NHS

Luciana Berger Excerpts

Wednesday 5th February 2014 Commons Chamber

[Mr Hunt]

I am about to answer, if the right hon. Gentleman will be a little bit patient. The Act does not change the procurement requirements under which PCTs operated. It does not change the locus of the Competition Commission or the OFT under the Enterprise Act.

While we are correcting some facts, the right hon. Gentleman may be interested to know—as would my hon. Friend the Member for Taunton Deane (Mr Browne), but he is no longer in the Chamber—that we have the figures for the number of people admitted to the NHS with scurvy in 2011-12 and in 2012-13. In 2011-12, the number of admissions not just to A and E departments but in total—[Interruption.] Yes, including A and E departments. In 2011-12, eight people were admitted—[Interruption.] This was the right hon. Gentleman’s big argument about why A and E departments are under so much pressure. In 2012-13, 18 people were admitted. With the greatest respect, I think that the right hon. Gentleman is building his house on sand.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

We have figures for 2010-11, because they were included in the answer to a parliamentary question that I asked just before Christmas. The Minister of State, who is present, replied that they were not the total figures, because the Department had the hospital admission figures but did not have the figures for primary care admissions.

[Mr Hunt]

With the greatest respect, what we heard earlier from the right hon. Member for Leigh was a big argument about a massive growth of pressure on A and E departments that had been caused by, among other things, scurvy, and we found that the total number of admissions was 18. I think that that says a great deal.

--- Later in debate ---

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

This debate has laid bare the stark reality of the Government’s blinkered approach to the NHS. They are utterly complacent, hopelessly out of touch, and in complete denial not only about the scale of the crisis in A and E, but about how their changes to competition rules are making things even worse. They have nothing to offer patients and our hard-working doctors and nurses who tirelessly serve the NHS every single day, except smoke and mirrors to try to disguise the real causes.

The Government have come to the House today celebrating “the strong performance”—it is in their amendment—of A and E. We have previously heard the Secretary of State insisting that the NHS is getting better. Almost 1 million patients have waited longer than four hours in the last year and Ministers are asking for a pat on the back. In the last 12 months, trolley waits are up; delayed discharges are up; 18-week waits are up; median and mean waiting times are up; emergency admissions are up; cancelled elective operations are up; cancelled urgent operations are up; and we have even seen patients being ferried to A and E in the back of police cars because no ambulances are available. It is not getting better, it is getting worse.

If Ministers will not listen to us, perhaps they will listen to the experts and those on the front line. Today, the Foundation Trust Network has said that

“pressure on the emergency care system is growing”.

Ministers like to forget about the confusion and disorder that they have inflicted upon the NHS through their £3 billion top-down reorganisation, but they should acknowledge it. My hon. Friend the Member for Walsall South (Valerie Vaz) referred to it in detail, and it is the same top-down reorganisation that the Prime Minister promised would never happen on his watch.

Let me remind the House of the warnings the Government were given at the time. In December, Dr Clifford Mann, president of the College of Emergency Medicine, revealed that he advised Ministers more than two years ago of a growing crisis in A and E. But his words were unheeded, leaving him and his colleagues feeling like

“John the Baptist crying in the wilderness.”

Dr Mann warned that the Health and Social Care Act 2012 would take up

“a lot of time and resources from the medical royal colleges and other organisations.”

He added that it

“tied us all up in knots”—

and created—

“a lot of decision-making paralysis and stasis in the system”.

While Dr Mann was warning of dangerously low staffing levels, spending on expensive locum doctors in A and E has rocketed by 60% in the past three years.

The issue here is that too few doctors are picking emergency medicine in the final stages of their training, and who could blame them? It might take six years to train a doctor, but it only takes a second for the Government’s A and E crisis to deter a junior doctor from going into emergency medicine.

The disruption the College of Emergency Medicine talks about is the disruption that the care Minister and his fellow Liberal Democrats allowed to happen when they nodded through the Health and Social Care Act, but we hear reports that his party is preparing to disown the NHS reorganisation and pretend it had nothing to do with them.

The right hon. Member for Sutton and Cheam (Paul Burstow) has admitted today that he got it wrong on competition. Why does the care Minister not own up and admit that he got this wrong, and that he should have listened to his own supporters and hundreds of thousands of people across the country who pleaded with him not to go through with it?

The human cost of that mistake is clear for all to see. We can see it in the sheer number of people coming through the doors of A and E. As my right hon. Friend the shadow Health Secretary pointed out at the beginning of this debate, attendances at A and E rose by 16,000 in the last three years of the Labour Government. In the first three years of this Government, they have rocketed by 633,000. Ministers may be pleased that the NHS is still standing after being subjected to this level of pressure, but the question they should ask is, why are so many more people coming to A and E in the first place?

[Mr Jeremy Browne]

The hon. Lady mentioned the figure of 633,000 extra people presenting to A and E. In his opening speech, the shadow Health Secretary attributed a proportion of that number to people who had scurvy or rickets, as he tried to paint a Dickensian picture of national squalor. Now that she has had a few hours to check, can she tell me how many of those 633,000 people were diagnosed in A and E with either scurvy or rickets?

[Luciana Berger]

The hon. Gentleman may not have been here when we had the response from the Health Secretary. I will come on to the very points the hon. Gentleman raises in my speech, and I look forward to going through all the big issues we have with malnutrition in this country.

I echo the comments made by my right hon. Friend the shadow Secretary of State about the sneering we have heard from Government Members this afternoon regarding some very serious issues. Any case of scurvy in 21st-century Britain is shameful.

My hon. Friend the Member for Stretford and Urmston (Kate Green) talked about the catalogue of coincidences that have led to so many more people going to A and E in the first place. I refer back to the increase of 16,000 in the last three years of the Labour Government, and of 633,000 in the first three years of this Government. Why is that? A quarter of walk-in centres have closed. NHS Direct was abolished. The guarantee of a GP appointment in 48 hours was scrapped, and extended GP opening hours were cut. As my hon. Friends the Members for Easington (Grahame M. Morris) and for Worsley and Eccles South (Barbara Keeley) said, £1.8 billion has been hacked from social care budgets, with thousands of people losing their care packages.

[Angie Bray (Ealing Central and Acton) (Con)]

Is the hon. Lady prepared to admit, just a teensy bit, that some of the added numbers going to A and E, which I agree are putting a lot of pressure on the departments, are partly to do with the change in GP contracts introduced by the Labour Government? That is driving people to A and E, because no GPs are working the hours that would allow people to be seen.

[Luciana Berger]

I just do not know what to say to that because it is so ridiculous. There was an increase of 16,000 in the last three years of the Labour Government, which has rocketed to 633,000 in the first three years of this Government. The gap in those figures is tremendous. The GP contract happened in 2004. When have we seen crises in A and E? Not under the Labour Government, but under this Government—the Tory-Liberal Democrat Government.

What else has happened under this Government? We have seen the Health Secretary handing back £2.2 billion of underspend to the Treasury, 2,300 managers receiving six-figure pay outs and £1.4 billion siphoned off to pay for redundancies. My right hon. Friend the Member for Leigh also raise the issue of the amount of money NHS trusts are now having to spend on expensive legal fees as a result of competition, introduced through the Health and Social Care Act. That goes to show that when it comes to our NHS, this Government know the cost of everything but the value of nothing.

As the hon. Member for Stafford (Jeremy Lefroy) said, our elderly population is growing, but half a million fewer older people are receiving support compared to 10 years ago. That means more older people going to A and E because they cannot receive the care they need at home, and more older people stuck in hospital beds because there is no safe place to discharge them to.

[Margot James]

Will the hon. Lady give way?

[Luciana Berger]

I am not giving way because I have only three minutes left.

As my right hon. Friend the Member for Leigh said earlier, the CQC recently reported that in the last year, more than half a million pensioners were admitted as an emergency to hospital with potentially avoidable conditions. There is another reason for that: it is now harder, not easier, to get a GP appointment under this Government. The Royal College of General Practitioners says that it will soon become the norm for people to wait a week or longer to see their GP. Just this week, I was contacted by a constituent whose partner was suffering from chest pains. They contacted the GP but could not get an appointment for eight days.

This is what patients are having to endure right across the country, and it is being made even harder by the cost of living crisis hitting families all over Britain. People are having to eat less, and less healthily, and more than half a million people are being forced to turn to food banks. As my hon. Friend the Member for Worsley and Eccles South described so poignantly, carers are having to make the choice between heating and eating. GPs are now asking patients when they last had a meal. It is no coincidence that, as food bank use has exploded, so have cases of malnutrition. There has been a 42% increase in malnutrition cases, and in 2012-13 more than 5,000 people were thus diagnosed in English hospitals. I share the view of my hon. Friend the Member for Stretford and Urmston that that is a disgrace in 21st-century Britain.

Doctors are now treating diseases we thought had all but disappeared. It is not just scurvy; rickets and vitamin deficiency are also on the rise. The Government have already given us the longest fall in living standards since the 1870s; we now have the Victorian diseases to match. They should be ashamed of every single case of these 19th-century diseases returning to 21st-century Britain.

That is not all. With energy bills up by £300 and more children living in fuel poverty, is it any wonder that episodes of hypothermia have jumped by 40% in the past three years? We have seen a 29% increase in the number of excess winter deaths—31,000 deaths that by definition were entirely preventable—while new figures this week show a dramatic increase in the number of older people being admitted to A and E for cold-related illnesses. Furthermore, there have been 145,000 more cases of over-75s being treated in hospital for respiratory or circulatory diseases, compared with 2009-10.

Ministers cannot resolve the crisis in our NHS. They know what is happening and that their policies are stoking the crisis, but they will not admit it. Only Labour can preserve, protect and progress our NHS. Our approach focuses on the patient, and it champions integration and collaboration, not competition, fragmentation and profit. We want a public, integrated NHS free at the point of use, and a whole-person approach that combines physical, mental and social care and helps to take the pressure off A and E. That is the principle behind our motion today, and I urge Members on both sides of the House to support it.

Early Childhood Development

Luciana Berger Excerpts

Thursday 30th January 2014 Westminster Hall

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I commend and congratulate the hon. Member for South Northamptonshire (Andrea Leadsom) on securing this debate. I also congratulate the hon. Member for Brighton, Pavilion (Caroline Lucas), my right hon. Friend the Member for Birkenhead (Mr Field) and the right hon. Member for Sutton and Cheam (Paul Burstow) on their work in developing this manifesto and promoting the ideas within it. This debate has been constructive and well-informed. Many excellent points have been made that will resonate strongly with those on both sides of this Chamber.

When the first national health service hospital opened its doors in 1948, it was conceived as part of an all-encompassing system of social security, supporting everyone in our society from cradle to grave. Only in recent years, more than 60 years on, have we have come to understand just how much that short time in the cradle—those very first few months—can ultimately decide how long, healthy and happy a life a newborn baby will enjoy.

We must do everything we can to give all babies born in Britain today the best possible start in life. That was underlined earlier this week in an open letter to The Times from 23 of the UK’s leading child health experts. They warned that, for the first time since the Victorian age, it is predicted that living standards for children will be lower than for their parents and that child mortality is still stubbornly higher in Britain than in other western European countries. They called for a greater focus on younger generations. We have heard some powerful and encouraging contributions to that debate today; I want to build on what other hon. Members have said and focus on some of the challenges that we must address. I want to focus on early intervention, maternal support and care, and general help for all mums and dads. That is by no means a comprehensive list of what I would like to cover, but it is most fitting for the debate.

All hon. Members who spoke referred to the importance of early intervention. The maxim that prevention is better than cure is one of the most enduring in public health. As the “The 1001 Critical Days” manifesto details, more than a quarter of all babies in the UK are estimated to be living in complex family situations that present heightened risks to their well-being. The sad reality is that babies are far more likely to suffer from abuse and neglect, and up to seven times more likely to die in distressing circumstances, than older children.

We have a duty to reach out to families in difficult circumstances and to maximise opportunities for them to access support. Not only is it the right thing to do, but it is the best thing for the public purse. According to the Royal College of Paediatrics and Child Health, there is increasing evidence to show that spending on early-years intervention can yield a return on investment as high as 6% to 10%. If it is done in the right way, early intervention can save money, save lives and improve the well-being of parents and children.

An example is the pioneering work by Manchester city council and its partners. They have created a scheme in which midwives, outreach workers and health visitors work together to identify at the earliest opportunity the families most in need. It is an inspiring project, with which my hon. Friend the Member for Manchester Central (Lucy Powell), the shadow Minister with responsibility for children and child care, has been closely associated. We heard from the hon. Member for South Northamptonshire about how the programme is making a difference when it comes to registering a child’s birth.

Under the scheme, every new mother is visited eight times from about 12 weeks before the birth of their child until just before the child’s fifth birthday. Crucially, all the professionals who are supporting those mothers hold joint fortnightly meetings and can let each other know if a parent needs additional help. Their work is integrated and intelligence is shared between organisations —a very strong theme in the “The 1001 Critical Days” manifesto. It is a world away from some of the haphazard experiences of the past. Hon. Members may have heard the anecdote about how health visitors in the past would wait by the nappy aisle in supermarkets to identify expectant mothers; we must do more to encourage close working and data-sharing, so that that is no longer necessary.

[Mr Sheerman]

I totally support the work of the 1,001 group. All the work done—certainly during my chairmanship of the Select Committee on Children, Schools and Families—indicates that early intervention is vital. It is also vital that such intervention is regular, persistent and delivered by highly skilled, well-trained people. The problem is that that is expensive.

[Luciana Berger]

My hon. Friend makes knowledgeable points that, given his experience on the Children, Schools and Families Committee, he is well placed to make. The example that I shared with the House—this is separate from the 1,001 days manifesto—shows that there are many activities going on around the country to address some of the issues, but the challenge is that the activity is not happening everywhere. We need to lead from best-case examples, which is why data sharing is so vital to make a difference. Will the Minister comment on what steps the Government are taking to encourage these activities to happen throughout the country?

I am also keen for the Minister to address the point made by my hon. Friend the Member for Rotherham (Sarah Champion), who is no longer in her place. She mentioned the early intervention grant, which has funded many of the programmes that we are discussing. When the fund was first introduced, it totalled nearly £3 billion, but by 2015 it will have almost halved to around £1.5 billion. We have had contributions this afternoon about Sure Start centres, many of which have relied on the funding of the early intervention grant, and it is a blow that 576 such centres have had to close their doors since the last election. The hon. Member for East Hampshire (Damian Hinds) commented that he did not know what Sure Start was for—

[Damian Hinds]

To be clear, I did not say that—

[Mr Mike Weir (in the Chair)]

Order.

[Luciana Berger]

I will give way to the hon. Gentleman.

[Damian Hinds]

To be clear, I was talking about what happened when I was on the Education Committee, the successor Committee to the one chaired by the hon. Member for Huddersfield (Mr Sheerman). When we asked people what the purpose of Sure Start was, we got different answers, even from practitioners in the field.

[Luciana Berger]

I thank the hon. Gentleman for his clarification. I apologise if I misrepresented his words.

[Mr Sheerman]

I, too, found that fascinating. When we first started looking at Sure Start children’s centres, they were concentrated in the 500 wards with the greatest poverty. We soon realised that more families in poverty were outside those 500, so we had to change the policy totally.

[Luciana Berger]

The point that I wanted to make about Sure Start, as a result of what has been said by both Government and Opposition Members, is that it is widely acknowledged that the centres have made a real difference to families. I have Sure Start centres in my constituency; Liverpool city council has gone out of its way to do everything possible to keep all centres throughout the city open—it has had to remodel and look at a hub-and-spokes model, given that we will have experienced cuts of 54% by 2016-17—all because of the centres’ importance to communities.

In one of the most deprived wards in my constituency, the Sure Start centre is giving vital support to parents in the most deprived households. It is providing meal packets for £1—fresh food with recipes—to encourage parents to cook for their children. That is making a real difference to those children’s nutrition, in particular in their early years. In another, more affluent, part of my constituency, the children’s centre is tailoring its services to the need in that area, because this ward has a high incidence of multiple births. That Sure Start centre is providing a vital support service for mothers who have twins and triplets—for parents contending with the challenges presented by a multiple birth.

Those centres are making a real difference in my constituency. Their staff—including Liz Parsons, a manager in the Picton Sure Start centre, to name just one person—provide vital hands-on support to parents, often first-time parents or parents with lots of children. The centres provide support, including parenting support, to many families in my constituency.

[Damian Hinds]

Like the hon. Lady, I pay tribute to the staff in the Sure Start centres in my constituency; they do a fantastic job. We all know that there are fantastic Sure Start children’s centres out there, but it is also worth dwelling on the fact that at the macro level we may not quite have cracked the formula. If we compare the millennium cohort study with the previous one, for the children who have been alive throughout the Sure Start period, the gap between the rich and the poor has not been narrowed at age five.

[Luciana Berger]

Towards the end of my contribution, I shall reflect on the hon. Gentleman’s points about social mobility. He commented that the gap between rich and poor might not have changed. Nevertheless, Sure Start centres have provided vital services to parents and families who might not have contended with that specific issue, but have dealt with a lot of other ones that we have discussed.

In the debate, we have not touched on health visitors, who are integral to this issue. It is welcome that the Government are committed to increasing the number of health visitors. The latest figures from the Health and Social Care Information Centre, however, show that there are 1,234 more health visitors than in April 2010, but that is less than a third of the way towards the Prime Minister’s target of 4,200 new health visitors by April 2015. With the deadline looming, will the Minister please offer some words of assurance about meeting the target?

[Andrea Leadsom]

I have talked to a lot of health visitors, and there is a concern that by letting speed be the only target, we might pile a lot of new health visitors into the system but diminish our ratio of experienced health visitors to inexperienced ones, and those trying to support new health visitors will struggle. Generally speaking, my feedback from health visitors is that they are happy that the rate of new arrivals is not as rapid as the hon. Lady might like.

[Luciana Berger]

I listened to the hon. Lady’s point about the speed of introduction, but reflecting on the experience in my area of Liverpool, the work load on our health visitors is such that they cannot provide the best service possible, because they are so swamped by the amount of visits that they have to do. I contend that there is a challenge in the work load on health visitors. Will the Minister share with us what steps her Department is taking to meet the target?

On maternal support, in particular during the months of pregnancy, with births in the UK at a 40-year high, prioritising maternity services has never been more urgent. Around 10 stillbirths happen in Britain every day, and we have one of the highest stillbirth rates: according to The Lancet, Britain is ranked 33rd out of 35 countries with similar income levels. The charity Sands has linked that to maternity care, issues to do with inappropriate risk assessments for potential mothers and low uptake of perinatal services. Given that neonatal mortality and stillbirth have been indicated as areas for improvement in the NHS mandate to 2015, will the Minister please share with us what activities her Department will undertake to lower the stillbirth rate in England?

The findings of a National Audit Office review late last year are also of concern. It found that more than half of birthing units are not meeting staffing guidelines; that more than one in 10 had to close for a fortnight or more last year; and that 28%, or nearly a third, were forced to turn away mums-to-be at the door between last April and September because of a lack of space or a shortage of midwives. We can all understand how stressful that must be for women towards the end of their pregnancy.

[Mr David Amess in the Chair]

I thank my hon. Friend the Member for East Lothian (Fiona O'Donnell) for raising the important issue of premature babies and for sharing her personal experience of having premature twins and of the importance of the neonatal care received by her sons. A parent in a similar position who had to work might struggle to balance that with visiting the hospital and developing a bond with the babies.

We all have friends or family, or know people who have been expectant mums—some people in the room have been expectant mums—so we know that a skilled midwife can make all the difference between a smooth pregnancy and a stressful one. It is deeply concerning, therefore, that the NAO has highlighted that there is a shortfall of 2,300 midwives. The hon. Member for South Northamptonshire highlighted the increase in midwives’ work loads. The Royal College of Midwives has also calculated that the gap between the number of midwives we have and the number that the NHS in England needs will not be closed until 2026.

Before the previous election, the Prime Minister promised that there would be 3,000 new midwives during this Parliament. Again, regretfully, that target is some way short of being delivered. I am aware that there are many midwives in training, but the high drop-out rate and impending retirements could mean that we face significant shortages for some time to come. We would appreciate any reassurance that the Minister can provide on that matter.

Will the Minister also comment on the training that midwives receive? We have heard from a number of Members about the importance of maternal mental health. Mental ill health is one the biggest risks to a pregnancy, with one in 10 mothers suffering a mental illness before or after birth. Last November, I asked the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), what proportion of midwives were trained to provide expectant mothers with mental health support. Unfortunately, he was not able to provide a figure, but I am sure that both he and the Minister agree that we need more midwives who are confident in providing that kind of support.

We also need more specialist mother and baby mental health units. It has been estimated that as much as 50% of the UK lacks any kind of specialist perinatal mental health service. There are only 17 mother and baby mental health units across England, and they are geographically disparate. There are just two in Scotland and one in Wales, and none in Northern Ireland. As both the hon. Member for South Northamptonshire and my hon. Friend the Member for East Lothian said, it is a postcode lottery.

The hon. Member for South Northamptonshire talked about the 1% of mothers who might experience a psychotic episode. That could lead to mothers being hospitalised two or three hours’ drive away from their loved ones. It could also mean that they are separated from their babies. That is good for neither the mother’s well-being nor her newborn child’s development.

I thank all those Members who have raised the importance of support for parenting. A number of Members thanked Home-Start for the work that it has done and the way in which it so helpfully supports parents. We have also heard about specific challenges on early intervention, maternal support and maternity care. However, we know that the challenge of improving early years development reaches far beyond those specific issues. The hon. Member for East Hampshire raised the issue of social mobility, for example; many social determinants extend well beyond the reach of the Department of Health. The hon. Member for South Northamptonshire suggested that the issue could be looked into more widely, perhaps at Cabinet level, and I take that point on board.

Both my hon. Friend the Member for East Lothian and the hon. Member for East Hampshire raised the issue of the importance of digital networks and social networks. They are indeed important, and I welcome the work done by Mumsnet and Netmums, but I would like to put on record the challenges there are for many mums who do not have access to the internet, or perhaps do not know how to use computers. Although digital networks are important and can help to support parents—both mums and dads—one issue that we need to look at further, which is far beyond the reach of the Department of Health, is access to the internet and to broadband, particularly for people living in rural areas. There is also the issue of being able to afford that internet access: people might not want to have to go to a public library to connect and reach out about specific personal issues. We should be thinking about those matters.

There are other issues that we should address, which again reach far wider than the remit of the Department of Health. For example, there is the problem of parents who are struggling with the cost of living, and those who are working all hours and do not have the time to be with their children because they are working all day. We must establish genuine parity of esteem between mental and physical health, across the board. We have to protect babies and children from specific dangers—just yesterday in the House of Lords, for example, there was a debate about protecting children and babies from smoke in cars. There is no better investment that we can make as a society than in our children.

[Dame Tessa Jowell (Dulwich and West Norwood) (Lab)]

I pay tribute to the hon. Member for South Northamptonshire (Andrea Leadsom), with whom I have had the pleasure of collaborating on the all-party group on conception to age two—the first 1,001 days. Does my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) agree that there is an increasing amount of scientific evidence on early childhood that shows the value of intervention in the first 1,000 days? Will she join me in commending the campaign to see early childhood represented in the new millennium development goals in 2015, which will benefit tiny children and their mothers, not only in this country but around the world?

[Luciana Berger]

I thank my right hon. Friend for her important contribution to this debate. She has summed up many of the earlier speeches on the importance of this issue and how vital early intervention is. Right at the start of the debate, we heard about the science relating to the difference in brain development of children who get that care, love and affection in early life, and those who do not. As we heard, that care is vital to the development of a child over their entire lifetime. I echo her remarks on the millennium development goals. This issue is important not only for us in the UK but further afield, right across the world. I support her call for early intervention to be included in the 2015 goals.

[Andrea Leadsom]

I pay tribute to the right hon. Member for Dulwich and West Norwood (Dame Tessa Jowell) for all her work on promoting early years development in the post-millennium development goals. I did not touch on that today, but she has played an enormous role. I can report that UNICEF has asked us to speak at the UN on the importance of the earliest years and how early intervention can support children, not just in this country but around the world. It is fantastic that she has been able to pop into the debate, and I commend her for all that she is doing.

[Luciana Berger]

I thank the hon. Lady for her intervention. I will now seek to conclude.

[Mr Sheerman]

My hon. Friend briefly alluded to smoking and children’s exposure to smoking in cars. There was good news this morning from the Government: there will be a free vote on the issue. Back in the mists of time, my very first private Member’s Bill was on banning children from being carried unrestrained in cars. There was a tremendous backlash against that Bill in certain parts of the House; people said that it breached human and individual rights. We won that battle, and I hope that we can win the next one. It is wrong that a child, who has no choice, has to go in a smoky environment and breathe in dreadful fumes that can affect their health for the rest of their life.

[Luciana Berger]

My hon. Friend’s intervention has given me the opportunity to expand on this serious political issue, with which we are engaging in the House at the moment. He rightly points out the opposition there was to rules on wearing seat belts. The discussions on that issue are relevant to our discussions about banning smoking in cars when children are present. When we had no rules on wearing seat belts, only 25% of the population wore one; since the introduction of the rules, more than 90% of the population wear a seat belt, and that has made a massive contribution to safe car travel.

It is worth noting that there is overwhelming public support for banning smoking in cars when children are present. Around 80% of the public think that we should deal with the issue, and it will be interesting to see what happens in the vote. It is also worth putting on record that when there was a vote on a private Member’s Bill on the issue in 2011, 22 MPs from the coalition supported it, including a current Health Minister. I welcome the free vote, and I hope that we are successful when the proposal comes before the House on, I believe, 10 February.

To conclude, a broad, holistic approach will ultimately make the difference for children, and for future generations.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 14th January 2014 Commons Chamber

[Mr Jeremy Hunt]

Yes, we are looking at that closely, with the Minister responsible for paediatric services doing so particularly closely. In principle, we support what my hon. Friend is trying to achieve with that document and we welcome its contribution to the debate.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Last week, we heard shocking revelations about the reasons behind the Government’s U-turn on minimum unit alcohol pricing. In particular, researchers at Sheffield university have confirmed that they were asked by government not to publish a report that would have undermined the Government’s decision to shelve minimum unit pricing. Why were Ministers so keen to suppress the report? Will the Secretary of State please tell us why some of our country’s leading public health experts are accusing Ministers of deplorable practices and of dancing to the tune of the drinks industry?

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

On the hon. Lady’s substantive point, the reports for the British Medical Journal investigation, which I read in full, did not say that at all and in fact confirm that that was not asked, so what she says is not quite right.

On the wider point, over the past two weeks we have heard a succession of attacks from the hon. Lady and the Opposition about dealings with industry and business. This Government have set out to work in partnership across business and industry, with public health experts and local authorities, to tackle some of these really big public health issues. It is simply incredible that the Labour party believes that these big issues can be taken seriously without engaging with business. Instead of demonising businesses, let us hear some praise for those such as Lidl, which yesterday announced that sweets would be removed from all its checkouts across the country, in response to its customers—a voice that is too little heard by the Labour party.

Hospices (Children and Young People)

Luciana Berger Excerpts

Wednesday 18th December 2013 Westminster Hall

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I begin by congratulating the hon. Member for Pudsey (Stuart Andrew) on securing this debate on a topic about which he is clearly passionate. I pay tribute to him and to all the members of the all-party parliamentary group on hospice and palliative care for the work that they have done to bring this important issue to the fore.

As we have heard, there are 49 children’s hospices across the UK, which all do fantastic work for young people and their loved ones. As my right hon. Friend the Member for Rother Valley (Mr Barron) said, much of the hospice movement is supported by volunteers and millions of pounds of charitable donations. Many hon. Members from both sides of the House made passionate representations on behalf of their local hospices and the holistic care that they provide. Hon. Members have raised many powerful points, and I hope to touch on several of them. I want to focus on three points covered in the debate. First, I will set out the full scale of the care crisis facing young people with complex health and care needs; secondly, I will explain why that is an issue not simply for individual families but for society at large; and thirdly, I will touch on some of the areas that need attention to make life better for those young people, particularly those receiving palliative care.

As we have heard, more than 40,000 children and young people in England have palliative care needs. That includes children suffering from curable and chronic conditions, children with severe disabilities, and children and young people nearing the end of their life. That represents a 30% jump over the past 10 years. There has been a particularly marked increase in the number of 16 to 19-year-olds requiring palliative care, as we have heard from several hon. Members, to around 4,000 young people, which accounts for roughly 10% of young people under the age of 19 with complex care needs. That is in many ways a positive sign, because it demonstrates the great advances made in science and medical technology, and the fact that they have resulted in people living longer.

Cancer accounts for around 14% of young people diagnosed. Cancer Research UK figures show that five-year survival rates for teenagers and young adults have risen significantly across all cancers across the past 25 years. In the late 1980s, less than three quarters of young men lived longer than five years after having cancer, but the rate is now better than eight in 10. For girls and young women, the five-year survival rate now stands at 84%. There has been a particular improvement in leukaemia; the survival rate has jumped from less than 50% to more than 60%.

We are moving in the right direction, but as we have heard from hon. Members today, that presents a particular challenge, because more young people live beyond the reach of children’s care and transition into social care. Too many young people who receive care from children’s services turn 16, 17 or 18 and then fall off a cliff during the transition to adult social and health care. The right hon. Member for Chelmsford (Mr Burns) and the hon. Member for Pudsey highlighted the specific challenges facing young adults, and we heard an emotive quote from Lucy Watts, who summed up the situation well. Much more needs to be done to make the transition work better. Some of my constituents who have accessed wonderful services at the Alder Hey children’s hospital struggle when the health professionals and familiar surroundings that they have been accustomed to for so long change—a point that my hon. Friend the Member for Rotherham (Sarah Champion) articulated. Many families are shocked by the reduced support that they receive in many aspects of adult social care after they have made that switch.

Transition is a hugely stressful process, and in most cases families are moving from dealing with a single, comprehensive agency to managing several different agencies with up to four points of contact. It is easy for gaps to emerge in that fragmented process. Many conditions reach crisis point in late adolescence, so it is all the more important that young people and their families receive responses from care and health agencies in an appropriate, sensitive and timely fashion. There are too many instances of people having to endure the agony of being put on hold, or waiting for a reply to an e-mail, when their loved one has an urgent care need.

That is all in the context of a crisis in adult social care. Since 2010, £1.8 billion has been cut from council budgets for adult social care, and we await the impact of the local authority settlements which have been released today. That means that fewer people receive help with paying for their care and more people face increased charges for vital services that help them to get up and get washed, dressed, fed and helped to bed at the end of the day.

Let me make a brief comment on the wider costs to society. Demand for care is growing at a time when resources are being reduced. The costs to society of a bad care transition—whether those costs take the form of greater illness, negative social and educational outcomes, or possible early death—are far greater than the cost of putting in place adequate resources to ensure a good transition. I welcome some of the modest measures that the Government—[Interruption.]

[Sandra Osborne (in the Chair)]

Order. The sitting is suspended for a Division for a minimum of 10 minutes.

--- Later in debate ---

On resuming—

[Luciana Berger]

Before the Division, I was sharing with the House my welcome for some of the modest measures the Government put forward in the Care Bill, which the House debated on Monday. It represents a small step towards a better social care system, and builds on the Labour Government’s work to provide stronger rights for carers and improved access to information and advice.

Let me conclude by looking at some areas that still require attention, and with a few questions for the Minister. I praise the many charities working in the sector, particularly Marie Curie Cancer Care, which has a hospice not too far from my constituency, and Together for Short Lives, the leading UK charity for children with life-threatening and life-limiting conditions. Their joint “Don’t let me down” report, published last year, set out sensible and important proposals, a number of which the Government adopted, but four areas of concern remain.

First, we need a much more joined-up approach to commissioning health and social care services for children with palliative care needs. Currently, we have a split: NHS England commissions specialist care, and local authorities manage social care. That fragmentation means that the very high variation in access to and quality of services, depending on where people live, will continue. I would be grateful if the Minister told us the Government’s assessment of that postcode lottery, and what they are doing to address the disparity.

Secondly, children and young people need to be consulted, so that their care caters for them and their needs. There is a particular role for health and wellbeing boards in that. More than half the health and wellbeing boards have explicitly examined care for terminally ill adults, according to the National Council for Palliative Care. The likelihood, however, is that far fewer will have engaged with children and young people on the same scale. I would welcome a response from the Minister on that specific point. Thirdly, the different agencies that provide hospice and palliative care to children and young people need to talk to one another much more. Local authorities are unable to share data. What solutions are Government considering to address that problem? Fourthly, a solution needs to be found to enable all the information and records about a young person’s needs to travel with them. Too many young people have to tell their story all over again when they need to access a new service, or when they are transitioning.

The debate this afternoon has been positive and constructive. On this side of the House, we are ready to work with the Government to improve outcomes for young people and children who need hospice and palliative care. We hope to deliver an integrated, whole-person approach to health and social care. Whole-person care is about meeting the needs, whether physical, mental or social, of people of all ages, so that they are able to live an independent and dignified life. That is ultimately what the future of health and social care needs to look like, with world-class hospice and palliative care front and centre. That is what we are committed to delivering, so that we can help those who need it most.

Tobacco Packaging

Luciana Berger Excerpts

Thursday 28th November 2013 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the Government’s policy on standardised packaging of tobacco products.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

In accordance with the notice I gave the House yesterday afternoon, this morning I made a written statement announcing that Sir Cyril Chantler will carry out an independent review of the evidence on the impact of standardised tobacco packaging on public health.

Tobacco use, especially among children, remains one of our most significant public health challenges. Each year in England more than 300,000 children under the age of 16 try smoking for the first time. Most adults who smoke started before they were 18 years of age. As a result, we must do all we can to stop young people from taking up smoking in the first place, if we are to reduce smoking rates.

We have listened to the strong views expressed on both sides of the House, including when we debated standardised packaging in a Back-Bench business debate earlier this month, to which I responded. Many Members then told me that the evidence base for standardised packaging continued to grow and urged the Government to take action. Similarly strong views have been expressed in the other place. As a result, I believe the time is right to seek an independent view on whether the introduction of standardised packaging would be likely to have an effect on public health. In particular, I want to know the likely impact on young people.

I have asked Sir Cyril to undertake a focused review, reporting in March next year. It will be entirely independent, with an independent secretariat, and he is free to draw evidence from whatever sources he considers necessary and appropriate. It will be up to him to determine how he undertakes the review, and he will set that out in more detail in due course. As the House will know, Sir Cyril has confirmed that he has no links with the tobacco industry. The review is not a public consultation. The Government ran a full public consultation in 2012 and the responses will be available in full for the review. To maximise transparency, the Department will also publish the substantive responses received as soon as possible.

The Government will also take advantage of the opportunity offered in another place by tabling an amendment to the Children and Families Bill to provide for a regulation-making power. If, on receiving Sir Cyril’s review, the Government decide to proceed, that will allow standardised tobacco packaging to be introduced without delay. The Government have been consistent in their desire to take an evidence-based approach to public health, and we will introduce standardised tobacco packaging if, following the review and consideration of the wider issues raised, we are satisfied that there are sufficient grounds to proceed.

--- Later in debate ---

[Luciana Berger]

We have seen plenty of U-turns over the past three years, but only a Government as shambolic as this one could U-turn on a U-turn. It is not so much that they have lost their way on public health—they are running around in circles.

Will the Minister answer a straight question: does she support standardised packaging for cigarettes—yes or no? In the week running up to this being debated in the other place, does she honestly expect us to believe that this has nothing to do with the fact that the Government are on the brink of a humiliating defeat?

The Minister says that we need another review, but the Government have already had a review and the evidence is clear for all to see. Did that not already find that standardised packaging made cigarettes less attractive to young people and health warnings more effective, and did it not refute the utter falsehood that some brands are safer than others? All the royal colleges and health experts are united behind the case for standardised packaging—I commend everyone who has campaigned for this measure—but is it not the case that if the lobbying Bill goes through in its current form, it will prevent charities such as Cancer Research UK from ever raising such issues in an election year?

Is not the Prime Minister more interested in listening to Lynton Crosby and the vested interests of big tobacco than cancer charities and health experts? What further evidence does the Minister need? What do Ministers know now that they did not already know when they U-turned on this before the summer recess? Why are the Government delaying this still further? Some 79,230 children will have taken up smoking in the 139 days since the Government U-turned on standardised packaging in July, and about 70,000 more will have had their first cigarette by the time the review reports next March. We should be legislating now, not delaying.

[Jane Ellison]

I thought that was a rather disappointing and naive response. This is a complex area of public health policy, and it is important to follow a clear process and to follow the evidence. The hon. Lady might not believe me, but perhaps she will believe the right hon. Member for Leigh (Andy Burnham), who in November 2009, when he was Health Secretary, wrote:

“we would need…convincing evidence showing the health benefits of this policy before it would be acceptable”.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 26th November 2013 Commons Chamber

[Mr Hunt]

I commend my hon. Friend for the campaigning he does for high standards in his local trust. That has not been easy because, as he says, there have been a lot of problems there, although I hope he thinks that we are beginning to turn a corner. The decision on the funding allocations will be made by NHS England before Christmas, and the things that he says will, of course, be taken into account.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Yesterday we learned that the number of people suffering from hypothermia has soared by almost 40% on this Government’s watch. This morning the Office for National Statistics revealed that the number of older and vulnerable people who died unnecessarily last winter jumped by 29%. For every person who tragically loses their life over the winter months, eight more are admitted to hospital, putting huge strains on our crisis-ridden accident and emergency services. Will the Secretary of State please tell us what he is going to do about it?

[Mr Hunt]

I do not think I have yet answered a question across the Dispatch Box from the hon. Lady, so I welcome her to her post. I just say that she should be careful what she chooses to turn into a political football, because hypothermia admissions, as Public Health England said in August, are very closely linked to the number of cold days over a winter and the length of that winter. We had a particularly difficult winter last year, but the number of winter deaths was nearly 20% higher under the previous Government, when the right hon. Member for Leigh (Andy Burnham) was Health Secretary.

Tobacco Packaging

Luciana Berger Excerpts

Thursday 7th November 2013 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

This is the first time I have had the privilege of speaking with you in the Chair, Madam Deputy Speaker, and I look forward to it.

I thank the hon. Member for Harrow East (Bob Blackman) for seeking this debate, the co-sponsors from all parties and the Backbench Business Committee for making it possible. It has been a very good debate, with many thoughtful and powerful contributions and, I think, a large degree of consensus. There is a clear reason for that consensus. In the final analysis, this is a debate about children. Adults do not take up smoking; children do. Despite hon. Members having referred to a drop in the take-up of smoking, more than 200,000 children still take up smoking every year. Eight out of 10 smokers start by the age of 19. As my right hon. Friend the Member for Rother Valley (Mr Barron) said, there are few new smokers over the age of 21. In my patch, there are 460 regular smokers across Liverpool who have not yet turned 15. As the right hon. Member for Sutton and Cheam (Paul Burstow) said, we are talking about a childhood addiction, not an adult choice.

We know that about half of those children—half of all regular smokers—will eventually be killed by their addiction. Contrary to the presentation by the hon. Member for Ribble Valley (Mr Evans), who I am sorry to see is not in his place, tobacco is different from other products, because if it is used properly, as instructed, it kills one in two of its users. It is the only product for which there is an international treaty, the World Health Organisation’s framework convention on tobacco control, precisely because it is not like any other product and has to be treated differently.

Smoking remains by far the largest preventable cause of cancer. As my hon. Friend the Member for Barnsley Central (Dan Jarvis) said, more than 100,000 people die across the UK from smoking-related diseases every year. In Liverpool, 346 deaths per 100,000 are attributable to smoking, whereas the national average is 201 deaths per 100,000. The hon. Member for Rossendale and Darwen (Jake Berry) spoke about NHS spending on the cancer drugs fund.

The question that we should be asking ourselves is whether we are doing everything we can to discourage children from starting to smoke in the first place. Contrary to what the hon. Member for Aberconwy (Guto Bebb) said, I make no apology for asking the emotive questions. Are we doing all that we can to protect our young people? Have we exhausted every measure at our disposal? With that in mind, I want to cover three broad themes: first, why packaging matters so greatly; secondly, why the arguments against standardised packaging do not stand up to close scrutiny; and thirdly, why we cannot afford to wait.

I echo what was said by the hon. Member for Harrow East, my hon. Friends the Members for Stockton North (Alex Cunningham) and for Barnsley Central and my right hon. Friend the Member for Rother Valley about the part that packaging plays in encouraging young people to smoke. It is widely accepted that in the years since the last Labour Government banned tobacco advertising in 2002, the tobacco industry has developed far more sophisticated ways of using packaging to entice people to smoke.

We have all seen what cigarette and tobacco packaging looks like in Britain today, with its bright colours, shiny veneers and slimmed-down packets. We have heard about the boxes shaped like perfume bottles and lipsticks, with the glamorous slogans to match. One slogan that struck me was:

“Indulgence—change the taste to suit your mood”.

Such novelty packets appeal to young people, because that is exactly what they are designed to do. Academics at the university of Stirling tested that by surveying more than 1,000 children for a study that was published in the British Medical Journal a few weeks ago. They found that the children were overwhelmingly more attracted to the packets with such designs.

[Dame Angela Watkinson]

The hon. Lady has spoken about children starting to smoke. Does she agree that the main responsibility lies with their parents, because the money has to come from somewhere? If it does not come from their parents, where does it come from?

[Luciana Berger]

That point has been made by other hon. Members in this debate. I remember from when I was a young person that children do not get their money only from their parents and that they do not necessarily buy the cigarettes themselves. Often, they see other people getting out their packs of cigarettes.

The children in the university of Stirling study who were shown a packet of Silk Cut cigarettes were found to be more than four times more likely to be susceptible to smoking. Those children had never smoked.

It is the packaging that entices children. If we want to discourage children from ever starting to smoke, we need to question whether that is an acceptable way to market a product that is highly addictive, seriously harmful and clinically proven to kill. Smokers advertise tobacco brands to other people every time they take out their pack to smoke. The packets should not be glitzy adverts, but should carry strong and unambiguous health warnings about the dangers of smoking. We should not allow those warnings to be subverted by the design of the rest of the packet.

I will move on to my second theme. We have heard a few arguments against standardised packaging in this debate. We have also heard those arguments from the tobacco industry. I will deal with each of the arguments in turn. Much of the discussion has centred around evidence. Hon. Members have said that there is no evidence that standardised packaging will work. That is not true.

Last year, the systematic review by the Public Health Research Consortium, which was commissioned by the Department of Health, looked at all the evidence on standardised packaging. The findings are clear for everyone to see. It found that standardised packaging is less attractive, especially to young people. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) rightly pointed out that it takes away the cool factor. The review also found that standardised packaging makes health warnings more effective and combats the utter falsehood that some brands are safer than others. Those findings have been backed up by 17 studies that have been published since the systematic review. Government Members, including the hon. Member for Ribble Valley, have asked for evidence. We have the evidence.

A separate study that was published in the British Medical Journal in July looked at research from Australia soon after the introduction of standardised packaging. It found that smokers who used standardised packs were 66% more likely to think that their cigarettes were of a poorer quality, 70% more likely to say that they found them less satisfying, 81% more likely to have thought about quitting at least once a day in the previous week and much more likely to rate quitting as a higher priority in their lives than smokers who used branded packs. Not only are people less likely to take up smoking when presented with standardised packs; people who already smoke are more likely to think about quitting if the cigarettes that they buy come in standardised packaging.

[Barbara Keeley]

My hon. Friend is being very generous with her time. The hon. Member for Rossendale and Darwen (Jake Berry) seemed to be quite satisfied with the Government’s action on this issue, although that is perhaps not surprising given the views that he has put forward in this debate. However, it is a fact that fewer people have quit smoking successfully and that fewer people have attempted to quit with NHS help over the last year. That is the first time since 2008-09 that those figures have fallen. I talked about quit services in Salford, but such services are now less successful and there must be a reason for that. Does my hon. Friend take that as seriously as I do?

[Luciana Berger]

I thank my hon. Friend for that important intervention. The figures that came out just the other week do show a drop in the number of people who are quitting smoking through NHS services. I am very concerned about that. As I said at the start of my contribution, 200,000 young people still take up smoking every year. That is exactly what we are seeking to address in this debate.

We have reflected a lot on the Australian experience. The former Australian Health Minister, Tanya Plibersek, reported that there was a

“flood of calls…in the days after the introduction of plain packaging accusing the Government of changing the taste of cigarettes.”

She went on to say:

“Of course there was no reformulation of the product. It was just that people being confronted with the ugly packaging made the psychological leap to disgusting taste.”

That is a significant point. Far from there being no evidence, there is a swathe of evidence.

The second claim raised during our debate is that standardised packaging would increase the trade in counterfeit cigarettes, or impact on the printing trade. Again, it is important to clarify that we are talking about standardised packaging. I have heard hon. Members use the term “plain packaging”, but we are not discussing that. I know I am not allowed to demonstrate this at the Dispatch Box, Madam Deputy Speaker, but standardised packaging is clearly printed; it is not a plain pack. Current packaging is already so easy to forge that covert markings enable enforcement officials to identify counterfeit cigarettes, and all key security features on existing packets would continue on standardised packets. Standardised packaging would make pictorial warnings more prominent and packaging harder to forge.

We heard in an important contribution that standardised packaging might lead to an increase in illicit trade, but that is simply not true. Andrew Leggett, deputy director for tobacco and alcohol strategy at Her Majesty’s Revenue and Customs, stated in oral evidence to the House of Lords European Union sub-Committee on Wednesday 24 July:

“There are a number of potential factors that weigh on counterfeit packaging”,

but that if standardised packaging was introduced, it was

“very doubtful that it would have a material effect.”

[Jake Berry]

I thank the hon. Lady for giving way to give her a chance to find her place. Does she acknowledge that the Government’s current policy on standardised or plain packaging is exactly the same as it was under the previous Government?

[Luciana Berger]

I thank the hon. Gentleman for his intervention but more than three years have passed since that point. I am immensely proud of everything the Labour Government did through their tobacco strategy to reduce smoking. We heard from my hon. Friend the Member for Barnsley Central about the many measures we introduced, but we must do more and go further, and in my concluding remarks I will say why I am disappointed with the Government’s current approach.

The third claim I want to counter is that the proposed changes to tobacco packaging are somehow a symptom of the nanny state. People should, of course, be allowed to make their own decisions, but we should not be standing by while industry sets honey traps and uses every means at its disposal to try to make those decisions for them. Nearly all new smokers are children, we are dealing with an addictive product that is clinically proven to kill, and smoking rates are higher among the most vulnerable groups in our society, particularly children in residential care. That is why today’s debate is so important.

I will conclude with my most important point, which is why we cannot afford to delay. The Minister has previously made it clear that the Government’s position is to wait and see. Her predecessor did the same, despite saying that she personally had been persuaded of the case for standardised packaging a few months previously. Just today, about 570 children across the country, none of them older than 15, will have their first cigarette, and approximately 71 will have done so while we have been debating this subject. If we wait and see, we will be standing idly by while hundreds of thousands of young people become victim to this deadly addiction.

The Opposition have made their position clear. If the Government wish to bring forward legislation to make standardised packaging a reality, they can count on our full support. That was our position before the Government changed their mind about this issue in July, and it is our position now. The Children and Families Bill is making its way through the other place. Labour has tabled an amendment to that Bill to introduce standardised packaging that will be debated in the coming weeks and voted on later this year. That simple measure would make a huge difference and is clearly supported by Members on all sides of the House. On behalf of those 71 children who have started smoking during this debate, and the 200,000 who will start every year, I urge the Minister and her Government colleagues to do the right thing and support our amendment. Let us save future generations from the perils of smoking.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Jane Ellison]

At the risk of repeating myself, all I can say to my right hon. Friend is that I am looking at that very carefully. He is right that we all want to stop children and young people smoking. There is a mass of evidence out there, and we are gaining new evidence and information all the time to help us make decisions. I will continue to look at it as one of the absolute priorities within my brief.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I welcome the hon. Lady to her new post. We knew that her predecessor supported standardised cigarette packaging: Labour will table amendments to the Children and Families Bill in the other place and in this place to make that a reality. I have listened to contributions from Members on the Government Benches supporting the policy. Will the Minister tell us today whether she supports standardised packaging?

[Jane Ellison]

We are very aware of the discussions that have been going on in the other place and the amendments that have come forward, in which we have taken considerable interest. At this stage, we want to look at all the available evidence, because new information is coming through, before coming to a view. I take this opportunity to welcome the hon. Lady to her new post.

Psychological Therapies

Luciana Berger Excerpts

Wednesday 16th October 2013 Westminster Hall

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Sir Edward, it is a pleasure to serve under your chairmanship this morning.

This has been a thoughtful and important debate on a subject that is not talked about nearly enough. Every day in Britain, people of all ages and backgrounds, and from all communities, have their lives blighted by the spectre of mental illness. Theirs are some of the great untold stories of our society. As many hon. Members have already said, the issue of mental health has been swept under the carpet for too long. One in six people are afflicted by mental illness, but all too often they are scared into silence. That is why this discussion is so important.

I also congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) on securing this debate and on the campaigning that he has done on this issue. In addition, I thank him for giving me the opportunity to talk about mental health in my first debate as Labour’s newly appointed shadow Minister with responsibility for public health.

This debate is even more timely because of the news that we have heard on the BBC this morning, to which a number of hon. Members have already referred. Dr Baggaley, the director of medicine at South London and Maudsley NHS Foundation Trust, has said that our mental health services are in “crisis”, following the news—after the BBC made freedom of information requests—that in a little more than two years we have seen the loss of 1,700 mental health beds. I note that the Minister of State, Department of Health, who is the Minister with responsibility for care, said this morning that the situation is “unacceptable” and that the provision must improve. I hope that the Minister who is here in Westminster Hall today will refer to that when he responds to the debate.

We have heard a number of valuable contributions this morning. In responding to the excellent points that have been made, I will cover three broad themes: first, I will reiterate the importance of early intervention; secondly, I will talk about the improving access to psychological therapies programme, including some specific issues about how IAPT needs to work better; and thirdly, I will talk about what we need to do beyond IAPT.

Let me begin with early intervention. As hon. Members have already said, the long-term consequences are clear if we do not tackle mental illness early; indeed, we can already see those consequences right across our society today. We can see them in the workplace, where mental illness is the largest single cause of long-term sick leave; we can see them in our criminal justice system, where 70% of those in our prisons have a mental illness; and we can see them in our economy, where mental ill health costs Britain’s businesses £26 billion every year, or £71 million every day. Also, in our health service, according to the London School of Economics the physical health care necessitated by mental illness costs the NHS an extra £10 billion each year. All those points show why the case for action could not be any clearer.

I am sure that, like myself, many hon. Members will have had experience of constituents coming to them for assistance; indeed, several hon. Members have referred to those experiences in their contributions to the debate. Constituents come to us in deep distress and dire circumstances. However, many of those situations could have been avoided if those people had received specialist treatment for mental illnesses at a much earlier stage. I echo the hon. Member for Halesowen and Rowley Regis, who said that it is absolutely crucial that we look at this issue of early intervention.

That was why in 2007 the last Labour Government launched the IAPT programme, which helped to make respected and evidence-based therapies available to more people than ever before. As we heard in the hon. Gentleman’s opening speech, thousands of people have been helped on that programme so far. Since then, the current Government have continued the programme and extended it to cover more people, which is a welcome step. However, as this debate has made clear, IAPT is still a developing scheme, with areas that are in need of much improvement. So, my second theme is to focus on those areas that require attention, and I would be grateful if the Minister could address them in his closing remarks.

There are three areas in particular that require attention. The first is funding. Spending on IAPT has increased from zero in 2008-09, when the programme was first launched, to £214 million in 2011-12. The Department of Health has also allocated £54 million to improve access to therapies for children and young people, which is a good step. However, it must be noted that Ministers always pledged that IAPT funding would be additional funding and would not replace existing psychotherapy services. Despite those assurances, non-IAPT therapy services have been cut by more than 5%. Funding has fallen from £185 million in 2009-09 to £172 million in 2011-12. What makes that even more worrying is that overall mental health spending has been cut in real terms for the second year in a row.

That real-terms cut has particular resonance when it comes to the second area that requires attention, which is waiting times; again, waiting times have already been mentioned by hon. Members during this debate. NICE’s aim is that patients receive access to evidence-based therapies within 28 days of referral. It is regrettable that this debate falls the day before the latest programme statistics are published. According to the latest figures, however, which are for 2012-13, more people are having to wait longer to start receiving treatment for anxiety or depression.

[Seema Malhotra]

My hon. Friend makes very important points about waiting times and how they have continued, and also about the cuts to services. Given that the number of university students seeking counselling has risen by a third in the last four years, does she agree that it is important to recognise the impact that the drop in funding could be having on vulnerable students, sometimes forcing them to leave university, which can affect the rest of their life? With the number of students in that situation increasing and without data for average waiting times, we must recognise the importance of early intervention and very fast response.

[Luciana Berger]

I thank my hon. Friend for that intervention, and she raises an important issue. There are lots of different groups of people who do not have access to these sorts of services or who have to wait a disproportionate amount of time to access them. We have already heard hon. Members talking about older people who might not be able to access the IAPT programme, and my hon. Friend refers to university students, who do not necessarily fall into the category of children and young people, but who, as young adults, are struggling with leaving home and with financial pressures.

I have not seen any direct research about what effect the current cost of living crisis is having on our population—I hope that there will be some research into that issue—but my experience from my case load as a constituency MP indicates that we have a problem in our society regarding the pressures of life. More people are having to access these services and therefore the services should be available, which makes the issues of waiting times even more relevant.

More than 115,000 people had to wait more than 28 days from referral until their first treatment or therapy session, which was a 19% increase from the previous year. The hon. Member for South West Bedfordshire (Andrew Selous) made the point that this issue is not only about the statistics but the people behind the statistics, who have to go through the trauma of waiting for treatment and suffering the uncertainty of not knowing when it will come.

On Monday, someone contacted me to say that they had been waiting for a year and a half for cognitive behavioural therapy in the Wirral, on Merseyside, and just this morning on BBC “Breakfast”: there was a woman who was interviewed who had had to wait 17 months for talking therapies treatment. Eventually, she had to be sectioned as her condition deteriorated while she waited for treatment. These cases are not unusual— there are too many cases like them—and it pains me to learn of them. According to a report produced by the We Need to Talk coalition of mental health charities and royal colleges, one in five people have been waiting for more than a year to receive treatment. However, the same report found that people who receive treatment within three months are almost five times more likely to be helped back into work by therapy than others who have to wait for one or two years. As another person wrote to me this week, even a six-week wait can seem a whole lot longer if someone is clinically depressed. Just as we focus on waiting times for cancer treatment and other examples of physical care, we must do the same for mental health therapies.

I will repeat the commitment, which my right hon. Friend the Leader of the Opposition made a year ago, that the next Labour Government will rewrite the NHS constitution; that we will strengthen the rights that it grants to patients; that we will create a genuine parity between mental and physical health care; and that we will set down a new right of access to the therapies that we have been talking about this morning. That will mean that mental health patients will be entitled not only to drugs and other medical treatments but to psychological therapies, and they will have the same guarantees on waiting times, professional advice and patient experience.

However, in addition to how long it takes to receive treatment, we need to examine the range of therapies that are available in the first place, which brings me to my third broad theme; again, it is a theme that has been already been referred to by other hon. Members, but it is important to reinforce it and to ask the Minister to respond to it. Different people are affected by different mental health conditions for all sorts of different reasons. That is why we need diverse mental health provision, with a range of therapies, to cater for people with different needs, preferences and personalities. As the hon. Member for Halesowen and Rowley Regis said, only five types of therapy are currently available via IAPT. Moreover, 90% of IAPT funding has gone towards cognitive behaviour therapies, with limited support for other modes of therapy. The United Kingdom Council for Psychotherapy has described this as an

“overwhelmingly manualised and brief approach to therapy that sits at odds with the professional practice of the majority of leading psychotherapists and counsellors.”

We need to look at going beyond basic therapies that help people go about their day-to-day lives more adequately. There needs to be appropriate room for more intense and longer term psychological treatments, so that the underlying causes do not go unaddressed.

The hon. Member for South West Bedfordshire mentioned the need for couples therapies. The hon. Member for Halesowen and Rowley Regis also talked about older peoples’ problems with accessing treatment.

There is a patient choice issue, too. According to a survey of 500 service users by Mind, only 8% of people had a full choice about which therapy they received and just 13% had a choice about where they received therapy. The 8% who had full choice of therapies—a very small number—were, on average, three times happier with their treatment and five times more likely to say that therapy had helped them back into work. As the programme develops, we need to do all we can to ensure that it caters to people’s individual needs.

What needs to be done beyond IAPT? As welcome as IAPT is, we have to remember that the programme currently only aspires to be available to 15% of the population. The programme’s three-year report, published last November, shows that it is currently delivering 45% recovery rates and aims to reach 50% by March 2015. The big question this raises is, what about the other 50% to 55%—the 50% who continue to suffer from conditions, having gone through the IAPT process, but are not eligible for more intensive psychotherapy services under the stepped care model? That question, and this debate, requires an answer that goes far beyond the IAPT programme. It requires ending the artificial dividing lines in our NHS and pursuing a whole person, fully integrated approach to mental, physical, social and care issues, as Labour has indicated, and it demands a complete revaluation of how we, as a country, think about and approach mental health. That is what Labour’s mental health taskforce is looking at, under the expert leadership of Stephen O’Brien, the chair of Barts Health NHS Trust.

General mental health support should not start in hospital or the treatment room. It needs to start in our workplaces, our schools and our communities, even across our kitchen tables and in the conversations we have with one another. There is no reason why we should not be able to talk about mental health and psychological therapies in the same way we do about access to sexual health services, vaccinations or cancer treatment, but we have a long way to go.

I look forward to the Minister’s response. I hope that he will respond to my questions and issues raised by other hon. Members. Returning to my opening comments on today’s news about the crisis in mental health provision and the reduction in the number of beds, the point of our debate is access to services that would prevent people from going into those beds in the first place. However, we hear today that bed capacity is at 100%. I hope that the Minister will mention those issues as well, because they are interlinked.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 11th June 2013 Commons Chamber

[Anna Soubry]

I am sure that Mr Crosby would be grateful for that bigging-up. I can assure the hon. Lady that, as she knows, if standardised packaging was as simple as she tries to suggest, no doubt the last Government would have introduced it in some way. I am proud of the fact that we have made sure that the point of sale legislation has been achieved. As she knows and as I have said before, this is a difficult and complex issue. It requires a good and healthy debate. Let us bring on that debate. Perhaps the Opposition would like to use one of their Opposition days to bring it forward. I will be more than happy to take part.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

5. What estimate he has made of the optimal level of bed occupancy in NHS hospitals.

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

Average annual bed occupancy rates for all NHS beds open overnight have remained stable between 84% and 87% since 2000. The Government do not set optimal bed occupancy rates for the NHS. NHS hospitals need to manage their beds effectively in order to cope with peaks in both routine and emergency clinical demand.

[Luciana Berger]

I listened carefully to what the Minister said, but the Royal College of Physicians has warned that this winter there were more black alerts—when a hospital has no beds available—than there were over the previous 10 years combined. What urgent action are the Government taking to reduce bed occupancy levels and prevent next winter being even worse?

[Dr Poulter]

We had this debate last week. The long-term pressures on the NHS, as we know, are the result of an aging population, with increasing numbers of older people arriving in A and E with complex needs, so the challenge is to ensure that they are better treated in the community. That is why my hon. Friend the Minister of State launched the integrated care pilots last month. We are also seeing more patients treated as day cases than ever before. About 80% of elective admissions are now treated as day cases, which shows a massive improvement in the speed and quality of care in the NHS.

--- Later in debate ---

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

We will certainly look into the issue that my hon. Friend raises, but he will be aware that there are campaigns throughout the NHS focused on supporting local food producers, which is important in many constituencies, particularly rural ones, and developing best practice and encouraging nutrition. Chefs such as James Martin have been involved in helping to drive up standards of care, particularly in Yorkshire and other parts of the country.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

T5. I listened carefully to the Public Health Minister’s answer just three questions ago, but the Government have disproportionately cut funding to the most deprived local authorities, including Liverpool, and these local authorities have today been shown to have higher mortality rates. How does the Secretary of State expect to close, rather than widen, health inequalities?

[Mr Jeremy Hunt]

We actually gave a real-terms increase to all areas, including Liverpool, and followed the independent advice. If funding for public health in Liverpool is lower than it should be, that is because the last Government set the baseline way lower than it should have been.