets; I will come to that, but first I want to talk briefly about STPs. Again, there is little democratic involvement; the changes are being ushered in across the north-west and across Lancashire.

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

The hon. Gentleman mentions what the public want; is he aware that a slight majority of the public are in favour of third-party private providers providing care in the health service, as long as they demonstrate better value for money?

[Graham P. Jones]

I think the public are primarily concerned not with better value for money but with better healthcare, and they are not getting it.

--- Later in debate ---

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

It is a pleasure to speak while you are in the Chair, Sir Graham. I add my congratulations to the hon. Member for Hartlepool (Mike Hill) on his introduction of the debate. May I start by clarifying a point in his opening remarks? He conflated, I think, paying for healthcare and outsourcing, which to my mind are two completely separate things.

Let me explain something that informed my thinking on this subject many years ago. When my son, who is now 21, was only one, my wife and I went to Menorca as new parents, and our son took ill on the last day, after a lovely week there. He deteriorated quite badly in the middle of the night, and we were told by the doctor to take him to a hospital. We went to a lovely, shiny steel-and-glass hospital and rushed him in. By the time we got to the hospital, he was barely breathing, and new parents panic so much in those situations. We carried him to reception, thinking that he was only a few gasps from passing away, and we were asked, before they treated him, to present our credit card. We waited for 20 minutes while that was dealt with, and those were the longest 20 minutes of our lives, so I think that any Government Member or, indeed, anybody in the Chamber today who would consider moving the current system from a system of taxpayer-funded care to one in which people pay at the point of delivery would be misguided, to say the least.

This debate is not about whether we pay for care, and let us be clear: healthcare in this country is not free; it is taxpayer-funded. But the foremost principle—the foremost thing we must get right—is what is in the best interests of the patient. That is the principal thing that we should be discussing. The second thing that we should be discussing is what is in the best interests of the taxpayer, who funds the care of all the people who need care in this country. The third thing is who provides that care. This is patient first and certainly profit second. No ideology about private sector interest or involvement, or purely public provision, should get in the way of that. This debate should be about how we deliver the best service most effectively and efficiently. The question we should be asking today is how we provide a world-class service to get the best outcomes for patients and the best deal for the taxpayer.

To me, what the evidence points to is clear, despite the very good points that Opposition Members make about fragmentation. I accept that there are at times problems with commissioning that we need to resolve and get right, but to me a blend of public and private sector interests—a partnership between the two—would provide the best outcomes. Indeed, a report by the World Health Organisation emphasised the value of competition and the incentive structures of private organisations as spurs to good performance, while recognising the need for a public role in resource allocation. That, to me, says everything about how we should manage our health system.

As has been said, there are a number of different private providers. I do not think that anybody is arguing that GPs, for example, should not be involved in our healthcare system, or community care or residential care, and they are all private sector providers. It is also fair to point out that the rate of growth for private sector provision over the last seven years, since the coalition Government of 2010, is very similar to that for private sector provision before that time. This issue should not be party political; those are the facts. The figure went from 2.8% in 2006-07 to 4.4% in 2009-10 and then, I think, to the current 7.7%, so the rate of growth is very similar. Those facts are from Full Fact, which is an independent fact-checking organisation.

[Mike Amesbury]

Does the hon. Gentleman agree that the great battle of ideas in the past resulted in something that seemingly we now all take for granted and claim to love—the NHS? Historically, the NHS was opposed; in fact, it was opposed 22 times on a three-line Whip by the Tory party, so the idea of the NHS, which is free at the point of delivery and based on need, is of course politically driven. My political party helped to create the NHS. It was a key driver in that and will certainly save and grow the NHS.

[Kevin Hollinrake]

I agree with that point entirely. We all love the NHS and respect so much the work of the people who work in that service, so congratulations on the fact that Labour introduced the NHS, but that is not the point. This debate should not be about ideology; it should be about what works.

[Richard Graham]

Just on a point of fact, about two weeks ago it was the anniversary of the first White Paper on a national health service, which was presented to Parliament by the wartime Conservative Health Minister, Willink. The thinking behind much of that came of course from civil servants, of whom Beveridge was undoubtedly one of the more important, and he was a well known Liberal. I therefore suggest to my hon. Friend that before conceding the historical point, which we should accept absolutely, that bringing the national health service into being was a Labour achievement, we should point out that there was in fact a huge amount of cross-party consensus, particularly during the war years, in the lead-up to the birth of the NHS. It is important that we all recognise the contribution of all parties in its origins.

[Kevin Hollinrake]

I am very grateful for that historical clarification. One thing I used to say in my business to any people who came to me with new ideas was that ideas are 10 a penny. What matters is how we implement things. What matters is how we implemented things then and how we implement things today. That is what makes the critical difference in whether something will succeed or fail.

[Rachael Maskell (York Central) (Lab/Co-op)]

I am grateful to be able to make an intervention, but will the hon. Gentleman not recognise that the Lansley reforms, which brought in a new funding formula, have completely broken the NHS? I am talking not only about the fragmentation, but about the fact that the funding fights against itself, and therefore it is a complete distraction from providing a planned NHS service, which is the solution that is needed in the system.

[Kevin Hollinrake]

I am grateful for the hon. Lady’s intervention. I absolutely think that funding needs to be fair. There are certain instances we can look at as to whether the funding for certain CCGs in York and north Yorkshire is unfair. We need to ensure that the funding is got right wherever people are. It is incredible that we have a postcode lottery for healthcare in this country; things differ in different parts of the country, based on many of those issues. They are issues that we absolutely need to resolve.

[Dr Whitford]

Will the hon. Gentleman give way?

[Kevin Hollinrake]

May I make some progress? I have taken three or four interventions in a row.

[Dr Whitford]

It is on the point about a postcode lottery.

[Kevin Hollinrake]

Okay.

[Dr Whitford]

I thank the hon. Gentleman for giving way. During the 33 years that I spent working in the NHS, the main aim was to get rid of postcode prescribing. He must recognise that the CCG system enshrines postcode prescribing.

[Kevin Hollinrake]

As I said, there are concerns. I have concerns: some of my constituents have difficulties. The overall quantum of healthcare funding—I will return to this at the end of my remarks—is putting pressure particularly on rural areas that I represent. We need to tackle a number of different issues. With regard to the future of healthcare funding, my perspective is similar to that of my hon. Friend the Member for Gloucester (Richard Graham): we should be working on a cross-party basis to deliver the solutions.

In terms of private or public, the public are absolutely behind the point that they have no preference. A greater number of people express no preference, in terms of a private sector or public sector provider, as to who provides their healthcare. Yes, of course the public are massively in favour—89% are in favour—of a taxpayer-funded healthcare system, but on the question whether the care should be delivered by private or public providers, it is a very different picture.

[Stephen Pound]

The hon. Gentleman has been extremely generous in giving way. I am reluctant to wander too far down memory lane, but when the NHS and I were born at the same time, in July 1948—[Laughter.] Two great institutions, both in need of considerable support! The NHS was born out of compromise. I spent 10 years working in the Middlesex Hospital. We had a private patients wing. The entire GP facility within the NHS has been private. GPs have always been self-employed. There has been compromise. The issue is not the fact that there is a compromise and private practice within the NHS, but the fact that there is a creeping expansion of privatisation, which my constituents and, I would suggest, those of every right hon. and hon. Member here feel is corrosive to the heart of the NHS. Yes, there is privatisation within the NHS, but we have to stop it. We must not expand it. We must return to core principles.

[Kevin Hollinrake]

It is only corrosive if it is not in the patient’s interest. There are clear commissioning rules that it must be in the patient’s interest for this commissioning to take place. The key is what is right for the patient. I do not doubt that the hon. Gentleman may be right that some of the commissioning is wrong, but whether it is private or public should not be the overriding principle; it should be what is right for the patient.

[Rachael Maskell]

Will the hon. Gentleman give way?

[Kevin Hollinrake]

I will make some progress, having given way a number of times. Some years ago, when I first became an MP, I met the chief executive of York Teaching Hospital Trust, Patrick Crowley. He talked about the fact that private providers are providing care in York—in the hon. Lady’s constituency—just as they are in my constituency. He was very comfortable with the relationship between the public sector provision at York Hospital and the private sector provision at Ramsay Health Care, where I have experienced treatment. It was incredibly efficient, and the people I spoke to who worked for that organisation spoke very highly of it. There should not be this ideological rejection of the private sector.

I want to make some key points. According to The Health Foundation’s report, more than 50% of people said that the NHS often wastes money. That is not a criticism but a reality in an organisation with 1.7 million people working for it. The way to try to reduce waste—again, this is our responsibility to the taxpayer—is to ensure that we eliminate it wherever we can. The public sector does a brilliant job in the NHS. I am not calling that into question. However, in my view, good businesses—I have been in business all my life—can have a positive impact on healthcare provision. Good businesses focus on the customer first, and therefore the patient first. They make the most of their most precious resource, which clearly is their people. They are good at innovating and reducing waste, and they should deliver at the best possible value. After all those things have been taken into account, a good business should then consider whether it can still make money, and if it cannot it should not enter that field. The principle should be what is right for the customer, or the patient.

I met one of the nation’s most successful and prominent business people, who told me—to illustrate how we can drive out waste and bureaucracy from a service—that he was approached in 2007 or 2008 by Tony Blair and Gordon Brown and asked to look at reshaping the health service to make it more efficient. He came back to them and said that he would be prepared to take this project on. He said that the first thing he wanted to do was to give all nurses a 30% pay rise—this is a private sector business man; I am not saying that Brown and Blair were going to privatise the NHS—but that he wanted no more money from central Government. He would put matrons back on the wards. He would put in a clinician-first approach, with admin and management second, and strip away the bureaucracy, which must be music to the ears of every nurse and doctor working in the health service. He planned to reduce admin and management by 20,000 people. He was also going to look at the purchasing system in the NHS.

Clearly, the private sector can look at these issues and drive out waste in whatever capacity as long as it is in the interests of patients. Waste in purchasing is a key element. John Abercrombie, the consultant who looked at purchasing in the NHS, established that one trust was paying £126 for a wound protector and another was paying 36p. There clearly are private sector providers that could come into this sector and help to reduce waste, delivering a better deal for the taxpayer.

My final point is about the long-term funding settlement. I echo the comments of my hon. Friend the Member for Gloucester. We need a long-term funding settlement not just for the NHS, but for social care, because they are inextricably linked, although we need different funding settlements for the two different elements. Unless we have that long-term funding settlement, whatever we discuss today, because of demand—and more money is going in—we will just be shuffling deckchairs on the Titanic. It should be cross-party and take into account rural needs. I have constituents who have seen services centralised to the point where they have to travel long distances to access healthcare. An elderly couple in Scarborough have to go to York for treatment because heart treatment has been centralised into York from Scarborough. They do not drive, so they have to take a bus to York and stay in a hotel overnight to get to the consultation appointment on time. The quantum needs to be greater and we need to ensure that we keep delivering our services right across the country, including in those rural areas. I agree with my hon. Friend that we should look at a hypothecated tax—either direct or indirect taxation—to increase the quantum of money to a significant degree.

The Select Committee on Housing, Communities and Local Government looked at the German system of social insurance for social care, in which people make a small payment from their monthly salary on a pay-as-you-go system. When they need care, instead of suffering the catastrophic cost in later life, on the basis of an independent assessment, that support can be provided through third-party care, or they can draw down the money and pay it to relatives to look after them in their own home, which can have a positive social consequence.

We need to look at these things in detail and on a cross-party basis. I believe in a taxpayer-funded system on the basis of the best outcomes for patients and the best deal for the taxpayer, and that we should move towards a long-term funding solution, so that ultimately we can let the clinicians get on with the job.

[Stewart Hosie in the Chair]

--- Later in debate ---

[Alex Chalk]

I am grateful to the hon. Lady. I respect her past record and her contributions to the House. There is an ongoing debate among clinicians—no doubt colleagues of hers—about what the NHS should cover. Most of the clinicians I speak to would welcome a more open, non-partisan and grown-up debate about the full extent of the NHS, but the guiding principle should not be confused. Whatever it is that the NHS can provide, the core principle is that it will provide it to individuals in our country regardless of their personal circumstances. I am at pains to emphasise that, because from listening to some of the contributions of Opposition Members—no doubt made entirely sincerely, but made none the less—one could be confused into thinking that that principle was under attack. It is not, and it never will be.

The debate is about the delivery of a common goal. Many take the view, with some justification, that we should be open to solutions that deliver that goal most effectively for patients. Last year, the respected and politically independent King’s Fund wrote in its report:

“Provided that patients receive care that is timely and free at the point of use, our view is that the provider of a service is less important than the quality and efficiency of the care they deliver.”

When debating this important question, we should not rewrite history. As the hon. Member for Ealing North (Stephen Pound) has conceded, it is a fact that certain services have been provided independently since the NHS’s inception 70 years ago. Most GP practices are private partnerships; the GPs are not NHS employees. Equally, the NHS has long-established partnerships for the delivery of clinical services such as radiology and pathology, and non-clinical services such as car parking and the management of buildings and the estate. To give an everyday example, the NHS sources some of its bandages from Elastoplast. That is common sense. It would be daft if public money was diverted away from frontline patient care to research and reinvent something that was already widely available. It would be just as daft if the NHS had to do the same for its water coolers or hand sanitisers.

As the King’s Fund put it in its 2017 report:

“These are not new developments. Both the Blair and Brown governments used private providers to increase patient choice and competition as part of their reform programme, and additional capacity provided by the private sector played a role in improving patients’ access to hospital treatment.”

Throughout Europe there are healthcare systems that offer high-quality care, free at the point of use, and make use of far greater numbers of private providers than the UK.

I want to say a few words about the impact on my constituents in Cheltenham. I will give three brief examples. First, Cobalt is a Cheltenham-based medical charity that is leading the way in diagnostic imaging. It provides funding for research, including into cancer and dementia, which it does as part of a research partnership with the ²gether NHS Foundation Trust. It assists with training for healthcare professionals, and it even provided the UK’s first high-field open MRI scanner, which is designed for claustrophobic and larger patients. Are we seriously suggesting that is an affront to patient care in Cheltenham? Not a bit of it. Are we seriously suggesting that getting rid of it would be a good idea? Emphatically no.

Secondly, we have the Sue Ryder hospice at Leckhampton Court, which is a 16-bed hospice that delivers truly excellent care in the Gloucestershire countryside. It also provides hospice-at-home services. It also supports, as I know, family, carers and close friends. It is part-funded by the NHS and by charitable donations. It shows astonishing compassion, but also creativity and innovation in how it delivers care. The third example is Macmillan and its nurses. I need say no more about it—it is a fantastic organisation. To suggest that these independent providers and charities are somehow not good for patient care is to stretch a political principle beyond breaking point.

We also need to slay the myth—there was just a glimmer of it today, but it was not really developed—that somehow different types of providers are held to different standards. All providers are held to the same standards and given rigorous Ofsted-style inspections and ratings by the Care Quality Commission. For my constituents in Cheltenham, I want to see resources allocated as effectively as possible to free up resources for facilities such as A&E at Cheltenham General Hospital, which can only be delivered there. There is growing demand for A&E in Cheltenham, and the service needs to be 24/7.

It is right to say, however, that there are some legitimate concerns that can be properly addressed. The experience of Carillion has laid bare the chaos that can be caused when private providers take on significant contracts and then fail to deliver. We have to recognise that the consequences of failure in health services would not simply be an unfinished construction project, important though that is, but could be a decline in the quality of patient care. I mention that only because community services are disproportionately served by independent providers, but let us keep this in context. Based on a survey of 70% of CCGs in 2015, Monitor published analysis in its report, “Commissioning Better Community Services for NHS Patients”, showing that independent providers were responsible for just 7% of contracts. We should be vigilant, not dogmatic and quasi-religious in our approach. The NHS as a whole must ensure that no contract ever becomes too big to fail and that contingencies are always in place to cater for such an eventuality.

[Kevin Hollinrake]

My hon. Friend is making a very fine speech. He mentioned the failure of Carillion. There are many lessons from that and many reasons behind the failure. One is that Carillion worked on wafer-thin margins in its contracts, which illustrates that the taxpayer gets very good value for money because of the competitive nature of the bidding process.

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[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Hosie. I apologise for not being here at the start of the debate but I was serving on a statutory instrument Committee. I am grateful that you are allowing me to speak in today’s important debate about our NHS.

I felt motivated to speak when I entered Westminster Hall and listened to the debate, particularly on the assertion that privatisation is not such a bad thing. I want to draw out the issue of NHS funding. The funding system is broken. I am grateful to the Minister for meeting me recently to discuss the real challenges in York’s funding system. I look forward to hearing that progress has been made as a result of that, but there are real challenges within the funding system and I want to challenge some of the assertions made about that.

We must understand that the NHS was designed to work as a whole. The types of services that move to the private sector are low risk and high volume, such as hips, knees and cataracts. If we add those together, someone can cream a profit—I would prefer a reinvestment—off the top of providing those services. The NHS used to take the additional money and reinvest it in the more expensive parts of the NHS, such as intensive therapy units, the renal service, for which the drugs are very expensive, and A&E. The fine balances of NHS finances worked. However, when we remove those opportunities, because the hips and knees are being delivered by another organisation that makes a profit out of the NHS, although the risk is left with the NHS, NHS finances collapse because the cross-funding is not going into those services, which is exactly what we are seeing at the moment. I first had that debate with Andrew Lansley when he put his proposals forward, and it has come to pass that NHS finances are not working because that balance has been taken out of the finances. The opportunity for the NHS to generate the resources that are vital for the critical care parts of the NHS is removed.

[Kevin Hollinrake]

The hon. Lady makes a good point, but the reason the NHS is under pressure is hugely increased demand. There is more money going into the NHS, and we would all concede that we need to put more money in, but demand is the essence of the problem. It is not because we have private sector companies operating within it.

[Rachael Maskell]

The hon. Gentleman is right that demand on the NHS is huge, which takes me to a further point that I will raise shortly. We recognise that we need more resource in the NHS, but the fragmentation and the fact that so much money is taken out for contract management as opposed to reinvestment into health services creates challenges. We now have lawyers and managers managing those contracts in the NHS instead of the money filtering through to healthcare, as it would in a planned health system. Of course, when we have fragmentation, we have to work with multiple systems across multiple agencies, and trying to get the organisations to talk to each other also puts pressure on the system.

We have a growing ageing demographic and increased pressures on the health service, but, because we now see a disconnect between some of the NHS’s other services, such as prevention and public health, we do not have the levers in the system to drive better health in the community, and more risk therefore ends up back at the door of the acute services. As the situation escalates, the acute system is more and more challenged, not least because of the different funding mechanisms and interests of the CCGs and the acute trusts. If we look at a tariff system versus the CCGs’ interests, we see that they clash with each other, which then means we have a waste of resource.

I can give examples of how the funding is broken and not working within York. I have had discussions with the CCG and the acute trust. The CCG has to fund tests and other services that are not picked up elsewhere in the tariff system. Where do those services go? They go out to the private sector, so there is a cycle of decline and trying to manage a system where the fundamentals of how NHS funding works are not addressed. I suggest to the Minister that if we brought together a planned health service with proper funding, the rest of the system would fit in place, but we have to take out the private motive within the NHS, which is clearly why many organisations are involved.

We have only to look at some of the services that are provided. I think of the Serco contract in Cornwall, where only one GP was in service for the whole of the county. I think of Serco again in Suffolk and how it provided community services. When it was not generating a profit, it said, “We’re off. We’re not interested in this service any more”, leaving some of our most vulnerable people in the community high and dry, with the NHS of course picking up the cost every single time and picking up the pieces. That is no way to run a critical health service in our country. That is why we need to move to a fully planned health service in public hands.

I want to draw on one other example of a private company: Virgin Healthcare. It was first of all an incubator within the forerunners to CCGs, seeing what was coming along the tracks and the opportunities there. I can cite many services provided by Virgin Healthcare and how it has looked to profiteer and cut services. I was head of health at Unite overseeing sexual health workers. Virgin cut sexual health services and as a result there was a rise in the prevalence of sexual disease. The services also became fragmented. The community was not provided with a service, and there was a complete failure to achieve the objective of the service.

Elsewhere, we see Virgin suing the NHS because it is not winning contracts. The business of Virgin is about generating as much money out of the state as it possibly can. Private companies use the NHS for their own interests to fill the pockets of shareholders as opposed to supporting patients. We must take the profit motive and private companies out of the NHS because that model is completely broken.

I will move on to two other issues. The first is staff in the NHS. I worked in the NHS for 20 years, so I know what it feels like. People do not want to work for private companies. They want to have one set of terms and conditions, and to engage with one set of training. They want one set of rules, and most of all they want the pride of working for the NHS.

[Kevin Hollinrake]

Will the hon. Lady give way?

[Rachael Maskell]

No, I will make some progress. People want to work in the interests of patients. It is important that we maintain that, because it is healthcare workers who give all the hours of unpaid overtime that nobody ever talks about. Why would they want to do that for a private company? They do it because of the sense of public service that comes from our country’s greatest pride: the NHS. We therefore need to listen to what our NHS staff say. That is why I take issue with the hon. Member for Cleethorpes (Martin Vickers), who spoke about union leaders shouting off. They represent more than 1 million people working in our NHS. They are the voice of people working in the NHS.

[Kevin Hollinrake]

rose—

[Rachael Maskell]

As a union leader who spent 20 years working in the NHS, I certainly spoke up for all my members, who were deeply concerned about the destruction of the NHS because of the privatisation and fragmentation that was happening across it.

The second issue is what is happening to NHS buildings. We know that buildings were moved into NHS Property Services, which is a wholly owned company with one shareholder: the Secretary of State. He is looking through the Naylor report, which is not included in legislation at the moment, to reduce the estate. There may be some good cases for that, but profit should not be at the head of the argument. We should look at how the estate can be reinvested for the benefit of the community.

Parkland at Bootham Park Hospital in my constituency would make a fantastic public park and would address some of the mental health challenges in our city, which was the purpose of the hospital. I ask the Minister to take a further look at that opportunity. Under Treasury rules, the building and the parkland have to be sold to one private provider. Clearly, that would not work for my city. With regard to the rest of the estate at Bootham Park Hospital, it would be great to see the old mental health hospital converted into key-worker housing to support the rest of the NHS. York is in real crisis with regard to recruiting staff, because they cannot afford to live in the city. If we had key-worker homes on that estate, it would create a sea change. That is about putting public interest at the front, not private profit.

Finally, I want to talk about the future, because I am aware that time is moving on. I truly believe that the only way forward for our NHS is to have one planned public service, with full integration of mental health, physical health, public health and social care, provided in the interests of the community. We need play-space to look after the community, and no more fragmentation. It is ridiculous that we have so many regulators and so many different providers. The whole system is fragmented and fighting against itself. If we had one planned system, it would not only simplify the system, but ensure that the money is invested back into the heart and needs of patients.

--- Later in debate ---

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

It is a delight to serve under your chairmanship, Mr Hosie. In the scope of the history of the NHS, I would like to make a little punt for the Highlands and Islands Medical Service—a forerunner of the NHS that was founded in 1913, a long time before the UK NHS.

To make a gentle point to the hon. Member for Gloucester (Richard Graham), I will read the World Health Organisation’s 1995 definition of privatisation. Privatisation means

“a process in which non-government actors…become increasingly involved in the financing and provision of health care, and/or a process in which market forces are introduced into the public sector.”

Patients who attend any of the four UK health services will receive amazing care, but that is predominantly due to the dedication of the people who work in them, some of whom are working against much harder pressures than others. Government Members talked about outsourced cleaning and car parking as a good thing. There was evidence that it was the outsourcing of cleaning, and poor-quality cleaning, that led to the rise of hospital-acquired infections.

[Kevin Hollinrake]

rose—

[Andrew Selous]

Will the hon. Lady give way on that point?

--- Later in debate ---

[Dr Whitford]

I have only just started, and there is not much time left. It is repeatedly mentioned in this House that patients and carers in England have to pay significant car parking charges. That should not be seen as a benefit.

The Conservatives introduced the internal market in 1990. That introduced competition between NHS hospitals, and even at that point created an “us and them” mentality in my local area. It created divisions between the GPs and the hospital through the purchaser-provider split. Sometimes, if a patient was sent to me but had a problem that I diagnosed as pertaining to a different department, I could not refer them on, because the GP would not fund it. They had to go back to the GP and start again. That was both inefficient and, at times, dangerous.

Unfortunately, I have to criticise official Opposition Members, because I remember in 1997 when Labour got in and talked about going back to one NHS. Those of us who worked in the NHS were delighted. Sadly, we soon started to hear about foundation trusts and, in essence, we were back to the same policy. It was Labour that introduced independent treatment centres, initially with block contracts for common operations such as those on hips and knees. Most of those contracts were not met, and were therefore of incredibly poor value. GPs were being pushed to refer their patients to the ITCs. That was eventually recognised, and the move was made towards payment by results, which eventually led to the tariff. Capital funding was also kept off the books, leading to the private finance initiative, which we have discussed many times in this place. PFI has been shown to result in between £150 million and £200 million of profit per year for the companies that hold the contracts. That is putting a huge strain on many trusts.

In the 2010 election, the Conservatives promised no top-down reorganisation. Unfortunately, just a couple of years later, with the introduction of the Health and Social Care Act 2012, we saw that that was not true. The Act came into force in April 2013, and section 75 in particular pushed commissioning groups to put contracts out for tender. That has created relentless pressure to bring independent sector providers into the NHS. As the hon. Member for Thirsk and Malton (Kevin Hollinrake) mentioned, it has risen from £2.2 billion in 2006 to £9 billion in 2016-17, more than 10 years later. That is approximately the same cost as providing all GP services, so it is not a minor cost; it is significant. The independent treatment sector in 2015-16 won approximately 34% of contracts—a figure that rose to 43% in 2016-17. However, as the independent treatment sector has moved towards more community services, it is now winning approximately 60% of contracts. There is no question but that there is greater involvement of private companies in providing healthcare.

We hear all the time about waste in the NHS, but we have had circular reorganisation throughout my career—from 100 health authorities to 300 primary care trusts, to 150 primary care trusts and to a little more than 200 clinical commissioning groups. CCGs were described as putting power into GPs’ hands, but less than half of CCGs have a majority of clinicians on them, and less than 18% have a majority of GPs. We are now going to go through another change, with the introduction of 44 sustainability and transformation plans or accountable care organisations. The costs associated with the redesign, the redundancies, the new organisations, the external consultants and the change managers are all described as one-offs, but this has been repeated relentlessly over the past 30 years and has resulted in huge waste. Much smaller organisations, such as hospital trust and ambulance trusts, are now run by very senior managers with six-figure salaries—the same size as those received by the people who ran health authorities at the start of all this. That is a waste.

Then there are the running costs of the market itself—the contracting design, the tendering, the bid teams, the corporate lawyers, the billing and the profits. The costs of the system are utterly opaque. It is not possible to penetrate the veil of commercial sensitivity, and the Department of Health does absolutely nothing to show where public money is spent. It is estimated that the cost of the English healthcare market is between £5 billion and £20 billion—no one really knows. We have no evidence of precisely how high the costs are, and there is absolutely no evidence of a benefit, so it is not possible to do a cost-benefit analysis.

[Kevin Hollinrake]

The hon. Lady is talking about the efficiency of the system, but is she aware that the Commonwealth Fund report, which addresses some of the issues she is talking about, described the NHS as the most efficient healthcare system in the world?

[Dr Whitford]

The 2014 “Mirror, Mirror” report was actually based on the years before the Health and Social Care Act 2012 came into force—2010 to 2013—and at that time the NHS was No. 1 in eight out of 11 markers. That was due not to privatisation, but to easy accessibility. One of the key things is that patients can access the NHS quickly and easily. That ranking is not based on the system of reform that the Health and Social Care Act introduced.

[Kevin Hollinrake]

The hon. Lady seems to be implying that the internal market is a problem, but it has been in place since my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) was the Chancellor. Efficiencies have been driven, and she must take into account the internal market reforms that are in play.

[Dr Whitford]

The difference is that the original market was an internal market; what we have at the moment is an external market, which means that money is leaving the NHS and going to external companies. That is quite different from competition among hospitals.

To tackle waste, we should start with the cost of the market. Even if it is at the lowest end—£5 billion—it would help to clear the debt and pay for the hole in social care. It would make a significant difference.

In the five years leading up to 2013, the NHS always somehow managed to find money down the back of the sofa, and it scraped out with about £500 million at the end of each year. In 2013-14, it was overdrawn by £100 million. The next year, the figure was £800 million, and in 2015-16, it was £2.5 billion. People sometimes say, “There’s this little bit of efficiency, and this little bit has been saved”, but when I started the UK spent 4.5% of its GDP on health, and the highest it reached was 9%. Imagine if all that money had gone to frontline care, as the hon. Member for Thirsk and Malton talked about, and was used to pay nurses properly, get rid of bureaucracy and actually deliver care. We can do that only if we have a planned single system; we cannot do it if we create an entire bureaucracy.

Scotland diverged in 1999 when we got devolution. We abolished hospital trusts in 2004 and primary care trusts in 2008. We have place-based planning in the form of health boards, which have led to the integration of primary and secondary care. We now face the difficult challenge of the integrated joint boards for integrating health and social care. Look at our success: in-patient satisfaction is up to 90%, delayed discharges have been down every single year and Scotland has had the best accident and emergency performance since March 2015. In February, emergency department performance in Scotland was 90.3% in four hours; in England, it was 76.9%. Look at how the challenge evolved: it literally started in April 2013, when the NHS in England came under pressure.

I have frequently welcomed the plan to move to place-based planning. I agree that the term “accountable care organisations” is unfortunate, but the model contracts put out in August still make it clear that independent sector providers could bid to run an entire accountable care organisation. There is no statutory structure. The basis must be that there absolutely has to be accountability and a statutory responsibility. I believe there should be a presumption of a return to the NHS.

It is crucial that we reform the perverse incentives. Hon. Members have mentioned the tariff. Hospitals earn money only if people are admitted. They make money out of those who are not that sick and lose money on people who are incredibly sick. How will a hospital take part in this if keeping people in the community, which we all want, means that they lose money? That should be reformed in this place. Section 75 of the Health and Social Care Act caused the Nottingham University Hospitals NHS Trust to waste £500,000 preparing a bid for the Nottingham Treatment Centre against Circle, which then just pulled out. Hon. Members have mentioned that Virgin has sued six Surrey CCGs, one of which leaked that it is paying £328,000. Multiply that by six, and we are talking £2 million. The idea that outsourcing to private companies has brought benefits simply does not stack up. We are putting money into care. Get rid of outsourcing and fragmentation. I support the idea of place-based planning, but patients, not budgets, have got to be in the middle of it.

--- Later in debate ---

[Justin Madders]

Members are indicating that my hon. Friend the Member for York Central did take interventions. It is not for me to comment on that, but I thought her speech was superb, and it came from many years of experience in the health service. However, on the contribution of the hon. Gentleman himself, I have to say that I disagree with him—this debate is about not a local election or weaponising the NHS, but about the 240,000 members of the public who signed the petition, which was launched some five months ago.

The hon. Gentleman also challenged us to find Conservative Members in support of privatisation—they may not express that support publicly, but we need only look at what has happened to the health service under a Conservative Government to see that privatisation has accelerated since 2010. There is also the famous 2005 pamphlet that advocated privatisation of the NHS. The Health Secretary has, I know, disowned his comments as one of the co-authors, saying that the pamphlet no longer represents his views, but at least five other current Conservative Members were co-authors, so there are questions to be asked about it of those on the Government Benches.

As other Members have said, private sector involvement has of course always been an element of the NHS, but since the Health and Social Care Act came into force there has been a step change in that involvement. After the Act became law, the amount of cash going to private sector partners went up by a staggering 25% in the first year alone. That is part of a broader trend identified by House of Commons Library research—the equivalent of £9 billion a year of NHS funds now goes into the private sector, which is double the figure under the previous Labour Government.

As we have heard, there are also huge problems with litigation arising from the 2012 Act. Money should not be spent on lawyers, procurement processes, tendering and court cases; it should be spent on patients. Given the longest and most sustained financial squeeze in the history of the NHS, we can ill afford money to be used in that way. The financial squeeze has also had consequences for how NHS hospitals are forced to use the private sector. Elective procedures in the private sector have gone up by 58% in the past year alone.

[Kevin Hollinrake]

Will the hon. Gentleman give way?

[Justin Madders]

I am sorry, I shall take no more interventions, because I am struggling for time.

Patients are voting with their feet. Owing to the deterioration in waiting times, over three years the number of patients going abroad for treatment has trebled to 144,000 last year. With the Government abandoning the 18-week waiting time target, and the widespread rationing of some treatments, that figure will surely get worse. Does the Minister accept that those figures are a matter of concern, and does he expect them to increase or decrease in the next 12 months?

[Kevin Hollinrake]

Will the hon. Gentleman give way on a matter of record?

[Justin Madders]

Okay.

[Kevin Hollinrake]

I am grateful. The hon. Gentleman will correct me if I am wrong, but I think he said that the growth rate in outsourcing has increased under this Government and the coalition. Full Fact, however, states that the growth rate was similar under both Governments—the Governments since 2010 and the previous Government.

Surgical Mesh

Kevin Hollinrake Excerpts

Thursday 19th April 2018 Commons Chamber

[Dr Lewis]

Indeed. I would be surprised at that, because if that is what Dame Sally believes she ought to be making different recommendations.

I have been given a particular study, which is described as the largest study of surgical mesh insertions for stress urinary incontinence. Over 92,000 women were surveyed in this particular examination, including all NHS patients in England over an eight-year period. The conclusion states:

“We estimate that 9.8% of patients undergoing surgical mesh insertion for SUI experienced a complication peri-procedurally within 30 days or within five years of the initial mesh insertion procedure. This is likely a lower estimate of the true incidence.”

I reiterate my point about acceptable and unacceptable percentages. When we are talking about these very large numbers, even relatively low percentages make the procedure too risky to be used in anything other than last-resort circumstances similar to those described by the hon. Member for Glasgow North.

In the past decade, my constituent Emma has undergone X-ray-guided injections, ultrasound scans, MRI scans, in-patient stays, tests galore, more and more scans, and, eventually, a biopsy. She has been refused referral to a mesh specialist centre. It seems highly likely that she should never have been given a mesh implant in the first place after the trauma of such a difficult birth, which leads me to the next point about inadequate warnings. I understand from my constituents that they were given little warning, and in many cases no warning at all, about the potential dangers.

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

My right hon. Friend is making some very important points. Does he agree that prevention is better than cure? If physiotherapy were offered to women after childbirth, that might obviate the need for any surgery at all as a result of these kinds of complication.

[Dr Lewis]

Indeed. The problem with this issue, as it has been impressed on me at any rate, is that this has been put forward as a quick-fix alternative to other procedures, whether surgical or not, which would take much longer.

Having paid thousands of pounds for private specialist assessment, in the end Emma eventually managed to get the sort of referral she wanted. I have been given the following clinical summary of her condition:

“Vaginal mesh; foreign body giant cell reaction, chronic inflammation and fibrosis.”

I have a page here that lists some 50 different symptoms related to implant illness and foreign body giant cell reaction. I venture to suggest that if this ghastly catalogue of things that could go wrong had been shown in advance to those 100,000-plus women who have had a mesh implant, more than 90% of them at least would have turned it down.

This is what my constituent Eileen wrote to me:

“The effect that this has had and is still having on my life is massive. I can no longer carry out basic tasks at home or do things with my children due to the pain. I need to take medication every day from my GP to try and ease the pain. I cannot go to work at present due to the pain and I am currently on sickness absence leave from my job. The mesh implant that I have had has and is continuing to destroy my life. I need an operation to remove the mesh implant, but the operation is very complex and unfortunately there are limited amounts of surgeons who are experts in the full removal of these mesh implants. Due to my financial situation, I am not in a position to be able to afford to have the full removal of the mesh implant done privately and therefore I am having to wait for this to be done on the NHS which is taking far too long.”

I turn now to Helen, who probably has the most horrifying story of the lot. She was 35 when given what was described to her as routine surgery 16 tortured years ago. She was initially told that it was her fault that her body was rejecting the two mesh implants. She then went through a cycle of implants, the removal of protrusions and eroded segments and seven bouts of surgery. Three TVTs—trans-vaginal tapes—are still inside her, she suffers chronic pain from orbital nerve damage, constantly needs painkillers and has had constant side effects, indifferent treatment and a refusal to admit fault or to refer her to an out-of-area specialist in mesh removal. She writes:

“I do not want anyone from the hospital coming near me ever again. I have lost complete faith in them. I have been lied to and told repeatedly it was my body rejecting the mesh; but, unbelievably, they kept putting more in.”

She suffers from truly terrible bowel problems, some no doubt caused by the side effects of the painkillers and the sleep aids she has to take. Consequently, she suffers from depression, loss of confidence and lack of self-esteem. She further writes:

“I feel let down by professionals who were supposed to treat me to the best of their ability. There has been information about the adverse effects of mesh around for years, yet these doctors are still happily inserting them into thousands of women.”

She is desperate to be referred to one of the few doctors who specialise in mesh removal and feels trapped under the control of the very people who have let her down. She continues:

“I want these devices out of my body.”

Who can blame her?

Let me conclude by quoting, from an article in The Daily Telegraph of 23 October last year, a lady who suffered for eight years:

“I just wish I had never, ever had it done. I would rather have coped with that very minor problem of stress incontinence than this. If I had known even one of the possible risks of the surgery there is no way I would have had it done. I am furious that I was never told that this could happen.”

--- Later in debate ---

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

I thank and congratulate the hon. Members for Kingston upon Hull West and Hessle (Emma Hardy) and for Pontypridd (Owen Smith), as is customary and also entirely justified on this occasion. This issue must be kept in the public eye.

One of the great privileges of being an MP is being able to give people a voice—to represent people in our constituencies who have been wronged, often in terrible circumstances through no fault of their own. In this case, for me that person is here today in the Gallery: Jacqui Cheetham. I am delighted to be able to represent her story, and her words are far more powerful than mine could ever be. When she visited me at my surgery what came across was the scale of the problem and also its traumatic consequences given the relatively minor condition that Jacqui suffered from before the operation took place.

I would like to use Jacqui’s words rather than my own, because, as I have said, they are far more powerful than mine could ever be. She explained that she had two surgeries using mesh, in 2005 and 2006:

“Within a few days of surgery I had severe pain in my groin and bladder. I was referred back to York Hospital on many occasions. The surgeon said he could find nothing wrong with me and eventually recommended I saw a psychiatrist, as he believed it was all in my head. As a teenager I had a history of mental health problems when my parents went through a nasty divorce. I was left to bring up my younger sister and take my main, secondary school exams. I simply could not cope but because this is on my medical records, even though the mesh operation was many years later they still referred back to that time and thought this must also be psychological. My GP spoke up for me and told them I was not depressed and demanded they find a solution. Eventually I was given a MRI scan and the mesh was found sticking into my bladder. I was then operated on to partially remove the mesh. After the operation, the surgeon described the pain of the mesh sticking into me as being like barbed wire as the raw edges of the material had hardened. It’s intended that your body should mould itself into it and removal would be like extracting it from concrete…

Since 2006 I have lived my life in constant pain. I take concentrated Oramorph and wear…Buprenorphine patches. I also take codeine for ‘break-through’ pain.

I was a fit young mother in my late 30s when I had this done, suffering mild incontinence. My ambition was to run the London Marathon and I found the incontinence merely a nuisance. How I wish I could go back to those days! I would never have had this operation, had I known this possible outcome. I was not warned of any such dangers.

I now cannot walk far. I can’t stand or sit for extended periods of time. I struggle with simple tasks that require my concentration. Both my drugs and my pain affect my sleep. I am now 50, though I feel much older.

Quite simply, this operation has ruined my life and has had a massive impact on my family. My children are now grown-up but they were young at that time and I was unable to be a proper mum to them; unable to run and play with them as a parent should. There seems to be a misconception that the mesh which causes the greatest problems is “prolapse mesh” but this simply is not the case. All mesh can cause problems.”

I know that the ministerial team is very concerned about, and aware of, these issues, in part due to the fine work of parliamentarians. Ministers rightly point out that no healthcare system in the world has yet banned this treatment, and they set about the review in February 2018, which has provided much of the information that we now have to address these points.

As my right hon. Friend the Member for New Forest East (Dr Lewis) pointed out, the scale of the problem is becoming clearer, but I do not believe we understand the true scale yet. The recent Guardian report said that out of 100,000 operations there were 6,000 removals, so there is an issue with at least 6%, and that is just the ones that have been removed, so we know the scale is greater than is currently acknowledged.

Something needs to be done now. It is heart-warming that the people who come to our surgeries to tell their stories want most of all to prevent this from happening to others, and we must pay credit to the people from the Sling the Mesh campaign for what they have done to benefit others as well as trying to redress some of the difficulties they experience themselves.

The hon. Member for Kingston upon Hull West and Hessle raised the issue of physiotherapy, and she is absolutely right: prevention is better than cure. She mentioned that this problem has cost the healthcare system £245 million; it would be a true economy, not a false economy, to implement what she suggests as a simple first step for new mothers.

We also need to get to the bottom of the issue by having a true audit, including of, for example, private patients, to make sure we know the true scale of the problem; I support those calls. It must also be sensible when there are alternatives to look at a suspension of this treatment today. Burch colposuspension and autologous sling are alternative treatments, and it makes sense to me and certainly my constituent to suspend this treatment and look at other treatments in the meantime while we find an alternative. Perhaps the new Sheffield University treatment will prove effective, but, as the Chair of the Health and Social Care Committee said, it needs to go through a clinical trial rather than women effectively being used as human guinea pigs. I support the extension of that until clinical trials can show that we have a solution without the traumatic consequences that affected so many women.

Oral Answers to Questions

Kevin Hollinrake Excerpts

Tuesday 20th March 2018 Commons Chamber

[Stephen Barclay]

The right hon. Gentleman is right to raise that serious issue. There needs to be a culture change in Wirral, and I am happy to continue to meet him and other Wirral Members to discuss that. He will be aware of the NHS Improvement report on that issue on 5 March.

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

According to Lord O’Neill, diagnostics prior to prescription of antibiotics is the most important of the 10 commandments in the O’Neill review on antimicrobial resistance. Will the Minister update the House on progress towards that very important goal?