Oral Answers to Questions

Paul Blomfield Excerpts

Tuesday 5th December 2023 Commons Chamber

[Victoria Atkins]

I will be delighted to visit that hospital with my hon. Friend—I suspect that I will be visiting a lot of hospitals.

[Paul Blomfield (Sheffield Central) (Lab)]

T8. Was the Secretary of State consulted about yesterday’s announcement by the Home Secretary? If she was, did she agree with him that it will have no impact on overseas recruitment, or does she hear the fear of care providers about its consequences?

[Victoria Atkins]

Yes, I was. What is more, we looked carefully at the figures in relation to overseas care workers. We are grateful to all international people who work in our NHS and our care system, but we need to tackle the migration rate, which is too high. The package presented yesterday by the Government is a thoughtful and careful one to tackle legal migration.

Healthcare Students: Pay and Financial Support

Paul Blomfield Excerpts

Monday 20th November 2023 Westminster Hall

[Marsha De Cordova (Battersea) (Lab)]

I beg to move,

That this House has considered e-petitions 610557, 616557 and 619609, relating to pay and financial support for healthcare students.

It is a pleasure to serve under your chairmanship, Ms Fovargue. I congratulate the petitioners, Victoria, Charlotte and Jacorine, on starting the petitions, which were signed by more than 36,000 people. I thank all the organisations that prepared briefings ahead of the debate, including the Royal College of Nursing, the Royal College of Midwives and the National Union of Students, and I thank the Petitions Committee for its work.

Today’s debate is timely, as many of our constituents have been impacted by the cost of living crisis in multiple ways, but the impact on students and the unique challenges they face are rarely acknowledged. The president of Universities UK, Professor Steve West, stated:

“Students risk becoming the forgotten group in the cost of living crisis.”

Academic and workplace commitments leave little room for students to earn outside their studies, so it is inevitable that cost of living pressures will hit them hardest. Those pressures are more pronounced for those studying healthcare subjects, as many are mature students and may have to balance parenting duties with course commitments, not to mention the extra costs they face supporting their children.

Healthcare students who responded to the Petitions Committee’s survey ahead of the debate said that they were struggling with the cost of living, with 58% saying that it was difficult or very difficult to afford energy, including gas and electricity. Nineteen per cent said that they had visited a food bank, and 26% said that they were considering using one. Further adding to the pressure, healthcare students are required to complete thousands of hours of unpaid clinical placements over their course programme. One student nurse said:

“I wanted to leave my course this year when I was working on placement and not able to afford food. I was so hungry, and my energy was so depleted that it was affecting my work. I was struggling so much financially that the staff resorted to giving me toilet rolls, sanitary products and even paying for some food for me.”

As healthcare students are not paid or classed as workers, they often lose out on additional support or entitlements, such as the 30 hours of free childcare available to working parents. Many said that they were under considerable financial strain and found their workload difficult to manage, as they were juggling childcare, their unpaid nursing placements, study, and a second, paid job. Worryingly, many said that they were considering leaving their course due to financial pressures related to childcare costs, with 93% strongly agreeing that healthcare students should be eligible for free childcare. In the words of one student:

“I am working just as hard as I was when was employed by my local police force 12 months ago and yet, as I am now considered a student and not a worker, I can no longer claim the 30 hours free childcare for my 3-year-old. There are shortages of many NHS staff so I can’t understand why the government does not make it easier for parents to study for these roles.”

It is a fact that England has the least generous financial support for healthcare students.

[Paul Blomfield (Sheffield Central) (Lab)]

I regret that I cannot stay for the whole debate, but, as chair of the all-party parliamentary group for students, I wanted to make a contribution. My hon. Friend refers to a debate that we had seven years ago, I think, when I recall the then Minister, Ben Gummer, told us that he was keen to share the benefits of the undergraduate student funding system with healthcare students, including nurses and midwives, who had previously benefited from the bursaries, and was anticipating that that would lead to better support and an expansion of the number of people coming into the service.

Does my hon. Friend recognise that those of us who argued at that stage that the changes would lead in the other direction have been validated by experience? Does she agree that we have seen more potential nurses and midwives, particularly mature ones, no longer entering the profession? Also, is she concerned—I hope that the Minister will respond to this point—about the UCAS figures for this year, which show a 16% decline in the number of people applying for healthcare courses?

[Marsha De Cordova]

My hon. Friend makes an important point, which I will come to shortly, and he is absolutely right. It is clear that the changes to the bursary scheme have led to a fall in the number of students taking up these much-needed roles.

Since the removal of the bursary scheme, students studying nursing, midwifery and allied health professional courses in England are only eligible for the standard student finance package of tuition fee and maintenance loans, whereas students in Wales, Scotland and Northern Ireland who are eligible enjoy fully funded education.

I am sure that, in responding to the points made by my hon. Friend the Member for Sheffield Central (Paul Blomfield), the Minister will point out that since 2020, students eligible for the standard student support package receive an additional £5,000 training grant through the NHS learning support fund, that there are additional grants for some qualifying students and that the Government have increased travel and accommodation support. But that simply is not enough. Eighty per cent of student midwives in England who took part in the Royal College of Midwives survey said that they would be taking on additional debt over and above the loans available to students. Moreover, nearly three quarters of student midwives in England said that they expect to graduate with debts of more than £40,000. I am sure that my hon. Friend agrees that that cannot be acceptable.

Government-imposed barriers are making healthcare studies unaffordable for many students. In the first year after the changes to the bursary model, the number of applicants from England for nursing courses fell by 23%. My hon. Friend highlighted the latest UCAS figures, which showed that this year there has been another fall in the number of people applying.

Why does this all matter? I will make two key points today. The first is that it is a matter of fairness and equity. Healthcare students make a significant contribution and play a vital role in delivering high-quality healthcare. Many of those on placements are often required to cover the responsibilities of qualified healthcare workers, due to the workforce shortages.

The Government must look at increasing financial support for healthcare students, and I hope the Minister will address that point. They could do so by creating a scheme to offset or write off debt run up by healthcare students through tuition fees if they commit to working in the NHS for a period of time. That would be similar to the scheme in Wales, which I am fairly certain is working. They should also ensure that higher education funding models are complemented by a financial package for students, to make sure that grants reflect the true cost of living, as they do in Scotland, which has the most generous living cost support. The Government should also extend the 30 hours of free childcare to those on placements.

I would welcome it if the Minister addressed those points in his response. To adequately address fairness and equity, the Government must also focus on intersectionality by looking at the age and sex of healthcare students, as many tend to be women and/or mature students, who are more likely to have dependants.

The second point I want to touch on is the workforce crisis in the NHS, which is so severe that it is undermining the NHS’s capacity to properly deliver its services—we all know it is on its knees. The long-term workforce plan produced by NHS England suggested that the system is operating with over 150,000 fewer staff than it needs. According to the Royal College of Nursing, there are 43,000 vacant registered nursing posts in the NHS in England alone.

Like my hon. Friend the Member for Sheffield Central, the general secretary of Unison, Christina McAnea, rightly predicted the damage that the Government’s reforms would do were they to get rid of the bursary scheme. She said:

“They seem not to care that in a few years’ time”—

that is now—

“the NHS will be seriously short of nurses and there will be too few new recruits coming through to fill the gaps”.

Seven years later, we can all attest to that being the truth.

The NHS, our greatest institution, was established 75 years ago by a Labour Government, and it is experiencing some of the most severe pressures in its history. Waiting lists are at an all-time high. Ministers point to the impact of the pandemic, but waiting lists were already too high before the pandemic. If we want to make sure our NHS survives another 75 years, the Government must make progress on the workforce challenges. They need to look at all options and think bigger to incentivise more people to take up healthcare professions. Restoring some sort of financial support package may do that. They must fundamentally rethink the way they approach their support for healthcare students, including by making extra funding available for healthcare education and training.

We owe it to our healthcare students to ensure that they have adequate financial support as they provide the care that keeps us all healthy, and to protect the long-term interests of our country by having a workforce that can truly deliver all the services that the national health service provides.

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Fovargue. I welcome the Minister to his latest position on the Government Front Bench. I hope he enjoys what remaining time the Conservatives have in government in the Department of Health and Social Care. I wish him all the best over the next few months.

I am grateful for the opportunity to respond to the debate on behalf of the shadow Health and Social Care team. I thank my hon. Friend the Member for Battersea (Marsha De Cordova) for her powerful speech, and my hon. Friend the Member for Sheffield Central (Paul Blomfield) for his wise contribution. I also thank the Petitions Committee for its work in preparation for the debate.

Being a student nurse during the cost of living crisis is tough. We know that valuing our NHS workforce through fair pay and conditions is crucial to tackling vacancies, yet according to the RCN’s 2023 summer survey, almost nine in 10 student midwives in England—89%—worry about the amount of debt they are in, and 74% of them expect to graduate with debts of more than £40,000.

[Paul Blomfield]

My hon. Friend is making a very important point, and I am sure that he will come on to say that the experience of midwives also applies to nurses and others on healthcare courses. The report by the APPG for students, which I mentioned a moment ago, highlighted the way in which the student funding model was broken, not least by pointing out that, according to Save the Student, the average loan now falls short of living costs by £439 every month. Most students are dealing with that by taking on ever-increasing amounts of paid employment, which is raising some concerns. One Russell Group university told us that a significant number of its students work more than 35 hours a week. Does my hon. Friend agree that that option is not available to most nurses, midwives and other healthcare students on similar courses, because of the structure of their courses? The Government are failing to address that issue.

[Andrew Gwynne]

My hon. Friend hits the nail on the head. We are talking about student nurses and student midwives, who do not have any spare time to dedicate to other forms of paid employment: it is physically and mentally impossible for them to do so. There needs to be greater recognition of the unique nature of these kinds of students. Many students—including me, many years ago—rely on extra support to make ends meet, but people studying in the caring professions, including nursing and midwifery, do not have that same ability. That was one reason why there was always additional support for those groups of people.

Fifty-eight per cent of respondents to the survey conducted by the Petitions Committee for this debate said that it was difficult or very difficult to afford energy, including gas and electricity, 19% said they had visited a food bank, and 26% said they were considering using one. That is a national scandal—a cost of living scandal that is having a devastating impact on our ability to recruit and retain staff in the national health service. Over nine in 10 student midwives in England—91%—know someone who dropped out of their midwifery studies because of financial problems.

The Conservative Government abolished NHS bursaries for student nurses, midwives and allied health professionals back in 2017. Students undertaking their degree since then have had to pay to train to work in the NHS. As a result, not surprisingly, the number of applications to study nursing in England fell, with applications down by almost 30% by 2019. It is not rocket science to work out what caused that. Labour said at the time that the decision to remove the NHS bursary was the wrong one, and the Public Accounts Committee, in its September 2020 report, agreed that the decision

“failed to achieve its ambition to increase nursing student numbers.”

That is just another example of a Government who have time and again failed to plan for the long term.

In this NHS workforce crisis, we have deteriorated to the point where we now have over 100,000 vacancies, including 40,100 nursing vacancies. We have waited so long for the NHS workforce plan, and now we finally have it. Labour has been calling for a workforce plan for years, and I am glad that the Government pinched the plan of my hon. Friend the Member for Ilford North (Wes Streeting). Since its publication, though, not much has happened. It makes clear the scale of the neglect—a wasted decade of drift and inaction, impacting not only on staff but on trainees.

Placements are an important part of nursing and healthcare courses. They provide the vital supervised training that allows students to gain the necessary skills and experience to meet education outcomes and work in clinical settings. Labour knows the value of placements, which is why increasing them is an important part of our plan to expand the NHS workforce. We will focus on ensuring we have the roles, trainees and senior professionals needed to tackle the challenges we face and seize opportunities, drawing on a diverse range of skills and inspiring people around the country to pursue a career in the NHS and caring professions. We will also work with health staff and their trade unions to review existing training pathways and explore new entry routes to a career in the NHS, including high-quality apprenticeships.

The childcare sector is under huge strain. While some healthcare students may be eligible for parental support from the NHS learning support fund of £2,000 a year, that is dwarfed by the ever-increasing cost of childcare. It leaves many studying parents vulnerable to childcare costs, particularly considering the hours needed to fulfil placement requirements. It has been reported by openDemocracy that some nursing students considered leaving their courses because of financial pressures related directly to childcare costs. That is, sadly, a trend across our economy. The cost of childcare is pricing parents, especially women, out of the professions they love.

Does the Minister agree that adequate support for a profession as critical as nursing or midwifery should not depend on where a person studies but should be the same across the board? What assessment has he made of support at all stages of training for studying parents, in order to build an effective and inclusive workforce in our NHS? The 11,000 people who signed the petition will be looking for a response from the Government, so does the Minister regret the decision to abolish NHS bursaries? What additional support can healthcare students expect, given the current cost of living crisis?

Two in five student nurses and three in five student midwives said that they considered leaving their course last year, so we must take this seriously, especially given the threat to the future of the NHS workforce that it poses. Already students have cited the placement experience and lack of support as major factors in their leaving their course. The Conservative-made crisis in the NHS only makes this worse. We might have expected in this month’s King’s Speech to hear of something to deal with the worst NHS crisis in its history, but there was virtually nothing.

The energy price cap has increased by half this Parliament, the cost of living crisis is hammering healthcare students, and we have a flagship energy Bill that

“wouldn’t necessarily bring energy bills down”.

Whether we are talking about the NHS or the cost of living crisis, this Conservative Government look like they have thrown in the towel. They are divided, weak, out of ideas and out of time. Every day that goes on, it is British people, our public services and our patients who pay the price. For Labour’s part, we know that our healthcare staff are our national health service’s most valuable asset, and we know how vital it is to ensure that there is a pipeline of future talent coming through. That is why the next Labour Government will put their workforce plan at the heart of their plans to restore, renew and rejuvenate our national health service.

NHS Long-term Workforce Plan

Paul Blomfield Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

My hon. Friend is exactly right. As a former Health Minister, he knows these issues extremely well. There is a requirement—this is something the chief medical officer, Professor Sir Chris Whitty, has spoken about—for more generalist skills in the NHS, not least given that one in four adults now has two or more health conditions. We need flexibility to respond to changes not just in technology, but in service design, which will evolve as well.

My hon. Friend is also right about the wider issues of culture. I think the whole House was concerned about recent reports of sexual assaults linked to the NHS. One of the key features of the agreement we have reached with the NHS Staff Council is to work more in partnership on violence against members of NHS staff. I know there will be consensus in the House that that is unacceptable, so we are working with trade union colleagues on how we tackle it. Again, with racism, we still have too many cases of concern. There are a number of areas of culture that we are working constructively with trade union colleagues and others to address.

[Paul Blomfield (Sheffield Central) (Lab)]

I thank the Secretary of State for his comments about Bob Kerslake, whose spell in public service included his time as chief executive of Sheffield City Council. He continued to have many roles in the city, where he will be much missed.

After this Government’s 13 years in charge, morale in the NHS is clearly at rock bottom, with the value of pay falling, pressures increasing and a record number of staff—almost 170,000—leaving the NHS last year. The CEO of NHS Providers said that that must be reversed, but all the Secretary of State talks about is a little bit of working flexibility. Does he recognise that he has to address the crisis in morale to stem the tide of people leaving the NHS?

[Steve Barclay]

It is simply not correct to say that this is simply about flexibility—for example, look at the very significant changes made on pension tax. That was the No.1 demand of the British Medical Association consultants committee, and the Government agreed to it. A significant amount of work is going on. The NHS people plan talked about not just flexibility but some of the cultural points that are important. Some roles that have been introduced need to expand, such as some of the advanced positions like advanced clinical nurse or physician associate, where there are opportunities for people to progress their careers. It is worth pointing out that, once again, not a single Welsh Labour MP has turned up to defend their party’s record in Wales. As we set out a long-term workforce plan, we are setting out that ambition for England, but we see very little from the Labour party in Wales.

Eye Health: National Strategy

Paul Blomfield Excerpts

Wednesday 17th May 2023 Westminster Hall

[Marsha De Cordova (Battersea) (Lab)]

I beg to move,

That this House has considered the potential merits of a national eye health strategy.

It is an absolute pleasure to serve under your chairmanship, Mrs Harris, and I am pleased to have secured today’s debate. Let me begin by placing on the record my thanks to the many organisations that have sent through their briefings and shared their knowledge and expertise, including the Association of Optometrists, the Royal College of Ophthalmologists, Specsavers, SeeAbility and the Royal National Institute of Blind People, which have all supported my National Eye Health Strategy Bill as well.

There is no question but that we need the Government to introduce an eye health strategy in England, because there is an emergency in eye care. Huge backlogs, which were apparent before the pandemic, are leading to people unnecessarily losing their sight. The annual economic cost of sight loss is currently estimated at £37.7 billion. An estimated 2 million people are living with sight loss in the UK, and anyone can be affected by it. As Members, we will all have constituents who have been or are being affected, because 250 people begin to lose their sight every day, with a shocking 21 people a week losing their vision due to a preventable cause. On top of that, we know that 50% of all sight loss is avoidable. We should all be asking why so many people are needlessly losing their sight or going blind.

The backlog for ophthalmology appointments in England is one of the largest in the NHS, with over 630,000 people on waiting lists as of 23 March this year—more than 9% of the total backlog. Ophthalmology has been the busiest NHS out-patient clinic for the last three years, with 7.5 million hospital attendances in England in 2021-22. It is shocking that eye care accounts for only 2.6% of NHS consultants and 1% of the total number of doctors.

[Paul Blomfield (Sheffield Central) (Lab)]

I congratulate my hon. Friend on securing this really important debate. She is making a significant point about capacity. Does she agree that there is a need to ensure that the long-awaited workforce plan the Government have promised pays proper attention to this area of specialism and takes account of the need to train more people as part of the provision being made for additional medical training?

[Marsha De Cordova]

I thank my hon. Friend for his intervention, and he is absolutely spot on. I will come to the workforce plan and the Government’s expectations, but he is absolutely right that it must include this specialism. There must also be an element of training and upskilling.

--- Later in debate ---

[Marsha De Cordova]

Again, my hon. Friend makes an intervention that is 100% accurate. We obviously have to ensure that spending is done effectively and properly, and ensuring that resources are allocated in the community and alleviate pressures on hospitals will obviously lead only to better outcomes and savings.

At the most recent meeting of the all-party parliamentary group on eye health and visual impairment, ophthalmologist Dr Seema Verma from St Thomas’s Hospital spoke about the importance of MECS and locally commissioned optometry clinics in south-east London, which prevented 32% of referrals from being sent to hospital eye care services. If my hon. Friend the Member for Vauxhall (Florence Eshalomi) does not mind, I would very much like to invite the Minister to visit the eye department at St Thomas’s and the MECS community service, if he has not already done so.

Better joined-up care requires spending on infrastructure. Improved IT connectivity for two-way transfer of patient and clinical data would enable better patient care, and improved use of clinical skills and facilities in primary care, enabling more patients to be seen and treated closer to home. Everyone can get the theme here: community, community, community.

The eye care sector has been championing a single national electronic eye care referral system or EECR—there are so many acronyms—that would facilitate direct optometry to ophthalmology referrals, without people having to go through their GP. That would reduce the administrative burden on GP services, devolving some of the lower-risk cases to optometry and addressing unwarranted variations in referral and follow-up pathways.

[Paul Blomfield]

I thank my hon. Friend for giving way again, and she really is making a powerful speech. She made the point about the single route of referral in that relationship between primary and secondary care. Does she recognise that that is not only better for patients but—reflecting the comment my hon. Friend the Member for Lewisham East (Janet Daby) made a moment ago—for the NHS, saving it an estimated £2 million a year?

[Marsha De Cordova]

That is exactly the point. Joining up services, which is what my Bill seeks to do, would essentially save the state money, which is crucial.

I have mentioned devolving services and supporting the pathway. When the Minister responds, will he provide an update on where the Government are up to in creating this referral and joined-up pathway system, or EECR, to be specific?

The third area of the strategy would be workforce expansion. There is a significantly uneven distribution of ophthalmology workforces across England, and a quarter of the profession is nearing retirement age. That is extremely concerning, because nearly 80% of eye care units already do not have enough consultants to meet current demand, with over 50% finding it more difficult to recruit for consultant vacancies. In the last year alone, 65% of units had to use locums to fill those consultant vacancies. What do the Government plan to do to respond to this workforce crisis? They say they are bringing forward their plan, but when will it be published?

At the APPG meeting in April, we addressed the challenges of the eye care workforce. Speakers from the Royal College of Ophthalmologists, the College of Optometrists and the Association of Optometrists all made strong recommendations and put forward credible solutions. Again, I would be happy to facilitate a meeting if the Minister is yet to meet those trade bodies. He would hear first hand their strong and credible recommendations, which seek to address some of the workforce challenges.

The Government must make better use of existing workforces while expanding capacity to meet future needs, including by adopting Labour’s call to double medical school places to 15,000 a year. That needs to be complemented with investment in training for wider eye care and multidisciplinary teams and with an expansion in the number of non-medical roles.

The fourth area would be health intelligence and data.  For too long, population data has not been utilised effectively to pinpoint the location of need and the places where opportunities for change can be found. A strategy would solve that by focusing on robust data collection to inform decisions and improve the delivery of service. The UK has no national data to identify people at risk of sight loss. There is potentially a case for looking at how registration for the certificate of vision impairment system works to see whether it could be used to map out an evidence base to show where people with sight loss are living. The lack of data means there is likely to be unmet need in the system, with some people who experience visual impairment not being treated, and some developing conditions that could be avoided if they were treated earlier—as I said earlier, 50% of all sight loss is avoidable.

Without that data, we do not know whether public expenditure on eye health is meeting people’s needs, because that expenditure is not based on any evidence. Where there are still no treatments for certain conditions, the Government should increase spending on eye research, which gets a fraction of the investment it desperately needs. According to UK Research and Innovation, the Government, charities and other public bodies invested £1.4 billion in medical research in 2018, but only 1.5% of that was invested in eye research. To put that in context, only £9.60 was spent on research for each person affected by sight loss in the UK. That is worrying, given that 250 people begin to lose their vision every day.

The fifth area would be improving public awareness. As I said earlier, 2 million people each year turn up to A&E or try to get a GP appointment for a problem that could be dealt with by a community optometrist. A strategy would involve campaigns on the importance of maintaining good eye health, educating the public on the difference between eye screening and eye tests, and improving signposting to where people need to go for help.

England is the only country in the UK without an eye health strategy. Strategies can deliver positive outcomes, as has been the case in Scotland. In England, there are health strategies for other conditions, so why not for eyes? The benefits would transform lives, alleviate pressure on health services and reduce economic costs. Our goal should be to ensure that no one loses their sight unnecessarily. Most people in the Chamber know that I have a condition called nystagmus. I have been living with my sight loss all my life, but those who come to sight loss later in life face even more barriers and challenges.

I would like the Minister to address the following questions. He will get fed up of me saying this, but why will the Government not commit to an eye health strategy for England? Will they appoint a Minister—it could be this Minister—whose sole responsibility is eye healthcare? What are they doing to ensure that every integrated care board has a MECS and that their commissioning is consistent with that of the 23 that already have such services? Five ICBs have no form of MECS provision at all, so what will the Minister do to ensure there is consistency in our communities? When will the Government publish their overdue long-term workforce plan? Will there be a focus on ophthalmology? As I have highlighted, only 1.5% of the £1.4 billion going into medical research involves eyes, so will the Government increase spending on eye health research?

NHS Strikes

Paul Blomfield Excerpts

Monday 6th February 2023 Commons Chamber

[Will Quince]

I will gladly write to my hon. Friend on the specifics, but he is right to point out that NHS spending in England this year is about 11.4% higher in real terms than it was in 2019-20. He is right to point to his constituents on the waiting lists, and I want to get the numbers down as quickly as possible, particularly for those who have been waiting the longest. On top of a £2 billion recovery fund, we have invested £8 billion over three years; we have already opened 92 community diagnostic centres, and we will open 160 by March 2025; and we have opened 89 surgical hubs, with an aim to open 140. Our aim is 9 million more treatments and diagnostic appointments by 2024, so that constituents of my hon. Friend who have been waiting too long get that service.

[Paul Blomfield (Sheffield Central) (Lab)]

Ministers are hiding behind the independent pay review process. The Minister knows that recommendations have been ignored when it suited the Government in the past. NHS employers want negotiations, the unions want negotiations and the public want negotiations. The Minister says it is time to come together in the interests of patients. He is right, so why do the Secretary of State and the Prime Minister not come together with the unions and sort it out?

[Will Quince]

I have met employers, and I believe in open and honest dialogue. What the hon. Gentleman has not accepted—and I appreciate that being in opposition is the easiest job in the world—is that, as I have pointed out, every 1% is £700 million. I have a budget this year of £153 billion and, yes, that is rising, but I have some huge challenges. We have huge challenges to tackle within our NHS. The hon. Gentleman the shadow Secretary of State just says, “Negotiate, negotiate”—

Oral Answers to Questions

Paul Blomfield Excerpts

Tuesday 1st November 2022 Commons Chamber

[Mary Glindon (North Tyneside) (Lab)]

6. What estimate he has made of the average waiting time for mental health treatment.

[Paul Blomfield (Sheffield Central) (Lab)]

22. What estimate he has made of the average waiting time for mental health treatment.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

Waiting time targets for adult talking therapies were exceeded in 2021-22, with 91.1% accessing those services within six weeks and 98.6% within 18 weeks.

[Maria Caulfield]

I thank the hon. Lady for her campaign on this issue. I am very sorry to hear of the tragic case of Charley Patterson. We recognise that, particularly with the pandemic, there has been a significant rise in mental health conditions for young people and children. We are expanding services so that an additional 345,000 children and young people can access NHS mental health support, and we are providing more support in colleges too. I am very happy to meet the hon. Lady to discuss her campaign further.

[Paul Blomfield]

When I recently visited Sheffield College, students told me about the difficulty they face in accessing mental health services, and it is the same every time I visit a school to talk to students about the priorities for this place and for the Government. According to Mind, one in six young people have a mental health problem. We know that referrals for children and adolescents hit record numbers this summer. Early intervention is crucial but is simply not available. Young people are waiting months and months for their first appointment with child and adolescent mental health services after referral. There is a deepening crisis and, frankly, what the Minister just described will not address it, so what more will she do to ensure proper funding of mental health services for young people?

[Maria Caulfield]

I have highlighted that there are additional pressures—more children and young people are coming forward with mental health conditions—but I assure the hon. Gentleman that we are putting early intervention directly into schools. Mental health support teams now cover 26% of pupils, with the aim of going up to 35% of pupils by April, and we intend to increase that further. So we are getting in as early as possible. Over 420,000 children and young people were treated through NHS-commissioned services in the last financial year. There is more to be done, but we have made a good start.

NHS Dentistry in England

Paul Blomfield Excerpts

Wednesday 22nd June 2022 Westminster Hall

[Paul Blomfield (Sheffield Central) (Lab)]

It is a pleasure to see you in the Chair, Mr Stringer. I pay tribute to the hon. Member for St Ives (Derek Thomas) for the way he introduced the debate and covered so much of the ground we need to pay attention to.

This is a funny old place. We wait for months to talk about dentistry, and now we have had two debates in two days. I spoke in yesterday’s debate and I do not want to repeat the points I made then, but I do want to develop some of them. We clearly face an extraordinary crisis in dentistry. It was fascinating to see all the Members intervening on the hon. Member for St Ives, telling their stories about constituents who had contacted them, unable to access NHS dentistry. We had that yesterday throughout the debate, with some horrific stories about the self-treatment that some people have been driven to carrying out with pliers. That emphasises the scale of the crisis across the country.

If we had all hung about after Prime Minister’s questions, and the Speaker had asked, “Has anybody here not had a constituent contact them about access to NHS dentistry?” no hands would have gone up. We all face this problem. I met our local dental committee last week. I said yesterday that, in response to that meeting, it commissioned a survey across the city, speaking to about half the practices. Only one could offer a waiting time shorter than a year. For 29%, it was up to two years; for 32% it was more than two years. The biggest number—35%— said, “At this moment, we simply can’t take anybody on to the waiting list.”

It is a shocking situation that we find ourselves in. I will not repeat everything I said yesterday, but I cited the example of a pregnant constituent who wrote to me. She said:

“I have a MATB1 form entitling me to free dental care whilst I’m pregnant and for a year after birth. Unfortunately, I can’t use this as I can’t find an NHS dentist”.

There is a reason why pregnant women are given access to free dentistry: they face particular problems with oral health during pregnancy, which will give rise to long-term problems unless they are addressed. We know, too, that unless people get the dental service they need when they need it, that creates all sorts of other long-term health problems that are not only hugely damaging to them individually, but ultimately costly to the NHS. Not getting the money in the right place at the right time just causes more problems for budgets further down the road.

The most shocking part—I am overusing that word, but perhaps it is appropriate—of the contributions we heard yesterday was about children. The No. 1 cause of child admissions to hospital is rotting teeth, which arise from the failure to get children dental treatment when they need it. The hon. Member for St Ives made a really good point about our lack of ambition, which is a point we can make about successive Governments. The fact is that we do not have the ambition for NHS dentistry to cover the entire population, in the way we would expect for all other aspects of health provision—even if we do not always get that provision right. We need to have a fundamental debate about dentistry.

There are two ways of addressing the problem, which Members have alluded to. One is the contract. Yes, the contract was introduced by a Labour Government in 2006—let’s be honest—and it became fairly clear fairly soon that it was not working. In 2008, the Health Committee described it as not fit for purpose. Alan Johnson, who was then Health Secretary, commissioned the Steele inquiry, which reported in 2009. In 2010, we committed to reform the contract, and the Conservative Government made the same commitment, so this issue is cross-party and involves successive Governments, and we need to sort it out.

When I was going through the problems in the contract yesterday, I was pleased that the Minister nodded at each point I made. I would be grateful if, in her summation today, she could give us an insight into the contract reform that the Government are looking at, because we do not simply want to see tinkering, a little bit of shifting here and there, or—as I said yesterday—tweaking at the edges. Since the Health Committee reported in 2008, the contract has needed fundamental reform. Yesterday, I said that it was wrong that the contract was based on units of dental activity using figures from the two years previous to 2006, which are now massively outdated, and the Minister nodded. I said that it contains huge discrepancies in remuneration rates between practices doing the same work, and she nodded. I said—this was particularly relevant during covid—that the contract provides penalties, through financial clawback, for underperformance and not achieving targets, even if the reasons for non-achievement are completely beyond the control of practitioners, such as an inability to fill a job or the infection protection measures that were put in place. However, there is no reward if a dental practice overperforms—if it sees more people or deals with more teeth. The Minister nodded at that one, too.

The contract limits how much NHS treatment a practice can provide because of the quotas and the way that providers are contractually obliged to spread their NHS work and not be responsive to demand as and when it arises—the Minister nodded at that point, too. I would be grateful if she confirmed in her summation that the Government intend to address all those points, and indeed others, in reforming the contract.

The second aspect is the lack of funding for dentistry, which has fallen further than in any other part of the NHS. We should all recognise that it is a Cinderella service in the NHS. According to the BDA, funding for NHS dentistry has fallen by 25% since 2010, which, as I say, is completely out of line with the rest of the NHS. Alongside reforming the contract—we do not simply want a sleight of hand in solving these issues—what do the Government intend to do on funding? We heard about the £50 million Government investment for emergency funding as a result of covid, but there were problems with that—I say that with respect to the hon. Member for Darlington (Peter Gibson), who raised it in our debate yesterday. It was time-restricted funding for one quarter and was offered in a very short timeframe, which made it difficult to implement and involved work in addition to the contract. Practices were told that if they tried to help and then did not meet their standard contract target as a result, they would face financial penalties.

Unnecessary restrictions were imposed on the emergency funding by some commissioning teams—for example, in Sheffield, it had to be for out-of-hours access. The Minister is shaking her head. That might not have been what was required by the Government, but it was required by many commissioning teams. The net result was that lots of that money was not drawn down. I asked the Secretary of State yesterday to indicate how successful the initiative had been by telling us how much money had been drawn down, and he was not able to. I hope that officials have been able to provide the Minister with that number today, so that she can give us an indication of the success of that initiative.

I will say no more now because I am conscious that other Members want to speak, and we should all share our experiences from across the country, but I hope that we will not kick the issue down the road again and that the Minister, in her winding-up remarks, will commit to a comprehensive statement on where the Government intend to move on contract reform and funding to solve the crisis. If they do not make a statement before the summer and if we do not take action urgently, we will really be seeing the potential death of NHS dentistry.

--- Later in debate ---

[Maria Caulfield]

The hon. Lady says, “Here we go,” but it is important to recognise that for two years there were no routine appointments available due to infection control measures. We are now back up to 95% of activity, but the backlog that existed before is significantly larger than it was.

It is also important to recognise that the nub of the problem around covid has been the dental contract. The shadow Minister may not have heard what I said yesterday, but we have been negotiating a new contract with the BDA; we started those negotiations on 24 March, a final offer went to the BDA on 20 May, and we are awaiting its response. We have been in negotiations; we have not just been waiting for the work to be done. We expect to make an announcement before the summer recess—I said that both at oral questions last week and in the debate yesterday. We will be making an announcement in the coming weeks on those contract reforms.

[Paul Blomfield]

It is helpful that the Minister has given us that information about the offer made to the BDA. Can she confirm that the offer addresses the four points I asked her about on flaws in the contract? I raised those points in the debate yesterday, and they reflect concerns across the House. Is it the sort of fundamental reform of the contract that will stop dentists being driven out of the NHS and into private practice?

[Maria Caulfield]

I obviously cannot comment while there are live negotiations ongoing, as I am sure the hon. Gentleman will appreciate, but the offer will drive some reforms in respect of the issues raised by a number of colleagues around fair payment for dentists’ level of activity. It will also look at the whole dental team and not just dentists. We have looked into whether we need legislation to be able to upskill dental technicians and dental nurses, for example, and we do not, so we are able to make progress on some of those areas, reward them for the work that they are doing and enable them to take on more work. A number of the issues that the hon. Gentleman raised will be covered by that.

The hon. Member for Enfield North may not know this, but before the latest round of negotiations, there had been a number of pilot studies over the last few years looking at completely reforming the UDA model and moving to a capitation model. Those pilot studies unfortunately did not produce the results we were hoping for. They did not increase access for patients, they did not reduce inequalities and they did not point to a sustainable model, so we did not go forward with that model. That is why we started new negotiations earlier this year on reform.

It is wrong of the shadow Minister to say that nothing has been done over the last 12 years. We had two years of covid where there was no routine dental activity; only urgent appointments were undertaken. Before that, there were three years of pilot studies on the capitation model; those were not successful, which is why we have not driven forward those changes. It is important that when we introduce changes, they address the fundamental issues that have been raised in this afternoon’s debate.

[Paul Blomfield]

Could I press the Minister in particular on the point that I made on financial clawback? It has been made clear to many of us who have talked to dentists that one of the most demotivating factors in the current contract is that while they are not rewarded for additional performance with NHS patients, they face clawback if they underperform, including for reasons that are completely beyond their control. I understand that for the last quarter that is currently being considered, 57% of dentists are going to face financial penalties. Those are the sorts of issues that are tipping them out of NHS dentistry. Will that issue be addressed?

[Maria Caulfield]

We are looking at the issue of clawback. Obviously we are in negotiations, so I cannot say what the final outcome will be. However, on the point that the hon. Gentleman makes about clawback during the last quarter, when the omicron variant was a particularly significant factor, we made clear to commissioners and dentists that if there were issues arising from omicron—patients who could not attend their appointments, or dental teams that were unable to be at work—they would not be subject to clawback. I would be disappointed if dentists who could not undertake their units of dental activity for covid-related reasons were penalised with clawback for that, because we made it very clear that there needed to be a flexible mechanism to mitigate some of those issues. If the hon. Gentleman has examples of that, I would be happy to take them away and ask officials to look into them.

Access to GP Services and NHS Dentistry

Paul Blomfield Excerpts

Tuesday 21st June 2022 Commons Chamber

[Sajid Javid]

The hon. Gentleman is now using the past tense. A moment ago, he claimed that it was under threat. He clearly has no issues with giving false information in this House. The truth is that, if Wakefield wants a better future, as everyone in Wakefield deserves, only one by-election candidate can provide that, and that is Nadeem Ahmed.

We intend to go much further to build a truly 21st-century offer in primary care. That includes Dr Claire Fuller’s independent review, which I found to be extremely valuable, and the changes that will stem from that as well as the many others that we will bring forward shortly. We will work with the population and the profession alike. The hon. Gentleman was right to focus on the importance of the profession, but he did forget to mention, as I referred to earlier, that since March 2019 we have more than 2,380 additional GPs in primary care, record numbers of doctors in training and more than 18,000 additional primary care professionals.

Let me turn briefly to the important steps we are taking in dentistry. Urgent care has been back at pre-pandemic levels since December 2020, and the 700 centres for urgent care that we set up to provide treatment for patients during this difficult period have helped thousands of patients across the country. At the start of this year we put an additional £50 million into NHS dental services, which boosted dental capacity by creating 350,000 extra appointments. Dentists are currently required to deliver 95% of pre-covid activity, and we are planning to return to 100% shortly. I commend all the dentists who are already achieving that.

[Paul Blomfield (Sheffield Central) (Lab)]

The Secretary of State referred to an additional £50 million. As he knows, the way in which that was framed made it difficult for dentists to draw down the money. Will he tell the House how much of it has been drawn down and used?

[Sajid Javid]

I do not have the exact figures to hand, but I know that millions of pounds were drawn down and used to deliver tens of thousands of appointments across the country. That made a huge difference to a great many people.

--- Later in debate ---

[Paul Blomfield (Sheffield Central) (Lab)]

A range of important issues has been raised by those on both Front Benches and in the interventions on them, but I want to focus specifically on NHS dentistry issues.

We have all had so many constituents contact us, and I would like to share a small selection of mine. One new resident to the city said:

“I moved to Sheffield earlier in the year. I am unable to register for an NHS dentist. I am being quoted waiting lists of eighteen months just for a check-up.”

Another wrote:

“My partner has been trying to get into a dentist for a check-up for around 18 months. We have rung every dentist within a 6-mile radius to be told they are not taking on NHS patients…and he will need to go private.”

One woman wrote to me:

“I have a MATB1 form entitling me to free dental care whilst I’m pregnant and for a year after birth. Unfortunately, I can’t use this as I can’t find an NHS dentist”.

A young mother told me:

“We’re told dental care is important and that we should get our children seen early and regularly. We moved to Sheffield in December 2020. I started to look for a dentist. I’ve been on a waiting list for a year with no progress.”

Another parent told me:

“Our son was referred for NHS orthodontic treatment by his dental practice in February 2019 at the age of 12. He has now been on the waiting list for 35 months and will turn 15 next month. He still has not had an initial assessment appointment.”

[Lilian Greenwood]

I thank my hon. Friend for giving way; the Secretary of State seemed to forget to do so. Does my hon. Friend share my concern that, even before the pandemic, the No. 1 reason for hospital admission among children aged five to nine was tooth decay? Is that not a shocking indictment of the failure to address health prevention and care for children and their teeth, and is it not a bit galling for the Secretary of State to suggest that this is the fault of the last Labour Government, when before the pandemic his Government had already been in power for 10 years?

[Paul Blomfield]

I thank my hon. Friend for that intervention, and she is absolutely right about how that highlights the crisis we are facing in NHS dentistry. That exists right across England, and it was interesting to hear comments from other nations, because significantly less is spent on dentistry in England than in Wales, Scotland or Northern Ireland. The Secretary of State blames everything on the contract, but the cuts to dentistry have been deeper than in the rest of the NHS, with spending a quarter less than it was in 2010, and I am not surprised that he made no mention of that.

Last Wednesday, I met our local dental committee to discuss the problem—dentists who are committed to their profession and to NHS provision, and who want a solution—and following our discussion, they commissioned a survey of waiting lists across the city. Some 37 practices responded, which is about half of the city’s providers, but only one practice could offer a waiting time shorter than a year. For 29% it was up to two years and for 32% more than two years. The most significant number was that 35% of practices were unable to add any patients to their waiting lists.

Across England, the number of dentists providing NHS services fell from 24,700 in 2019-20 to 21,500 now, which is a fall of 15% in just two years—

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

indicated dissent.

[Paul Blomfield]

I see the Minister shaking her head.

However, there is provision for those who can pay. Healthwatch reported last year:

“Whilst some people were asked to wait an unreasonable time of up to three years for an NHS appointment, those able to afford private care could get an appointment within a week.”

That is adding to health inequalities, and it is not because dentists are reluctant to take on NHS patients, but because the system discourages them from doing so. We have patients wanting NHS dentistry and dentists wanting to provide it.

It is true that there are flaws in the 2006 contract. It is based on units of dental activity using figures from the two years prior to its imposition, which are now massively outdated. It contains huge discrepancies in remuneration rates between practices doing the same work. There are penalties through clawback for underperformance for reasons beyond the control of practices, but no reward for overperformance. I see the Minister smirking, but she has been delivering this contract, and the Government have been operating within it for 12 years. There are limits on how much NHS treatment a practice can provide. That is because of quotas and the way that providers are contractually obliged to spread their NHS work. Dentists have a disincentive to take on new patients, who are more likely to have greater treatment needs, because the fee-per-item system was replaced with a system in which the same is paid for one filling as for 20.

[Maria Caulfield]

indicated assent.

[Paul Blomfield]

As the Minister is nodding, let us review the position as regards the contract. Back in 2008, the Select Committee on Health declared the system not fit for purpose. The then Health Secretary, Alan Johnson, responded by ordering a review of the system. In 2009, the Steele inquiry reported, and in 2010, we committed to reforming the contracts, but 12 years on, nothing has happened.

Ministers also blame covid. Clearly, it has had an impact; there was a backlog of 3.5 million courses of dental treatment after lockdown, and patients are inevitably presenting with bigger problems and increased need, which means longer appointments and extra work, for which dentists get no remuneration. The Ministers sitting on the Front Bench have presided over this flawed system. In quarter 4 of 2021-22, 57% of practices faced financial penalties for being unable to meet the targets that those Ministers effectively imposed; the problem is due to the additional infection prevention control requirements and the lack of adjustment to the remuneration system.

We have reached a tipping point for NHS dentistry. Unless the Government act, the number of complaints that all Members of Parliament are getting will only grow. More practices will move to a private model, which will add to the difficulties, because the system does not work for them.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

NHS services are devolved, but many concerns about them are shared across the UK. Some of my constituents have concerns about the price of NHS dentistry offered through private dental practices, and about transparency in how final costs are calculated. Does the hon. Gentleman agree that, particularly given the economic climate, practices must give cost breakdowns before treatment begins, so that patients can budget and understand what they are paying for?

[Paul Blomfield]

We need transparency, and that starts with a new structure for remunerating dentists—a structure that no longer disincentivises them from taking on NHS patients, and that does not push them towards private care. If we do not make those changes, the system will get worse. Some 50% of NHS practices have already reduced their NHS commitment, and 75% are planning to reduce further their contracts. Patients will face frustration and all the pain involved in not accessing help when they need it. As others have commented, children’s oral health will be severely damaged. It is a disgrace—it shames the country—that last year, hospitals in England carried out almost 180 operations a day on children to remove rotting teeth, and it cost the NHS more than £40 million. Those problems will impact those children throughout their life. Poor dental health is linked to endocarditis, cardiovascular disease, pneumonia, premature births and low birth weights, all of which add strain and cost to the NHS.

The good news is that there is an answer, but it is in the hands of the Government. We need to restore adequate funding to dentistry in England, and we need a commitment that the long-promised contract reform will take place. It must be real reform, and not tweaks at the edges. Otherwise, we face the slow death of NHS dentistry.

Government Action on Suicide Prevention

Paul Blomfield Excerpts

Wednesday 8th June 2022 Westminster Hall

[Kerry McCarthy (Bristol East) (Lab)]

I beg to move,

That this House has considered Government action on suicide prevention.

As always, it is a pleasure to see you in the Chair, Mr Bone.

Three weeks ago today, I hosted an event on mental health and suicide prevention in Speaker’s House. We heard from two members of the band Joy Division/New Order because the event took place on the 42nd anniversary of the death by suicide of the singer, Ian Curtis. I want to take this opportunity to thank Stephen and Bernard from the band for coming along, because if it had been just me speaking about this subject, not as many people would have listened, although I am sure a mass audience is hanging on to my every word today.

At the event, we also heard from Simon Gunning, chief executive officer of Campaign Against Living Miserably, or CALM, whom I thank for meeting me yesterday in advance of the debate. I also thank Mr Speaker, who spoke movingly about his daughter’s suicide and the recent loss of his brother-in-law. We also heard from the leader of the Labour party and the Minister. I thank the Minister for speaking at the event, but I hope she will forgive me for seizing the opportunity of securing today’s debate to press her further on some of the issues we discussed then. It is good to talk, but it is even better to see action.

I am sure the Minister will remind us that the Government are consulting on their 10-year mental health plan, which will also be used to inform a refreshed national suicide prevention plan—the previous one is 10 years old. I am a little concerned that the issue is being bundled up within the one consultation and that there are only passing references to suicide in the consultation overview, which is what most people will read. In fact, suicide is not mentioned at all in the chapter on crisis, which is where I would most expect to find it, and people have to go to the mental health and wellbeing plan discussion paper to find any detail. I hope that that does not mean that suicide is being treated as an afterthought.

We are told that the details of the suicide prevention plan will be set out in due course, but given that suicidality is recognised by the Government as needing its own separate strategy, I do not understand why it does not warrant its own consultation. The latest coroners’ statistics show that deaths by suicide are at a record high, and it is obvious that the Government have not met their target of reducing suicide by 10%. Clearly, a better strategy is needed.

I accept that setting any kind of target is complex. We saw a spike in suicides after the 2008 financial crash; we are now emerging from a pandemic that has taken a terrible toll on people’s mental health and the cost of living crisis is starting to bite. A lot of factors are not in the Minister’s control, but as is often said, what is measured is what gets done, so there has to be something to aim for. To help us to get there, several organisations have raised with me the need for real-time data. The Government are developing a national real-time suicide surveillance system, so perhaps the Minister will update us on progress with that.

As the British Psychological Society has explained, suicidal behaviour cannot be understood from any one perspective alone. Suicidality is best explained as a complex interplay between risk factors across domains. Not everyone who experiences bereavement or relationship breakdown, or who is under massive pressure at work or is struggling financially, will feel suicidal. There is often an accumulation of pressures and events, sometimes stretching back to adverse childhood experiences and exacerbated by adult trauma, although sometimes it is just that something bad has happened.

It is difficult to unpick all that, but Professor Louis Appleby has suggested some priority areas for the suicide prevention plan: where rates are high, such as among middle-aged men; where rates are rising, even if they are quite low, which relates to children and young people; where there is proximity to prevention, such as among current mental health patients; and where there is public concern, such as for university students. Professor Appleby also suggests, for political reasons, that the north should be a priority. That might also be because he is based at Manchester University and he is perhaps pushing his home turf, but as part of levelling up. Economic aspects such as poverty and unemployment can be big factors.

[Paul Blomfield (Sheffield Central) (Lab)]

In 2017, my constituent Jack Ritchie took his life at the age of 24 as a result of gambling addiction. I am pleased that his mother and father are in the Gallery with us today. It is estimated that there are more than 400 gambling-related suicides each year. The national suicide prevention strategy recognises high-risk groups, and my hon. Friend has highlighted the comments from Professor Appleby. Does she agree that as gambling-related suicides account for almost 8% of all suicides that group should be recognised in future strategies as high risk?

[Kerry McCarthy]

I thank my hon. Friend for his intervention. I know there was a very good debate in this Chamber yesterday morning, which unfortunately I could not attend, where such issues were raised. There are some discrete areas where a specific intervention suggests itself, such as gambling addiction, alcohol abuse, post-natal depression, or veterans’ mental health. I certainly feel that such risk factors ought to be reflected in the suicide prevention plan.

A quick win would be to obstruct people from accessing the means to die by suicide, with obstacles placed in their way. A lot of suicides are opportunistic. For example, the British Transport Police is very good in terms of how it polices stations and watches out for signs that somebody might be thinking of jumping in front of a train, and helplines can be flagged up at places such as the Humber bridge and the Clifton suspension bridge, but there are also physical measures that would make suicide more difficult. People might say, “Well, perhaps people will just go somewhere else,” but it does not always happen like that. If the moment is lost, there is a good chance a life will be saved.

Will the Minister tell us a little bit about the plans for the revised suicide prevention plan? Will it have clear priorities, with an evidence-based, tailored plan in each case for how we will bring rates down, and then targets set on that basis? One organisation described the current approach as very much a “throw everything at the wall and hope something sticks” approach. We need a far more tailored approach.

Will the Minister also tell us where the boundary falls between what is in the remit of the Department of Health and Social Care and work that requires action by other Departments? We have already talked about gambling, and the debate yesterday was answered by the Under-Secretary of State for Digital, Culture, Media and Sport, the hon. Member for Mid Worcestershire (Nigel Huddleston). The Online Safety Bill is another example of where another Department is taking the lead, and I am worried that the Government will not fully seize that opportunity to crack down on sites promoting suicide and self-harm. I gather there is a bit of a difference of opinion between the two Departments, which is particularly disappointing given that the current Secretary of State for Digital, Culture, Media and Sport, the right hon. Member for Mid Bedfordshire (Ms Dorries), was the first Minister for Suicide Prevention. Does the Minister agree that we need to strengthen the Bill’s provisions on this issue, or has she lost the battle with the Secretary of State for Health and Social Care? I hope not, and I hope that, if the Bill is not strengthened in Committee, we can improve it on Report.

The review of special educational needs and disability is another potential missed opportunity. It is meant to be a joint effort by the Department for Education and the Department of Health and Social Care—there is a joint foreword—but there is very little in it on child and adolescent mental health services. Given the overlap between children struggling at school who cannot get the right diagnosis and cannot get a timely education, health and care plan and children who end up in the mental health system, joint working is really important.

Obviously, it is not just children with SEND who struggle. One in six children are now said to have a probable mental health condition, up from one in nine in 2017. More than 400,000 under-18s were referred for specialist mental health care between April and October last year. These are children at the more severe end of the spectrum—those who presented with suicidal thoughts, self-harming or eating disorders. The number of attendances at A&E by young people with a diagnosed psychiatric condition has tripled since 2010.

We know that CAMHS is at breaking point. There are huge waiting lists, and severely mentally ill children are being cared for in inappropriate settings or being sent hundreds of miles away from home for treatment. It is said that half of all mental health problems are established by the age of 14, rising to 75% by the age of 24. If we do not want today’s children to be tomorrow’s suicide statistics, we need to do much more, much faster, to help them now, and I just do not see that sense of urgency from the Government. This consultation is all wrapped up in a 10-year plan, but we need a 10-day plan. We need action now.

One issue we discussed at the event in Speaker’s House was how schools could better nurture children’s creativity and give them an outlet for their emotions through music and art. We also talked about whether the current trajectory of education, with schools very focused on grades—someone described them as “exam factories”—places undue pressure on children. I agree with that to a large extent and worry about cuts to things like music education, which mean that creatively inclined children do not have that outlet. It is not plain sailing for the other 50%, the academic ones, either. Just because a child does well in education does not mean that they are set up for success in the wider world, whether that means higher education or the world of work.

I am sad to say, as a Bristol MP, that Bristol University has become known for the number of student suicides in recent years. It is obviously not the only university to have experienced this, but it has come to particular attention. There needs to be a constant process of reflection and review. We have just had the court ruling in the tragic case of Natasha Abrahart. She was a very able student at Bristol University, but she suffered terribly from social anxiety and just could not handle the oral side of her course and having to do presentations. Rather than trying to force all young people into one model of what success and achievement look like, institutions need to adapt to them. I hope that Natasha’s parents will be able to pursue their campaign to ensure that that happens in the future.

I have also spoken to various groups about data sharing, which I appreciate is a complicated area. When should parents of university students, who are adults, after all, be informed? What are the boundaries of patient confidentiality? Some students might be deterred from speaking to mental health services at uni if they think that their parents might be told, particularly if they are grappling with something like their sexuality or if they have become involved with drugs. There are all sorts of things that young people would not want their parents to know about. Some might come from abusive family backgrounds and their parents would not be helpful or supportive, but in many cases the parents would have desperately wanted to know that their child was struggling to the extent that they were.

Steve Mallen from the Zero Suicide Alliance thinks that more could be done within data protection laws to protect students, and I hope that that is under active consideration.

Adult Social Care

Paul Blomfield Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

My hon. Friend is absolutely right. Half of the social care budget today is spent on working-age adults. It is not just spent on elderly people. Of course, many people with disabilities or learning disabilities want to continue to work and they want to be supported in that. A supported house and the right mental health support are obviously the right approach, and that is something that we will be working on in this White Paper.

[Paul Blomfield (Sheffield Central) (Lab)]

The Minister was right in the way she described the crisis in social care. We have residential and domiciliary provision that falls chronically short of what is needed, care staff who are undervalued and grossly underpaid, and an army of unpaid carers—particularly young carers—who do not have the support they deserve. The problem is that what she has announced does not address any of that. It is frankly extraordinary that she says that this is the product of years of work. Where is the substance? As questions from both sides of the House have recognised, does today’s statement not show that when the Prime Minister promised a plan to fix social care, all he ever had in mind was an asset protection scheme for the wealthier, paid for by the many who would never benefit from it?

[Gillian Keegan]

I want to pay tribute to the 1.54 million people who work in this sector, because they offer the most incredible care, and also to unpaid carers. The hon. Gentleman mentioned young carers, and it is important that we support them. We will work with the Department for Education, which will amend the schools census at the earliest opportunity to include young carers so that we can identify them and put in the support around them. I do not agree with what the hon. Gentleman said about today’s statement. In 13 years, the Labour Government produced two Green Papers, a royal commission and a spending review, but absolutely nothing that has made a difference to anybody. Of course, none of the Opposition Members have yet had the pleasure of reading the plan, but I can assure them that it is a plan that will deliver on a 10-year vision and start the changes that, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said, have been ducked since 1940.