Leaving the EU: NHS

Paul Williams Excerpts

Thursday 22nd March 2018 Westminster Hall

[Dr Paul Williams (Stockton South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer, for the first time, I believe. I congratulate my right hon. Friend the Member for Exeter (Mr Bradshaw) on securing this debate and I thank all other hon. Members who have contributed and will contribute.

I have to declare many interests in this debate. Not only am I a patient of the NHS—not too frequently, I hope—but I also work in the NHS. I began my career as a medical student in 1991 in Newcastle and I spent thousands of days working in NHS hospitals, worked for many years as a GP, seen thousands of babies born in the NHS, helped to manage hundreds of good deaths and worked with thousands of colleagues, who are some of the most committed people one could ever hope to meet. My mum worked in the NHS as a nurse. My dad still works in the NHS, managing a practice. My partner works in the NHS and many of my friends work in the NHS. Tomorrow morning, I will be doing a GP surgery at the beginning of the day before working in my constituency and ending the day with an MP surgery.

My experience has taught me that it is the people who make the NHS, Mr Stringer. It is not just the ones whom politicians always talk about—doctors, nurses, paramedics and midwives. The NHS has amazing people working as laboratory technicians, physiotherapists, speech and language therapists, pharmacists, medical secretaries; people working in finance, planning, leadership, estates management, catering and cleaning. Add to that all the people who work in social care, providing care and support to people in their own homes, and in nursing and residential homes, and we have an army of people all dedicated to health and care.

Many of the people in that army do not begin their lives in the UK. We have always welcomed people—particularly, but not exclusively, doctors, nurses and midwives—from other parts of the world. In the last 20 years, the migration into the NHS from other EU countries has been significant, so that EU migrants now make up more than 5% of nurses, one in 10 of all hospital doctors and more than 5% of midwives. There are more than 60,000 EU citizens working in our NHS, giving their lives to helping our NHS. There are another estimated 90,000 EU citizens working in our social care system. Joan Pons Laplana, a Spanish nurse who has worked in the NHS for 17 years and just won the nurse of the year award, says that the uncertainty over Brexit is leading to EU citizens leaving the NHS. Whatever the Government say about EU citizens’ rights, their message is not yet getting through and it is not being believed. People are not hearing them.

Some 10,000 EU health workers have left the NHS since the Brexit vote. As my right hon. Friend the Member for Exeter has mentioned, there are enough EU midwives working in the NHS to staff around 12 maternity units. Between them, EU midwives provide care for around 40,000 mothers in England each year. There are 1,388 EU midwives as of September 2017, representing 5.4% of the workforce. But since the Brexit vote, the number of EU midwives coming has reduced and the number leaving has increased. There was a net loss of 183 EU midwives between October 2016 and September 2017. At that rate there would be no EU midwives left in the UK within a decade. This is happening right here, right now. It is a direct consequence of the Brexit vote.

Whichever way we look at it, the situation is bad. Between September 2016 and September 2017, there was a fall of 89% in new EU registrations to the Nursing & Midwifery Council, a drop from 10,000 people registering to just 1,000 in just one year.

It might be said that we should train our own nurses, not rely on nurses from overseas. I say to that yes and no: yes, we should provide more nursing and midwifery training placements, but changes to nursing bursaries have not led to any increases in placements offered by universities. At the moment, one in 10 nursing posts is vacant. What does that lead to? It leads to wards that might be a nurse down, putting pressure on the other staff, and hospitals having to spend billions of pounds on bank staff to fill the gaps. What does it mean for patients? It means having to wait longer for their appointment, no nurse being available when they are in pain and press their buzzer, and midwives being unable to give the one-to-one care that women deserve when they are in labour. When there are thousands of nursing and midwifery vacancies across the UK, we cannot afford to lose any staff.

The Government might say that they will guarantee the rights of EU staff already here, but that is not enough. Brexit is already making it less desirable for EU clinicians to come to the UK to practise. To limit the damage as much as possible, we need to keep the door open to EU staff and, more than that, we need to actively encourage them to keep coming.

This is not just about nurses; it is about doctors, too. The General Medical Council surveyed more than 2,000 European economic area doctors practising in the UK last year. More than half of them are considering leaving the UK, and 91% of those say that our decision to leave the EU was a factor in their considerations. Those are doctors, nurses, midwives and other important frontline clinical staff from EU countries doing an amazing job for our NHS whom we cannot afford to lose when the NHS is already under immense pressure.

Staff are important, but so is the money to pay them. We have already seen a slump in the value of the pound, making it less attractive for EU nationals to come and work here. That slump has also made it more expensive for the NHS to buy supplies and medicines; the Health Service Journal has estimated £900 million of extra costs each year. We have already seen our economic growth fall from the best in the G7 to the lowest. That reduction means less money for our country and less money for our NHS. Let us be honest: the NHS is not getting the money that it needs from the Chancellor of the Exchequer because when he looks at growth forecasts, he sees downward curves. He sees not enough money coming in to meet the growing needs of our ageing population. The lost growth that has already happened as a result of the Brexit vote is the equivalent of £350 million a week. That has already happened, and the future looks worse.

For the north-east of England—the part of the country that I represent—the Government’s own analysis of the impact of Brexit on the economy shows a reduction in economic output over the next 15 years. The Government’s analysis predicts that if we left the EU but stayed in the single market and customs union, we would grow by 2% less than if we stayed in the EU. It predicts 11% less growth even with a comprehensive trade deal and, if we end up with a no-deal Brexit, 16% less growth. That all means much less money for the NHS, not only now but for the next 15 years.

We have to ask, is it all worth it? This is not the deal that people thought they were getting when they voted to leave the EU. It is not the deal that my constituents in Stockton South, some of whom are here today, wanted, whichever way they voted.

If it were not enough that we have a staffing crisis being made worse by Brexit and a huge hole in our finances, we also need to look at the companies that work so hard to provide drugs and supplies for our NHS. Much of our medical research takes place together with European partners. More than 340,000 patients are enrolled in EU-wide clinical trials, with the UK leading the way in Europe for conducting clinical trials. We have the same set of rules for research as our European partners, and the same set of rules for adoption of new medicines. Together, we form a formidable partnership, representing almost one quarter of the global market for pharmaceuticals; alone, we are only 3%. If we separate from the European Medicines Agency but keep what the Government call “close regulatory alignment”, we will lose our influence and our leadership role in developing these systems and processes. We could end up a rule taker, not a rule maker. If we set our own rules that are different from those of the EU, we risk becoming de-prioritised for new medicines. As my right hon. Friend the Member for Exeter said, on average, Swiss patients get new drugs almost six months later than EU patients. We risk being excluded from clinical trials, for which data is held and co-ordination takes place at an EU level.

The supply chain for medicines and medical devices works now, but there is a risk that it will be disrupted if we leave the customs union. Do not just take my word for it; ask the members of the Association of the British Pharmaceutical Industry, made up of small and medium-sized enterprises working in our med-tech sector, which makes products that cross borders. They say they risk being put out of business by rising charges and more complex customs arrangements.

I am not doom-mongering about the future; this is happening now. The European Medicines Agency is already leaving the UK, taking with it 900 staff, about £300 million in taxable turnover each year, and the UK’s prestige from hosting such an esteemed organisation. The Committee asked Phil Thomson, president of global affairs at GlaxoSmithKline, how much his company had already spent on preparing for Brexit. He said that it was £70 million, which GSK would much rather have spent on cancer research. Those are the costs of Brexit to our NHS.

I know that nobody intended to harm the NHS by voting to leave the EU, but it is time to tell the truth: the NHS, which was already struggling, is now on its knees because of the Brexit vote. Brexit represents a threat to its very existence. Brexit should carry a health warning. Medical health experts—60 former presidents and chairs of medical royal colleagues, more than two dozen patient groups and healthcare unions—warned before the Brexit vote that this would happen. We are already experiencing a worsening of the staffing crisis and less money. In the future, less access to drugs and significant extra unnecessary challenges to research will collectively harm the NHS. Is it all worth it?

[Philip Davies in the Chair]

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[The Minister for Health (Stephen Barclay)]

It is always a pleasure to serve under your chairmanship, Mr Davies. May I begin my joining colleagues in remembering PC Keith Palmer and all those injured in the attack this time last year?

I congratulate the right hon. Member for Exeter (Mr Bradshaw) on securing the debate. He is a former Minister of State for Health. It is always interesting to hear from him both in his capacity on the Committee and with the experience he brings to the House on health issues. I also pay tribute to the Chair of the Health and Social Care Committee for the very informative report that was published this week.

I will start by addressing workers’ rights, which were raised by the shadow Minister. The Government have made it very clear that there is a commitment to protect workers’ rights and to ensure that they keep pace with changing labour markets. We do not need to be part of the EU to have strong protections for workers. The Government have a very strong commitment on that.

One of the key points raised by colleagues during the debate was the workforce. I am happy to respond constructively to the challenge set by the shadow Minister to send a strong message to EU staff within the NHS on how valued and essential they are. Healthcare professionals are internationally mobile. They are a key component of the NHS. There is consensus across the House on how valued they are as a part of the NHS, and that is very much part of the Government’s approach.

The NHS is a people business. Two thirds of what we spend in the NHS is on staff costs, so it is absolutely essential that there is a clear message to NHS staff. That extends to the people who are trying to re-run the referendum debate and go back to past arguments, who ignore the fact that, according to the latest figures, which go up to September 2017, there are 3,200 more EU nationals working in the NHS than at the time of the referendum.

[Dr Paul Williams]

There might be more EU nationals working in the NHS, but the number of EU clinicians has reduced. I believe that our points about doctors, nurses and midwives are still valid.

[Stephen Barclay]

There has been a slight reduction in nurses; the situation is more textured for clinicians as a whole. The hon. Gentleman did not touch on the fact that there are almost twice as many doctors from the rest of the world than from the EU. The NHS recruits internationally, and that will still be the case after Brexit. The Prime Minister has signalled repeatedly that the UK will be open to the brightest and best, and that will continue to be the case regardless of the deal we do.

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[Stephen Barclay]

I do not know the precise date but, having come to the House from a corporate career, I know that decisions can usually be stopped if there is a concern. The gestation is often for a longer period, but that does not mean that the decision cannot be stopped. The right hon. Gentleman may be able to point to one or two decisions, but there have been a number of significant decisions in the life sciences industry. I look at the investment in Oxford and Cambridge and, for example, the commitment of the Bill and Melinda Gates Foundation and its significant investment in the life sciences industry. I also look to the work that my hon. Friend the Member for Mid Norfolk (George Freeman) has done on the life sciences industry in terms of the golden triangle of London, Oxford and Cambridge. This is a sector that we should be championing, not talking down.

There has been significant investment in the life sciences industry in the past 12 months. It is perfectly valid for colleagues to raise concerns and to recognise the need for the Department to reassure and address specific issues as part of our planning for Brexit. However, it is misleading to suggest that this industry is not thriving when we see the highest investment in Europe coming to the UK, we see 3.5% of the global market coming into the UK and we see Oxford and Cambridge—the golden triangle, as it is termed—thriving in the way we have seen in recent months. Kent Council has been getting in on the act with NCL Technology Ventures, which has put further money into forward-looking medical technology. Even local authorities are recognising the benefits of investment in the life sciences. International and domestic investors are coming together in this area. It is beholden on us in these debates to better reflect the reality of what is happening.

I am always keen to listen to the hon. Member for Stockton South (Dr Williams), who always speaks with authority on medical matters, not least as he is a practising clinician. However, on this occasion I fear he strayed into Treasury matters when he started to talk about the UK growth forecast diminishing. As a former Treasury Minister, I was particularly interested in his remarks, and I gently point out that they were at odds with the Office for Budget Responsibility. The OBR is clear that the growth forecast for 2019 and 2020 is 1.3%. That rises to 1.4% in 2021 and to 1.5% in 2022. The OBR recently improved its growth forecast.

[Dr Williams]

I agree that I am straying into Treasury matters, but I have read the IMF’s forecasts for the UK economy for 2019, which were downgraded from 1.6% to 1.5%, when many of our closest partners, including the United States, Germany and Canada, were upgraded. I have also seen that the UK’s economic growth has fallen from the highest in the G7 to the lowest. That has all happened since our decision to leave the European Union. Is it not true that the IMF predicts that our economic growth will be less than it would have been if we had not made that decision?

[Stephen Barclay]

We can see the variability of forecasts, but the OBR’s forecast, which is the one that really matters—there is consensus that the Government rely on it and that Government planning is undertaken on the basis of it—shows a clear trajectory of improvement that is not reflected in much of the doom and gloom that we have heard in recent weeks. The debate is better informed if we tie it into the benchmarking that the Government use when setting fiscal policy.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) commented on the fact that her constituents are bored by the length of the Brexit debate. I am sure that if anyone is watching the debate, that will resonate with them. That is why it is so important for us to look forward. We should look at the areas of real concern where the Department needs to focus, such as maintaining the regulation and considering the mutual recognition of qualifications, which is a real issue that we want to make progress on with the European Union, because it is of concern to people. To look constructively at how we address some of those issues is far better than having groundhog day on the same areas.

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[Stephen Barclay]

I am a former member of the Public Accounts Committee. The then Chair, the right hon. Member for Barking (Dame Margaret Hodge), would always talk about following the public pound. The National Audit Office has considerable reach in doing that.

My point is that subsidiary companies are within the NHS family. They are 100% owned by the NHS foundation trust that sets them up. They are a better vehicle than the alternative of contracting out, which gives far less grip over how services are provided. The legislation passed by a Labour Government is welcome. We should not re-write history and suggest that legislation that was fine in 2006 should suddenly be presented as privatisation.

That goes to what we sometimes see in the Brexit debate—I will bring this back to the Brexit debate, Mr Davies—in terms of a trade deal with the US. We are sometimes told that a trade deal with the US in a Brexit context is alarming and somehow a threat to the NHS, often by the same people who are very positive about the EU. When TTIP was being debated, the EU lead negotiator said TTIP was not a threat to the NHS.

[Dr Williams]

If there is no threat from a trade deal with the United States, will the Minister rule out the possibility of United States pharmaceutical companies gaining the ability to market directly their products to UK patients in any future trade deal?

[Stephen Barclay]

My point is that we will have control of our trade deal. The Prime Minister has made it clear that there will be no change in the protections afforded to the NHS. The subject of the debate is Brexit, and we are talking about the difference between being inside and outside the EU. The regulatory controls as they would have been under TTIP will be no different in the new landscape.

I remind the hon. Gentleman, who was very critical of Brexit, that more than 61% of people in Stockton voted to leave the EU. He might think that his voters are misguided and wrong, and that they made a huge error in how they voted, but I hope he agrees that it is right that the Government respect that democratic decision and deliver control over our trade policy.

Oral Answers to Questions

Paul Williams Excerpts

Tuesday 20th March 2018 Commons Chamber

[Mr Hunt]

I am looking forward to reading my hon. Friend’s report into this topic in May. We are a bit of a curate’s egg in this country. We have five of the world’s top 10 medical research universities and more than double the number of Nobel prizes of France, so we do incredibly well on the research side, but some of our hospitals are still running on paper, which is totally inappropriate. That is why we are determined to implement the Wachter review.

[Dr Paul Williams (Stockton South) (Lab)]

Co-operation in medical research, science and innovation with our European partners must not be hindered by a bad Brexit deal. What steps is the Secretary of State taking to ensure that UK patients are not left behind during the negotiations?

[Mr Hunt]

Let me reassure the hon. Gentleman—as a doctor, he is very conscious of such issues—that the absolute need to ensure that we have an uninterrupted supply of the most critical drugs is forefront in our minds. We are confident that we will be able to achieve that, but we also want great collaboration with European universities, which is why we have said that we would be happy to be an associate member of the European Medicines Agency.

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[Stephen Barclay]

My hon. Friend always, quite rightly, champions the work of nurses. She is also right to signal the importance of the nursing apprenticeships, which offer a new route, particularly for many healthcare assistants, to progress within the NHS. It is right that we increase the number of pathways for nurses in order to deliver the excellent care that they provide.

[Dr Paul Williams (Stockton South) (Lab)]

T6. During the first seven weeks of 2018, 10,375 more people died in hospital than in the same weeks in the previous five years—one extra death every seven minutes. It was not colder than usual and deaths from flu were not up, but our hospitals were under unprecedented pressure. Why did all these extra deaths occur?

[Mr Hunt]

As the hon. Gentleman will know, these figures cover England and Wales. He will also know that they do not take account of changes in population or changes in demography, so we use the age-standardised mortality rate, which, according to Public Health England, has remained broadly stable over recent years.

Psychosis: Early Intervention

Paul Williams Excerpts

Thursday 15th March 2018 Westminster Hall

[Dr Paul Williams (Stockton South) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Moon. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this debate. It is a subject that we are both passionate about, as are many people in this room. I pay tribute to the commitment that he made to mental health services during his time as a Minister and beyond.

Psychosis can be a terribly destructive condition. When it starts in adolescence, as it does for most people, people can lose out on schooling, relationships with friends and family are strained and the foundation on which the rest of people’s lives will be built is severely tested. Psychosis is not just about the symptoms—the delusions, hallucinations and suspiciousness that people feel. It is a social condition too. It often leads to a withdrawal from society—avoiding friends, avoiding leaving the house, losing schooling and losing work—and that is why it is such a pernicious condition. It can harm somebody’s life chances. It is a condition that leads to lost opportunities.

I am pleased that the right hon. Gentleman has drawn parallels between psychosis and cancer. We have not conferred, but I am also going to do so. We see how good cancer services are. It is important to have that comparator and to hold mental health services to the same standards as physical health services. We should think about psychosis in the same way as physical health services think about cancer. As soon as somebody shows signs of psychosis, they should have rapid—two-week—access to expert diagnostics. If the diagnosis is made, it is right that they get a superb package of care to give them the best possible chance of recovery. That care includes psychological therapies, medication, help with their physical health and, of course, rehabilitation.

If somebody receives that rapid package of care and support, there is half a chance that they will get back into education, employment or an apprenticeship. The rest of their life will be radically different. However, if they do not get that care, support and treatment, the figure for that drops to between 7% and 12%. That is what happens to people who do not get that package. If there was a pathway for cancer that improved survival and recovery from 10% to 50%, we would all know about it and fight for it. I am pleased that within this room there is the same passion and commitment to early intervention in psychosis.

The right hon. Gentleman outlined some of the costs to society of untreated and unmanaged psychosis, but I have a few things to add. Some 65% of all admissions to in-patient mental health units are for psychosis. The police spend increasing amounts of time detaining people under section 136, many of whom have psychosis. A lot of homelessness is associated with psychosis, and many prisoners have or had psychosis. As well as costs to society, there are also big costs to the individual. A person with a severe mental health problem such as psychosis will die, on average, 20 years younger than someone who does not. They are not dying of the psychosis; they are dying of physical health problems that are caused by their underlying mental health problems.

It is important that we are having this debate, but it is unfortunate too. In September 2016, the right hon. Gentleman led a similar debate on this very subject, and 18 months on we are learning that many of the things raised in that debate are still not happening. During that debate, the then Minister said:

“To improve access to NICE-recommended psychological therapies, we have to ensure that there are the staff numbers and the appropriate skills mix to deliver the full range of treatment to those who need it.”—[Official Report, 7 September 2016; Vol. 614, c. 163WH.]

Yet the survey conducted for the right hon. Gentleman’s recent report highlighted some worrying trends around resources and staff numbers. Many patients are not receiving the full range of treatments and interventions that should be included in the specialist EIP care package. Many trusts say that they simply do not have the staff and resources to meet demand.

I return to the analogy with cancer. The Government’s ambition is that 50%, rising to 60% by 2020, of people aged 14 to 65 experiencing a first episode of psychosis should have access to a NICE-compliant care package. If we were to replace the word “psychosis” with “cancer”, there would be outrage at that target. Why should it not be 90% or 95%? Why should the ambition not be 100%? If we were talking about cancer, we would already be hiring the radiologists, laboratory scientists, surgeons, nurses and technicians that we need for the pathway. I want to give credit where credit is due. Setting a 50% standard is at least a step towards achieving parity of esteem, but that ambition is clearly not yet a reality.

NHS England’s data show that more than 60% of patients start treatment within two weeks of referral. However, if we look at the data in a different way and ask people who have started treatment how long they waited, the figures paint a very different picture. In January 2018, even though 722 patients had started treatment within two weeks of referral, 1,344 patients were still waiting to start treatment, and more than 700 had been waiting more than two weeks. We are talking about figures, but those figures represent people—more than 700 people who were waiting in January of this year. Often these are young people who are not going to school because of new mental health problems that could be managed. During that time relationships are breaking down, people are losing their jobs and people’s life chances are being harmed.

There is regional disparity as well. The north of England, where my constituency of Stockton South is, has the lowest proportion of pathways completed within two weeks of referral and the highest number of total referrals still awaiting treatment. It seems that we have not yet put sufficient resources into our mental health services for the psychologists, occupational therapists, mental health nurses and care co-ordinators who are important to implement this pathway. I have to say that the staff who are working in this area are doing amazing work and transforming lives. I would like to thank them for what they do, but this now needs to be taken to another level and delivered to a much greater scale.

The right hon. Gentleman’s research shows that mental health trusts invest, on average, just half the amount that NHS England estimates is needed to provide EIP in line with NICE guidelines. As he stated, only 29% of trusts say that they are able to offer their patients the full NICE package of care. I urge the Minister to acknowledge that service providers still have ground to make up, and to recognise that they need greater support and resources to do so.

I really hope that the Minister responds with a plan to make things better for the people who we all know are still not getting the service that they need. I have no doubt of her personal commitment to improving mental health services, but she must match rhetoric with ensuring that commissioners are actually putting significant amounts of extra money into mental health services on the ground, and that providers are turning that cash into services that meet the needs of these priority patients. If this were cancer instead of psychosis, we would be doing it—let’s make parity of esteem a reality.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mrs Moon. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on proposing this debate to the Backbench Business Committee—a proposal for which I was a signatory—and securing this important and timely discussion.

The right hon. Gentleman and I have shared many platforms in supporting joint campaigns, and we have debated often the state of our mental health services. We have come to expect from him a level of forensic detail, commitment to improvement and genuine compassion for those with severe mental illness, and today he has not disappointed. We may have very small differences in approach or policy, but he and I share a big-picture commitment to world-class mental health services in this country; to genuine, tangible parity of esteem—real equality—between physical and mental health services; and to a transformation in the way that we view mental illness, talk about mental illness and treat those with mental health conditions.

As with many other forms of mental illness, all the experience and evidence point to the fact that the best time to intervene in cases of psychosis is as soon as possible. The work of Professor Patrick McGorry in Australia and proponents of early intervention in the UK clearly shows that early intervention can have a huge impact on the health of the individual patient, with more chance of them living with conditions in a managed way and ultimately more chance of their recovery.

I echo some of the right hon. Gentleman’s points about the benefits of getting back into employment and the importance of accessing individual placement and support. That is a well-evidenced measure that has already made a tangible difference to many people living with mental ill health. I will reflect on the experience in my area, Merseyside, where Mersey Care provides the majority of mental health services, including early intervention in psychosis. It did an audit of all the patients that it looks after in both the community and in-patient services. It is staggering that just 3% of their patients are in any form of employment. If we compare that figure with people in physical health services, the inequality—the massive disparity—when it comes to mental health is a great concern. That strikes at the heart of the issues that we are discussing.

It should not surprise hon. Members that the earlier we treat any condition, be that a mental or physical health condition, the more likely we are to get a positive result. In terms of system reform in the health service, early intervention clearly fits into the mantra of prevention being better than cure. I have said it before, but I will say it again: if people are not convinced of how important this is by the moral and social reasons, the financial and economic consequences of not contending with mental health sooner should be enough.

For the NHS to be sustainable in the long term, when it will increasingly have to contend with lifestyle-related diseases, we need a seismic shift from treating diseases and conditions when they present in crisis in their most acute forms to a system that allows us to detect them in their earliest stages, to manage them with early interventions and to do everything to avoid certain conditions in the first place, although that is not always possible. That is as true of mental illness as it is of cancer, cardiovascular disease and coronary heart disease.

The issue is not just health outcomes, but the impact that psychosis has on the totality of an individual’s life and their opportunity to be involved in education, employment and training, to maintain relationships with family and friends, to own a home or maintain a tenancy, to be able to go to work and to not be in our criminal justice system. Those outcomes have far-reaching and long-term consequences that are not contained solely within the Department of Health and Social Care, although a Health Minister will respond to today’s debate.

With that in mind, in February 2016, the Labour Front Bench, including me as the then shadow Minister for Mental Health, welcomed the inclusion of the access and waiting time standard for early intervention in psychosis in “The Five Year Forward View for Mental Health”. The commitment was that NHS England should ensure that by April 2016, 50% of people experiencing a first episode of psychosis had access to a NICE-approved care package within two weeks of referral, rising to at least 60% by 2020-21.

It is important to reiterate that laudable target and ambition. It was modest, but it was an important first step and it was welcomed across the House, so it is with heavy hearts that we review progress since then, and realise that the system is failing to reach the target stipulated in the “The Five Year Forward View for Mental Health”.

Once again, we should recognise the detailed work of the right hon. Member for North Norfolk in unearthing the emerging picture from across the country. Every Minister’s worst nightmare is the ex-Minister armed with the tools of freedom of information requests and parliamentary questions, and who knows the darkest secrets at the heart of the Department.

We now know that the access and waiting time standard for early intervention in psychosis is not being met. Too many providers cannot offer the full NICE-approved package of care. There is variation across the country, with, as ever, the poorest people in the poorest parts of the country receiving the poorest levels of service. That real inequality is a social justice issue.

I echo the concerns expressed by my hon. Friend the Member for Stockton South (Dr Williams) about the figures for his constituency in the north of England. The north of England commissioning region has the lowest proportion of completed pathways and the highest number of total referrals still awaiting treatment—two thirds. That should be a serious concern for us all. The inverse care law, first identified some 40 years ago, is alive and kicking when it comes to mental health services.

The latest picture published by NHS England shows that far from the steady progress we all desire, the proportion of patients in the early stages of psychosis that started treatment within the two-week target was lower in January than it was in May 2016. In the first 10 months of 2017-18, 9.1% fewer patients started EIP treatment within the two-week target, compared with the first 10 months of 2016-17.

Behind those figures, as other hon. Members have indicated, are real people who are suffering the early manifestations of psychosis, which can be extremely disturbing for them and for their friends and family. I have had the privilege of visiting a number of in-patient units, not just in my constituency but across the country, and I have heard first hand about patients’ experiences. The longer they have to wait, the greater the negative impact can be on their condition and on their chance of recovery.

The Royal College of Psychiatrists points out that if people do not receive help early enough, they are more likely to experience poor physical health, lower levels of social functioning, and poorer occupational and educational outcomes. That is a serious concern for us all, which is why we are here this afternoon.

We also have to think about what happens in the future. I am grateful to YoungMinds for its analysis of the sustainability and transformation partnerships, due out next month, which shows that less than a quarter of STP plans demonstrate an explicit commitment and clear plan to meet the EIP target for 2020-21. It is not just about what has happened in the past and looking at the results retrospectively, but about what will happen in the coming years. The Government have endeavoured to have STPs, and the EIP target should be at the heart of what they are doing. Unfortunately, it is not, despite the fact that the implementation of that waiting time target is one of the nine requirements for STPs, as set out in the NHS planning guidance.

I will turn to an area that is of particular interest to me. In the year since the birth of my child, I have been even more aware of the need to support the mental health of new mums. Around 85% of new mothers experience some change in their mood, and for around 10% to 15% of them, that might mean more serious symptoms of anxiety and depression. More than 1,400 women experience post-partum psychosis each year in the UK, which is between 1 and 2 in every 1,000 mothers. I was struck that a woman is between 30% and 40% more likely to experience a period of psychosis in the year after childbirth—more than at any other point in her life.

Post-partum psychosis can take many forms, including hallucinations, depression, delusions and mania. It can be extremely distressing for mothers, their partners, their wider families, and of course, the child. I have had the opportunity to visit two mother and baby units across the country to hear from mums first hand. The condition does not discriminate. It can affect women of any background, colour and income, and it can have serious and far-reaching consequences.

The National Childbirth Trust, the Maternal Mental Health Alliance and others have specifically highlighted the paucity of provision of mental health services for new mothers and the effectiveness of the six-week check in identifying the early stages of mental ill health, including psychosis. In the mix of the debate, I hope the Minister will be able to comment on that.

[Dr Paul Williams]

I, too, have read the National Childbirth Trust’s report, “The Hidden Half”. It says that despite it being a vulnerable time for women, more than half of women who experience post-natal mental health problems say that they were not asked about them by any health professional. Will my hon. Friend join me in calling for that to be added to the GP contract so that GPs routinely provide a six-week check for the mother, as part of the six-week check for the baby?

[Luciana Berger]

I thank my hon. Friend for raising that important report and the campaign, which I have considered as well. The National Childbirth Trust makes an important point about the connection that GPs have with new mums and their babies. I recall that my GP did ask me about my mental wellbeing and how I felt, but that is not the case for every mum. It is something that we should consider, along with ensuring that every contact counts when it comes to new mums and their babies—be that with the health visitor, a midwife who might come to the home or someone in the hospital. We need to look at the whole spectrum of engagement to ensure that we consider the mental health of mum and baby every step of the way.

I mentioned mother and baby units, which are incredibly important. For anyone who does not know, they are an opportunity to ensure that if the mum is experiencing a period of psychosis or another serious mental illness, they are still able to be with their child. The units offer extremely specialised care and incredible attention from clinicians, who do a remarkable job of ensuring attachment so that mums are not disconnected from their babies, even if they have to be moved across the country.

Mother and baby units are very important for recovery rates. I have asked several parliamentary questions about them, but I want to ask more in the context of this debate because of their importance to mums who experience post-partum psychosis. In January, I asked the Secretary of State, in a written question,

“how many mother and baby beds commissioned by NHS England Specialised Services in 2016/17 are (a) available and (b) in use.”

I asked that because although we know that beds have been commissioned, it is not clear whether they are available or in use. The figures that I received in response to a previous question showed a decrease of one in the number of beds available across the country since 2010. I ask the Minister the same question again, publicly, because her response in January was:

“The information requested is not available.”

I do not think that it is a difficult question to answer. In the context of this debate, it is a very important one, so I hope the Minister’s officials will provide her with an answer today. Post-partum psychosis, no less than any other kind, requires early identification and early intervention, but we are not doing enough to treat or support post-partum psychosis alongside other forms.

Let me conclude with some brief questions that I hope the Minister will address. First, what steps is her Department taking to address mental health inequalities and the waiting times postcode lottery, particularly in cases of early episodes of psychosis?

Secondly, how can the Minister guarantee that money allocated for mental health services is actually reaching the frontline in all the areas in which it is needed? There are many examples of mental health budgets being raided to pay for other parts of the NHS.

Thirdly, does the Minister agree with the Royal College of Psychiatrists that we need to improve the financial data available for early intervention in psychosis services? Without it, we cannot be sure that services are properly investing in EIP.

Fourthly, does the Minister believe that frontline mental health services have adequate numbers of staff—including psychiatrists, mental health nurses and therapists—to meet the targets set out in the five year forward view? I echo the praise of other hon. Members for our frontline clinicians, who do an incredible job under very challenging circumstances but are severely stretched, as we hear time and again. They cannot meet the workforce challenge alone.

Lastly, what steps will the Minister take to drastically improve early intervention in cases of post-partum psychosis, especially at the six-week check for new mothers, so that we can support women in the first weeks after the birth of their baby?

I congratulate the right hon. Member for North Norfolk again on securing the debate. Let us hope that our deliberations this afternoon will lead to concrete improvements and swift action from the Government to prevent unnecessary psychosis, intervene early to prevent unnecessary suffering, and help as many people as possible across the country towards a meaningful path to recovery.

Respite Care for Vulnerable Adults: Teesside

Paul Williams Excerpts

Monday 12th March 2018 Commons Chamber

[Dr Paul Williams (Stockton South) (Lab)]

I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing the debate. I also congratulate him on his leadership in this area and on his engagement with the families and the clinical commissioning groups.

The challenge of being a carer for an adult with complex needs is a lifelong challenge. I have enormous respect and admiration for the people who do this work. My grandmother’s sister—I have just worked out that she is my great-aunt—has spent her life looking after several different adults with complex needs. She adopted them as children and has cared for them. I have seen the enormous amount of love and compassion that she has given them, and I have seen in all my constituents who have contacted me, and in my work as a GP in my constituency, the love and compassion that go into looking after adults with complex needs. But this comes at a cost for carers, mainly to their health. They often prioritise the needs of the person they are caring for and do not think about preventing their own ill health problems or about properly looking after problems as they arise. There is also a time cost. Being a carer for an adult with complex needs is a massive time commitment, a money cost and a career cost. So there is huge cost.

[Jim Shannon]

It is also important to get the issue of young carers recorded in Hansard. I have a vibrant young carers association in my constituency, in Regent Street, Newtownards. The work they do with elderly family members is the reason those families are together, so the issue of young carers is so important. Does the hon. Gentleman encounter the same issues I have in my area when it comes to young carers? Does he agree on the importance of keeping families together and of what young carers do?

[Dr Williams]

I thank the hon. Gentleman for highlighting the needs of young carers. In my constituency, as in those of all Members in this House, there are young people who grow up suddenly when they find themselves needing to be carers and who really do hold families together.

In the context of how difficult this caring can be and the tremendous efforts that people make in order to keep their loved ones well and look after them, the provision of occasional respite is the least we should be doing as a society. It is the least we should be doing to say thank you and to sustain the incredible efforts that these people are making. Like my hon. Friend the Member for Stockton North, I give some credit to the two CCGs involved, Hartlepool and Stockton-on-Tees CCG, and South Tees CCG, for taking some responsibility for this. We all see the constant jostling between local authorities and commissioners of health services about who should fund these issues in a time of austerity, but our CCGs have stepped up to the plate and taken ongoing responsibility for funding these issues.

However, a number of constituents have contacted me in what I can only describe as a state of panic during these consultations and since the outcome of the consultations was announced. They are fearful that their much-needed breaks are going to be taken away from them. As my hon. Friend pointed out, their fears may well prove to be ill-founded, but this should not mean that they should be discounted. Change is always difficult for people, but the possibility of services being cut has caused genuine anxiety for these people and we should rightly be recognising it. We all know that caring can be physically demanding, but it can also be mentally demanding, especially if it is being done for long periods of time. Adequate respite is essential if these carers are to be able to maintain their own health and wellbeing. It is also essential that carers are closely involved in any decisions about what is adequate and appropriate for their family members and for themselves. As he has said, a respite package should be designed around the needs of the whole family, not just those of the individual with complex needs.

What we are seeing, though, is limited funding. I do not know whether this is ring-fenced funding that the CCG has or whether it is taken from an overall pot, but there is limited funding. CCGs have a number of conflicting priorities. We know that throughout the health service demand is increasing and outstripping any increase in resource that it has. The limited funding and the rising need for this particular kind of care mean that for some people packages of care are likely to be reduced. That is causing people significant anxiety.

Before I finish, let me say that our experience on Teesside illustrates that health and social care do not exist in isolation from each other. Some small steps have been taken, including by changing the Department of Health’s name to the Department of Health and Social Care, but respite care is a really good example of where some more concrete steps can be taken to bring together health and social care funding. There should be a partnership between local authorities, clinical commissioning groups, parents, carers and the people with complex needs, so that they can work together. Respite care is an issue on which we should be seeing integration at its best. If we are talking about integration, I have to take the opportunity to talk about the forthcoming Green Paper on social care. It is inconceivable for me that in 2018 we should be considering social care in isolation. Will the Department think about whether the Green Paper should really be on health and social care together, rather than just on social care?

I pay tribute again to the carers who have come together to fight for the very best services for their loved ones. They deserve for us to listen, to consider and to act, so that they get the respite services that they need for themselves and their families.

Oral Answers to Questions

Paul Williams Excerpts

Tuesday 6th February 2018 Commons Chamber

[Mr Speaker]

Dr Williams, you wanted to speak a moment ago; have you abandoned the idea?

[Dr Paul Williams (Stockton South) (Lab)]

indicated assent.

[Mr Speaker]

Very well.

NHS Winter Crisis

Paul Williams Excerpts

Wednesday 10th January 2018 Commons Chamber

[Dr Paul Williams (Stockton South) (Lab)]

Thank you for giving me the opportunity to speak in this debate, Madam Deputy Speaker. I have worked in the NHS since 1996, as a doctor, in hospitals, as a GP and as a commissioner of services, and I must say that it feels as though we are going back to the ’90s at the moment, with long waiting times. Even before this unprecedented decision to suspend operations for a month, we were already breaching 18-week targets in many trusts. From a patient point of view, it feels as though the standards are deteriorating, particularly in my constituency, with the difficulty people face in accessing an ambulance when they need it.

I wish to share two insights into the problem and two potential solutions. My first insight is that, no matter what Ministers say, some of this is about the money. We have seen an anaemic level of growth in NHS funding in the past eight years. As we have heard from others in this debate, we have also seen cuts to social care funding and to public health budgets. We have also had a long-standing underinvestment in prevention, general practice and out-of-hospital care, although I appreciate that that is being reversed now. The money that came in the Budget was too little, too late. It is hard for commissioners and providers to spend that money when they get it at the last minute, because they have to get people to come in to do the work to spend that money. Had the money come earlier, we would have been able to put in place much better contingencies.

As well as this situation being about money, it is also about having the wrong strategy. There has been planning for reactive services, but at the same time we have been cutting prevention. We have been doing planning for healthcare services, but not enough planning for social care services. We have also been planning by giving this emergency injection of cash to acute hospital services, but while we have been cutting, prioritising and fragmenting community services. We have seen 5,000 fewer community nurses and a 45% reduction in the number of district nurses since 2010.

What do I suggest should happen now? We need to change the strategy. We cannot just respond by providing more and more acute hospital beds. We need to focus on prevention; on having good-quality community services, community nursing, social care; on having better palliative care, because most people want to be able to die in their own home, not in hospital; and on having more emphasis on screening. We also need to focus on poverty reduction and tackling deprivation, as people living in poverty are much less likely to access prevention and much more likely to be acutely admitted to hospital. I include in that people with mental health problems—the most vulnerable people.

Integration is the right direction of travel, but we have to change some things about how it is being achieved, the first of which is the name. Calling these organisations “accountable care organisations” lends people to think that this is an idea captured from the United States. We might call them “public health boards”—something that puts the needs of populations at the centre of healthcare and of healthcare planning. We need to make sure that the leadership teams of these organisations are focused on out-of-hospital care and not on just providing more and more acute hospital services.

There is also a fundamental contradiction to address, because we still have section 75 of the Health and Social Care Act 2012, which mandates competition, yet we are trying to get organisations to collaborate.

So it does not have to be like this—it is not inevitable. Huge praise must go to the staff, and I myself have done shifts over the short recess. With the right type of investment, the right preventive strategy and proper collaboration, uninhibited by competition, we can do better.

NHS Winter Crisis

Paul Williams Excerpts

Monday 8th January 2018 Commons Chamber

[Mr Dunne]

My hon. Friend highlights articulately the fact that proper co-ordination between local authorities and NHS trusts in some areas means that they can cope with the pressures better than others. I commend the example that she has given.

[Dr Paul Williams (Stockton South) (Lab)]

I worked as a doctor on the NHS frontline last week. I saw elderly patients who would have been better off being looked after at home by community and social care, and people waiting far too long for ambulances. Cancelling non-urgent work just makes more patients suffer. What does the Minister say to the woman with Crohn’s disease who is in pain and has terrible symptoms now that the bowel operation for which she has already been waiting for six months has been delayed again? The only way she will get the operation now is if things get even worse and she becomes an emergency case.

[Mr Dunne]

I put on the record my appreciation of the hon. Gentleman’s role not only on the Health Committee but in undertaking shifts, as he mentioned. On deferred procedures, we have given very clear instructions that time-critical operations should not be cancelled—cancer operations should not be cancelled. Ultimately, it comes down to the clinical decisions that are made at each hospital about who they should treat and who they believe can wait.

Oral Answers to Questions

Paul Williams Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Hunt]

My right hon. Friend has talked to me extensively about this in private, and I fully understand his concerns. The Government are increasing funding to the NHS, which involves extra money going both to out-of-hospital services, such as general practice, and to hospital services. We expect all areas of the country to find sensible ways for those two sectors to work together.

[Dr Paul Williams (Stockton South) (Lab)]

I refer Members to my entry in the Register of Members’ Financial Interests.

Has the Secretary of State seen the recent report of the Royal College of General Practitioners, “Destination GP,” on how to inspire medical students to pursue a career in general practice? Will he consider the report’s recommendations to help to better support medical student placements in general practice?

[Mr Hunt]

I will absolutely consider the sensible recommendations of that report. People on both sides of the House, such as the hon. Gentleman, who were GPs before being elected do a fantastic job of flying the flag for general practice. We are making some progress. Some 3,157 medical school students have gone into general practice as a specialty—the most ever—but there is lots more work to do.

Tobacco Control Plan

Paul Williams Excerpts

Thursday 19th October 2017 Commons Chamber

[Dr Paul Williams (Stockton South) (Lab)]

I am grateful to my right hon. Friend the Member for Rother Valley (Sir Kevin Barron) for securing this important debate.

There used to be a time when cigarettes were perceived as cool—but people were being conned. Powerful tobacco companies were placing their products in movies and using careful branding to make us think that cigarettes would make us more attractive, more athletic, or even smarter. What they forgot to tell us was they also leave people unable to breathe, cause heart attacks, and kill half of those who use them. Some 15% of adults in the UK still smoke. In some parts of my constituency, half of all people still smoke. Not surprisingly, these are also the areas where people die youngest. I predict that in 50 years’ time nobody will smoke. We will look back on the 20th and early 21st centuries and shake our heads and laugh at the idea that people were poisoned with tobacco and paid for the privilege.

Like many Members in the Chamber, I would like to see England smoke-free. That means no young people starting to smoke because they know that it will make their breath smell and their teeth bad, no pregnant women smoking because they know that each time they smoke a cigarette their baby is also smoking a cigarette, and no young parents smoking because they know that their kids will copy them as soon as they are old enough. It means people in their 40s and 50s quitting, because lungs decline rapidly if people continue smoking beyond this age, and in time they struggle to breathe. It is never too late to stop. It is best never to start, because stopping smoking is one of the hardest things that someone will ever do—but one of the most worthwhile. As many Members have mentioned, half of all cigarette smokers will die of smoking-related conditions. There is a powerful case for continuing to take stronger action towards a smoke-free society, and I welcome much of the tobacco control plan for England.

It is important to recognise success. Smoking rates in the north-east of England have fallen to just over 17%—down by almost a half since 2005, and the largest regional fall in smoking rates in the country. Having 200,000 fewer smokers in the region could mean 100,000 fewer premature deaths. This is, in part, due to the work of successive Governments who have pushed the issue up the agenda.

I welcome all the ambitious targets that the tobacco control plan for England sets for future reductions, but I particularly welcome the focus on stopping smoking in disadvantaged social groups. The decline in smoking in our society has not been uniform and, as in many areas of society, many people have been left behind. However, it is wrong to think that just providing services to people living in poverty will be enough. My experience of working in areas of socioeconomic deprivation in England has taught me that health behaviours do not occur in isolation. It is genuinely hard for someone to stop smoking if they are worried about how they are going to pay their next bills; they are threatened with losing their benefits, perhaps even having to wait six weeks for universal credit; they have insecure work; they live in a community threatened by crime and antisocial behaviour; and they are struggling to look after their family. Smoking is often a symptom of other problems. Reducing smoking requires poverty reduction and true engagement at a community level to make life better and easier for people living in areas of deprivation.

I would now like to focus on those with mental health conditions. As has been mentioned, the smoking rate among people with mental health conditions has remained stubbornly high. In Stockton South, the rate is about 40%, even though smoking rates have fallen among the rest of the population. It is one of the single largest factors in the lower than average life expectancy among people with a mental health condition. For someone who has a mental health problem, stopping smoking is good not just for their physical health but for their mental health too. There is evidence that if someone with depression stops smoking, it can have an effect on improving their mental wellbeing similar to taking antidepressants.

Closing the gap in smoking rates is not a straightforward task. It is a challenge that requires a collaborative approach, including not just the NHS but communities, mental health charities, anti-smoking organisations and, not least, smokers themselves. I welcome the plan’s commitment to work with the Mental Health and Smoking Partnership to identify how we reduce rates of smoking in this population. However, while the ambition of the plan is welcome, it is not clear how the Government intend to assess progress within the population of those with mental health problems. I would be grateful if the Minister could tell us what he intends to do to make sure that there are reliable, national ways of measuring smoking rates among the whole population of those with mental health conditions, not just those with severe mental health problems. Government should know how they will assess whether targets are being achieved.

Like other Members, I am concerned about cuts that local authorities are making to public health funding, their hands often tied by huge Government cuts. I am particularly concerned about cuts in smoking cessation services. The evidence is quite clear: well-run services that combine behavioural therapy and prescription of nicotine replacement products offer smokers who want to quit the best chance of success. Community-based interventions to tackle inequalities are stressed in the plan, but that will be empty rhetoric unless the funds to do this work follow. The five year forward view and the sustainability and transformation partnerships place a significant emphasis on prevention. The pressure on NHS services in future can be significantly eased if we ensure that we make the necessary investments in prevention now. Government must finance the public health provision necessary to put effective tobacco control policies into action and to enforce tobacco control legislation where it is being broken. That Government commitment is threatened by austerity, and by cuts in local government funding in particular.

It would be a welcome boost if the political consensus that exists in this House—it spreads across all parties— on the need for tobacco control were supported by a commitment to fund local authorities in England to deliver the radical steps that we now need to make the next push towards a smoke-free society.

Autism Diagnosis

Paul Williams Excerpts

Wednesday 13th September 2017 Westminster Hall

[Dr Paul Williams (Stockton South) (Lab)]

I congratulate my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous) on securing this important debate.

Waiting frustrates us all. Waiting for a bus, one might have expected it in just 10 minutes or so, and it is frustrating to have to wait a bit longer. Waiting to speak in a debate, it sometimes takes many hours to be called —thankfully, not today. But how long should a parent wait if their child is not making friends, has difficulty communicating their needs, avoids eye contact and likes lining things up, and if they think that that child might have autism?

I mentioned on social media last week that I was going to speak in this debate. I have had more than 500 responses from people, each one telling me their story. Nichola has been told that she has to wait three years for her son to be assessed; Eleanor has been told she will have to wait four years for her daughter. Jodie-Marie said that that for her son it was two years, for Louise it was two years and for Janine it was three years. Leigh has a child who was referred last year and been given a first diagnostic appointment in June 2019.

Delays leave many families unable to obtain the education and social support they need, and mean that during the crucial years of child development children are not receiving optimal care. Stuart Dexter leads autism support charity Daisy Chain in the constituency of my hon. Friend the Member for Stockton North (Alex Cunningham) and is in the Public Gallery today. He lives and breathes such stories of frustration every day.

Stuart told me that parents cannot understand why in Middlesbrough assessment takes four months to begin but in Stockton, the town next door, it takes three or four years. The two towns are next to each other and work with the same mental health trust, but have two completely different experiences of care. I can tell those parents why: there is no central leadership of the process, no measurement and no targets, and responsibility is fragmented. Local authorities and CCGs are not working together properly, and the staff delivering assessments work for four different organisations.

On behalf of hundreds of people in Stockton South living with autism, I will ask the Minister two questions. We all come into politics to make a difference and they are not party political. Will she include indicators on diagnosis waiting times in the mental health services data set, to measure how long it takes for people to get diagnosed? Will she commit to introducing a waiting time standard for autism diagnosis and to including it in the CCG improvement and assessment framework, setting a target for maximum waiting times? Those actions might seem small but they could be a huge and welcome leap forward in creating a diagnosis process that is fit for purpose. If they were included in the NHS mandate for 2018-19, we could make a massive difference for thousands of families.

[Several hon. Members rose—]