Oral Answers to Questions

Rehman Chishti Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Hunt]

I simply say to the hon. Gentleman that the purpose of that policy was to allow us to train more nurses; in fact, we will be training 40,000 more nurses during this Parliament. We have more than 11,000 more nurses in our NHS wards, and at Countess of Chester hospital—the hon. Gentleman’s own hospital—there are 172 more nurses than in 2010.

[Rehman Chishti (Gillingham and Rainham) (Con)]

6. What progress he has made on improving hospitals in special measures.

[The Minister of State, Department of Health (Mr Philip Dunne)]

We want the NHS to offer the safest, highest quality care anywhere in the world, so we are now tackling unacceptable performance. That is in contrast to the Labour party, which ignored failures for so long. Since introducing the rigorous special measures inspection regime, 31 provider trusts have gone into Care Quality Commission special measures, of which 15 have been turned around as a result of significant quality improvements. I congratulate again the staff of Sherwood Forest, Wye Valley, Norfolk, and Suffolk trusts, all of which have come out of special measures in recent months.

[Rehman Chishti]

Medway Maritime Hospital has made significant improvements since it was put into special measures: mortality rates and length of patient stay are down; leadership is excellent; and there has been extensive investment in the A&E. Does the Minister agree that it is the right time for the hospital to come out of special measures? Will he join me in paying tribute to the excellent work of the hospital’s staff?

[Mr Dunne]

I congratulate my hon. Friend on his role in championing Medway Maritime Hospital, which I visited earlier this autumn. The CQC is in the process of re-inspecting Medway and will publish its findings in the new year. I congratulate the trust on its improvements thus far that were highlighted by my hon. Friend, which include reducing its average length of stay on admission wards from 11 days to only 3 days.

Mental Health Taskforce Report

Rehman Chishti Excerpts

Wednesday 13th April 2016 Westminster Hall

[James Morris (Halesowen and Rowley Regis) (Con)]

I beg to move,

That this House has considered the report from the independent mental health taskforce to the NHS in England.

It is a pleasure to serve under your chairmanship, Mr Wilson. This is a very important debate on the “Five Year Forward View for Mental Health” report, published in February. I pay tribute to the chair of the taskforce, Paul Farmer, who is the chief executive of the mental health charity Mind, and the vice-chair, Jacqui Dyer, for all their work. I also thank all the other members of the taskforce and the people throughout the country who contributed to its work. It is an excellent study that contains more than 50 concrete recommendations about how we need to go about improving mental healthcare in our country.

The report represents an historic opportunity. There are three reasons why I believe it is pivotal to the whole history of our approach to mental healthcare in Britain. First, both the public debate in Britain about mental health and our social attitudes towards it have been transformed over the past 10 years. The quality of the debate in Parliament, the media and the public square is at a completely different level from where it was for many years. We are addressing issues of stigma and are open to discussing mental health problems in society.

Secondly, there is a general recognition in the Government and across parties that for too long, mental health care has been underfunded in the national health service. There is now a mature debate about how we should fund mental health services over the next decade.

Thirdly, I strongly believe that, as a result of the work of many people from all political parties over a long period of time, mental health is now at the top of the list of public policy priorities. We now have the political will, which is manifested in the Minister himself, who is absolutely committed to delivering on the plan formulated by the independent taskforce. Those are the reasons why I believe the report represents an historic opportunity.

The report provides a route map for change so that we can give hope to those throughout the country who are currently suffering from mental health problems and who may not be getting, or feel that they are getting, the level of service that they should from the NHS. I shall concentrate on the implementation issues highlighted in the report. There have been many reports over the past 20 years, and many strategies have been determined by Governments of both main political parties. I think we would all agree that over that period we have not made sufficient or fast enough progress, given that mental health issues are becoming more visible in society and given the prevalence of the mental health issues we are seeing across the age range and across the social and economic landscape of the country. There is a real urgency that we get this right, and now.

What do we need to do to drive the change that we all want to see in the quality and availability of mental health care in Britain today? The report focuses on four areas that are critical to implementation—commissioning; the importance of research and data; the incentives, levers and payments for services in today’s NHS; and leadership in the NHS and across Government. The truth is that, to achieve our goal of transforming mental health services in Britain, we need urgent action in all four areas.

The report is clear about the challenge we currently face on commissioning. It states:

“The quality of local mental health commissioning is variable. We found a twofold difference in apparent per-capita spend by CCGs, a more than threefold difference in excess premature mortality in people with mental health problems in England and a fourfold variation in mortality across local authorities.”

The reality is that we need better and more effective commissioning at a local level.

The report discusses the model of commissioning set out by the “Future in mind” taskforce, which looked into child and adolescent mental health services and came up with recommendations for improving commissioning. Those recommendations, which are picked up in the “Five Year Forward View” report, speak to the need to improve commissioning across mental health services and across the age range.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I pay tribute to my hon. Friend for securing this debate and for all he has done for mental health in his time in Parliament. He has been an absolute champion of it. Does he share my concern, which is shared by the Royal College of Psychiatrists, that there is currently no proper accountability for local clinical commissioning groups? The Bill on accountability in commissioning that I presented to Parliament last year would have required every CCG in the country to report back to the Secretary of State every year on the resources and spend in the local area. That way we would know exactly what was going on and could ensure parity of esteem in resources and allocation.

[James Morris]

My hon. Friend makes a very important point. He is right, and I will come to the need for greater accountability later in my speech.

On commissioning, the “Five Year Forward View” report states:

“The transformation we envisage will take a number of years and without clear information about what the best care pathways look like and good data on current levels of spending, access, quality and outcomes, it will be hard to assess the impact of organisational change and ensure mental health services are not disadvantaged.”

Its very first recommendation is:

“NHS England should continue to work with Health Education England…Public Health England…Government and other key partners to resource and implement Future in Mind, building on the 2015/16 Local Transformation Plans”—

which I know are in the process of being implemented—

“and going further to drive system-wide transformation of the local offer to children and young people so that we secure measurable improvements in their mental health within the next four years.”

I dwell on those recommendations because—this speaks to my hon. Friend’s point—we need more transparency on what clinical commissioning groups are spending and where. The report is clear that there is currently simply too much variability across the country. I have long been an advocate of the importance of local, decentralised decision making. It is important that clinical commissioning groups have the freedom to commission services that they think are appropriate to their local population. The report is clear that we need a more consistent approach on mental health services that focuses on collaboration and more integrated commissioning across the spectrum.

--- Later in debate ---

[James Morris]

That is precisely what I am arguing for. Over time, we need to move to a model that does not discriminate between mental and physical health, with integrated payment reflecting the fact that there are a lot of conditions and a lot of comorbidity. Getting the payment system right in the NHS is fundamental to everything about the aspiration for parity of esteem. “Parity of esteem” is an interesting set of words, which can be interpreted to mean that we want a culture change or a system change—all of which is right—but to achieve it we need to change the payment model for how services are commissioned and purchased in the NHS.

[Rehman Chishti]

I agree with the model that my hon. Friend is proposing. From my discussions with the Royal College of Psychiatrists, which has backed a Bill on accountability, I believe that such a model would achieve a more holistic approach for patients, which can only be a good thing for outcomes.

[James Morris]

Again, my hon. Friend is absolutely right. The model contained in recommendation 47 and discussed in the report should drive the achievement of parity by moving towards an integrated tariff or pricing model. A lot of detailed work needs to be done to achieve that—I am not saying it is something that the Minister will be able to implement in the next week—but it goes, fundamentally, to the transformation argument that is at the centre of the report.

Perhaps most importantly, the report talks about the importance of, and absolute need for, strong leadership in the NHS and across Government to drive the change and to make things happen. This is not only about the NHS, but about the whole of Government; it is about putting mental health at the heart of our thinking in many different areas. We need a cross-Government approach, with a strong grip at the centre. I say that despite being someone who believes in devolution, because in mental health policy we have reached the stage of consensus, with much agreement about what needs to be done, but we need political will and a grip at the centre of Government to make things happen. The truth is that the existing system needs to be challenged. We need a culture of challenge—if we say that we are allocating money to mental health, why is it not being spent? Why is it not delivering the outcomes that we need?

As the report highlights, successful implementation is about not only co-ordinating our healthcare response but what we need to do on mental health in education, criminal justice and, as my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) said, back to work programmes in the Home Office. Everything should be working together to achieve the goal of supporting the five-year transformation plan for mental health.

The last recommendation of the report, recommendation 58, might sound somewhat technical and bureaucratic, being a little obsessed with governance, but it is fundamental. It states:

“By no later than Summer 2016, NHS England, the Department of Health and the Cabinet Office should confirm what governance arrangements will be put in place to support the delivery of this strategy.”

That process of ensuring that the recommendations are followed through, that there is a performance and accountability framework, and that change is driven from the centre strikes me as fundamental.

The implementation challenges highlighted in the report are substantial and require action on multiple fronts. As I said earlier, the Minister has shown absolute commitment to addressing many of them. Will he give us an update on what progress has been made in the four areas that I have described today, namely commissioning, data and research, new payment mechanisms in the NHS and leadership in the NHS and across Government?

Getting this right is an historic opportunity. As I said at the beginning, to some degree the stars are aligned: we have a high-quality public debate; much more openness about mental health and its discussion; a mature debate on how we fund mental health; and political commitment at the highest level of Government, with the Prime Minister having made several speeches on and commitments about mental health in the past few months. We have the opportunity to drive forward what a 21st-century mental health care system should look like and make it deliver for all the people out there who need care and support. They are relying on the opportunity being realised and on us getting it right.

Dementia and Alzheimer’s Disease

Rehman Chishti Excerpts

Tuesday 12th April 2016 Westminster Hall

[Jim Shannon]

I thank the hon. Gentleman for that contribution. In the digital debate yesterday, there was mention of the clusters for those caring for people with dementia. There are 82 across the UK mainland, including some in our area and in Scotland and Wales. Lots of things are happening, and we need to see them develop.

To be fair—I know the Minister will say this in her response—the Prime Minister made very good comments about the 2020 challenge on dementia, which contains some marvellous things that can pave the way forward. The simple things can really make a difference and change people’s lives easily.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I applaud the hon. Gentleman for securing this very important debate. He is talking about getting the simple things right. In the Medway towns, we have dementia cafés—one is located in Medway—where families and sufferers can be brought together to share their experiences and get the support they need in their local area, which is absolutely vital at that time.

[Jim Shannon]

I thank the hon. Gentleman for that point.

Oral Answers to Questions

Rehman Chishti Excerpts

Tuesday 9th February 2016 Commons Chamber

[Jane Ellison]

I reject that analysis. It is for local authorities to take decisions on local public health spending, but they are mandated by legislation to commission open-access sexual health services that meet the needs of their local population, and in fact there is a great deal of innovation around the country in how people are doing that. For example, in Leeds, they are redesigning services to enable people to access sexual health. [Interruption.] The shadow Minister laughs, but the question of how much they would have invested in the NHS goes unanswered by the Opposition—a question that was never answered at the general election. On prevention, as I have said, the public health grant is not everything. In the next financial year alone, for example, the Department will spend £320 million on vaccines. We have introduced two world firsts: the child flu programme and the meningitis B immunisation programme. Right across the piece, this Government are investing in prevention and in our NHS.

[Rehman Chishti (Gillingham and Rainham) (Con)]

2. What progress his Department has made on improving the performance of hospital trusts in special measures.

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

9. What progress his Department has made on improving the performance of hospital trusts in special measures.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Eleven out of 27 hospitals have now exited special measures, having demonstrated sustainable improvements in the quality of care. Overall, trusts put into special measures have recruited 1,389 more doctors and 4,402 more nurses, with one estimate saying this has reduced mortality rates by 450 lives a year.

[Rehman Chishti]

Following the recent Care Quality Commission report on the Medway hospital, the staff and new chief executive are working hard to turn around long, historic and deep problems. What further support can the Secretary of State and the Government offer the hospital to help turn it around and get it out of special measures? I thank the Secretary of State and his Department for the support they have given to the hospital so far.

[Mr Hunt]

I thank my hon. Friend for his enormous support for that hospital, which has been through a very difficult patch. I had a long meeting with the chief inspector of hospitals about the Medway yesterday. My hon. Friend will be pleased to know that, over the past five years, we got 106 more doctors and 26 more nurses into the trust. We now have a link with Guy’s and St Thomas’s that is beginning to bear fruit. There is a lot more to do, but we are determined to ensure that we do not sweep these problems under the carpet and that we deal with them quickly and deliver safer care for my hon. Friend’s constituents.

Southern Health NHS Foundation Trust

Rehman Chishti Excerpts

Thursday 10th December 2015 Commons Chamber

[Mr Hunt]

Sir Robert Francis’s report “Freedom To Speak Up”, which I received and presented to Parliament just before the election, looked specifically at this issue and the difficult problems people face when they speak out about a problem in their trust. Sadly, on occasions, not only are they hounded out of that trust but they find it difficult to find a job anywhere else in the NHS, because word gets round on the old boys’ network. I think, however, that if we need whistleblowing at all, we have failed. We need a culture where, when people raise concerns, they are confident they will be listened to. That is a big statement to make, but other industries have managed it, including the airline, nuclear and oil industries. I do not think any health care service in any other country has managed to get this right. Individual hospitals—Salford Royal in this country, Virginia Mason in Seattle—have fantastic learning cultures, but I want the NHS to be the first whole health economy to get that culture right.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I welcome the Secretary of State’s answer to the urgent question. I speak as a Member with a hospital in special measures that had the seventh-highest mortality rate in the country in 2005-06. Does he agree that to address this problem we need tough CQC inspections, good local leadership—Medway hospital now has an excellent chief executive—and the right support from the Government?

[Mr Hunt]

My hon. Friend is absolutely right. It seems wrong to draw any crumbs of comfort from the awful things in the draft report, but we can draw some comfort from the fact that the NHS itself is commissioning hard-hitting reports that do not pull any punches—the new CQC inspection regime does exactly that. I commend all the staff at Medway hospital who have worked so hard to raise the standard of care over the last few years. I know it has not been easy for them.

Mental Health

Rehman Chishti Excerpts

Wednesday 9th December 2015 Commons Chamber

[Norman Lamb]

I was so pleased that the hon. Gentleman made that point in his speech, and I pay tribute to him for the work he has done. The answer is not simply to have more beds; we should also be reducing the length of stay, which often is not therapeutic for the individual. Getting them into secure housing is central to their health and wellbeing.

[Rehman Chishti (Gillingham and Rainham) (Con)]

Will the right hon. Gentleman give way?

[Norman Lamb]

I am afraid that I cannot give way, as I have very limited time.

At the heart of that inequality is the stigma that still attaches to mental health. We have made real progress in combating that stigma, but we have a way to go. My message to the Government is that the inequality of access is morally wrong. We cannot begin to justify one person not getting access in the way that somebody else does in our publicly funded NHS. I am pleased that the Secretary of State has acknowledged that that is a scandal, but the Government now have to deliver that equality of access. We have to deliver by 2020 the vision that he and I set out last October.

That inequality of access is not only morally wrong, but economically stupid, as many Members have mentioned. The Centre for Mental Health reckons that neglecting mental ill health costs us about £105 billion a year, so continuing to neglect it is stupid and completely counterproductive. If we make the investment up front, we will achieve savings further down the track. I therefore welcome the £600 million that the Chancellor indicated in the spending review would be made available over this Parliament for mental health. That is real progress, but it is not enough. We have to keep arguing the case for genuine equality.

We need to do two things. First, we need to spend the money differently. Many hon. Members have made the point that we need to shift resources away from containing people, often in long-stay, secure settings, to early intervention, recovery and ensuring that there is proper crisis support in the community to stop hospital admissions, which can be so damaging to someone’s wellbeing.

Secondly, up-front investment is needed to fund a programme for comprehensive maximum waiting time standards, including for children and young people, so that there is a complete equilibrium, with equal rights of access to treatment. We published that vision last year, and I hope that the Secretary of State will deliver it. If we give up on the right of equal access, if we give up on ending that discrimination at the heart of our NHS, and if we do not end this historic injustice, we will let down countless families across the country, and that would be an utter disgrace.

[Johnny Mercer (Plymouth, Moor View) (Con)]

I thank the hon. Member for Liverpool, Wavertree (Luciana Berger) for bringing forward this debate. I truly believe that mental health is the social challenge of our generation. Suicide is now the biggest killer of young men under 50 in Britain. Today, 17 of our fellow men and women in this country will take their own lives. This year, thus far, has seen the greatest number of male suicides ever. Suicide kills more young people than any physical illness.

I am currently trying to visit every school in my constituency before the end of the academic year, and the teachers I speak with have been genuinely struck by the dramatic increase in mental health problems in our young people, even since I left school some 15 years ago. With all those statistics, there is also the classic issue of underreporting of mental health conditions, given the stigma surrounding the whole issue, so the real extent may, if anything, be worse.

I believe that how we deal with this challenge will define the future of communities such as mine in Plymouth. I genuinely believe that our approach to mental health is that important. I am determined to win that battle for those in Plymouth who do not have the strength to fight for it themselves. What do we do? It requires a genuine shift in our attitudes—that most difficult of changes to achieve—and a cultural change in how we view and consequently deal with mental ill health.

As the Secretary of State suggested, interventions in mental health can produce the most brilliant results, whether it is the inspirational staff at Marine Academy Plymouth making talking about mental health a part of the school day; South West Trains employing staff specifically to look out for people on the network who are in that 10 to 15-second trance before they throw themselves in front of an oncoming train; or the Royal Marines in Plymouth taking responsibility to talk about mental health away from the medical chain and putting it with the main chain of command in order to totally de-stigmatise talking about post-traumatic stress and other prevalent mental health conditions in young men.

In any of those examples, early intervention and talking about mental health can have dramatic effects, but even that is not enough on its own, and that is the nub of the problem. The interventions that really work are early interventions, so last weekend I started an executive mental health group in Plymouth to determine a way of producing a project similar to one running in Trieste in Italy. Now, city council chiefs, commissioning group heads, police chiefs and healthcare providers will get together every month in the local police station until we have a 24/7 mental health capability in Plymouth to match our 24/7 capability for dealing with physical healthcare.

[Rehman Chishti]

My hon. Friend is making a brilliant speech. Does he agree that local commissioning group spending should reflect commitments made at a national level on parity of esteem for mental and physical health?

[Johnny Mercer]

I completely agree, and I draw my hon. Friend’s attention to the comment made by our right hon. Friend the Member for North Somerset (Dr Fox) on how important it is to ensure that CCGs ring-fence the funding so that we get the parity of esteem that I am trying to establish in Plymouth, and which I know the Government are committed to establishing across the country. It might take five months or five years in Plymouth, but I and the others will keep going until we get there, because this problem is actually too big to fail at.

We must be the Government who turn the corner on this. If we are to be so—rightly—fixated on a healthy economy to deliver our manifesto pledges, we must be equally as committed to our less high-profile commitments to those who will not make as much noise if we fail but whose need is of equal, if not greater, importance.

[Jeff Smith (Manchester, Withington) (Lab)]

I want to make some brief remarks in support of the motion and, just as importantly, to welcome the opportunity to talk about this issue. I do so as someone who, like many Members of this House, and many millions of people across the country, has had my life affected by mental ill health. I grew up in a home where a very close family member suffered from severe depression and had a number of breakdowns. I experienced how it affected the whole family over many years, and not just individual suffering, but the effect on everyday family life of regular hospitalisation and the need for other family members to be home carers. Like most of us probably, I have a number of friends who have been affected by mental ill health, and some years ago a close friend committed suicide as a result of her depression.

I have my own personal experience of mental ill health. Like other Members of the House—I think that there are probably a number of us—I have suffered from depression. As a result of these depressive episodes, I know how it feels to be unable to function normally, or to perform even the most basic everyday tasks, because the weight of the depression is so overwhelming. I know how debilitating depression and other mental ill health can be. It is quite difficult to explain to people who have not experienced that just how debilitating it can be.

I am really heartened that mental health is increasingly being not only recognised, but acknowledged and spoken about. People increasingly accept that it is an illness that should be without stigma or taboo. The more that mental health is discussed, the clearer it becomes that it is something that affects people in huge numbers from all walks of life, all backgrounds and all ages. More and more I think my experience is not unusual.

As a councillor for many years before coming to this House in May, I noticed an increase over the years in the number of people coming to advice surgeries with serious mental health problems. Most of us will have stories about how constituents with mental health problems have been failed by the system. We need to treat those people with more sensitivity and understanding. It is the right thing to do not only for the individual, but for society and the economy.

[Rehman Chishti]

With regard to addressing constituents’ needs, the hon. Gentleman might have seen that I have a private Member’s Bill on perinatal mental healthcare. The aim is that mothers should be able to get that healthcare at that most vulnerable time within a reasonable distance from home—75 miles—because at the moment we have a postcode lottery on where they can get it.

[Jeff Smith]

That is a very important issue, and I thank the hon. Gentleman for bringing forward his private Member’s Bill.

A person recently came to my surgery who had some very difficult personal circumstances that left them unable to work due to mental health issues. They were told by an official at the jobcentre that in order to maintain their benefits they were required to take part in telephone counselling, without reference to their GP. That turned out to be an extremely detrimental experience. It brought up episodes from the past that meant that my constituent was set back in their recovery and is now even further away from the ability to regain confidence and rejoin the workforce.

Because of my personal experience, I understand how depressive illness can blight the life of an individual, but it blights our society too. It is difficult to measure the cost of mental ill health to society, but it clearly runs into several billion pounds each year. That is why cuts to mental health services, particularly preventive services, are a false economy, as the Secretary of State acknowledged in his very good words earlier. We are all seeing the effects of the cuts to social care budgets, to wider council support budgets, and to mental health trust budgets. That is a bad thing at a time when demand is growing and we can finally acknowledge the need for concerted action to tackle this issue, and that is why I am supporting this motion.

I have experienced how medication and physical treatment can make a difference—medication worked for me—but I know that psychological therapy can also make a big difference. It is illogical that the right to one of those can be enshrined in the NHS constitution but not the other. We are making progress on parity of esteem, as I think we can all acknowledge across the House. We now need to go beyond that ambition and that rhetoric and match it with action.

--- Later in debate ---

[Chloe Smith (Norwich North) (Con)]

People deserve better service. For too long some constituents have battled to get the care they need. Many do get excellent care, and I pay tribute to the staff of the Norfolk and Suffolk mental health foundation trust, who dedicate their lives to caring for thousands of patients successfully. I am pleased to see the hon. Member for Norwich South (Clive Lewis) and the right hon. Member for North Norfolk (Norman Lamb) here. I hope they will work with me and meet the trust here next week.

What we should be debating today is how to complete the job of bringing mental health into the light, into equality with physical health and into an era where the norm is of a better service, with every patient getting the treatment they need. I am currently helping constituents who have lived with seeing someone they love go down in a spiral—fast, sudden, out of control and finding it too hard to know what to do. I am concerned about continuity of care, the role of GPs and out-of-county beds. Poor provision of services is not acceptable or just: people deserve a better service.

I want to say three things: first, funding matters; secondly, equality matters; and thirdly, good management matters. On funding, I welcome the steps that the Government are taking to increase investment. The Norfolk and Suffolk mental health foundation trust has been open about the funding shortfall it can see in its books compared, for example, with the Norfolk and Norwich hospital down the road. The chief executive has called for the same system of funding for mental health compared with physical health.

Of the seven CCGs in the region, Norwich devotes the highest proportion of its budget to mental health. Although the overall budget for this year rose by just over 6%, spend on mental health increased by just over 4%.

[Rehman Chishti]

Will my hon. Friend give way?

[Chloe Smith]

I am afraid that I cannot take an intervention.

Norwich CCG notes that its

“spend on mental health has increased significantly in real terms, by almost £2m.”

It believes that

“access to mental health care is consistent across the county in line with demand.”

I welcome the announcement today of transparency measures, which will help us to understand such a statement.

On equality, we need proper parity of esteem between mental and physical health to be made a reality through funding. It is welcome that, in the planning requirements, commissioners are required to invest additionally in mental health.

Finally, good management is also needed, as the Minister for Community and Social Care recently argued in the Eastern Daily Press. By the way, I pay tribute to its campaign on mental health. My trust is in special measures and subject to an improvement plan. We must work with the trust to help it to get better. The staff have made very clear the pressures that they perceive; I also pay tribute to them. The CCG found that the trust was good at caring, but inadequately led. Monitor found that its financial management was lacking. Patients deserve better and other trusts are doing better: Norwich deserves better.

Junior Doctors’ Contracts

Rehman Chishti Excerpts

Wednesday 28th October 2015 Commons Chamber

[Heidi Alexander]

Tired doctors make mistakes. It is obvious but it is true. Nobody wants to return to the bad old days of junior doctors too exhausted to provide safe patient care. It is bad for doctors, it is bad for patients and it is bad for the NHS. So why are this Government hellbent on forcing through these unsafe changes?

The Secretary of State claims that the changes are about making it easier for hospitals to ensure that the staff needed to provide safe care at the weekends and on nights are available. Is he saying that there are not enough junior doctors on hospital wards and in A&E departments at these times currently? If so, how many more junior doctors would be present at these times as a percentage increase on current staffing levels if the new contract goes through? If the changes are about increasing the cover at weekends and nights, surely it means less cover at other times of the week unless he finds more money for more doctors.

I understand the arguments for increasing consultant cover at weekends and nights. I understand it is vital that patients who are admitted on a Sunday get to see a consultant as quickly as those admitted on a Tuesday, and I am pleased that the BMA’s consultants committee is negotiating with the Government on improving levels of consultant cover. Indeed, everyone in the NHS supports the principle of seven-day services. But this debate is about junior doctors. Junior doctors are already working evenings and weekends. So why has the Health Secretary tried to make this a row about seven-day services?

Let me quote some of the claims that the Secretary of State has made in recent weeks. In response to a question on the junior doctor contract from my hon. Friend the Member for Wirral South (Alison McGovern), he said:

“someone is 15% more likely to die if admitted on a Sunday than on a Wednesday because we do not have as many doctors in our hospitals at the weekends as we have mid-week.”

In response to a question that I asked him about junior doctors, the Secretary of State said that the overtime rates that are paid at weekends

“give hospitals a disincentive to roster as many doctors as they need at weekends, and that leads to those 11,000 excessive deaths.”

He went on to say:

“there are 11,000 excess deaths because we do not staff our hospitals properly at weekends.”—[Official Report, 13 October 2015; Vol. 600, c. 150-1.]

The authors of the research that the Secretary of State has been quoting said that it would be “rash and misleading” to claim that the deaths were all avoidable. Yet the Health Secretary has got dangerously close to doing just that. Indeed, he has gone so far down that route that some people do not think that our hospitals are properly staffed at the weekend. I know of elderly patients delaying their visit to hospital because they do not think that there will be enough doctors there. That leads to more complicated treatment, longer patient recovery time, people’s lives being put in danger and a bigger bill for the NHS to cap it all off. That is appalling. Don’t get me wrong: I am as committed as anyone to high-quality care, available 24/7, 365 days a year, but the Secretary of State needs to be careful with his words. He should look in the mirror and ask himself whether his soundbites are true to the conclusions of the study he references.

[Rehman Chishti (Gillingham and Rainham) (Con)]

Rather than quoting the Secretary of State, I quote back to the hon. Lady the words of Professor Sir Bruce Keogh, the NHS medical director, who said that if the weekend effect is addressed, it “could save lives”.

[Heidi Alexander]

I am very grateful to the hon. Gentleman. Let me quote the editor of the British Medical Journal, who wrote to the Secretary of State on 20 October, saying that he had

“publicly misrepresented an academic article published in The BMJ”.

She asks him to clarify the statements that he has made in relation to the article to show that he fully understands the issues involves. She further says:

“Misusing data to mislead the public is not the way to achieve”

the very best health service for patients and the public. The Health Secretary needs to be clear on exactly how reforming the junior doctor contract will deliver a seven-day NHS. He should set out how he plans to pay for seven-day services, and precisely which services he is talking about.

--- Later in debate ---

[Mr Hunt]

That is exactly what I would like to happen, but it can happen only if members of the BMA walk through my office door—it is open—and sit down and start negotiating, which they have refused to do since last June. Just as it is wrong to pit doctors against patients, it is also wrong for the Labour party to pit the Government against doctors. In the previous Parliament, Labour wanted to cut the NHS budget, but we protected it. In May’s election we promised £5.5 billion more for the NHS than Labour did, and in the last Parliament a Conservative-led Government delivered 9,000 more doctors to the NHS, 1 million more operations a year, and 600,000 more people were referred for urgent suspected cancer every year.

Because we are not stopping at that, and because we are passionate that the NHS should offer the highest standards of care available anywhere in the world, the Government have also been honest about the problems facing the NHS. Two hundred avoidable deaths every week is too many—it is the equivalent of a plane crash every week. Nor is it acceptable that twice a week we operate on the wrong part of someone’s body, or allow other “never events” to happen. In many of those areas the NHS is performing at or better than international norms, but that does not make such things any more acceptable. We want the NHS to be the first healthcare system in the world to adopt standards of safety that are considered normal in the airline, nuclear or oil industries.

[Rehman Chishti]

The Secretary of State said that we are open to problems being highlighted. May I thank him for what he did by putting hospitals into special measures? Medway Maritime hospital had the seventh highest mortality rate in 2005, yet nothing was done. Support is now being given to that hospital to turn it around. We are highlighting problems, but we are also introducing measures to fix those problems.

[Mr Hunt]

I thank my hon. Friend for his consistent support for his local hospital. It has had many troubles, but it is beginning to show signs of turning a corner. If we want to turn things around, we must first be honest about the problem.

I welcome the shadow Health Secretary to her place. Her predecessor tried to minimise the care problems that took place under a previous Labour Government, and he described our attempts to put them right as trying to “run down the NHS”. I hope that she does not do the same. Labour used to be the party that stood up for ordinary men and women; it cared enough about them to set up the NHS, so that no one had to worry about getting good medical care, whatever their circumstances. People need to know that they can depend on our NHS seven days a week. Instead of making mischief about a flawed doctors contract that was introduced by a Labour Government in 2000, the hon. Lady should stand with us as we sort out this problem. Be the party not of the unions but of the patients who depend on high quality care, day in, day out. Professor Bruce Keogh talked about the moral and professional case for concerted action. Surely in that context, she might reconsider this rather ill-judged attempt to make party political capital out of a very real problem.

Everyone who cares about the NHS should want the same thing. The hon. Lady should tell the BMA to get around the negotiating table, something she conspicuously failed to do. In doing so she would stand alongside the many independent voices calling on the BMA to return to the table and discuss a solution with the Government—the Royal College of Surgeons, the Royal College of Physicians, NHS providers and the Academy of Medical Royal Colleges. If she does not do that, the British people will draw their own conclusion about which party is backing the NHS with the resources it needs, which party is supporting hospitals to become safer at the weekends, and which party is standing four-square behind doctors and nurses in their ambition to deliver high quality standards of care for patients. There is only one party that can be trusted, one true party of the NHS, and that is the Conservative party.

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[Dr Whitford]

I think that how this has been handled is a total disincentive, but that could change. We could simply take the decision to move to negotiations without preconditions—without the threat of imposition. We are talking about a threat to impose changes to the terms and conditions of people who, in the past, routinely worked more than 100 hours a week, as I did. That is a ghost that haunts the NHS and it really frightens junior doctors.

[Rehman Chishti]

rose—

[Dr Whitford]

I will give way one last time, but I need to make progress; otherwise nobody else will get to speak.

[Rehman Chishti]

I have a huge amount of respect for the hon. Lady. She talks about her experience of working long hours. Does she think that what the Secretary of State has just said about introducing new limits on junior doctors’ working hours is the right way forward?

[Dr Whitford]

What the Secretary of State has not explained is how, within the same pay envelope, there will be more people at weekends, but not working extra hours—and not having fewer during the week. At the moment, we have a circle that cannot be squared. We need to see the detail of how that can be done. If the vision is to have more routine work at the weekend, that would result in a massive uplift in the number of doctors, which we simply cannot afford. We are already haemorrhaging doctors. Acute physicians describe 48% of junior places as unfilled, with the figure for obstetrics being 25%. They can go anywhere. We heard that over 1,500 of them registered for certification for overseas work just last week. We need to be careful that we are attracting them to stay. They are the brightest and best in our society; they have chosen a vocation. We need to bring them to the table, but by offering to start with a blank sheet of paper—not threatening them. As has been said, they are not radicals, but people who want to do the best for their patients.

I suggest that the Secretary of State and those working with him look at how they have spoken to both senior and junior doctors over this summer. Frankly, being new to this House, I found that to be quite shocking and quite disgraceful. We should draw a line under that and try to change the tone. We need to go forward and find a solution that is fair to junior doctors, fair to patients and safe—one that is not exploiting people and not threatening people.

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[Norman Lamb (North Norfolk) (LD)]

It is a pleasure to follow the hon. Member for South West Wiltshire (Dr Murrison), who made a thoughtful and valuable speech. As a principle, we must be willing to accept the importance of debating the reform of working arrangements if we believe that there is evidence that current arrangements are undermining the best possible patient care, and I know that junior doctors absolutely accept that view. But I have to say that I am not convinced by the Government’s arguments.

I mentioned earlier that I had talked to hospital leaders, who shared their view that junior doctors’ arrangements are not the problem. It was striking, listening to the Secretary of State, that he referred to a shortage of consultants at weekends. It was notable also that when I talked to hospital leaders, they spoke of a concern that some senior consultants in some specialties make outrageous demands for additional pay for weekend work. There is a problem there, and I would support reform of that situation, but I am not convinced by the case for reform of the sort that the Government are pursuing. The Secretary of State also rightly talked about juniors being clinically exposed at weekends. Again, the issue is a shortage of consultants at weekends, not issues relating to junior doctors.

I met some junior doctors yesterday and found them all to be very passionate and completely dedicated to the NHS. I found them to be not driven and motivated by pay. I have to say to the Secretary of State and the Under-Secretary of State for Health, the hon. Member for Ipswich (Ben Gummer), that junior doctors find it frankly insulting to be told that they have been misled by the British Medical Association. They are intelligent enough to make up their own minds, and they have done. The Secretary of State should choose very carefully the arguments that he puts to them. The Government must also recognise a basic reality—the contract will work only if it is attractive to junior doctors. If it is not, they will vote with their feet and do what the daughter of the hon. Member for Totnes (Dr Wollaston) has done and go to Australia—or Scotland or the United States—to work instead of in the NHS.

The reform and extension of plain time gives rise to real concerns about its impact on emergency medicine, on acute medicine, on intensive care and on maternity services—those areas where there is a particular need for substantial evening and weekend working.

[Rehman Chishti]

I have immense respect for the right hon. Gentleman’s work on mental health. In relation to the shortage of specialists, does he agree with the Royal College of Psychiatrists that psychiatrists should be put in that category?

[Norman Lamb]

I totally agree, and I am very grateful to the hon. Gentleman for raising that point.

Will the Minister clarify what the Secretary of State said with regard to no loss of pay for individual junior doctors because I fear that those may have been weasel words? He talked about working up to the legal maximum. Is he talking about working up to 48 hours or up to 56 hours? He has given no guarantee that those doctors who may still work 60 to 70 hours in a week will not end up losing their pay. It is very important that the Government are clear on that.

The Government seek to extract too much from a limited pot of money. We all know that £10 billion is not enough to keep the NHS going until 2020. We need to work together. I repeat the Liberal Democrat call for a non-partisan commission to ensure that we achieve a new settlement for the NHS and for care, and to engage with the public and the workforce to ensure that we get this right.

NHS: Financial Performance

Rehman Chishti Excerpts

Monday 12th October 2015 Commons Chamber

[Ben Gummer]

I point the hon. Gentleman to parts of the country such as Torbay, Greenwich and the soon-to-be-devolved Greater Manchester authority where the relationship and integration between social care and hospitals is producing exactly the kind of linked up action that he identifies for falls. If we can achieve that at local level we will have a truly integrated health and social care system that is not imposed from above but created by those who deliver care on the front line.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I welcome the Minister’s statement. A comprehensive economic evaluation conducted last year by the London School of Economics and the Centre for Mental Health calculated that the annual cost of perinatal mental illness to the NHS is £1.2 billion, and the total cost to society is £8.1 billion. The Minister will know that on Wednesday I will introduce a private Member’s Bill that is supported by the Royal College of Psychiatrists and will save lives and costs. Will the Minister ensure that that is fully considered?

[Ben Gummer]

My hon. Friend raises an important matter that has also been raised by my hon. Friend the Member for South Northamptonshire (Andrea Leadsom). Given my responsibility for maternity services, I am particularly focused on the need to do better in perinatal mental health and maternity care, and I hope to say something about that in the not-too-distant future.

Oral Answers to Questions

Rehman Chishti Excerpts

Tuesday 7th July 2015 Commons Chamber

[Ben Gummer]

I am afraid that the hon. Gentleman is not right. Progress has been made. Ten years ago, that might not have been the case, but the Care Quality Commission was strengthened under the previous Government and it is regulating refractive eye surgery. Moreover, the doctors who perform those operations are regulated by the General Medical Council, and the Royal College of Ophthalmologists is bringing forward a certification scheme because of the moves that were taken by the last Government.

[Rehman Chishti (Gillingham and Rainham) (Con)]

5. What progress the Government have made on improving safety in hospitals in special measures.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The 21 hospitals that have been put into special measures under the new inspection regime have recruited 458 more doctors and 1,012 more nurses, and all of them have made good progress, including the Medway and Burton hospitals.

[Rehman Chishti]

I thank the Secretary of State for the support that he has given Medway Maritime hospital. Will he welcome the appointment of a chief quality officer at Medway hospital? It is one of only two trusts to have done that, and it is helping to improve safety and bring Medway out of special measures. Will he join me in paying tribute to the brilliant staff at Medway hospital, who are working day and night to turn things around?

[Mr Hunt]

I do pay tribute to them, and I welcome Dr Trisha Bain to that post. Ten years ago, that hospital had one of the worst mortality rates in the country. Since then, it has recruited nearly 100 more doctors and 83 more nurses, and has teamed up with Guy’s and St Thomas’. There is a culture of transparency and honesty about failings and a rigorous focus on improvement that were not there before. I hope that the whole House will welcome that change in culture.

Drugs: Ultra-rare Diseases

Rehman Chishti Excerpts

Tuesday 16th June 2015 Westminster Hall

[Greg Mulholland]

The recommendation from NICE is strange—I will come on to that—given that, clearly, the drug is effective.

Sam and other children and adults with Morquio disease are not the only people being let down. There are other conditions. I have been working with Members and organisations on the mutation of Duchenne muscular dystrophy and tuberous sclerosis. We have come together to campaign as one to say that we need a better way of approving drugs for ultra-rare conditions. At the moment we have a system in this country where people with ultra-rare diseases are discriminated against, and that must stop.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I pay tribute to the hon. Gentleman for the work that he has done and for securing this debate. On other rare conditions, I have a very sick two-year-old in my constituency who suffers from neuroblastoma, a rare form of cancer that only 100 children suffer from each year. It is difficult to accept that my constituent has to raise money and travel to the United States to get treatment. We should ensure that children or anyone suffering from rare conditions, such as Ruby Young and those in the hon. Gentleman’s constituency, get the treatment they need at the first port of call in their own country.

[Greg Mulholland]

The hon. Gentleman is right to say there are other such conditions. I will not be able to mention them all today, but other Members may wish to do so. I will concentrate on the three conditions that I have been working on: Morquio, Duchenne and tuberous sclerosis. Some 180 people suffer from those conditions. I am sorry to say that all those people and their families have been hugely let down by the repeated failure of process by NHS England and by the thick wall of bureaucracy and utter lack of accountability.

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[Greg Mulholland]

The Batten Disease Family Association explained that to me when I met with representatives, but unfortunately that is not even in the consideration for 25 June. That is why we need an overhaul.

We have a five-year Parliament. I hope that the Minister will serve as the Life Sciences Minister for a considerable time, if not for the whole Parliament. His challenge as the Life Sciences Minister, as well as dealing with the accountability deficit that clearly exists in NHS England’s decision making, must now be to initiate a proper process for the approval of drugs for rare conditions. Of course there are cost implications, and of course drugs must be effective, but the situation is that there are effective drugs that this country is not funding, while other countries with less strong economies are finding the money in their health services to fund them.

[Rehman Chishti]

The hon. Gentleman talks about funding, but one aspect that precedes funding is awareness of such diseases. For example, the Government’s “Be Clear on Cancer” campaign does not take into account rare conditions and cancers such as neuroblastoma, from which my constituent, who is near death, is suffering. The Government must ensure that rare conditions are part of the bigger campaign, so that the people suffering from them get the help that they need as well.