NHS Winter Crisis

Luciana Berger Excerpts

Monday 8th January 2018 Commons Chamber

[Mr Dunne]

I visited the Medway hospital when it was still in special measures and saw the pressures with the configuration of the A&E and the challenges that that posed to good patient flow. I am pleased that significant investment has already gone into Medway to try to resolve some of those physical characteristics. I absolutely agree that we should praise the staff of the hospital for the work that they have done in turning it around so well.

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

Three months ago at the Health Committee, Jim Mackey, the head of NHS Improvement, told us that

“we are running tighter than any of us would really want to and we have not had the impact from the social care investment…that we had hoped for; so, it will be difficult—it will be very tight—over winter.”

The Government knew that this crisis was coming, and the social care investment to which the Minister has referred this afternoon has not been enough. Why have this Government not acted?

[Mr Dunne]

The Government have acted. We provided £2.9 million of extra money to the hon. Lady’s area to cope with winter pressures. Chris Hopson, who is the chief executive of NHS Providers, has said that this winter was better prepared for “than ever before”.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right, for the simple reason that prevention is better than cure, and about half of all mental health conditions become established before the age of 14. That is why it was so significant that, following the Budget, we announced the allocation of an extra £300 million through the mental health Green Paper, precisely to improve the service we offer students in schools.

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

The Secretary of State has, on numerous occasions, to both the media and this House, referred to an increase of 4,300 staff working in mental health trusts since 2010. In response to my written parliamentary question, he was unable to clarify whether this 4,300 figure includes the 1,478 people who were rebadged as mental health trust staff following a trust merger in Manchester last year. Nor would he confirm whether this figure includes the 858 people NHS Digital says were already working in the sector, who transferred from primary care trusts to mental health trusts when primary care trusts closed back in 2013. Would the Secretary of State offer the House some festive cheer and take this opportunity to set the record straight?

[Mr Hunt]

I am very happy to offer the hon. Lady festive cheer and to explain to her that, even if her suspicion is right—and I do not believe it is—there has still been a significant increase in the number of staff employed in mental health trusts. The other suspicion she has constantly raised in the media and in this House is that mental health funding is being cut. She will know that the best news of this year is that, last year, funding actually went up by £575 million.

Mental Health Provision: Children and Young People

Luciana Berger Excerpts

Tuesday 12th December 2017 Commons Chamber

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

It may be quite late in the evening, but I wish to raise some serious issues arising from the publication last Monday of the Government’s Green Paper on children and young people’s mental health provision. I am pleased to see the Minister on the Treasury Bench and look forward to hearing her response shortly. It is a shame that the publication of the Green Paper last week was not accompanied by an oral statement when there is so much to discuss, but it is heartening to see so many Members in the House so late this evening.

After talking to people with lived experience of mental ill health, young campaigners, clinicians and parents over the past few months, I know that there was a huge degree of anticipation and expectation attached to the Green Paper. The issues are well known to hon. Members. Demand for mental health services for young people is increasing. The number of children being admitted to A&E in a mental health crisis is at a record high. Self-harm among young people, especially teenage girls under the age of 17, has increased by 68% over the past three years. Face-down restraint was used more than 2,500 times on people under the age of 18 in mental health units in 2014-15, which is the last year for which records are available. Yet face-down restraint is something that should be—and is expected to have been—phased out.

The money allocated to mental health is not reaching the frontline, and when I and many others called for the cash to be ring-fenced in the Budget, that call went unheeded. I had the opportunity to ask the Minister at the Health Committee to ring-fence the money, and her response was that:

“in my experience ring fences ultimately become ceilings.”

I tell her today that young people in my area would certainly take that ceiling.

This financial year, the Young Person’s Advisory Service, the main mental health service for children and teens in Liverpool, has been cut by £757,000—a 43% cut. We have seen a raft of cuts to other key mental health services in my area, including services for young carers and the Liverpool Bereavement Service.

A recent Care Quality Commission report confirmed that young people across the country are waiting up to 18 months to access the treatment they need. Too many are turned away because they do not meet increasingly out-of-reach thresholds. Young people are literally being turned away and told to come back when their condition is more serious.

A local primary teacher emailed me recently and set out the cases of three students under the age of 11 who had been referred by his school to child and adolescent mental health services, including one who had displayed signs of a split personality and one who had harmed the family pet without showing signs of remorse. All three referrals from that primary school were rejected. Over the past two years, 100,000 children have been rejected by services, despite being referred. I ask Members to imagine if we treated cancer the same way.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing such an important issue to the House at this time of the day. Taking into account reports that mental health problems affect about one in 10 children and young people and that 70% of children and young people who experience a mental health problem have not had appropriate interventions at a sufficiently early stage, does she agree that it is time not for words but for action that would see the Health Department and the Department for Education working cohesively to address the issue she has put forward?

[Luciana Berger]

The hon. Gentleman makes a really important point about co-ordination between various Departments to ultimately effect change and support young people across the country, and that is what I and so many others are really looking forward to. However, I am going to set out in the rest of my remarks why I think the opportunity has been missed.

We have seen programmes such as Channel 4’s “Kids in Crisis”, which have brought many of the issues I have set out to a broader audience. That has included the scandal of too many young people having to travel hundreds of miles from their homes to receive treatment and support—and that is if they get in at all.

We know that the younger generation, coming into adulthood, are prone to a range of mental health conditions: depression, anxiety, eating disorders, self-harm, suicidal thoughts, phobias and other challenges. Those destroy confidence, blight education, training and employment opportunities, alienate young people from society, and, in some cases, drive families to tearful despair.

There is a social justice aspect to this too. Children from the poorest fifth of households in our country are four times more likely to have a mental health difficulty than those from the wealthiest fifth. Health inequalities in our country persist as strongly in mental health as in physical health.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

Would the hon. Lady agree that, in my vast and far-flung constituency—the second biggest geographically in the UK—what she says about distance is an extraordinarily pertinent and very worrying issue for my constituents?

[Luciana Berger]

I thank the hon. Gentleman for his intervention. We have heard from many Members on both sides of the House about families having to travel hundreds of miles to access treatment. Just last week, I heard of one young person being sent to Scotland to access in-patient treatment for eating disorders, because there was not a bed available for her in England. In certain parts of the country, it is certainly the case that people have to cross boundaries and to go north and south to access services, in a way that we would not accept if this was for physical health services.

Given this growing and what I can only describe as desperate demand for services for young people, I and many others eagerly awaited the Green Paper. I have read it many times, but it was—and I hate to say this—a disappointment. I believe that Ministers have failed to meet the scale of the challenge. The £300 million outlined for mental health support in schools sounds really impressive—until we read the detail and we realise that Ministers aim to reach just a fifth of schools over the next six years, with eight out of 10 schools remaining without the extra support until 2029. It really is a drop in the ocean. Ministers intend to roll out services over the next decade as though there was no urgency or imperative for action. I hardly need to point out that this means that most eight-year-olds today will see no benefit from these proposals throughout their entire childhood and adolescence.

[Sandy Martin (Ipswich) (Lab)]

I thank my hon. Friend for bringing this important issue to the House. Does she share my concern about the waiting times between referral for treatment and the start of treatment? Does she agree that much self-harm and, indeed, suicide of young people takes place during that waiting period? Does she believe, as I do, that while four weeks would be an improvement on most of the waiting times that our children and young people have had to face up until now, that maximum wait needs to be upped to until actual treatment and not just until the assessment for treatment?

[Luciana Berger]

My hon. Friend pre-empts a question that I was going to ask of the Minister, because it is not clear whether the pilot that the Government are going to introduce is based on a four-week waiting time for assessment or a four-week waiting time for treatment. Those two things are very different. In many parts of the country, young people will sometimes have an immediate assessment but then have to wait weeks, if not months, to actually access the treatment that they need.

[Alex Chalk (Cheltenham) (Con)]

The hon. Lady speaks with passion and authority on this subject. As the Member of Parliament for Cheltenham who has witnessed this explosion in adolescent mental health problems, I share her concerns. Does she agree that as well as looking at cure, we need to look at prevention and to understand why this explosion is taking place? The time has come for a really good, authoritative body of work to get under the bonnet of why these problems are arising as they are.

[Luciana Berger]

I thank the hon. Gentleman from the bottom of my heart for that intervention, because that is the crux of the point that I am seeking to make. I have sought to highlight some of the issues in the Green Paper, and I will highlight a few more, but the greatest problem is what is not in it—namely, what we can do to prevent mental ill health in our young people rather than deal with and treat it when they become mentally unwell. I will come to that in a moment.

The Royal College of Psychiatrists eloquently states what I believe, which is that the Green Paper lacks

“a suitable scale of ambition or speed of action.”

The royal college reminds us that in the Health Education England mental health workforce plan, which sets out the posts for which the NHS aims to recruit from now until 2021, there are no new consultant psychiatrist posts for children and young people’s community services—none at all. Yet we know that there is a massive shortage of child psychiatrists in our country.

[Helen Whately (Faversham and Mid Kent) (Con)]

I commend the hon. Lady for securing this debate because it is really good to be having a conversation about this Green Paper. It is worth mentioning that it is a great moment of progress to have a joint piece of work between healthcare services and the Department for Education on getting into the issue of mental health in young people, which is such a growing problem. Like my hon. Friend the Member for Cheltenham (Alex Chalk), I think that we have to get into understanding the causes better. As the hon. Lady said, we need to take action at greater pace and to a greater scale. Does she welcome the fact that, as the Royal College of Psychiatrists says, there has been a step in the right direction in that that there is an evidence-based approach, which is to be welcomed? Does she agree that a particular challenge that must be addressed is the need to recruit and retain the workforce that we need to deliver this care and support to young people?

[Luciana Berger]

I thank the hon. Lady. I believe that we both share the concern about the challenge of recruitment within the mental health workforce. The Government themselves acknowledge that there is an issue by way of the fact that they have put forward a plan to recruit these extra thousands of mental health workers between now and 2021. In the context of our conversation this evening about young people in particular, it is particularly disheartening and dispiriting that the specific plan that was set out only a few months ago contains nothing to expand the number of child psychiatrists—something that we desperately need. In the north-west, we really struggle to fill vacancies for those posts.

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

My hon. Friend is making a great speech about the real crisis in child mental health. Does she agree that the Green Paper places more and more focus on teachers, as opposed to health professionals, providing mental health support? Teachers are already really stressed by the volume of work that they have to do and they are not trained as medical professionals, so should that emphasis change?

[Luciana Berger]

I thank my hon. Friend for that important contribution. Another question that I hope the Minister will answer is how we can properly equip and train teachers to contend with the responsibility that they will be given if the plan set out in the Green Paper goes ahead. At the same time, the Department for Education is piling extra pressure on students with more testing. There are fewer teaching staff, which adds to the pressure on the remaining staff, and class sizes are larger. Cuts have been made to mentors, pastoral care and counselling. There has been a 13% reduction in the number of educational psychologists in our schools. The Royal College of Nursing points out that the number of school nurses has dropped by 16%, while the number of school-age pupils has gone up by 450,000. Young people face bullying, online threats, dysmorphic body image and advertising in a way that no previous generation has done.

Like many hon. Members, I am upset, appalled and outraged every week by the heartbreaking cases that constituents and their families raise with me in person or via email. Many Members in this House will recall the case in August of 17-year-old Girl X. She was restrained more than 100 times in a place that was not fit for her care, and she was left without a secure bed. The UK’s most senior family court judge, Sir James Munby, raised her case and warned us that we would have “blood on our hands” if this suicidal and vulnerable young woman did not get the treatment that she needed. But why was his continued intervention needed?

The case of Jack was brought to me this weekend. Jack is eight years old, and he has autistic spectrum disorder. He is in a severe state of anxiety and distress, and he has spent the last eight weeks on a ward in Alder Hey Children’s Hospital. He has had no specialist support from CAMHS and no specialist in-patient bed. He is getting more ill, and his family are, in the words of his mum Kerry, “in complete crisis.”

Just this afternoon, I heard about the case of Martha, who is 15 and has a history of self-harm. She has been admitted to A&E twice after taking an overdose. From a referral in June, Martha is still waiting to see a mental health professional. In the cases that I have described and thousands like them, every day counts, but young people are waiting weeks and months for treatment while their conditions worsen and their families are left distraught.

I do not believe that the Green Paper does anything for young people such as Jack, Martha or Girl X, or for thousands of other young people, whose lives should be filled with optimism and wonder as they look to a future laden with promise. I am concerned that instead, they are going to face years of torment, anguish and pain, made worse by the fact that so much of it is preventable. The majority of adults with diagnosable mental health conditions will have developed them under the age of 18. The life chances of thousands are being blighted. We are leaving a generation in pain; they are being let down because the care is not there.

Ultimately—I agree with the point made by the hon. Member for Cheltenham (Alex Chalk) —what is missing is the proper focus on prevention. How can we prevent mental ill health and keep our children well? We know that the first 1,001 days of a child’s life determine their life chances and life outcome, and that is why the previous Labour Government invested millions in Sure Start and children’s centres. We need to remove the factors that create mental ill health in the first place: neglect, childhood trauma, domestic abuse, bullying, insecure housing and poverty. Unfortunately, the Green Paper does not address those issues. Indeed, the words Sure Start, deprivation, homelessness and inequality do not appear in the Green Paper even once.

We do not need to be economists to understand that it is far more expensive to run a service that is based on crisis than a service that is based on prevention, not just in human terms, but in terms of taxpayers’ cash. What a wasted opportunity. I sincerely hope that the consultation on the Green Paper will be meaningful, that Ministers will listen to the voices of young people and experts across the country who are crying out for change, and that we will see some action.

In conclusion, will the Minister tell the House—I have asked this question, but let me reiterate it—whether the pilot, which I know is only a pilot, will introduce a four-week waiting target for assessment or for treatment? The Green Paper guarantees funding only for the period of the spending review, so what guarantees can the Minister offer us for maintaining funding after the initial three years are up? What will happen then? How will the lucky fifth of schools be selected for the first wave of support? How will her Government address the aim of real parity of esteem between mental and physical health? Reading the Green Paper, it seems to enshrine imparity by supporting only 20% of children over the next six years. Finally, is she convinced that this really is the best her Government can do for the greatest asset that we possess—our young people, who are our nation’s future?

--- Later in debate ---

[Jackie Doyle-Price]

I thank the hon. Gentleman for his intervention. I am pleased to acknowledge that I have a very good dialogue with the Scottish Health Minister. It is fair to say that all four nations can learn from each other when it comes to delivering better health outcomes and sharing best practice.

We know that young people are sometimes still taken to police cells when they are in a mental health crisis. The hon. Member for Liverpool, Wavertree outlined the very distressing case of the young woman who had been restrained many times. The Under-Secretary of State for the Home Department, my hon. Friend the Member for Louth and Horncastle (Victoria Atkins), and I yesterday announced new police provisions that will finally put an end to this practice. We will ensure that children will always be taken to places of safety. The issue of prone restraint for children really needs to be examined.

The Green Paper will build on these foundations to build a new approach to supporting the mental health of our children and young people. With over £300 million of funding available, we will train a senior designated mental health lead in every school and college to improve prevention work—many schools have already made that commitment—and create brand new mental health support teams working directly with schools and colleges, and we anticipate that they might be working within multi-academy trusts or through local education authorities, and some might be provided through the NHS. Through the pilots we will discover what works, and it will not necessarily be a one-size-fits-all approach.

[Luciana Berger]

I am conscious of the time and that the Minister will soon conclude her remarks, but I have two points that I would like her to respond to. Does she accept that what she is laying out is essentially replacing much of what has been lost in schools: the number of educational psychologists, peer mentors and counsellors lost from our schools because they do not have the funds to pay for them? I hope in her final remarks she can address prevention, which is a very serious point. What are she and the Government going to do to prevent mental ill health in our young people?

[Jackie Doyle-Price]

I do not accept the premise of the hon. Lady’s first point. We are trying to build a critical mass that schools will have access to. On prevention, the investment we are making in mental health first aid and training in schools will enable staff in schools to see when people are going through mental ill health issues. The earlier we can put that support in place the better. We are working with the Department for Digital, Culture, Media and Sport on what we can do through social media. We know that online bullying is causing a lot of mental health issues. As I say, this is a Green Paper. We are making money available. We want to see what works and we want to take this forward in a consultative manner. We will respond fully to any points made as a result of that consultation.

Autism Community: Mental Health and Suicide

Luciana Berger Excerpts

Thursday 30th November 2017 Commons Chamber

[Dr Cameron]

I wholeheartedly agree. As I said, the police are on the frontline. They face the crux of the matter when it comes to matters of life or death. They are doing their very best with the training and resources that they have, but there requires to be a clearer pathway so that people who are at that crisis stage can access health services—and probably crisis health services—and so that the police have somewhere to ensure that the clinical needs of those people are met. It is unfair for our police to have to take care of people’s clinical needs when that is not what their training provides for.

In 2016, an academic study in Sweden, which was published in the British Journal of Psychiatry, found that people with autistic spectrum disorder were nine times more likely to die by suicide than the rest of the population. The latest research indicates that people with autistic spectrum disorder account for a harrowing proportion of suicides in the UK. There is a 16-year gap in life expectancy between people with autistic spectrum disorder and the general population. To put it all very bluntly, people with autistic spectrum disorder are 28 times more likely to consider suicide than the average population —28 times. The statistics make one thing abundantly clear: what we are doing now to support people with autistic spectrum disorder is not working and is not enough. Research shows that almost seven in 10 people with autistic spectrum disorder experience mental health issues, including anxiety and depression. Services must be in place to ensure that people are cared for holistically. We have to meet all their clinical needs, which may mean their autism or their learning difficulties, but they will almost certainly have mental health issues. Quite frankly, we do not have services in place today that take account of the complexity of such needs.

What types of things are going wrong for people at the frontline? It is difficult for people with autistic spectrum disorder to access mental health support through the usual routes. For most of us, that might mean going to our GP as a first point of contact for primary care for mental health problems, but a GP practice is a daunting, unfamiliar place for people with autistic spectrum disorder. One young man wrote to me and described a recent trip, saying that it was

“quite hard for me to access the GP anyway. The whole environment is difficult. It’s noisy, there’s often children, it’s very hot. There’s also a loud beep when they call the next person that I find really quite painful. When you’re feeling emotionally poorly that becomes almost impossible.”

GP surgeries make reasonable adjustments for wheelchair users every day—simple changes that make the life of the patient easier—so the same policies should be implemented for people with autistic spectrum disorder. We need training to raise GP awareness. Access needs to be easier. We need to ensure that GPs know who on their register has a diagnosis of autistic spectrum disorder.

If an autistic person bypasses the GP and goes straight to mental health services, they may face unprecedented waiting times or they may simply be refused treatment. When individuals do attend services, they may find that they are discharged without any follow-up. At the Health Committee last week, we heard how a young autistic boy was turned away by child and adolescent mental health services four times, despite feeling suicidal, because he had not yet attempted to take his own life. Things have hit crisis point, and we need to ensure that we engage in prevention. Someone attempting to take their own life should not be the point at which they receive treatment. We need early intervention to pinpoint the symptoms of difficulty and where we should be aiming the treatment.

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

I thank the hon. Lady for securing this very important debate. We both sit on the Health Committee, and during the inquiry into suicide prevention we heard that the point at which someone is most likely to take their own life is, tragically, when they are discharged from in-patient care. The Committee’s recommendation was that everyone should be contacted within at least three days, and we are waiting for the Government to respond that. Does she agree that everything should be done to ensure that the most vulnerable, including people with autistic spectrum disorder, should be supported in that period when they are extremely vulnerable to ensure that they do not take their own life?

[Dr Cameron]

I agree. That is an extremely valid point. If people arrive at A&E for crisis intervention and are admitted for a period of time, it is important that they are discharged with some follow-up. People often return to the same circumstances that led to the difficulties in the first place, and if they do not have some support to deal with those difficult circumstances, they may be in a vulnerable situation and may try to self-harm or take their own life once again.

If a person with autistic spectrum disorder feels unable to go to the GP or to reach out to services in their local community, they might try to ring a suicide helpline. However, that can be extremely difficult in itself for a person with autistic spectrum disorder who finds communication and social interaction difficult. They might be able to verbalise only some of their difficulties, and they may then find there is no follow up from that service, either. Early access points and early intervention are crucial to preventing suicide and preventing mental health problems being exacerbated. Much more has to be done at that critical early intervention stage to ensure access to services.

If a person with autistic spectrum disorder reaches a health professional, they often find that their mental health problems are overlooked or misdiagnosed, which might be because they present an extremely complex case. They might also have concomitant learning difficulties, and they might not present the symptomatology that would usually be expected for anxiety or depression per se because their symptoms are complicated by their autistic spectrum disorder. It is extremely important that mental health practitioners have training in autistic spectrum disorder, in the types of presentation that they might need to identify and, particularly, in risk issues.

Diagnosis is still a postcode lottery. I hope to continue working with the Minister on that issue, because we need an understanding of who is appropriately trained in diagnosis of autistic spectrum disorder and what level of specialty we have in different professions. What is the workforce plan to ensure that this very great need is addressed across our society? This is so important. People with autistic spectrum disorder say they do not know where to go locally. As a member of the Select Committee on Health, I have asked services about that, and they say, “We don’t really have a map of who can diagnose and who can provide specialist intervention in a given area of NHS England.” Streamlined services would make it so much easier for people to gain that initial access.

I do not want to take up the whole debate, so I will provide a brief overview before letting others speak. Many Members want to contribute to this important debate, but I wish to touch on a few other important issues.

I request that the Minister look at what mental health therapies work specifically for people with autistic spectrum disorder who have concomitant mental health difficulties. There is no adequate research base yet, but we know it is critical—it is lifesaving—so we need to prioritise funding. Traditional mental health therapies might not work in the same way for people with autistic spectrum disorder. If one of us presented at a GP surgery, we might be offered cognitive behavioural therapy, but we do not know whether that is the best option for a person with autistic spectrum disorder, or whether some kind of adapted therapy would be more appropriate. That important work should be undertaken, and undertaken quickly, to engage people in appropriate therapies and save lives.

I have been contacted by a couple of individuals whose poignant accounts have struck me. One is an individual from my constituency who says that she has continually tried to access CAMHS for her daughter, who has been repeatedly self-harming. It has placed the family in such a stressful situation over a lengthy period that the family, including the mother and carers, now feel that their own mental health is under stress.

It is extremely important that we ensure not just that individuals can access the system but that we preserve family life, that we support carers and families, and that we do not place an additional burden on the NHS and other services. Families and parents may go on to develop their own depression and anxiety when dealing with an intractable situation because they do not know how to cope. If we do not address the problem at its root, we will multiply the problem for services across the UK.

--- Later in debate ---

[Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)]

It is a pleasure and honour to speak in this debate, secured by the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), because it is such an important issue. It is critical to make sure that those on the autistic spectrum are absolutely wrapped up in our mental health and medical services so that we no longer need even to raise this issue in the House. To that effect, the Government have put mental health on the political agenda as no Government have before. We have invested more in mental health than any previous Government, hired tens of thousands of staff and, most importantly, enshrined the parity of esteem of mental and physical health into law. The Prime Minister took a big step forward last month by opening a review of the Mental Health Act 1983, because too many people are still suffering discrimination.

[Luciana Berger]

I do not seek to be partisan in these sorts of debates, but it is important to note for the record that the amendment to introduce parity of esteem for mental health into the Health and Social Care Act 2012 was tabled by Labour peers in the House of Lords, and unfortunately Tory peers voted against it. I would not like the Government to seek to claim credit for the fact that parity of esteem is now enshrined in law.

[Mrs Trevelyan]

I thank the hon. Lady for her comments.

Despite the cross-party efforts of all those for whom this is a passionate policy area—for 18 years I have cared for my son, who is now a young adult with autism—there are some people who are having a miserable time in the mental health system and are not yet benefiting from improved access to core therapies and services: men and women throughout the country on the autistic spectrum. We must do better.

Across the board, a quarter of us will experience mental ill health during our lives, but within the autism community that rises to eight in 10—of those diagnosed as autistic, eight in 10 suffer from mental ill health. To those of us familiar with autism, that is sadly not a surprise. Society is designed for us neuro-typicals, as my son likes to call me—I am not sure it is meant as a compliment—so almost everything designed for us can cause stress or worry for those who are wired differently. A different perspective on the world has huge potential benefits for our society and economy, and we fail all those on the autistic spectrum to the detriment of not only the individual but society more widely.

We are failing these individuals. When I did some research for this debate—as I always do, if I can, for anything relating to this subject—I was appalled to discover the scale of suicide across the autism community. Autistica, the UK’s autism research charity, revealed international findings that autistic people without a learning disability are nine times more likely to die by suicide than the rest of the population. The charity’s research is now beginning to uncover almost identical rates in the UK as it starts to build the research database. As a parent, that is just awful to hear; but as an MP, it is a rallying cry. The exact causes are still being researched. We live in a complex environment and people are complex anyway. If we stick them in an environment that is often alien, it is not surprising that it is sometimes too hard to cope.

There are three clear ways in which our mental health services are letting our autistic citizens down now, and we have a duty to address them. First, we know that autistic people’s mental health problems are often misdiagnosed or missed completely. Despite mental health problems being the norm, there are no systematic mental health checks for autistic people. These problems can often present very differently, partly because so many become practised at masking their feelings to fit in. If someone is severely autistic, it is perhaps almost easier to identify them as sufferers, but those who are managing to live in a mainstream environment have learned some extraordinarily clever, adaptable ways to cope with our neuro-typical world and to their own very severe mental ill health. What is truly traumatic for one autistic person might not be for another, so when they do seek help, as the hon. Member for East Kilbride, Strathaven and Lesmahagow highlighted, autistic people can often find that their worries are dismissed out of hand. They are missed or misunderstood.

The NHS Five Year Forward View for mental health recommends the development of autistic-specific care pathways for mental ill health. That work, as I understand it, is supposed to begin in 2018, but we have heard nothing about it since February. Perhaps the Minister will be kind enough to update us on the project: is it still taking place; who is leading it; what is its scope; and how will autistic people be involved in helping to design it to make sure that we are not missing some very obvious things? Those things might not necessarily be obvious to those of us who are neuro-typical, but we must think in the different way that our wonderful autistic community so often does. This is a crucial opportunity to begin transforming care for autistic people, but we must get it right.

Secondly, we know that autistic people can struggle to find the support that works for them. It is assumed that what works for us neuro-typicals will also work for them. Autistic people may benefit from cognitive behavioural therapy but, as the hon. Lady who is an expert in providing such support says, being made to group work with strangers can be entirely counter-productive. We need to think about how we can adjust that support. The idea that someone who has issues with understanding, with being able to read faces, with processing information would in any way feel supported when they are in a state of deep stress shows a complete gap in understanding. The stresses and the symptomatic problems of people with autism make it more difficult for them to cope.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 14th November 2017 Commons Chamber

[Mr Hunt]

My hon. Friend is right to challenge me on that, because we are asking all clinical commissioning groups to increase their funding for mental health in real terms year in, year out. Some 85% of CCGs are doing that, and an extra half a billion pounds reached the frontline of mental health last year. Regrettably, Croydon is not part of that 85%, so I will take his question away and find out exactly what is happening.

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

How does the Secretary of State expect to achieve the plans to increase the mental health workforce when only last week the head of NHS England, Simon Stevens, said:

“On the current funding outlook, it is going to be increasingly hard to expand mental health services”?

[Mr Hunt]

It has been challenging to expand mental health services over the past seven years due to the financial pressure on the NHS, but we have succeeded. We have 4,300 more people working in mental health trusts and £1.4 billion more is being spent on mental health than three years ago. We have a plan—it is a good one—and we are going to ensure that it happens.

Mental Health Units (Use of Force) Bill

Luciana Berger Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[Helen Whately (Faversham and Mid Kent) (Con)]

I congratulate the hon. Member for Croydon North (Mr Reed) on introducing the Bill. I welcome the opportunity to speak on this important subject and I am pleased that the Government are supporting the Bill.

The more we speak about mental health—privately, publicly and especially here in Parliament—the more we wear away the stigma that surrounds it. As chair of the all-party group on mental health, I often speak to service users, professionals and campaigners from organisations such as Rethink Mental Illness, Mind and the Royal College of Psychiatrists. They tell me there has never been a better time to be a mental health campaigner. We have the five year forward view for mental health, a truly comprehensive and widely supported strategy to improve mental health care; a Prime Minister who is committed to fighting the injustice of inadequate treatment; and a Government who are spending record amounts on improving mental health care.

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

The hon. Lady has highlighted the commitment made by the Government, but does she share my concern that commitments of money that have been made are not actually reaching the frontline and there is a wealth of evidence showing that many CCGs are diverting funds intended for mental health to other parts of our NHS?

[Helen Whately]

I have enormous respect for the hon. Lady; she is doing a huge amount of work campaigning on mental health. I have looked into the question she raises about finances getting to the frontline, and 85% of CCGs are spending at the level they should be on mental health, so the majority are meeting their obligation of increasing their mental health spend. I agree that a minority are not, and they are rightly being looked at and questions are being asked about what is going on there and why they are diverting money away from mental health, but the majority are doing so. The rate of spending on mental health is going up faster than the rate of extra money going to the CCGs—so the rate of spending on mental health is increasing faster than the increase in other parts of health. That is the right thing to do, as we must improve the status of mental health in our healthcare system and achieve parity of esteem, an ambition that I know the hon. Lady shares.

All of us have been moved by the awful story of Seni Lewis, who died after being restrained face down. As we have heard, that was not an isolated case. Those awful cases are happening despite the fact that there are strong guidelines even now on the use of restraint. The Mental Health Act code of practice states that restrictive practices should be used only when there is a possibility of real harm to the patient or other people. There is also National Institute for Health and Care Excellence guidance that states that staff should be trained to avoid or minimise restrictive practices on children and young people. Despite that, instances of restraint have been going up: 17% of girls and 13% of boys admitted to child and adolescent mental health services were restrained in 2014-15. The hon. Member for Croydon North is nodding as I say that. So the use of restraint is going up and is being used when there are better alternatives.

Restraint should be a last resort. It does enormous physical and psychological damage at times to the individual being restrained, and, as others have said, there are similar implications for those applying the restraint. So the Bill is badly needed and I welcome it, in order to put in place the right systems to train staff, create proper oversight of when restraint is used, and make the system more transparent and accountable.

[Luciana Berger]

Does the hon. Lady share my concern about not only the number of times people are being restrained, but the number of times particular individuals can be restrained? In the summer, we heard the example of girl X: Sir James Munby, the most senior family court judge in our country, wrote to the Government to raise the example of this girl, who was restrained 117 times because there was not an adequate place fit for her care. Does the hon. Lady agree that that is totally inadequate—in fact, horrifying?

[Helen Whately]

That is a shocking example, and I agree that both the general issue of the use of restraint and cases when particular individuals are having to be restrained multiple times need to be looked at.

I should provide some balance and say that I recognise that there are times when restraint is necessary. That has been made clear by the people providing mental health care whom I have talked to, but it is vital that the staff who restrain are properly trained, and the provisions of clause 5 of the Bill address that. By being properly trained, they will also be able to help protect patients from trauma and injury as a result of restraint, and it will also protect staff from possible litigation when things go wrong, which would of course be bad for staff who are trying to do a good job in providing mental health care. As others have said, this is a very tough and challenging, as well as a very rewarding, sector to work in, and I, too, thank that workforce.

I have also been told that at present anyone, no matter what their background and experience is, can offer their services as a restraint trainer. It seems strange that a certain standard is not required of the trainers who train people in restraint methods. Some kind of accreditation is surely required to ensure that the training is of an appropriate standard. I find it astounding that that is not the case, and that definitely needs to be looked into.

We need to get restraint right and ensure that the use of restraint techniques follows medical evidence. I want to put on record that, while the Mental Health Act code of practice says that there should be no planned or intentional use of restraint due to the risk of restricted breathing, the Royal College of Psychiatrists has warned me that the current medical evidence does not support the use of one type of restraint over another. This is clearly an incredibly difficult area to talk about, but we need to ensure that when restraint is used, the least harmful and least dangerous methods are employed.

It is certainly true to say that the level of restraint overall is too high across the system. The level of variation that exists between mental health units indicates that there are times when restraint is not always necessary. The Care Quality Commission has published a report, “The state of care in mental health services 2014 to 2017” in which it picks up on that particular point. The report states that the CQC is

“concerned about the great variation across the country in how often staff physically restrain patients whose behaviour they find challenging. This wide variation is present even between wards that admit the same patient group.”

The fact that similar patients are being admitted but receiving different treatment in different parts of the country indicates that something is going wrong. Those who are carrying out more restraint should surely work out how they can emulate those who manage to carry out less. The CQC also noted that

“those wards where the level of restraint is low or where they have reduced it over time have staff trained in the specialised skills required to anticipate and de-escalate behaviours or situations that might lead to aggression or self-harm.”

That points to the fact that training is part of the key to reducing that worrying variation.

The Bill will introduce extra monitoring. There is often a resistance to extra monitoring because of concerns about box-ticking and form-filling, but the professionals are actually supporting it in this case. The Royal College of Psychiatrists is backing the Bill, and it recognises the need for the right regulations and for proper oversight to reduce the use of restraint in mental health units. In fact, it has gone further and signed a memorandum of understanding with the College of Policing and the Royal College of Nursing on the use of restraint in mental health and learning disability settings. So the agenda is already moving on, and the Bill is helping to focus minds on what can be done straightaway, before it even becomes law, to improve the use of restraint.

I reiterate that we need to look at the use of restraint in special schools. There was a case involving some autistic children in my constituency who were restrained in a really shocking way. No one has ever got to the bottom of what happened in that situation. I will work with my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan), who has suggested that we should work together to take action on these problems as well.

As those of us who are active in campaigning on mental health will know, a major reform of the Mental Health Act 1983 is coming our way. That is very welcome and much needed. The reform will, for example, tackle the rise in sectioning and bring mental health legislation up to date. It might also have looked into the question of restraint, but it is a large piece of work. It is therefore absolutely right that, in the meantime, this Bill will take action quickly to improve the use of restraint in these difficult circumstances. Once again, I congratulate the hon. Member for Croydon North on bringing in the Bill, and I look forward to supporting it.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 10th October 2017 Commons Chamber

[Jackie Doyle-Price]

I am sure that we are all very sorry to hear of the death of my right hon. Friend’s constituent, and we send our condolences to her family. It is extremely difficult to balance patients’ right to confidentiality with the needs and requests of their families, and we will study any recommendations that emerge from the coroner’s investigation.

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

I heard what the Secretary of State said about funding earlier, and what the Minister said a moment before. However, I sent freedom of information requests to every CCG in the country, and found for the second successive year that more than half of them are not increasing the proportion of their budgets that they spend on mental health. That flies in the face of a commitment made by the Secretary of State at the Dispatch Box, and it flies in the face of the spirit of the Five Year Forward View for Mental Health. On World Mental Health Day, will the Minister, along with the Secretary of State, commit herself to ensuring that we ring-fence the money that they say is available for mental health?

[Jackie Doyle-Price]

On World Mental Health Day, I can confirm that we are spending £574 million more on mental health this year. It remains our principle that decisions should be made locally by CCGs, but we have very clear expectations of them, and they will be held to account via inspections.

Social Care (Liverpool)

Luciana Berger Excerpts

Tuesday 7th March 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. I apologise for being a moment late in coming over from the Select Committee on Health. I congratulate my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman) on securing this important and timely debate on behalf of all our constituents.

[Mr Philip Hollobone (in the Chair)]

Order. If the hon. Lady would like to sit, she is most welcome to do so.

[Luciana Berger]

That is kind, but I am fine. Thank you so much.

This is a pertinent and serious issue that affects thousands of people across the area that my hon. Friends and I are privileged to represent. I also endorse the comments made by my hon. Friend the Member for Garston and Halewood (Maria Eagle). I will seek not to reiterate but to add to the comments that have already been made. I will raise some of the additional pressures that Liverpool has faced in the nearly seven years since the cuts were first introduced in 2010 and add some personal reflections from constituents who are experiencing those cuts at first hand. We are ultimately here on behalf of our constituents, and we should share their experiences with the House so that we understand the tragic human element and implications of the cuts. I will also reflect on my own experience of being in an accident and emergency department in Liverpool on a Friday night just a couple of weeks ago and seeing the number of ambulances waiting there. At least 10 paramedics were waiting to book people in, many of whom were older people. We know from the figures that delayed discharge is a significant challenge, and I believe that issues in accident and emergency departments are compounded by cuts to social care.

As we heard from my hon. Friends the Members for Liverpool, Riverside and for Garston and Halewood, 5,000 fewer people in Liverpool are receiving support via care packages than in 2010. I have connected with two constituents about that issue in the past week alone. One, a lady called Sobia, is paralysed. She used to receive overnight care, but despite her condition becoming worse and even though her children are now of an age when they are going to university and are not as available to care for her as they were previously, she has seen that care stopped because of the cuts to social care in Liverpool.

In the past few weeks I have intervened on behalf of one of my constituents called Veronica, who had additional support to help her with various things. She is still waiting for some of that care to be reinstated. I have every sympathy with Liverpool City Council for the difficult decisions it is having to make in the current circumstances; the council is under significant pressures, as we have heard. Those pressures do not look set to get any easier. In particular, in the Liverpool city area we have demographic pressures—as many places do across the country—with the growing, ageing population. We know that the 65-plus age group is set to grow by 50% in the next 20 years. That is a significant challenge for any area to contend with, particularly given the cuts that have been incurred so far.

Liverpool City Council faces financial pressures as a result of the introduction of the national living wage. It is to cost £13.9 million in 2017-18, rising to £24.7 million by 2019-20, which is not an insignificant sum for the council to contend with. The Law Commission is also reviewing a specific piece of legislation, and I hope that changes will come forward soon to help Liverpool City Council cope with the 400% increase in deprivation of liberty safeguards applications, which cost £1 million a year. We know that that needs some attention, and I hope that changes to the legislation will have some impact, because that is £1 million of the significantly larger sum that the council has to contend with.

The demand pressures we see locally are also significant. We know that every week Liverpool City Council is arranging care packages for up to 100 people leaving hospital, which is a 51% increase compared with last year. There are also a lot more complex home care cases, which cost a significant sum and may require two carers calling four times a day. We know that adult social care assessment requests have risen by 15% since 2010, up from 18,000 a year to 21,000, and are expected to rise to nearly 23,000 by next year. There were also 5,715 requests for support from new clients, which was a 10% increase on the previous year.

We as constituency MPs, on behalf of our constituents, are contending with the challenges today. I have shared just a few of the additional challenges—financial pressures, demand pressures and demographic pressures—that mean that Liverpool City Council faces even more challenges as the years progress. It is on that basis that I endorse the comments made by my hon. Friends. We need the Government to give serious attention to this matter.

Social care cannot be dealt with separately from our wider health service. The two go hand in hand. It is no surprise that more people are turning up to our accident and emergency departments or our GP surgeries when 5,000 fewer people get care packages today than did in 2010, given that we know need has increased. The Chancellor will give the Budget tomorrow, and I look forward to hearing in the Minister’s response what representations he and his Department have made to ensure that social care is given the attention and resource that it desperately needs and deserves on behalf of the thousands of constituents who do not receive care but deserve it and the thousands more elderly people who will need it in the future.

I have not reflected specifically on constituents who might need mental health support but are not getting what they need and deserve today and going into tomorrow. This situation cannot be allowed to continue. We see and experience in our surgeries and weekly visits constituents who have to contend with the daily realities of not getting the support they need and deserve. We anticipated something in the autumn statement but there was nothing. On behalf of all our constituents, I sincerely hope that the Minister will give us some glimmer of hope that tomorrow there will be something that positively impacts on all of our constituents’ lives.

--- Later in debate ---

[David Mowat]

I thought that I had said that I agree with the hon. Lady that it would be wrong to punish those that are doing better. She mentioned that Knowsley is one of the stronger councils in that regard; St Helens is even stronger. It would be completely wrong if that were the basis of the allocation. Frankly, that is not my understanding.

I want to talk a little about what the Government plan to do on social care. Part of that involves recognising the pressures that exist. One thing that we get into quickly in social care discussions is a debate about adult social care and frail people—people on the borderline between being ill and being old. If they are ill, they are in hospital under the NHS, and if they are not, they are old, and care is either means-tested or provided by the council. That is a difficult area.

One third of the pressure on councils such as Liverpool arises not from older people but from people with severe learning difficulties, autism and disabilities more generally. Over the past decade, thankfully, the health inequality from which that cohort suffers has decreased considerably, and the life expectancy of people in those categories has increased. The cost to local authorities is clearly severe. In addition, the Government are determined to press ahead with a programme called Transforming Care, which came out of the Winterbourne View case. Too many people with severe learning difficulties were in institutions and long-term hospitals, with all that goes with that. We are moving them into communities with the help of local authorities. There is a plan to move some 3,000 people out of institutions—places hopefully much better than Winterbourne View—and into care. All of that creates pressures of the sort that we have been hearing about in this debate, but that does not mean that it is not the right thing to do.

[Luciana Berger]

Does the Minister acknowledge that those 3,000-plus people should have been moved a lot sooner? According to various reviews, we should not be in the present situation, with too many people still in that type of accommodation who should not be there.

[David Mowat]

That is a fair challenge. We have a plan, and we are implementing it in that process. Winterbourne View was about seven years ago now. I have met a number of parents of the children affected and there has been a lot of pressure from them to go as far and as fast as we can. I make the point that every one of those facilities is a project of its own in terms of finding other accommodation and putting in place care—sometimes round-the-clock care. To answer the hon. Lady’s question directly, I would like us to go faster, but I think that we are doing as well as could be expected given the starting point. However, it is a fair challenge.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

I join my hon. Friend in doing that. It is really important, contrary to what the former shadow Health Secretary, the hon. Member for Lewisham East (Heidi Alexander), says, that we praise NHS staff when they do remarkable things. There is a lot of pressure everywhere in the NHS, and praising NHS staff is not being self-congratulatory; it is recognising when a good job is being done.

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

Further to the very important question of my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle), Members on both sides of the House may have seen “Panorama” last night. Frankly, it was shocking and disgusting. I am ashamed to live in a country where in the past year there have been over 1,000 more unexpected deaths under the care of our mental health trusts. That is not a reflection of a country that cares equally about mental health and physical health. In spite of what the Secretary of State just told us, the money is not getting to where it is intended. What is he actually going to do to ensure that no person in our country—not a single person—loses their life because they have a mental health condition for which they are not being treated properly?

[Mr Hunt]

I agree with the hon. Lady that there is a huge amount that we need to do to improve mental health provision in this country, but a huge amount has been done and is being done. As she knows, we are now seeing 1,400 more people every day with mental health conditions. We are committing huge amounts of extra money to mental health provision, and we are becoming a global leader in mental health provision, certainly according to the person in charge of the Royal College of Psychiatrists. We have to support the efforts happening in the NHS, because we are one of the best in the world.

NHS and Social Care Funding

Luciana Berger Excerpts

Wednesday 11th January 2017 Commons Chamber

[Jonathan Ashworth]

I entirely respect the hon. Lady’s work as a nurse before she came into this place—[Hon. Members: “She still is.”] I beg her pardon. She is still a nurse, and I genuinely respect her, but if we are not raising these matters on behalf of our constituents, we are failing in our responsibility as Members of Parliament. We must never forget that this is not just about the staff in our NHS; it is about patients and their safety, which must always be our absolute priority.

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

I am grateful to my hon. Friend for kindly giving way and for his important remarks. I echo his point that this is about patients across the country. My constituent’s mother, Angela, has been waiting for an acute mental health bed for more than a week. She was taken in an ambulance to A&E, but she could not be treated locally in Liverpool because the department was full. She was treated for the physical effects of her mental health condition in an ambulance and sent home. Her family are devastated and are concerned about her condition. Her story is one of countless stories across the country, and we need to recollect and focus on those stories today.

[Jonathan Ashworth]

My hon. Friend speaks passionately, as she always does, on behalf of her constituents and, more broadly, on mental health provision. Again, I hope the Secretary of State will respond to her on the specifics of that case.

My hon. Friend talks about patient care, and she is absolutely right. All of us, or at least many of us, in this House will have been getting stories from constituents telling us of their recent experiences in hospitals. I have been given a few, and I will share some heart-breaking examples with the House. Again, I will not reveal the names of trusts and hospitals, but I will pass them on to the Secretary of State after the debate.

Example No. 1 is of a mum of four children under 10 years old who has a secondary tumour in her liver. She was due to go into hospital this Thursday to have the tumour removed. Her surgery has been delayed for at least two weeks, so that the hospital could cope with the winter crisis and because no beds are available. She has not yet been given a new date.

Someone else got in touch with me this morning. Their wife has been on the waiting list for a knee replacement since April last year. An appointment for early December was cancelled owing to the hospital being on black alert. A few weeks later, the hospital phoned with an appointment for today, which was cancelled yesterday.

Again, these patients are not trying to score political points or to politicise matters. They are decent, hard-working people who are simply desperate for something to be done.

--- Later in debate ---

[Mr Hunt]

That is absolutely right. To back up my hon. Friend’s point, yesterday’s OECD report said that in Australia, Belgium, Canada, France, Italy and Portugal, at least 20% of A&E visits are inappropriate. NHS England’s figure is up to 30%, which is why we need the public’s help to relieve pressure and that is what I meant when I talked about an honest discussion.

[Luciana Berger]

The Secretary of State told us just a moment ago that there are now over 300,000 more people over the age of 80. Surely he would have known that information from census and Office for National Statistics data when his Government took over seven years ago, so why is it that we are now seeing on the front pages of our newspapers that one in four of our A&E wards is unsafe and that we have so many challenges across the country, including in my constituency?

[Mr Hunt]

We did know that information and that is why we thought it was totally irresponsible to want to cut the NHS budget in 2010, and not to back the NHS’s own plan in 2015. As a result, we have 11,000 more doctors. In the hon. Lady’s local hospital, 243 more people are being treated within four hours every single day.

--- Later in debate ---

[Mr Dunne]

We have heard a number of comments from Opposition Members—I am pleased to say that they were outnumbered in this Opposition day debate by Government Members—rehearsing some tired phrases to mislead the public over alleged increasing independent provision in the health service and also misrepresenting what my right hon. Friend the Secretary of State was saying in his remarks about A&E targets. Having said that, I wish to pay tribute to the hon. Member for Chesterfield (Toby Perkins), who is in his place, and the hon. Member for Workington (Sue Hayman), both of whom showed considerable personal courage in explaining the circumstances surrounding the death of each of their fathers, and they did so in an entirely honourable and sensible way, and I am grateful to them for sharing that experience.

I congratulate my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) on managing to get her son into hospital to have his appendix treated on Boxing day. As she said, that showed that that service was working well.

The Opposition sought to take the moral high ground in this debate. The hon. Member for Dewsbury (Paula Sherriff) challenged Government Members on whether they had visited hospitals over the Christmas period other than on an official visit. Her position was completely punctured by my hon. Friend the Member for Lewes (Maria Caulfield) who pointed out that she was doing a night shift between Christmas and new year in her role as a nurse—she was not on an official visit.

There have been some impressive contributions. I thank the Chair of the Select Committee on Health, my hon. Friend the Member for Totnes (Dr Wollaston), who was supportive of a more nuanced target for A&E, and for her calm and generally constructive comments, and my right hon. Friend the Member for Chelmsford (Sir Simon Burns) for his support for the success regime in Essex and for pointing out that it is not closing any of the three A&E departments in the hospitals there. I also thank my hon. Friend the Member for Crawley (Henry Smith), who made a very thoughtful speech and welcomed the opening of an assessment unit in Crawley to help to relieve pressure on the A&Es nearby. Finally, I thank my right hon. Friend the Member for Forest of Dean (Mr Harper) for another thoughtful contribution from the Back Benches.

Of course, the Conservative party and the Government recognise that our NHS faces the immediate pressures of the colder weather and the wider pressures of an ageing and growing population. There were nearly 9 million more visits last year to our A&Es compared with 2002-03—the year before the four-hour commitment was made. That is more than 2 million A&E attendances every month, and our emergency departments are now seeing, within the four-hour target, 2,500 more people every single day compared with 2010.

[Luciana Berger]

Will the Minister give way?

[Mr Dunne]

I will not give way. The hon. Lady did not give way and I have a very short time left in which to speak.

Compared to when the Conservative party came into office in May 2010, in 2015-16 there were 2.4 million more A&E attendances. That is in the context of a much busier NHS overall. The NHS is delivering 5.9 million more diagnostic tests. Some 822,000 more people are seen by a specialist for suspected cancer and 49,000 more patients start treatment for cancer every year compared with the year before we came to office. It is therefore the case that a Government of any colour would be faced with the same problems, but it is this Government who have committed to funding the NHS’s own plan for a sustainable future. Had we followed Labour’s plans, the NHS would have £1.3 billion a year less, which is equivalent to 13,000 fewer doctors or 30,000 fewer nurses.

We remain committed to the vital four-hour A&E promise for those patients who need to be there. We are proud to be the only country in the world to commit to all patients that we will sort out any urgent health need within four hours. Only three other countries—New Zealand, Australia and Canada—have similar national standards, but none of theirs is as stringent as ours.

Today it is the Conservative party that is the party of the NHS. That is why we pledged more than Labour did and why we are delivering more funding with a higher proportion of total Government spending going into health in each year since 2010. Funding for the NHS will rise in real terms by £10 billion by 2020-21 compared with 2014-15. That sum is front-loaded with £6 billion being delivered by the end of this year, as the NHS asked for. It was this Government who established an independent NHS with an independent chief executive. It was this NHS that came up with its own plan and we were the only party to back it. We agree that the NHS and social care face huge pressure and, yes, there is more for us as a Government to do. However, we entered winter with a more comprehensive plan than ever before, and we have confidence that plans are in place to cope with the current pressures we face—winter, A&E and delayed discharges—and to sustain the system for the future.

I conclude by saying a huge thank you to the 1.3 million staff in the NHS and the 1.4 million people who provide social care. They are the ones who continue to make this possible. We are aware of the pressures they are under, especially during winter. We have increased the number of doctors and nurses, as the Secretary of State said earlier, especially in A&E, and we have launched plans to recruit more doctors and nurses. Without them, we would not have a national health service that provides such a high level of care.