Community Pharmacy in 2016-17 and Beyond

Paul Blomfield Excerpts

1st reading: House of Commons
Thursday 20th October 2016 Commons Chamber

[Paul Blomfield (Sheffield Central) (Lab)]

The Minister was right to describe community pharmacies as the essential front line of the NHS. What assessment has he made of the additional pressures and costs that will be put on other parts of the NHS as a result of this decision?

[David Mowat]

The King’s Fund study and the £42 million integration fund are directly focused on services and on enabling pharmacies to become more integrated with GPs. In addition, I repeat that 1,500 more clinical pharmacists than we have now will be working for GPs in 2020. That is a huge difference.

Defending Public Services

Paul Blomfield Excerpts

Monday 23rd May 2016 Commons Chamber

[Paul Blomfield (Sheffield Central) (Lab)]

I will endeavour to meet that demand, Madam Deputy Speaker. It is a pleasure to follow the hon. Member for South West Wiltshire (Dr Murrison), who made a very measured speech. I came close to agreeing with his last point, if not his earlier criticism of our Front Benchers, because this Queen’s Speech provided an opportunity to tackle the funding crisis in the NHS. Sadly, however, it did not take that opportunity; nor did it tackle the crises in social care and, indeed, the impact of the disproportionate cuts on local government. Instead, the Government are turning their ideological fire on two areas of hugely successful public provision—the BBC and higher education. The hon. Member for Salisbury (John Glen) made the point that we should not be ideological in the public versus private debate. He is right: what matters is what works.

In that context, what is the BBC White Paper all about? If the BBC were some colossal failure, plumbing new depths in unpopularity, there might be cause for reform, but we all know it is not such a failure. The BBC is the envy of the world. It is hugely popular in the UK, as we know from the overwhelming support it received in the Government’s own consultation. It is fair to say that the Government’s plans are not as bad as some of the leaks made out. I hope that that is an indication that the Government are listening. It is probably the tried and tested strategy of leaking something really bad so that, when they publish something that is simply bad, everybody breathes a sigh of relief and thinks it is okay.

Although the plans are not as terrible as was feared, there are still serious concerns. Underlying the proposals appears to be the idea that the BBC is bad for the market and therefore has to be reshaped in line with the views of the Murdochs because it is too popular, too successful and too good at what it does. The Government want to add new distinctiveness criteria to the BBC’s mission statement, which they say should be

“discernibly different in approach, quality and content to commercial providers”.

In so much of what it does, the BBC is already different, so what is this about?

The proposals could stop the BBC competing on a level playing field with commercial providers in producing popular and successful programmes. This Government believe in markets to drive up quality, so why are they interfering in this market to handicap the most successful player? They want the charter to make it clear that the licence fee is not solely for the use of the BBC, and they want to establish a contestable fund for which commercial rivals can bid. What is that about?

Why is there a requirement for the BBC to recruit 150 local reporters to feed news content to local newspapers? We all support local newspapers, and we should debate their future, but quietly top-slicing a block of public funds for that purpose without a full debate sets a dangerous precedent. The proposal for Ofcom not just to become the BBC regulator, but to have a brief to assess the market impact of

“any aspect of BBC services”

sends a worrying signal, as does the plan to undermine the BBC’s independence by allowing the Government to appoint as many as half of the non-executive directors to its new all-powerful board, which will have responsibilities for editorial direction and programming.

What is it all about? Is it that successful public services challenge the Government’s world view that only the private sector can deliver quality, or is it just that the Government do not like the BBC? In 2008, the Prime Minister wrote that the BBC has a “left-wing bias”, is “instinctively pro-Big State” and has become “oversized and over-reached itself”. His one-time hon. Friend the Member for Uxbridge and South Ruislip (Boris Johnson) has called the BBC

“statist, corporatist, defeatist, anti-business and”—

of course—

“Europhile”.

Perhaps most revealing is the Culture Secretary’s comments that the BBC’s approach to impartiality drives him “insane” and that its ceasing to exist is a “tempting prospect”. I must say that those comments actually make him unfit for the post he holds. Prejudice is no basis for good policy, and I hope that the Government will think again.

I hope the Government will also think again about the higher education White Paper. We have one of the best university systems in the world. It is good for UK students, and, despite the best efforts of the Home Office, it is good at attracting students from all over the world, bringing in over £10 billion of export earnings, so we should take care about meddling in it.

The higher education White Paper proposes a teaching excellence framework. I agree that a focus on teaching excellence is a good thing, but if we get the measurement of teaching quality wrong, we will create perverse and unintended consequences. That concern was expressed by the Business, Innovation and Skills Committee, when we looked at the proposed metrics, which also risk damaging our reputation internationally. Our universities are known around the world for the excellence of our independent quality assurance. If we move from the current system of quality assessment to the proposed three tier ratings, we will immediately send out a message internationally that not all our universities are outstanding. A system of ranking might be okay if it were part of an internationally agreed approach, but if we take a unilateral stand on dealing with quality assurance within our university system, we will be sending out the message that our system is not quite good enough, which will damage our brand and deliver students into the hands of our competitors. As I have said, the Home Office is already spectacularly effective at doing that.

There is also a risk in opening up the sector to new providers. We do not need to look very far to see that risk in practice. We simply need to look at the United States, on which the model is based. Universities operate there on a business model in which unscrupulous providers milk the publicly funded loans system and recruit students to substandard courses: the public lose, the public purse loses, students lose, and the companies pick up the profits. In recent years, more than two dozen companies running for-profit colleges in the United States have been investigated or sued by state prosecutors. Together, the 152 schools under investigation received about $8.1 billion in federal student loan and grant payments in the last fiscal year, according to an analysis in The New York Times. Some of those companies are already operating in the UK and are looking for the opportunity, which this higher education White Paper provides, to extend their operations. As with the BBC, it seems that the Government are not making decisions on the basis of what works and are putting ideology before the evidence. On both these matters, I urge them to think again.

Brain Tumours

Paul Blomfield Excerpts

Monday 18th April 2016 Westminster Hall

[Paul Blomfield (Sheffield Central) (Lab)]

Shortly after my election to this place in 2010, I was diagnosed with a brain tumour, an experience I share with the hon. Member for Hexham (Guy Opperman). We were both able to return to the House fully fit thanks to the excellent work of surgical teams in the NHS in Sheffield and in London. Does the hon. Member for Ross, Skye and Lochaber (Ian Blackford) recognise that, alongside research, support for victims of brain tumours is also important? Does he recognise and celebrate the excellent work done by charities such as Headway, which supports those suffering from the consequences of brain tumours and other brain injuries?

[Ian Blackford]

I am most grateful for the hon. Gentleman’s intervention. He demonstrates, as does the hon. Member for Eastbourne (Caroline Ansell), that we are so lucky that people such as them have been able to come through this. It demonstrates why we need investment in diagnosis, research and support for those affected and their families—so much needs to be done, because there is so much that we are losing as a society. So many young people’s lives are being taken away. If we do the right thing by putting that investment in, we can deal with the issues and ensure that many of our people can survive this dreadful disease.

National Minimum Wage: Care Sector

Paul Blomfield Excerpts

Wednesday 23rd March 2016 Westminster Hall

[Paul Blomfield (Sheffield Central) (Lab)]

I beg to move,

That this House has considered Government policy on enforcement of the national minimum wage in the care sector.

I am delighted that you are in the Chair, Mr Rosindell, and that so many colleagues are here to speak about this issue.

I am pleased to have secured this debate, although I am disappointed that it is still needed, because we had a debate on this very issue, led by my right hon. Friend the Member for Oxford East (Mr Smith), back in November 2014, during which it was acknowledged that we had a real problem. That was acknowledged by all sides, including by the Minister at that time, the right hon. Member for North Norfolk (Norman Lamb), because in March that year the National Audit Office had estimated that up to 220,000 home care workers in England were being illegally paid below the national minimum wage. Eighteen months on, we still have the same problem.

We could talk forever about numbers, and I am sure that a number of colleagues will cite statistics, but I think the human stories explain what the issue is really about.

[Angela Rayner (Ashton-under-Lyne) (Lab)]

I worked in the sector as a home help and represented home care workers. Does my hon. Friend agree that the human stories are quite tragic? What home carers end up having to do is subsidise their employers, who do not pay them travel time. A good employer will see the value of their staff, and pay them correctly and appropriately.

[Paul Blomfield]

I thank my hon. Friend for that intervention and I completely agree with her. I will illustrate that point further in my comments today.

[Nick Thomas-Symonds (Torfaen) (Lab)]

My hon. Friend has talked about the delay and the lack of action since the previous debate. Is not one of the reasons for that the fact that, when investigations are launched into these matters, they take an inordinately long time?

[Paul Blomfield]

My hon. Friend is absolutely right. Indeed, arising from our last debate, six investigations were commissioned. I asked a parliamentary question about those investigations. They were launched in February 2015 and have yet to report. That is clearly a disgrace.

I was talking about the human stories in my constituency. I know of two local women who work for a care company that uses GPS technology to monitor when they arrive for and leave appointments. They told me their stories. The company monitors the time that they spend travelling; to be accurate, it monitors the distances that they are travelling, but it does not pay them for that time. Incidentally, the company also rips them off on the cost of travelling; it pays them 12p a mile for using their own cars, when Her Majesty’s Revenue and Customs assumes for its calculations that 45p a mile is a reasonable benchmark.

One of the women, Sharon, told me that it was not unusual for her to be out of the house at 6.15 in the morning and not return until 11 o’clock at night. She gets a break, but she is only paid for seven hours’ work, which is the time she is actually at appointments. Never mind how long it has taken her to get to an appointment or to travel between appointments. Consequently, a so-called “hourly” rate of £7.52 means that, according to Melanie, who works alongside Sharon:

“A 15-minute visit is worth £1.88”.

These women have even been refused payment for the time they have spent waiting for ambulances to arrive for people in their care. Why do they put up with that abuse? As Sharon told me:

“You get in a bit of a trap, because I actually do love the work.”

We should be ashamed that tens of thousands of people like Melanie and Sharon across the country, who look after our most vulnerable, are treated in that way simply because they care.

It also makes a mockery of our national minimum wage legislation. Let us be clear that it is a criminal offence knowingly not to pay the national minimum wage. However, the situation has not improved since we last debated this issue. In fact, there are signs—

[Melanie Onn (Great Grimsby) (Lab)]

Does my hon. Friend agree that it is a disgrace that only 36 English councils out of 152 that are responsible for social care stipulate in their contracts that home care providers must pay for workers’ travel time?

[Paul Blomfield]

I do indeed and I pay tribute to those councils that are now changing their rules, so that when they commission they require workers’ travel time to be paid. Hopefully, more councils will follow their example.

I am disappointed that the Government seem to be taking this issue even less seriously than when we last debated it. Last summer, HMRC launched a new national minimum wage campaign that allows employers who have not been paying it to escape punishment. That is shocking. But it is simple: offending employers can declare details of arrears owed to their employees. They then “self-correct” and, with a cursory follow-up by HMRC, that is it—no more HMRC sniffing around and examining their practices. I do not know of many crimes where the offender escapes punishment entirely if they come forward. As I say, it makes a mockery of the increases in penalties for non-payment of the national minimum wage that were introduced under the coalition Government.

According to the Low Pay Commission, between 2011 and 2015, £1.75 million was recovered in arrears for 8,698 workers, which amounts to an average of £201 per worker. The shameful thing, however, is that that is just a drop in the ocean. The Resolution Foundation, which the Minister will know is chaired by one of his former colleagues, a former Conservative Minister, estimates that 160,000 care workers are collectively cheated of £130 million each year. The Resolution Foundation estimates that the average amount of arrears owed to care workers is more than £815, which is four times the rate at which HMRC is recovering the money.

The real scandal is that it does not have to be like this. The Government have the power to act, but they appear to lack the will to do so. Therefore, let me set out some proposals and I look forward to hearing the Minister’s comments on them.

For a start, the Government are far too reliant on self-reporting. The use of zero-hours contracts is rife in this sector; for example, both Sharon and Melanie, to whom I referred earlier, are on such a contract. So who is going to rock the boat when there is so little job security? Following up on every call made to the helpline is all well and good, but what are the Government doing to help those vulnerable care workers who do not dare to make such a call?

[Chris Stephens (Glasgow South West) (SNP)]

I thank the hon. Gentleman for giving way and I congratulate him on raising this important issue. Regarding self-reporting, does he agree that the biggest single reason that employees are reluctant to do that is fear of dismissal and, if they are not dismissed, fear that there will be a cut in their hours?

[Paul Blomfield]

I thank the hon. Gentleman for that intervention and I think he is right. It is the fear experienced by workers in this sector that is driving unreporting. The Government need to do something about that.

Establishing a formal public protocol to handle third-party whistleblowing would be a step forward. Currently, for example, when a union makes a complaint on someone’s behalf, it receives no feedback as to what is happening with that, and that is no way to facilitate reporting.

We also need proactive investigation into a sector in which we know abuse is rife. Following pressure from Labour that was led by my right hon. Friend the Member for Oxford East, the coalition Government began an investigation into six of the largest care providers, but that was over a year ago. What have they found out? Have affected workers been compensated? What is happening? I hope that the Minister will give some answers, because effective investigations will help to change the culture. Where HMRC investigations uncover non-compliance, why does it not then look at the whole workforce? The chances of co-workers being on the same terms and conditions and suffering from the same abuse is high, but HMRC does not follow through.

I have made a number of suggestions about how the Government might act—I will not speak for too long, because a number of colleagues want to contribute to this debate—but I want to focus on a single demand, which I emphasise would not involve the Government in significant cost, but would be transformative. It is a course of action that has been recommended by the Low Pay Commission and Unison, and it is simply to require employers of hourly paid staff to state clearly the hours they have been paid for on their payslips. We have heard how companies such as the one employing Melanie and Sharon have sophisticated technology to track exactly what their employees are doing. They already monitor the time spent at appointments and travelling for work. The proposal would be easy for companies to do and would introduce a level of transparency that would change those companies’ culture. It would also give workers the information through which they could challenge companies and utilise the helpline. Section 12 of the National Minimum Wage Act 1998 already makes provision for such regulation. Will the Minister work with me and his team to bring about that simple change?

All of us here know that there is a bigger fundamental problem with the chronic underfunding of the sector. Private providers are threatening to leave the market and not-for-profit providers are telling me that they cannot sustain the level of care that they want and rightly seek to provide. Vulnerable people, the elderly, those with learning difficulties and family members fearing for the life of their relative as they wait for an ambulance are all suffering as a result. That is before the national minimum wage increases to what the Government have laughingly called the national living wage. We all agree that is overdue. It is inadequate, but it is nevertheless a small step in the right direction.

We all know that the recently announced council tax social care precept is nowhere near enough to plug the funding gap, so we should be deeply concerned by the wider crisis in social care, and not only in its own right, but because of the impact it will have on the national health service. Notwithstanding that and the desperate need to address the funding shortfall, the labour market enforcement measures that I have mentioned are necessary and will be a step forward, and I hope the Minister will engage with me in taking those up.

[Several hon. Members rose—]

--- Later in debate ---

[Paul Blomfield]

I congratulate you, Mr Hollobone, on the seamless and unnoticed way in which you assumed the Chair.

I thank all Members for their contributions, which are too numerous to cover in a couple of minutes. They have illuminated the scale of and damage caused by the problem. It is ironic that a sector that is supposed to be about care shows so little duty of care to its employees. To illustrate the cross-party concern, I cite the words of the hon. Member for Dudley South (Mike Wood) that something is very wrong indeed with national minimum wage enforcement in the care sector and that has to change.

I thank the Minister for the constructive way in which he has engaged with the debate and the issues that we have raised. I do not think he covered all the points that a number of us raised. I will write to him and I hope he will have an opportunity to get back to me on those.

I want to follow through on the Minister’s suggestion that the Government may take up the issue raised by the Low Pay Commission and Unison and to ask him to indicate—he can do so simply by nodding—that he is willing to meet me, the commission and Unison to discuss how we can move forward with implementation of transparency on payslips.

[George Freeman]

indicated assent.

[Paul Blomfield]

The Minister is nodding and I am pleased to acknowledge that we will be able to have such a meeting.

Question put and agreed to.

Resolved,

That this House has considered Government policy on enforcement of the national minimum wage in the care sector.

Junior Doctors Contracts

Paul Blomfield Excerpts

Thursday 11th February 2016 Commons Chamber

[Mr Hunt]

I think that is the first time in living memory in this House that a Welsh MP has got up and said that they think things are better in the Welsh NHS. Just look at the waiting times that people face for basic operations on the NHS in Wales—far, far longer than in England. We will take no lectures about how to run the NHS from Labour in Wales.

[Paul Blomfield (Sheffield Central) (Lab)]

I represent three fine hospitals and one great medical school, and I spend a lot of time listening to junior doctors and medical students. The Secretary of State talks about the crisis in morale in the NHS among junior doctors. Does he not recognise that his handling of the dispute has done so much to enhance that crisis, and that today’s announcement will make it so much worse?

[Mr Hunt]

Not at all. The choice I had was to do something about mortality rates at weekends or to duck the issue. Under the Conservatives, we do not duck issues about mortality rates. We do the right thing for patients. After Labour’s record, I should have thought the hon. Gentleman would be a little more circumspect.

NHS Bursary

Paul Blomfield Excerpts

Monday 11th January 2016 Westminster Hall

[Paul Scully]

The hon. Gentleman has not listened to what I have said, because the whole point about the loan system is that the loans will not kick in until after a student has graduated, so the repayments will not start until that point. Student nurses will not be making any repayments while they are studying and doing those placements, but I absolutely take the point that nursing is a very different proposition from a normal degree in so much as placements take up 37 or 38 hours a week and beyond, which is a considerable strain on nurses.

[Paul Blomfield (Sheffield Central) (Lab)]

The hon. Gentleman cites the example of the introduction of fees for other university students, but does he acknowledge that the impact has been patchy and that the one group that has been significantly discouraged from going into higher education as a result of those fees is mature students? Mature students are particularly well represented among nursing, midwifery and allied professions, which we encourage.

[Paul Scully]

It is beholden on us to explain the system to mature students, because I see no reason why they should be discouraged.

--- Later in debate ---

[Paul Blomfield (Sheffield Central) (Lab)]

I am delighted to follow the hon. Member for Lewes (Maria Caulfield), who made a powerful contribution. Many of the points she made echo those raised by my constituents. She gave a devastating critique of the Government’s proposals. I am grateful to the 154,000 people who signed the petition. That reflects their concern about the Government’s proposals, and we should recognise their contribution. Without them we would not be having this debate in quite this way today. When I last checked, my constituency had the highest number of signatories to the petition. Many have written to me expressing their fears about the impact of withdrawing bursaries for student nurses, midwives and the allied health professions. It is important that we recognise the diversity of professions that are impacted by the Government’s proposals and the different demographics and the different factors that will have an impact.

I am pleased to have the opportunity to press some of my constituents’ concerns on the Government, and I will quote from four. Teri-Lisa Griffiths wrote to me about her mum, who is from a working-class home and was forced to leave school due to family income and family pressures. In her desire for personal development and to be a positive role model for her children, she went to university and trained as a nurse. She said

“attending my mum’s graduation was one of the proudest moments of my life and reinforced my aspirations to attend university and aim for a professional career. The proposed changes leave me dismayed at the potential implications both for the NHS and wider social mobility…With a young family to raise, my mother would never have been able to achieve this without the financial support offered through the NHS bursary.”

Susi Liles is a graduate nurse who did a first degree in sociology. She drew on that experience, saying that

“the work load for the nursing degree is much more than for a normal degree, and there are fewer holidays”.

She also said that

“you couldn’t do other work while training.”

Other Members have made that point. She pointed out that nurses simply do not earn enough money to repay the loan, and we could contest some of the figures that have been given. She said that the bulk of nurses on band 5 would not find it easy to pay rent, run a car, which is usually a necessity for shift work, and meet all the other costs of living while also repaying their loan.

Jessica Gallagher, whose mother has been a nurse for 40 years and who has been qualified herself for two years, works in an acute and emergency setting. She said:

“I truly love my job but as a ‘mature student’, I have no doubt that I would not have completed the course had it not been for the bursary support.”

Ella Williams is a student midwife in her final year. She told me:

“I have struggled financially as it’s not really feasible to have a job as well as do degrees like mine.”

Echoing the point that the hon. Member for Sutton and Cheam (Paul Scully) made in opening the debate, she also said that, unlike other students,

“although you are learning you are then almost free labour. Sometimes it is disheartening to feel you are working as hard as everyone else, but doing it for free and I think that students would feel that even more were they getting no government assistance. I completely love what I do, but…I’m sure it isn’t just me that feels as though I’m headed into a career that is misunderstood and undervalued by the government.”

All those women have two things in common in appealing to me as their Member of Parliament: they are not affected by the changes and they have no personal axe to grind. They are not individually going to lose out. They simply want to share their experience of why taking away the bursaries and introducing tuition fees will damage the NHS and the professions of which they are proud, and they make powerful points. We have already discussed the impact on mature students. They have been disproportionately hit by the introduction of tuition fees and the new regime in higher education as a whole. We know that they are positively disproportionately represented within nursing and in particular within midwifery and allied professions. We also know that they are more likely—my hon. Friend the Member for Walthamstow (Stella Creasy) made this powerful point—to have dependents, and the changed arrangements will hit them in that regard, too. The changes will be a particular barrier to those from lower income families. Nursing and midwifery have been an important route of social mobility for many who have ruled out university because of the cost. The package is attractive and makes stepping up into a profession more achievable.

My constituents and other hon. Members have made the point that student nurses cannot work outside the course. Before I was elected to this place in 2010, I worked at the University of Sheffield, where I was partly involved in negotiating the contract for the university to take over nursing and midwifery training. From my experience working with those students, I know that it simply is not feasible for student nurses to do what other students do in offsetting the cost of their higher education by working while they are studying, because of the intensity of the course, the time spent in clinical practice and the early, late, night and weekend shifts that are a normal part of their studies. I was under the impression that nursing students have to complete a minimum of 2,300 hours in clinical practice, but the hon. Member for Sutton and Cheam said that it was more than that. I will take his advice. None the less, it makes it impractical for them to work as other students do and it is wrong to treat them like other students.

I was unsure about the hon. Gentleman’s numbers on this, but my understanding is that, for a nurse on a band 5 salary, repaying the loan would cost about £900 a year. In practical terms, that is approaching a 5% cut in salary. The Government’s training policy in other sectors is to introduce an apprenticeship levy, and I agree with that, because it says that employers have to take responsibility for training their workforce. That is right. But what are the Government doing when they are the employer? They are saying the reverse: that the employee should take responsibility for training the workforce. They are imposing a 5% cut on nurses to meet the cost of training the NHS workforce. That is wrong.

The Government are stumbling into a potential disaster, not only for the lives of those who will not be able to pursue their dreams of a career in nursing, midwifery or the allied health professions, but for recruitment in the NHS. When I was elected in 2010, I assumed that I would disagree with the Government on a number of issues, and I have not been proved wrong. Nevertheless, I also assumed that, by and large, they would pay attention to evidence when reaching decisions and, on issues as important as this one, listen to that evidence. As has been pointed out already, so far that does not appear to be the case with regard to the serious concerns raised across the professions—those working in and managing the health sector—about the effect of the changes.

If nothing else comes out of this debate, will the Minister at least agree to publish the evidence that the Government considered when they first reached this decision? Most importantly, will he agree to a proper consultation on the full proposals, not just a technical consultation on their implementation? In his opening speech, the hon. Member for Sutton and Cheam said that this debate was positive because the Government had initiated a discussion that would give nurses and midwives the opportunity to shape future funding arrangements. He said that the current system is not good enough, as did the hon. Member for Lewes. They are right: it is not good enough. But why not come up with a better system, rather than a worse one? If the consultation to which the hon. Member for Sutton and Cheam aspires—one that engages with student nurses and midwives to reshape the system—is to mean anything, it must be proper, full and comprehensive. I hope the Minister will commit to that today.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I add my voice to those of other Members who have spoken today to say how much I appreciate the decision of the Petitions Committee to bring the matter to the notice of the House. I thank my hon. Friend the Member for Sutton and Cheam (Paul Scully) for outlining the case as many of the petitioners see it. As both shadow Ministers—the hon. Members for Lewisham East (Heidi Alexander) and for Central Ayrshire (Dr Whitford)—said, we had a high-quality debate, and Members raised a huge range of points in a calm and collected but passionate way. I hope Members will forgive me if I address as many points as I can. I hope to finish before the end of our allotted time, so that people can get away, but I am aware of the number of different points that were raised. I am also aware of the intense public interest in this important issue, which is why I want to make sure that I address every point that was raised—including detailed points.

Many Members, including the hon. Member for Lewisham East, were here for the debate on tuition fees in 2011. It was a searing experience. It is the only time I can think of—the hon. Lady and other Opposition Members will remember this—when protests could be heard by those in the Chamber. We all remember, too, having to leave by secret exits because of the riot outside. It was understandable that, at the time, people were so passionate about the change being made. The hon. Member for Ilford North (Wes Streeting) was a central player in the great debate, and he acquitted himself with honour. He explained in great detail his side of the argument—and that of the National Union of Students—at the time of probably the most controversial change made under the coalition Government. Yet every single one of the claims made at the time—the central claims against the changes—has been proven untrue.

I want to address the core point made in the considered speech of the hon. Member for Sheffield Central (Paul Blomfield)—that the Government should make changes on the back of evidence. My contention is that that is exactly what we are doing. Since the changes made in 2011, there has been an increase in the number of students in every part of the higher education universe. Most importantly, to my mind, there has been a considerable increase in the number coming from disadvantaged backgrounds. That is precisely why, even if it were not for the reasons that I want to come on to about why what we are doing is important for the NHS and for nursing in particular, it is an important change. Nursing students are the only significant group of students not to have been included in the reforms that have so significantly benefited the rest of the university sector.

[Paul Blomfield]

Clearly we could have a lengthy debate—I am sure you would counsel us not to, Mr Evans—on the merits of the student loan system. I was surprised by the Minister’s unequivocal statement a moment ago. Will he agree that one section of the demographic that has been negatively impacted by the introduction of the new student funding regime in 2012 is mature students?

[Ben Gummer]

I will not agree with the hon. Gentleman’s contention. UCAS figures for mature students in 2011, the year of the change, show that there were 42,170 acceptances. That figure dropped in the following year, as did the figures for all students across the university sector. It then went up to roughly the same figure in 2013, and up again in 2014. In 2015 the figure was 48,690, so the number of mature students has increased, and in percentage terms the increase is, I believe, more than that for university students of the normal age. When we consider the core reasons for the change—expanding the opportunity to go to university, through the number of places; increasing quality, which has improved according to a number of metrics; improving student experience, which has also happened in the past few years; and, most importantly for a university system, creating a ladder of opportunity for those born with least—we see that the reforms have delivered by every one of those measures. It is precisely for that reason that, even were it not for the wider issues that the NHS confronts, I would believe what we are doing to be entirely right. It enables us to spread to nurses the same benefits that have been realised in the rest of the student population.

[Paul Blomfield]

I thank the Minister for giving way again. I want to challenge him on those figures, which I guess—I do not have them before me—relate purely to full-time students. If we consider full-time and part-time students, we see unambiguous evidence that the number of mature students has fallen dramatically.

[Ben Gummer]

The numbers do relate to full-time students. I concede that, in the case of part-time students, there have been, for a longer period than the time since 2011, problems in maintaining a rise consistent with that across the population. The Chancellor has accepted that fact, which is why he devoted specific attention and funds in the spending review to supporting part-time mature students. However, in this case we are talking about a nursing degree that is, for the vast majority, a full-time one. For the majority of nurses—I believe the figures are not quite those given by the hon. Member for Central Ayrshire, although I do not have them to hand—their degree is a normal undergraduate degree, taken before maturity. For all those people, I want the same benefits that have been provided across the rest of the university sector. The hon. Member for Sheffield Central was a Member in the previous Parliament, as was the hon. Member for Lewisham East, and they made exactly the same claims then as they do now about a reduction in opportunity, a reduction in number of applicants and a reduction in all the areas where we want universities to perform. I am afraid they have been proved wrong and the Government have been proved right, and that is why it is important that we extend those benefits to nursing.

I will address in terms the process by which we have come to this decision, about which the hon. Member for Ilford North raised some detailed questions, and our intention for the wider reform of training routes into nursing. It is important that hon. Members should see the changes that we are making to university training as part of a wider reform enabling us to increase both numbers and the quality of courses, as well as improving the student experience for nurses entering nurse registration by whatever route. The policy has been worked through in considerable detail in the Department of Health. There has been consultation with leading nursing professionals. The Department of Health is advised by a number of chief nurses. All were consulted and involved in working up policy in this area, which is entirely how it should be.

We have been very open about the fact that we want a full and detailed consultation about how the proposals should be implemented. We want that to be thorough and to involve everyone, whether they oppose or are in favour of the changes, so that we get the detail right. While I will maintain that the overall policy direction is correct for the reasons I have given, it is important to make sure we implement the detail correctly. If we do not get it right, it could have a perverse impact. If we do, this could be an important moment for the nursing profession, because we will be able to do something that previous Governments have not been able to do. Even in the wildest spending realms of the imaginations of some colleagues of the hon. Member for Lewisham East, it would not be possible to commit the resources to expand the training places that the route we have decided on will make possible.

The Opposition must answer a central point when they set out their opposition to the proposal. The fact is that we want to give more training places to people who want to become nurses. Last year, there were 57,000 applicants for 20,000 places. We want to expand the number of places so that people get the chance to become a nurse, but within the current spending envelope—even if we were to increase it more significantly than we propose to over the next five years, and certainly far more significantly than the Opposition propose—it is not possible to do that.

[Ben Gummer]

I agree with the hon. Lady that one key thing we have to do is ensure we have a permanent workforce and do not depend across the service on agency and locum nurses and doctors. However, part of that is ensuring we have the workforce numbers trained to be able to fill places. In the past, we have failed to predict workforce numbers with any accuracy, which is something all Governments are guilty of.

No matter what happened to training places, the changes required across the service because of the impact of Mid Staffs on our understanding of safe staffing ratios has meant an increase in the requirement for nurses. At the moment, in the very short term, that requirement has to be plugged by agency and locum nurses, but we want to replace them with a full-time permanent staff that is sustainable. I hope the Opposition are able to bring an alternative view—I would be interested to hear it—but if we are to increase the number of training places, we have, simply put, to be able to afford to do so. The surest way of expanding places is to repeat exactly what we did for all other university degrees back in 2011, which has seen a massive expansion in training places.

The other point that the hon. Member for Lewisham East and her colleagues must address if they wish to oppose this reform is how they would afford not only the expansion in training places, but the maintenance support for nurses going through training. I completely agree with the hon. Member for Central Ayrshire and my hon. Friend the Member for Lewes (Maria Caulfield): the current bursary funding is not generous. It is certainly not sufficient for many, especially those with caring duties, to maintain themselves, but how can we find the increase while ensuring we expand places at the same time?

Through reforming bursaries, we are ensuring that we can increase the cash amount by 25%—something that, again, could not be funded out of the existing envelope, even though we are increasing NHS spending more than any other major party promised at the last election. We are therefore able to provide the support that people going through nurse training are rightly asking for.

[Paul Blomfield]

The Minister makes great play of the comparison between the reforms introduced in 2012 for other undergraduates and this reform. I admire the way he talks—I say that without any irony—about sharing the benefits of the current scheme with student nurses, midwives and allied professions. I am not quite sure they would describe a £56,000 debt as a benefit. Putting that to one side, does he not recognise the sharp difference between other undergraduates and those studying nursing, midwifery and allied professions in terms of the commitment to clinical placements, the shift patterns and everything else that will prevent them from being able to take employment in order to offset the cost of their education?

[Ben Gummer]

That is the case at the moment. The hon. Gentleman must answer the question of precisely how we increase support for people who are working in clinical learning placements. Converting the bursary regime means that we can increase that support by 25%.

It is easy for the hon. Gentleman to make a play to the gallery about how the reforms might work, but I ask him again to look carefully at the experience of other students and at the 47,000 applicants who are unable to secure a place because of the constriction in places. He is not able to give those people an answer about how we expand places without resources that I imagine he is not willing to commit from his position. The best way of giving those people the opportunity is reforming the education system. I am afraid that it is simply not credible for the Opposition to decry the proposals, which is their right, without providing an alternative of how we might fund the additional places and the maintenance of those who are in position.

Oral Answers to Questions

Paul Blomfield Excerpts

Tuesday 5th January 2016 Commons Chamber

[Paul Blomfield (Sheffield Central) (Lab)]

T6. Before Christmas the Chancellor pledged to match the charitable fundraising of Great Ormond Street hospital to a maximum of £1.5 million, using money from outside the health budget. The Secretary of State will know that Great Ormond Street is one of only four specialist children’s hospital trusts in the UK, and one of the other three is in my constituency. Does he agree that the Government’s matched funding should be extended to all four trusts, and will he join me in making that case to the Chancellor?

[Mr Hunt]

I am happy to look charitably on the wishes of the hon. Gentleman, without, of course, making any guarantees.

Mental Health

Paul Blomfield Excerpts

Wednesday 9th December 2015 Commons Chamber

[Luciana Berger]

I will come on to the very serious issue of perinatal mental health that the right hon. Gentleman raises. Again, we should all be very concerned about that issue.

I am very concerned that there has been a psychiatry recruitment crisis, with a 94% increase in vacant and unfilled consultant posts. The NHS constitution treats mental health and physical health differently. The Government claim to be increasing mental health budgets, but patients and professionals tell a different story. Ever since Ministers discontinued the annual survey of investment in mental health three years ago, we do not have an accurate picture of spending on mental health in our country.

[Paul Blomfield (Sheffield Central) (Lab)]

My hon. Friend is making an important point about the transparency of spending. Last June, I asked the then Health Minister, the right hon. Member for North Norfolk (Norman Lamb), who is in his place, when figures would be published, and he told me that the Government were working with NHS England to provide meaningful data. Last month, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) tabled a question for written answer asking when the information would be available. It is still not available. Does my hon. Friend agree that the Government should come clean?

[Luciana Berger]

I thank my hon. Friend for his very important intervention. One of the key points of my speech is that there is so much we should do to shine a spotlight on what is happening to mental health funding right across the country.

Oral Answers to Questions

Paul Blomfield Excerpts

Tuesday 7th July 2015 Commons Chamber

[Mr Hunt]

I think that we must respect the independent view of the Competition and Markets Authority, but I also think that there are lessons to be learned by the NHS more generally from the way in which that process was conducted. There will have to be changes on the ground if we are to give patients the care that they need in the very constrained financial circumstances in which we operate.

[Paul Blomfield (Sheffield Central) (Lab)]

T3. In March this year I had a very useful meeting involving Devonshire Green & Hanover Medical Centres in my constituency and the then Under-Secretary of State, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who recognised the threat posed to practices that serve patients with complex, demanding, and therefore costly needs by the withdrawal of the minimum practice income guarantee. The hon. Gentleman promised to follow up that meeting, but since then we have heard nothing. Will the Secretary of State guarantee that no practice will close as a result of the withdrawal of MPIG, and what will he do to ensure that that is the case?

[The Minister for Community and Social Care (Alistair Burt)]

The withdrawal of the minimum practice income guarantee was announced in 2013 because it was unfair. In fact, more practices will benefit from its removal than will lose from it. As for those that will lose, NHS England is already in contact with people about transitional care support. The practices that the hon. Gentleman mentioned have received some of that support, and I understand that the conversations are continuing.

Child and Adolescent Mental Health Services

Paul Blomfield Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Paul Blomfield (Sheffield Central) (Lab)]

It is a pleasure to follow the hon. Member for Totnes (Dr Wollaston), whose very thoughtful and incisive speech drew on both her own rich experience and the Select Committee’s excellent report.

In the September recess each year, I organise a series of consultation meetings across my constituency. The one I enjoy most is that with young people. It is organised with a range of youth groups, such as Members of the Youth Parliament, and brings together a good number of young people aged from 18 to their early 20s. It is really sparky and lively, and they pull no punches in raising issues. When I ask them what are the top priorities that I, as their Member of Parliament, ought to take up on their behalf, it has been very striking just how high mental provision has come in the past couple of years. That would not have been the case when I was young.

The fact that young people themselves put such a high priority on mental health as an issue should send us a very clear warning signal. That does not only apply in Sheffield. Following ballots of tens of thousands of young people across the country, the Youth Parliament has made mental health one of its two priority campaigns this year. If it is so important for young people and they are pressing us on the issue, we should be deeply concerned.

In advance of today’s debate, I have been in contact with three of the groups I work with in Sheffield: CHILYPEP —the Children and Young People’s Empowerment Project; Young Healthwatch; and STAMP—Support, Think, Act, Motivate, Participate—which is a group of 14 to 25-year-olds who have come together with the specific objective of improving mental health support for other young people. They are concerned about the current state of provision, or what they would describe as the lack of provision, and they fear for the future and the impact of cuts on an already desperately inadequate service.

The groups have identified three key problems. The first is that reductions in funding are taking place at a time of increasing need. The second, which very much echoes the points made by the hon. Lady and the report, is about the lack of early intervention. The STAMP young people’s manifesto states:

“Act now, tomorrow could be too late!”

That indicates the severity of what we are talking about. The third is that young people are abandoned at 16.

[Mr Jim Cunningham (Coventry South) (Lab)]

On the issue of resources, budget cuts have been inflicted on local authorities, such as Coventry. Some of them have had to find about £3 million or £4 million, which is an extra burden. The Government hope that local authorities can somehow resolve that situation, and then they wonder why they have problems with young people.

[Paul Blomfield]

My hon. Friend makes a very important point. Such a matter is close to my heart in Sheffield, where funding from central Government will halve over the lifetime of this Parliament. That is putting an enormous strain on all the related services and support for young people that can play a broader role in alleviating some of the difficulties. In Sheffield, we are very conscious that our position is in sharp contrast to that in wealthier parts of the country.

The first point is about cuts at a time of increasing need. We know that budget cuts to front-line services are difficult and can be devastating at any time, but cuts to child and adolescent mental health services are being made at a time of increasing need. From 2011-12 to 2013-14, Sheffield CAMHS saw a 36% increase in referrals, and a 57% increase in initial appointments. If we are serious about reducing stigma, talking openly about mental health problems—we have made enormous advances in doing that—and having parity of esteem, we should welcome those referrals. However, that demand comes against the background of what has effectively been a 4% budget cut, disguised as a requirement to drive efficiency savings. That has had severe consequences for the level of support that young people are receiving. There has been a stark increase in waiting times.

[Grahame M. Morris (Easington) (Lab)]

It is certainly true that councils are faced with really tough decisions, given the 40% cuts to local government budgets. My understanding is that within the overall mental health budget of £14 billion, only £0.8 billion goes on child and adolescent mental health services. That seems to be a disproportionately small sum of money, given the scale of the problem.

[Paul Blomfield]

My hon. Friend makes a powerful point. It is a relatively small sum of money. Perhaps that indicates that a relatively small level of resource intervention could make a significant difference.

As I was saying, the consequence of the rising demand and falling resource in Sheffield is that some 18% of young people—almost one in five—wait over 13 weeks for treatment. The cuts not only impact on young people up to the age of 17, but have a knock-on effect on adult mental health services and on acute and emergency provision.

[Robert Flello]

Although demand is rising, there is still a current of demand that does not even present itself. There is a huge level of unmet demand, simply because people do not present themselves to systems such as CAMHS, but try to self-medicate or whatever.

--- Later in debate ---

[Paul Blomfield]

I am very grateful to my hon. Friend for that intervention. While on one level we have seen enormous progress in the openness with which we confront mental health issues and the willingness of people to come forward, we must be deeply conscious that there is still a wider problem of people who do not present. The absence of resource and the inability of the system to support people with needs when they do seek help sends out a powerful message, because young people are very well networked. Those who might be on the tipping point of coming forward to seek help will get the message from their friends, “What’s the point, because you have to wait so long?” That is an important point.

That brings me to the second point that young people raise with me, which is the importance of early intervention. Again, that was emphasised by the hon. Member for Totnes. In the words of STAMP:

“Act now, tomorrow could be too late!”

I want to share the harrowing words of one 18-year-old young woman who is involved in the STAMP project in Sheffield:

“Sometimes I think, do I have to kill myself to get help? I probably do. It happens all the time. People are desperate for help, the only way they can get it is if they are at harm, so people harm themselves or attempt suicide just to get put on another waiting list. It just shouldn't be like that.”

She is right; it clearly should not be like that. Nobody should have to reach crisis point before receiving the support and care that they need, and certainly not our young people.

At a time of increasing need, we need to look at how we can do more with less money. Early intervention is a way of doing that. The hon. Member for Totnes made that point powerfully.

[Robert Flello]

I appreciate my hon. Friend’s speech very much. He has put a thought in my mind about a point that the hon. Member for Totnes (Dr Wollaston) also raised about early intervention. Given that the cuts to other local authority front-line services have been worse than decimated in places such as Stoke-on-Trent, those services that would have been early intervention-type services—and, indeed, pre-early intervention services—are just not there any more.

[Paul Blomfield]

I thank my hon. Friend for making that powerful point. The situation in Stoke, Sheffield and Coventry underlines his point that there used to be a hinterland beyond the NHS of youth groups, activities and support networks, many of which were supported by local government funding in combination with funding that was often raised within communities. The withdrawal of that funding, as local authorities have increasingly had to focus on statutory services, has put many of those groups at a tipping point and left the support that is available very weak.

The third point that young people have made to me is about being abandoned at 16. Historically, CAMHS in Sheffield have worked with people up to the age of 16, leaving those beyond that age—before they turn 18 and become part of adult provision—to fall through a hole. Things looked a bit brighter for 16 and 17-year-olds when the clinical commissioning group committed just £300,000 a year to a service for them, although I am not sure why it did not include 18-year-olds as well. However, budgets are squeezed and it has since been announced that the funding will be cut by a third. That is another example of the budget pressures being experienced and it is happening within the NHS as opposed to local authorities, which we have discussed.

In effect, £200,000 allows the service to work with little more than 100 young people aged 16 to 17 in a given year. On funding relative to need, there are 12,627 young people aged 16 to 17 living in Sheffield and it is estimated that 10% of them have some sort of mental health challenge. That leaves more than 90% of those we could expect to need support with no service at all. We cannot keep talking about reducing stigma, eradicating stereotypes and parity of esteem between physical and mental health without funding services properly when people—especially young people—need that help. We have serious questions to answer on the challenges posed to us by the issues raised with me by young people in Sheffield and those raised by the Youth Parliament.

We know that, nationally, mental health problems account for 28% of morbidity, but only 13% of expenditure is committed to mental health. Where is the parity in that? I hope the Minister will address that when he responds to the debate. We need to put our money where our mouth is. I am pleased that Labour has committed to increasing the proportion of mental health spend on CAMHS, which is currently a tiny amount of 6% even though three quarters of adult mental illness begins before the age of 18.

[Norman Lamb]

I agree with the hon. Gentleman about the need to increase resource in children’s mental health services. Is the proposal he mentions designed to increase investment in mental health or to shift resource from adult mental health to children’s mental health?

[Paul Blomfield]

I am sure my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) on the Front Bench will come back to this issue. My understanding is that our proposal is both to increase the overall resource available in the NHS and to shift resource within the service towards supporting CAMHS.

We will also train NHS staff and teachers to spot problems sooner. We will expand talking therapies and work towards a 28-day waiting time standard for access to both adult and young people’s talking therapies. That is crucial, given what I have heard from young people. Moreover, as I said a moment ago, we will invest an additional £2.5 billion in the NHS to fund extra nurses, doctors and other health workers, to relieve pressure on the service. We owe it to our young people to respond to their calls and I am pleased to have had the opportunity to articulate some of their concerns.

[Several hon. Members]

rose—