Mental Health

Nic Dakin Excerpts

Thursday 16th May 2013 Commons Chamber

[Mr Jones]

My hon. Friend makes a good point. The starting point should be the medical history of those individuals. Someone at the Department for Work and Pensions has said that it is not possible to identify such individuals, but that is complete nonsense. The process my hon. Friend has just suggested should be the starting point.

Professor Harrington’s review of the process put forward the idea of mental function champions. The Government spun that idea out a bit, as though it was the big answer to the problem, and I actually fell for it at the beginning, thinking that those people would be the ones who would carry out the assessments. That was not the case, however; they are there to give advice to the Atos assessors. We still have assessors with no mental health qualifications.

Representatives of the charity Mental Health Matters, a good advocacy charity in the north-east, have just met Atos to ask about the champions, and a number of questions have been raised. Atos would not tell them how the champions were recruited, and there is no indication that they need any formal qualifications. I understand that they are given a two-day Atos in-service training course, but they do not interact with any of the royal colleges or other outside bodies. Remarkably, they are also not accountable to the DWP. I put it to the Minister that he needs to tell the DWP that this must be looked at again. The process is not only causing a lot of heartache and difficulty for many of our constituents; it is actually not a good use of public money. People are failing the tests and going to appeal. At least one of my constituents has been affected in that way. They sometimes go through the process and end up in a residential hospital for a month, which must cost more than the amount of benefit that might have been saved.

We also need tailor-made programmes for people with mental illness. We should consider a separate work stream that could include voluntary work, given that many people with mental illness find the transition back into work through voluntary work easier than being thrown straight back in. We also need a pool of employers who understand and are sympathetic towards people with mental illness. There is an idea that such people can just join the normal job market and that employers will just accept that they might not turn up for work for a day or a week because they are not feeling well, but that is not the case. Those people will not keep their jobs for very long.

[Nic Dakin (Scunthorpe) (Lab)]

I was at a recent meeting of the Mind support group in Scunthorpe, and I was concerned to hear people saying that they were anxious about taking on voluntary work because of the impact it could have on their benefits and their access to other services. Does my hon. Friend think that that issue needs to be looked at?

[Mr Jones]

Yes, it does. If there were a separate work stream for those individuals, of which the voluntary sector was a part, we could use the voluntary sector to get people back into the world of work. I agree with my hon. Friend, however, that they should not be penalised for doing so through loss of benefits.

I also want to talk about the old issue of the NHS reorganisation. It provides some great opportunities for doing things differently, and there should be an opportunity for local providers to bring in the third sector. I have one problem with that, however. I am president of the local Mind, which has just received a contract to provide certain services, and the process it has to go through is very difficult. I am not suggesting for a minute that such organisations should not be performance managed, because there are some large contracts involved, but we need an easier system for applying for the contracts. We also need to ensure that when bodies are competing for the contracts, people can access the services.

Another area of concern is the increased waiting lists for IAPT services. I know that the world has changed since 1 April, and people who lobby on behalf of mental health services are going to have to change their lobbying tactics. It is important to ensure that commissioning groups have an understanding of mental illness and of the importance of IAPT services.

If we look at the Royal College’s report, we find that people are going through the system saying they are quite happy when they get a diagnosis, but are then told they might have to wait up to a year for a talking therapy—that is just no good. What we need—again, this will save the NHS and the economy money—is a quick service such as the IAPT service. I know from people in my own constituency and others who have written to me that the wait is totally unacceptable. If we want to make this work, we have to make sure we have a joined-up service and that people who want a diagnosis get the support they need quickly. Otherwise, people will be stuck in this no man’s land between diagnosis and treatment.

Another area on which the new organisation needs to focus is local government. Local government now has an important role in health care through health education and protection. The Royal College of Psychiatrists is working with councils on a project to have champions at the local level. It is important for local councils to have councillors or chief officers who can champion the need for mental health services locally.

I welcome the debate. It is important to talk about these subjects, and the more we do, the better. To adopt an old BT phrase, “We need to talk”. If we talk about it—whether it be in schools, the workplace or here—we will erase the stigma of mental illness. That has to be the goal: mental illness being treated just like any other long-term condition. People should not be afraid of admitting to it and should not feel that they cannot be helped. We also need to recognise that in many cases—including, I have to say, my own—it can be strength rather than a weakness.

Heart Surgery (Leeds)

Nic Dakin Excerpts

Monday 15th April 2013 Commons Chamber

[Mr Hunt]

There are some risks, of course, in suspending surgery, but when we have mortality data such as those that Professor Sir Bruce Keogh was faced with, there are also considerable risks involved in doing nothing in response. The decision was taken not to close the children’s heart unit but to suspend surgery until he could get to the bottom of whether there was any truth in the data. He had a very difficult decision to make, given that situation, but I think he made the right decision.

[Nic Dakin (Scunthorpe) (Lab)]

Parents of very poorly children in the Scunthorpe area who have been very effectively supported by the Leeds unit have been dismayed to hear what has been happening over the past month or so. The Secretary of State has given us clear answers this afternoon, and I thank him for that. He has said that there will be a resolution to the Safe and Sustainable review as soon as possible. Will that be in 2013 or at some point beyond that?

[Mr Hunt]

I very much hope that this does not go beyond 2013, but I am afraid that that is not in my hands, because of legal due process. Legal proceedings are under way at the moment and I have to consider the advice of the Independent Reconfiguration Panel, but I want to stress to the hon. Gentleman, as I have to many hon. Members, my determination to resolve the situation as quickly as possible.

Leeds Children’s Heart Surgery Unit

Nic Dakin Excerpts

Tuesday 30th October 2012 Westminster Hall

[Nic Dakin (Scunthorpe) (Lab)]

Thank you, Mr Hollobone. That is very helpful, as your chairmanship always is. It is a pleasure to serve under your chairmanship.

I welcome the Minister to her post, and I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing this debate. His cross-party and cross-regional leadership on this matter has been a credit to him and the region, and it is a pleasure to have worked with him. I hope we have a satisfactory outcome. He has spelled out in clinical detail the key issues in this case: the need to get the right clinical outcomes; the discrepancies in the clinical information issued throughout the process; the number of operations necessary to secure a unit; and the difficulties in securing that number of operations if Leeds closes and other centres are expected to receive its patients, given that if there is patient choice, it is clear that patients from the area that I represent, Scunthorpe, will probably go south, rather than north, to access services.

The hon. Gentleman has reminded us of the largest petition that I can remember in the region, which some 600,000 people signed at fairs and civic events in my constituency and, presumably, across the whole region. That was an active process in which people were engaged and supportive. Counting that as one response is not giving the public view the weight that it should have.

The villages and towns of the area that I represent will always be peripheral and on the edge. People from our area must travel to access services. It is interesting to note their concerns. I will refer to a couple of correspondents, because theirs are the voices of which we need to be reminded, and their observations echo the points made by the hon. Member for Pudsey. One correspondent said:

“All of us heart families, as you can imagine, are devastated…Please can you review this decision and hear our views?”

Behind the petition signed by 600,000 people are many people’s views. Another correspondent said:

“Our daughter is diagnosed with a rare condition, truncus arteriosus. She had major open heart surgery in July 2011 at Leeds general infirmary. Naturally, we were devastated with the diagnosis, coming to terms with it and going through her operation and hospital stay. The service they provide at Leeds is…at its best. I feel that our daughter is in extremely safe hands there. The staff on ward 4, ward 10 and HDU provide the best quality of care. The cardiologists and surgeons are truly amazing in the work they do. Whilst our daughter was in hospital, this was a terrifying time for us. Leeds is a good hour’s drive away, which is bearable in this situation”,

but

“it could endanger lives if people have to travel further, for example those babies born who need emergency heart surgery. I have read so many comments on the support group page that if Leeds surgery closed and they had had to travel further afield, their baby would not have survived the journey.

All the facilities are on site at Leeds general infirmary, i.e. X-rays and other investigations that need to be done prior to operation. Again, if Leeds was closed and we had to go to Newcastle, my understanding is the checks have to be done at other hospitals, again endangering lives in those more serious cases.”

Another constituent of mine says:

“I would now like to explain how the threatened closure affects my daughter. I have a 5 year old daughter who has 22q deletion…She has a number of complex, life-affecting and life-threatening health conditions, including serious congenital heart defects, as well as learning and communication problems. She is a pupil at St Luke’s school in Scunthorpe. Routine antenatal appointments at Scunthorpe failed to pick up her problems; an additional late scan there found a problem, and antenatal care was then transferred to Leeds.

Leeds general infirmary provides many services under one roof. During her stay on the cardiac ward, I required treatment due to birth complications and had access to the midwifery team and appropriate treatment. I was unable to walk following the birth for several days, and was able to stay on the heart ward with food provided and then in family accommodation.”

That emphasises the proximity of all services, and how that affects the well-being of not only heart patients, but mothers and other family members.

I take note of your instructions and encouragement, Mr Hollobone. I feel that I have reinforced the issues that were raised in the excellent speech made by the hon. Member for Pudsey, and I have added a couple of illustrations from my constituency that underline the point.

Adult Social Care

Nic Dakin Excerpts

Monday 16th July 2012 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

Adult social care is probably one of the biggest, if not the biggest, challenges that we as politicians and policy makers face. We have heard thoughtful contributions from Members on both sides of the House explaining why it is so difficult. If people are fortunate, they never need to access adult care. If they are unfortunate, they do need to do so, or members of their family do. As we heard from the hon. Member for Southport (John Pugh), it can be a cruel lottery. One of our purposes should be to minimise the extent of that lottery and maximise entitlement and support for all individuals.

One of the most humbling experiences I have had since becoming Member of Parliament for Scunthorpe was going to visit a constituent in his home last week on this very issue of care and support. He is a similar age to me. When he was younger, near the end of his training in the medical profession, he went out into the sea and suffered a terrible accident. As a result, he was paralysed from the neck down. Since then, he contributed to society in a number of different ways. He retrained in higher education until he was advised by his GP to retire because if he did not, in the GP’s words, “the wheels would come off” and he would no longer be able to contribute to society.

After going to see my constituent, he wrote to me—this is about individuals and real people’s lives—about the publication of the draft social care bill:

“I have just been reading the latest on social care funding on the BBC website—it would seem that meaningful cross-party dialogue re Andrew Dilnot’s recommendations has broken down and that the government wants to put decisions off until the spending review late next year.

My suspicions about kicking into the long grass appear justified!...I have already contributed over £60000 towards my care package and seem to be paying more and more each year—despite the fact that North Lincolnshire council reduce the value of my care package every time there is a review.

My condition has not improved. I am, in fact, starting to suffer more and more of the long term complications that inevitably hit ageing tetraplegics.”

The worry and concern are there. When visiting my constituent in his home, I observed that the people who were providing the care were brought in at his expense. Resources were not adequate, because that cost was being taken out of his small pension from working in higher education, which went up by 5% a couple of weeks ago, although the contribution to North Lincolnshire council went up by 25%. What is the incentive to do the right thing in difficult circumstances when those sort of things happen?

What I have described was additional care. The core care was provided by my constituent’s mother, who was in her mid 80s, and his sister, who travelled for two and a half hours to spend half the week helping to care for him. As politicians, we need to step up to the plate. It is about leadership—cross-party leadership—and being able to do the right thing for people, such as my constituent, who suffer misfortune. Had that misfortune occurred, as he said to me, in a car crash, he would have received insurance compensation, which would have paid for his care package. Because it took place in a situation of utmost tragedy—nobody was responsible for it, but it was a total misfortune—there is no underpinning support from the state, which should properly protect him and his family from having to pay more and more money. My plea is for us to show the leadership across the parties—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order.

Violence against Health Workers

Nic Dakin Excerpts

Tuesday 3rd July 2012 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

Our national health service employs more than 1.7 million people. Of those, just under half are clinically qualified, including 120,000 hospital doctors, 40,000 general practitioners, 400,000 nurses and 25,000 ambulance staff, as well as an army of other health care workers. Only the Wal-Mart supermarket chain, Indian Railways and the Chinese People’s Liberation Army directly employ more people.

On average, our health service deals with 1 million patients every 36 hours. That is about 500 people a minute or eight people a second. As those figures suggest, the size and volume of the NHS means that literally millions of interactions between patients and staff occur every single day. In the vast majority of cases, these interactions are positive and result in successful outcomes for patients and staff alike, which is why, simply put, the NHS is one of the best health care models on the planet. But sadly, things sometimes go wrong for patients and badly wrong for staff. The superb staff who provide such sterling service to the public can find themselves the victims of violence while working on our behalf to provide those very services. The purpose of this debate is to highlight this wrong and seek support from the Government for righting it.

The NHS management service’s latest statistics reveal more than 150 reported physical assaults on health care staff per day—and that is before verbal assault is taken into consideration. According to the latest 2010-11 NHS survey, 7% of NHS staff had been victims of assault in the previous 12 months. The Royal College of Nursing’s research reveals further troubling statistics, with almost 11% of those surveyed having been assaulted at work in the previous two years and more than 60% of all respondents having suffered verbal abuse at work. Indeed, one respondent commented that

“verbal abuse seems to just be accepted as part of our work”.

That is totally indefensible.

In Northern Lincolnshire and Goole hospital trust, which serves the Scunthorpe area, there were 13.1 assaults per 1,000 members of staff in 2009-10. Although that figure is below the national yearly average of 16.8 per 1,000, it is still far too high. One assault against any person simply trying to do their job in any profession, never mind people who routinely save lives every day, is completely unacceptable.

Two weeks ago, I joined a local ambulance crew for five hours of their 12-hour shift, and I was hugely impressed by the professionalism of the paramedic team and the staff at Scunthorpe general’s accident and emergency department. Patients were treated with great skill, care and dignity, which is exactly as it should be, but I was shocked to learn that the fantastic paramedic I was with had gone to a house call about a year ago and was seriously assaulted by the man he had gone to help. He was chased around the house by the man, who violently and persistently assaulted him. The assault was so bad that it resulted in his being off work for six months.

I received today this e-mail from a staff nurse at Scunthorpe general hospital:

“I understand that you are taking part in an adjournment debate tonight on the above subject. I was assaulted by a patient in January this year. With colleagues I went to clean up a patient that…had attacked a nurse earlier in the day and no one felt able to approach him since. I was subjected to a violent attack which meant I was on sick leave for three months. I have had intensive physiotherapy and still attend physio regularly. I suffered a needlestick injury while trying to sedate the patient and will be tested for blood borne viruses in the next few weeks. During the time I was off work and, for some time since, I have been in constant pain, I had limited use of my right arm and restricted movement of my neck. I could not hold a pen to write or brush my teeth. Everyday tasks took hours and I became depressed and withdrawn. Even now I am unable to perform all my duties as a nurse. Yet, mine was not a serious injury. I have made considerable improvement but will always have some level of pain and restriction of movement.”

She goes on to thank us for raising this issue in Parliament.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this issue to the Chamber, and I wish to associate myself with his comments. In Northern Ireland, including in my constituency and in particular the Ulster hospital, there have been several attacks on accident and emergency personnel and ambulances. It is not specific to Scunthorpe but happens across the UK. Would better co-ordination between the hospital authorities, ambulance and emergency personnel and the police be a way of addressing some of these issues?

[Nic Dakin]

I thank the hon. Gentleman for his comments. He reminds us that, sadly, the problem affects people across the nations of the United Kingdom. I will come to the issue he raises later, but I want now to quote the final comments of the nurse who wrote to me:

“You can have no idea what it means to have this problem recognised and debated. I do not expect to be compensated in monetary terms for the pain I have suffered or the possibility that I may not be able to work to retirement age but I do want to see measures put in place to effectively protect staff who are expected to deal with difficult and violent patients.”

The costs of such assaults are multi-fold. There is the cost to the NHS of care for the victim, the cost to the NHS of the health worker’s absence from work and the possible loss of an employee if recovery is not complete. Added to that is the potentially devastating impact on the health worker’s own health and well-being, with further strain on family, friends and the wider community. I would like to pay tribute to all the fantastic people working in the NHS, including the people and organisations working hard to prevent such violence from taking place against health workers. Northern Lincolnshire and Goole Hospitals NHS Trust has launched an e-petition to heighten public awareness of the issue. The fact that the trust has recognised it in this way is to be applauded, but there is much more to be done. That is why the trust’s partnership approach, working with Unison and others to find ways of practically addressing the issue, is to be welcomed.

NHS Employers—part of the partnership for occupational safety and health in health care—is also actively involved in raising the issue of violence and aggression against staff, and is looking at how it can be managed, working hard to help create healthy and productive workplaces. Work is also under way—led by NHS Protect, with input from the Royal College of Nursing and others—to look at preventing and managing physical assaults on staff which result from a patient’s underlying medical condition, such as dementia. Many physical assaults result from a patient’s underlying clinical condition, but rather than ignoring this, steps can be taken to reduce the risks. Work to take these positive initiatives forward needs to be systematically supported and funded if it is to bring real change and reduce the risk to health workers from such patients.

All these initiatives are positive and to be welcomed. However, I want to highlight a number of concerns raised with me by the Royal College of Nursing, Unison and others. I am keen for the Minister—who I know is committed to ensuring that the Government do their best in this area—to say in his response what practical steps the Government are taking to address those concerns. The Government have funded work by the Design Council with a limited number of A and E units to reduce violence through design solutions. That is to be welcomed. How will the work be evaluated, and how will any improvements to the safety of staff and patients in such units be shared and implemented more widely? With the end of Secretary of State directions, which required NHS trusts to have measures in place to protect staff, how will it be possible to ensure that all provider services meet standards similar to those currently set under Secretary of State directions? They include access to a local security management specialist, training on conflict resolution, central reporting of physical assaults and a requirement to follow policies and guidance—for example, lone working guidance—published by NHS Protect.

Lone working nurses and health care workers absolutely need protection. They often form an invisible work force. Many health workers already work alone with limited, if any, back-up or support. The quite proper policy direction of providing more services in the community means that more health workers are likely to find themselves in potentially vulnerable situations as sole workers. How will Government ensure that there are systems in place to minimise risk and protect the work force?

Full consideration needs to be given to the possible impact of changes in health care delivery combined with efficiency savings on the likelihood of risk of violence against staff. In particular, a risk assessment of the impact of closing units, lengthening A and E waiting times and staff shortages needs to be undertaken and the effects mitigated. That needs to be recognised. In this climate of cost-cutting and austerity, how can we be certain that such measures will be put in place to reduce the risks to staff? Staff who report incidents need more support from their employers and the police. They need feedback after they have reported incidents, and they need to know what action is being taken to prevent any reoccurrence. Lack of feedback and support can lead to under-reporting of incidents and reduced morale.

I welcome the fact that pressure from Unison has resulted in a change to the code for Crown prosecutors to increase the number of prosecutions for assaults on public servants. The closer working relationship between NHS local security management specialists and trade union safety representatives has been a positive development. NHS Protect has also agreed protocols with the police and the Crown Prosecution Service. Under the memorandum of understanding with the Association of Chief Police Officers, the police are committed to progressing all cases of violence and abuse against NHS staff as a priority. The Crown Prosecution Service has also made a commitment to

“work with the police to ensure that these cases are treated with the seriousness that they deserve and encourage a robust charging policy”.

It is crucial that that should lead to a more consistent approach by police forces to following up the perpetrators of either physical or verbal abuse. RCN research suggests that police follow-ups are sometimes inconsistent around the country. Some forces follow up complaints robustly and work closely with local hospitals, but others appear reluctant to get involved in procedures, especially when the incident involves a patient with an underlying mental health condition. Such incidents in particular need more close examination, as a significant number of physical assaults on health workers are by patients with underlying mental health problems. How can the Government ensure that the memorandum of understanding between ACPO, the CPS and NHS Protect will be consistently and effectively implemented?

The reporting and investigation of assaults also need to be properly addressed. According to the RCN survey, although only about 11% had suffered physical abuse at work, 74% of the incidents they recalled were never reported to the police. Staff need to be confident that they will be supported by their employers and the police. They need to be given the confidence always to report assaults. There needs to be a culture of trust that, when reported, such assaults will be taken seriously and fully investigated, with proper support given to the victims. Proper feedback and support in the reporting process will help to keep up morale in the NHS work force and reassure staff that they should not expect to be put in danger while carrying out their duties on behalf of all of us.

In this age of austerity, budgets are being squeezed, and organisations that protect workers are being asked to do important jobs with a lot less funding. For example, the Health and Safety Executive, which plays an important role in keeping people safe at work, has had its work force reduced by a third in the last 10 years, with the number of inspections that it carries out falling from 75,000 to 23,000 a year. That could lead to the real danger of worker safety being jeopardised, which makes it even more important for NHS employers to take completely seriously the need to protect their work force and minimise the risk of attack from patients. Health and safety is not red tape; health and safety saves lives.

Worryingly, the cuts in NHS and local authority budgets and in the Health and Safety Executive are in danger of combining with the confusion caused by the NHS reforms to cause local security management specialists to become increasingly reliant on safety representatives to help them to identify those work areas in which NHS staff will be most at risk. Many local security management specialists used to work with primary care trusts. With the abolition of PCTs, there is a possible danger of confusion and uncertainty about their role in the workplaces that they cover. How will the Government ensure that the risk inherent in the changes does not lead to more health care workers finding themselves in situations in which their personal safety is put at risk?

Every single person should be able to go to work without the fear of physical harm. I strongly back Unison’s calls for a zero-tolerance approach to safeguarding NHS staff. Everyone needs to work together with a clear and persistent focus to make sure that all staff can carry out their work free from the fear and the threat of physical or verbal assault. When individuals are found guilty of attacks on health care workers, that should inform the sentencing and be treated with the utmost seriousness.

As Julian Corlett, Unison branch secretary for Scunthorpe general hospital, wrote to me:

“Violence directed at health workers is never acceptable and is not part of the contract of employment. We must dispel the myth that violence in the NHS is inevitable, or unpredictable and therefore uncontrollable. It therefore remains our key objective to see a significant and sustained reduction in the number of violent incidents directed at NHS staffs across the country, with more prosecutions and severe sanctions for those perpetrating such violence. There has to be the presumption that those committing these offences are more likely to face prosecution than not if we are to see sustained reductions in the figures anytime soon.”

Julian speaks from experience with great passion and clarity; his words will echo round this Chamber and in the world outside it. We should be vigilant and proactive in ensuring the safety of those who work within the NHS. In the words of the children’s laureate, Michael Rosen, on the 60th anniversary of the NHS, we must do all we can to protect the

“hands that touch us first...and the hands that touch us last”.

Oral Answers to Questions

Nic Dakin Excerpts

Tuesday 12th June 2012 Commons Chamber

[Anne Milton]

My hon. Friend is absolutely right that education, social services and health services need to be brought together. That is exactly why bringing public health into local government is critical. If we add to that list housing and local business services, we have the mix to turn around many people’s fortunes. Some of the 66 indicators in the framework are school-readiness, social connectivity, air pollution and chlamydia, and they will all require local government to work at every level with all agencies to reduce inequalities.

[Nic Dakin (Scunthorpe) (Lab)]

What steps is the Department of Health taking to address the inequalities in regional health outcomes for pancreatic cancer?

[Anne Milton]

We are doing a number of things, and the most important is devolving responsibility for public health to local areas. It is clear that delivering improvements in diagnosis, outcomes and so on for people with pancreatic cancer relies on different actions in different areas. The important thing is to give local people the power and money to do what they know is right.

Pancreatic Cancer

Nic Dakin Excerpts

Wednesday 23rd May 2012 Westminster Hall

[Eric Ollerenshaw]

My hon. Friend represents Pudsey, a Yorkshire constituency, so he says it like it is. I will go on to say something about hospices; what he said about them is true. In a sense, for a lot of families cancer is almost like the end. With pancreatic cancer, proper treatment is vital and nobody should underestimate the work of the hospice movement. As I say, I will go on to say a couple of things about hospices.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate the hon. Gentleman on securing this very important and timely debate. I also pay tribute to his passion for this issue and to the personal experience that he brings to this debate; he brings real understanding. In addition, I pay tribute to Pancreatic Cancer UK, which is doing excellent work, and to campaigners such as Maggie Watts, a campaigner in my constituency. She has direct experience of this issue and is driving an e-petition forward on it.

Does the hon. Gentleman not agree that we need more support from the Government in the area of research into cures? Only 1.6% of research funding is spent on pancreatic cancer, and the Government can move things forward here.

Health Transition Risk Register

Nic Dakin Excerpts

Thursday 10th May 2012 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend. I am sorry that the right hon. Member for Blackburn is not here; I told him that I would quote from his evidence to the Justice Committee. I will therefore not attempt further to interpret what his view might be. I think that what he said to the Justice Committee was consistent with the view that those implementing the FOI Act should bear it in mind that there was an exemption for the formulation and development of policy, as my hon. Friend implies. There was not an exemption for Cabinet collective discussion; there was an exemption for the formulation and development of policy. In each case, we have to weigh the public interest very carefully. Clearly, there will be many circumstances in which the public interest in disclosure outweighs the necessity for there to be a safe space for private discussions about issues of risk. In this case, in December 2010 my colleagues and I were clear that it would have been wholly wrong, and disruptive and damaging, to the policy development process for the document to be published at that time.

[Nic Dakin (Scunthorpe) (Lab)]

What does the Secretary of State so fear about what is in the risk register that he refuses to show it the light of day and defies a tribunal ruling?

[Mr Lansley]

I know that I cannot ask the hon. Gentleman a question, but I wonder whether he has read the document I published on Tuesday about what is in the risk register. I bet he has not.

Oral Answers to Questions

Nic Dakin Excerpts

Tuesday 27th March 2012 Commons Chamber

[Mr Lansley]

My hon. Friend will know that no decision has yet been taken on the location of children’s or adult congenital heart surgery centres in England. Neither the draft adult clinical standards nor the proposed standards for children’s services require services for children and adults to be collocated.

[Nic Dakin (Scunthorpe) (Lab)]

Will the Secretary of State ensure that the relationship between adult and children’s cardiac services is properly considered as part of the review?

[Mr Lansley]

On both children’s and adult congenital heart services, all relevant clinical factors should be taken into account in the review, but I reiterate the point that I made to my hon. Friend the Member for Leeds North West (Greg Mulholland): the standards for those services do not require children’s and adult services to be collocated.

Health and Social Care Bill

Nic Dakin Excerpts

Tuesday 20th March 2012 Commons Chamber

[John Healey]

I find it dismaying, because there are so many people who are committed to the health service, work in the health service or are dependent on the health service, as we all are, and they want answers to that question, but the Government are simply not giving them. To be honest, I think that this stems from the genesis of the legislation, something that was ruled out explicitly in the Conservative party manifesto and the coalition agreement but then sprung in a White Paper less than two months after the general election. That meant that the civil service, the health profession and the NHS were unprepared for this huge reorganisation and this huge Bill, so in many respects, beyond the main decisions set out in the White Paper in July 2010, all the evidence indicates that the Government are making it up as they go along. The fact that we have seen more than 1,000 amendments to the Bill since it was first introduced is a further indication of that.

Is the Minister coming back?

[Nic Dakin (Scunthorpe) (Lab)]

My right hon. Friend is making a very decisive set of points. I would like briefly to draw his attention to the local patient healthwatch group in north Lincolnshire, Who Cares, which has produced some hard-hitting reports on matters such as mental health and discharge from hospital. Does he feel that arrangements are being put in place that will allow that sort of independence of view and those hard-hitting reports that help to improve the quality of care in future?

[John Healey]

My hon. Friend hits right at the heart of the flaws in the arrangements proposed tonight, which I was going to move on to. I am sure that Who Cares has its ear to the ground, good local connections and strong representation, and I want to see that continue, as I am sure he does. The real question is whether those organisations can go beyond hard-hitting reports, and who then will be accountable for the action that might need to be taken to follow them up. Where are the enforcement powers that could ensure that any problems they identify on behalf of patients are properly dealt with? I will move on to that point in a moment.

In a sense, that links to the point I wish to put to Ministers now. In the arrangements before us it seems that if a local healthwatch organisation is not up to standard, is not doing the job and is somehow failing patients in an area or falling short of what is expected, we will be offered a new provision, a new power introduced by the Government through an amendment in the other place, for HealthWatch England to write a letter to the local authority, telling it that it must do better. Thinking of the two local authority leaders in the area that I am privileged to represent—Steve Houghton, the leader of Barnsley metropolitan borough council, and Roger Stone, the leader of Rotherham metropolitan borough council—I could not use language in this House that is likely to reflect their reaction. If I think of them, as elected local government leaders, receiving a letter from a sub-committee of a national quango responsible for regulating things that their local authorities have little or no responsibility for, telling them that they are not doing their job properly, I can just imagine their reaction. Quite frankly, “You’re having a laugh.” That is simply not a serious power of, or provision for, redress on behalf of patients when a local patients’ representative organisation is failing to do the job properly. So, no enforcement powers and no intervention powers, only the power to write a letter to the local authority.

In the end, that brings us to the point. At this stage, in the final hour, at the end of this extraordinary Bill’s passage through Parliament, we can see very clearly the truths at the heart of it. There is provision for an independent national commissioning board, an independent market regulator and independent hospital foundation trusts, but there is no provision for an independent patients’ organisation.

In this Bill there are powers to ensure strong action to guarantee competition, strong action to guarantee financial efficiency and strong action to guarantee professional concerns, but there are no powers to guarantee any sort of action, let alone strong action, on behalf of patients.

I listened very carefully to my hon. Friend the Member for Leicester West (Liz Kendall), who made a very good speech from our Front Bench. When she notes that the representative body, National Voices, says on behalf of patients and interests groups, “You’re setting us up to fail,” and reads the letter from Malcolm Alexander, the chair of the National Association of LINks Members, who says, “You’re creating weak bodies that will not be independent,” I think that we in this House should be worried. Such action is, to borrow a phrase, pennywise, pound foolish. The Government are cutting what to Ministers and civil servants might seem to be small corners, but there could be big consequences for patients.

I see a link—a common characteristic—between this debate and our earlier debate on the risk register. The Government will live to regret at length poor judgments and decisions made in haste and under pressure now. The Secretary of State will face the question of whether to release the transition risk register. If he insists on remaining resolute in refusing to disclose, and if he insists on keeping it secret, patients will ask, “What are they hiding from us?” In the future, in the months ahead, long after the Bill has received Royal Assent and is on the statute book, patients will rightly ask when things go wrong, “Did they know these risks were there, and why didn’t they tell us?”

The same applies to HealthWatch. When things go wrong, patients will find that they do not have the recourse and the representation that they may need to act and intervene on their behalf, and they may well find that the arrangements that we are invited to pass tonight are too weak to help them. I say to the Health Secretary, who is now on his own on the Front Bench, that this is likely to reinforce that lack of confidence and lack of trust in the notion that the Government’s huge upheaval in our NHS, and this huge piece of legislation before the House, really is in the best interests of the NHS and NHS patients.