NHS and Social Care Commission

Debate between Norman Lamb and Valerie Vaz

Thursday 28th January 2016 Commons Chamber

[Valerie Vaz (Walsall South) (Lab)]

It is always a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy), who is a great defender of the NHS, both locally and nationally. I congratulate the right hon. Member for North Norfolk (Norman Lamb), who was a very assiduous Minister; my hon. Friend the Member for Leicester West (Liz Kendall), who is not in her place but who was an assiduous shadow Minister; and the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who unfortunately cannot be here but who was also an assiduous Minister and a member of the Health Committee.

It is with great difficulty and a bit of sadness that I say that I do not support the motion. I know that it comes with great heavyweight backing from public figures—MPs and former Ministers—but I do not think that it will take the debate forward. When we set up a commission, it can feel like we are kicking something into the long grass, and that is what it feels like we are doing today. This issue has been going on for a long time, and it is, I feel, a lack of political will that is failing to drive the changes forward.

We have had the evidence. There has been a pilot scheme, which was set up by my right hon. Friend the Member for Leigh (Andy Burnham) in Torbay in 2009. The integrated care trust is operating. A former Secretary of State for Health, Stephen Dorrell, who was a very good Chair of the Select Committee on which I served, gave an interview on 22 January in The House magazine in which he recalls asking an adviser:

“What is the oldest quote from a health minister saying how important it is to join up health and care services?”

This answer came back:

“Dick Crossman, the Health Secretary in the late 1960s.”

That is how long this issue has been going on, and it has cross-party support.

I want to touch on what some hon. Members have been saying about cross-party support. Perhaps I have been on a different planet, or perhaps, a bit like Bobby in “Dallas”, I have woken up and it is all a dream, but I recall being on a cross-party Health Committee, ably chaired by Stephen Dorrell, that produced many reports, but never a minority report. We came up with a number of conclusions that Members are now saying that we should consider.

In our report on public expenditure, we said that very little of the money spent by the NHS on people with long-term conditions was spent in an integrated way, which meant that significant amounts of money were wasted. In our report on commissioning, we said the NHS Commissioning Board should work closely with local commissioning bodies

“to facilitate budget pooling and service integration to reflect patient priorities.”

In our 12th report of the 2010-12 Session on social care, we said that efficiency savings would not be possible without further integration between health and social care. That has been an aim of successive Governments, but has not been properly achieved.

In our 11th report of the 2012-13 Session, “Public Expenditure of Health and Social Care”, we said that

“health and wellbeing boards and clinical commissioning groups should be placed under a duty to demonstrate how they intend to deliver a commissioning process which provides integrated health, social care and social housing services in their area”

and that there was

“evidence, for example, that 30% of admissions to the acute sector are unnecessary or could have been avoided if the conditions had been detected and treated earlier through an integrated health and care system.”

In our seventh report of the 2013-14 Session, “Public Expenditure on Health and Social Care”, we said that

“fragmented commissioning structures significantly inhibit the growth of truly integrated services.”

In our second report of the 2014-15 Session, “Managing the care of people with long-term conditions”, we said that

“in many cases commissioning of services for LTCs remains fragmented and that care centred on the person is remote from the experience of many”

and that an integrated approach was necessary to relieve pressure on acute care.

Members of the Health Committee, including the hon. Member for Totnes (Dr Wollaston) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), who unfortunately had to leave this debate to go to a young carers’ meeting in her constituency, have all sat through that evidence. I know it is real, because it will be on the website of the Health Committee. There are pages and pages of evidence on where we can get things right.

In particular, our report on “Social Care” said:

“Although the Government has ‘signed-up’ to the idea of integration, little action has taken place... The Committee does not believe that the proposals in the Health and Social Care Bill will simplify this process.”

We called for a single commissioner with a single pot of money who would bring together the different pots of money and decide how resources would be deployed.

One thing we did as part of our inquiry into health and social care was to visit Torbay, which has not been mentioned today, where we saw integrated care in action. Mrs Smith, who is fictitious but could be any one of our constituents, has one point of contact: she only has to make one phone call. Mrs Smith has seamless social care up to the health service and back again. The health service workers have been upskilled and can help her through the whole system. The local authority and the local hospital worked together so that when Mrs Smith is unwell and has to go to hospital, she can be tracked through the whole system. That is integrated care in action in Torbay. One concern was what would happen and whether such integrated systems would work under the Health and Social Care Act 2012, but I have seen it working.

There is another interesting area where integrated care is working. Another visit we made was to look at integrated care in Denmark and Sweden. In Denmark, we saw the most fabulous building in which elderly people could be cared for, and where they could be visited by GPs. It looked more like a hotel than a home. We were told, “We are looking at your system. We are looking at Mrs Smith.” At that point, we nearly fell off our chairs, because we had come to Denmark to find out how its system works.

[Norman Lamb]

I appreciate the hon. Lady’s kind words. She is talking about all the various initiatives and the need for political will, but the conclusion is that none of those things has happened. There has not been the political will because of the acutely partisan environment in which we all work. Does that not make the case for a process—which the Government could buy into and all the parties could commit to—that will deliver change in a defined period?

[Valerie Vaz]

I think that the Health Committee structure has such a purpose.

--- Later in debate ---

[Norman Lamb]

The Government have not bought into it.

[Valerie Vaz]

Well, they have. The Government have a responsibility to respond to the Health Committee. If the right hon. Gentleman waits until the end of the speech, he will see where I am heading. I agree with his idea that something needs to be put together. I do not like knocking good ideas on the head; I like to see such things taken forward. As the hon. Member for Stafford (Jeremy Lefroy) said, it is either “a commission or whatever”. It may be that the right hon. Member for North Norfolk has a good role to play in pulling all this together and taking forward the idea somehow, but at the end of the day, it is a political decision for the Government of the day to consider.

I want to move on to discuss my local hospital, Manor hospital, and the local authority. In Walsall, we are lucky to have a settled community, and we have one local authority dealing with the local hospital. Work is carried out by the local authority and the hospital together, and they can talk things through. When difficulties arose at the hospital in Stafford—the A&E closed, and we had to take on extra maternity services—it was much more difficult, taking on patients from different areas, to deal with local authorities in different areas. Such relationships had not been built up, but they can be built up and, with the best will in the world, I am sure they will be. We know that workers in the health service work very hard and extremely well together to ensure that such relationships exist. If that works for one local authority, I am sure it can work for other neighbouring authorities.

Interestingly, the right hon. Member for North Norfolk has involved two former Secretaries of State for Health, Alan Milburn and Stephen Dorrell, in his commission. If I was really cruel, I might say that they were Secretaries of State for Health, so why did they not do something about it then and why do they think they can do something about it now? As I have said, there is a way forward. Many Members have alluded to the myriad reports. The King’s Fund has produced a report, the Nuffield Trust has produced one and many universities have produced reports. There have been lots of words, but we need a little more action.

My only difficulty with the proposed commission is the accountability structure. I am not sure who it would report to and there would be no obligation on the Government to respond to it in the way that they have to respond to the Health Committee.

I want to touch on the issue of money. We had a reorganisation of the health service that cost £2 billion and counting. If the Government can sit down with a company to reduce its tax liability and, hence, what flows into the coffers of the Treasury, that has an enormous impact on the Mrs Smiths of this world and on all of us. That is why, as our second report of 2014-15 stated, the Government said in evidence to the Select Committee that

“the ambition of achieving integrated health and care services by 2017 had been given ‘quite a turbo charge’ by the introduction of the Better Care Fund”.

The then Minister of State, the right hon. Member for North Norfolk, said that

“by 2015 the whole country will be starting to see a significant change.”

That may be something that the Health Committee could look at and produce a report on or even that the “commission”—in inverted commas—or whatever it is that the right hon. Gentleman and his colleagues extract from the Government could consider.

We have the evidence—we have the care trust and the pilot—and, in the Government’s own turbo-charged words, we have the will, hopefully. Finally, I am not persuaded that a commission will bring about the change that all of us so desperately need.

NHS Specialised Services

Debate between Norman Lamb and Valerie Vaz

Thursday 15th January 2015 Westminster Hall

[Norman Lamb]

My hon. Friend makes a legitimate challenge. These anomalies have not been addressed so far, but they need to be at some point. I do not seek to deny his point.

The hon. Member for Mitcham and Morden (Siobhain McDonagh) highlighted the work of Headway, which provides incredible support for people with brain injuries and their families. She mentioned the helpline and the emergency fund, which will be of enormous help to families in the incredibly difficult circumstances they face.

The hon. Member for Bristol East mentioned the Cystic Fibrosis Trust—another amazing patient organisation that does extraordinarily important work. She talked about the importance of equity of access, and it is incredibly important that that principle is maintained in any changes that take place. We do not want to return to the postcode lottery that existed in the past. Again, I am happy to try to provide responses to the questions she asked at the end of her speech.

The hon. Member for Walsall South (Valerie Vaz) was incredibly generous in her remarks about the shadow Minister, and I feel the same about him—let us be blunt about that. I appreciate her kind remarks about me—indeed, the feeling is entirely mutual. She made some really important points about epilepsy and Epilepsy Action. She highlighted concerns about many CCGs and health and wellbeing boards not yet engaging fully in work on epilepsy. That critical issue goes beyond this debate, but I completely take the point that there needs to be a lot more understanding and recognition of the importance of good epilepsy care that follows good practice and addresses the awful problem of so many people losing their lives unnecessarily to this condition.

[Valerie Vaz]

The issue is actually within the scope of the debate. We are talking about co-commissioning, but CCGs are not ready.

[Norman Lamb]

I totally accept the point. Again, I hope to reassure the hon. Lady.

The hon. Member for Luton North (Kelvin Hopkins) referred to robotic assistive surgery. I do not want to give him any particular hope, but it is always possible for new procedures to be added to the list of those that come within specialised commissioning. The prescribed specialist services advisory group keeps the list under review. Just as there are proposals to remove procedures, there is always the possibility, if the case is made and the four conditions that need to be taken into account are met, that additional areas can be included.

NHS Commissioning Board

Debate between Norman Lamb and Valerie Vaz

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

This Government will ensure that there is no unfair competition, such as existed under the previous Government, whereby private providers got handed guaranteed income on a plate, irrespective of whether or not they did the work. I am clear that nothing in our legislation will prevent a real drive towards integrated care, to which the hon. Lady and I share a commitment.

[Valerie Vaz (Walsall South) (Lab)]

Will the Minister say whether there was a mistake in the instructions given to parliamentary counsel in drafting these regulations? Will he also tell us which Minister signed them off?

[Norman Lamb]

This comes down to a question of the legal drafting and a legitimate concern that the regulations did not meet the policy objectives set out clearly in the Health and Social Care Act and during the course of the debates on it in Parliament. We simply want to ensure that that objective is faithfully met.

Backbench business

Debate between Norman Lamb and Valerie Vaz

Thursday 14th February 2013 Westminster Hall

[Norman Lamb]

I am nervous about treading on other ministerial toes, but I am sure that in one way or another we can get the issue addressed properly. I am grateful to the right hon. Gentleman for informing me so well.

The hon. Member for South Derbyshire (Heather Wheeler) made a helpful contribution and discussed the need to raise awareness of eating disorders. She mentioned personal, social, health and economic education in schools. All schools are encouraged to provide young people with good, age-appropriate education about sex and relationships, but we are reviewing PSHE to establish how teaching can be improved. There is clearly a need to improve the teaching in many schools.

The hon. Member for North Tyneside (Mrs Glindon) mentioned her local service, NIWE, and the important work that it is doing. She spoke about the number of people who are not diagnosed but who none the less suffer from eating disorders, and about the fact that they have the highest mortality rate of any mental illness. She said that early intervention was important.

I was struck by what the hon. Lady said about recovery groups. This morning I spoke at a conference on mental health. I spoke specifically about recovery and a new way of looking at mental health. We must move from trying simply to treat the condition to working collaboratively with professionals and people experiencing the condition, and we must focus on recovery. Fantastic results are being demonstrated from that shift in approach. It is frustrating that in some parts of the country, great things are happening, but it is patchy, as many hon. Members have said, and improvement is needed. She also made the point that mental health is the poor relation, as I have acknowledged. That must change.

I pay tribute to the hon. Member for Enfield, Southgate (Mr Burrowes), who has had to leave, for the work that he has done on addictions, focusing on treatment and recovery. He has been committed to improving the experience of people suffering from a range of addictions. He, like other Members, discussed the growing prevalence of the condition among teenage boys, which should worry us all. My hon. Friend the Member for Wells (Tessa Munt) spoke movingly. She mentioned the cult of celebrity, pressure on youngsters, variability of services around the country and access to those, the quality of care being variable and the need for much improved training and for multidisciplinary teams.

Interestingly, my hon. Friend mentioned issues of consent, a difficult area about which there are strong views on both sides. I am acutely aware of the horrible position of a parent wanting to help, but being unable to because of the legal constraints that prevent them from making an effective intervention. We need to think more about that, and the Children’s Minister is also involved in the discussion.

My hon. Friend the Member for South Basildon and East Thurrock got it right. Fascinatingly, he talked about his discussion with his children last night. I am so pleased that his television is broken, because it has led to our being given a valuable insight that we might otherwise not have had. He mentioned the increasing prevalence among males, including among gay men, which is a real concern. He also talked about the need for help for parents in understanding the condition much better.

The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), was right to talk about holistic care and the need to look at the whole individual. I will mention other things that he said as I go through my speech. I wish his son a happy birthday today, as he enters his teenage years.

The hon. Gentleman asked a couple of questions. On collating national statistics, we have a long way to go on the collection and interpretation of data relating to mental health. I have a fortnightly meeting on mental health in my office, so that we maintain an absolute focus on achieving tangible improvements. We talked specifically about data yesterday. The Health and Social Care Information Centre is getting more data but is not yet able, with the resources available, to interpret those. I want the same resources applied to mental health as to physical health. That is a challenge that I have made to the system.

The hon. Gentleman mentioned National Institute for Health and Clinical Excellence guidance. NICE is independent. I do not know whether there is a need for a review—a renewal—of the advice. I am happy to talk further to him about that.

This is an occasion on which we should not just raise awareness of the issue as part of eating disorders awareness week, but send a clear message to people with eating disorders, their loved ones and families: we hear you when you talk about your concerns. I am determined, as the Minister responsible for mental health, to do what I can to help.

I pay tribute to the work of Beat, based in Norwich in my county of Norfolk, which does brilliant work. Hon. Members have also mentioned Anorexia and Bulimia Care and the fantastic work that it does.

Eating disorders can be tremendously dangerous and damaging conditions. The UK has the highest rates of eating disorders in Europe. But it is a disease that is often hidden, as hon. Members have said. Sufferers are often unwilling to seek help or to recognise they have a problem. Reported cases are the tip of the iceberg. It is a disease that often strikes at the young. In 2009, the adult psychiatric morbidity survey showed that 20% of 16 to 25-year-olds admitted to having “a problem with food”. That is a significant percentage.

According to the Health and Social Care Information Centre, in 2011-12 the biggest increase in hospital admissions for eating disorders was among girls aged 10 to 15. The shadow Minister, the hon. Member for Denton and Reddish, mentioned admissions of those under 10, as well—shockingly, more than 50 children under 10 were also admitted.

[Valerie Vaz (Walsall South) (Lab)]

I apologise for not attending earlier, Mr Walker; I was in another debate in the main Chamber. I congratulate the hon. Member for Romsey and Southampton North (Caroline Nokes) on securing this debate.

The Minister mentioned young people. Will he say what services are available for 17-year-olds in terms of continuity of care, as they move to adult services?

[Norman Lamb]

I will talk about that later. In so many respects, we have problems with people falling through the gap between children and adolescent mental health services and adult services, and that is matched in other areas, as well. There is a need to deal with this. The draft Care and Support Bill deals with the transition from teenage to adult services. I will return to that matter. I thank the hon. Lady for her intervention.

A generation of young people is growing up depressed and unhappy with their relationship with food. I want to tell hon. Members about a case in my constituency. Charlotte Robinson was a bright, outgoing young woman who was about to secure straight As at A-level and had dreams of going to Cambridge—between Duke of Edinburgh’s awards and learning to fly helicopters—but tragically, Charlotte was a victim of anorexia, stolen from her family in her prime, with her whole life ahead of her. That is what I meant when I said that for some, thankfully, there is life after anorexia—but not for everyone.

Charlotte’s parents, Christopher and Pauline, who are remarkable people, have campaigned tirelessly to help others. Pauline even ran the London marathon in pink wellies, such is her commitment. They are fantastic people and their attitude was that they did not want other families to experience the same horror that they have gone through, so they have been determined to change things in their county of Norfolk. They discovered that there was no specialist commissioned service at all in their own county. This is what we find. Hon. Members have talked about the enormous gaps in services around the country.

As a result of Christopher’s and Pauline’s fantastic determination, there is now a specialist commissioned service, but it took their efforts to achieve it. Their efforts have helped to fund local centres and a helpline in Norfolk, working with NHS Norfolk and the charity Beat, which I have mentioned. Their focus is on early intervention, helping people like Charlotte—helping children, young people and adults as soon as they need help. Charlotte’s decline was dramatic and rapid and the wait, although nothing like the nine months that we have heard about, still was too long for her.

Speedy access and early intervention are critical. That is why our mental health strategy prioritises early intervention and demonstrates how timely action can help.

In many cases, eating disorders stem from low self-esteem or are linked to stress and emotional problems. That is why our support for local organisations in improving mental health services locally is so important. Our mental health and suicide-prevention strategies both include actions that local organisations can take to improve mental health in their areas: ensuring that children and parents get mental health support from birth; that schools and colleges promote good mental health, alongside targeted support for those at risk of mental health problems; that public services recognise people, of all ages, at risk of mental health problems and take appropriate, timely action; and that health services step in early if there is psychosis or a crisis, to stop more serious problems occurring.

The right hon. Member for Knowsley and my hon. Friend the Member for Romsey and Southampton North raised the problem of transition—moving from being a young teenager at home to a young adult. Often the problem is exacerbated by moving to university, where people suddenly lose contact with services that might have been available to them at home. As my hon. Friend mentioned specifically, that is where things can break down. Away from friends and family, in a new and often stressful environment and, crucially, registering with a new GP, young people can often enter a spiral of decline. The problem must be addressed.

I will now outline some of our ambitions for services. From this April, the NHS Commissioning Board will commission specialist services for eating disorders for adults and children. Having one specialist group to ensure that specialist services are commissioned everywhere has the potential to improve the position in many parts of the country where such services are inadequate or missing. The Commissioning Board will develop a national service specification and encourage better planning, access and outcomes, helping to bridge the gap when someone moves and raising the level of care throughout the country.

We want clinical commissioning groups to commission services with early intervention in mind. We also expect adult social services to work alongside CCGs to focus existing support on early intervention, integration, personalisation and recovery. Social services have a role to play, involving service users as equal partners in commissioning and monitoring services, ensuring that services are designed for the people who use them.

Public health services can articulate the many benefits of good mental health and, because of their pivotal role in the new system, they can talk about mental health directly with members of the public. The transfer of public health to local government, alongside children’s services, social care and other services, with a seat on the health and wellbeing board, potentially gives it a prominence that it has not had in the past. The funding settlement for public health has also surprised many people, with significant real-terms increases this year and next. There is great potential for a focus on public mental health in a way that we have not had in the past, so I hope that we can take advantage in the best possible way of that opportunity.

Of course, the problem cannot be fixed by tweaking the system. A huge stigma remains around mental health, which means that in too many cases children and young people are not getting the support that they need. That is particularly the case with eating disorders, and people affected often feel marginalised and excluded, unable to talk about their suffering. The problems can be compounded if the sufferer is a man or suffering from a less stereotypical but no less serious eating disorder, such as atypical anorexia or a binge-eating disorder. Personal testimony and the courage of individuals in speaking out send a powerful message, and challenge that stigma.

The Department of Health is therefore funding Time to Change, a brilliant campaign that was started under the previous Government but continues now. We are providing £16 million between 2011-12 and 2014-15, the first time that Time to Change has had central Government funding. It will also get a further £4 million from Comic Relief, the second time that that charity has awarded its largest UK grant to Time to Change. Run by the charities Mind and Rethink Mental Illness, Time to Change is England’s most ambitious programme to end the stigma and the discrimination against mental health through activities ranging from education to publicity. It aims to reach 29 million members of the public, explaining mental health and helping them to understand conditions, including eating disorders, that might at first seem alien or scary.

I was delighted that two young women from Time to Change came into the Department of Health recently to speak about their own experiences of mental health. They spoke about how talking about their own mental health had empowered them. One said that it had, “given me my life back”. Their stories were both moving and inspiring and I pay tribute to all those who find the courage to open up and to talk to others. Time to Change aims to increase the confidence of 100,000 people with mental health problems, helping to give them the self-belief that they need to recover.

The Time to Change campaign also works with schools to support children and young people facing problems of integration and bullying that can be caused by mental health issues. I have not only signed up to committing the Department of Health to be an exemplar employer on mental health, but made the commitment to try to get every other Department to sign up as well. We cannot encourage others to behave in the right way unless we practise what we preach. That is a challenge for Government, and I have not yet achieved that aim, but I am determined to pursue it.

The reasons for eating disorders are complex, as has been made clear in the debate this afternoon. Biology and genetics play their part, but so too does the pressure from our celebrity culture and the media. A recent controversy ignited by stick-thin La Perla lingerie models erupted only last week, and it is important to send out the message that organisations that do this sort of advertising have a responsibility; they cannot opt out. Government cannot do everything on its own. Everyone in society has a responsibility to get the right messages out. I was pleased to hear the shadow Minister’s reference to Vogue, which has made a good commitment to avoid getting out the wrong images.