Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 15th November 2016 Commons Chamber

[Nicola Blackwood]

I know that the British Lung Foundation has called for a taskforce on lung health. Given that a million people have been diagnosed with COPD and a further million remain undiagnosed, the Government and the NHS are keen to work with the NHS and the voluntary sector to find practical and innovative ways of improving outcomes for patients with respiratory disease, and I will consider my hon. Friend’s proposal as part of that process.

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

The number of nurses working in mental health has fallen by 15% since 2010, from 45,384 to 38,774. Why is that, and does the Secretary of State believe that it will achieve real parity of esteem for mental health in our country?

[Mr Jeremy Hunt]

What I can tell the hon. Lady—who, I know, rightly campaigns hard on mental health—is that we are treating 1,400 more people in our mental health services every day than we did in 2010, and we will be treating a million more people every year when we have implemented the taskforce report. We are investing more, and we are making good progress.

Community Pharmacies

Baroness Berger Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Jonathan Ashworth]

The hon. Gentleman talks of efficiencies; he will presumably have seen the research that says if people cannot get to a pharmacy one in four will go to a GP. We will see greater demand on GP surgeries and A&E departments. That is not efficient. It is a false economy, which is why the Pharmaceutical Services Negotiating Committee has said the proposals are

“founded on ignorance of the value of pharmacies to local communities, to the NHS, and to social care, and will do great damage to all three. We cannot accept them.”

It is why the chief executive of Pharmacy Voice described the decision as

“incoherent, self-defeating and wholly unacceptable”,

and it is why charities such as Age UK have said the plans are

“out of step with messages encouraging people to make more use of their community pharmacists, to relieve pressure on overstretched A&E departments and GP surgeries.”

Age UK has hit the nail on the head: these cuts to community pharmacies completely contradict everything we have been told by Ministers over recent years and will lead to increased pressures and increased demands on GP surgeries and A&E departments.

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

My hon. Friend has made some crucial points about how the funding has been allocated across our country. There are 129 community pharmacies across the whole of Liverpool, yet just two of them will be eligible for this payment. Does my hon. Friend agree that that is absolutely outrageous and will impact on the entire population of Liverpool?

[Jonathan Ashworth]

My hon. Friend is right, and even after this scheme is in place pharmacists who are eligible for the mitigating funds are still saying that they will have to close despite them.

We believe in the importance of community pharmacies, because

“pharmacies have a big role to play in this, as one in 11 or 12 A and E appointments could be dealt with at a pharmacy”—[Official Report, 25 February 2014; Vol. 576, c. 162.]—

and:

“Pharmacies have an important role to play, because they could save a significant number of A and E and GP visits.”—[Official Report, 23 October 2014; Vol. 586, c. 1049.]

Those are not my words: they are the words of the Health Secretary, said from that Dispatch Box over the last two years.

If the message the Health Secretary has been giving at that Dispatch Box is that community pharmacies are a way of relieving pressure on A&Es and GP surgeries, why is he now coming to the House to support cutting community pharmacies? It is a complete false economy. I will give way if he wants to explain that. He does not, probably because he knows it is a completely false economy.

--- Later in debate ---

[David Mowat]

When one takes into account the £112 million that we are spending on getting more pharmacists into GP practices, the right hon. Gentleman’s point is incorrect.

[Luciana Berger]

Will the Minister give way?

[David Mowat]

I will give way to the hon. Lady in a moment.

Finally, I want to talk about the work that we are doing to ensure that everyone in the country has access to a community pharmacy. We have developed a scheme with two components. First, all pharmacies that are more than 1 mile from another pharmacy will be eligible for additional funding, which will almost entirely mitigate the impact of the changes. That component is specifically designed to protect areas where current provision is quite spread out. In total, it will apply to around 1,400 locations—roughly half urban and half rural. Pharmacies that are in the highest 25% by prescription volume, and therefore most profitable, will not be eligible for the scheme. Secondly, there is a near-miss scheme under which pharmacies that are located up to 0.8 miles from each other and in the 20% most deprived areas in the country can apply to be reviewed by NHS England as a special case. The final safeguard is that NHS England has a continuing duty to ensure the adequate provision of services. Its role is to commission a new pharmacy in any area where it believes access is inadequate. That duty will continue.

[Luciana Berger]

I thank the Minister for very kindly giving way. Will he correct the record on something? Pharmacies are not all private enterprises. Many co-operatives across our country provide community pharmacies, often in rural and isolated areas. For the purposes of this debate, will he clarify his understanding of the distinction between a community pharmacy and a GP pharmacy? That has not been clear in his remarks so far.

[David Mowat]

The distinction is that a community pharmacy is part of a privately owned business that dispenses and is paid in that way. The ones that we are hiring into GP practices will leverage GP time and do medicine reviews, and I expect them to enable the pharmacy network in an area to work more cohesively. It is a welcome and, frankly, overdue step forward.

--- Later in debate ---

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

I rise to speak in support of the Opposition motion. I put on record my thanks for the extremely hard work that has been done on this campaign by a number of my hon. Friends, particularly my hon. Friend the Member for Barnsley East (Michael Dugher).

Community pharmacies play a really crucial role in my constituency and, indeed, right across the country. We know from the many statistics, and the surveys and inquiries that have been done, that they are trusted. When I speak and listen to my constituents, it is clear that they trust the community pharmacies that they engage with, and also develop very close relationships with the people who work in them. I see that for myself when I go to collect my prescriptions locally. They are enormously busy places. I note that the hon. Member for Hertsmere (Oliver Dowden) said that they just deliver drugs, but they do so much more than that within our communities.

[Oliver Dowden]

That was not my point; I was saying that many large-scale dispensaries, particularly in supermarkets, do little more than deliver drugs, but we need to focus on the community pharmacies that provide the wider services.

[Luciana Berger]

The hon. Gentleman has just spoken in support of the Opposition motion.

When we had an urgent question on this subject, I listened closely to the Minister, who talked particularly about how far he expected people to travel and said that lots of community pharmacies were not very busy. Over recent weeks, I have made a point of looking through the windows of my local community pharmacies to see whether any of them are in fact empty, and it is fair to say that none of them are at any point. The statistics show how busy our local community pharmacies actually are. The figures speak for themselves. The average community pharmacy sees, on average, 137 people every single day. They dispense 87,000 prescription items over the course of a year. They support, on average, 250 people with diabetes, 389 people with asthma, 463 unpaid carers, 805 older people, 1,317 with a mental health condition, and 1,416 people discharged from hospital. The last figure is particularly important. I will not presuppose what the Health Committee report that comes out tomorrow might say about pressures on our winter A&E services, but it is fair to say that many people are expecting, following a summer crisis in the A&Es in our hospitals, that our local hospital services will be under enormous amounts of pressure. Our community pharmacies already do a really important job in supporting our constituents who have been discharged from hospital.

I have had the opportunity to listen to members of my local pharmaceutical committee. When I asked them what the local stats and figures were so that I was equipped for this debate, I was very struck by what they said. Hon. Members have already mentioned to the Minister—it is regrettable that he is no longer in his place—the pharmacy assessment scheme and how it has been put together. It is enormously regrettable, to put it politely, that it does not take account of deprivation. That means that the pharmacies in the most deprived areas of our country, where patients have greater health needs, are not entitled to claim the payment. I made this point earlier, and I make it again: in Liverpool, we have some of the highest levels of deprivation; Kensington ward is in the top 20 in the country. No pharmacies in my constituency are eligible for the pharmacy assessment scheme payment, and just two across the whole of Liverpool are eligible—one in Croxteth and one in Netherley. That means that all the other 129 community pharmacies across Liverpool, and six distance-selling pharmacies, face the full funding cut. That puts at risk the very vital service that they offer to my constituents and people across Liverpool.

The funding cut in this financial year has already had an impact on our local pharmacies. Some have already curtailed their free, but unfunded, delivery service to patients. My hon. Friend the Member for Barnsley East highlighted the hours in which those services are often provided. They are a lifeline for house-bound and vulnerable patients across our country.

Other pharmacies are already in the process of making staff redundant, so they will have to survive on fewer staff. Pharmacists in some of our community pharmacies will, therefore, inevitably be tied more to the dispensing bench rather than undertaking the enhanced clinical role that NHS England, the Department of Health and Ministers expect them to deliver under the five year forward view.

The point about deprivation is so important. As my hon. Friend the Member for Leicester South (Jonathan Ashworth) said in his important opening remarks, it is outrageous that the pharmacy assessment scheme will further widen health inequalities in our country. We will have a specific debate about that issue next Tuesday, so I ask the Minister to reflect on it. In 2016, we have a responsibility to close the gap, not promote schemes that will widen it. I note in particular that the scheme makes no provision for patients and communities with protected characteristics under the Equality Act 2010.

I know that many other hon. Members wish to speak, so I will make a very brief point in the 13 seconds that I have left. Some Members, including the Minister, keep calling community pharmacies “private enterprises,” but there are many co-operatives that provide these services, often in rural and isolated areas across the country.

[Several hon. Members rose—]

--- Later in debate ---

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure to follow the hon. Member for Burnley (Julie Cooper). I was interested to learn of her personal experience in the sector. She gave a well-informed speech that was in stark contrast to that of her boss, the hon. Member for Leicester South (Jonathan Ashworth). She was generous to contributions from Opposition Members, but it is only fair to say that Members on both sides of the House expressed considerable support for the work done by community pharmacies up and down the country. There is unanimity in the House on the importance of not only pharmacies’ current work, but their increasing role in supporting the NHS and providing services in future.

I am grateful for the contributions made today by 24 hon. Members, in addition to the Front-Bench speakers. I wish to start my remarks by referring to the impact that these proposals will actually have on the typical pharmacy, because I am sorry to say that there has been considerable confusion, mostly among Opposition Members, about what the proposals deliver. The average pharmacy will see a reduction in taxpayer subsidy of £16,000 a year. The largest element of that is a reduction in the establishment payment, which is a fixed payment of between £23,000 and £25,000 that most pharmacies receive just for being there. It will be reduced by 20% from 1 December, which equates to a reduction of just over £400 per month, or £100 a week. From April, it will decrease by a further £400 per month, to £200 a week. Those are not huge reductions for private businesses. This element is a 40% reduction in the only fixed taxpayer subsidy that I am aware of that is paid to private businesses up and down retail high streets in England.

Meanwhile, pharmacies will still receive £1.13 for every prescription item they dispense, with the average pharmacy dispensing 87,000 items a year, as was said by the hon. Member for Liverpool, Wavertree (Luciana Berger), who is, sadly, not in her place.

[Luciana Berger]

I am here.

[Mr Dunne]

Oh, she is—I apologise. We are also introducing a new quality payment scheme worth up to £6,400 a year, so that the amount of NHS funding community pharmacies will be receiving will remain very significant.

In addition to payments from the NHS, pharmacies can earn extra income from a range of sources other than dispensing fees. About half the clinical commissioning groups in England already commission minor ailment services from pharmacies. These services include: flu vaccinations, which are topical today; stop-smoking schemes, which were topical last month, in Stoptober; and emergency hormonal contraception. All of those provide an additional source of income for community pharmacies. I believe the right hon. Member for North Norfolk (Norman Lamb) referred to healthy living pharmacies, and they will now qualify for this new quality payment, whereas they have not in the past—I hope he will welcome that. The Local Government Association’s briefing ahead of this debate echoed that fact, saying that

“there are significant opportunities for councils to commission public health services from community pharmacies as a key element of their health improvement strategies.”

In addition to those two alternative sources from NHS and non-NHS public bodies, in many cases pharmacies get a whole section of private sector income from non-publicly funded elements. That has not been referred to at all, but it is a significant element in the profitability of many pharmacies.

The Government’s vision in these reforms is to bring pharmacy into the heart of the NHS. The Opposition spokesman, the hon. Member for Leicester South, gave what appears, from his early outings at the Dispatch Box, to be becoming a trademark speech in his new role, seeking to scare the public about the proposals without demonstrating a genuine understanding of how community pharmacies are funded or owned, or of what is proposed by the measures. Since 2005-06, there has been an 18% increase in the number of pharmacies, so that today some 1,800 more operate in England than did so 10 years ago. Next year, pharmacies in England will receive £2.6 billion in funding from the NHS. NHS England supports the developments that we are proposing. The suggestion is that we will decimate NHS services because we will push a large number of people out of community pharmacies to their GP, but that is not the belief of NHS England. This is not about pharmacy closures—the point made by almost every Opposition Member who spoke—but about securing better value from the funding that we provide, modernising the way in which we do it so that pharmacies are not the only sector in the country that receives direct taxpayer subsidy for opening premises on the high street, and encouraging them, through increasing payments in the future, to provide more services to help patients in every community.

Community pharmacies are already much more than the place to which we go to get our medicines. They are an essential front-line service, providing care direct to patients and increasingly advising on a wide range of public health issues, for which, as I have indicated, they are paid separately from their dispensing fees. In doing so, they can relieve, and are relieving, pressures on other parts of the NHS.

Our package of reforms are about advancing that agenda, by rewarding quality for the first time, and moving to an enhanced role for the community pharmacy network in providing value-added services, as well as dispensing prescriptions. Yes, it does include making efficiencies in the way that these pharmacies are funded—I am talking about a reduction of £200 a week from next April—but those savings can be made within community pharmacies without compromising the quality of services or the public’s access to them. A key element of our proposals is that we will protect those pharmacies on which communities depend the most through the pharmacy access scheme, which has been supported by many hon. Members. A review of eligibility will assess the impact on those pharmacies in 20% of the most deprived areas, close to the one-mile test. That review opened yesterday and lasts for six weeks.

The hon. Member for Sedgefield (Phil Wilson) referred to the pharmacy access scheme. He admitted that, by his calculation, 40% of the pharmacies in his constituency will benefit from the scheme. I can update him on that. Nine out of the 20 pharmacies—or 45%—in his constituency will benefit. Indeed, his constituency will be one of the biggest beneficiaries of this scheme.

In summary, the reforms are what the NHS needs and what patients and taxpayers expect. I am confident that we will see a community pharmacy sector that is more efficient and better integrated with the rest of the healthcare system and delivering better services for patients as a result. I urge colleagues to support the amendment to this motion.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

NHS Funding

Baroness Berger Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

If the Chancellor had taken the Labour party’s advice, the NHS would have had £5.5 billion less to spend every single year. I just ask Members who are worried about their A&E departments, worried about mental health and worried about GP provision on which of those services the axe would have had to fall if we had followed Labour’s spending plans?

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

Since the 2010 general election, we have lost over 1,500 mental health beds, there are 5,000 fewer mental health nurses and over 400 fewer doctors working in mental health. The pledge that the Secretary of State made at that Dispatch Box on 9 December—that every clinical commissioning group would increase its spend on mental health—lies in tatters. When will this Government’s rhetoric on equality for mental health be matched with adequate resources?

[Mr Hunt]

I will tell the hon. Lady when that rhetoric became reality. We now have the highest dementia diagnosis rates in the world, according to some estimates. We are treating three quarters of a million more people with talking therapies every year than we were in 2010. Every single day, we are treating 1,400 more mental health patients. By the end of this Parliament, because of our spending plans, we will be spending £1 billion more on mental health every single year, treating 1 million more people. I think that that is pretty good.

Community Pharmacies

Baroness Berger Excerpts

Monday 17th October 2016 Commons Chamber

[David Mowat]

Yes, I will confirm that. I am not in a position to announce today precisely how the access scheme will work, but I agree with my hon. Friend that a central part of it will be to make sure that everybody has a baseline distance to travel to get to a pharmacy and that everybody in the country will be able to access pharmacies within a reasonable time.

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

NHS England’s five-year forward view stresses how important prevention is. Community pharmacies, which are anchored in the communities they serve, are vital in keeping people out of their GP surgeries and out of accident and emergency. The Minister talks about distance. What will the distance be? If I reflect on my own constituency, where the millionth signature of the petition was signed, my constituents really value each and every one of our community pharmacies. How many will he be cutting and how far does he expect people to travel to access one?

[David Mowat]

The hon. Lady mentions the five year forward view. If she reads the “General Practice Forward View”, she will see that central to it is the recruitment of 2,000 pharmacists into GP practices across the country by 2020. That is how we will embrace the pharmacy profession and link it much more closely to GPs. I am not in a position, because we have not yet announced it, to discuss in detail today the final form of the access scheme and how it will work. Let us be very clear, however, that we do not expect people to have appreciably more of a journey to any pharmacy. We are talking about tens of metres, if any. The fact is that we will protect the pharmacies that need to be protected, so that everybody in the country has access within a reasonable time.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Dunne]

I am grateful to my hon. Friend for raising baby loss awareness week. I am sure that, along with other hon. Members, she will be participating in the Backbench Business debate on that later this week. In February the independent maternity review, Better Births, made a number of recommendations, including on neonatal critical care. We are studying those recommendations and are due to report initial findings from our work in December.

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

I listened very closely to the Secretary of State’s comments earlier on mental health. On 9 December he stood at that Dispatch Box and said that

“CCGs are committed to increasing the proportion of their funding that goes into mental health.”—[Official Report, 9 December 2015; Vol. 603, c. 1012.]

However, my research shows that 57% of clinical commissioning groups are reducing the proportion they spend on mental health—yet another broken promise. When will we have real equality from this Government for mental health?

[Mr Jeremy Hunt]

I will tell the hon. Lady what this Government have done. We have legislated for parity of esteem for mental health. We are treating 1,400 more people every single day for mental health conditions compared with six years ago. We have a new plan that will see 1 million more people treated every year by 2020, including a transformation of child and adolescent mental health services. That is possible because we are putting into the NHS extra money that her party refused to commit to.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 5th July 2016 Commons Chamber

[Mr Jeremy Hunt]

I am a little stumped, because I was never really sure whether we would see that money. All I can say is that I am committed to successful negotiations with the EU, and I am delighted that a number of people who championed the Brexit vote have said that any extra funding should go to the NHS.

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

As we celebrate the 68th birthday of the NHS—one of the Labour party’s proudest achievements—let us not forget the fact that there are thousands of people across our country with mental health conditions who continue to face stigma, discrimination and prejudice. Recent reports tell us that young people are waiting up to a decade to receive the appropriate treatment, and future plans for children and young people’s mental health are not up to scratch. Will the Minister please tell us how many more NHS birthdays will have to pass before real equality for mental health is secured?

[Alistair Burt]

How I miss the hon. Lady sitting on the Opposition Front Bench with her questions on mental health. I pay tribute to the exceptional work that she has done in this particular area. The £1.25 billion extra that is going into children and young persons’ mental health over the course of this Parliament—I along with other Members in the House have absolutely fought to make sure that it stays in the plans—will help. We have done more work than ever before in relation to combating stigma, but she is right to raise that, as it is essential that we do. It is also essential that the money that is provided centrally goes through clinical commissioning groups into mental health spending, and I am quite sure that she and I will make sure that happens.

Southern Health NHS Foundation Trust

Baroness Berger Excerpts

Wednesday 8th June 2016 Westminster Hall

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

It is a great pleasure to serve under your chairmanship this afternoon, Mr Hanson. I congratulate the hon. Member for Fareham (Suella Fernandes) on securing this important debate, and on her heartfelt contribution. She made some excellent points, which I am sure the Minister will be keen to address. It is impossible not to be moved by the catalogue of tragedy that has unfolded at Southern Health foundation trust. This afternoon we have heard the distressing and tragic cases of the most vulnerable people in the country—people with learning disabilities or mental health conditions.

The trust has an enormous responsibility. In my role as shadow Cabinet Minister for mental health I see many trusts across the country, and I am struck by the trust’s size, and the fact that it is responsible for more than 40,000 patients. That is significant in the context of this afternoon’s debate.

We have remembered the lives that have been cut short. We have heard about Connor Sparrowhawk, “Laughing Boy”, who was tragically left to drown in a bath—the same bath in which another patient died in 2006; Angela Smith, who took her own life; David Hinks, who we heard about from the hon. Member for Havant (Mr Mak); and David West, who died in the care of Southern Health. Like too many families, David’s father Richard was repeatedly dismissed when he persistently raised his concerns, and he was treated very badly after the death of his son.

I believe that we are here today only because of the resilience shown by these families, their friends and campaigners. I make special mention of Sara Ryan, Connor Sparrowhawk’s mum, who sadly cannot be with us today but who I am sure will be looking closely at Hansard after this debate. Despite the horrendous way they have been treated after the death of their loved ones, and the barriers—not least financial—that they have faced in their quest for justice, they have never given up in their campaign to reveal the truth.

Only this morning I was at a trade union conference, where I heard from Margaret Aspinall, chair of the Hillsborough Family Support Group. She talked of the struggle that she and the other families of the 96 went through to access justice. I am reminded of the parallels, because she has very publicly challenged why publicly funded organisations can spend significant sums of money on legal fees for inquests, but the families are, in Margaret’s words, left to “beg and borrow”. I have previously asked the Government how much the NHS is spending on legal representations at inquests, to try to shed light on this particularly significant matter. The Minister was not able to give me a reply, but in the context of this debate I urge him to try again. It is particularly relevant and pertinent that we should know how much is being spent while families throughout the country, and particularly in the cases we are speaking about this afternoon, are having to spend enormous sums of money just to access justice on behalf of their loved ones who have passed away.

It should not be left to families alone to have to fight for the answers. Too many people have been denied decent care and systematically let down by the very organisation that was charged with their wellbeing. We have heard about hundreds of unexpected deaths that occurred at Southern Health between April 2011 and March 2015, most of which were not considered to require an investigation. We know that, over the past five years, 10 patients who had been detained for the safety of themselves or others jumped off the roof of a hospital run by the trust. Access to a roof was still permitted to people at risk of suicide.

We have also heard about the reports on Southern Health that have demanded changes and improvements to patient safety—improvements and changes that, by and large, the trust has failed to implement over far too many years. I believe it is a story of chronic management failure. Most astonishingly of all, it is a story of a chief executive who remains in post despite this litany of failures on her watch over a number of years. I cannot imagine a chief executive in any comparable organisation who would still be in post with such a record. I take a different view from the hon. Member for Fareham and the Minister: I do not say this lightly, but I do not believe that Katrina Percy should still be in post. Does the Minister have confidence in the chief executive of Southern Health foundation trust?

Like other Members, I welcome the appointment of Mr Tim Smart as the new chair of the trust, following the previous chair’s resignation. We know that he has recently launched a new appraisal of the capabilities of those involved in the governance of Southern Health, and that is not before time. I understand that he has met some of the victims’ families, and I hope that marks the start of an ongoing and meaningful dialogue, not a one-off encounter. Mr Smart has an incredibly difficult job to do to rebuild faith in the trust and to ensure that governance arrangements are robust and sustainable. Most importantly, he must move swiftly, after months of sclerosis, to ensure that patients are not at risk and that no more preventable deaths can ever be allowed to occur.

When the Secretary of State responded to the urgent question on Southern Health from the Labour shadow Secretary of State last December, he rightly said that, more than anything, people want to know that the NHS learns from such tragedies. But the most recent CQC report shows that Southern Health has not learned from these tragedies. The Secretary of State also said:

“Nor should we pretend that this is a result of the wrong culture at just one NHS trust. There is an urgent need to improve the investigation of, and learning from, the estimated 200 avoidable deaths we have every week across the system.” —[Official Report, 10 December 2015; Vol. 603, c. 1141.]

We know that the case of Southern Health is not unique. In my role as shadow Cabinet Minister for mental health, I receive many pieces of correspondence from people right across the country. I was contacted only recently by Richard Evans, father of Hannah, who took her own life while in the care of the NHS.

Hannah had a very long-standing history of complex mental illness. The conclusion of the inquest was that Hannah had died by hanging. The jury’s narrative verdict listed nine serious failings that contributed to her death, describing her treatment as “limited... inadequate...and insufficient.” The coroner further submitted a regulation 28 report in which he included the full jury narrative, stating that it

“revealed a serious breakdown of care in relation to Hannah”,

an individual with

“exceptionally complex needs who represented a very high risk of suicide.”

One of the most serious failings was that Hannah was able to get hold of an electrical cable, which she later used to take her own life.

Hannah’s tragic case shows that failures of care are not the preserve only of Southern Health; they take place in other parts of the NHS and in other parts of the country. We have also heard of at least three deaths this year of young people in the care of Priory Group hospitals. I am in regular communication with Inquest, a charity that works with those bereaved by a death in custody or detention, which sends me details of case after tragic case from across the country.

The Minister must address these questions in his response. I asked him this in an urgent question last month, and I ask again: does he have full confidence in the governance arrangements at Southern Health? If so, what evidence does he have to support his view? If not, what is he going to do to change, reinforce and strengthen governance arrangements at Southern Health? Is he content with the pace of change at the trust and the degree to which the trust’s board has implemented the recommendations made to it over recent months? What steps has he taken to ensure that similar situations cannot arise in other NHS trusts? What steps will he take to ensure that when a family loses a loved one, they are not left to fight and pay for justice on their own?

On that last point, I hope the Minister can go into some detail, because if any good can come from this sorry and tragic tale, it is that new systems are put in place to ensure that no other families are put through the sorrow and grief that the families of the victims of Southern Health have been put through, and that when deaths occur, they receive full independent investigations. Appallingly, such investigations have happened only on a few occasions.

We all understand that the NHS is a vast, complex institution. It deals with 1 million patients every 36 hours and employs more than 1 million people. Of course human error and tragic mistakes cannot always be prevented, but the lesson of Southern Health is that sometimes things go beyond human error. They can escalate to catastrophic levels of systemic failure, preventable deaths and cover-ups; they can descend into a culture of denial and secrecy; and they can end up at the opposite end of the spectrum of decency and compassion that characterises so much of our national health service and the caring professionals who work for it. That is why we call for a full public inquiry into preventable deaths in the NHS, so that light can be shone, families can grieve, and justice can be done. The victims and their families deserve nothing less.

It should not be left to individual families to have to fight and fund their own efforts to achieve justice. The British public, as the owners and funders of our national health service, need to be reassured that every part of it is working to its highest standards, with the best quality of care, particularly for some of the most vulnerable people in our country.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 10th May 2016 Commons Chamber

[Mr Hunt]

Of course I am happy meet my hon. Friend and his constituents. A close friend of mine who wanted to take a place in this House ended up dying tragically early because he had type 1 diabetes and was not able to get the care that he needed, so I am very aware of those issues. What we are doing in England, which is different from Wales, is publishing transparent indicators of the quality of diabetes care CCG by CCG. Those data will be published before the summer recess and will enable us to look at the disparities in care. I am sure there is more we can do.

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

Research published yesterday by NHS Providers and the Healthcare Financial Management Association showed that half of mental health trusts had not had an increase in their budget in 2015-16 and just a quarter of providers are confident that they will receive a funding increase for this financial year, 2016-17. Will the Secretary of State finally admit that the supposed additional investment in mental health that he talks about so often has not materialised for the patients and services that need it most? What is he going to do about it?

[The Minister for Community and Social Care (Alistair Burt)]

I thank the hon. Lady for her question and for her support for me in the recent London marathon. With reference to her question, it is precisely for the reasons she gives that it is so important for us to make sure that CCGs do transfer the extra money that is available for mental health into mental health services. That is why there will be more transparency and a scorecard for CCGs. She is absolutely correct—it is essential that that money flows through and we are determined to ensure that. Yesterday’s report only shows how right our current actions are to make sure that that happens.

Southern Health NHS Foundation Trust

Baroness Berger Excerpts

Tuesday 3rd May 2016 Commons Chamber

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

Urgent Question: To ask the Secretary of State to make a statement on the safety of care and services provided by Southern Health NHS Foundation Trust.

[The Minister for Community and Social Care (Alistair Burt)]

I thank the hon. Member for Liverpool, Wavertree (Luciana Berger) for her question. At the outset of my response, I want to express my deep concern and apologies to the patients and family members who will again have felt let down by the contents of last week’s report from the Care Quality Commission. Our first duty to patients and their loved ones is to keep them safe. This applies to all of us with a role to play in the NHS, from the frontline to this House, and the Government are therefore clear that it is imperative to be open and transparent about what has gone wrong in order to minimise the risk of similar failings occurring throughout the NHS as a whole. We must ensure that the trust itself continues to be scrutinised and supported to make rapid improvements in care. If that means intervention from the regulators, they will not hesitate to take the necessary action, and we will not hesitate to back them.

Last week’s CQC report followed a focused inspection announced and requested by my right hon. Friend the Secretary of State in December 2015. The report from the CQC set out a number of concerns, including: a lack of robust governance arrangements to investigate incidents; a lack of effective arrangements to identify, record or respond to concerns about patient safety; and a need for immediate action to address safety issues in the trust environment. The report also found that the senior management and board agendas were not driven by the need to address these issues. None of those matters is acceptable.

NHS Improvement has taken action in recent months to address the issues at the trust. It has been working closely with the CQC and the trust, and on 24 March, NHS Improvement appointed an improvement director to the trust. On 14 April, following a CQC warning notice on 6 April, NHS Improvement placed an additional condition on the trust’s licence, asking it to make urgent patient safety improvements to address the issues found by the CQC. That condition gave NHS Improvement the power to make management changes at the trust if it did not make progress on fixing the concerns raised.

On 29 April, following the resignation of the trust chair Mike Petter, NHS Improvement announced its intention to appoint Tim Smart as the chair of the trust. As chair, Mr Smart will have responsibility for looking at the adequacy of the trust’s leadership. Given the centrality of issues of governance to the CQC’s report, I welcome the action taken by NHS Improvement. The direct appointment of a new chair by a regulator is a relatively rare step, and it reflects the seriousness of the issues at the trust. NHS Improvement will continue to monitor the situation closely in the coming weeks and months.

I understand that the CQC is considering the trust’s response to its warning notice, and the risks it highlighted, before deciding whether to take any further enforcement action, and none of its options is closed. The notice required significant improvements to be made by 27 April. Dr Paul Lelliott, the deputy chief inspector at the CQC, was directly responsible for the report, and I spoke to him this afternoon. He informs me that the delivery plan required by 27 April has been received and is in the process of being evaluated. NHS Improvement is working closely with the CQC and the trust, and the improvement director appointed by NHS Improvement is on site regularly, so there is constant independent oversight of the progress being made, as well as the formal monthly progress meetings between NHS Improvement and the trust.

In addition to the action we are taking on Southern Health, it is vital that we learn the wider lessons for the NHS as a whole. First, I hope the whole House can agree that it is right that we have robust, expert-led inspection from an independent CQC that provides an objective view about issues of safety and leadership, and that this is backed with action from NHS Improvement where that is required. Secondly, it is vital that we take the issue of avoidable mortality as seriously for people with learning disabilities and mental health problems as we do for other members of our society. To that end, the learning disability mortality review programme has been put in place by NHS England to ensure that the causes of this inequality are understood, and with the aim of eliminating them. In addition, the CQC will be leading a review of how all deaths are investigated, including those of people with learning disabilities or mental health needs. There can be no question but that the CQC report makes for disturbing reading, and that it demands action at local and national levels. We owe our most vulnerable people care that is safe and secure, and I am determined that we will do all we can to ensure patient safety.

[Luciana Berger]

I thank the Minister for very brief advance sight of his response. Patients and parents have a right to be angry at the failure of Southern Health NHS Foundation Trust, and we in this House have a duty to be angry on their behalf. To read the litany of failure, missed warnings, reports and recommendations ignored, and secrecy over the last four years would make any reasonable person angry, too. Friday’s CQC report shows that very little has been done since the House last discussed the matter in December.

The scandal at Southern Health has happened on this Government’s watch, and Ministers must take responsibility for what has happened to some of the most vulnerable people in our country. We should be angry that Connor Sparrowhawk was left to drown in a bath. We should be angry that Angela Smith took her own life. We should be angry that David West died in the care of this NHS trust—his father was repeatedly ignored when he raised his concerns. All of them were denied the care that they so desperately needed. Last week, the BBC reported that over the past five years, 12 patients who had been detained for their safety or that of others have jumped off the roof of a hospital run by this trust. Access to a roof was still permitted to people at risk of suicide. If all those tragic incidents were the only signs of systemic failure, we should be angry, but there is a much bigger story of neglect and malpractice, which aggregates into a major scandal.

When the Secretary of State responded to the urgent question on Southern Health in December, he rightly said:

“More than anything”

people will

“want to know that the NHS learns from”

such

“tragedies”.—[Official Report, 10 December 2015; Vol. 603, c. 1141.]

The CQC report published on Friday shows that that clearly has not happened. So I ask the Minister: first, what guarantees can the Minister give to the 45,000 patients currently in the care of Southern Health, and their families, that they are safe? Secondly, where is the accountability, the culpability and the responsibility? There seems to be very little. I heard what he said about the chair, but does he agree that the chief executive’s position is now untenable, and that she should be sacked? Thirdly, will he listen to the heartfelt pleas of the victims’ families, the campaigners, and all of us who are demanding a full public inquiry into Southern Health and broader issues, such as the abject failure adequately to investigate preventable deaths?

As the Secretary of State said in December, such issues are not confined to one trust. The Ofsted-style ratings that he previously mentioned will make a difference only if there is proper accountability and the ability to take action to make real improvements to patient care and patient safety. The families have behaved with such dignity and tenacity, and we owe them a debt of gratitude, but it should not be left to them alone to push for accountability.

I listened carefully to what the Minister told the House, but I remain unconvinced that enough has changed. Four months ago, we heard similar reassurances. Today, we are debating the Government’s failure to act. The time for yet more warm words and hollow reassurances is over. We need action, and we need it now.

[Alistair Burt]

I thank the hon. Lady for her response. We are not actually debating the Government’s failure to respond at all. The Secretary of State did exactly what he said he was going to do, and the CQC’s inquiry and work that followed can be seen in the report that was produced last week. The report contains a number of further concerns—there is no doubt about that—and people are right to be angry, but there is a process to find out what is going on and to do something about it and that process is in place. That is what NHS Improvement is doing and it is important that that is done.

There is an issue of urgency, which is really important. There are things that are discovered and things take time to get done. I am not content with that in any way, but the process is in place to do something about that. The CQC has been engaged and has ruled out no option for further action. Its options are quite extensive, including prosecution for things that it has found. The process started by the Secretary of State is not yet finished. That my right hon. Friend has demonstrated his commitment to patient safety from the moment he walked into that office cannot be denied by anyone, and this is a further part to that.

I asked the same question that the hon. Lady asked about safety directly to the CQC this afternoon, and I spoke to Dr Paul Lelliott who compiled the report. I asked whether people are safe at the foundation trust today. People are safe because, as we know, the CQC has powers to shut down places immediately if there is a risk to patients. It has not done so, but I am persuaded that if it had found such a risk it would have closed things down. There is therefore no risk to safety in the terms that the hon. Lady suggests.

On the chief executive’s position, the power to deal with management change is held by NHS Improvement. I also offer a brief word of caution. There is a track record of Ministers speaking out, at great cost, about the removal of people in positions over which they have no authority. That is understandable in situations of great concern when an angry response seems right, but it is not an appropriate response. The chair has gone, and processes are available should any more management changes be necessary, which is important. Colleagues in the House can say whatever they like, but a Minister cannot and must say that appropriate processes can be followed, because that is right and proper.

I do not yet know about an inquiry, and I want to wait and see what comes out of the further work being done in the trust. I do not rule out some form of further inquiry, but an inquiry is physically being carried out now by the actions taking place on the ground. What needs to follow is urgent action to respond to what the CQC has said, and a long drawn-out public inquiry is not necessarily the right answer. More work might be necessary, but I need to consider that in relation to further work being done at the trust.

On preventable deaths, as I made clear in my statement, I am sure that not enough attention has been given to those cases that require further investigation across the system, often dating back many years and preceding this Government. We have turned our attention to that issue, and we will make changes because such inequality must end.

World Autism Awareness Week

Baroness Berger Excerpts

Thursday 28th April 2016 Commons Chamber

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

I congratulate the right hon. Member for Chesham and Amersham (Mrs Gillan), and the other sponsors of the debate, on enabling the House to discuss the important issue of autism. Let me echo a remark that was made by my hon. Friend the Member for Heywood and Middleton (Liz McInnes). We have heard many excellent speeches, but I am particularly grateful for the contributions of Members who have shared their experiences as parents of children with autism. That added greatly to our discussion.

I welcome one of the central calls in the motion, the call for an enhanced national awareness campaign. Raising the profile and public understanding of autism would break down some of the stigma, tackle the prejudices, and make it easier to explain autism to those who remain unaware of the realities of the condition. I pay tribute to the charities working in this field, including the National Autistic Society, Autistica, and Ambitious about Autism, which are fighting for people with autism and their families. They are campaigning for proper diagnosis, decent treatment, social acceptance and full, productive and dignified lives for people with autism. I also commend the many organisations, campaigns, towns and cities that are doing so much to raise awareness. There have been many contributors to the debate, but I have only eight minutes so I hope that hon. Members will forgive me if I do not mention them all.

The National Autistic Society has brought some important survey evidence to our attention. It has already been mentioned in the debate, but it is worth reiterating that although almost the entire population of this country has heard of autism, only 16% have any real understanding of the condition. That reveals a huge gulf between awareness and understanding, which is why a national campaign to develop better awareness of the realities of autism would be a welcome development. It should be led by, and involve fully, people with autism and their families, so that the campaign can be authentic and focus on the issues that really matter. Research by Ambitious about Autism has highlighted two specific audiences for such a campaign: teachers—40% of whom say that they lack the knowledge they need—and employers and jobcentres. While 99% of young people with autism say that they want to work, only 15% of adults with autism are in employment.

It is clear that people with autism and their families face terrible prejudice and stigma. The figures in the National Autistic Society survey show that too many people with autism and their families feel socially isolated or do not go out because they are worried about how the public will react to their autism. My hon. Friend the Member for Lancaster and Fleetwood (Cat Smith) shared the fact that people do not understand what a meltdown is. People are sometimes asked to leave a public space because of behaviour associated with their autism. This paints a picture of social isolation and daily humiliation. Autism is a condition in which people have difficulty interpreting the world around them, and that is compounded by the reactions and hostility of other people.

It is obvious that we are a long way from having public spaces that are safe for all people with autism. I welcome the fact that my own city, Liverpool, has started a bid to become one of the first autism-friendly cities, but we need to become an autism-friendly nation. [Interruption.] The Minister for Community and Social Care, mentions Manchester from a sedentary position, and I note the remarks made by my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) in that context. I hope that the Minister will address the issues of awareness, stigma and prejudice. I hope that he will also commit to supporting the Autism Access Award, to ensure that our public buildings and spaces are autism friendly. I am pleased that the House of Commons started work on this earlier in the year, and I hope that we can make progress to ensure that our workplace also becomes autism friendly.

Many hon. Members have mentioned the challenges relating to the Department of Health. Will the Minister tell us what efforts individual Departments and agencies beyond the Department of Health are making to support people with autism and which Departments and agencies have an up-to-date strategy for dealing with autism? What commitment will he make today to ensure that any that do not have such a strategy will adopt one?

The second substantive part of the motion relates to the length of time it takes to diagnose someone with autism. Many Members on both sides of the House have talked about this today. Autism requires an early diagnosis to enable individuals with autism and their families to be properly supported. As we have heard, however, adults are having to wait more than two years for a diagnosis, and for children, the figure now stands at 3.6 years. On my weekly visits across the country, I hear many of the stories that have been echoed in the Chamber today. In my own city, Liverpool, there are no fewer than 700 families waiting for an assessment. That is totally unacceptable; it is far too long. The long wait compounds the condition and makes a bad situation worse.

I have heard at first hand from the Liverpool Autistic Children’s Alliance, a parent support group that meets in my constituency, the difficulties experienced while waiting for a diagnosis, particularly in relation to education. The parents talk about not getting an education, health and care plan and therefore having no access to training to help them to support their children. They also speak of challenges in accessing appropriate education. We have heard that the NICE quality standard on autism makes it clear that people should wait no longer than three months, once referred, for their first diagnostic appointment. That standard is clearly not being met across the country, meaning that thousands of people are being let down. Given the importance of prompt, accurate diagnosis, I hope that the Minister will commit to asking NHS England to report on autism diagnosis waiting times for every clinical commissioning group in the country and then to hold them to account when the waits are too long. I hope that he will also ensure that NHS England’s new autism care pathway includes and reduces those diagnostic waiting times.

Research presented by Autistica and drawn up by the London School of Economics shows that the costs associated with autism are more than those of cancer, heart disease and stroke combined. They are at least £32 billion a year and include expenditure on hospital services, home healthcare, special educational facilities and respite care and lost earnings for both people with autism and their parents. Despite the costs, the outcomes for people with autism remain so poor. We heard during the debate about co-morbidities, extremely high rates of mental illness, poor physical health, social exclusion, lack of opportunities for employment and education, and, tragically, early deaths. Several contributions discussed the amount spent on awareness, but research also has the power to improve all those poor outcomes. Research spending on autism remains incredibly low at just £3 million a year, which is paltry given the scale of the challenge.

As shadow mental health Minister, I am aware that mental illness is also a huge challenge for people with autism, who are far more likely to have at least one mental health condition. The burden of anxiety and depression on people with autism is vast, about which we heard many personal accounts during today’s debate and which I hope the Minister will address in his remarks.

I will conclude on an important point about the fact that too many people with autism in our country are dying too young. The figures are startling. If we look at the research that was in the press only a few months ago, we see that people on the autistic spectrum die on average 18 years earlier than the general population. For autistic people with a learning disability, that figure rises to 30 years. That cannot be acceptable in this country in 2016. People with learning disabilities are at greater risk of suicide, and the most disturbing statistic is that the risk of people with autism committing suicide is nine times higher than that for the typical population, which is a scandal. I raise it during this debate because, as we have heard in some contributions, it is a particularly specific and pertinent issue that needs addressing, particularly in the light of the fact that suicide prevention organisations are not providing autism-appropriate services. From representations from many autism organisations, I know that phone lines for those who might be having suicidal thoughts are not appropriate for someone with autism. I hope that the Minister will address suicide prevention strategies and ensure that they are appropriate for people with autism.

I welcome today’s debate and its many superb, thoughtful speeches. I hope that the families listening to our discussions will feel that we are addressing their many concerns. I look forward to the Minister’s reply.