Oral Answers to Questions
Luke Evans Excerpts(2 days, 11 hours ago)
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Dr Luke Evans (Hinckley and Bosworth) (Con)
The Royal College of General Practitioners has said the national insurance tax increase is expected to cost 2.2 million appointments. We know from answers to written questions that have been submitted that GPs, hospices and care homes are not exempt from the increases, and will not find out until April what, if any, mitigation will be put in place, so cutbacks are now being planned. Will the Secretary of State explain how his choice to tax GPs will increase GP access?
Wes Streeting
I can reassure health and care providers that we will be setting out allocations long before April next year. I recognise that people need to plan ahead of the new financial year. When deciding allocations, we take into account the range of pressures on different parts of the system. People have heard what I have said already about the need to shift out of hospital into primary and community services. The shadow Minister talks about choices; Conservative Members seem to welcome the £26 billion investment, but oppose the means of raising it. I am afraid they cannot do both. If they support the investment, they need to support the way in which we raise the money; if they do not support the way in which we raise the money, they need to spell out how they would raise it or be honest about the fact that if they were still in government, they would continue to preside over a mismanaged decline.
Dr Evans
One GP described the situation as “Schrödinger’s primary care”: GPs are seen as private contractors, so not exempt from the NI increases, but they are exempt from the small business relief because they are deemed to be “public”. Did the Department of Health team knowingly go along with the Treasury team’s plan to tax primary care without mitigation, leading to cuts? Or did it not understand or spot the complexity of what is going on, so mitigations have to be put in place now? Which is it?
Wes Streeting
I was terribly impolite; I should have welcomed the shadow Minister to his place in response to his first question.
Conservative Members seem to welcome the £26 billion investment and are happy to tell us how it should be spent, but they oppose the means of raising it. They cannot do all those things. They need to be honest with the country: either they support the investment in the NHS or they say they would cut it. Which is it?
Respiratory Health
Luke Evans Excerpts(1 week ago)
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Dr Luke Evans (Hinckley and Bosworth) (Con)
It is a pleasure to serve under your chairmanship, Mr Rosindell. This is my first day in my new role; it seems appropriate to take over this brief and speak in a debate on respiratory illness, because dealing with respiratory illness was my first ward job as a junior doctor. I worked for four months in accident and emergency department in the west midlands, and then my first ward job was dealing with respiratory conditions in Solihull hospital, so I have seen up front just how important respiratory medicine is.
I put on the record my thanks to the hon. Member for Strangford (Jim Shannon) for securing this debate. He may often get called last in the main Chamber, but he clearly has a trick for successfully securing debates. I look forward to perhaps having a cup of tea with him to learn how he is so successful.
It is both a blessing and a curse to hear the hon. Member for Newcastle-under-Lyme (Adam Jogee) make the same argument that his predecessor made about the quality of air in his constituency. I gather that it is a tip that causes a huge amount of problems there, and I hope he has success in getting the issue sorted. I also hope he takes some comfort from the fact that the previous Government passed the Environment Act 2021 to put in place legal limits to try to improve air quality and, of course, offered air-quality grants.
There is clearly an interest in respiratory conditions in both the east and west midlands, given the contribution from the hon. Member for Redditch (Chris Bloore), who is no longer in his place. Having worked over in the west midlands, I have now transferred to the clearly better east midlands.
Adam Jogee
I gently push back on the narrative that the previous Government made the sort of progress in tackling the issues at Walleys Quarry that the shadow Minister just implied. My constituents continue, on a daily basis, to deal with the worst effects of the hydrogen sulphide levels that the site emits. Hydrogen sulphide is a heavy gas and there are schools around the area. The impact on our children and the respiratory health of young lungs is massively underrated and fails to be part of the conversation. I invite the shadow Minister to come to Walleys Quarry and to Newcastle-under-Lyme to smell the situation for himself.
Adam Jogee
There has been a lot of sobriety in this debate so, rather than having a cup of tea, I will take the shadow Minister to the Waggon and Horses pub in Newcastle-under-Lyme for a slightly colder refreshment.
Dr Evans
I am very grateful to the hon. Gentleman for that offer.
I congratulate the hon. Member for Blaydon and Consett (Liz Twist) on her work in the APPG. She was of course right to highlight smoking as a big problem, and health inequalities are also important. We also know that people experiencing health inequalities generally struggle to access healthcare, let alone healthcare for respiratory conditions—we have not even discussed the equipment and expertise needed to deal with such conditions.
The hon. Member for Sherwood Forest (Michelle Welsh) spoke about pulmonary fibrosis, a really important condition that is not given the precedence it deserves given how debilitating it is for patients who suffer with it. I pay special tribute to her for raising that issue so powerfully and so emotionally. She is a true champion for doing something about a condition that is not thought about nearly enough.
The hon. Member for Winchester (Dr Chambers) is absolutely right about holistic approaches. They are outside the remit of this debate, but housing, environment and smoking are of course all big factors. We have not even talked about comorbidities yet. We know that people over the age of 60 are usually on several medications and may have heart problems or musculoskeletal problems as well. That will have a really big impact.
With regard to the hon. Member being a vet, I think I am right in thinking that he is still allowed to practise on humans, while I certainly am not allowed to practise on pets. That is not something for a debate today, but I think it is noteworthy; if there is a problem you should rush to him too, Mr Rosindell. What he said about antimicrobial resistance is really interwoven into everything, because there is a danger of over-prescriptions for chest infections that turn out to be viruses. That is a really problematic issue that is growing, and it is the next probable pandemic, with no easy solution. He is right to highlight that.
I thank the members of the APPG for all the work they do, led by the hon. Member for Strangford. It is really important to be able to get a debate and raise these issues, and to have the infrastructure behind the members to support the team in dealing with and producing updates.
I myself have a personal history with respiratory medicine, having ended up on the intensive care unit with bilateral pneumonia after an appendicectomy in my late 20s. It has left me, at previous times, at a brittle asthma clinic. There were many attempts to diagnose what was going on, but nothing was ever found. I had to be treated with repeated steroids and felt, full on, what it is like to suddenly not be able to breathe, not be able to exercise and have that ability taken away.
When they are listening to this debate, the key thing for the public to realise is just how important our breathing really is. A breathing condition is so seminal to everything we do. There is a reason why in an emergency it is ABCDE, or airway, breathing, circulation, disability, exposure: because breathing is quite literally life. Many people have experienced having that taken away a little bit by getting covid; that has at least made people aware of just how bad viral illnesses can be.
Turning to some of the other conditions that we have not talked about—I feel like I am back in one of my medical exams in the fifth year—we have heard about asthma and COPD, but we have not talked about pulmonary embolisms, pneumoconiosis or TB. We did hear about cystic fibrosis, but we have not heard about mesothelioma or sarcoidosis. Pneumonia is a really important one to talk about too, as is lung cancer, and there are probably some that I have missed.
Respiratory conditions are really important: they make up the third place for all deaths, so they need that attention. I was therefore pleased to see the last Government come forward with the community diagnostic centres—170 community diagnostic centres going up across the country to get better access to MRI scans, CT scans or blood tests. Those will be really important, and I was lucky to have a £24 million investment for a CDC in Hinckley, which will have MRI and CT scanners, and is being built as we speak. That will be transformative for my community when they are caught between two big centres towards Nuneaton and Leicester. I hope those measures will mean that respiratory conditions play an important part in the hospital rebuild programme and the current review, and that we will ensure we have the apparatus and equipment to support them.
Turning to the nitty-gritty of the debate, I entirely agree with the idea of prevention. The Conservatives brought forward measures to deal with smoking. I hope that as the Government step forward with further ideas of how to tackle smoking and push for a smoke-free generation, we will be looking at that very closely.
The hon. Member for Strangford really hit on a point about data. Health policy must be driven by decent data, and the APPG’s work highlights how respiratory conditions tend to fall behind in that. I have questions for the Minister about what work is being done now only on the simple matter of how we record things, but on how we can join up that dataset. For example, in my constituency we have two boundaries; we are caught between North Warwickshire and Leicestershire when getting answers to tests. An asthmatic does not have an asthma attack directly where they live—they could be on holiday. Sharing information on what has happened with treatment and investigations is really important.
That leads me on to spirometry. Spirometry is key, but where it is and how it is achieved is too sporadic, as is the skillset to deliver it. Then, of course, we have FENO—fractional exhaled nitric oxide—which can help to aid the diagnosis of asthma. That will be key, and the Opposition look forward to seeing what the new BTS guidelines, worked up with NICE, show on dealing with asthma.
I have a couple more questions for the Minister. I appreciate that this is not her brief, so I should be grateful if she passed on any questions she cannot answer for a written response. We have heard that the likes of the RSV vaccine are really important; new vaccines are coming out to tackle this huge problem for the elderly and the young. The vaccine was introduced for those aged between 75 and 80, but it would be interesting to see whether there is scope to grow that and see who else is responsive. I gather from work done by my Opposition colleagues that there is still some debate to be had and evidence to be gathered on what that would look like. I would appreciate it if the Minister took that point away. What steps are the Government taking to increase the uptake of flu and pneumonia vaccinations? Prevention is better than cure.
Finally, it was mentioned that the last Government looked at chronic health strategies. It appears that the new Government have decided to take a different tack with chronic conditions. I appreciate that that is their prerogative, but there is a danger that we could have a lag. The data that has been gathered, the research that has been looked at and the policies that have been structured for the past five years or so could fall by the wayside, even though we have heard how much of an emergency it is to deal with respiratory conditions. Could the Minister clarify whether interested parties will need to resubmit the work they have done, or whether the work will be a continuation within the new structure that the Government are planning? Is there any timescale on what that would look like?
Clearly the Conservative Government were unable to get the long-term health strategies in place in time before the election. Time is ticking on, and we have a winter coming up. It is really important for organisations to understand where they stand. Christmas is coming up, and I well know from my time as a GP—I should declare an interest, as my wife is a GP as well—that Christmas is the busiest time, and respiratory conditions are one of the top reasons for that. If anyone out there is listening, getting vaccinated is imperative. I advise everyone to do so.
We know that the staff of these organisations will go above and beyond when they see someone struggling for breath. They will take their time to get the right history and get medication and treatment in place. We give them our greatest thanks, from the Opposition side of the House, for all the work they have done and will do in the busy Christmas period. I am sure that that sentiment is shared by the Government.
National Insurance Contributions: Healthcare
Luke Evans Excerpts(1 week ago)
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Dr Luke Evans (Hinckley and Bosworth) (Con)
(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the impact of changes to employer national insurance contributions on primary care providers, hospices and care homes.
The Minister for Secondary Care (Karin Smyth)
I am grateful to the hon. Member for asking this important question. It gives me the opportunity to say to GPs, dentists, hospices and every part of the health and care system that will be affected by changes to employer national insurance contributions that this Government understand the pressures they face and take their representations seriously. The Chancellor took into account the impact of changes to national insurance when she allocated an extra £26 billion to the Department of Health and Social Care. There are well-established processes for agreeing funding allocations across the system, and we are going through those processes now with this issue in mind.
This Government inherited a £22 billion black hole in the public finances, broken public services and a stagnant economy. Upon taking office we were told that the deficit the previous Government recklessly ran up in my Department alone would mean delivering 20,000 fewer appointments a week instead of the 40,000 more we promised. The Chancellor and my right hon. Friend the Secretary of State were not prepared to see further decline in our NHS. That is why we put in an extra £1.8 billion to stop the NHS going into reverse this year.
We built on that at the Budget, delivering the significant investment that the NHS needs to get back on its feet, backing staff with investment in modern technology, new scanners and new surgical hubs, and rebuilding our crumbling primary and secondary care estate. Alongside that, we delivered a real-terms increase in core local government spending power of around 3.2%, which will help to address the range of pressures facing the adult social care sector, including £600 million in new grant funding for social care. We are now working through exactly how that money will be allocated, as per normal processes. As the Secretary of State set out yesterday, we will ensure that every pound is invested wisely to deliver the Government’s priorities and provide value to taxpayers.
The Department will set out further details on the allocation of funding in due course, including through NHS planning guidance and the usual consultations, including on the general practice contract. As part of these processes, we will consider the impact of changes announced to employer national insurance contributions in a fair and open way over the next five months, before the changes come into force in April 2025.
Dr Evans
I draw the House’s attention to my declaration of interests.
Many in the health sector will have been pleased to hear the announcement of the extra funding for the NHS, only for their joy to be struck down by the realisation that a manifesto promise not to raise national insurance contributions had been broken. That was compounded further by the discovery that a raft of frontline care providers—care homes, hospices, care charities, pharmacies and GPs, to name but a few—will not be exempt from the NI rise, leaving them with crippling staff bills and the threat of closures and redundancies. The hospice sector expects the cost to be £30 million—closures and redundancies. The initial assessment of the cost to GPs is £260 million—closures and redundancies, at the expense of 2.2 million appointments. For the care sector, the changes will cost £2.4 billion, dwarfing the £600 million in social care support that was announced. Does the Minister accept that it is inevitable that council tax will have to rise to support the increase in NICs?
For the first time, the National Pharmacy Association has announced collective action. Its chair said:
“The sense of anger among pharmacy owners has been intensified exponentially by the Budget, with its hike in national insurance employers’ contributions and the unfunded national living wage increase, which has tipped even more pharmacies to the brink.”
Will the Minister clarify who is exempt from NI? Will the Government admit that they got it wrong and make a change? The Prime Minister, Health Secretary and Chancellor have all said that allocations will be made “in the usual way”. Will the Minister clarify what the usual way is? Will mitigations be put in black and white to the House and the public? Is this part of the £20 billion, or new funding?
More importantly, will the Minister lay out a concrete timetable for hospices, care homes, GPs, pharmacists and all other allied health professionals, who are making decisions now? This seems to be another example of a big headline from the Labour party but no detail.
Karin Smyth
Well, really. I am quite dumbfounded by the hon. Gentleman’s response. I respect him for his professional practice, and he knows the state of the NHS that we inherited from the previous Government, as reported in Lord Darzi’s report. He talks about joy, but there was no joy when we inherited the mess they left back in July. He talks about people being tipped to the brink, and they absolutely were, as Lord Darzi made clear.
As I said, we will go through the allocation of additional funding in the normal process, which will be faster than under the previous Government because we are committed to giving the sector much more certainty. The normal process, as the hon. Gentleman should know from his time in government, is to go through the mandate and the planning guidance and to talk to the sector about the allocations due next April, as I said in my opening statement.
Karl Turner (Kingston upon Hull East) (Lab)
It is disappointing to put it mildly that the Opposition spokesperson was unable to mention the record funding committed in the Budget.
Mr Speaker
Order! The shadow Minister has been granted an urgent question. He asks the questions; he does not answer them from the Front Bench.
Income Tax (Charge)
Luke Evans Excerpts(2 weeks, 2 days ago)
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Wes Streeting
That is a commitment that we have made and a commitment that we will keep. I am happy to ensure that the hon. Member can meet the relevant Minister and project team as we get under way on delivering that project.
I did actually go back to check the pledges made by the Conservative party in its 2024 manifesto just to see how extensive the work of fiction was, only to find that the manifesto page on its website now reads “page not found”. The truth is, had the Conservatives won the election, it would have been deleted just as quickly.
That was not all I was told when I became Secretary of State in July. Despite 18 months of strikes in the NHS, there was no funding put aside to end the junior doctors’ dispute. What is more, the previous Health Secretary had not met the resident doctors since March—the Conservatives had given up even attempting to end the strikes. People should remember that this winter. For all the challenges that the NHS will face, this will be the first winter in three years when NHS staff will be on the frontline, not the picket line. That is the difference that a Labour Budget makes.
I was told that GPs would be qualifying this year with no jobs to go into. The Government found the funding and we are hiring an extra 1,000 GPs this year. That is the difference that a Labour Budget makes.
Dr Luke Evans (Hinckley and Bosworth) (Con)
On the Budget, GPs, hospices and care homes have been found to be either exempt or not exempt from the national insurance contributions. Will he clarify whether hospices, care homes and primary care are exempt or not? That really matters to their costs.
Wes Streeting
I am grateful for that intervention for two reasons. First, it gives me an opportunity to say to GPs, hospices and other parts of the health and care system that will be affected by employers’ national insurance contribution changes that I am well aware of the pressures, we have not made allocations for the year ahead, and I will take those representations seriously.
Secondly, it gives me a chance to ask the hon. Member and the Opposition: do they support the investment or not? Are they choosing to invest in the NHS or not? They are now confronted with the hard reality of opposition. Just as when we were in opposition we had to set out how much every single one of our policies would cost and how those would be funded, they have to do that now. If they oppose the investment, they have to tell us where they would make the cuts in the NHS. If they oppose the investment, they have to tell us where they would make the cuts in school budgets. Those are the choices that we have made, and we stand by those choices. The Opposition will have to set out their choices, too.
I was told that because the Conservatives had run up huge deficits in NHS finances, I would not be able to deliver the 40,000 extra appointments a week that we had promised. In fact, I was told that we would have to cut 20,000 appointments a week instead. The Chancellor and I were not prepared to see waiting lists rise further. She put the funding in, and an extra 40,000 patients will be treated by the NHS each week. That is the difference that a Labour Budget makes.
Access to Primary Healthcare
Luke Evans Excerpts(1 month ago)
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Karin Smyth
I am tempted, but I know that many of the hon. Lady’s colleagues want to speak, and I am sure she is on the list.
Fixing the NHS will take years of discipline and hard work, and we are in this for the long haul. However, we must first clean up the mess we inherited, and that work has begun in earnest. We have found the funding to recruit an extra 1,000 GPs this year as our first step towards fixing the NHS’s front door and making the system more flexible.
Dr Evans
One of the keys to delivery is the GP partnership model, which is the mechanism by which they are set up. The Secretary of State, who is now in his place, said in 2023 that he wanted to phase out the GP partnership model, although he later reneged on that position. It would be interesting to hear what the Government now perceive to be the best model for delivering primary care, as that is really important for GP partners.
Karin Smyth
I wish the hon. Gentleman well with his own access to a GP at the moment. We are committed to working with the profession on the best way to organise primary care. The critical point is that primary care, however it is organised in neighbourhoods, is there for our constituents when they need it. It is not there now. The model is not working and has not worked over a period of time. It has merits, as we have said, and we are continuing to talk to people. I have worked in the sector for a number of years, so I understand the point the hon. Gentleman makes.
Layla Moran (Oxford West and Abingdon) (LD)
The challenges facing the NHS are no secret. In my new role as Chair of the Select Committee, I have begun to meet key stakeholders. The list of things that we need to consider is enormous. I pay credit to those who stood for the Committee, and welcome those who made it on. I understand that Conservative members have been chosen, but I do not yet know who they are—I ask them to forgive me if they are here. I look forward to cracking on.
I will start by highlighting to Ministers a few of the reports by the previous Committee, which I urge them to look at. One is on dentistry and another on pharmacies —and they are from 2023 and 2024, so they are extremely current. There is a note of frustration in the dentistry report as it points out that it makes the same recommendations that the Committee had made 15 years prior. I hope that this Government will take our Committee’s recommendations extremely seriously. Such cross-party recommendations are made thoughtfully—we are here to help.
Today, I will focus on the GP crisis. Another Committee report from October 2022, for which I take no credit—it was done by the previous Committee, so credit should go to its previous Chairs and members—points out what we already know: GPs are overstretched and patients are frustrated. The British Medical Association reports that a single GP now manages an average of 2,282 patients, a significant increase on 2015 figures. I know that there are even more acute numbers across the country. That has led to longer waiting times and difficulty in accessing care. One of my constituents wrote to me about his wife, who was struggling to book a GP appointment. The surgery does not even take phone calls—or at least that was what she thought. It opens an online form for a few minutes at 8 am, and as soon as the appointments are gone, it closes the form. We then called the practice, which pointed out that patients could ring, although it seems that that message is not getting across to those patients.
That experience is being felt across the country, but I do not blame the GPs, because they are trying their very best. The Royal College of General Practitioners found that over 40% of GPs might leave within the next five years, with stress being a key factor, and the crisis in general practice affects the entire NHS. When patients cannot see a GP, they often turn to A&E, worsening pressures on emergency departments. GPs play a vital role in managing long-term conditions and co-ordinating social care at both ends of that flow of patients. Without a functioning general practice system, the entire healthcare ecosystem suffers.
So what can be done? The Committee made four main proposals, which I hope Ministers will include in their 10-year plan. First, we need to urgently increase the number of fully qualified GPs in the system. That means more than just training them: retention is also key. Secondly, we must embrace and improve digital health solutions, undertaking a full review of all primary care IT systems from the point of view of clinicians and patients. We also have to accept that for some people, digital just does not work.
Dr Luke Evans
I was a member of that Committee and helped to author that report. One of the key things that we want to see from the clinical perspective is the ability to join up the IT side, so having a place to share technology is really important. For example, every GP practice suffers with the question of how to set up its appointment system, yet bizarrely, if I wanted to set up as a GP on my own, there is no centre of excellence to say what is the best way to do so. Does the Chair of the Health and Social Care Committee agree that it would be valuable if we had a single point of expertise that each practice could ask, “What’s the best solution that you’ve seen elsewhere in the country?”
Layla Moran
I thank the hon. Gentleman for his work on the previous Committee. The GPs I have spoken to point to that report as describing what they would like to see done, so all credit is due to the ideas that have come out of it.
The third area I wish to mention is prevention, which is at the heart of the Darzi report. That report makes it clear that focusing on prevention and early intervention will relieve pressure on the NHS in the long run.
Finally, I want to talk about continuity of care, which was a key theme—indeed, an entire chapter—in the Darzi report. It makes it clear that seeing the same GP over a long period leads to fewer hospital visits, lower mortality and less cost to the NHS. This is not about some sort of nostalgic harking back to the way things used to be: if we want to solve what is, in my view, the biggest thesis question in the NHS today—the productivity issue—we need to be looking at interventions such as that. Continuity of care within GP practices, understanding the whole person and the whole family, is one of the ways the report identified of making GPs’ time more productive.
The challenges are immense, but not insurmountable. We owe it to our healthcare professionals and, most importantly, the patients to fix this crisis, and I look forward to working collaboratively with my new Committee members to help the Government do so.
Mental Health Support
Luke Evans Excerpts(1 month, 1 week ago)
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Dr Luke Evans (Hinckley and Bosworth) (Con)
Thank you, Mr Dowd, for allowing me to take off my neck brace to speak. I congratulate the hon. Member for Ashford (Sojan Joseph) on speaking so powerfully on this topic. I was a doctor before I came to this House, so for me the topic is important. There is a clear distinction when we debate this topic between mental wellbeing and mental health. Lockdown proved that everyone’s mental wellbeing gets punished, but not everyone has a mental health issue. That is important when we are trying to segregate services: how do we supply the correct services to the people who need them the most?
I have spent the last five years in Parliament campaigning around body image and for a men’s health Minister, particularly with regard to suicide. But I turn my attention to something close to my heart that is really important: the issue of adolescent mental health, because I am deeply concerned by the increase in children who are suffering. It is not just things such as eating disorders; we are seeing attention deficit hyperactivity disorder, we are seeing anxiety and we are seeing autism.
I plead with the new Minister to think radically, in a positive way, when it comes to the NHS. In my area of Leicestershire, 40% of child and adolescent mental health services is taken up by dealing with ADHD and autism. That takes a lot of attention away from the kids who are self-harming, or have eating disorders or significant serious depression or psychosis. There is a radical solution: pull out education and health and pool those services as specialisms. That would build on the work that the last Conservative Government did on placing representatives and mental health workers in school, and would allow GPs and CAMHS the freedom to concentrate on what they need to deal with.
John Glen (Salisbury) (Con)
On that point, may I draw my hon. Friend’s attention to the role of care co-ordinators with adolescents, and the problems and challenges of the transition to adult care? That moment can be critical in securing a pathway to an effective outcome. Often, the confusion over where responsibilities are delineated and begin has been a difficulty for my constituents.
Dr Evans
My hon. Friend is absolutely spot on. The cliff edges that exist in the NHS—and education and social services—cause a real problem, particularly for families, because at 18 someone does not just lose their diagnosis.
It is important to pool those areas because it allows us to stratify the way that we use our limited resources, and we know that health costs will continue to go up and spiral. I urge the Minister to have a think about potentially creating almost a national special educational needs and disabilities service, which would pool education and health experts together, releasing schools and relieving GPs’ primary care and secondary care with specialists. Now we have the set-up of ICBs, there is scope to do that regionally across the 42 areas.
It is well worth thinking about pooling those resources together, because it would be possible to give specialist help; and as the hon. Member for Ashford said, identifying people early means that they will not end up in a crisis. That brings us back to preventive care, to identify those who are having problems with wellbeing or who have mental health issues. For me, that is the crux of what we need to do: how do we pool the resources in a way that is sustainable for the taxpayer and, most importantly, service users and providers—the children and adolescents, and the staff who have to cope with some of the most difficult problems? I leave the Minister with that thought.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
It is a pleasure to serve under your chairmanship, Mr Dowd. I start by declaring that I am a former consultant psychiatrist and that a family member is a consultant psychiatrist.
Listening to this debate has been a mixed experience. It has been great to hear the wealth of talent and expertise that we have in the House, but at times it has been harrowing to hear people speak about their personal experiences or those of their constituents. That is a reminder to us all of just how substantial the impact of mental illness can be on people—our families and friends. The tone in which this very sensitive debate has been conducted is fantastic.
I thank the hon. Member for Ashford (Sojan Joseph) for bringing forward this debate, for the wealth of experience—22 years—that he brings to this place, and for a very balanced speech in which he acknowledged the catchment investments under the previous Government and raised the importance of waiting lists. When I was first elected, I brought up targets for mental health in a private Member’s Bill, which did not end up going anywhere, on waiting times for getting an in-patient bed when one is requested for somebody with a mental disorder. Of course, we all want improvements in mental health care and treatment, and there need to be improvements in mental health care and treatment. I am sure there will be no disagreement across the House about that.
The hon. Member for Ashford was absolutely spot on to mention housing, work and benefits. It is a testament to his experiences in psychiatric nursing that he went on to mention the surrounding holistic care. One of the challenges of debates on improving mental health services is that we must acknowledge that that involves many other areas of public policy, public provision and cultural factors, and try to broaden that as much as possible.
Dr Evans
The former Member for Doncaster, who is now sadly not in this House, was a significant champion for men’s and boys’ health—suicide in particular, which has been mentioned here, is such a problem. My hon. Friend stated the case for mental health being a pan-Government policy area—does he believe that strengthens the argument for having a Minister for men and boys to go across Government and think about all these issues, especially as suicide is the leading cause of death for young men under the age of 45?
Dr Spencer
My hon. Friend is absolutely right to point out that, sadly, suicide is the No.1 cause of death among young men. My understanding, although the stats change all the time, is that below the age of 45, suicide is the No.1 cause of death among both men and women. It is absolutely right that we look at sex-specific approaches to intervention. Factors affecting health in men will be different from factors affecting health in women.
I want to go back to the social elements of mental health care, which the hon. Member for Ashford mentioned, and a smoke-free society and banning tobacco. Certainly when I was practising, 50% of tobacco was consumed by people with a severe mental illness. That raises a whole host of concerns and issues about what is happening with tobacco consumption and people with a mental disorder.
My hon. Friend the Member for Hinckley and Bosworth (Dr Evans) was absolutely right, given his experience, about something he has mentioned many times in the House: the importance of delineating mental wellbeing and mental illness. I tend to think about it in this way: we all have mental health, but we need to separate mental wellbeing from mental illness. The two are different and need different approaches, as was echoed by my right hon. Friend the Member for Salisbury (John Glen) and the new hon. Member for Stroud (Dr Opher), who gave rise to a very fertile discussion on his views on the area. The hon. Member for Leicester South (Shockat Adam), who is no longer in his place, rightly pointed out inequalities in detention and outcomes for those from minority ethnic backgrounds. That is a very important issue.
That brings me on to our record in Government over the past 14 years; there are a few things I want to pick out. One is that we set parity of esteem in law through the Health and Social Care Act 2012, which was a big step forward. We still need parity of esteem in outcomes, but nevertheless that was a very important step. We expanded access to psychological therapies and I am particularly pleased by the expansion of individual placement and support, which has been shown to help people get into work, particularly those with a chronic and enduring mental illness. We have seen more people take up maternity care, and we also invested in the mental health estate.
In fact, in my own constituency, we have a new mental health hospital. The Abraham Cowley Unit is being rebuilt, which will provide world-class care for people living in my patch. Perhaps most important of all, given the conversation that we have had today, is the decrease in in-patient and out-patient suicide that we have seen over the years. Of course, I recognise that there are a variety of factors driving that but we should be pleased that things are moving in the right direction on suicides, although there is more to be done.
Today is World Mental Health day and it is a very broad topic, but in my time I would like to focus specifically on one area that, as it certainly was in my former career, is often neglected—psychosis. It particularly affects people suffering from schizophrenia or bipolar affective disorder. It can be a very disabling illness and has been responsible for quite a degree of disability and health concern in the UK. Often debates such as these, and debates in the media, do not focus on psychosis and I think a big part of that comes from the stigma attached to it. People who work in the sector, and those with expertise here, will know that it is an area of great need both in terms of community mental health teams and in-patient settings. The hon. Member for Stroud was absolutely right and I am glad he pointed this out: the 10 to 15 years of life lost following a diagnosis of psychosis is something that we have to fix.
I believe that we also need to improve access to treatments such as clozapine, which is an excellent treatment for schizophrenia. I am pleased to have previously worked with Clozapine Support Group UK in its campaign to try to get more access to clozapine for people for whom it is indicated. We have also seen the reform of the Mental Health Act 1983, which the former Prime Minister Theresa May kicked off with the Wessely review. I was part of the working groups on the Wessely review, particularly looking at helping with the tribunal system, and I was on the pre-legislative scrutiny committee as well. How we look after people detained for treatment in the absence of consent is very important, and I am pleased that this Government have committed to take forward the work on reviewing that Act.
I thank everyone who works in the care and treatment of people with mental illness. As we have heard today, that is a very broad sector; it is not only people who work in the NHS but those who work in the third sector in a variety of organisations and institutions. That is very important work.
Andrew Gwynne
The right hon. Gentleman is absolutely right. That will be one of the big challenges with the prevention agenda more generally, because often the investment we have to make today does not pay dividends immediately and there is a bit of a punt. Having been a Treasury Minister, he will know the challenges that that can present to the Treasury orthodoxy, but we have to push on this agenda.
I always say that being an MP and a GP is only one letter apart. We are often dealing with the same people who present with the same problems but from a different angle. We go away as Members of Parliament trying to fix the issue as they have presented it to us, and the GP will write a prescription and send them off having sorted out the issue as it was presented to them. However, the beauty of social prescribing is that there is an opportunity to deal with the whole issue in the round. The argument has been won with almost everybody, and any tips from the right hon. Member for Salisbury (John Glen) so we can get this over the line with the Treasury will be welcome.
I should mention my hon. Friend the Member for Darlington (Lola McEvoy), and welcome the hon. Members for Winchester (Dr Chambers) and for Runnymede and Weybridge (Dr Spencer) to their Front-Bench positions.
In the minutes I have left, I want to say to the House that many of the issues raised by Members during the debate are symptomatic of a struggling NHS. If we look at the figures, the challenges facing the NHS are sobering. In 2023, one in five children and young people aged eight to 25 had a mental health problem, which is a rise from one in eight in 2017. The covid-19 pandemic has exacerbated need, with analysis showing that 1.5 million children and young people under the age of 18 could need new or increased mental health support following the pandemic.
Dr Luke Evans
I want to raise an issue as the Minister is the Minister responsible for prevention. One of the biggest and most shocking things we saw during the pandemic was the increase in eating disorders, which is a very difficult topic for any Government around the world to try to break down. We know that the impact of eating disorders lives with people for the rest of their life and can cause them to lose their life, so will the Minister ensure that they are looked at as a priority? There was previously a roundtable; will he look into doing something similar again to bring experts together?
Andrew Gwynne
I am reluctant to commit Ministers to roundtables when I am covering another portfolio, because then they will do the same when they cover me in Westminster Hall debates, but I will say that we take this agenda incredibly seriously. When we were in opposition we gave support to the then Government, and I assure the hon. Gentleman that we will do everything we can to support people who have eating disorders and to get the right provision and support at the right time to the people who need it.
As I was saying, the covid-19 pandemic has exacerbated the need for mental health support. Around 345,000 children and young people were on a mental health waiting list at the end of July this year, with more than 10% of them having waited for more than two years. Some groups of children and young people are disproportionately impacted by mental health problems largely driven by a complex interplay of social and environmental determinants of poor mental health, as we heard in the debate.
We are committed to reforming the NHS to ensure that we give mental health the same attention and focus as physical health. It is unacceptable that too many children, young people and adults do not receive the mental health- care that they need, and we know that waits for mental health services are far too long. We are determined to change that, which is why we will recruit 8,500 additional mental health workers across child and adolescent mental health services. We will also introduce a specialist mental health professional in every school and roll out Young Futures hubs. We are working with our colleagues at NHS England and in the Department for Education as we plan the delivery of those commitments.
Early intervention on mental health issues is vital if we want to prevent young people from reaching crisis point. Schools and colleges play an important role in early support, which is why we have committed to providing a mental health professional in every school. However, it is not enough to provide access to a mental health professional when young people are struggling; we want the education system to set young people up to thrive, and we know that schools and colleges can have a profound impact on the promotion of good mental health and wellbeing. Doing this will require a holistic approach, drawing in many aspects of the school or college’s provision. I know there are many schools that already do this work, and my Department is working alongside the DFE to understand how we can support best practice across the sector.
As I have said, our manifesto commits us to rolling out Young Futures hubs. This national network will bring local services together and deliver support for teenagers who are at risk of being drawn into crime or who face mental health challenges. The hubs will provide open-access mental health support for children and young people in every community.
On other aspects of our plans, the mental health Bill announced in the King’s Speech will deliver the Government’s manifesto commitment to modernise the Mental Health Act 1983. It will give patients greater choice, autonomy, enhanced rights and support, and it will ensure that everyone is treated with dignity and respect throughout their medical treatment. It is important that we get the balance right to ensure that people receive the support and treatment they need when necessary for their own protection and that of others. The Bill will make the Mental Health Act 1983 fit for the 21st century, redressing the balance of power from the system to the patient and ensuring that people with the most severe mental health conditions get better and more personalised care. It will also limit the scope to detain people with a learning disability and autistic people under the 1983 Act.
Finally, Lord Darzi’s report identified circumstances in which mental health patients are being accommodated in Victorian-era cells that are infested with vermin, with 17 men sharing two showers. We will ensure that everyone is treated with dignity and respect throughout their treatment in a mental health hospital, and we will fix the broken system to ensure that we give mental health the same attention as physical health.
If I have not answered Members’ questions, those Members will be written to by the relevant Minister. I again congratulate my hon. Friend the Member for Ashford on securing the debate.
NHS Performance: Darzi Investigation
Luke Evans Excerpts(1 month, 2 weeks ago)
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Victoria Atkins
I will finish this point. That transition must begin with the language that the Secretary of State is choosing to use about the NHS. Interestingly, we have heard a little bit of nuance for the first time tonight, perhaps because health leaders are raising concerns that his “broken” narrative is damaging public confidence and will lead to people not coming forward for care, as was reported on the day that the right hon. Gentleman gave his speech to conference. That narrative is hurting the morale of staff who are working tirelessly for their patients. As the confected doom and gloom of the new Chancellor damages business confidence, so too does the Health Secretary’s relentlessly negative language risk consequences in real life.
Let me say what the Health Secretary refuses to acknowledge: the NHS is here for us and is ready to help. Its dedicated staff look after 1.6 million people per day, a 25% increase from the days of the last Labour Government. That is why I am always a little concerned whenever the right hon. Gentleman harks back so far; I do not think he has quite understood the change in capacity and scale of the national health service since we inherited it from the last Labour Government. The majority of those 1.6 million people will receive good care. [Interruption.] These are just facts, but I know the Health Secretary finds them difficult to receive.
Victoria Atkins
In one moment.
Of course, it is important that we focus relentlessly on those patients who do not receive good care, but that will not be achieved by writing off the 1.5 million people who work in the NHS. In fact, the NHS has more doctors, nurses and investment than at any point in its history. It is delivering millions more outpatient appointments and diagnostic tests and procedures for patients than in 2010, and NHS mental health services are supporting 3.6 million people a year, a 10% increase in one year alone.
Victoria Atkins
I will give way to the doctor behind me, and then I will give way again.
Dr Evans
It is interesting that Lord Darzi chose 2010, because there were some good points in what the Labour Government put in place, but there was also the problem of Mid Staffs. We had the Medical Training Application Service fiasco around medical careers, for which Patricia Hewitt had to apologise, and we had the £11 billion IT project that was put in place and has now failed as well. These things shape the NHS, and when we are trying to come up with solutions, they impact on the way that doctors, leaders and politicians come together. Does my right hon. Friend have suggestions for how we can take the politics out of this debate, enabling us to have a sensible debate on reform, which I think both sides of this House would like to see?
Victoria Atkins
I thank my hon. Friend, who brings his clinical experience and expertise to this debate. I say frankly to the Secretary of State that I wish he had taken the approach of the Defence Secretary, who has set up a cross-party commission on defence spending. Indeed, he has invited my former colleagues to sit on that review, because he understands that we bring an enormous amount of knowledge, experience, and—dare I say it?—some hard knocks from working in those massively complex Departments.
The right hon. Gentleman knows me. We have done good-humoured battle over the Dispatch Boxes for a long time now, and had he come to me and asked me to help him, I genuinely would have. [Interruption.] The public are hearing this. They want politicians to cut all the flim-flam and the bluster and work together, and had the right hon. Gentleman been serious about the Darzi report, he would have done exactly as his colleague around the Cabinet table has done and conducted a cross-party review of the NHS to ensure that we can make real progress. It is interesting that the Health Secretary does not appear to agree with the approach that his Cabinet colleague has taken.
Dr Luke Evans (Hinckley and Bosworth) (Con)
Thank you, Madam Deputy Speaker. I have removed my neck collar, which I am allowed to do, but if Members see my head wobbling, I ask them to intervene and I will put it straight back on. I welcome the hon. Member for South Norfolk (Ben Goldsborough) to his place. With the respect that he talks about and commands, I am sure he will be an asset to the House.
I come to the debate with a slightly unique perspective, and three minutes is very little time to make my point. I have been a doctor since 2007; I sat on the Health and Social Care Committee for three years; and, most recently—and probably most obviously—I recently had spinal surgery on my neck. However, that is not my only foray into the NHS: I have had both knees and my shoulder operated on and my appendix out, and I ended up in intensive care with bilateral pneumonia after that, so I have seen a fair amount of it.
Dr Evans
Absolutely. In this debate, health is a political football. It always strikes me that there is a rising tide across the western world, and at the four points of the nation. In Scotland, the NHS is run by the SNP; in Wales, it is run by Labour; in Northern Ireland, it is also separate; and we had the Conservatives, who have now handed it over to Labour. All of them are struggling, and we would do well to remember that. I came into politics not to change the world but to solve that—that sounds cheesy. In my last two minutes I have a set of suggestions—as any good doctor would do, I will look at the short term, the mid term and the long term—to try to improve it.
We could start with a root and branch review into prescribing, which is one of the most wasteful things in the NHS. On top of that, it is worth looking at the European working time directive, which hampers doctors when they study. Overnight, that could increase the ability to see more patients by a couple of percentage points. I spent nine months waiting for my operation, and there were a number of appointment letters. I had the ability to understand them and work my way through them, but a root and branch review of communications—the simple bread and butter of the NHS—would be very welcome. Comparable data across the nations, to see what goes on, is so important.
For the medium term, I would like statementing when people go into the NHS. Everyone knows how much it costs when they go to America—£40,000 for a ski accident. It costs that much here, and people would do well to remember that when they do not turn up to their appointments. On the IT system, we focus a lot on patients but I would like more focus on the staff and how they can use IT. I would like capping of GP lists—a sensible way, now that we have a workforce plan in place, to grow our staffing.
Finally, for the long term, in the 20 seconds I have I suggest a national service for SEND, taking education and health together to deal with mental health. Some 40% of the child and adolescent mental health services referrals in Leicestershire relate to autism and ADHD. That is a real problem that could easily be solved. In my final five seconds, I suggest an NHS centre for clinical excellence to share best practice. It is not good enough.
Tobacco and Vapes Bill
Luke Evans ExcerptsTuesday 16th April 2024
(7 months, 1 week ago)
Commons ChamberRead Full debate Tobacco and Vapes Bill 2023-24 View all Tobacco and Vapes Bill 2023-24 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Victoria Atkins)
I beg to move, That the Bill be now read a Second time.
Before I start, I should declare an interest: before I was elected to Parliament, I used to prosecute serious and organised crime, including organised crime gangs who attempted to import illicit cigarettes.
For a moment, I would like us to imagine that we are not in this historic and magnificent Chamber but instead standing at the entrance of a local hospital. A patient comes through the doors, struggling to breathe; smoking sent their asthma spiralling out of control. A minute later, another patient passes by; smoking caused the heart disease that they are battling. A minute later, another person comes in, and then another. That vicious cycle repeats itself nearly every minute of every day in our national health system, because here in the United Kingdom almost one hospital admission a minute is the human cost of smoking.
Smoking leaves people with premature dementia. It puts them in care, attached to oxygen, for the rest of their life. It increases the risk of stillbirth by almost 50%. It is responsible for 75,000 GP appointments every month, and it takes about 80,000 lives every year.
Dr Luke Evans (Bosworth) (Con)
I urge everyone who has come to the debate to go to a respiratory ward—I served on one for a year in my first junior doctor role—to watch people gasp for breath, struggle and fight, with their relatives asking you as a doctor to do something and you simply cannot. If the Bill is a step forward in stopping that situation, I am very much in favour of the Secretary of State taking it forward.
Victoria Atkins
I thank my hon. Friend for bringing to the Chamber his professional experience and the real-life consequences for his patients. If I may, I will unpack some of the details behind that invaluable intervention. The premise behind the Bill is exactly as he says—to stop the start—because there is no safe level of smoking and no safe tobacco product. In fact, it is the only product that, if consumed as the manufacturer intends, will kill two thirds of its long-term users.
The Bill is not about demonising people who smoke or stopping them from buying tobacco if they can do so today. It will not affect current smokers’ rights or entitlements in any way. Indeed, we want to help them to quit. We are supporting them by almost doubling funding for local stop-smoking services. Instead, the Bill is looking to the future, to give the next generation the freedom to live longer, healthier and more productive lives.
Oral Answers to Questions
Luke Evans Excerpts(11 months, 3 weeks ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
The shortage of ADHD medication is a global issue; it is not Brexit-related. We are hoping to have some positive news over the coming weeks.
Dr Luke Evans (Bosworth) (Con)
Victoria Atkins
May I thank my hon. Friend for bringing his professional expertise to the Chamber? Of course, minimising “did not attends” is a critical part of ensuring that clinical time is optimised, and I will take his suggestion away and mull it over.
Mental Health Treatment and Support
Luke Evans Excerpts(1 year, 5 months ago)
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Neil O’Brien
I was just coming to that, but on the point about prevention and the social origins of these things, we are in agreement about tackling the origins of these things. In terms of financial security, that is why we are providing financial help worth £3,300 per household, one of the most dramatically generous packages anywhere in Europe. The question of good housing was raised earlier. We have the Social Housing (Regulation) Bill and we are taking action to extend the decent homes standard to the private rented sector.
Dr Luke Evans (Bosworth) (Con)
Is it not the case that we have to be really careful about what we are talking about? There is a difference between mental wellbeing and mental health. We all suffer with our mental wellbeing but we do not all suffer with our mental health, and we therefore need to have the support that is appropriate. Social prescribing, for example, has a fundamental ability to help people who suffer with their mental wellbeing. Are the Government doing anything more to drive up social prescribing, so that GPs and allied professions can get the support from the third sector and other voluntary organisations that people so desperately need for their mental wellbeing?
Neil O’Brien
My hon. Friend, as an experienced clinician, makes an important and thoughtful point. This is exactly why we have so dramatically increased the number of social prescribers in primary care. An example in Britain is the parkrun practices initiative, which is connecting people to sporting and cultural activities that can improve mental wellbeing as well as mental health. My hon. Friend is completely right, and that is why this is a priority for us.
Dr Evans
My hon. Friend is making a powerful speech about raising awareness. Yesterday, I hosted members from the NFU, who candidly said that, a few years ago, they would never have been speaking about these kinds of issues. We know that rural communities and farmers in particular suffer when it comes to asking for help. Is it not exactly those organisations coming forward and speaking about the problem that allows us to have this debate?
Dean Russell
I thank my hon. Friend for his important intervention. This morning, I was fortunate to host the Royal College of Psychiatrists. We had a roundtable discussion with different charities, organisations and leaders in this space about what we need to do and what that looks like. It looks like more funding—there is always an argument for that and rightly so; it means ensuring that we support people who have gone through crises, and that we look at that long-term support; but it is also about how we shift the conversation. For me, it must be about parity between physical and mental health. A few years ago, an amendment was tabled that would have introduced more parity of funding. As a Government, we need to look again at that amendment. Other important steps would include a mental health Bill. I appreciate that we need to move forward with that as soon as possible, and I echo the calls for such legislation, but we should not be damning everything that has been done so far, because huge strides have been made, especially in relation to extra funding.
When I was a councillor many years ago, I worked with local schools to look at what support was in place. I wanted to know whether the children as well as the teachers were aware of the support that was available. If we were to do the same survey today, we would find that the situation is far better than it was 10 or 15 years ago, but, as I have said, there is still a way to go.
I want to finish on a few brief points. When we consider the challenges around mental health, we must understand that the problem is not mental health alone. There is always some sort of comorbidity and there is always some impact on physical health. When we talk about parity, we are not just saying, “one person with mental ill health and one person with physical ill health must be seen equally”. That, of course, is important, but we must also be mindful of the fact that if somebody has a mental health condition it may affect their ability to work. On the flipside, a physical health condition may impact a person’s ability to get out of bed in the morning and their ability to do exercise. All those things are essential.
I hope that my words, from the Conservative Back Benches, will echo across the House: we want to get to a position where mental health is a priority across all of society. Both the Government and our communities play a part in that, and how we talk about this matters. I hope that we can talk civilly about the opportunities that are available. I urge colleagues to talk about what support is out there as much as, quite rightly, challenging Government and all of us to do more.