NHS Funding Bill

Pete Wishart Excerpts

Legislative Grand Committee & 3rd reading: House of Commons & Legislative Grand Committee: House of Commons & Programme motion: House of Commons & 3rd reading & Programme motion
Tuesday 4th February 2020 Commons Chamber

[Justin Madders]

It is a pleasure to see you in the Chair, Dame Rosie. In my speech I will address amendment 2 and, as we are dealing with everything in one go, the other amendments and new clauses submitted in my name and the names of my right hon. Friends.

It seems that Members across the House are anxious that the Government’s laudable aims on parity of esteem for mental health services are given some legislative teeth. The NHS long-term plan rightly calls for more investment in mental health services to give mental health the same priority as physical health. That is the right approach and it is one that we support. However, as we can see by the amendments that have been tabled today, there is scepticism about how that will actually be delivered. Investment in mental health services has been seriously neglected in recent years and mental health patients are some of the people who have been most let down by the Government in the last decade.

No doubt we will hear from those on the Government Benches that mental health spending is increasing, and that the funding set out in the Bill will benefit mental health services, but the reality is that on this Government’s watch, we have seen a mental health crisis emerge. We are not getting the investment at the level required and services are simply unable to keep pace with demand. As a consequence, the number of people living with serious mental health problems is rising. Patients are unable to access vital psychological therapies within six weeks and often have to wait over 100 days for talking therapy treatments. Thousands of mental health patients continue to be sent hundreds of miles from home, because their local NHS does not have the beds or the staff to provide the care they need. These are often young people in desperate circumstances being sent away from their family and friends—their support network, as it were—and that to me sounds a long way away from parity of esteem. We know that adults in need of help with eating disorders are waiting more than three years for treatment, while hospital admissions for eating disorders increase year on year. The number of people living with serious mental health problems is continuing to rise and suicide levels are at their highest since 2002.

Even against this awful backdrop, however, it is children’s mental health services that are suffering most from the chronic lack of funding. Children’s mental health services account for just 8% of total mental health spending, and the Government’s continual failure to prioritise children’s mental health has led to services for children effectively being rationed. We know that on average, children and young people visit their GP three times before they get a referral for specialist assessment. They then have to wait more than six months for treatment to start. Suicidal children as young as 12 are having to wait more than two weeks for beds in mental health units to start treatment, despite the obvious risk to their lives.

Three out of four children with mental health conditions do not get the support they need. With over 130,000 referrals to specialist services turned down, despite children showing signs of eating disorders, self-harm or abuse, the problem has become so bad that some children and families are being told by their GPs to pretend that their mental health problem is worse than it is to make sure they get the help they need. Four hundred thousand children and young people with mental health conditions are not receiving any professional help at all—400,000. That is a scandalous figure. We know that mental health conditions in adults often begin in childhood, so it is not only an outrageous dereliction of duty to our young people; it will also end up costing the NHS and society far more in the long run.

[Pete Wishart (Perth and North Perthshire) (SNP)]

I do not want to detain the hon. Gentleman too long, because he is making a very good speech and very important points, but I just wonder whether he has any views about the setting of this debate in the Legislative Grand Committee, the de facto English Parliament. SNP Members are excluded from voting in this debate and excluded from tabling any amendments, yet the Bill will have a fundamental impact on the health funding of Scotland through Barnett consequentials. I am interested in his views on that process, so will he say something about them? Can we have Labour support, so that this nonsense stops and we go back to one class of MP in this House where everybody can participate equally?

[Justin Madders]

I thank the hon. Gentleman for his intervention. I understand his frustration absolutely. I think he has a very fair point, Dame Rosie, that because of the Barnett consequentials there is a role for SNP Members—indeed, all Scottish and Welsh Members—in this debate. Clearly, that is a separate issue to the whole English votes for English laws process, but the fact is clear that on the face of the Bill there are Barnett consequentials, which mean that the devolved nations ought to have a say.

It is really no wonder, given the background I have just set out, that children are reaching a crisis point before getting the support they need, and that the number of children attending accident and emergency for their mental health in a situation of crisis is increasing year on year. That is not inevitable. With real investment, we could reverse the trend of long waits, rationed treatment and inadequate care if we allocated more of the NHS budget to mental health. As we know, mental health illnesses represent 23% of the total disease burden on the NHS, but just 11% of the NHS England budget. That is a long way off the parity of esteem that we all seek to achieve.

We know that the Government plan to put in an extra £2.3 billion a year by 2023-24, but that is not enough. The Institute for Public Policy Research has said that to achieve parity of esteem for mental health services, funding for those services needs to grow by 5.5% on average not just next year, but over the next decade. The NHS plans to spend £12.2 billion on mental health funding in 2019, but the IPPR estimates that that needs to reach 16.1 billion by 2023-24 alone.

Of course, we support the increased funding for mental health in the Bill, but we know the NHS has to live within the 3.3% uplift provided under the Bill. The Institute for Fiscal Studies, the Health Foundation, NHS providers, the British Medical Association and many of the royal colleges say that health expenditure should rise across the board by 3.4% just to maintain current standards of care. By definition, there will actually be less money for funding in other areas. That means there is a risk of further raids on the mental health budget. In previous years, money allocated to mental health services, particularly children and adolescent mental health services, has been diverted back to hospitals to deal with the crisis there.

Labour would have done what was desperately needed. We would have put in an extra £1.6 billion a year immediately into mental health services, ring-fenced mental health budgets and more than doubled spending on children’s mental health. That is why we are seeking to amend the Bill to ensure mental health services do not lose out because of other financial pressures in the system. We are calling on the Government to ensure that guarantees for mental health funding are protected by ring-fencing mental health funding. We also seek to require the Secretary of State to come to the House annually to report on the amounts and proportion of funding allocated to mental health services, and on their plans to achieve parity of esteem for mental health services.

On the Labour Benches we are not convinced that mental health is a priority for this Government, despite what they say. They may want to position themselves as the party of the NHS, but as long as they continue to neglect mental health and push services deeper into crisis, they will not come near that aim. We intend to push amendment 2 to a Division, because we want to hold the Government to account. We want transparency on mental health spending and we want a clear road map from the Secretary of State on how he intends to make parity of esteem a reality.

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[Jeremy Hunt]

My hon. Friend makes an important suggestion. We considered such a thing when I was at the Department of Health and Social Care, but we decided that it would be very expensive. One of the tragedies is that many people who suffer actually make no legal claim because they are so committed to the NHS, so we have a system that gives huge amounts of money to one group of people and nothing at all to those who decide that they do not want to sue the NHS.

We need to look at tort reform, because most barristers and lawyers working in this field want the outcome of their cases to be that the NHS learns from what went wrong and does not repeat it. Unfortunately, that is not what happens with the current system. The involvement of lawyers and litigation causes a defensive culture to emerge, and we actually do the opposite. We do not learn from mistakes, and that is what we now have to grip and change.

I want to say something positive, because if we do change that we will be the first healthcare system in the world to do it properly. We are already by far the most transparent system in the world, mainly because people in this place are always asking questions about the NHS—and rightly so. Healthcare systems all over the world experience the same problem. It is difficult to talk openly about mistakes because one can make a mistake in any other walk of life and get on with one’s life, but if someone dies because of the mistake, that is an incredibly difficult thing for the individuals concerned to come to terms with. That is why we end up on this in this vicious legal circle.

On capital to revenue transfers, I was a guilty party during my time as Health Secretary. There were many capital to revenue transfers because we were running out of money, so capital budgets were raided. I fully understand why the Opposition wanted to table amendment 3, but I respectfully suggest that the trouble is that it would result not in more money going into the NHS but in more money going back to the Treasury from unspent capital amounts. The real issue of capital projects is getting through the bureaucratic processes that mean that capital budgets are actually spent.

[Pete Wishart]

I congratulate the right hon. Gentleman on securing the chairmanship of the Health and Social Care Committee, and I look forward to joining him on the Liaison Committee. He is a former Secretary of State, so he surely understands and appreciates that this Bill has a significant impact on Scotland, because it will affect our budgets through the Barnett consequentials. Does he think it is right that we are excluded from tabling or even voting on any amendments?

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[Pete Wishart]

I wonder whether, like me, my hon. Friend feels that this English Parliament is actually pretty similar to the usual Westminster Parliament that we do all our business in. Does he agree that the English votes for English laws procedure has been about the most divisive, disruptive and useless procedure ever put into this House? It makes distinctions between classes of Members of Parliament in this House, and what we are doing today is disallowing us to vote on issues that are vital to the Scottish health service. Does he agree that it is a disgrace, and that it must go?

[Patrick Grady]

Yes; I absolutely agree. My hon. Friend is right: I barely noticed the difference as this place magically transformed itself into the Legislative Grand Committee (England). Incidentally, I do not know whether he remembers, from his time here, whether the Scottish Grand Committee was ever permitted to meet in the Chamber of the House of Commons. I fear it was not, so quite why the English Grand Committee enjoys that privilege and does not have to meet elsewhere in the building or elsewhere in England is kind of beyond me. But my hon. Friend is right that those of us from seats in Scotland and Wales and Northern Ireland are, for the first time, being actively excluded from the opportunity to vote on amendments.

The right hon. Member for Alyn and Deeside (Mark Tami) may also have been a member of the Procedure Committee back in the day; I certainly seem to remember points about the cross-border hospitals being raised. He has constituents in Wales who use hospitals in England that will be affected by this legislation, and he is unable to vote on or amend those provisions.

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[Patrick Grady]

I thank my hon. Friend for that. The contributions she is making demonstrate precisely why Members from Scotland should have been allowed to participate fully in this stage of the Bill and the whole process.

If the official Opposition choose to press any of their amendments this afternoon, we will seek to express our views, on behalf of our constituents, by walking through the Lobby. We will walk past the signs that say, “England only” and if the Tellers from the Government Whips team choose not to count us, that will be their decision. Of course they will also have to discount any of their own colleagues from Scotland and Wales who deliberately or accidentally end up in the Lobby; perhaps that is also an argument for getting rid of this ridiculous voting Lobby system, but I appreciate that that is for another day.

The Government could have avoided this situation, by allowing proper time for a Report stage, where Members from Scotland and elsewhere could move amendments. They could have committed the Bill upstairs to a Public Bill Committee, but they chose to convene an English Parliament here in the Chamber of the House of Commons, which is supposed to represent the whole of the UK.

[Pete Wishart]

My hon. Friend has taken over the EVEL mantle with great aplomb. I understand that the “England only” signs are already in the Lobby, and this in the UK Parliament of Great Britain and Northern Ireland! What does that say to people from Scotland? What does it say, given that this Bill determines so much of our health spending in Scotland? Surely the days of EVEL have to come to an end. We cannot go on like this. This is the Parliament for everybody across the United Kingdom; it is not their Parliament to squat in.

[Patrick Grady]

It really does not feel like that at the moment, does it? Hear no EVEL, see no EVEL, speak no EVEL should be the mantra, because my hon. Friend is right; this might not be the last time.

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[Edward Argar]

In the 15 or so minutes remaining to me, I will endeavour to address all the points that have been raised. First, I thank Members on both sides of the House for their contributions and for the amendments that have been tabled. I particularly thank the shadow Minister for his typically reasonable tone in making his case forcefully. This Committee debate has been a wide-ranging and important one.

I will turn in detail to the amendments shortly, but, in the interests of time, I will swiftly address the requests for meetings or visits. The hon. Member for Stockton North (Alex Cunningham) was right when he said that he saw me nodding. I will be very happy to meet him, my hon. Friend the Member for Stockton South (Matt Vickers) and the chief executive of his hospital trust to discuss the issues that he raised. I will also be very happy to meet the hon. Member for Harrow West (Gareth Thomas) separately to discuss the issues that he raised.

[Pete Wishart]

rose—

[Edward Argar]

I will give way very briefly, because the hon. Gentleman is eating into his own time.

[Pete Wishart]

The Minister is in a very accommodating mood. Does he accept that this Bill has funding implications and consequences for health spending in Scotland?

[Edward Argar]

As has been very clear throughout the progression of this Bill so far, there are Barnett consequentials, which will be dealt with in the usual and appropriate manner.

I will turn to the detail of the amendments in a moment, but before I do, let me say that my hon. Friend the Member for Telford (Lucy Allan) addressed the debate in Westminster Hall just before the general election. In that, I said that if her constituents wanted a strong voice in this place, they should vote for her. I am very pleased that they did exactly that. Her speech shows exactly why.

This legislation is a simple Bill of two clauses. The substantive clause—clause 1—puts a double-lock duty on the Secretary of State and Her Majesty’s Treasury to ensure that NHS England will receive, as a minimum, £33.9 billion extra a year by 2024, enshrining in law the NHS England revenue budget rise in line with the Government’s manifesto commitment. The Bill has deliberately been drawn narrowly to focus on that core commitment.

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[The Chairman of Ways and Means (Dame Eleanor Laing)]

Under the programme order of 27 January, I must now put the Questions necessary to dispose of the proceedings in the Legislative Grand Committee (England) on the Committee stage of the Bill, and on the consideration —Report—stage and the consent motion in the Legislative Grand Committee (England). I can see some puzzled faces around the Chamber, and not only among those who have newly been elected to this place, so for the sake of Members unfamiliar with our procedures in respect of Legislative Grand Committees, I will set out what is about to happen.

I will put the Question on amendment 2, which has already been proposed from the Chair. I will then call a member of the Legislative Grand Committee (England) to move amendment 3 to clause 1. When he has done so, I will put the Question on that amendment. I will then put the single Question that clause 1—or clause 1, as amended, if it has been so amended—and clause 2 stand part of the Bill. I will then call a member of the Legislative Grand Committee (England) to move new clause 4. When he has done so, I will put the Question that the new clause be added to the Bill.

[Pete Wishart]

Can you read it again?

[The Chairman]

I could, but we might get to the stage where there are no votes at all.

When the proceedings in the Legislative Grand Committee (England) on the Committee stage of the Bill are concluded, I will resume the Speaker’s Chair for the Whip to report the Bill from Committee. As the three-hour knife has now fallen, there are no amendments for consideration on Report, as the hon. Member for Glasgow North (Patrick Grady) rightly pointed out in his point of order earlier.

The House will again resolve itself into the Legislative Grand Committee (England) to give consent to the Bill as a whole. I will call the Minister to move the consent motion formally, and I will put the Question on the consent motion forthwith. I can see that everybody understands this a lot better now. When the proceedings in the Legislative Grand Committee (England) on the consent motion are concluded, I will resume the Speaker’s Chair and call the Minister to move the Third Reading of the Bill.

I remind hon. Members that, if there is a Division in the Legislative Grand Committee, only Members representing constituencies in England may vote. All Members may vote on the Third Reading of the Bill.

[Pete Wishart]

On a point of order, Dame Eleanor. I am very sorry, but although I was listening very carefully, I did not quite catch all of that. Do you mind repeating it once again, please?

[The Chairman]

I fully appreciate that the hon. Gentleman may not have caught all of that, but I happen to know that he is one of a handful of people in this House who does actually understand this procedure. I hope that I am one of the others, and everyone else will pick it up as we go along.

The Chair put forthwith the Question already proposed from the Chair (Standing Order No. 83D), That amendment 2 be made.

The Committee having proceeded to a Division.

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[The Chairman]

It is not as if any hon. Member of this House is ever invisible or, indeed, inaudible, but merely, once again, following Standing Order No. 83W, which this House resolved to put into the Standing Orders of the House.

[Pete Wishart]

On a point of order, Dame Eleanor. [Interruption.] I hear the groans from my Conservative colleagues. I have to keep my record of speaking in the English Parliament—it is a record that I very much cherish and look forward to maintaining. These events are being televised and people throughout the United Kingdom, particularly those in Scotland, are observing our proceedings with a degree of mystification and bewilderment. What Scottish viewers will see is the baying, groaning and booing of Conservative Members about Scottish Members of Parliament asserting their rights to have their say on the funding of the national health service. Can you confirm that that is the case and that this House really needs to grow up, behave itself and come into the 21st century?

[The Chairman]

I understand the point that the hon. Gentleman makes. I would say, as Mr Speaker always says, and as every occupant of the Chair always says, that our behaviour in this Chamber should, at all times, be of a standard that makes us never ashamed to be watched by anyone on television or in any other way, regardless of the subject of our proceedings. I notice that that has engendered some slightly better behaviour—thank you.

Motion made, and Question put forthwith,

That the Legislative Grand Committee (England) consents to the NHS Funding Bill, not amended in the Legislative Grand Committee (England).— (Edward Argar.)

Under the terms of the Order of the House of 27 January, I must now put the Question necessary to bring to a conclusion the proceedings in the Legislative Grand Committee on the consent motion. The question is the consent motion. As many are of that opinion say “Aye”—[Hon. Members: “Aye!”]—of the contrary “No”—[Hon. Members: “No!”]. The Ayes have it—[Interruption.] We now come to a scientific matter. Members representing Scottish seats are well aware that they do not have the right to vote on this particular motion. They therefore do not have the right to shout “No” when I put the question. I can hear “Aye” from the Government Benches. The hon. Member for Perth and North Perthshire (Pete Wishart) knows that I am more than capable of discerning a Scottish “No” from a non-Scottish “No”—[Interruption.] Order. I am ruling that the shouting of “No” from the SNP Benches does not mean that we are going to have a Division.

Question agreed to.