Mental Capacity (Amendment) Bill [Lords]

Melanie Onn Excerpts

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[Melanie Onn (Great Grimsby) (Lab)]

Has the Secretary of State had any discussions with the Justice Secretary about the application of the measures in this Bill upon those who are serving prison sentences, particularly indeterminate sentences?

[Matt Hancock]

I have had some discussions on that subject, and I am happy for the hon. Lady to take up that point in more detail either directly with me or with the Minister for Care, or in Committee, because there are significant interlinkages between the two areas.

The Bill builds on the extensive work and recommendations of the Law Commission. It has been fully scrutinised by the Joint Committee on Human Rights and then improved by the other place, as has been discussed. I am grateful for all that work. Ultimately, it is about striking a balance between liberty and protection.

Hospice Funding and the NHS Pay Award

Melanie Onn Excerpts

Wednesday 31st October 2018 Westminster Hall

[Liz McInnes]

There is a theme developing on recruitment and retention. We have shortages of particular groups of staff, and a two-tier pay arrangement for different NHS providers will only exacerbate those problems.

[Melanie Onn (Great Grimsby) (Lab)]

The points that colleagues have made seem to reflect the situation around the country. The hospice in my constituency, St Andrew’s, provides end of life and respite care for adults and children. The chief executive spoke to me when I went to the opening of its new garden, and expressed exactly the same concerns and fears about future staffing arrangements. The hospice has an incredibly dedicated team of staff, but fears losing them if they can get better pay elsewhere in the NHS.

[Liz McInnes]

My hon. Friend highlights the problems that hospices up and down the country are experiencing with the recruitment and retention of staff. I will explore those issues further in my speech.

--- Later in debate ---

[Melanie Onn]

The chief executive of a social enterprise that provides social care in my constituency under the Care Plus Group TUPE-ed out several staff in order to continue to provide those services. Those staff are on Agenda for Change contracts, but they will not receive the Government uplift in pay, because as the chief executive says:

“The plan is to fund only NHS trusts and foundation trusts, to pay the uplift directly to them.”

The issue goes much wider in the healthcare sector than hospices. It will affect providers of health and social care in our communities, as well as those staff contracted out from the NHS, including porters, orderlies and caterers. I know that Unison is campaigning for those staff who have been privatised within the NHS. Does my hon. Friend think that all those staff are integral to providing healthcare for all of us, and should be included in the uplift?

[Liz McInnes]

My hon. Friend is absolutely right: this goes wider than hospices. It applies to non-statutory, non-NHS organisations that provide essential services to the NHS. Staff being TUPE-ed out is difficult, and I hope the Minister will consider it in her remarks. The pay award has to be funded from somewhere, and it is extremely unfair if NHS staff are TUPE-ed out to a non-NHS provider and lose out on the pay award as a result.

The chief executive of Springhill talked to me about the role of the clinical commissioning group, saying she hoped that

“the CCG will recognise this significant additional burden when agreeing our annual contract”,

and that it will

“not be expecting us to reduce our costs this next financial year.”

I know, and the interventions I have taken show, that the problems experienced by Springhill Hospice are replicated up and down the country, and I am grateful to hon. Members for sharing their experiences from their own communities.

Hospice UK estimates that, over the course of the three-year NHS pay deal, charitable hospices will face an additional bill of between £60 million and £100 million. It says that the Department of Health and Social Care’s criteria for non-NHS providers to access the additional funding set aside to support the implementation of the NHS pay award exclude the majority of the country’s charitable hospices from that essential support. The Department itself has acknowledged that most charitable hospices do not employ staff on NHS terms and conditions, as the staff working in hospices are not NHS employees. However, as hospices recruit their staff from the same local pool as the NHS, they have little option but to mirror the pay award made to NHS staff in order to recruit and retain the staff they need. As a consequence, hospices face a difficult choice: they must either ask their local communities to donate more to fund the pay award or look at options to reduce services proportionately to cover the cost. Neither is a palatable option for the hospices or for the communities that they serve.

The Department maintains that hospices should look to their clinical commissioning groups for additional support, yet research by Hospice UK shows that in recent years two thirds of hospices in England have seen their NHS funding cut or frozen—in many instances, for several consecutive years. In the absence of tariffs reflecting the costs of care, the NHS currently makes a contribution towards the costs of providing hospice care. It is on average just 30% of the costs of providing adult hospice care services and just 15% for children’s hospice services, although that funding varies widely around the country.

Hospice UK has suggested a solution to the problem, which is to follow the precedent set in 2004, when the employer contribution to the NHS pension scheme was doubled from 7% to 14%. At the time, the Labour Government acknowledged that charitable hospices would face an additional cost that they could not recover from elsewhere, so they set aside a national pot of funding to be distributed centrally to mitigate the impact. That worked very well and is a model that would work well in relation to the NHS pay increase by recognising the unintended consequences for charitable hospices while maintaining the integrity of the deal negotiated and agreed with the NHS trade unions.

Additionally, I have been contacted by my hon. Friend the Member for Plymouth, Sutton and Devonport (Luke Pollard), who tells me that he has secured an agreement for 3,000 healthcare workers in his constituency who work for a social enterprise to receive Government funding to finance the pay rise, so clearly a precedent has already been set. I would be interested to hear the Minister’s comments on that.

The pay deal that has been agreed is a pay deal for NHS staff and is welcomed. Since this debate was announced, I have also been contacted by the Chartered Society of Physiotherapy.

[Melanie Onn]

It has taken me a little while to catch up, but did my hon. Friend just say that a colleague has managed to secure an independent agreement that the pay deal will be honoured for some workers in a hospice setting? If so, how is it possible that one person can get such an agreement from Government but everyone in this Chamber who is raising issues cannot?

[Liz McInnes]

I thank my hon. Friend: that is exactly the point that I wanted to make. A deal has been done in Plymouth for a social enterprise provider that is not a hospice but a provider of mental health services. Obviously, smaller deals are being done. My hon. Friend the Member for Plymouth, Sutton and Devonport is not able to be with us today, but I was very interested in the evidence that he sent me. The Department of Health and Social Care needs to look at the smaller deals that have been done and ask itself what on earth is going on.

To return to the issue of physiotherapists, they are clinical staff whose role in hospice care is sometimes forgotten. The CSP told me that its members overwhelmingly backed the pay changes when consulted earlier this year. It pointed out to me the importance of the physiotherapist’s role in enabling people with a terminal illness to stay active as long as possible—a really important role—and went on to say that with the current shortage of physiotherapists, it is relatively easy for staff to change roles if they wish to do so, and that employers who cannot broadly match NHS pay rates will find it increasingly difficult to recruit staff.

There is clearly real concern that the NHS pay award will have an unforeseen but damaging impact on charitable hospices and other organisations that are already at a significant disadvantage compared with other non-NHS providers in not receiving reimbursement for the costs of the care that they provide to NHS patients. A sustainable hospice movement is an essential component of delivering the improvements in end of life care that the Government have rightly sought. The Government must look again at the conditions imposed on non-NHS providers and consider how funding may be made available to prevent a diminution of the end of life care service.

--- Later in debate ---

[Derek Thomas (St Ives) (Con)]

I thank the hon. Member for Heywood and Middleton (Liz McInnes) for securing the debate. “Fantastic” is probably the wrong word to use, but this is an important opportunity for us to speak about the great work that hospices do, the part that they play in all our local communities and how they help people and their families at the most difficult times of their lives. It is an honour to take part in the debate. I want to talk about the role of hospices, how they contribute to the desire to integrate health and social care and, as a result, how they must be funded to deliver the great work that they do.

This may seem a strange thing to say, but I have spent my most special moments at the bedside of someone in a hospice. Over the years and even as an MP, I have taken the opportunity to sit alongside people and their families in our local hospice, St Julia’s, which is just on the edge of my constituency, and I always leave with an incredible sense of gratitude for the work that the hospice does and how it helps people at that difficult time. It helps people to live and die well, which is what I am sure we would all love to be able to do when the time comes.

Let me explain what I have learned in recent years. Even now, the word “hospice” assumes that that is where we will die if we have—dare I say it—the right kind of illness to justify that, but I am learning that hospices are actually far from just places to die. People can go into one when they are very sick and come out a week or two later, having had various things done to help them, to get their body working again and to identify the right medicine. Hospices can give people time to work out what medicine or drug is really the right one for them. My mum was ill for a very long time. She was given a few weeks to live, but actually lived for more than a year. She spent 10 days in a hospice when we really thought it was the end and then she went on for a good six or seven months after that, simply because the hospice was able to correct her medication and—well, “flush her out” is probably the way to put it. It was lovely to come together as a family and sit alongside her, and to give my dad a break; he had about 10 days of really important respite. The hospice movement across the country, in my constituency and across Cornwall is fantastic. When I go there, it is a different experience from when I go to sit beside the bed of someone in an urgent care setting who is also reaching the end of their life.

In Cornwall, we are learning that hospices are not just about taking people in the closing days or months of their lives, but about alleviating pressure on urgent care by taking people out of a ward where it is not really appropriate for them to be in their last few days, and on community care. In response to trying to get the money it needs, our hospice has done a great bit of work by going out to homes and supporting people there in their last few days and weeks.

The point is that, by properly funding hospices and all the work they do, I am convinced that we would create a saving for the wider NHS as well as the beds that are needed for other people. That is important in my constituency, because our main hospital is in special measures—“requires improvement” is where we are at the moment—and one area of that is about palliative care. The frustration is that there is a desperate need for beds in the hospital, but in the hospice, beds are available all the time. It is simply about a lack of commissioning joined-up thinking and working together, and not having enough money in the hospice system.

Hon. Members have given various quotes about how much NHS funding hospices receive. Some time ago, my first question in Prime Minister’s questions, when the then Chancellor was replying, was about how little Cornish hospice care was funded. At that time, about 11% of the money came from the NHS. That is in a part of the world where there is a lot of deprivation and average earnings are low, so the rest of that money was being found by people who were not awash with cash. I do not know that it has improved much since; we are still one of the areas that receives the least money for our hospice care.

That is frustrating, because people are dying in the urgent care centre who should be in a hospice. Three weeks ago, I spent time with a family who were desperate to get their mum out of my local hospital, which is part of the urgent care set-up. I do not want to be unfair to the hospital team, but unfortunately, they were so keen to get the lady home that they waited for care packages that did not arrive, and she died in the hospital when she could have been in the hospice.

[Melanie Onn]

I thank the hon. Gentleman for making that important point, which raises an issue that I have had with a constituent. His wife was sent home supposedly well after going into hospital for urgent treatment but sadly she died two days later. Going to the local hospice, St Andrews, would probably have been a much better option for her, but it had not been thought of in that process.

[Derek Thomas]

The hon. Lady is absolutely right, and I have heard several stories where that has been the case. Separate to the debate, there is an obsession—I use that word because it might get the Minister’s attention, although it may be the wrong one—with getting people home at every possible opportunity. When I sit with those people, some of whom are desperately lonely, I ask whether that is right for them or whether hospices, community hospitals and other settings would be more appropriate. I want us, as leaders and politicians, to be careful not to create an assumption that home is always the best place, because I do not believe that. It certainly was not for my mum in the last days and weeks of her life.

Addressing some of the challenges requires an uplift in the funding available to hospices across the board, and we must pass on pay increases to nursing staff. I say again that when I go into my hospice, the working environment is very different from that in the urgent care centre, but I have already said that Cornwall is a low-wage area with a high cost of living due to the beautiful environment that we live in, which attracts people and pushes up the cost of housing. It is expensive to live in my part of the world, so nurses are not choosing to leave the hospice setting because they prefer urgent care—obviously, we need them there as well, so I am not trying to discourage that—but because they need the money to live. We should not be saying, at any stage, “It is okay, because hospices are a different environment to work in and they might prefer it there, so they will settle for lower wages.” I hope that we would never assume or expect that.

I met the chief executive of Cornwall Hospice Care soon after the pay award, and he expressed concern that the money being offered to NHS nurses and staff would have a negative impact on hospices and other parts of the system where people are not directly employed by the NHS. I agreed to raise that in the House at the first opportunity, which I have done, and I am grateful for this opportunity to do so as well.

I know that I am among friends when I say that the value of hospice care is not underestimated. The work that hospices do for children and adults is fantastic. They are an essential part of bringing health and social care together and ensuring that people are cared for in the right setting and as close to home as possible. We all know that it is better to be near our families, whatever our health situation, and certainly during the last moments of our life.

As I have said, people are dying in my urgent care centre, which has already been judged as poor for palliative care, when there are beds in the hospice not far away. That must be addressed, and I want the Minister to intervene to put pressure on the system—or systems, at the moment—on the question of why we cannot do more. There has been progress in the last three years towards working better together, but making the right decision is painfully slow for somebody who does not actually have the time for that decision to be made. There have been improvements in working together, and the managers in all the systems in Cornwall, including the hospices, have healthy relationships, but things seem to be getting stuck at ward level, so patients are potentially not getting the best care.

As I have said, hospices now do fantastic work in the community, which has been a response partly to funding but also to need. They are going out into people’s homes to help families and individuals to manage their care properly. I have made fairly clear the two things that are needed to help hospices to deliver that vital role. In the discussions around the NHS pay award, what engagement opportunities have the Minister and the Department had with hospices? Have they been included in discussions about how that can be addressed and passed on? I would love the Minister to look closely at the situation in Cornwall, which will be true elsewhere too, where the money available for hospices is not enough. That is a choice made at a local level by commissioners, not the Department.

We should also assess whether we are making full use of what is available in hospices. If there are 12 beds with people in who are being cared for in the right place, that care is far more cost-effective than if there are eight beds, as is the case in my local hospice. It is not just about throwing more money at hospices, but about making better use of resources. That will reduce the cost of care while ensuring that those people, who have such a challenge ahead of them in the days and weeks to come, are given the care, love and attention that they absolutely deserve and that we would expect in the great nation in which we live.

Social Care Funding

Melanie Onn Excerpts

Wednesday 17th October 2018 Commons Chamber

[Barbara Keeley]

It is really up to the Secretary of State, whose party has not produced any proposals, to answer that. On the point about cross-party working, it is the Conservative party that has no proposals. The only proposals it has come out with are the damaging ones that have now been abandoned.

[Melanie Onn (Great Grimsby) (Lab)]

My hon. Friend is doing a very good job of reminding the Government that they are the ones in power and the ones with the decision-making powers. If they support the Select Committees’ report, they should bring forward their Green Paper and adopt them all in full. They have the opportunity to do that.

I want to ask my hon. Friend about unmet need and the growing gap between social care funding and continuing healthcare funding. I am increasingly seeing severely disabled individuals in my constituency with very high levels of need being bounced from pillar to post between continuing healthcare funding and social care funding, neither of which is meeting their needs. What does she suggest the Government do to bridge that gap?

[Barbara Keeley]

I suggest that the Government start with the cash injection that our social care system needs. The Labour party promised a £1 billion injection upfront to ease us out of the crisis and £8 billion across this Parliament. I suggest that that would be a starting point and that the Conservative party then tell us how it will fund social care in future.

--- Later in debate ---

[Matt Hancock]

Through the Barnett formula, we have made available funding for Scotland today, which in England we are spending on adult social care. I very much hope the SNP Government in Holyrood will make sure they do the right thing by this funding and ensure that it goes to helping people get out of hospital when they medically can leave hospital but need care once they get out. I think we are agreed between us that the SNP Government in Holyrood should spend this money wisely.

[Melanie Onn]

I am keen to learn how much extra my constituency is getting, given that the Secretary of State is doing a roll call of all that. I also wish to ask him about the comments he made about the streams of funding for social care and healthcare. Is he proposing that funding would be ring-fenced? There is a concern that when we try to integrate the two, urgent healthcare will always come before social care.

[Matt Hancock]

That need not necessarily be the case. It was slightly disappointing that the hon. Lady, who is normally a great champion of cross-party working, did not welcome the £780,000 extra for Grimsby, but you can’t win them all. The people of Grimsby need to know that we are there to support them and to support their local NHS.

I now turn to the long-term funding pressures. The lifetime care costs of a 65-year-old today are about £45,000 on average, but those total average costs that people face are not distributed evenly. Some people face no care costs at all, whereas the care costs for someone with dementia who lives into their 90s can run into hundreds of thousands of pounds. As a society, that is the challenge we face, yet right now there is no way to predict or insure this potential financial burden. We are committed to ensuring that everyone has access to the care and support they need. However, as has always been the case, that must be based on the principle of shared responsibility. With sensible planning, people should not have to fear the risk of losing everything. The adult social care Green Paper, which will be published later this year, will bring forward a range of ideas to address the long-term challenge. We want to learn from what has been proven to work, with one example being the auto-enrolment pension reforms, which have been taken forward on a cross-party basis over a decade. The rate of opting out has been remarkably low, and this has put in place the foundations for the strengthening of our pensions system over time. The Green Paper will propose a range of options and ideas, learning from both the UK and from around the world.

Oral Answers to Questions

Melanie Onn Excerpts

Tuesday 24th July 2018 Commons Chamber

[Melanie Onn (Great Grimsby) (Lab)]

What action is the Minister taking to ensure that the National Institute for Health and Care Excellence guidelines on equal access to IVF are adhered to, so that people such as my constituent Rebekah Hambling, who sadly lost her IVF baby to group B strep, are not denied further rounds of IVF in North East Lincolnshire because they would still have been eligible in other CCG areas?

[Jackie Doyle-Price]

I agree with the hon. Lady. It is unacceptable that seven CCGs offer no IVF treatment at all, which is establishing a postcode lottery. We keep reminding NHS England and CCGs of the NICE guidelines and we expect them to follow them.

Learning Disabilities Mortality Review

Melanie Onn Excerpts

Tuesday 8th May 2018 Commons Chamber

[Caroline Dinenage]

My hon. Friend is absolutely right that the workforce in our health and social care system is absolutely fundamental to the way we look after people in our country. We must be able to attract, recruit, retain and bring back into the system people who have left it. We are currently compiling a workforce strategy jointly between Skills for Care and Health Education England, and it will be reporting later in the year.

[Melanie Onn (Great Grimsby) (Lab)]

Parents come to me all the time expressing their grave concerns about what will happen to their children with learning difficulties and disabilities if they are not around to support them. In my constituency I have had reports of instances of bullying from other people in the community, of targeting by drug dealers and of exploitation by private companies such as mobile phone providers and utility companies, and that there are difficulties accessing mental health support. If the Minister is truly keen to show the Government’s desire to improve on the current appalling state of affairs, do not early support and state responsibilities need to be looked at more closely as well?

[Caroline Dinenage]

The hon. Lady is right to make the point more broadly, rather than just about the healthcare outcomes for people with learning disabilities. We need to look at how we protect people more broadly, and this issue must particularly be a terrible worry for the ageing parents. I take on board what the hon. Lady said, and we will definitely feed it into the system to see what more we can do in support.

Social Care

Melanie Onn Excerpts

Wednesday 25th April 2018 Commons Chamber

[Anna Turley]

My hon. Friend raises an important point. Much has been said today about the prestige of the sector and that suggestion would go a long way to addressing that.

[Melanie Onn (Great Grimsby) (Lab)]

To follow up on the issue of training, it is important that people who are going into people’s homes to care for them or who care for people in a home setting have all the training they require to perform the duties that are expected of them. Too often, they are not given the training they need and are expected to do far more than they are qualified to do.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I believe there is a voluntary time limit of seven minutes. We are in danger of spoiling that. If we do, I will have to bring in a time limit of about 5 minutes. I do not want to do that, so I need Members to help me ensure that everybody gets an equal amount of time.

Emergency Services and New Estates

Melanie Onn Excerpts

Tuesday 27th March 2018 Westminster Hall

[Jenny Chapman]

I agree, and I am grateful to see my hon. Friend and other hon. Members present. I regret not asking for more time, because conversations that I have had with hon. Members in the lead-up to the debate have indicated that there is substantially more interest in the problem than I had realised.

Like many young couples, Andy and Charlotte had recently moved into their new property. It was their first home together, in which they dreamt of starting a family. On the night of 11 February 2017, Charlotte found herself in a situation she had never thought she would encounter. Her partner Andy, a fanatical cyclist, had just completed a 50-mile bike ride—he had ridden more than 1,000 miles in the previous year. After settling down for the night, Andy became unwell, and it was later confirmed that he had suffered a cardiac arrest. Charlotte called 999, proceeded to carry out CPR on her husband and spoke to the operator.

Charlotte told the operator that the ambulance crew would need to access her estate via a particular road. Unfortunately, although a property may have a postcode, many homes on the 40,000 unadopted roads on new estates are not visible on the systems used in emergency or first responder vehicles.

As I later found out by sending freedom of information requests to all ambulance trusts, in many cases, emergency vehicle sat-navs are updated only every six to eight weeks on average. Even when updated regularly, the information used to update the sat-navs is only as up to date as that provided by Ordnance Survey. There is no standard process across ambulance trusts or other emergency services. One trust stated that it is

“aiming to update a minimum of every 6 months but sooner if practically possible”.

Thanks to Charlotte’s directions, the paramedics were in the correct area, but the ambulance ended up driving down a lane that led to a river bank with no bridge across to her estate. Charlotte could see the ambulance, but its way was blocked by a five-foot wall on one side and a six-foot fence on the other. The paramedics had no choice but to reverse back up the lane for three quarters of a mile, causing further significant delay.

Charlotte heroically gave CPR to her husband and directions to the operators. Thirty minutes after she dialled 999, paramedics finally arrived on the scene and took control. Their best efforts to resuscitate Andy tragically came too late to save his life.

I applied for the debate because in different circumstances, we would not be having this discussion. It is often the case that, through awful events, faults are identified and can be dealt with. Although nothing can bring Andy back, Charlotte would like his story to be used to stop similar incidents happening in future.

About 200,000 homes were built in 2017. Many hon. Members have such developments in their constituencies, so it is important that we get this right.

[Melanie Onn (Great Grimsby) (Lab)]

Has my hon. Friend given any consideration to earlier action? Perhaps local authorities could better engage with health services, ambulance services and Ordnance Survey at the planning stage.

[Jenny Chapman]

Yes. As I will go on to explain, the problem is that there is no standardised approach, but there ought to be.

At the moment, ambulance trust mapping databases are provided under the national public sector mapping agreement. Under the terms of that agreement, Ordnance Survey releases updates free of charge every six weeks, but it is reliant on local authorities or developers submitting a request. As I mentioned earlier, emergency vehicle GPS systems are updated only every six to eight weeks on average, when they receive a routine mechanical service—though even that is not the case for all trusts. There is potential for delay at several stages of the process.

There is no consistency between local authority areas, and I have found idiosyncratic practices. In one local authority, the ambulance trust said that its way of dealing with the problem was to send its officers along to planning meetings in person so that it could be promptly informed of new developments. Surely we can find a better way of doing it than that.

If different systems operate across emergency services, we miss the opportunity to find a much more collaborative approach. I ask the Minister whether, given the technological advances at our disposal, an auto-upgrade solution is possible. Most of us have self-upgrading smartphones. With lives at risk, surely we must be able to find some kind of new solution along those lines.

The practices of local authorities and developers could be standardised to ensure that they request that Ordnance Survey carries out work when at least one property on a development is occupied, even if the development is not completed and the roads are not adopted. If the postal service and Amazon can find a property such as Charlotte and Andy’s to deliver mail, could procedures and knowledge not be shared in a joint approach?

A good example can be found in the north-west. The North West Ambulance Service Trust response to my freedom of information request stated:

“On new large developments the map is often blank…so the team add descriptive route notes to aid crews. For example, take the first left on to Flower Crescent off New Bridge Street”,

which might be an existing road. That highlights that different and better ways of developing new mapping systems could save such incidents from occurring.

In speaking on Charlotte’s behalf, I want to make it absolutely clear that what happened was in no way the fault of the paramedics or the operator. It is a flaw in the complex system that our emergency services work with. I have called the debate to make the Minister aware of the problem in the hope that he will commit to act promptly to find the best way to resolve it.

To give some additional information, we sent an FOI request to every ambulance trust. I can provide the Minister with the responses we received, so he can see the disparity for himself. London Ambulance Service said that it had recorded 17 of these occurrences during the last three years, whereby crews had encountered difficulties in locating new build properties. The Welsh Ambulance Service recorded four occurrences, but most ambulance trusts just did not record incidents at all, so we do not know how frequently they are happening.

Given the risk to our constituents and the number of new developments, and the fact that this is a completely solvable problem—it does not require additional resource, and requires only someone’s attention to look at the process and organise it—the Minister could commit to action today.

--- Later in debate ---

[The Minister for Health (Stephen Barclay)]

It is a pleasure to serve once again under your chairmanship, Mr Hollobone. I commend the hon. Member for Darlington (Jenny Chapman) for securing this debate. First, I extend my sympathies and, I am sure, the sympathies of all those present, to Charlotte for her loss.

The hon. Lady has used a Westminster Hall debate in the finest tradition, by raising an issue that I was not previously briefed on to the degree that I am now as a consequence. There is ongoing work on it, which I will happily update her and the rest of the House on. She has highlighted an issue that affects all of us in all our constituencies, because as the Government seek to build more housing, this issue will grow across constituencies and have greater reach. Also, as she rightly said, it applies not only to the ambulance service but to the blue-light fraternity as a whole, so I very much commend her for raising the issue.

The hon. Lady showed that she already has an in-depth knowledge of some of the challenges caused by the time lag in how systems are updated. However, I am pleased to reassure her that there is work ongoing in this area specifically. The Department of Health and Social Care is centrally procuring new control room and vehicle communications systems for NHS ambulance trusts, which will be able to update wirelessly. There are questions as to the frequency of those updates, which relates to the point that my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) made about the flow of information from the Department for Communities and Local Government, the planning system and the Ordnance Survey. The ongoing work in the Department is looking at how the central procurement of information into control rooms can ensure that there is a better supply of data about new housing of the sort that the hon. Member for Darlington referred to.

Although the effective deployment and maintenance of GPS systems is, as I am sure the hon. Lady recognises, an operational matter, they are centrally funded systems. As she said, the Department for Business, Energy and Industrial Strategy sponsors the Ordnance Survey, which owns the public sector mapping agreement. That is a 10-year agreement entered into in 2011, which provides the geographical datasets that are used centrally. That information includes data to advise emergency services of the best locations in which to position their vehicles at any given time of the day, based on historic patterns of where they are most likely to be needed. Updates to those datasets are available every six weeks, and the Ordnance Survey is engaged with the emergency services on their specific needs and on whether increasing the frequency of that supply of information would be useful.

As the hon. Lady may be aware, there has recently been a trial, which concluded at the end of February, and the Ordnance Survey is currently analysing the findings of that work in order to develop options. The North West Ambulance Service—not the north-east service—was part of the initial trial, and it has fed its experience into that process. So there is ongoing work on central procurement and also on that trial, examining the issues that the hon. Lady has brought before the House today.

I recognise that the frequency of the updates has been variable, and the hon. Lady was quite right to draw the House’s attention to that. As part of the ambulance radio programme, a replacement mobilisation application has been procured for use in ambulance vehicles across all the NHS ambulance trusts in England. Under that contract, the supplier is required to provide mapping software and an embedded satellite navigation system to assist ambulance crews with the prompt location of emergency incidents. The contract also requires the supplier to provide automated, over-the-air map and satellite navigation updates on a quarterly basis, and to report the current versions of the maps being used for audit purposes.

I am sure the hon. Lady will join me in welcoming those developments. The new system will make up-to-date map and satellite navigation data more readily available to all emergency crews.

[Melanie Onn]

Has the Minister given any consideration to my hon. Friend’s concern about the lack of data that has been collected, and would there be any benefit to collecting that information, to make sure that the new system that will come on-stream is distinctly preferable to the old system?

[Stephen Barclay]

The hon. Lady makes a pertinent point; I was just going to come on to the issue of timing. There are two aspects to this process: the updating of control systems and the updating of vehicles. Different work is happening on both those things, but she suggests a third point to be considered—the data that feeds into those two systems, and the time period between housing development coming on-stream and the systems being updated. Those are the points that I take from her remarks and they will inform further discussions with Government as part of the pilots and the other work that is already under way.

The North East Ambulance Service has improved the processes for updating its mapping system, and I suspect that much of the credit for that goes to the hon. Member for Darlington for raising the issues that she has raised. The trust has upgraded its computer-aided dispatch system and control room mapping updates, and they can now be installed without affecting the wider system, which was one of the difficulties previously. The upgrade allows for six-weekly additions of notifications received from local authorities when new housing estates are opened, better equipping 999 dispatchers to guide ambulance crews to locations when they need assistance. Other ambulance trusts have similar arrangements for updating the control room systems that are currently in place.

The North East Ambulance Service Trust has also improved the frequency of its updates to its individual vehicle mapping systems, moving from an annual update to one every six months. Again, that is not the timeline that the hon. Lady quite rightly highlighted, but it does show that there is a focus on this area, and it shows the direction of travel on improvements.

We recognise that there is variation in the updating of ambulance vehicle systems. That is driven by the fact that different systems are in place in different services. For example, some trusts are able to update their ambulances through wi-fi, while others require lengthy manual updates to be performed during regularly scheduled vehicle servicing. Following this debate, one of the issues that I will be keen to explore further with officials is what will happen as we procure new vehicles. We will consider what can be done to address the issues that the hon. Lady raised today.

The common ambition among ambulance trusts is to upgrade vehicles in a six-month rotation, and we will improve on that rate further with the new national solution. Some trusts have also taken the approach of providing personal-issue tablets with online-style mapping, which can be used by ambulance crews as a back-up to the vehicle’s satellite navigation system and use the most recent commercially released maps.

A range of work is under way within the ambulance service on changes to how calls are triaged and processed, which will address some of the imbalance between rural and urban areas that we have seen in the past. There is work on changes to control room systems and on upgrades. I will happily take forward the point raised by the hon. Member for Great Grimsby (Melanie Onn) about the timescales and about what work can be done and is being done on that.

The hon. Member for Darlington deserves credit within her own trust area for raising these issues as a consequence of the tragedy that Charlotte has had to endure. There is a focus within ambulance trusts across England on the need to ensure that upgrades are made in a more timely fashion. The hon. Lady has rightly brought that point before the House, and I will continue to take it forward with officials in the weeks and months ahead.

Question put and agreed to.

East Midlands Ambulance Service

Melanie Onn Excerpts

Wednesday 21st February 2018 Westminster Hall

[Ruth George]

To be honest, when I was at East Midlands ambulance HQ, the waiting time at Lincoln hospital was seven hours for patient handover. Unfortunately, in those situations ambulances are diverted to where patients who need help urgently can get the care they need. Part of the problem is the handover times, particularly at Lincoln.

The longest 10% of urgent responses took more than 82 minutes, which is twice the target of 40 minutes. For category 3 urgent calls, 10% of East Midlands calls took more than three hours 22 minutes against a target of two hours. In practice, that means that people who are very seriously ill or in pain are waiting hours and hours for an ambulance. My constituent, Debbie, contacted me on Saturday night at 10 o’clock. Her 82-year-old mum had a hairline fracture of her hip. It had not been diagnosed, and suddenly her mum found herself in excruciating pain and unable to move. Despite calls to 111 and then 999, there was simply no ambulance available.

It was only when Debbie called at midnight and said that her mum was passing out of consciousness due to exhaustion and pain that the call was upgraded to category 2 and the ambulance arrived 20 minutes later. By then her mum had been waiting in agony for more than nine hours. The ambulance crew apologised, but they had been on more urgent calls the whole time. Debbie and many other constituents have contacted me to ask, “Why is this happening?”

A few weeks ago, I visited the ambulance control centre at Nottingham to see the management of East Midlands ambulance calls across the whole region. It was a Friday lunchtime, but even at that time the emergency calls and urgent calls were stacking up. I listened in as people were calling back to find out how long an ambulance would take. Health professionals, families, neighbours and shop assistants were all caring for someone who was seriously ill and needed an ambulance. They were undergoing hours of pain, worry and uncertainty.

From that experience and from speaking to local paramedics and East Midlands ambulance managers, it seems that there are four key reasons for the issues. The first is our geography. East Midlands ambulance covers a huge area, from the border of Manchester in my constituency to the shores of Lincolnshire. It has the second lowest population density in England after the south-west, but also the second-lowest investment in transport infrastructure after the north-east. It is not only a large region; it is hard to get around.

Secondly, when ambulances do get their patient to hospital, they encounter some of the longest waits for transfers. In 2015-16—the latest figures that we can obtain—only 44% of handovers in the east midlands were completed within 15 minutes, compared with 58%, on average, across England. This winter, handover times in some hospitals have got much worse. At my constituents’ local A&E at Stepping Hill, ambulances were waiting for more than three hours. At Lincoln hospital, it was more than seven hours. When vulnerable people are waiting in severe pain for an ambulance, to have them queued up outside hospitals unable to hand over their patients is incredibly frustrating.

The third issue is the level of demand. In the east midlands, the number of responses rose from 222,000 in 2011-12, to 335,000 in 2016-17—an increase of more than 50%.

[Melanie Onn (Great Grimsby) (Lab)]

I thank EMAS for coming to meet with the northern Lincolnshire and Lincolnshire group of MPs last year, when we were concerned about ambulance provision. Subsequent to that, paramedic Lee Hastie gave an account to the local Grimsby Telegraph about his experiences, particularly in relation to demand for ambulance services, saying that most of his calls on an everyday basis now relate to drug and alcohol abuse. Does my hon. Friend consider that cuts to local government drug and alcohol services have gone some way to increasing the demand on our ambulance services? They are essential services that, at a community level, simply are not there any longer.

[Ruth George]

I would certainly concur with that statement. It is one of many areas in which the lack of services at an urgent level is creating an increased demand—but in no way has East Midlands ambulance service’s funding increased to cover that level of demand, as we will see later.

Part of the increase is due to the 111 service. We saw the chaos that 111 created when the coalition Government brought it in to replace Labour’s NHS Direct with a much cheaper service with hardly any clinicians. Things have improved, but at busy times the 111 service still does not have enough qualified staff to make decisions, so the call-handlers have to be risk-averse, follow their script, and call out an ambulance if there is any doubt at all.

We have seen the number of 111 calls resulting in an ambulance call-out gradually increase from 100,000 in 2011-12 to 1.3 million across England in 2015-16. That is almost 14% of all ambulance call-outs going to people who did not request an ambulance in the first place—people such as my constituent Gemma. She suffered abdominal pain and called 111 for an out-of-hours doctor to come and see her. Even though Gemma told the call-handler that if she needed to get to hospital she would drive herself there, they still sent an ambulance to her. Gemma was diagnosed with gallstones, and next time she had an incident and needed pain relief urgently she again called 111 to tell them that she knew what the problem was and to ask for a prescription. Instead, they again insisted on an ambulance and would not accept a refusal. Gemma actually drove herself to A&E because she was so determined not to use ambulance time.

The ambulance service says that it is not allowed to reassess 111 calls that have been allocated for an ambulance response, so even if it expects that it is not necessary, it cannot use its expert clinicians to provide the telephone advice and decide whether an ambulance is really necessary. I will get on to the question of resources shortly, but besides resources, my local paramedics have asked whether the ambulance service can reassess 111 calls that it is given if it is in any doubt. I put that question, from them, to the Minister.

Oral Answers to Questions

Melanie Onn Excerpts

Tuesday 6th February 2018 Commons Chamber

[Jackie Doyle-Price]

The hon. Lady is quite right to press me on these issues. Clearly, there is going to be ongoing trauma, and we need to pay attention to that and make sure that there are adequate resources. I can assure her that this is very high on the list of priorities for the ministerial group. We have committed £23.9 million of national Government funds to address survivors’ needs, with additional expenditure on wider support. The autumn Budget committed a further £28 million to help support victims. I can also assure her that I am in regular contact with Central and North West London NHS Foundation Trust to make sure that we are doing our bit to address this need.

[Melanie Onn (Great Grimsby) (Lab)]

2. If he will make an assessment of trends in the time taken between referral and treatment for patients at hospitals in Northern Lincolnshire and Goole NHS Foundation Trust in the past 12 months.

[The Minister of State, Department of Health and Social Care (Stephen Barclay)]

In the past 12 months, the average waiting time for patients to start consultant-led treatment at hospitals in northern Lincolnshire and Goole was about nine weeks. We recognise that some trusts face particular challenges with their waiting lists due to rising demand. That is why a package of support, including a system-wide improvement board, has been established within the trust.

[Melanie Onn]

The statistics that the Minister has given are very interesting. The Library has said that there is an average wait of 32 weeks—far longer than the nine weeks that he mentioned—and that it is six weeks longer in 2017 than it was in 2016. This is happening on his watch. What is he going to do? My constituents do not accept that it is good enough.

[Stephen Barclay]

I think the hon. Lady prepared her follow-up before hearing the answer. There is an improvement board established within the trust, chaired by NHS Improvement, that is tasked with reducing waiting times and ensuring that the standard is improved. Currently, the average time waited is 11 weeks for out-patients and seven weeks for in-patients.

Hospital Car Parking Charges

Melanie Onn Excerpts

Thursday 1st February 2018 Commons Chamber

[Melanie Onn (Great Grimsby) (Lab)]

I am very grateful to be able to take part in this important debate. I congratulate the right hon. Member for Harlow (Robert Halfon), my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy), and my neighbour, the hon. Member for Cleethorpes (Martin Vickers), on securing it.

Diana, Princess of Wales Hospital in my constituency provides a range of helpful wellbeing services. The site has an A&E, a dialysis unit, a child development unit, a nursery, an eating disorder unit, and health education spaces. It covers a huge range of services that deliver to a very wide community. There are two main areas that I want to address: first, the difficulties and challenges for patients caused by ever-increasing parking tariffs; and, secondly, car parking issues for staff, which have been raised with me on a number of occasions when I have been at Grimsby’s hospital.

In Grimsby, I can go and park in the Iceland car park, in the centre of our town, for £1 an hour. If I need to park for more than two hours, I might go to the Abbey Walk multi-storey, again in the centre of town, and pay £3.50 for the privilege of four hours’ parking. Having worked in places like York, I know that I should be very grateful for the seemingly small amounts that it costs to park in the centre of our town, so I count my blessings. When those smaller amounts are set against what people are expected to pay in hospital parking charges, it feels very much to my constituents as though the NHS is over-inflating the expense and putting an unnecessary burden on patients and families.

The charge for an hour’s parking at Diana, Princess of Wales Hospital has recently increased to £2.10— £1.10 more than in the centre of our town. If I go to the hospital to pick up a prescription, it might take—on a good day, admittedly—just a few minutes to collect the prescription, but on top of the prescription cost, I am paying another £2.10 to do so. Last week, I went for a blood test. I walked in, got my ticket, checked on the screen, and saw that there was a wait of about 68 minutes. It took me a matter of minutes to get the blood test, but the sitting in the waiting room lasted about 68 minutes. The cost of that visit was therefore £3.50. I am not bemoaning the cost to my personal pocket. I can afford it, but many in my constituency cannot, and the cost is prohibitive.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

Does my hon. Friend agree that, as well as the issues that have been raised powerfully so far, the example she gives shows the opportunity for greater flexibility? In Hounslow, for example, free half-hour parking has been introduced to support local businesses. It is the same for leisure centres. We need to be proportionate as we consider the overall issue, and that is what was can do today.

[Melanie Onn]

My hon. Friend raises an important point. There is room for flexibility, and all trusts should be looking at what they can do to make parking less prohibitive so that people are not put off.

It is galling for my constituents to know that parking charges are much lower in other areas of the town. Local authority car parks, shops and private parking companies all have the same issues of maintenance, lighting and security, albeit to different degrees, but they are not charging that high rate. It feels very much like profiteering off the back of people who have no choice but to be at hospital, whether that is for themselves, their friends or their relatives. The trust offers concessions through lower costs for blue badge holders, although they are not exempt from charges, as well as for parents who are staying overnight with poorly children and those having cancer treatment. That is, of course, incredibly welcome. However, when the justification for the charges is that they pay for the maintenance of the site, it really does not stack up, given the costs of other paid parking sites in the town.

An automatic number plate recognition system was recently installed at the Diana, Princess of Wales Hospital, which led to even more frustration and concern for constituents. While that fantastic new automated system was supposed to make the process a lot quicker and easier for people, all it did was to cause additional delays and costs. After spending time in the waiting room, as I had to, people had to come out to try to pay for their parking with the new machines. It caused absolute havoc, and there were queues going around the block, and people ended up tripping over into the next pay band and paying even more. The process caused an extraordinary amount of frustration and reflected very poorly on the trust, which is a real shame.

The knock-on effect of the charges is that surrounding streets, such as Second Avenue, Edge Avenue and Limetree Avenue, which are all residential streets with limited on-street parking, get filled with the cars of patients, staff and people attending the hospital. I know that there is nothing illegal about that. There is nothing wrong with people parking in those residential streets, but it really irritates residents if a parked car crosses a dropped kerb or impinges on people’s driveways. That is not only incredibly frustrating, but it gives rise to increased concerns about road safety, especially in school hours.

The right hon. Member for Harlow addressed very well the broader point that people with disabilities or long-term illnesses are generally financially worse off than the rest of the population. The additional cost represents a significant inconvenience and potential hardship for people who can least afford it.

Hospital staff have increasingly been talking to me about this issue. There have been discussions with staff about increasing the amount that they already pay to go to work. An increase has been postponed for now, but the opportunity for it to be brought back next year is, I understand, very much on the table, and the increase will be significant. As the right hon. Gentleman indicated, the people affected will be not just consultants or senior executives who might be earning a very good wage. We are also talking about porters, healthcare assistants and medical secretaries—all the people behind the scenes who keep the hospital going—being expected to pay even more.

The frustrations for staff are immense. They say that they already struggle to get a parking space, not least because some shifts overrun. The likelihood that someone might do an eight-hour shift in the NHS at the moment is frankly negligible. Most people, through their own good will, are giving more to the NHS and working beyond their shift. They do not want to leave their patients in the middle of an incident. The number of parking spaces available is therefore reduced, and people are leaving home an awful lot earlier—an hour to an hour and a half earlier—than their shift starts, which increases their working day immensely.

Most of this is not just about travel time. I know that the roads are congested around the Diana, Princess of Wales Hospital, but that is not the only issue. There is also the problem that people are driving around car parks trying to find a space. It is incredibly frustrating that people are paying for a space at work and cannot get one, and sometimes that is even making them late for work.

[Royston Smith (Southampton, Itchen) (Con)]

The hon. Lady makes a very good point about congestion, with people trying to find parking spaces and there not being enough. Would a compromise be for hospitals to charge a reasonable flat rate, rather than abolishing charges completely, which would exacerbate the very situation she is describing?

[Melanie Onn]

That is certainly worth looking at. We need a system that does not put people off attending their appointments, and that certainly does not prohibit people going to work or cause them to arrive late. Any suggestions that would allow us to reach a sensible solution would be very welcome.

Finally, I will conclude by saying that all car parking charges should be set in the context of a long-term transportation plan that includes park and ride systems, as well as increasing people’s ability to use public transport, cycles and everything else. The reality is that not enough has been done on any of those things to enable people to use alternative methods of transport that will get them to work at the time they need to be there, or to appointments at the time they need them, so it has all been for nothing. The charges are incredibly prohibitive because no other methods of easy, regular transport suit the patients and the staff.