NHS and Social Care Commission

Debate between Norman Lamb and Geraint Davies

Thursday 28th January 2016 Commons Chamber

[Norman Lamb]

I totally agree with the hon. Lady. I have always been a strong supporter of the forward view. Simon Stevens is a good leader of the NHS. He has a vision, and he recognises that the solutions to this challenge often lie beyond the NHS. Some of the models that are being trialled across the country are very interesting. I do not want what I am saying to be seen in any way as undermining the very good work that is under way in the so-called vanguards around the country.

[Geraint Davies (Swansea West) (Lab/Co-op)]

On bed blocking, when I was leader of Croydon Council it cost £300 a night to keep someone in Mayday hospital and £100 a night for us to provide a bed as a local authority. We had no money, so I asked the health authority to pay for our beds and save £200, and it did. However, that was an ad hoc strategy, and surely we want a holistic, integrated approach, as the right hon. Gentleman is so eloquently explaining.

[Norman Lamb]

I totally agree with the hon. Gentleman’s last point, but also his substantive point. The problem is that these are all ad hoc arrangements that are about good leaders doing something despite the system, not because of it. We have to mainstream this and align the incentives throughout the healthcare system so that everyone is focused on preventing ill health, preventing deterioration of health, and getting people better as quickly as possible.

Let me give an example of the pressure that the system is facing. It is fair to say, as a gentle challenge to the Government, that this year we are not seeing the data on accident and emergency pressures over the winter period, so the situation is slightly hidden from view. However, I heard that on Tuesday this week all the hospitals in Hertfordshire, north London, Bedfordshire, Northamptonshire and Leicestershire were on black alert, which occurs, in essence, when hospitals are completely full and under enormous pressure. One of the key system leaders in that area said that he had not seen anything like it for 20 years. This is happening at a time when there is no flu epidemic, and certainly no severe weather. This is one of the mildest winters on record, and yet we are seeing hospitals placed under impossible pressure.

--- Later in debate ---

[Norman Lamb]

The right hon. Gentleman makes a very powerful point. Indeed, the staff are working under impossible pressure.

Incidentally, the assumptions about the funding gap by 2020 do not take into account the work that the right hon. Gentleman and I have done together to make the case for equality of access for people who suffer from mental ill health. This is about a historical injustice that has to be dealt with. Paul Farmer, who has led a taskforce for NHS England, has concluded that mental health will require an extra £1.2 billion a year by 2020 in order to ensure equal rights of access with everyone else. It is very hard to deny the justice of that cause and the right of people to get access to social care in the same way as everyone else.

[Geraint Davies]

rose—

[Norman Lamb]

I am conscious that you may start to get slightly irritated with me, Madam Deputy Speaker —

[Norman Lamb]

I am relieved. I sensed that I might be getting into trouble. I will give way to the hon. Gentleman.

[Geraint Davies]

Very briefly, in terms of aggregating the expenditure of health and social care, which, incidentally, is higher in Wales where there is an attempt to have a more integrated approach, the cutting of social care will increase the total amount, as undue pressure will be put on the NHS, which then cannot release beds, and it costs more per night to keep someone in a hospital.

[Norman Lamb]

The hon. Gentleman is absolutely right. Simon Stevens has made the point that if we cut social care, the £30 billion gap widens. There is no escaping from that. The brutal truth is that the whole system is under very substantial pressure. Analysis by the Office for Budget Responsibility, which is independent of Government, shows that between now and 2020, we are planning to spend a reducing percentage of our GDP on health. At a time when demand is increasing so dramatically, does that decision make any sense at all? Back in 2013, the OECD did an analysis of all OECD countries in the European Union. Only five were spending a lower proportion of their GDP on health than we do. The NHS is very good value for money, but it is under extraordinary pressure.

Health

Debate between Norman Lamb and Geraint Davies

Monday 9th June 2014 Commons Chamber

[Norman Lamb]

I am sorry to disappoint the hon. Gentleman, but it was under the Labour Government that it was made clear that competition law applied to the health care system. Indeed, the Labour Government’s guidelines on the NHS replicated exactly the regulations under section 75 of the Competition Act that this Government have introduced. Time and again, we hear false claims by Labour Members.

This Government have developed a new health and care system that is totally patient-centred, led by health professionals, and focused on delivering world-class health outcomes. The difficult decisions that we have made on public finances have meant that we have been able to protect the NHS budget. The shadow Minister spoke as though the Government have had to face no financial challenge at all. She knows that across Europe, Governments have slashed pay for health workers and introduced co-payments. We have done none of that. We have protected the budget for the NHS, and we are proud of doing so; Labour did not commit to that in its manifesto at the last election. The truth is that the NHS is doing extremely well under a great deal of pressure.

This Government have laid solid foundations to transform our NHS to help it to meet the challenges of an ageing population, drive up standards, and focus absolutely on compassionate care. My hon. Friend the Member for Mid Worcestershire (Sir Peter Luff) spoke movingly about his experience of the importance of compassionate care. We have introduced tough, robust inspections overseen by new chief inspectors of hospitals, of social care, and of general practice. We have introduced ratings of hospitals, care homes and GP practices so that people know how good their local services are. We have introduced, for the first time, fundamental standards and the ability to prosecute—to hold to account organisations and directors who seriously fail patients. We have introduced a fit and proper person test for directors; for the first time, compulsory training for health and care assistants; and—I am particularly proud of this—a statutory duty of candour to ensure that there is openness when things go wrong in the NHS or the care system.

[Geraint Davies]

Given the Minister’s focus on accountability and transparency, why will he not support the regulation of psychotherapists and counsellors? My private Member’s Bill would have protected 1 million people. He or I could set up shop as psychotherapists tomorrow and see these vulnerable people who are currently at risk. Why will he not protect them?

[Norman Lamb]

The Government are not convinced by the argument for statutory regulation. The hon. Gentleman and I have had this debate many times, and I am happy to continue to discuss the matter with him.

In the wake of Francis, the Government are clear that poor or unsafe care will not be tolerated. There will be consequences for those who fail patients.

Opposition Members have criticised the lack of health legislation in the Gracious Speech, yet, as several of my hon. Friends, including the Members for Witham (Priti Patel) and for Rochford and Southend East (James Duddridge), have noted, people are not out there on the streets demanding a new NHS Act of Parliament; they want safe, good, compassionate care.

The Government remain committed to legislating on professional regulation when parliamentary time allows.

Gay-to-straight Conversion Therapy

Debate between Norman Lamb and Geraint Davies

Wednesday 20th November 2013 Westminster Hall

[Geraint Davies]

Is the Minister aware that the number of people who go to psychotherapists has tripled under this Government to 1 million? Given that number and given that we have heard evidence about people being referred by GPs, is it not now high time for regulation to stop abuse and potential abuse?

[Norman Lamb]

I will come to that. I do not think that the fact that numbers have increased can be blamed on this Government.

We are not aware that the NHS commissions this type of therapy. In my replies to correspondence, I have confirmed that the Department of Health does not recommend the use of conversion therapy—I have made clear today my personal view on that—and it is not a National Institute for Health and Care Excellence-recommended treatment. That is self-evident. Furthermore, the main national professional associations for psycho- therapy have declared that they regard conversion therapy as wrong.

In February 2010, the UK Council for Psychotherapy said:

“UKCP does not consider homosexuality or bisexuality, or transsexual and transgendered states, to be pathologies, mental disorders or indicative of developmental arrest. These are not symptoms to be treated by psychotherapists, in the sense of attempting to change or remove them.

It follows”—

this is very important—

“that no responsible psychotherapist will attempt to ‘convert’ a client from homosexuality to heterosexuality”.

Similarly, in September 2012, the British Association for Counselling and Psychotherapy set out the following:

“The…Association…is dedicated to social diversity, equality and inclusivity of treatment without discrimination of any kind. BACP opposes any psychological treatment such as ‘reparative’ or ‘conversion’ therapy which is based upon the assumption that homosexuality is a mental disorder, or based on the premise that the client/patient should change his/her sexuality.”

In January 2013, the British Psychological Society published a position statement that opposed any psychological, psychotherapeutic or counselling treatments or interventions that view same-sex sexual orientations as diagnosable illnesses. It declared:

“This includes freedom from harassment or discrimination in any sphere, and a right to protection from therapies that are potentially damaging”—

that point was made by hon. Members—

“particularly those that purport to change or ‘convert’ sexual orientation.”

This issue is clearly causing a great deal of concern in the House, and rightly so. The hon. Member for Ayr, Carrick and Cumnock, as well as sponsoring this important debate, tabled an early-day motion in June. It called on the Government to take steps to ban gay conversion therapy and to investigate NHS links to conversion therapists. Several hon. Members present have referred to that motion and put their names to it.

The hon. Member for Swansea West (Geraint Davies) tabled a second early-day motion, calling on the Government to regulate counsellors and psychotherapists. There have also been a number of parliamentary questions on the issue. As hon. Members will know, the hon. Member for Swansea West has also introduced a private Member’s Bill seeking regulation of therapists. That is scheduled for Second Reading this Friday.

The Government have already said that there are no plans at this stage to introduce statutory regulation of psychotherapists. We do not believe that regulation would necessarily prevent this type of counselling in any case, as it would not depend on the type of therapy offered.

The Command Paper entitled “Enabling Excellence: Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers”, which we published in February 2011, sets out the Government’s vision for the future of work force regulation. That paper makes clear our continuing view that, although statutory regulation is sometimes necessary, it is not always the most proportionate or effective means of assuring the safe and effective care of patients or social care service users. That is why we provided powers to the Professional Standards Authority for Health and Social Care in the Health and Social Care Act 2012.

The Professional Standards Authority oversees the work of the health care profession regulators, including the Health and Care Professions Council. Those powers facilitated the establishment of voluntary registers for unregulated health care professionals and health care workers in the UK, social care workers in England and certain students.

The accredited voluntary registration scheme to which I am referring is not a form of regulation, nor is the PSA a regulator. To be accredited, organisations must provide evidence to the PSA that they are well run and they require registrants to meet high standards of personal behaviour, technical competence and, where relevant, business practice, but the scheme does not endorse any particular therapy as effective and it makes it clear that accreditation does not imply that it has done so. However, organisations seeking to be accredited can set their own rules about what therapies their members can or cannot offer.

As accredited voluntary registration appears to be gaining momentum and is proportionate to the risk, we believe that statutory regulation would not be appropriate and the costs to registrants or the taxpayer could not be justified. This is not to say that we are ruling out statutory regulation for this group for ever. We will continue to assess the need for it. I give an absolute assurance about that.

This is not to say that lesbians, gay men and bisexual people cannot seek counselling or therapy because they are distressed about a particular aspect of their sexuality—that is very important—or that a therapist should not try to help their patient with whatever is causing them distress, which may involve helping them to come to terms with their sexuality, family arguments over their sexuality, or hostility from other people. Supporting people through aspects of their lives that are difficult or challenging is a large part of what therapists do. I think that my hon. Friend the Member for St Austell and Newquay (Stephen Gilbert) made that point in his intervention.

We want to minimise the risk that lesbians, gay men and bisexual people who seek counselling about their sexuality will face therapists attempting to change their sexual orientation because the therapist considers that being gay is wrong. That, of course, is completely unacceptable. That is why Department of Health officials last week met representatives from the UK Council for Psychotherapy to discuss a way forward on this important and sensitive issue. Officials will work in partnership with the council in the following ways.

First, the UK Council for Psychotherapy has agreed to draft, in consultation with the other relevant professional bodies, a public statement on conversion therapy that provides information and outlines the views held by those organisations. That is incredibly important. Once produced, that statement will be widely publicised and placed on relevant websites to ensure that individuals seeking a counsellor or therapist will be aware of those bodies’ views on gay conversion therapy.

Secondly, the Department of Health will host a round-table event in the spring to which it will invite relevant individuals and organisations in order to discuss ways to achieve greater quality and consistency across the profession in general, as well as on this specific issue. Thirdly, and subject to the progress of the private Member’s Bill, the Department will consider writing to statutory regulators, setting out key principles, to be agreed with the professional bodies.

In addition, although we are not aware of such therapies being commissioned by the NHS, my officials will explore with NHS England what actions it can take to ensure that clinical commissioning groups are not commissioning them locally. That is one of the issues that I am happy to discuss with hon. Members. I totally agree that it is not something that public money should have anything to do with.

I hope that I have assured those who have spoken passionately and persuasively in today’s debate that the Government are listening and taking action. I repeat my offer to meet hon. Members. We have a lot to be proud of. The UK is once again recognised as No. 1 in Europe on lesbian, gay, bisexual and transgender equality by the International Lesbian and Gay Association, and we continue to make great strides forward on equality. I hope that that reassures hon. Members both that this Government are strongly committed to advancing lesbian, gay and bisexual equality and that we are taking the issue of gay conversion therapy extremely seriously.