Covid-19

Munira Wilson Excerpts

Monday 16th March 2020 Commons Chamber

[Matt Hancock]

Yes, most people recover within seven days of first showing symptoms—most people, not all. Many become very ill, but for most people this is a mild to moderate illness, and the vast majority of the evidence is that once they have recovered, the illness does not come back for some time. Of course, all the evidence is kept constantly under review.

[Munira Wilson (Twickenham) (LD)]

Will the Secretary of State clarify some details of his answer to the hon. Member for Tooting (Dr Allin-Khan) regarding testing of our frontline healthcare workers and, just as important, our frontline social care workers? Our services are stretched to the max already. We cannot afford to have those who do not need to self-isolate self-isolating, potentially multiple times if they do not know whether they have had the virus.

[Matt Hancock]

I entirely understand that point. I want to get testing to everyone who needs it as soon as possible.

Coronavirus

Munira Wilson Excerpts

Wednesday 11th March 2020 Commons Chamber

[Matt Hancock]

Yes, absolutely. My hon. Friend has brought that to my attention before. We have done research into it, and we are working with over two dozen commercial companies that have tests of this kind. In fact, I had a meeting on this today.

[Munira Wilson (Twickenham) (LD)]

I welcome the Secretary of State’s focus on social care. Will he clarify how much of the additional spending in today’s Budget will go into social care? Will PHE issue protective equipment to careworkers? His statement referred to adult social care. There are many sick children in this country who are reliant on care. Will he ensure that children’s needs are not overlooked? I wrote to him about that earlier this week, and I would welcome clarification.

[Matt Hancock]

As the hon. Lady knows, guidance is coming out this week. She is right about the importance of protective equipment, and of course, we are taking that into account. The Chancellor set out that more money will be available in social care if it is needed—and I expect that it will be—and announced a total of up to £5 billion for the NHS and social care, while saying that his door is open should more be needed. These are all very important considerations, and the guidance will be out shortly.

Oral Answers to Questions

Munira Wilson Excerpts

Tuesday 10th March 2020 Commons Chamber

[Helen Whately]

My hon. Friend will be aware that already some of the funding that adult social care receives is through a council tax precept, but I would be delighted to meet him as part of the cross-party talks we have initiated to address the challenges in social care.

[Munira Wilson (Twickenham) (LD)]

There are numerous reports of people with symptoms of coronavirus being refused a test by 111 because they cannot name an individual who has been diagnosed with the virus. Yesterday the Secretary of State’s ministerial colleague, the noble Lord Bethell, said about 111 that there must be people who had had “bad experiences”. Will the Secretary of State confirm whether it is indeed policy not to test those with symptoms who cannot be contact traced, or whether many people are simply having a bad 111 experience?

[Matt Hancock]

The 111 protocols are of course driven by the clinicians. I will look into the specifics of the case that the hon. Lady mentions was raised in the other place yesterday, but we keep those protocols under constant review—not least as the epidemiology of the virus changes as the number of cases increases—to ensure that we have the very best advice.

Health Inequalities

Munira Wilson Excerpts

Wednesday 4th March 2020 Commons Chamber

[Dr Whitford]

If the right hon. Gentleman waits to hear the rest of my speech, I will highlight some of the differences in child poverty.

We have seen life expectancy for those women falling, but when we look at healthy life expectancy, the gaps are even bigger. Time spent in poor health is increasing, and that of course puts pressure on the NHS and care services. We in this Chamber are always discussing the pressure that the NHS is under. Emergency admissions in areas with low life expectancy are double the numbers in wealthier areas. Women in deprived areas will now spend two decades or more of their life in poor health. Improving the healthy life expectancy by at least five years was actually a policy in the industrial strategy, so that people could be active and engaged in the economy, but what we have seen is an adverse effect both on health and health equality.

We know that someone’s health for most of their life is determined in the early years, even starting when their mother is pregnant. Child poverty is central to this and it is rising. It is defined as children in households with less than 60% of median income. England had child poverty down to 27%, but it is now 31%. Scotland had it down to 21%, and it is now 24%. That is because welfare changes are taking place right across the UK. Poverty is decided in this Chamber; it is not decided anywhere else, and the Scottish Parliament, as we have heard, spends a lot of energy on trying to mitigate it.

As we know, housing costs are a major contributor because of the shortage of housing. This is a rising issue among the poorest: 38% of the poorest will spend 30% or more of their income on rent or housing. That figure was 28% 10 years ago. The Scottish Government have built 87,000 affordable houses, and that is part of why our child poverty level is lower. It is the housing impact. In the 2015 general election, the Conservatives promised 200,000 starter homes. They built precisely zero.

Some 4 million children are growing up in poverty, and that will affect their whole lives. Whenever the issue is raised at the Dispatch Box, we are told that unemployment is down and that people must work their way out of poverty. We are told that that is how we change things, yet two thirds of those children already have a working parent. The problem is that all of this drives ill health.

[Munira Wilson (Twickenham) (LD)]

Does the hon. Lady agree that children living in poverty are more likely to suffer mental health issues? They face a double whammy, as the Children’s Commissioner recently found, in that there is also a postcode lottery in spending on children and young people’s mental health, which varies between about £15 and £200 per person, depending on the area.

[Dr Whitford]

I totally accept that, and actually, children in low-income families have three times the rate of mental health problems. Three-year-olds in a household with an income of less than £10,000 have two and a half times the chronic diseases, and by the time they start school, we find that the poorest children have over a year’s gap in vocabulary. It is important to try to balance that. That is one reason that the Scottish Government are investing in early learning for all children—all three-year-olds and four-year-olds and vulnerable two-year-olds—and also have put in a pupil equity premium that allows the school to have additional funding to try to meet the challenge where they are serving poorer communities.

The problem starts before the child is born. A woman carrying a female child is carrying her grandchildren, because the eggs in a female are formed in the womb. That means that if that mother is badly nourished, she will be affecting health for the next two generations. That needs to be changed, which is why we have invested. We have the best start grant, which goes to the pregnant woman at birth, when the child starts nursery and when the child starts school. There is also food support, because we need to change this right at the start of life.

Health and wellbeing should be an overarching priority for any Government and for all their citizens, regardless of where they live. This requires a “Health in all policies” approach, not saying, “Clean air is DEFRA’s issue.” We need this as a cross-government policy whereby every decision is checked to see whether it will improve the physical, mental and environmental wellbeing of the citizens the Government are responsible for.

Medicines and Medical Devices Bill

Munira Wilson Excerpts

2nd reading & 2nd reading: House of Commons & Money resolution & Money resolution: House of Commons & Programme motion & Programme motion: House of Commons & Ways and Means resolution & Ways and Means resolution: House of Commons
Monday 2nd March 2020 Commons Chamber

[Chris Green]

That is a significant concern. The Government have reduced the starting point in the immigration Bill from £30,000 to about £25,000 and I believe the points-based system will have the flexibility we require, but those areas should be judged and reviewed as time goes on. Certainly in these sectors we want highly qualified, highly skilled and highly experienced people to come to the UK.

One big concern in medicine is data. A lot of what we do in medicine falls into the category of big data: the acquisition, transmission, storage and application of that data. This is a really interesting time for technology. The devices themselves are able to generate good quality data. As has been highlighted, it is now so much easier for personal devices to be worn not just for a few hours or a couple of days, but for a long period of time. People are now able to go about their daily lives in a normal way, whether they are exercising or doing something as basic as having a shower. Some devices could not previously cope with people taking exercise or having a shower, but increasingly, devices are able to cope. They can amass a vast amount of data. It is pretty much impossible for a clinician or a GP to judge such a huge wealth of data, so we are increasingly looking at how GPs and hospital consultants can use artificial intelligence and other methods to give them a helping hand in carrying out the assessments. They might end up with tens of thousands of pages of data and a consultant just will not have time to consider it all. Using artificial intelligence could help them to do the assessments and come to conclusions.

[Munira Wilson (Twickenham) (LD)]

Does the hon. Gentleman agree that all Members, on both sides of the House, still have a big job of work to do with the public to inspire confidence in how their data is used in an appropriate and anonymised way? What he is saying is really important. Data saves lives and can improve outcomes, but there is, understandably given previous experiences, a great deal of suspicion among the public about how their medical data might be used.

[Chris Green]

That is an incredibly important point. We need confidence that when data is taken, it is secure, protected and anonymised in the appropriate way, and that only the right organisations have access to it. I believe that data is a key area for the NHS and what it ought to be able to deliver. The NHS should be a huge repository of data, and universities, charities and businesses, with the appropriate controls, ought to be able to use it. As we move on—perhaps a particular aspect relates to rare conditions—the size of population needed in order to gather and analyse that data will increase. I hope my hon. Friend Minister will take note of this point and perhaps elaborate on it at the end of the debate. We need to ensure that our relationship with the EU will enable us to continue to collaborate on clinical trials and that data transmission across the European Union, and across Europe more widely, is efficient and effective.

--- Later in debate ---

[Munira Wilson (Twickenham) (LD)]

I must start by declaring an interest: before arriving in this place, I spent some nine years working in the pharmaceutical industry for two European companies, and I continue to hold a small number of shares granted to me by Novartis Pharmaceuticals Ltd.

Although I and my party support this legislation, clearly it is important that the UK should have the ability to regulate human medicines, veterinary medicines and medical devices following the end of the transition period. It will not surprise Members to hear me say that we believe it is extremely regrettable that we are even in this position in the first place. Clearly, in terms of ensuring that British patients have safe and swift access to medicines and medical devices, and ensuring our life sciences industry continues to remain competitive, our interests would have been best served by staying in the EU. That is why we will continue to fight tooth and nail against a hard Tory Brexit, despite the reckless and threatening approach to negotiations being taken by this Government. A hard, no-deal Brexit at the end of this year could spell catastrophe for British patients and the life sciences industry.

My main concern is that the provisions of this Bill could allow for significant regulatory divergence for medicines and medical devices from the rest of the EU. The medical research community and manufacturers are united in their call for the UK to remain as close as possible to the EU, preferably through negotiating associate membership of the European Medicines Agency. Any divergence from European regulation should take account of three principles: patient safety; early access for British patients to the latest innovations; and the competitiveness of the UK life sciences sector. In using the powers of this Bill to seek any divergence from the European regulatory framework, the No. 1 consideration should always be protecting patient safety. Any bid to make a UK stand-alone regulatory system more competitive than Europe must not seek to undercut the EU in safety standards, be that in terms of clinical trial regulation or the hurdles a new medicine, vaccine or device must clear to secure marketing authorisation or accreditation in the UK.

I would also take this opportunity to urge Ministers to consider, as they enter into negotiations with the EU, the critical and indeed life-saving importance of remaining part of the EMA’s pharmacovigilance network. By collecting and sharing real-time data on approved medicines, the EMA is able to identify trends and quickly take actions to inform patients and health professionals about safety concerns. By remaining part of a network across 28 countries rather than just the UK on its own, our network would have far wider coverage, with a far greater number of patients using a drug, thus increasing the likelihood of the data collected being more accurate, and concerns being picked up at an earlier stage. Related to that point, I wish to highlight the shocking and wanton disregard for public health and safety that we have heard from the Government about wanting to withdraw from the EU’s early warning system on pandemics, given the serious global challenge we face on coronavirus. Even the Government’s former Minister Baroness Blackwood has been saying in the media today that that is not the way forward to ensure that we protect patient safety. We all know that disease knows no borders, so it is ridiculous and isolationist, as the hon. Member for Central Ayrshire (Dr Whitford) has said, to withdraw from that system.

The second principle to consider when using the powers within this Bill to diverge from European regulation is ensuring that British patients continue to have swift and early access to the latest innovations. I welcome the Government’s intention to use these provisions to ensure that NHS hospitals are able to manufacture and trial the most innovative new personalised and short-life medicines. The UK should be at the cutting edge of supporting those pioneering new treatments to be made available to British patients. However, we must not forget that the vast majority of medicines, and indeed devices, coming through the pipeline are not in that category. Any significant divergence from the EU regulatory framework will inevitably lead to delays in new technologies being made available to British patients.

As has been mentioned, the maths is obvious: the EMA covers 25% of global medicines sales, whereas the UK on its own makes up only 3%. Companies are likely to submit applications for new drugs to the EMA before the MHRA, meaning that UK patients risk having slower access to the latest medicines—we see this with Switzerland, Canada and Australia already. How will the Government ensure that the MHRA’s processes remain among the fastest in the world, while maintaining patient safety? The hon. Member for Newton Abbot (Anne Marie Morris) implores us to be a leader in that regard, not a follower, but it makes no commercial sense for us to be outside the European regulatory framework. I know that from my personal experience of working on the dreaded Brexit taskforce when I was in industry. My European regulatory colleagues were not in the slightest bit interested in helping me and British colleagues define, and then represent to Government, what a competitive new divergent system might look like. Understandably, commercially their priority was and remains the 445 million inhabitants of the other EU27, as opposed to the 66 million or so in the lone ranger that is the UK. That point is not lost on Cancer Research UK, which has specifically called for clause 2(1) in part 1 of the Bill to be used to facilitate UK recognition of and participation in the EMA’s medicines licensing processes.

One of the earliest ways that patients gain access to the latest innovations is through clinical trials. The Bill could be used to amend the regulations that govern clinical trials in the UK. It is worth noting that the number of trials conducted in the UK has fallen since 2016, with the UK falling behind the USA, Germany, Canada and Spain for phase 3 commercial clinical trials. Although there is an opportunity to make the UK more attractive for clinical trials, any such opportunity must not come at the cost of patient safety, and high standards should be maintained. Any stimulation of the clinical trial environment must include continued UK-EU collaboration on trials, which is critical for trials involving medicines for rare diseases or children, in respect of which the population in any one country is not sufficiently large for a trial. Furthermore, the EU’s clinical trials regulation, which is due to be implemented in 2022, should accelerate trial setup times, improve safety reporting and facilitate collaborative research, because of the digital infrastructure that underpins it. The UK played a pivotal role in developing the CTR and our patients would benefit greatly from it being implemented here.

My third point is closely connected to my previous point: any divergence from European regulation should take account of the competitiveness of the life sciences sector, which successive Governments have often described as a “jewel in the crown” of UK plc. Our remaining an early launch market by keeping in step with EMA is key to our continuing to attract high levels of foreign direct investment into the UK from pharmaceutical companies. Any additional burden on applying for marketing authorisation for medicines, or a separate system for the accreditation of medical devices in the UK, away from the CE marking scheme, will make the industries less competitive. Also key to competitiveness is the securing of frictionless and tariff-free trade as part of the negotiations with the EU. That is critical given the integrated and complex cross-border supply chains in the manufacture of medicines and medical devices.

To summarise, the Bill is necessary in view of the UK’s unfortunate decision to leave the EU. However, I urge caution on Ministers in respect of how the powers in the Bill are used. British patients must be kept safe, they must be able to access the latest medicines and technologies at the earliest opportunity, and we must not undermine the thriving life sciences industry in the UK. The Government’s quest to make the UK a Singapore-style regulation-light country must not see us undercutting safety standards in a bid to improve our competitiveness. As the Government seek to negotiate a trade deal with the EU, the way to safely ensure that British patients can access the medicines and technologies that they need, and the way to keep attracting industry investment into the UK, is by remaining as close as possible to the European regulatory regime.

Wuhan Coronavirus

Munira Wilson Excerpts

Tuesday 11th February 2020 Commons Chamber

[Matt Hancock]

It is difficult in a country dealing with a very large-scale outbreak, as China is, for the information to be completely accurate. However, a report published in the last 48 hours of a study of 1,099 cases from China has demonstrated that in those cases, the number of children who have been affected and symptomatic is very small. That gives us hope—and some evidence—that the impact is largely on the elderly and frail, less so on people of working age and much less so on children, which is a very good thing for children themselves and for everyone else, because with the flu, if children are spreaders, they tend to spread fast. That is the latest scientific advice coming out of China, although given the nature of the challenges the Chinese health system is facing, it is difficult to get an entirely clear picture.

[Munira Wilson (Twickenham) (LD)]

The Secretary of State has fielded various questions on the timescales for a vaccine. If I may be so bold, the chief medical officer told MPs last week that nothing less than a year should be promised for the development of a vaccine or treatment. Does he agree, therefore, that this is very much a long-term solution and that we must redouble our efforts on the public communication campaign on preventive and self-isolation measures?

[Matt Hancock]

Yes, I do. On isolation, in particular, the two go hand in hand. People can play a part in combating this virus by washing their hands and using tissues and, if they are symptomatic, by calling 111 before going to a doctor and self-isolating when necessary.

NHS Funding Bill

Munira Wilson Excerpts

Legislative Grand Committee & 3rd reading: House of Commons & Legislative Grand Committee: House of Commons & Programme motion: House of Commons & 3rd reading & Programme motion
Tuesday 4th February 2020 Commons Chamber

[Anne Marie Morris]

That point is extremely well made. Let me say, if I may, that there is also a challenge for any Government to be able to properly ascertain what the actual need is. There is a lot of hidden need. In rural communities such as mine, the real challenge lies with isolated elderly people and with lone workers—whether it be a farmer or a policeman. We know that farmers have the highest rate of suicide of any profession. Much of that mental health challenge is not understood or measured, which makes it critical that we look at that need and then, as my right hon. Friend sets out, make sure that what we do properly meets that need. He is absolutely right.

[Munira Wilson (Twickenham) (LD)]

I agree with the hon. Lady’s point about measuring outputs as well as inputs, but does she agree that one of the big challenges with CAMHS is the real dearth of data? There are many gaps in the data that is collected. I make this point advisedly, because there is another challenge in gathering more data. I have been lobbied in my own constituency by a charity supporting children and young people with mental health issues. Its funding has been put under threat by NHS England unless it starts to report the date of birth of the young people accessing its service and other information, which then undermines the anonymity that it guarantees to those children and young people, so reporting on the outputs is not actually that straightforward.

[Anne Marie Morris]

The hon. Lady makes a very good point—I think there are probably two points there. The first is what we should be measuring and when, and the second is about data and the privacy issue. The points are related, but separate. The first one, which is about measurement, is a point very well made. Certainly, the point at which my constituents are counted as being in the box and in need and being referred for mental health can be very far down the line from their first presentation. The figures will often not properly represent the number of people who are actually in need, so I think she is right that we need to be clear at what point we measure an individual coming into the system. I am not clear from what I have heard anecdotally that it is. Some clarity and perhaps an investigation into that would be very helpful. The hon. Lady’s point about privacy is a much broader issue, and I think it would be beyond the scope of this debate to look at it now. The point was well made, but it is a much bigger point for another day.

Through new clause 9, I am asking for an annual report that would show how mental health provision has improved. Such a report would state how we identified what we included in the mental health bucket that I mentioned; how we identified who is in need; how we measured whether that individual received an intervention, and whether any such intervention was timely; whether the individual’s condition has improved or got better; and how any improvement has been assessed, because that can be a very difficult question. I appreciate that for many individuals with mental health concerns, these are lifelong conditions. We would therefore not simply be measuring whether somebody is “cured”, but looking at the level of improvement and the extent to which the intervention has helped—or not helped—that particular individual. It is very complicated.

My new clause would require the Government to look specifically at how we are going to measure the extent to which we have been able to prevent mental health problems. Specifically, we need to start looking at the support we give in schools, to pregnant mothers and in many other situations. This provision would also require information on how we have diagnosed mental health problems. Too often in constituents’ cases, I find that it is only when a diagnosis is finally and formally made that there is any intervention or help. I have heard from a number of parents of young children and teenagers who have faced problems such as eating disorders and attempted suicide, but much to my concern and that of the parents, as no diagnosis has yet been made—because they cannot get an appointment and so on—the individual youngster who is self-harming is not yet considered to have a mental health problem. The consequence is that they do not get the support and assistance they need, so diagnosis is very important.

--- Later in debate ---

In the context of the Bill, we must remember what we are here for. I speak with generosity to Labour Members who I know care deeply about the NHS, but we are not here to try to score points; we are here to improve the state of our NHS. Everybody recognises that this is a good Bill, yet many of the amendments appear designed to create some sort of artificial dividing line between Members on this side of the Committee and that side, regarding who cares the most about the NHS or mental health. I urge all hon. Members to remember that the purpose of this Bill is to increase funding to our NHS and improve our mental health services, and I therefore do not support the amendments.

[Munira Wilson (Twickenham) (LD)]

I wish to speak to new clause 2, which is tabled in my name and those of my Liberal Democrat colleagues. As you know, Dame Rosie, I intended to push the new clause to a vote, but I understand that time pressures will not allow me to do so. I am disappointed by that, but I will be pressing the Government on this issue time and again. I want them to make it a high priority and to put it at the forefront of their policy making and commitments to the mental health of children and young people.

It is a pleasure to hear such a unified voice across the Committee about the importance of mental health, and there is a clear commitment to parity of esteem and to ensuring that mental health across the board gets the funding it deserves. I am therefore encouraged by the amendments, many of which I and my colleagues will support.

New clause 2 focuses specifically on the crisis—I used that word advisedly—in the provision of child and adolescent mental health services. It places a spotlight on the chronic underfunding of CAMHS, and seeks to encourage the Government and NHS England to deliver on their promises and improve transparency and accountability on those priorities.

Before I arrived in this place, I was aware of this significant and pressing issue. Less than two months since my election, however, I am utterly horrified by the cases of children and young people in crisis that cross my desk on a weekly basis—or more often—either through my surgery, my inbox, or anecdotally when speaking to acquaintances and contacts in my constituency and well beyond. New clause 2 seeks to make the Government and NHS England more accountable for the funding that they provide annually to CAMHS. That is very much in the spirit of the Bill. The Government are seeking to codify their promised expenditure on the NHS, and the new clause seeks simply to do the same thing in this important area, given that a number of welcome commitments have been made about CAMHS spending.

There are concerns that that funding is not reaching the frontline. Indeed, the evidence is clear. Just last week a report by the Children’s Commissioner stated that many CCGs are spending less than 1% of their mental health budget on children and young people. In 2017, the CQC revealed that CCGs have prioritised adult mental health over CAMHS because of the need to ration services. Other amendments seek to talk about mental health more broadly, but that is the reason why we need a particular spotlight on children and young people’s services.

The phrasing of new clause 2 seeks to ensure accountability against the ambitions of the long-term plan. Subsection (2) would help to demonstrate whether the promises on the growth of CAMHS spending outstripping mental health spending, and NHS spending across the board, are kept.

Subsection (3) shines a spotlight on regional variability. The Children’s Commissioner’s report last week talked about the enormous postcode lottery of spending on services. The numbers cited were staggering. In terms of low-level services, they ranged from 72p in some areas to £172 per child. On specialist services, they ranged from £14 to £191. We all expect some level of variation, but I am sure the Government would agree that that level of variation is utterly unacceptable. It needs to be tracked very publicly, so that spending and services can be improved to meet need.

Why is that so critical? As has been stated by various Members, half of all mental health problems are established by the age of 14. We know that 1.25 million children and young people had a mental health disorder in 2017. We have heard that since 2010 there has been an increase of 330% in admissions to A&E of children and young people diagnosed with a psychiatric condition. We know that only one in four children and young people is being seen by a specialist when they need to.

It is very easy to cite statistics, but behind them are individuals: children and young people and their stories. The stories I have heard are of teenagers self-harming, teenagers who are suicidal, teenagers who are a danger to themselves and their families, and young people who are excluded from school or are taking themselves out of school because of their mental health conditions. One piece of correspondence I received from a parent talked about her 17-year-old being referred for specialist treatment last November. He might be assessed, if he is lucky, in March and he will not get treatment for four to six months after that. That cannot be right. This child has at times been suicidal. I have also had a case of a 10-year-old with tier 3 needs waiting a similar amount of time for the initial choice assessment, who will be waiting a similar amount of time again for treatment.

We have had many plans, many vision documents and many strategies setting out wonderful lofty ambitions for the NHS. As I said, the long-term plan has some very laudable commitments on CAMHS. The Bill seeks to put into law what the Government promise on NHS spending. New clause 3 simply seeks to put into law the Government’s promises on spending on children and young people’s mental health disorders. I cannot press new clause 3 to a Division, but I very much hope that the Government will accept the spirit of my new clause and look to see what measures they can put in place to improve transparency and accountability. We owe it to those children and young people, because this really is a crisis and they need us to step up to the plate.

I will end my remarks with a quote from the mother of the 17-year-old I referred to earlier, because she puts it far better than I could:

“All these young people are our future and if we do not help them now, we are looking at a bleak future as these young people will end up being isolated from society, lack skills for work and relationships, find employment hard, perhaps even get into crime and ultimately will end up not having fulfilled lives and maybe end up being yet another statistic. We have not got this right and it is not just about the budgets or party politics; we need all of you to work together on this and treat this as an emergency.”

[Lucy Allan (Telford) (Con)]

What a pleasure it has been to listen to so many excellent speeches. In particular, I want to say how much I value the contribution of the former Secretary of State for Health, my right hon. Friend the Member for South West Surrey (Jeremy Hunt)—I am sure that Ministers will have listened to what he said. I thank everybody who has tabled amendments, which are very thoughtful and well considered. I am particularly grateful for the amendment on patient safety, and again, I am sure that Ministers will have heard what has been said on that issue.

It is a pleasure to speak in a debate where we are not politicising something that matters so much to our constituents and where we are coming together to contribute our experiences, either in our constituencies or professionally. For that reason, I am delighted to be speaking.

I do not support the amendments, however well intentioned, well formulated and well thought out many of them are. However, I would like to speak to the amendment on capital budgets because there are some learning opportunities for the Government in how they spend significant capital investment on hospitals, upgrades and reconfigurations of hospital services. Those upgrades and reconfigurations are indeed happening now, as was set out in the manifesto, but they were also happening before that. My constituency and the county of Shropshire have experienced significant capital investment, but there has been a very difficult, painful and protracted process in trying to bring that forward as something that will benefit the whole community and improve patient care across the county.

I raise that issue because I hope that Ministers will take away from that experience the fact that it is fundamentally wrong to have significant capital investment where local communities are pitched against one another, as has happened in Shropshire. We saw local CCGs propose that Telford should lose all its acute services and be stripped of its A&E and women and children’s services, with them being transferred to another community some 20 miles away that is significantly more affluent and has better health outcomes. In addition, it was intended that that community would also receive £312 million of capital investment in new facilities. I am sure that hon. Members can imagine how that would make our community feel, particularly when it is disadvantaged in many respects. It is a growing new town that will have 200,000 residents in the next 10 years. We have to provide services with equal access for all, because as this Government have said, they are about one thing: levelling up. They are about narrowing health inequalities and ensuring that there is equality of access to health services across our communities. Of course, the NHS has always been about need. Funding in the NHS should follow need.

I will not delay the House too much with further discussion of the situation in my constituency because I believe that my CCGs, after six years of debating this issue, have had another thought about how they might resolve the problem. It will require more Government funding, but they have already made it clear that the proposal that is currently on the table will also require more Government funding. It will provide a fantastic opportunity for us to resolve this situation, which has been ongoing for so long. So, if the Minister is listening to pleas for more capital funding, may I ask that we complete the proposal in Telford, which will be of such value to our community?

There are other learning points that come from the capital investment programme. CCGs and health trusts have a duty—indeed, the Secretary of State has a statutory duty—to narrow health inequalities. We see that across the country where there have been controversial reconfigurations of local hospital trusts and hospital builds. It is not just in Shropshire either; many MPs on both sides of the House have spoken of the need to narrow health inequalities and to ensure that more affluent communities do not benefit at the expense of more disadvantaged ones. This new Government could not tolerate that continuing in areas of disadvantage.

Wuhan Coronavirus

Munira Wilson Excerpts

Monday 3rd February 2020 Commons Chamber

[Matt Hancock]

That is absolutely right. We have tried to go above and beyond to help those who are currently in Arrowe Park. I did not know about the example that my hon. Friend gave, but there have been several others, including some of the biscuits that were given to people who were quarantined at Arrowe Park, which had apparently gone down very well.

[Munira Wilson (Twickenham) (LD)]

The Secretary of State will recall that during his last statement to the House on the Wuhan coronavirus I raised the importance of vaccination. At the time, he said that

“it is unlikely that a vaccine is going to be available—there is not one now—so that is not the route we should be looking at”—[Official Report, 23 January 2020; Vol. 670, c. 436.]

He has since announced that the Government are investing £20 million in speeding up development of a vaccine. Of course this is welcome, but what has happened in the last 10 days to change his mind and his assessment, and what is the realistic timeframe in which the public can expect to see a vaccine developed?

[Matt Hancock]

That is a very good question. We need to be cautious on the timings for the development of a vaccine, but I am pushing it as hard as possible. It is true that the science has developed in the last 10 days—scientists working around the world to understand the virus have made some progress—and I was convinced enough to put £20 million into that global effort; and we may well put more in. I was impressed by the science, as reported to me by the chief medical officer, so my assessment is now slightly more promising than when the hon. Lady last asked me this question.

Oral Answers to Questions

Munira Wilson Excerpts

Tuesday 28th January 2020 Commons Chamber

[Matt Hancock]

I worry about the delivery of health services to people in Wales. Although this issue is devolved, I am the UK Health Minister, and my hon. Friend is right to raise that issue for his constituents. The number of people waiting more than one year in Wales is over 4,000. In England, despite the much larger population, it is only just over 1,000. The Welsh NHS, frankly, is an advert for why people should not want the Labour party running the NHS.

[Munira Wilson (Twickenham) (LD)]

A number of women in my constituency have recently been in touch who are going through the menopause and struggling to access hormone replacement therapy, which they really need. What assessment has the Secretary of State made of current supplies of HRT, and what is he doing to address the shortages?

[Matt Hancock]

That is obviously an incredibly important issue. The shortages come from problems with factories outside the UK. We have been working hard on it through the autumn. I am advised that the shortages are starting to be mitigated and that production is back up and running, but we keep a close eye on it, because I understand how important it is.

NHS Funding Bill

Munira Wilson Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Munira Wilson (Twickenham) (LD)]

Along with my Liberal Democrat colleagues, I naturally welcome all commitments to additional expenditure on the NHS, and we will not be opposing the Bill. The questions that need to be addressed, which other Members have touched on, are whether the minimum expenditure enshrined in the Bill is sufficient, and why the Government have singled out NHS England’s revenue budget for protection without also prioritising other extremely important areas of the Department’s budget, which have a huge impact on revenue expenditure, such as public health, capital investment, workforce development and, of course, social care.

The NHS has been chronically underfunded for a number of years. As we have already heard from many other Members, our healthcare system in England is in crisis. We have a crisis in waiting times, a workforce crisis and an infrastructure crisis. However, the funding committed in the Bill will enable the NHS only to stand still in the coming years, maintaining the level of service that it currently provides. Those crises will continue. As we have heard, in real terms the additional £34 billion equates to only £20.5 billion when adjusted for inflation, and that equates approximately to a 3.3% increase every year. As we have also heard, many respected commentators and NHS leaders have said that some 4% extra a year is needed to transform services.

I fear that the hon. Member for Nottingham South (Lilian Greenwood) did not receive a response to her excellent intervention when she asked the Secretary of State what assurances the Government would provide that, should the rate of inflation increase owing to unforeseen circumstances—or, indeed, owing to Brexit, which, unfortunately, we face at the end of this week—the promised real-terms increase in NHS spending would be protected.

The crises to which I have referred are clearly epitomised in the challenges faced by NHS mental health services. The mental health system has experienced decades of underfunding and neglect, resulting in services and facilities that are all too often substandard and sometimes dangerous. Mental illness represents up to 23% of the total burden of ill health in the UK, but only 11% of NHS England’s budget. In terms of waiting times, the most mentally unwell are often left waiting the longest for treatment. I am particularly concerned that children and young people are being especially let down. We know that 81% of trust leaders say that they are unable to meet demand for community CAMHS, and only three in 10 young people with a mental health problem were able to access specialist services in 2017-18. In my own constituency, Off The Record, an excellent local charity that does sterling work to support young people with mental health problems, is often told by users of its service that access to local CAMHS is possible only if they are suicidal when they present themselves. That cannot be right.

The Secretary of State has given assurances today on his commitments to increase mental health and CAMHS spending, but we know that this is not always getting through to the frontline in an equal way. There is a lot of variability across the country and we need proper, accountable public tracking of expenditure to ensure that every area across the country can—[Interruption.] The Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries), is mouthing at me, but if she looks at Mind’s analysis of the variability of mental health spending across parts of the country, she will see that there is huge variability. We need to track it publicly to ensure that that priority investment is getting through. We have heard much from the Government about levelling up, and I hope that Ministers will accept that mental health, and CAMHS in particular, needs to be a priority area for levelling up.

[Elliot Colburn]

I am grateful to my south-west London colleague for giving way. She makes a passionate case for mental health spending. Will she join me in welcoming the Trailblazer programme that has been launched in schools in her borough and mine in south-west London? It puts mental health support workers into our local schools to help the children she has rightly identified.

[Munira Wilson]

I thank the hon. Member for his intervention, and I completely agree that we need more support for our children and young people, not only in schools but in universities for students who are suffering mental health crises.

On the workforce crisis, we know that there are more than 100,000 vacancies across NHS trusts in England. I met a nurse on the doorstep in my constituency during the election campaign who works at West Middlesex Hospital. She was in tears because of the strain that she and her colleagues are under in that hospital. Workforce is arguably the largest risk to the delivery and implementation of the NHS long-term plan, yet the funding in the Bill does not include education and training. Again, we heard assurances from the Secretary of State that money would be forthcoming for this, but it is not guaranteed. That leads me to wonder whether this is not a priority area, and whether it could be cut, should spending come under pressure in other areas.

The mental health workforce has experienced little growth over the past decade. Gaps are often filled with temporary staff, which is not only expensive but undermines continuity of care and relationships. A recent survey by the British Medical Association revealed that four in 10 mental health staff found their workload either unmanageable or mostly unmanageable. If we are to achieve the laudable mental health ambitions in the long-term plan, we need to see substantial investment in expanding the mental health workforce.

The crisis in NHS infrastructure is acute and growing. The budget in the Bill does not commit to addressing the need in capital spending, either in buildings or in technology. The NHS’s annual capital budget is now less than its entire £6.49 billion maintenance backlog, which is growing at 10% per annum. That means that leaky roofs, broken boilers, ligature points in mental health facilities and outdated technology cannot be repaired or updated. The Wessely review described the mental health estate as some of the worst the NHS has, which is impacting on the quality of care. The review showed how dilapidated buildings and poor facilities are hindering treatment and recovery for patients. Will the Government use the 2020 Budget to set out a major multi-year capital investment programme to modernise the mental health estate in particular?

The Bill is fine as far as it goes, but frankly it does not go very far. If we want to progress from the status quo and truly transform our NHS services, the real-terms increase needs to be around the 4% mark that many respected commentators have called for, and we need a more holistic approach across the whole departmental budget, not just in selected areas. We heard from the hon. Member for Central Ayrshire (Dr Whitford) about the huge cuts in public health grants to local authorities, and my fear is that public health spending could be cut further, as it sits outside the protected budget on the face of the Bill. That would be a false economy that puts further pressure on NHS budgets. And of course, until a solution to the social care crisis is in sight, the NHS will continue to shoulder the costs of inadequate social care provision.

This Bill is an opportunity to put mental health services on an equal footing with physical health in order to deliver true parity of esteem. I hope the Government will provide more guarantees that mental health, and CAMHS in particular, will not be overlooked, and that guaranteed funding will get through to the frontline. Liberal Democrats will be supporting what is largely a symbolic gesture in the Bill—a political gimmick to write into law what the public were promised more than a year ago. Is this a Government who trust themselves so little that they have to legislate to keep their promises?