NHS Trusts: Finances

Marie Rimmer Excerpts

Monday 1st February 2016 Commons Chamber

[Ben Gummer]

I can give the hon. Lady that reassurance. When I was in Hull a few months ago, I had a fantastic series of conversations with clinicians—not just those who are leading the hospital, but those on the frontline in the wards—about how to address the staffing challenges in Hull and east Yorkshire. It is tailored responses to the problems in individual localities that will provide the quality of service in Hull that she wants for her constituents. I am committed, as are the staff in Hull, to ensuring that she sees it.

[Marie Rimmer (St Helens South and Whiston) (Lab)]

Will the Minister join me in visiting my local clinical commissioning group, trust and social services? The reason I ask is that St Helens and Knowsley Teaching Hospitals NHS Trust has just been rated “good” in four of the five areas and “outstanding” in care. The chief executive is managing Southport hospital to help there in the interim. She previously helped Warrington out of its problems. We have no problem with our chief executive and our staff are outstanding and work hard. However, we are having to recruit nurses from Spain. There is a wonderful working relationship between the CCG, the hospitals and adult social care, with lots of pooling going on. Nevertheless, Whiston faces a £7 million deficit and that is not down to the PFI tariff. [Interruption.] Sorry, Mr Speaker, I will come to the question. Will the Minister please join me for a constructive discussion with those people to see what is happening on the frontline?

[Ben Gummer]

I know that the Under-Secretary of State for Public Health was in Whiston last year. I was in Manchester a few weeks ago, and I plan to go back there and to the north-west in the next few weeks. I will be doing a regional tour, and I would very much like to meet the hon. Lady and talk to her trust’s chief executive. She raises an interesting point, which is that chief executives in many trusts across the NHS are of exceptional quality. It is often easy to knock managers in the NHS, but there are some fantastic managers, and I am sure that her constituency has one.

Mental Health

Marie Rimmer Excerpts

Wednesday 9th December 2015 Commons Chamber

[Mr Hunt]

My right hon. Friend is, of course, absolutely right, and I think we do a great disservice to the many people suffering from mental health conditions if we allow this to become a partisan issue. Of course Oppositions must hold Governments to account for their promises, but we should never try to suggest that one side of the House cares more about this issue than the other or that the efforts on one side have somehow been compromised by a lack of interest in or commitment to the issue. It is clear from the number of Members of all parties speaking in today’s debate that the determination to improve mental health provision is shared right across the House.

We urgently need to address other issues, including the increase in eating disorders such as anorexia, which can be a killer. Between 5% and 20% of anorexia sufferers tragically die, and we have to do something urgently about that. We need to deal, too, with the pressures on child and adolescent mental health services, with which all Members will be familiar through their constituency surgeries. Referrals were up 11% last year, and we need to make sure that CAMHS is able to deal with that extra demand, as well as looking at what can be done to improve early intervention so that we reduce the increase in those referrals.

[Marie Rimmer (St Helens South and Whiston) (Lab)]

rose—

[Mr Hunt]

Let me make some progress, and I shall give way later.

We need to look at the use of police cells, which has often been spoken of here. We have seen a 55% reduction in the use of police cells over the last three years, but they were still used 4,000 times last year. Particularly for children, that is totally inappropriate, and it is often inappropriate for adults, too. Out-of-area placements for non-specialist care are another issue, and the Minister for Community and Social Care is working extremely hard and is committed to implementing a plan to turn this around by March next year.

--- Later in debate ---

[Mr Hunt]

We are working very closely with the Department for Work and Pensions to improve mental health provision for people who are looking for work—not just those who are experiencing difficulty in finding work because of stigma and bias among employers, but those who are in work but may fall out of the workforce because of a mental health condition.

We cannot do everything, in this area of health provision as in others, but that does not mean that we should not make tangible and measurable progress towards the ambitions that are shared by Members in all parts of the House. The first important step involves funding. The Chancellor delivered a record settlement for the NHS in the recent spending review, confirming a £10 billion real-terms increase in its funding over the course of this Parliament. That is very significant for mental health, because not only will there be a rise in the baseline funding of the clinical commissioning groups that hold local health budgets, but those CCGs are committed to increasing the proportion of their funding that goes into mental health.

[Marie Rimmer]

rose—

[Mr Hunt]

I will proceed with my speech for a little longer, if I may.

We are seeing the prospect of very real progress, and we as a Government need to give careful thought to which areas to prioritise. We do not have a monopoly of wisdom in this area, which is why we set up the independent mental health taskforce that is led by Paul Farmer, the chief executive of Mind. We will receive its report early in the new year. It will follow a successful independent report produced by the cancer taskforce, chaired by Harpal Kumar. I think that it is a good way of uniting the Government, Members in all parts of the House, and the mental health campaigning charities, so that we can decide together on the key areas that we want to transform in the coming years.

We are still working on the detailed planning, but we have already announced the provision of £2 billion of additional mental health funding over the course of this Parliament, which will benefit CAMHS, perinatal mental health treatment, the treatment of eating disorders, and talking therapy. Some of that funding is a result of promises made by the coalition Government which we have said we will honour, and some is a result of promises that we ourselves have made.

I agree with the hon. Member for Liverpool, Wavertree that as we increase investment in mental health, we need greater transparency in respect of the way in which that money is spent. I am pleased to say that next June, following consultation with the King’s Fund, there will for the first time be independently assured Ofsted-style ratings that will tell us very simply, CCG area by CCG area, whether mental health provision in the health economy as a whole is outstanding, is good, requires improvement, or is inadequate. As far as I know, ours is the first country in the world to do that. The hospital sector underwent the same process in the wake of Mid Staffs, and, on the basis of that experience, I believe that it will lead to a dramatic reduction in variation and an improvement in care as people are given independent information about how their services compare with those of their peers. That increased transparency will also mean the development of a new mental health data set, which will enable us to collect more and better data and then share them with the House, debate them, and learn what needs to be learnt.

--- Later in debate ---

[Mr Bradshaw]

My hon. Friend is absolutely right. As she clearly articulates, the picture on the ground is very different from the one that is so often painted by the Government.

The House may remember a case that caused headlines a couple of years ago when I raised it in another debate. A 16-year-old girl in Devon was kept in a police cell for two nights because no bed could be found for her anywhere in the country. Her case is not unusual. As we have heard in this debate, more than 6,000 people with mental illnesses were held in police cells last year.

[Marie Rimmer]

Does my right hon. Friend agree that the provision of tier 4 CAMHS beds is a national commissioning issue? Those beds are commissioned by NHS England, not by the CCGs. I think that that is a problem. The Government need to focus on the nationally commissioned beds. Many young people who have eating disorders get to the stage where they need such beds.

[Mr Bradshaw]

My hon. Friend is absolutely right. I hope that the Minister heard her intervention, because I will leave that bit out of my speech. I was going to raise the ongoing problem of the interface between mental health services for young people and adolescents and those for adults. A lot of people are falling through the gap.

There has been a lot of talk, including from the Government, about parity of esteem, but there is scant evidence of it on the ground at a local level. I ask the Minister to explain when he responds to the debate why, if the Government are serious about parity of esteem, NHS England has removed it from this year’s NHS mandate. That is the important document that the NHS publishes every year to tell local health services what they have to deliver. Why has parity of esteem been removed?

Why are the Government cutting so drastically the funding for public health, which delivers many preventive services, such as alcohol and drug treatments and psychological support for young people in schools, that stop people getting ill in the first place, saving money and lives?

As we have heard, after years of falling, the rate of male suicide is on the increase again. Suicide is the main cause of avoidable death among young males.

Junior Doctors Contract

Marie Rimmer Excerpts

Monday 30th November 2015 Commons Chamber

[Mr Hunt]

I cannot provide my hon. Friend with that information this afternoon, because we do not yet know whether the strike will go ahead tomorrow, and how many operations will end up being cancelled in advance of it because of the late notice, but I am happy to get that information for him when we have an estimate.

[Marie Rimmer (St Helens South and Whiston) (Lab)]

This junior doctors dispute is not just about pay. We are very fortunate to have such marvellous junior doctors. My concern, and I know that it is their concern, is about the change to the training of junior doctors in the proposed imposed contract, which will have such a negative impact on the research and development that makes our national health service the greatest in the world. Will you comment on the impact that the change in the contract will have on training and research? Will that be altered, and if not, will you please look at it again, because that is absolutely essential?

[Mr Speaker]

I will do neither of those things, but we will soon discover whether the Secretary of State wishes to do either.

Junior Doctors’ Contracts

Marie Rimmer Excerpts

Wednesday 28th October 2015 Commons Chamber

[Marie Rimmer (St Helens South and Whiston) (Lab)]

We have a very real problem in recruitment and retention in our national health service. Hospitals and general practices are forced to recruit doctors from overseas and highly expensive locum and agency staff. The British Medical Association has described the plans as unsafe and unfair. My postbag is full of letters from junior doctors in the past weeks. Many of them feel that they are already overworked and undervalued. The threat of the imposition of the new contract does nothing to make that feeling better and only compounds it.

One of my constituents, Elizabeth, was born in Whiston hospital, which is ranked the best hospital in the country—I am so proud of it. She has lived in St Helens her entire life and is now a junior doctor in the hospital where she was born, training to be a GP. Admirably, she wants to put something back in to her community, but she tells me her plans are at risk because the new proposals financially penalise those on maternity leave. She tells me that she will have an enforced pay cut of approximately 30%—I listened to what the Secretary of State said about that—which would leave her unable to pay her mortgage, which she carefully budgets for.

She would also be unable to pay for the compulsory exams needed to complete her training. Sadly, that means she would be forced to take her skills elsewhere. She went on to tell me that other countries, such as Australia, can offer a better quality of life compared with what the new proposals mean for her. Given the very real prospect that she might default on her mortgage, she would have no choice but to move abroad with her family. Applications for certification to practise abroad are soaring. These proposals will also impact unfairly on female junior doctors, 80% of whom are part-time trainers, as pay progression will be slower for them; we will lose even more doctors as a result.

I do not want to go back to the old days, when a junior doctor told me he fell asleep while with a patient—the patient had to wake him up. Another junior doctor was killed in a car crash on the way home after working for nearly 30 hours without a break. It cannot be proved that his working pattern was responsible, but nothing would convince his colleagues and family that that was not the case.

We cannot afford to lose the doctors we are training. Not one hospital in the north-west would be able to balance the books in the next financial year. The clinical commissioning groups are facing enormous financial challenges. Hospitals can only get the money from the tariff from the Government and the CCGs, and it is not there. We cannot pay consultants seven days a week if there is not the money in the CCGs.

NHS: Financial Performance

Marie Rimmer Excerpts

Monday 12th October 2015 Commons Chamber

[Ben Gummer]

Conservative Members disagreed with my hon. Friend’s predecessor on many points, but he did great cross-party work with Members who were not of his political persuasion to find a good solution for urgent care in his area. I hope that we will follow that model on a larger scale across the country. If we can do that, there will be a much better resolution to the challenges facing the NHS. Patients and people want us to address those challenges without turning the whole thing into a political circus.

[Marie Rimmer (St Helens South and Whiston) (Lab)]

I agree that the use of agency staff places a great cost on the national health service, and I am sure the Minister will accept that cutting the number of training places for nurses and doctors at the beginning of the previous Government will have had an impact on that. St Helens and Knowsley teaching hospital is currently recruiting in Spain because it cannot recruit here. Recruitment and retention are crucial, and more than 50% of doctors now apply to practise abroad. Does the Minister think it sensible to further punish trusts that are in financial deficit—there are many across the country—by reducing their quality pay if they do not balance the books this year?

[Ben Gummer]

The hon. Lady asks about nurse training places, and this year the number of places is consistent with the number in 2010. The key point is not just the number of nurses in training, which is determined by NHS providers, but the number of nurses in hospitals serving patients and the public. The number of nurses is currently at a record high thanks to this Government’s actions.

A&E Services

Marie Rimmer Excerpts

Wednesday 24th June 2015 Commons Chamber

[Dr Whitford]

Before the movement of out-of-hours GP services under the banner of NHS 24, most local areas had a doctors-on-call service. In my county, we had Ayrshire doctors on call, which was provided by local doctors at rooms in the A&E departments in our two hospitals. Patients quickly learned where they could go to be seen quickly. We also had a car service that allowed us to make home visits. That functioned very well until NHS 24 came and pulled it away.

We have to get back to local GPs working like that as part of a co-operative in a focal position. Each practice cannot generate enough GPs or work to have someone sitting there all day Saturday and all day Sunday. When the Secretary of State talks about 8 till 8, it is not clear whether he means that that will happen in each individual practice or on a regional basis. Most of the pilots that have started to publish their experiences have quickly made it into a doctors-on-call service. There is more common sense behind that approach and it is more sustainable.

We have to look at the flow within hospitals. We should not have trackers running around bean counting when patients had what done, but people going in front of patients, opening the gates, looking at bed management and ensuring that patients are in the right place.

All these matters cascade back on to staff. We are struggling to maintain and recruit staff. There was only a 50% take-up of trainees for accident and emergency, and we are haemorrhaging senior people, which exacerbates the problem. We need the co-location of GPs and we need to look at the exit block, not only out of A&E and into the hospital, but out of the hospital.

[Marie Rimmer (St Helens South and Whiston) (Lab)]

A 25% reduction in the number of GPs and practice nurses has been forecast over the next five years. I have the statistics to prove that. People talk about the cost of agency staff and locums in hospitals, which is out of all proportion. There are also massive increases in costs—

[Madam Deputy Speaker (Natascha Engel)]

Order. It is essential that we keep interventions to the absolute minimum.