Integrated Care

Luciana Berger Excerpts

Thursday 6th September 2018 Westminster Hall

[Dr Wollaston]

I thank the hon. Lady, my fellow Committee member, for her input. We on the Committee heard that there is a complex spaghetti of acronyms—STPs, ICPs, ACOs—and nobody knows what they mean. Even those working in the system struggle to keep pace with them and with the changes. We have to keep bringing it back to plain English and why it matters to people and hold our attention there.

The integration of health and social care has been a long-term goal for successive Governments for decades, so we might ask why it is not happening everywhere if we have been striving for it for so long. We saw and heard about many fantastic examples of good integrated care, but they sometimes felt like oases in a desert of inactivity. It is also possible to have an area that does some things very well but others not so well.

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

I commend the hon. Lady for the way she is making her remarks on our report, which I welcome. I looked closely at the Government’s response, in which they said that they

“remain keen to consider how to build political consensus on the case for reform and funding as part of the development of the NHS”

10-year plan, but we have heard no reference to exactly how any mechanism for reaching such a consensus might be pursued. We have heard a lot of talk about integrated care for many years, but we now find ourselves at a critical moment. The Government are about to launch their 10-year plan, and it must be front and centre of what they put forward.

[Dr Wollaston]

I will respond further to the hon. Lady’s remarks when I comment on legislative change and how we can get legislative change through a hung Parliament. I will also comment on the importance of engaging with the service and why that needs to come bottom-up from the service, and the importance of politicians from across the House listening to the service and being focusing on its message and the message from patients and patient representative groups. I thank her for her constructive input. The Committee has been successful in building consensus about how this should go forward. I hope the Minister has heard that intervention and that he will respond specifically to that point in his closing remarks.

--- Later in debate ---

[Dr Wollaston]

Hon. Members know that a lack of proper pre-legislative scrutiny that responded to concerns expressed led to many of the barriers. We have to go back and address them when they could have been addressed in a more collaborative process during the passage of the Health and Social Care Act 2012. I am thinking of the need to reconsider the legal basis for merging NHS England and NHS Improvement, and how we establish a better statutory basis for the process so that provider partnerships do not always have to go back to separate boards to gain their approval. It is about considering how we address issues such as geographical arrangements so that they make more sense to local communities. The Committee could play a constructive role in a host of areas but—I say this to the Minister—unless proposals are subjected to pre-legislative scrutiny and unless a cross-party consensus is established, proposals are likely to fail.

My final point—other Committee colleagues will probably want to develop it further—is this: what will happen around establishing a legal basis for integrated care providers? For two reasons, the Committee welcomes the change of name from “accountable care organisations” to “integrated care partnerships”. First, the original name confused the debate about Americanisation. The “accountable care organisations” proposed were not the same as those organisations in the States, and the original name caused a great deal of unnecessary anxiety. We do not see the process as Americanisation.

A concern raised with the Committee was that the process will be a vehicle for privatisation. We did not agree. In fact, we thought the opposite: we agreed with the witnesses who told us that the process provided an opportunity to row back from the internal market and away from endless contracting rounds, and move towards much more collaborative working. We would like that change to be properly reinforced within the legal status of health bodies, and are disappointed that the Government have not agreed to say categorically that these bodies would be classed as NHS bodies. When the Minister sums up the debate, I would like him to reflect on whether any form of wording can put the matter beyond doubt and ensure that these health bodies will not be taken over by large, too-big-to-fail private sector organisations.

It is not a concern that groups of GPs might want a leading role in the bodies. The Minister will know that the public concern is more about them being taken over by very large too-big-to-fail private sector organisations. It should be possible to come up with a solution. The Committee heard—the Minister knows this—that those working in the service have the view that the bodies are not likely in practice to be taken over by private sector providers. However, that public concern exists and is a barrier to change. If we can put this matter beyond doubt, we should try to do so.

[Luciana Berger]

I would add a bit of clarification on that point about the size of private organisations that might become involved. My concern is that, irrespective of size—whether private organisations are big or small—the threat of a takeover happening within our NHS has distracted the debate. Anything that would categorically rule it out would be very helpful.

--- Later in debate ---

[Dr Williams]

I thank the hon. Lady for emphasising that point.

My second point is on what the broader health goals of an integrated system should be. The NHS is focused on reducing unplanned hospital admissions. Although that is important—it is especially important because of the financial costs to the service of unplanned hospital admissions—I want to see integrated care providers trying to achieve broader health goals. Success should not be measured by a reduction in secondary care activity alone, although I agree that in many cases the use of unplanned secondary care is a failure of prevention. ICPs will provide healthcare for a population of people. They need to take a population needs-based approach to healthcare, and they need to be prepared to invest outside the traditional medical model of care, including investing in the voluntary and community sector. We know that loneliness, social isolation and bereavement can have a huge impact on health, and we need integrated care not to be integrated medical care, but integrated holistic healthcare. I consider that integrated care providers will have succeeded if resources are focused on improving the health of the members of our population who have the greatest health needs.

Health needs are often not expressed. The inverse care law tells us that those with the greatest needs often have the least access to healthcare. A clever healthcare system does not just react to the people who turn up; it works with communities to identify and address needs within communities. For example, many people with mental health problems simply do not access healthcare, and it is not only their mental health that suffers as a result; their physical and social health suffer, too. On average, people with learning disabilities die 15 years younger than those without. They do not die because of those learning disabilities; they die because they are not accessing healthcare, both preventive and curative. We know about the health issues suffered by people living in poverty and other vulnerable people, including those with substance misuse problems, homeless people, veterans and vulnerable migrants.

Overall, I will consider integrated care to be a success if the share of healthcare expenditure that goes to preventive care, community care and mental health care increases year on year. Also, prevention must be prioritised, and I am pleased it is one of the three named priorities of the new Secretary of State for Health and Social Care. We need prevention at all its levels: better early detection, better immunisation and screening coverage, better prevention of falls, and better prevention of mental health problems, including investment in prevention right at the beginning of life—the first 1,000 days—where it has the greatest impact.

My third test for success is that performance, quality and safety are all maintained within a system that is taking out competition. There is a genuine risk that taking away some of those internal market forces might take away some of the incentives to keep waiting lists and waiting times down and to improve quality. As we integrate care, we need to ensure that we maintain those things.

[Luciana Berger]

I am listening closely to my hon. Friend’s remarkably informed remarks. Taking him back to his second priority, prevention, does he agree that the Minister should be thinking about what he should be doing beyond his own Department? The Minister and his colleagues in the Department of Health will not on their own be able to do what is needed on prevention as well as tackle this country’s mental health crisis and increasing lifestyle-related disease. If we are to address those challenges seriously, it will also be about what happens in our communities, our schools and our workplaces. That comes from local government and is what will ultimately make the difference.

[Dame Cheryl Gillan (in the Chair)]

I remind colleagues that interventions are meant to be short. I hope Members will be able to keep them a little briefer.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 24th July 2018 Commons Chamber

[Jackie Doyle-Price]

My hon. Friend is right to highlight this, but it is worth bearing in mind that there are also positive effects from engagement on social media. The relationship between social media use and its impact on mental health is not conclusive. That is why the chief medical officer is carrying out a review of all the evidence in this area, so that we can understand and shape future policy. That report will be due next year.

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

The Government acknowledge that we are seeing an increase in the number of children suffering with their mental health. We have only to look at the figures on the number of children turning up at accident and emergency in a crisis to know that that is the case. This is a serious state of affairs. Why then are the Government releasing their response to the consultation on the Green Paper on young people’s mental health later this week, when we are in recess, and thus avoiding scrutiny in this House?

[Jackie Doyle-Price]

Respectfully, I say to the hon. Lady that this is a response to the consultation on the Green Paper, which has had considerable debate in this House. The suggestion that we have avoided scrutiny really does not pass.

Perinatal Mental Illness

Luciana Berger Excerpts

Thursday 19th July 2018 Westminster Hall

[Alison Thewliss]

I see we have had a change of Chair, Mr Rosindell. It is good to see you.

As I was saying before we were interrupted by the vote, the managed clinical network aims to ensure equitable co-ordinated access to mental health provision for pregnant and post-natal women. It seeks to understand current provision and promote improvements in local services, including access and options for families, professional expertise and effective service delivery. Beyond that, it will seek to contribute to improved early years health and development for infants, as part of a broader Scottish Government intention for improved early intervention. The MCN will make fuller recommendations before the end of this year on what services should be available in all board areas to meet the needs of women and their families.

The most exciting part about that for me was the women and families maternal mental health charter, “My Right to Good Care from NHS Scotland for my Baby, my Family and Me”, which was launched on 4 June. The charter has nine points, which I want to put on the record. They are, first, the right to be at the centre of my care, so that I have the information I need to make the best decisions for me, my pregnancy and my infant’s future health; secondly, the right to be seen by staff who have the appropriate level of knowledge and skills to assess and care for me; thirdly, the right to preconception and pregnancy advice and care if I have a pre-existing mental health condition; fourthly, the right to access expert advice and care about my maternal mental health when I require it, wherever I live in Scotland; fifthly, the right to have priority access to talking therapies during my pregnancy and post-natal period; sixthly, the right to be admitted jointly with my infant if I need in-patient mental health care; seventhly, the right to discuss my maternal mental health without fear of stigma or being judged; eighthly, the right for my family to have the information they need to help me and to get help for themselves; and ninthly, the right for my baby to have parents who are supported with their mental health. All these are very good points, which are the bedrock of what we should see in a mental health service for women and infants.

I cannot end my speech without mentioning my role as chair of the all-party parliamentary group on infant feeding and inequalities. The discussion in this country about breast feeding versus bottle feeding has become increasingly divisive. I do not want to venture into it, but a cause of many issues is the pressure on women to have the perfect, glowing, spotless, white-bloused-in-a-perfect-home version of breastfeeding, but that is unrealistic. It is more like chaos surrounding a knackered mother with all the surfaces covered in vomit and soggy muslin cloth—or maybe that was just me.

The hon. Member for Stockton South mentioned the perfect baby ads that we see and the idealised images of motherhood. We put pressure on mothers all the time without necessarily supporting them with being a mother and with the learned skill of breastfeeding. By not providing that support, we set women up to fail. Many carry that very personal pain around for a long time. It should not be that way.

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

The hon. Lady is making a very compelling case. I am sorry that I was unable to attend the start of this debate, but I commend Members on both sides of the House for bringing us together to discuss these very important matters. Does she, like me, worry that the reduction in antenatal services and services for new mums and dads, particularly in our children’s centres, increases the challenges that new parents and expectant parents face?

--- Later in debate ---

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I congratulate my hon. Friend the Member for Stockton South (Dr Williams) and the hon. Member for South West Bedfordshire (Andrew Selous) on securing this important debate and on how they opened it. We have heard contributions from the hon. Member for Strangford (Jim Shannon), my hon. Friend the Member for Canterbury (Rosie Duffield), the hon. Member for Bath (Wera Hobhouse) and the Scottish National party spokesperson, the hon. Member for Glasgow Central (Alison Thewliss). We also heard interventions from the hon. Member for Thirsk and Malton (Kevin Hollinrake), my hon. Friend the Member for West Ham (Lyn Brown) and, just a moment ago, my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger).

Pregnancy, birth and becoming a parent can be a special and rewarding time for many people. As we have heard, it is a time to celebrate new life and the start of the exciting journey into parenthood. However, for others, the stress and upheaval of pregnancy and becoming a parent can trigger existing mental health problems or spark new ones. Perinatal mental health issues can include severe mental health disorders that require severe immediate hospital treatment, such as postpartum psychosis. It may affect only two cases in 1,000, but it is a very serious condition and can put new mothers at risk of harming themselves and their baby. The issues can also include most common mental health conditions, such as depression, anxiety, post-traumatic stress disorder, obsessive compulsive disorder and panic attacks. My hon. Friend the Member for Stockton South spoke very well about the impact of those mental health conditions on the child’s development.

Given the expectation that pregnancy and becoming a parent should be a joyful time, women who experience those conditions can feel even more stressed and unhappy, and often that they are somehow to blame for their condition. A study by the Boots Family Trust in 2013 described some of those experiences. One mother said:

“I avoided friends at all costs as I lost the ability to communicate and became very isolated”.

Another said:

“I’m currently into my second pregnancy and think I am suffering from depression…I feel scared and feel like I have trouble bonding with this pregnancy…I don’t know what is wrong with me.”

We know that one in five women will experience mental health problems during pregnancy. Given the high prevalence of mental health issues in new and expectant mothers, the woman I just quoted should not have had to feel like something was wrong with her. We have heard many excellent examples in the same vein in this debate. One way to prevent women from feeling isolated or somehow to blame is by identifying those mental health issues and ensuring the proper support is put in place. Unfortunately, as hon. Members said, too often that does not happen.

Hon. Members rightly highlighted that identification is a major barrier to accessing support for mental health issues. I join them in congratulating the National Childbirth Trust on its #HiddenHalf campaign. The research underpinning that campaign shows that nearly half of all the mental health problems that new mothers experience are not picked up by health professionals.

As we have heard, early intervention is key. The sooner issues are identified, the quicker people can access appropriate support, and that surely drives better outcomes. It is simply not good enough that only half of perinatal mental health issues are picked up. As my hon. Friend the Member for Stockton South detailed, GPs should offer a post-natal check about six weeks after the baby’s birth. We have heard that a properly delivered check-up can have a transformative effect on new mothers who are experiencing mental health problems. Research by the National Childbirth Trust found that women directly questioned by a GP about their mental health were almost seven times more likely to disclose a mental health problem. If mental health problems are left untreated, they can escalate into much more severe mental illness.

The National Childbirth Trust also found that 95% of women who had experienced a mental health problem felt it affected their ability to cope or look after their children or family relationships. As we have heard, the six-week post-natal baby check is mandatory, but the maternal check was left out of the GP contract. As a result, the maternal check is often not done at all or becomes a rushed conversation at the end of the baby check. In one third of cases, the maternal check was estimated to last three minutes or less.

The National Childbirth Trust recommends that the Government fund the six-week maternal post-natal check so that GPs have the time to give every new mother a full appointment for the maternal check. As we have heard, the National Childbirth Trust also recommends an improvement in the guidelines for best practice around maternal mental health, including a separate appointment for that maternal six-week check, and they recommend better methods of encouraging disclosure of maternal mental health problems.

I have looked at the NHS England guidance, which states:

“There are no set guidelines for what a postnatal check for mothers should involve.”

It also states:

“The following is usually offered, though this may vary according to where you live...You will be asked how you are feeling as part of a general discussion about your mental health and wellbeing.”

We can and must do better than that.

I have already mentioned the pressure on women to feel happy after the birth of a child and how mental health issues can lead to their feeling that there is something wrong with them. It can often lead to women putting on a brave face. One woman, responding to the Boots Family Trust survey, said:

“I was terrified to admit to any health professional as I was scared they would take my son away.”

That is exactly the point made by the hon. Member for Glasgow Central and it demonstrates the challenges that GPs face in identifying mental health issues. Merely asking how a new mother is feeling is no substitute for a properly trained staff member identifying mental health issues and knowing how to encourage disclosure.

The National Childbirth Trust recommends that NHS bodies should support and invest in initiatives to facilitate and further develop GP education on maternal mental health. Earlier, my hon. Friend the Member for West Ham touched on the fact that investment in perinatal mental health would result in savings. It is worth thinking about how much that might be.

The statement from the Royal College of General Practitioners about perinatal mental health said that post-natal depression, anxiety and psychosis carry an estimated total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK, and 72% of the cost relates to adverse impacts on the child. That reinforces the very important points that my hon. Friend the Member for Stockton South made earlier. More than a fifth of those total costs—£1.7 billion—are borne by the public sector: mainly NHS and social care. I hope that that all helps to give the Minister ammunition. Sadly, the average cost to society of one case of perinatal depression is estimated to be £74,000: £23,000 relates to the mother and £51,000 to the impact on the child. There is every reason to try to make the case being made in the debate today.

We must make sure that, where a diagnosis has been made, appropriate treatment and support is made available. According to the Maternal Mental Health Alliance, a quarter of pregnant women and new mothers cannot access specialist perinatal mental health services that meet the full National Institute for Health and Care Excellence guidelines. Only 7% of the women who reported experiencing a maternal mental health condition were referred to specialist care. It took more than four weeks for the 38% of the women who were referred to be seen. Shockingly—we have heard several examples—some women waited up to a year for treatment. My hon. Friend the Member for Canterbury talked about such an example. In fact, it was recently revealed that there were only 131 specialist perinatal beds in the whole of the UK, with none in Northern Ireland or Wales.

We know that pressure on mental health trusts comes from money earmarked for mental health services being used to pay for other areas of the NHS. The Labour party would ring-fence mental health spending so that funding for mental health services is not siphoned off to pay for other priorities. In this debate we have heard much detail of the #HiddenHalf campaign. The Opposition support that important campaign and we would look at implementing it in government. We call on the Government now to make resources available so that every mother is given the perinatal support that she deserves. It is important that we also include that commitment to ring-fence mental health spending so that the funding that is meant to be for mental health services does not go to other priorities in the NHS.

The Government have made some commitments on perinatal mental health, and I am keen to hear from the Minister, if we have time, what progress has been made. The five-year forward view for mental health set a target to ensure that by 2021 at least 30,000 more women each year would be able to access specialist mental health care during the perinatal period. Given that we are now halfway through that phase of the five-year forward view for mental health, can the Minister tell the House what progress has been made towards that target and whether NHS England is on track to meet it?

In autumn 2017, at the maternal mental health ministerial roundtable, a number of commitments were made to improve perinatal mental health services. They included a commitment that the Department of Health would work with health system partners and other Government Departments to deliver improvements in perinatal mental health services, and a commitment that NHS England would expand specialist mental health services by 2021 to meet the needs of women in all areas. We have heard, as we hear in so many debates on health and social care, about very unfortunate postcode lotteries, so how is NHS England doing in expanding those specialist services to meet the needs of all women?

[Luciana Berger]

My hon. Friend is making a strong case, as have other colleagues, about the inconsistency of the availability of perinatal mental health services. Although there has been some investment, there are still many areas where there is no sufficient, adequate or indeed any immediate access, and mothers still have to travel too far across the country to access a bed if they need one in a mother and baby unit. Does she share the concern expressed by the British Medical Association that there is a 20% difference in referral rates in some areas, which illustrates the inconsistency of care? When the issue is so critical not only for the mother but for the child in its lifetime, that is something that the Government should urgently address.

[Barbara Keeley]

I absolutely agree with my hon. Friend. It is very important that the Minister tells us now or after the debate what is happening to expand the services so that we do not have what are almost deserts, where women have to travel either to get a bed or to get the service that they need.

Finally, there was a commitment in autumn 2017 that NHS Health Education England would support the roll-out of GP perinatal mental health champions across England. I am sure it would help if there was in every area a perinatal mental health champion speaking up for their own area. Will the Minister tell the House what progress has been made on these important commitments?

I want to conclude on a wider point about women’s mental health. Women are more likely to suffer from mental ill health than men, and yet too often women’s specific mental health needs remain a blind spot. Research by Agenda, the women’s mental health charity, has shown that mental health trusts are too often failing to consider women’s specific needs. Only one of the 35 trusts that responded to a freedom of information request by Agenda had a strategy on gender-specific mental health services.

Fourteen years ago, the Labour Government launched a comprehensive women’s mental health strategy to address the specific mental health needs of women. Sadly, that strategy was ditched by the coalition Government, and women’s mental health has since slipped down the policy agenda. The Mental Health Foundation has described it as being “almost invisible” in Government policy.

We have had an excellent debate today in which many useful examples have been given and many good points made. There is a strong feeling that we want to help the Minister do something about this issue. Will she in future match Labour’s commitment to have a national women’s health strategy that would work to deliver the targeted support that women and girls need?

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

It is good to see you in the Chair, Mr Rosindell. The debate has been excellent. I have enjoyed listening to all the speeches, which, without exception, have been thoughtful, constructive, and, in the case of people who have been through motherhood, very honest and gritty about the reality of the situation that we face. I pay tribute to the hon. Member for Stockton South (Dr Williams) for making as articulate a speech as possible on the issue. It covered the whole breadth of subjects that we need to consider. It was a real pleasure to listen to him. I will say the same about my hon. Friend the Member for South West Bedfordshire (Andrew Selous). I am pleased to see two men leading the charge on this subject. It is an important message that this is not a woman’s problem; it is a problem for society and for families. Ultimately, if we do not tackle it, society picks up the tab. It is great that two male Members of the House are leading the charge.

Many themes have come up in the debate, and I will try to address them all. I will begin by tackling the issue of the first 1,001 days. A number of hon. Members present are members of the all-party parliamentary group for the prevention of adverse childhood experiences. We recognise that the period from conception to age two is vital for every child’s development, and that is why we are prioritising and focusing on ensuring that there is sufficient perinatal mental health support at that stage. On the wider issue of adverse childhood experiences, the hon. Member for Stockton South mentioned that having four of them makes someone more likely to end up in prison. This is about the best kind of early intervention—for me, that is a no-brainer. We can identify those young people or children who are most at risk of falling out of society. Therefore, we should look at how best we can intervene early to support them.

[Luciana Berger]

I am delighted to hear the points the Minister has made about the importance of the first 1,001 days and the nought-to-two agenda. On that basis, might we expect the Government to respond to their Green Paper consultation on young people’s mental health by putting in place measures to support and help under-fives?

Mental Health Units (Use of Force) Bill

Luciana Berger Excerpts

3rd reading: House of Commons
Friday 6th July 2018 Commons Chamber

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

It is a privilege to be here today. Members from all parties are often in a quandary about whether and how to be here on a Friday when we also have constituency commitments, but it was important to me that I be here today to support my hon. Friend the Member for Croydon North (Mr Reed). He has been a shining example to us all—Opposition and Government Members—of how best to use a private Member’s Bill slot, particularly as a member of the Opposition. He has put forward a change to the law in a way that has essentially secured support from Members on both sides of the House, as we have heard from the speeches so far. He has not only carried Members with him but achieved the Government’s support. I do not want to jinx anything, but I anticipate and hope that, at the end of today’s deliberations, the Bill will progress to the other place.

It has been a privilege for me to play a small part in the process, having served on the Bill Committee. I also stand here on behalf of the Labour Campaign for Mental Health. Many people outside this place are following our discussions today and have followed what has happened to get to this point. People with lived experience, family members and clinical professionals are really pleased that we are working on something that is productive and positive. I believe, as does my hon. Friend the Member for Croydon North, that it will effect some change in our country.

I do not seek to speak for long, but wish to reflect on a few reasons why the Bill is so important. I hope that we will be joined by Mr and Mrs Lewis—I know that they are on their way—because it is a testament to them and to their courage and bravery that they have worked to ensure that, in the wake of the tragedy that they have experienced, some good will come from the tragic death of their son. Members from all parties have come together today to reflect on Seni’s death.

But it is not just Seni’s death; in fact, only this week we heard about some research done by the UK-based charity Agenda, which campaigns for women and girls at risk. That research shows that over the past five years, from 2012-13 to 2016-17, 32 women who were detained under the Mental Health Act died after experiencing restraint. That is another example of why the issues we are discussing are so important. Those 32 women lost their lives as a result of what happened to them in mental health units.

If we look a little more closely at the figures, we see that younger women made up the majority of those restraint-related deaths, and more than a fifth of them were from black, Asian and minority ethnic backgrounds. I listened very closely to the hon. Member for Shipley (Philip Davies), but I do think that it is important, in the context of what we are discussing today, to look very closely at defined and protected characteristics. We are seeing certain groups disproportionately affected by this action in more ways than others.

Many programmes have shone a spotlight on what happens inside some of our mental health services, in particular, the Dispatches programme “Inside The Priory”, which was shown on Channel 4 back in February. It had to use undercover cameras to expose what happened in one unit alone. It was particularly disturbing, because it showed the high-stress environments that exist in some, but certainly not all, of our mental health in-patient units. I have had the privilege of visiting a number across the country. However, when people find themselves in a crisis in such an environment, all too often, unfortunately, the staff are temporary, or they are bank staff or agency staff. To echo what others have said today, the fact that we have a recruitment crisis in this sector will have an impact on someone’s recovery. We should be doing everything possible to ensure that those environments are therapeutic and that they lead to someone’s recovery. I see this as something that is absolutely critical, but is it not a shame that we are discussing it today, and that we have to make this law? Actually, we should be doing everything possible to prevent people from getting into in-patient units in the first place, but if they are there, the settings should be right, the staff should be trained and full-time and the environment should be therapeutic. The fact that that is not the case is why this law is even more crucial.

We need to do everything possible to eradicate restrictive practices in in-patient care. This law is crucial in ensuring that when these things happen, everything possible is done to protect patients, to ensure that they are given a voice, and to ensure that they are not held or treated in a way that will exacerbate the very condition that saw them go into a mental health in-patient unit in the first place. Once again, I echo my thanks to my hon. Friend the Member for Croydon North for all the work that he has done to get us to where we are today.

Transforming Care Programme

Luciana Berger Excerpts

Thursday 5th July 2018 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House is concerned at the slow progress made under the Transforming Care programme, which was set up to improve the care and quality of life of children and adults with a learning disability and/or autism who display behaviour that challenges; recognises that a substantial number of people with learning disabilities remain trapped in, and continue to be inappropriately admitted to, Assessment and Treatment Units rather than living with support in the community; is further concerned at the lack of capacity within community services; notes evidence of the neglect, abuse, poor care, and premature deaths of people with learning disabilities; believes that the Transforming Care programme is unlikely to realise the ambitions set out in the Building the Right Support strategy before it ends in March 2019; calls on the Government to establish, prioritise, and adequately resource a successor programme that delivers a shift away from institutional care by investing in community services across education, health and social care; and further calls on the Government to ensure that such a programme is based on lifelong support that protects people’s human rights and promotes their independence and wellbeing.

May I thank the Backbench Business Committee for facilitating this important debate? Although the number of Members who have indicated a desire to speak is low, this incredibly important issue deserves to be debated in the House. I thank the hon. Member for Dulwich and West Norwood (Helen Hayes), together with other Members, for joining me in making the application for the debate. I have worked very closely with her on this issue, which we both care very much about.

I thank a number of voluntary sector organisations that have been incredibly helpful in preparing for this debate. I particularly want to mention the Challenging Behaviour Foundation, which is led by the very impressive Viv Cooper, as well as Mencap, the National Autistic Society, the Voluntary Organisations Disability Group and Shared Lives Plus.

It is perhaps sobering that we are debating this issue on the 70th anniversary of the NHS. I say that as someone who is a very strong supporter of the NHS, but for the people we are talking about in this debate, the record has not been a good one. The system has let down too many individuals and too many families. On this very significant day, it is important to recognise that the NHS has a lot of work to do to repair the damage that has been done to so many people, and to treat them properly.

The origins of the transforming care programme lie in the horror of the Winterbourne View scandal, which Members will remember. In that private hospital, people with learning disabilities and autism were abused and assaulted behind locked doors over a sustained period, and that was only revealed by brave whistleblowers. In the aftermath of that horror, I invited the families of those who had been patients in Winterbourne View to come to the Department of Health—I became a Health Minister in September 2012—to talk to me about their concerns.

I clearly remember a father called Steve Sollars, who talked to me about how he had watched his son become, in his words, increasingly zombie-like as he was pumped full of anti-psychotic drugs. Steve described how he tried to complain to the local authority and the primary care trust, as it was in those days, and said that he was just completely ignored. It really struck home when he said, “I felt guilty that I couldn’t do anything for my son.” I was left thinking how dreadful it was that we had got to a position in which state agencies had left an individual—a father—feeling guilty because they were ignoring his pleas for something to be done.

In the following months and years, I met some other parents of individuals trapped in hospital—sometimes in unattractive institutions—for long periods, all of whom felt that no one was listening to them. I refer in particular to Phill Wills, who campaigned brilliantly on behalf of his son Josh, who was stuck in a hospital in Birmingham for more than two years. The family live in Cornwall, so they had to make an incredible journey just to maintain contact with their little son.

I also met Shahana Hussein, the aunt of a girl called Fauzia, who was in St Andrew’s in Northampton. She talked to me about her fears of how her niece appeared to be trapped there. She was anxious that that might be her life course, and that she would never emerge from that place. I met Lynne McCarrick, whose son Chris had been stuck in Calderstones undergoing inappropriate treatment for a very long time, and Lorna and Sid, the parents of Simone, who is still stuck in hospital nine years after her first admission. For much of that time, she has been a long distance away from home, therefore making it impossible for her parents to visit, which is shocking in this day and age. Many of those families are present for today’s debate, and they remain extremely concerned about their loved ones and others who remain trapped in institutions.

The conclusion that I reached at that time, which I still hold, is that individuals’ human rights are routinely ignored and breached in serious ways. Someone who is convicted of a criminal offence and then sent to prison—other than the cohort who have received indeterminate sentences—generally knows the date of their release. However, people who go into institutions and their families do not know a release date, and many people stay in those institutions for much of their lives, which is shocking. To put it bluntly, they are treated as second-class citizens. I said that at the time, and I still say it now, because not enough has changed for any of us to be comfortable with the situation.

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

I congratulate the right hon. Gentleman and my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) on the leadership they have shown by securing this debate through the Backbench Business Committee. The right hon. Gentleman said that this programme came out of the Winterbourne View scandal, which was back in 2011. Does he share my concern that we are discussing this issue seven years later in 2018 and yet thousands of people in our country—thousands!—are still in institutional care? It is an absolute disgrace that we find ourselves discussing this issue.

[Norman Lamb]

I completely agree. That sense of complete injustice and the denial of human rights still exists. Nothing much has changed, which is why the debate is so important, and I share the hon. Lady’s view that we should not tolerate this scandal. What makes the situation even worse is that this is not a demand for vast amounts of extra public money; it is about how public money is spent. Our demand is that money is spent in a way that respects people’s human rights and gives them the chance of a good, happy life in the community, with the support of care workers, friends and family, rather than being trapped in institutions. It is shocking that the situation for very many people has remained exactly the same as it was all those years ago.

[Norman Lamb]

I do agree, and that is another big subject that I will be pursuing further in the light of the Gosport inquiry, which I established when I was a Minister. In that case, brave nurses tried to blow the whistle in 1991, but they were shut down by management and unable to pursue their concerns. More than 456 people lost their lives as a result of the inappropriate prescribing of opioids, and that was because whistleblowers—brave staff members—were not listened to. In every part of our health service, we must ensure that people feel able to speak up and that they have the legal rights to do so.

The outcome of our deliberations in the Department was to establish the transforming care programme, which was published in December 2012. Interestingly, it was pursued as a concordat and an agreed programme of action. It was supported by an amazing array of organisations, all of whose logos appeared in the document, including—critically—NHS England. Every organisation that signed up to the programme committed to

“working together, with individuals and their families—

note the phrase “with individuals and their families”—

and with the groups that represent them, to deliver real change.”

That was in December 2012.

These organisations that had committed “to deliver real change” also stated:

“Our shared objective is to see the health and care system get to grips with past failings by listening to this very vulnerable group of people and their families, meeting their needs and working together to commission the range of support which will enable them to lead fulfilling and safe lives in their communities.”

To put it bluntly, there has been a shameful failure on that commitment to change, which simply has not happened for the majority of people involved.

At that time we were operating in a fog. No data had been collected historically on the numbers of people in beds in institutions, so we had to rely on periodic censuses to find out whether anything was changing. When we conducted a census about 18 months after the start of the programme, it was shocking to discover that there had effectively been no change—it was business as usual. The really disturbing thing was that many private sector organisations were making substantial investments in new facilities and delivering the wrong model of care. Why did those organisations have the confidence to make major million-pound investments in inappropriate care? It seems to me that to justify such investment, they must have had reassurance from somewhere in the system that things would carry on as they were. It was shocking to discover the extent to which it was simply business as usual.

[Luciana Berger]

I apologise if the right hon. Gentleman is going to come on to this, but I want to reflect on the reports commissioned by NHS England and Sir Stephen Bubb. Back in 2014, Sir Stephen was commissioned to write a report entitled “Winterbourne View – Time for Change”, yet nothing happened in the wake of that report, other than a closure programme that was published back in 2015, on which we have seen little progress. In February 2016, Sir Stephen Bubb published another report entitled “Time for Change – The Challenge Ahead”, which again demanded urgent action. Does the right hon. Gentleman share my concern that although those reports were commissioned, there was very little response or action taken?

[Norman Lamb]

Again, I entirely share the hon. Lady’s view. I work closely with Sir Stephen Bubb and we have exactly the same view about this. He and I attended a meeting about a year ago with NHS England to discuss progress, or the lack of it. The hon. Lady is right to say that there is a culture of looking at things again and again, and then doing nothing about the conclusions reached, which is wholly unacceptable.

At that time, three issues stood out, and they involved perverse incentives that acted to prevent change from happening. First—this is extraordinary—the person who was making the critical decision about whether an individual should stay in a bed or be discharged was, and still is, the clinician employed by the provider organisation that makes money out of the person staying in the bed. That total conflict of interest has never been confronted. As Minister, I kept asking NHS England to act to address that issue, but it has not yet been resolved. If a private sector organisation is earning £4,000 or £5,000 every week from someone being in a bed, there is a strong incentive to keep them in that bed. There is also an incentive for public sector organisations that want to maintain their existence, and that conflict of interest has never been confronted.

Secondly, there is a complete failure to invest properly in community provision. This is all about the need to shift resources from institutional care to community support; in other words, shifting money from NHS England to local authorities. The original transforming care concordat made it clear that there should be a pooling of resources between specialist commissioning, clinical commissioning groups and local authorities. As the hon. Member for Liverpool, Wavertree said, seven years on we are still waiting for a proper pooling of resources so that the money can actually shift and investment can be made in community resources.

The third insight I had at that time was the most extraordinary and wholly unacceptable exclusion of families and individuals from any decisions that were being made about their care. This, I am afraid, continues today. It is very far from the personalised care that the NHS and the Government say they are committed to. In the light of what I saw as our complete collective failure to deliver that change—this was the thing that caused me most distress as Minister—I decided that we had to come up with new proposals for new legal rights, so that families and individuals could challenge decisions that were being made behind their backs about where they would be cared for and treated.

Shortly before the 2015 general election, we published a Green Paper, I think in March 2015, called, “No Voice Unheard, No Right Ignored”. It has an important title, but I am afraid that those rights and those voices are still unheard and ignored because it has never been implemented. Nothing proposed in the Green Paper has been taken forward by the Government. We now have a review of the Mental Health Act 1983, so there is another opportunity to address the scandalous lack of rights for individuals, but the time it will take before there is any legislation will be very long—I doubt whether it will be in this Parliament—and families will just be left waiting.

At that time I worked with Sara Ryan, a remarkable woman and the mother of Connor Sparrowhawk, known as Laughing Boy. He was a young man in the “care” of Southern Health who lost his life while he was within its institution. He drowned in a bath because of neglect. The Health and Safety Executive had decided not to investigate the case. I intervened and asked it to reconsider. It then decided that it could investigate and eventually, years later, prosecutions and convictions followed. The result of the tragedy that struck that family was that Sara Ryan and an amazing group of people worked together to produce a Bill that would have strengthened the rights of individuals. We worked closely with them in the production of that Green Paper.

Because no progress was being made following the 2015 general election, the Government and NHS England embarked on a new process. In October 2015, they published a document called “Building the Right Support”. The plan was to close between 35% and 50% of in-patient beds and, critically, ensure that local areas developed the right community support by—this is the critical date—March next year. The plan involved the creation of 48 transforming care partnerships covering the whole country. These partnerships between NHS England specialist regional commissioners, local authorities and CCGs were to facilitate the shift of money from NHS England to local authorities, so that people could be cared for in the community.

There was a plan for people who had already been in in-patient care for more than five years at April 2016 to be given a dowry to facilitate their transfer into community support. When campaigners asked how many dowries had been provided, NHS England said it did not know because it did not have any records on that. What kind of implementation of a national programme is it when we do not even know, and have no way of telling, how many dowries have been delivered? And why was it just for that one cohort of people? Surely every person stuck in a hospital or institution has the right to have the money go with them on their journey back into the community. I want to know from the Government how many dowries have been delivered so far and whether they will become part of the programme in the future.

As I said, the programme ends in March next year, along with other work on learning disabilities which campaigners are concerned will continue—I will come back to that at the end—including the learning disabilities mortality review. There has already been a lot of concern expressed about how the annual report was slipped out the day after the local election at the beginning of May. The report contained pretty shocking findings, with life expectancy falling massively short of the rest of us—for men by about 22 years; for women, by 29 years—without any clear justification. Some 13% of the cohort of people looked at in the mortality review were cases where the person’s health had been adversely affected by delays in care or treatment, gaps in services or organisational dysfunction, neglect or abuse. Those findings are shocking and concerning. The question for the Government, which I will come back to, is what happens with the findings of mortality reviews. We can all express concern when they are published, but unless there is a plan of action to address the failings identified in them then nothing will change.

The nine principles in the “Building the Right Support” document are very good. They are all focused on personalised care and getting people into the community, which we all agree must happen.

[Luciana Berger]

I normally would not make so many interventions and I hope the right hon. Gentleman is happy to take them—I thank him greatly. I just want to reflect a bit more on the learning disabilities mortality review. The title is quite technical, but it comes back to what he opened his speech with: we are discussing thousands of the most vulnerable people in our country and we have a responsibility to do everything we can to compensate for the fact that they are so vulnerable. The mortality review, launched in May of the previous year, found that one in eight of the deaths reviewed showed there had been abuse, neglect, delays in treatment or gaps in care. Today we celebrate the 70th anniversary of the NHS. Is it not a sad reflection that, amidst all the positivity, we need to do something about this issue so urgently?

[Norman Lamb]

I totally agree. It is, as I said at the start, sobering. In a way, all of us who strongly support the NHS must not laud it as a perfect institution with nothing to complain about. As far as this group of people are concerned, they have been very badly let down. Fundamentally, in many cases they have died early through neglect. That is intolerable in this day and age.

The nine principles, which are positive and empowering, are really good. I sign up to them completely. It is the implementation that is lacking and has largely failed. I say to the Minister that she is very fortunate to be in her wonderful job. My great frustration is that this programme came early in my time as Minister, but I learned, as I did the job, just how critically important implementation is. You think that by establishing good principles and getting everyone to agree to implement them those organisations will do what they have committed to do. It was probably naïve to think that. The reality was that nothing changed and it still has not changed. One critically important lesson to learn from that failure is to have a total, obsessive focus on implementation and national leadership.

Department of Health and Social Care and Ministry of Housing, Communities and Local Government

Luciana Berger Excerpts

Monday 2nd July 2018 Commons Chamber

[Dr Wollaston]

The hon. Lady is absolutely right. Health in all policies means using every opportunity to maximise public health. When Departments work together, such as on the childhood obesity strategy, we need maximum engagement across the whole of Government to make that effective. The way it was put to us when the Committee visited Amsterdam was that it should be viewed as a sandbag wall, and if any part of it is missing, we are not going to achieve what we want. That applies to all of public health.

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

To echo the point that has just been made, the hon. Lady will be aware that I presented a ten-minute rule Bill in April about having health in all policies. Does she agree that the Government should reinstate the Cabinet Office Sub-Committee on public health so that the entire machinery of government can come together to ensure that we do everything possible to keep people well, rather than having a service that treats people when they are sick?

[Dr Wollaston]

Absolutely. It is essential that we use every mechanism at our disposal to ensure that Departments work together. Public health is mostly delivered in the community, so we need that to happen at the local level, too. Councils should be reaching out into their communities and ensuring that they use every opportunity to deliver health in all areas when it comes to prevention.

One of the most welcome aspects of the funding settlement is that it is long term. For too long we have limped from one short-term sticking plaster to another, so I particularly welcome the fact that we now have certainty over five years combined with a 10-year long-term plan. In the Minister’s response, I ask her to reflect on the recommendation from the House of Lords Select Committee on the Long-Term Sustainability of the NHS for an office of health and care sustainability to do long-term horizon scanning. That means not just future demographic challenges, but long-term workforce planning, which has always been a huge challenge within the health service. Brexit, for example, has implications for not just the workforce, and there are many other challenges ahead, so it would be helpful to have an independent body that could consider such things and help to work out the necessary long-term funding.

My final points are about how we fund the new system. I would be delighted if there was a Brexit dividend, but I am afraid that I do not believe that there will be. I think there will be a Brexit penalty. The difficulty with people thinking that everything might be solved by a mythical future fund means that we are not levelling with them right at the outset that we are all going to have to pay for it. The challenge should be about how to distribute the cost fairly. That is the key point here.

I want to stop here to thank the citizens’ assembly that worked with my Committee and the Housing, Communities and Local Government Committee. I also thank the Chair of that Committee, the hon. Member for Sheffield South East (Mr Betts), for the Committee’s diligent work on this issue.

Going back to fairness, when I was in practice, it always came as a huge shock to my patients when they realised that if they had what might be really quite modest assets, they would have to fund all their social care. That shock was striking when the citizens’ assembly considered the matter. If we are to move to a properly funded system, it must look at the quality of social care, which is precarious in nature, and at the provider challenge. We must be realistic, and we have to make it clear that somebody has to pay. We cannot just put it off to future generations; we have to think about it and explain to the public what that means.

That is why, unusually, our Select Committee makes recommendations to both Front-Bench teams, because the failure to address this has been a political failure. On the one hand, measures suggested by the Labour party have been denounced by my party as a “death tax” and, on the other, my party’s suggestions have been denounced as a “dementia tax”, and that means we get nowhere.

If we are to avoid having the same discussion in five years’ time, we need to be clear about how we will get this across the line. That will require, particularly in a hung Parliament, the co-operation of both sides of the House. I therefore urge both Front-Bench spokespeople to commit to working together.

Members on both sides of the House have repeatedly said that we are prepared to form a parliamentary commission to go out and engage with the public, rather as Adair Turner did on the difficult issue of pensions, regarding what fairness means. We cannot offload this entire cost on to a relatively shrinking pool of working-age employed adults. We need to have a conversation that reaches out to everybody and asks, “What is the fair payment?”, and in return we must make sure those extra payments are earmarked for the NHS and do not just disappear into wider Government funding.

How we do that will mean conversations about national insurance with the self-employed, and it will mean conversations with people in retirement about their own contributions. We cannot put the cost entirely on to young people, many of whom are already, in effect, paying a graduate tax of 9% on everything they earn over £25,000. That would not pass the fairness test.

I am afraid that least fair thing of all would be for us to duck this challenge and leave even more people without the care they need, with disastrous consequences for them, for their loved ones and for their carers, because it falls into the “too difficult” box. This is difficult, but we need to grasp it, explain it to people and come to a decision.

--- Later in debate ---

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

It is an honour to take part in this debate in the week we celebrate the NHS’s 70th birthday. I thank the hon. Member for Totnes (Dr Wollaston), the Chair of the Health and Social Care Committee, of which I am proud to be a member, for all the important work she does.

Many of us have been active, particularly in the past week, in doing lots of work on our local health services and in campaigning on national things. Today’s debate is important because it comes in the wake of a number of reports. We have obviously had the report from our Select Committee, which considered the long-term funding of adult social care. In the past few weeks alone, my colleagues on both sides of the Committee and I have attended the presentation of reports on the funding of health and social care from the Institute for Fiscal Studies and the Health Foundation, co-ordinated by the NHS Confederation. We have seen reports from the Institute for Public Policy Research and a number of others.

Collectively, all those reports, including our own, have raised the challenges that our health and social care system faces, and those challenges are not news. We are not sharing a new story, and, in the context of this debate, it is not just about the money that is available for our NHS. Ultimately, we are all here because we want to ensure that we continue to have a national health service that is free at the point of use for all who need it, and that goes hand in hand with the provision of social care.

In my city of Liverpool, we have seen social care devastated in the eight years since 2010. We have seen our Government grant slashed by 60%. Social justice is a real issue, because we know that the north of England has been particularly and disproportionately hit by cuts to local authority budgets. Those cuts have been larger in the most deprived areas. Looking at the figures, we see that the 30 councils with the highest levels of deprivation have made cuts to adult social care of 17% per person, compared with 3% per person in the 30 areas with the lowest levels of deprivation.

That cannot be right, and it pains me, particularly when I speak to constituents on a weekly basis who are affected by this, because they have seen their social care packages taken away, or now cannot access them, or they have seen family members stuck in hospital because there is no social care package for them when they are ready to leave, and/or they are turning up at the doors of A&E because they are not receiving social care in their home.

[Diana Johnson]

Will my hon. Friend comment on the social care precept that local authorities can use to raise additional funding? In the poorest areas, because the council tax base is so low, the precept does not generate sufficient money to fill the gap and provide social care.

[Luciana Berger]

I thank my hon. Friend for that important contribution. To give an idea of what it is like in Liverpool, we do not raise enough in council tax to cover our social care bill alone. That is before we consider all the other services that our local authority has a responsibility to provide in our area. This is a critical issue. The onus has now been transferred to local authorities, with all the costs that come with it, and it is particularly difficult. We have seen a reduction of 7% in the total number of people in receipt of a care package, yet in the same period we have seen demand for support—measured by the number of referrals and requests for help—rise by 40%.

It is important that in this debate we are considering not just the funding that goes to health—we have heard the hon. Member for Totnes speak eloquently about the funding announcement and some of the challenges in what is not included. In particular, we are waiting to see what funding there will be for social care. We cannot divorce social care funding from the NHS. The two go hand in hand, and this is a critical issue—our Select Committee heard evidence on that only today.

The Minister has heard about this on many occasions—one of my hon. Friends will be raising this later, too—but the sleep-in care crisis is a particular issue for social care. Not only do we have this chronic underfunding in the care sector but we are also seeing a complete lack of Government guidance on payments for historical sleep-in care shifts. Social care providers, many of them in the charitable and voluntary sector, are facing a back bill of £400 million, and one provider has already been forced to close. A recent survey found that two thirds of those charities are now at risk of going out of business, and the Government urgently need to address the situation.

I listened closely to what the Minister had to say at Health and Social Care questions, and I hope she might have a new answer for us today, because this situation cannot continue. We had a meeting in Parliament where we heard at first hand from not only providers but people in receipt of care, some of them personal budget holders who will be personally liable to Her Majesty’s Revenue and Customs when they are expected to pay back this historical claim. I hope that the Government and this Minister will share with this House exactly what they are going to do on that, because time is ticking by and by March of next year these providers are expected to pay, as I understand it, £400 million. That could be a serious further detriment to the care sector.

I wish to finish by talking about something a little different, although echoing some of what we have just heard, on the issue of prevention and how we keep people well, which is important in the context of this debate. As I have said, many things have not been included in the Government’s announcement of the funding that is coming to our NHS. We do not know about transformation funding, capital spend or funding for Health Education England for the education of staff. All these elements are very important, but of particular importance is public health spending, which has been decimated over the past few years, to the extent where, as we have heard just today, smoking cessation services have been cut by more than 30% in the past year alone. That is just one example and it is not commensurate with the reduction in people smoking in our country. We need to think actively and urgently about how we have a wholesale reappraisal of how we keep people well in this country.

I want to ensure we have a national health service in 70 years’ time. It is all very well celebrating the anniversary today, but when it is increasingly contending with lifestyle-related disease, we have to be doing everything possible to keep people well, and that starts from conception. We have to address the whole area of what we do for the under-fives, as that is completely ignored at the moment and its funding has been decimated again. I urge the Government to share with the House what they are going to do to keep people well.

--- Later in debate ---

[Mr Marcus Fysh (Yeovil) (Con)]

It is a pleasure to follow the hon. Member for Crewe and Nantwich (Laura Smith), who made some interesting points about adult social care. I have similar issues in my constituency, where one of the main care providers increasingly sees private clients effectively subsidising local authority provision. The gap between the costs has been getting wider and wider. The concern of many of my constituents is whether they will be able to afford private care if public provision is not forthcoming.

It is also a pleasure to follow the hon. Member for Dulwich and West Norwood (Helen Hayes), who spoke about King’s College Hospital. My father was a registrar in neonatology—he is a paediatrician—at King’s in the 1980s, so it is a hospital that I know well, and I am sympathetic to the challenges of an inner-city area. In my area we have a rural district hospital, which is very high quality and gets very good results, and the people there do an outstanding job. The hospital is in deficit and has been part of the vanguard transformation initiative, which has meant extra costs. Sometimes the benefits of working in new ways do not show in the money saved initially, because we have to wait for wider population health outcomes to be able to judge that.

[Luciana Berger]

The hon. Gentleman raises the important issue of how we transform care to ensure that we do the very best for patients. Does he share my concern—this was raised by the National Audit Office only last Friday—that the vanguard programme has not delivered the depth or scale of transformation in service that was intended? Part of the reason is that there are not enough funds in the rest of the NHS to ensure that the transformation that we want to see can actually occur.

[Mr Fysh]

The hon. Lady makes a good point. It is about trying to understand when the effects will show up. Often what we have to do in the meantime is to run two parallel systems, in order to get one up and running, and that can be challenging. I welcome the extra money for healthcare but, as I said on Wednesday, we really should not allow it to crowd out other types of spending, particularly local government spending, which we have heard about in relation to social care.

In Somerset, the Conservative county council has undertaken nine years of efficiency savings. It has cut a lot of money out of its budget, but we are getting to the point where further cuts will make a significant difference to people’s lives and the provision of services. The Liberal Democrats left the county with nearly £400 million of debt. The repayments are £100,000 a day, which is really disappointing because we would much rather spend that money on services for the public. The county really needs about another £20 million. Ministers should look at whether the virements in the estimates are enough. I would like the amount in paragraph (2)(c) to be increased by £20 million to fund the very serious gap the county will otherwise have to make up through serious cuts to real people’s services.

It is worth highlighting the plight of children’s social care. The county has made great strides to deal with issues and modernise the service—it has spent a lot of money doing so—and that is an ambition we should all espouse. The difference between children’s social care and adult social care is essentially that adult social care gets cross-subsidised by private clients, as I said, and to some extent by its integration with the healthcare system. What does not really happen in children’s social care is the same level of integration or thought about how the education service integrates with it. In Somerset, we have very high transport costs for children who wish to be educated in Somerset but are placed outside it, for example in Bournemouth. That is something that we need to address.

The reality is that overall Somerset needs more funding. It needs fairer funding, because it is still massively underfunded relative to urban and other areas. On how to pay for that, we have heard good points about why we should not automatically look to tax rises. Public spending has come in under estimate, so there is scope at the moment for a bit of extra deficit funding. Given the fiscal and monetary tightening around the rest of the world that is taking some of the heat out of western economies, I think that would not be frowned upon. Local government funding in Somerset would be a very worthy recipient of such flexibility.

Childhood Obesity Strategy: Chapter 2

Luciana Berger Excerpts

Monday 25th June 2018 Commons Chamber

[Steve Brine]

I take my right hon. Friend’s views very seriously, but we want to protect children from the advertising of products that are high in saturated fat, salt and sugar, and we are going to consult on introducing a 9 pm watershed. He mentions online, catch-up and social media, and that is one of the reasons that this is an important area for us to consult on. We want to ensure that we get this right, and it is not about punishing the industry. The people who work in the industry and in advertising are also parents, members of society and taxpayers. They also have a stake in this and in the reason for it all to succeed.

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

I am really glad to hear the Minister talk about tackling the health inequalities of obesity among children, because we know that the gap between the least deprived and the most deprived children has become more pronounced over the past eight years. Will he go into a bit more detail about what he is going to ask local authorities to do to close that gap?

[Steve Brine]

I will work with local authorities on a new pathfinders programme, which the hon. Lady may not have had a chance to look at as it was published only this morning. We want to work with them to model solutions and barriers to action through the pathfinders programme. There are already some good examples, some of which are set out in the plan, including in Blackpool and at Derbyshire County Council, which are doing good things. Many local authorities already have a number of substantial levers and powers. We want to model the best so that others, such as Liverpool, can follow.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 19th June 2018 Commons Chamber

[Jackie Doyle-Price]

I hope the expansion of mental health services will stop people becoming rough sleepers in the first place by bringing forward support earlier in the process. In January, we announced a £1 billion investment in mental health, part of which will be focused on crisis care and helping people who are experiencing crisis to stay out of hospital. The workforce plan backs that commitment by planning 5,200 posts to support those in crisis. We will be working with the Ministry of Housing, Communities and Local Government on a forthcoming strategy to make sure we honour our commitments.

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

It is not just the size of the mental health workforce that is critical, but the pressures faced within those workforces. We have just learned that there was the highest number of out-of-area placements in January since records were first kept. Mental health doctors and nurses often spend hours hunting for out-of-area beds, taking them away from other patients. When is the Government’s pledge to reduce and eventually ban out-of-area placements actually going to start to become a reality?

[Jackie Doyle-Price]

The hon. Lady is right to raise this issue. We are determined to end out-of-area placements, but clearly that will require behavioural change on the part of commissioners, as well as making sure that the investment takes place. I know she will continue to hold me to account on this issue, because it is clear that out-of-area placements can cause harm and we must tackle them.

NHS Long-Term Plan

Luciana Berger Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

I have listened carefully to what my right hon. and learned Friend says. With regard to cancer care for people who have had a cancer diagnosis, I commend the work of Dimbleby Cancer Care—a really fantastic charity. The shadow Health Secretary, the Lib Dem health spokesman—the right hon. Member for North Norfolk (Norman Lamb)—and I attended the start of its annual 50 km walk on Friday night.

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

The Secretary of State closed by saying that he wants to transform health and social care, but every economic expert, from the Institute for Fiscal Studies to the Health Foundation, tells us that with a growing ageing population increasingly living with long-term conditions, this announcement will do nothing more than see the NHS stand still. Will he now admit that it is not enough to repair the damage of the past eight years of cuts to public health, GPs, and social care? How will he ensure that we have a service with new models of care fit for the 21st century?

[Mr Hunt]

It is funny, isn’t it: the hon. Lady says that this is not enough, but she did not say that when her own party was offering almost half the amount at the last election. She also says that every economic expert says that it is not enough. Let me tell her about one economic expert that does not say that—the Institute for Public Policy Research, left-leaning, in a piece of work done by Lord Ara Darzi, a former Labour Health Minister, who says that 3.5% is enough.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 8th May 2018 Commons Chamber

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

Back in 2010, we had 19 mother and baby units across this country, but cuts to those beds resulted in our then having 15 mother and baby units. Back in November 2016, the Government said we were going to see more beds opened. I listened closely to the statement the Minister has just made, but we are still waiting for beds that were announced back in November 2016. What are her Government going to do to ensure that mothers and babies will be kept together and can access the beds they desperately need?

[Jackie Doyle-Price]

I do not accept what the hon. Lady is saying. We are investing in new mother and baby units and making sure we have sufficiently good provision geographically so that mothers and babies can access them. We are also investing in more support in the community. I am pleased that the programme we are delivering, which is £365 million of additional support, will deliver early intervention for young mothers and babies.