Young People’s Mental Health

Lilian Greenwood Excerpts

Thursday 27th October 2016 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

It is a pleasure to follow the hon. Member for Bexhill and Battle (Huw Merriman), and I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) and the hon. Member for South Cambridgeshire (Heidi Allen) on securing this debate. My hon. Friend is having quite a week: she has pressed the Prime Minister about the serious issue of historical child sexual exploitation in her constituency; she is here today; and tomorrow she will help lead the charge on the Homelessness Reduction Bill. I am delighted that she has found time to lead this afternoon’s debate.

As one of the elected honorary presidents of the British Youth Council, I am particularly delighted that this debate arises from the Youth Select Committee’s report, “Young People’s Mental Health”. I hope that the fact that Members of Parliament have taken the initiative to make sure that we are debating it in the House of Commons reassures the UK Youth Parliament, youth councils and young people generally that their voice is being heard. Our challenge now is to make sure that their voice is listened to by Government.

It is also worth saying that much of the profile that the UK Youth Parliament enjoys in the Houses of Parliament, particularly the annual sitting, which will next take place in this Chamber on 11 November, arises from the personal support of Mr Speaker. I know that I speak on behalf of so many people involved in BYC and the UK Youth Parliament in thanking him for his consistent championing of young people’s voice in democracy.

My interest in young people’s mental health and the reason I am here partly stems from my time as deputy leader and cabinet member for health and wellbeing in the London Borough of Redbridge. However, the main reason I have chosen to be here instead of in my constituency on a Thursday afternoon is my experience, both as a councillor and as a Member of Parliament, of listening directly to young people talk about their concerns and issues, and those of their friends and peers, with mental ill health. Redbridge has a fantastic youth council, which, like the national UK Youth Parliament, has prioritised work on mental health. I will come on to talk about that.

While sitting in Redbridge Council chamber listening to young people from across our borough, I was struck by the way in which they talked in such an open, candid and courageous way about their own struggles with mental ill health and what they have seen in their classrooms and communities. Although much of what they described was harrowing and of concern from a public policy point of view, it is hugely encouraging that this generation of young people seem to be far more at ease with discussing mental health and have normalised discussing it in such a way that it is similar to how they discuss physical ailments. That gives us hope for the future when it comes to changing the culture surrounding mental health, which my hon. Friend the Member for North Durham (Mr Jones) has mentioned.

Recently I chaired a meeting of the all-party parliamentary group on youth affairs about mental health, and it was hugely encouraging to see young people from across the country pack one of the largest Committee Rooms of the House of Commons. The key message that came across was the failure of public services and health services to address concerns that many of those young people had experienced personally.

We know from so much of the research, particularly the excellent briefings we have had from charities such as YoungMinds ahead of this debate, that there are significant and well-known problems nationally with regard to mental ill health affecting children and young people. As my hon. Friend the Member for Dulwich and West Norwood said at the start of the debate, one in 10 children and young people has a diagnosable mental health condition. That is the equivalent of three children in every classroom. We also know that a great many more suffer periods of anxiety, emotional distress and ill health because of the growing pressures of childhood. That should give us all pause for thought and cause for concern.

Three quarters of young people with mental ill health may not get access to the treatment that they need. I am particularly concerned about the statistic that my hon. Friend shared showing that CAMHS is turning away nearly a quarter of children referred for treatment by parents, teachers and GPs. Those children have been referred by people who, to be frank, have expertise, and to turn such a high proportion of them away is wholly unacceptable.

[Lilian Greenwood (Nottingham South) (Lab)]

My hon. Friend is making a powerful contribution, as have many others. This summer, Healthwatch Nottingham published the results of its survey of young people about their experience of seeking help and treatment. It found that 26% of young people had not sought any help or treatment at all, despite feeling that they suffered from a mental health problem. That was twice as likely among black and minority ethnic young people. Does he agree that we need to do more to raise awareness of the help that is available, which needs to take account of the needs of all young people?

[Wes Streeting]

I agree strongly. That leads me neatly on to a point I wanted to raise about the provision for young people. It is not just young people generally who are having trouble accessing mental health services. The Government and the health services need to look carefully at the profile of the young people affected. During my time as head of education at Stonewall, we published “The School Report”, a piece of research undertaken with young people by the University of Cambridge. It found exceptionally high and extremely worrying levels of mental ill health among lesbian, gay, bisexual and trans young people. The alarming rates of self-harm and suicide, to which many hon. Members have referred, are even higher for that particular group. More than half of LGBT young people are self-harming. Around a quarter have attempted suicide or considered taking their own life. Those levels are of epidemic proportions. That points to a crisis among LGBT young people, which is a symptom of wider poor provision.

[Lilian Greenwood]

My hon. Friend will be interested to know that the same report says that young people who identified as homosexual or bisexual were most likely to have experienced a mental health issue in the past or currently, and that their experiences when seeking treatment and support were more likely to be negative. Does that not give more credence to what he is saying about the need to deal with their specific needs?

Glenfield Hospital Children’s Heart Surgery Unit

Lilian Greenwood Excerpts

Wednesday 19th October 2016 Westminster Hall

[Liz Kendall]

I share the hon. Gentleman’s concerns. We have to be aware that it is not just about the essential, vital emergency care and surgery when it is a matter of life or death and whether children can reach a centre in time. It is also about ongoing care and support. It is not just that they have one or two operations when they are little; they need care and support right through into adult life.

We must remember that children are part of families, and families have obligations. They have other children they need to get to school and they have work commitments. To throw that up in the air when they have those arrangements and their children need ongoing care and support is denying those patients choice.

[Lilian Greenwood (Nottingham South) (Lab)]

My hon. Friend is doing an excellent job in presenting the case. My young constituent, Jack Phillips, will be celebrating his first birthday later this month thanks to life-saving open heart surgery at Glenfield. His dad, Christopher, wrote to me:

“At such a devastating time having the support of our family who were able to visit from Nottingham regularly while we were in Leicester was vital to us.”

Is that not one of the issues about a centre being within easy reach of other parts of the east midlands?

[Liz Kendall]

My hon. Friend is absolutely right. We have to think about people’s needs in the round—the need for high-quality surgery; ongoing care and support; and, critically, help for those families for whom this is a terrible, frightening and ongoing experience. Making the east midlands the only place without a heart surgery unit does not make sense.

It does not have to be this way. In its own standards, NHS England says:

“Networks will need to establish systems to ensure that referrals…between centres are managed in such a way as to ensure that each clinician is able to achieve their numbers”.

Its own standards say that people need to work together so that everyone can achieve the best. However, at the moment NHS England is not developing the work. I am a long-standing champion of patient choice, but the current proposals deny choice to patients from across the country who use Glenfield children’s heart surgery unit on an ongoing basis.

[Liz Kendall]

The hon. Gentleman makes an extremely important point. The clinicians at the unit and the hospital bosses have striven continually to improve patient care. They are not complacent for a second. They bust a gut to keep making improvements. Those improvements will, I am sure, be recognised and acknowledged by the 58 patients in the hon. Gentleman’s constituency who are receiving continuing care at Glenfield. He is right to say that NHS England needs to look in detail at the improvements that have been and are being made. When NHS England came to the centre in September—I was more than a little disappointed that it had not made a visit before it launched its proposals to close the unit—it found that some of its perceptions were wrong.

One important standard for improving care is co-locating—bringing together, in other words—the different children’s services, which includes not just surgery but other heart support, paediatric intensive care and wider services available to children. NHS England initially marked Glenfield down for not having plans to co-locate services. I am afraid that that was completely and utterly wrong. On coming to the centre it discovered that there are indeed such plans. I would like the Minister to confirm that University Hospitals of Leicester trust has plans to complete the co-location of all the services before April 2019, and has secured all the capital budget necessary to build its new children’s services hospital. To put all that at risk when the hospital is trying to improve services would be a big mistake.

Finally, I want to discuss the impact on other services in Leicester and the region of closing the children’s heart surgery unit. It is extremely important. As I said earlier, NHS England has itself said that it would not put forward proposals to close the unit unless it had done a risk assessment of the costs and benefits, including the knock-on effect on other services. It has not yet done that. I am concerned about two services in particular. Glenfield has a world-leading extracorporeal membrane oxygenation service. Essentially, if someone has a weak heart and needs surgery on it, ECMO enables oxygen to be pumped back into the blood during the operation. Glenfield’s is only the second ECMO service in the world to treat more than 2,000 patients. It conducts 50% of the entire ECMO activity in the UK. It also has the country’s only national patient transport service enabling people who need ECMO to be transferred swiftly from anywhere in the country to Glenfield. The huge benefits of that service were seen during recent flu crises.

[Lilian Greenwood]

I thank my hon. Friend for being so generous in giving way again. My constituent, Alice Parker, was born at Queen’s Medical Centre 17 years ago. Her condition was so grave that her mum, Vicki, was told to expect the worst, but thanks to the expertise of staff at Glenfield who provide ECMO, Alice is now studying for her A-levels at Bilborough College and hoping to go to university to study biochemistry. Vicki describes the centre as “a true national treasure”, but actually, as my hon. Friend has said, it is an international treasure and it is vital that we do not lose the service.

[Liz Kendall]

That is right, and in fact Glenfield’s ECMO training is currently being provided not only to people from three other UK centres, but to people from seven other countries. NHS England seems to think that that work can be picked up and transferred somewhere, quickly and immediately, without loss of quality. In fact, as I know from speaking to many clinicians and nurses, that is not as easy as NHS England says.

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Dunne]

Considerable efforts are going into sorting out some of the historical challenges in the provision of both acute and community care in Devon. I hosted a meeting for a number of colleagues who are concerned about this and I am happy to continue to engage with colleagues across the county.

[Lilian Greenwood (Nottingham South) (Lab)]

Two years ago, Nottingham University Hospitals NHS trust privatised support services, including cleaning, handing them over to Carillion in an effort to save money. Since then there have been shortages of equipment, shortages of staff and an appalling decline in standards of cleanliness. Will the Secretary of State condemn Carillion for putting patients at risk? When will he ensure that hospital services in Nottingham are properly funded?

[Mr Jeremy Hunt]

The decision on whether to outsource services must be a matter for local hospitals. I know that that hospital has been struggling with its deficit. I have been to visit the hospital myself and I know it has been trying very hard to improve clinical care. If the contract is not working and the quality is not right, I would expect the hospital to change it, but it must be its decision.

Hearing Loss: Action Plan and Commissioning Framework

Lilian Greenwood Excerpts

Thursday 30th June 2016 Westminster Hall

[Lilian Greenwood (Nottingham South) (Lab)]

It is a great pleasure to see you in the chair today, Ms Vaz, and to have the opportunity to speak in Westminster Hall for the first time in a while.

I want to begin by congratulating my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) on securing today’s date and on the excellent work that he is doing to lead the all-party group on deafness. I am very proud to represent a constituency that is home to the national charity, the Ear Foundation, of which I am a patron. We are also home to the Medical Research Council’s Institute for Hearing Research, the Biomedical Research Unit on Hearing and the excellent audiology department of Nottingham University Hospitals NHS Trust. Their work is outstanding and makes a huge contribution to our understanding of hearing loss and deafness in the UK and of the ways in which we can best support those with hearing difficulties to fulfil their potential and live the lives they choose.

Back in November 2013, I secured an Adjournment debate on hearing loss in adulthood and I pressed the then Minister, the right hon. Member for North Norfolk (Norman Lamb), to get on with publishing the long-awaited action plan on hearing loss and to monitor its implementation. When it was published in March 2015, it was welcomed on both sides of the House and by everyone with an interest in hearing issues. It sets out clearly the high personal, societal and economic costs of hearing loss—the case for action—and the action that needs to be taken: better prevention, early diagnosis and the right provision of support and services.

As my hon. Friend the Member for Poplar and Limehouse has set out, the case for action is huge: 11 million people in the UK are currently affected by hearing loss; that is 1 in 6 of us, which translates to about 10,000 of our constituents. With an ageing population, both that number and the proportion of us affected is rising fast. But it is not simply the numbers affected that makes this a major public health issue; it is the significant impact that untreated hearing loss has on people’s health and wellbeing.

To communicate is to be part of society. Losing one’s hearing is not simply about the absence of sound. If not addressed, hearing loss becomes the loss of our capacity to take part in social life. It is a 24/7 condition and in most cases there is no cure, so it is no exaggeration to say that it can destroy lives. Because communication is at the core of human experience, people with hearing loss can find it very difficult to negotiate everyday interactions, whether in the workplace, on the bus, at the supermarket or in the local doctor’s surgery. It can lead to isolation and exclusion. It can also damage personal relationships. Many deaf people report finding it difficult to join in with family conversations and jokes. Couples say they feel more distant from each other and from their friends; and partners of people with a hearing problem describe feelings of loneliness and frustration.

Travelling on public transport becomes a challenge. A minor problem such as a platform alteration or a delayed connection can become a major problem if you miss the announcement. That can leave deaf people feeling anxious and vulnerable and worried about being left stranded or lost. Failure to address hearing problems does not just affect individuals and their families; it has implications for society as a whole.

It is estimated that hearing loss costs the UK economy £25 billion a year in lost productivity and unemployment. Too many people are forced to resign, retire early or take redundancy as a result of their disability. Of the 300,000 people of working age with severe hearing impairment, 20% report being unemployed and seeking work, and another 10% report that they cannot seek work owing to their ill health. As the state pension age rises and more jobs depend on people’s communication skills than was the case 20 or 30 years ago, such vulnerability to unemployment is a growing problem.

Research shows that hearing loss is also linked to other health problems, doubling the risk of developing depression and increasing the risk of anxiety and other mental health difficulties. There is also increasing evidence of links between hearing loss and dementia and evidence linking hearing loss to learning disabilities, diabetes, stroke and obesity. That is the bad news. The good news is the incontrovertible evidence that hearing aids and other technologies, including cochlear implants, improve people’s ability to communicate and their quality of life. They reduce the risk of depression and other health problems. But early intervention is key to maximising the benefits, so we must address issues relating to early diagnosis, prompt referral to high-quality audiology services and appropriate provision of hearing aids and other interventions.

Hearing aids are most effective when they are fitted early, but on average, as the my hon. Friend the Member for Poplar and Limehouse said, people wait 10 years before seeking help, and when they do eventually seek help, GPs fail to refer 45% of those reporting problems with their hearing to NHS audiology services. That is why I was so disappointed that the national screening committee decided not to recommend an adult hearing screening programme that could have helped us to address the issue.

I am sure the Minister has read the research report by Action on Hearing Loss and the Ear Foundation—I have it here—which posed the question, “Adult Hearing Screening: can we afford to wait any longer?” If he has not, he is welcome to have my copy. Their evidence tells us that the answer to the question is a resounding no. I hope the Minister will agree to look again at that evidence.

The idea that people do not wear their hearing aids and keep them in a drawer is outdated. Today’s technologies are accepted and are worn, although the more we can do to improve follow-up care and reduce stigma, the better. Tackling hearing loss is cost-effective. We cannot afford to wait years for a randomised controlled trial. We should be acting now.

We are also very concerned, of course, about the risk of rationing access to hearing aids, as local health commissioners’ budgets are under intense pressure. In fact, the report on NHS audiology across the UK published by Action on Hearing Loss and entitled “Under Pressure” showed that 30% of NHS audiology providers had had their budgets reduced. Along with increased demand, that had led to two fifths of providers making service reductions, resulting in longer waiting times, fewer follow-up appointments and reduced availability of home visits. In a small number of cases, providers were not providing two hearing aids to patients with hearing loss in both ears.

Worse still, as everyone is aware, North Staffordshire clinical commissioning group decided in March last year to stop funding free NHS hearing aids altogether for those with mild hearing loss. There was a fear that others would follow it in doing that, but so far, as a result of significant campaigning by Action on Hearing Loss and many others, that has not happened. South Staffordshire, South Norfolk, Kernow and Mid Essex CCGs, which had all signalled their intention to restrict hearing aid provision, have now decided otherwise, or have at least delayed a decision until the national commissioning framework is published. However, three CCGs in Worcestershire are currently consulting on potential changes to local health services—including a proposal to cut NHS hearing aid provision; so there is still a threat to services.

When I asked the then Minister, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), about the North Staffs decision, he told me:

“If the hon. Lady has concerns about local commissioning decisions, she should take them up with local commissioners…It is important that clinical services are now designed and delivered by front-line health care professionals, and if she is concerned about them, I am sure she will take that up with her local CCG.”—[Official Report, 15 October 2014; Vol. 586, c. 407.]

I know that the Minister who is present today shares the concerns of the all-party group about rationing, and I hope that he can give me greater assurance that the commitments in the Government’s action plan will be more than warm words and will translate into effective action. The action plan and the commissioning guidance present an opportunity to improve millions of people’s lives, and I hope that we will grasp it.

--- Later in debate ---

[Alistair Burt]

I must confess that I do not have an answer. He makes a perfectly fair point. Whether or not that is what people raise at the time they are in the surgery or whether they recognise it themselves or minimise it by saying, “I’m just getting old” or whatever, I do not know. I will make an inquiry and see what research we have at present. Family practitioner care and GP services are under constant review, and we have a number of different pilots and vanguards looking at the provision of primary care services.

I will see what emphasis is being given to this particular aspect. Certainly we recognise that the demographics indicate that all issues associated with getting older, which can include hearing loss, are rising up the scale and the agenda. I will make specific inquiry about whatever reasons we have at present in relation to this matter and write to each of the hon. Members present to give that information. I am very happy to do that.

[Lilian Greenwood]

I wonder whether the Minister thinks there is a role for raising public awareness to empower patients not just so that we improve GPs’ understanding—that might be the issue—but so that people are a bit more demanding and recognise that hearing loss is not an inevitable consequence of growing old that has to be put up with but something that can be addressed.

[Alistair Burt]

Absolutely. Again, there may be more to be done through charities, the third sector, the Royal College of General Practitioners and perhaps the British Medical Association, certainly about the thing that people have in the back of their mind and do not always raise. Clearly, if there has been a sudden change, people may mention it. I suspect that part of it may be that people’s hearing loss is gradual. Perhaps there is an earlier stage.

All colleagues mentioned early intervention and perhaps there is a point at which it should be stated that hearing loss is not necessarily a natural thing that people should accept; it is something that they could and should do something about. My father is a GP and he always said that the most important part of any consultation was when the patient had taken their coat from the chair and put it on and was just leaving the room and said, “Oh, there’s one more thing, Doctor.” At that point, he always brought them back. I wonder whether, for a number of patients, that one more thing that they think they might not bother the doctor with is actually that: “I’ve just been getting a little bit hard of hearing. Maybe it is something and nothing” and so on. Perhaps that is something we could promote and say, “If that is your circumstance, do let someone know, because there is support available.”

Let me develop the discussion. We spoke about rationing services. I am aware that NHS England supported a recent decision from North Staffordshire CCG because it was able to demonstrate that its commissioning policy was evidence-based and had followed extensive public engagement. The hon. Member for Nottingham South was right to say that I am extremely wary of rationing early intervention and hearing aids at the very early stage. I fully accept all the evidence that says that it is doing something at that early stage that prevents something else later on. As colleagues have said, no one else has yet followed that. There has been a lot of challenge. It remains possible for NHS England to intervene if it thinks that commissioning has gone badly askew, but for now that has not been followed.

I will make a general—if slightly light-hearted—remark about resources in the national health service. Due to the decision taken by the nation last week, those who promoted a decision to leave the EU have promised, I think, £350 million a week—or maybe it is £100 million a week—to come to the NHS. My understanding is that that will not happen immediately, but perhaps in two or three years’ time we might see that money written into the health service’s baseline. It would be nice if that were to be. That remains to be seen. Certainly if that comes to pass, it would be one silver lining in the clouds of last week, but I suspect that that will not be a decision for me to take.

Land Registry

Lilian Greenwood Excerpts

Thursday 30th June 2016 Commons Chamber

[Mr Lammy]

My hon. Friend is exactly right; I agree with her 100%.

[Lilian Greenwood (Nottingham South) (Lab)]

Will my right hon. Friend give way?

[Mr Lammy]

I will once more, but then I must make progress because so many Members want to speak.

[Lilian Greenwood]

I thank my right hon. Friend and congratulate him on securing this debate, which is very much welcomed by the 400 or more people in my constituency who work at the Land Registry. Does he agree that this proposal not only flies in the face of professional opinion, but comes at the worst possible time, demonstrates short-term thinking and represents poor value for money? Is the economic uncertainty created by the referendum result last week not an additional reason for the Government to drop these proposals?

[Mr Lammy]

My hon. Friend makes a very serious point. Even if there were a case for these proposals—I suspect all of us agree that there is no case—now cannot be the time to continue with them. There is no doubt that a private company would seek a profit and become a compulsory monopoly business, driving up the fees charged to users—the point raised by my hon. Friend the Member for Harrow West (Mr Thomas). A sale price of about £100 billion has been mooted in the press. A private company would therefore look to recoup this investment through the fees it charges and then turn a profit for its shareholders.

The argument we often hear in favour of privatisation is that competition will drive prices down, but this completely disregards the fact that the Land Registry is a unique asset in our lives. It is one of a kind, and users are compelled to pay the fees during any transaction involving land or property. There is only one Land Registry; it is a compulsory monopoly and we need to reflect on what would happen if this public monopoly became a private monopoly. We would have profiteering—pure and simple—by ripping off the public with inflated fees.

The Minister refused to answer my written question of 6 June about what steps would be taken to ensure that Land Registry service fees did not increase in the event of privatisation, so I hope we will hear something from him today. We are left to assume that the “protections” and safeguards that the Secretary State mentioned in the foreword to the consultation document do not include any protection from vastly inflated service fees. In time, whatever sum the Government might secure from a sale today will ultimately be paid for by the people and businesses who use and depend on the Land Registry’s services.

--- Later in debate ---

[Carolyn Harris (Swansea East) (Lab)]

I declare an interest. I am proud to say that the Land Registry has its largest UK facility in my constituency.

The Land Registry provides a substantial number of jobs to Swansea East and plays a very important socioeconomic role, not just in my constituency, but in the surrounding areas. In July 2014 the coalition Government shelved plans to sell the well-respected 150-year-old service. That was after only 5% of respondents to a consultation felt that privatisation would make the Land Registry a more effective and efficient service. The consultation produced an overwhelming response:

“Overall, across virtually all respondents, it was suggested that a case for change had not been made.”

Despite this, fewer than two years later, the Government are yet again reviewing plans to privatise the Land Registry. That is being driven by the Treasury’s demand to make cuts, with the short-term aim of cutting the national debt.

[Lilian Greenwood]

My hon. Friend is making a passionate case on behalf of the people she represents. Is she aware of the report from the New Economics Foundation, which concluded that future funds from the Land Registry would outweigh the cash cost of a one-off sale after 25 years? The plan fails on the Government’s own terms.

[Carolyn Harris]

I am aware of that and I will come to it later in my speech.

The consultation on moving Land Registry operations to the private sector was launched on 24 March 2016. Ludicrously, it closed two days later. I would argue that it was deliberately timed so that MPs would not notice the announcement, because we were all heading home for the Easter recess—I was actually on a train to Swansea, and I read of the plan on a Twitter post. Like many colleagues, I was furious at the way the announcement was made.

Currently, the Land Registry is entirely self-funding and no drain whatever on the Government purse. Furthermore, the service makes a surplus year on year. That is passed on to the public by way of reduced costs for using the service. It also provides the Treasury with a significant income.

A report from the New Economics Foundation shows that selling off the Land Registry would harm Government finances in the long term. It suggests that the Land Registry and other assets under threat of privatisation or part-privatisation are clearly able to innovate and deliver a profit without needing to be in the private sector.

The sale of the Land Registry will hardly put a dent in the national deficit finger—[Laughter.] We can all point the finger at the Government. At the same time, we will be giving up valuable assets and forgoing long-term revenue streams. Land Registry jobs are also well paid and, more importantly, well respected. It is important that we retain them as part of a well-mixed economy to give job opportunities and a way forward to people from all sorts of backgrounds.

Only an in-house Land Registry can continue to deliver a quality, trusted and impartial public service.

NHS (Government Spending)

Lilian Greenwood Excerpts

Wednesday 28th January 2015 Commons Chamber

[Chris Leslie]

That is rather interesting. The hon. Lady would criticise us if we said that we would do this through general taxation, but when we show where the money will come from—pound for pound—she criticises that as well. I want to hear the Conservatives say where they will get the extra money from for the NHS. I will come to that in a moment, but I will first give way to my hon. Friend.

[Lilian Greenwood (Nottingham South) (Lab)]

A moment ago, my hon. Friend was talking about the risks of privatisation. I know he shares my concerns about health services in Nottingham. What advice does he have for the voters of Nottingham who, as a result of the outsourcing of our hospital’s world-renowned dermatology department, which was then broken up, can no longer access acute dermatology services locally? How should our constituents vote on 7 May? [Interruption.]

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order. Mr Garnier, I am not going to tell you again. You are on a warning now. You make lots of interventions. Members show you respect, and I expect you to show it to others when they make their points.

--- Later in debate ---

[Dr Eilidh Whiteford (Banff and Buchan) (SNP)]

I apologise for not being in the Chamber for the beginning of the debate.

The issues raised in today’s debate about the challenges of providing health care for a population that is ageing and living longer with complex health conditions in a context of fiscal austerity and rising costs are some of the most pressing ones facing us as policy makers. We all acknowledge that it is difficult and there is no easy soundbite solution to the long-term challenges, but I do not believe that those challenges are insurmountable if we are prepared to prioritise health spending and address pressure points in the system.

[Lilian Greenwood]

It is interesting that the hon. Lady was talking about the costs of an ageing population. Is she aware of Monday’s report by Action on Hearing Loss, which showed that as a result of budget cuts and rising demand two out of five audiology departments offer patients a reduced service? The chief executive of Action on Hearing Loss described that as having a cruel and senseless impact on people with hearing loss. Should the Government not respond to that?

[Dr Whiteford]

I was not aware of that report, so I am grateful to the hon. Lady for pointing it out.

We all know that we do not have one NHS in the UK—we have national health services in each of the home nations that operate independently of one another and are accountable to the devolved institutions—but it is worth noting that in recent years our distinct national health services have gone down divergent policy paths. Those of us who remain committed to comprehensive health care, available free at the point of need, understand that the model is under ideological threat. I have been horrified by the NHS reforms in England that have removed the statutory duty of care, and that, as we speak, are enabling the creeping privatisation of services. For the sake of the peoples of these islands, those reforms need to be reversed, because the reality of devolution is that Westminster still holds the purse strings. The funding formula by which the devolved Governments receive their block grants is directly related to budget decisions made for England in devolved policy areas, so decisions to cut spending in NHS England, or to privatise services, have a direct knock-on effect on the money made available to the Scottish Government.

There has been a 10% cut in Scotland’s fiscal resource budget since 2010, and a 26% real-terms cut in Scotland’s capital budget. Nevertheless, the Scottish Government have increased the health resource budget by 4.6% in real terms, and every penny of additional budget consequentials accruing from health spending has been spent on health. This coming year, health spending in Scotland will break the £12 billion barrier for the first time.

The practical consequences of increased health spending in Scotland can be seen in record staffing levels—up 6.5% overall, with record numbers of consultants, over 1,700 more nurses and a 7% increase in GPs. We have cleaner hospitals—cases of MRSA are down 88%, and C. diff is down 81% in elderly patients since 2007. Our waiting times for in-patients and out-patients have improved dramatically. More than 97% of in-patients were treated within the 12-week target in the last quarter, and 90% of patients are now being seen and treated within 18 weeks of initial referral. Perhaps most telling of all, there has been a drop in the hospital standardised mortality ratios of almost 16% since 2008 and a sizeable reduction in premature deaths in the most deprived areas. And we have honoured our pay commitments to our NHS staff.

The Minister and other Members have today made many comparisons between the NHS in England and the NHS in Wales, but there have been no comparisons with the NHS in Scotland. That is because across a range of indicators the Scottish NHS is outperforming the NHS elsewhere, precisely because we have not gone down the privatisation route.

Just yesterday the brand-new Southern general was handed over to the NHS—an NHS hospital, paid for without the use of discredited private finance initiative or public-private partnership schemes that have been an atrocious waste of public money and are still costing NHS Scotland over £225 million a year. In the north-east, anyone visiting Foresterhill can see all the building work that is going on to improve facilities. Under previous Governments, NHS Grampian was severely short-changed by the funding formula, but the SNP Government have been closing that gap and next year will put in an additional £49 million, a 6% funding increase to bring it into line with other health boards.

We cannot be complacent about the pressures on our NHS. Despite the best efforts and commitment of staff, our NHS is under strain and it does not always get it right. As MPs we often see when things go wrong, but we need to see that against a background of increasing patient satisfaction overall and continuing improvement in patient care, despite enormous pressures. We heard earlier today that some of the pressure on A and E emergency care is a consequence of people having problems accessing primary care. Another area where pressure in one part of the NHS has extensive knock-on impacts is in relation to delayed discharge, which puts tremendous strain on patients, whether they are stuck in hospital desperate to get home, or stuck at home desperate to get into hospital for treatment, because no beds are available.

The Scottish Health Secretary announced an additional £100 million earlier this month to address delayed discharges, but the underlying issues are not just for the NHS. Back in 2010 the report of the Christie commission highlighted, among other things, the need for joined-up services between health boards, local authorities and others, and preventive early interventions to meet the challenges of rising costs and changing demographics in the context of tight public finances. In Scotland, much progress has been made since then, but nobody would pretend that there is not a lot still left to do, or that the process is straightforward. However, we just need to look at how the non-means-tested free personal care has enabled thousands of people to live at home to see the human benefits of what is increasingly being recognised as a cost-effective policy.

It is precisely those efforts to join up health and social care that are threatened by the austerity agenda and the promises of further cuts that both Front-Bench teams seem to have shackled themselves to. Local authority budgets are already under pressure, and further cuts to the public services that they provide, including social care and preventive early intervention work, risk driving up still further the acute pressures on our NHS. Our NHS is precious. Most of us depend upon it. We need to prioritise it and provide the resources that it needs to meet changing demands on it.

A and E (Major Incidents)

Lilian Greenwood Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

The hon. Gentleman makes an important point. In fact, I was talking with someone senior at the Royal Cornwall hospital on Monday about the particular pressures there. Indeed, some of the funding that we allocated to the NHS in the autumn statement for next year is designed to do precisely that—to allow hospitals to maintain bed capacity while we ramp up facilities in community and primary care. It is very important to get the timing absolutely right.

[Lilian Greenwood (Nottingham South) (Lab)]

Yesterday the emergency department at Nottingham’s Queen’s Medical Centre faced such intense pressure that the trust was forced to enact its internal incident plan and cancel planned operations and out-patient clinics. Higher than expected admissions and delays in discharging patients who are well enough to leave hospital have been creating problems for many months. How can we resolve what is now a crisis if the Secretary of State will not even acknowledge that his Government’s deep cuts to social care are undermining the efforts of our dedicated NHS and social care staff?

[Mr Hunt]

We are doing an enormous amount to support social care. Some £3.9 billion of NHS funds has been given to the social care system over this Parliament, and we have strongly encouraged local authorities to ensure that any savings they have to make are done through efficiency savings, not cuts to front-line services. The hon. Lady’s local hospital has received £11 million in funding to help it through the winter. We are doing a huge amount to support the NHS through a difficult period, and she should support those efforts.

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 25th November 2014 Commons Chamber

[George Freeman]

My hon. Friend makes an important point. Dementia is one of those diseases where the loved ones and the carers of patients often suffer every bit as much as the patients. That is why, under the Prime Minister’s leadership, we have launched the G8 dementia summit to bring together the world to tackle the disease. We have launched a dementia strategy. Diagnosis rates in Britain have gone from 42% to 55% in two years. We have launched a new dementia service and doubled research spending. We will have 250,000 staff trained by next March, and, from April, we will be investing £3.8 billion into the Better Care fund. It is an important disease that deserves our priority.

[Lilian Greenwood (Nottingham South) (Lab)]

The Ear Foundation recently published a report that estimates that the real cost of adult hearing loss is at least £30 billion a year. I hope that the Minister has read it. What is he doing to ensure that adults who could benefit from improved hearing technologies, including cochlear implants, do so, and when does he plan to publish the action plan on hearing loss that has long been promised?

[George Freeman]

I am not aware of the veracity of the £30 billion figure, but I will happily look at it, and I happily undertake to look at the progress of the report and the work that the hon. Lady raised.

Five Year Forward View

Lilian Greenwood Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

That is a very good point and I agree with my hon. Friend that we should aspire to a smoke-free Britain. We are making remarkable progress. The point the report makes—this goes alongside what my hon. Friend has said—is that we need to integrate our thinking about public health with our thinking about the services the NHS delivers. The better care fund has shown how it is possible to get excellent collaboration between local authorities and the local NHS for the delivery of social care. Transformational things are happening up and down the country right now. I would like to see the same thing for public health as well.

[Lilian Greenwood (Nottingham South) (Lab)]

Alcohol abuse costs the NHS in Nottinghamshire more than £55 million a year and cuts in social services are making the pressures worse, especially for emergency departments. Dr Stephen Ryder, consultant hepatologist at Nottingham University Hospitals NHS Trust, wrote to me recently to express his deep concern that the Government are not taking forward the introduction of minimum unit pricing. Why are this Government ignoring advice and clinicians and ducking the issue of dealing with cheap alcohol?

[Mr Hunt]

We are doing a number of things to tackle alcoholism. Alcoholism rates have continued to fall under this Government, so we are making good progress. The approach to alcohol is different from that to cigarettes, because responsible drinking is perfectly okay for a person’s health; it may even be good for their health, depending on which doctor they speak to. We want to be careful that our alcohol policies do not penalise responsible drinkers who may not have large salaries and worry very much about the pennies their shopping basket costs.

NHS Services (Access)

Lilian Greenwood Excerpts

Wednesday 15th October 2014 Commons Chamber

[Andy Burnham]

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

[Lilian Greenwood (Nottingham South) (Lab)]

One of the groups most affected by cuts to mental health services is children. On this Government’s watch we have seen increasing numbers of children with mental health difficulties treated on adult psychiatric wards. Is that not completely unacceptable?

[Andy Burnham]

My hon. Friend puts it very well. If mental health is the poor relation of the NHS, then child and adolescent mental health services are the poor relation of the poor relation. How can that be the case when we are talking about children who need the best possible support—the most vulnerable children—being denied the services that they need? My hon. Friend the Member for Leicester West (Liz Kendall) discussed at a shadow health team meeting a constituency case where a family were trying to find a bed for a child who was in a crisis and not one bed was available for that child in the whole country—not one bed. She is nodding. That is the reality. I wish that Government Members would focus on that rather than making complacent statements.

No amount of spin from the Government can disguise the fact that the NHS is heading for the rocks and urgently needs turning around, so the question is how we get it back on track. I have two positive proposals to put before the House on policy direction and on funding. Let me take each in turn. Instead of just admitting privately that the reorganisation was a mistake, the Government should be actively working with us to begin to put it right—and they will soon have a chance to do so. In five weeks, my hon. Friend the Member for Eltham (Clive Efford) will bring a Bill before this House to repeal the worst aspects of the Health and Social Care Act 2012. When the Government’s reorganisation was going through, their mantra was “Doctors will decide.” The Prime Minister repeated this in his “Today” programme interview during the Conservative party conference when he said:

“there’s nothing we’ve done which makes it more likely there’ll be private provision in the NHS”.

--- Later in debate ---

[Mr Hunt]

The right hon. Gentleman is quite wrong. My right hon. Friend said that there was a list of three providers, all with private provision involved. When the right hon. Gentleman was Health Secretary, he accepted that all-private shortlist for the Hinchingbrooke decision. In other words, the biggest privatisation in NHS history happened because of a decision taken by the shadow Health Secretary.

Government Members are not ideological. We believe there are times when we can learn from the independent sector, but, normally, people use the private sector when they are looking for innovation or better value. Only a Labour Government would sign deals with the private sector, paying 11% more than the NHS rate, and ending up paying more than £200 million for operations that never happened. What a shocking waste of money. When the right hon. Gentleman next talks about privatisation, instead of inventing a privatisation agenda that does not exist, will he apologise for a botched one that existed when Labour was in office?

Finally, there is a comparison that Labour never wants to make when talking about NHS performance: what happens over the border in Wales. That is where the policies that the right hon. Gentleman supports are put into practice. Let us see the difference. A record one in every seven Welsh people find themselves sitting on an NHS waiting list, compared with just one in 17 people in England. The urgent cancer waiting time target has not been met once since 2008 in Wales, but it has been missed in England in only two quarters in the whole period. A and E waiting times have been met every year in England, but they have not been met since 2008 in Wales.

[Lilian Greenwood]

Will the Secretary of State give way?

[Mr Hunt]

No, I will finish this point.

The British Medical Association, no friend of the Conservative party, described the NHS in Wales as being in a state of imminent meltdown. The point is that the NHS in England, like the NHS in Wales, faces huge pressure, but politicising operational problems in England, while denying much greater failings in Wales, is the worst kind of opportunism. For Labour Members, good headlines for Labour matter more than poor care on Labour’s watch. They are playing politics with our NHS. That not only scares people in England, but betrays people in Wales.

I shall conclude—

[Lilian Greenwood]

Will the Secretary of State give way?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. The right hon. Gentleman is not giving way. He must be allowed to speak.

--- Later in debate ---

[Lilian Greenwood (Nottingham South) (Lab)]

Earlier today, my hon. Friend the Member for Darlington (Jenny Chapman) asked the Prime Minister about the mothers from her constituency who marched 300 miles this summer to show their anger at this Government’s wasteful mismanagement of the health service. He dodged her question of course, because he has no answer to it. Is it reassuring that members of the Cabinet have finally realised what the rest of us have known for four years—that reorganising the NHS was a big mistake? I do not think so. There is disgust and anger out there, but not surprise. I was proud to walk alongside the Darlo Mums when their long march passed through Nottingham. The T-shirt I wore that day has a slogan on it. Sadly, I am not allowed to wear it here. It says, “Never trust a Tory with your NHS”. That is good advice.

We all remember what the Prime Minister promised before the election—no more top-down reorganisations. That promise did not last long. The reason I am angry is not just because that was not true, but because the reorganisation was the wrong policy at the worst possible time. We know that the finances are difficult. With both an ageing population and increasingly complex and expensive treatments available, the NHS faces unprecedented challenges. But instead of focusing on achieving the best possible outcomes for people with the resources available, the Prime Minister caused chaos: 4,000 staff were laid off and rehired; nurse numbers have not kept pace with demand; training places were cut; there are not enough GPs; training has been scaled back; hospitals are tied up in competition law; and savage cuts have been made to local authorities, leading to a crisis in social care and so pushing more and more elderly people into A and E when they should be getting the care they need at home. It is no wonder that morale is low when half of nurses say that their wards are dangerously understaffed; Ministers undermine the independent pay review body; and managers are being rehired after having six-figure pay-offs. But what makes me really angry is the impact that this wasteful reorganisation has had on my own constituents. I am proud of the NHS in Nottingham—whether in primary care, mental health services or our two acute hospitals. I know that we have great staff working incredibly hard for the people who need them, but at every level they face unbelievable pressure, and, in places, they are really struggling to cope.

The chief executive of Nottingham University Hospitals NHS Trust was very blunt when he met local MPs a couple of weeks ago. He told us that the trust faces the toughest ever cost-reduction plan, that this year he is planning for a deficit of £19.1 million—the first time the trust has been in that position—and that targets are being missed.

The accident and emergency department at Queen’s has missed the four-hour waiting target every month since August last year, and it reached its worst performance this June, in the middle of summer. I know our local hospital is planning for winter, but the crisis is already here. The reasons for the crisis are not simple, but it is clear that patient flow, both through and out of the hospital, is creating particular problems. Hundreds of patients who are well enough to be discharged or who should be receiving care and support at home or in residential care are still in hospital because their discharge is delayed. That is because, despite a commitment to joint working, social services cannot cope. The deep cuts to social care are having a real and direct impact on the NHS in Nottinghamshire and on my constituents.

NHS privatisation is now taking hold as commissioners are forced to put services out to the market. Let me tell the House about patient transport and my constituent, Jean. Jean is 84 years old and very unwell. She needs four hours of dialysis three times a week. Since a private company took over patient transport, she has been late for appointments, and had to wait for hours to be taken home. Such poor service has a knock-on impact on other patients in our city’s hospitals and the clinical commissioning group tells me that Jean’s experience is typical of feedback from other patients.

Last week, the chair of the hospitals trust described meeting a patient at 10 o’clock at night. That patient had been waiting since 10 o’clock in the morning to go home where his wife was waiting for him. Patients deserve so much better. Next May, they will have a chance to vote on the service, because Labour has a plan for the NHS. We will raise £2.5 billion for an NHS “time to care” fund. The money will come not from ordinary working people, but from ensuring that hedge funds and other tax avoiders play by the rules, and from asking those at the top to pay more and introducing fees on tobacco companies. The £2.5 billion will be used to employ enough doctors and nurses with the time to care for patients—20,000 more nurses to ensure that we get the basics right with safe staffing; 8,000 more GPs to help people stay healthy outside hospital; and 5,000 new home care workers and 3,000 more midwives. We will ensure better access and guarantee GP appointments in 48 hours or on the same day for those who need it. We will repeal the Tories’ NHS changes that put private profit before patients, so that our health service does the things that it should, such as care for patients and not argue about competition law. We will give patients and the public a real say over local services, and bring together physical health, mental health and social care into a single service to meet all of a person’s care needs —whole person care.

The message from the Darlo Mums to the Government was clear: hands off our NHS. It might not fit on a T-shirt, but my message today is equally clear. Labour built the NHS, Labour will save the NHS, and only Labour can transform it for the future.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to conclude this debate and to speak to the contributions of hon. Friends and hon. Members. It is a pity that when we have NHS debates, they sometimes become unnecessarily tribal and partisan. Some Labour Members often seek to talk down the local NHS rather than to stand up for their hard-working NHS staff who deliver high-quality services on the ground.

I want to talk about some of the successes this Government have delivered for our NHS and then I shall address some of the points raised in the debate. We know that even in these difficult economic times, this Government have protected our NHS budget with £12.7 billion more during this Parliament. That was something that the shadow Secretary of State, the right hon. Member for Leigh (Andy Burnham) called “irresponsible”, but it is not irresponsible to make sure that we continue to support and protect the NHS front line. We have stripped out over £5 billion-worth of bureaucracy and reinvested that money into front-line patient care. That has been audited by the National Audit Office, but the hon. Member for Leicester West (Liz Kendall) did not choose to highlight that point in her remarks. It has been confirmed and we know it is true.

I make no apology for the fact that we as a Government have focused ruthlessly on having a more efficient health service that frees up as much money as possible for front-line patient care. We have reduced the number of administrative staff by around 20,000, increased front-line clinical staff by over 12,500 and set up a cancer drugs fund that has helped 55,000 people who would not have received cancer drugs to receive them. There has been an unrelenting focus on promoting a more joined-up approach to care, to help deliver more care in the community for people with long-term medical conditions, particularly the frail elderly.

Let me deal with some of the comments and contributions to the debate. I would like to reassure my hon. Friend the Member for Morecambe and Lunesdale (David Morris) that the hospital in his constituency is, of course, not going to close and that any local scaremongering by the Labour party is wrong and misplaced. I would also like to reassure the hon. Member for North Durham (Mr Jones), who raised concerns about the north-east ambulance service, that the service has generally been performing well. In 2013-14, it met all its national targets. I urge the hon. Gentleman to write to me if he has any further concerns on behalf of local patients.

We heard strong contributions from my hon. Friend the Member for Norwich North (Chloe Smith), who made important remarks about the services delivered at the Norfolk and Norwich hospital, and I look forward to accepting her invitation to visit that hospital once again in the near future, and from my hon. Friend the Member for Bosworth (David Tredinnick) who made one of his regular pleas for more alternative medicine in the NHS. Importantly, he talked about the benefits of clinically driven commissioning. Under this Government, we have put doctors and nurses in charge of our NHS to make sure that services are delivered at local level. Patient services are run by doctors and nurses, not by bureaucrats, which has been a tremendous step forward. My hon. Friend the Member for St Ives (Andrew George) made a considered contribution about the previous Government’s record on encouraging private sector providers in the NHS—a point to which I shall return.

[Lilian Greenwood]

What does the Minister think about what happened to the clinical commissioning group in North Staffordshire, which decided not to allow people with mild to moderate hearing loss to have hearing aids, even though that was clearly not the view of the local health scrutiny committees or local patients? Is that not precisely putting in jeopardy preventive services, which would keep people in work and keep them active in the community rather than being isolated? It is stopping those people from participating.

[Dr Poulter]

If the hon. Lady has concerns about local commissioning decisions, she should take them up with local commissioners. Time forbids me from going into the rationing of services by the previous Labour Government. It is important that clinical services are now designed and delivered by front-line health care professionals, and if she is concerned about them, I am sure she will take that up with her local CCG.

The right hon. Member for Leigh (Andy Burnham) referred to a work force crisis in GP training. It is clear that under this Government 1,000 more GPs are now in training and working in the NHS than in 2010 when we came into government. If it is not accepted that that is good start, we have committed to training an extra 5,000 because we want more people working in general practice.

We have ensured that 1.3 million more people are being treated in A and E compared with the number in 2009-10. We have halved the time that people must wait to be assessed, and every day we are treating nearly 2,000 more people within the four-hour target compared with the number in 2010.

Competition was introduced into the NHS not by the Health and Social Care Act 2012 but by the previous Labour Government, of whom the right hon. Member for Leigh was a Minister. The Labour Government opened the door to private sector providers when they opened the first independent sector treatment centres in 2003. The Labour Government gave £250 million to private companies and independent sector treatment centres, regardless of whether they delivered that care. Labour was more concerned about giving money to the private centres than about ensuring that quality care was delivered. Labour paid independent private sector providers 11% more to provide the same care as NHS providers. That is Labour’s record on the private sector in the NHS—a record that shows that it is more committed to the private sector than any previous Conservative Government.