Unavoidably Small Hospitals

Rishi Sunak Excerpts

Tuesday 6th September 2022 Westminster Hall

[Rishi Sunak (Richmond (Yorks) (Con)]

It is a pleasure to speak under your chairmanship, Mr Hollobone, and thank you for accommodating me at a late stage in the debate. I had not planned on speaking, but this morning I saw the Order Paper and it turned out that I had more time on my hands than I had anticipated! It is a pleasure to be here with my hon. Friend the Member for Isle of Wight (Bob Seely) to discuss this very important topic.

I am here to speak about the Friarage Hospital in Northallerton, in North Yorkshire, which is in my constituency. It is one of the smallest district general hospitals in the country, serving a rural population of over 100,000 people and covering an area of a thousand square miles, stretching from the North York Moors at one end to the central Pennines at the other, bordered by York in the south and Darlington in the north. When I was first elected in 2015 and when I was campaigning before that, I told my constituents that the hospital would be my No.1 priority.

The reason for that is simple. Of course the NHS is the country’s most prized public service but, as we have heard in all the contributions from hon. Members today, the accessibility of healthcare in rural areas specifically is an issue of acute anxiety and the pattern over several years had been in a negative direction. Indeed, as I was being elected, my local hospital had lost its consultant-led maternity unit. Shortly to follow was the loss of paediatrics. That had an enormous impact on the local community. They feared for the very future of our beloved local hospital and I committed to do everything I could to reverse the flow of services away from it to ensure a bright future for the Friarage.

As my constituency neighbour, my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), rightly pointed out, when healthcare organisations look at such things they tend to think about centralisation, because it looks very efficient on a spreadsheet wherever they might be sitting, but it does not work for our constituents. One thing I will say to the Minister is that she should send a strong message to trusts, particularly those that cover large urban centres and smaller rural hospitals in the same area, to always think about accessibility when they make their plans, which I do not believe they always do as well as they could. Secondly, I echo my hon. Friend’s recommendation about booking appointments. That is a simple, practical thing and trusts can do a good job of it when members of the public have the option to travel to smaller hospitals nearby or to others further away and to get the timing of those appointments right. That has an enormous impact on people’s ability to access the healthcare that they need.

Shortly after I was elected, I had to deal with a challenge that we have already heard about today—the downgrading of our A&E. However, that marked a turning point and I say to the Minister that what followed can serve as an example of what the future of small rural hospitals can look like. Under the leadership of Dr James Dunbar and his team, at the Friarage we pioneered an innovative new model of an urgent treatment centre that is open 24 hours a day and is consultant-led, with a clinical decisions unit. That means that it can provide a far greater range of healthcare to my constituents, including far more care for children than would typically be found. The unit is staffed superbly by nurse practitioners. It is working brilliantly and all I will say to the Department of Health and indeed to trusts where there is a similar challenge is to look at the model and see how it can be replicated around the country because, as I say, it is working brilliantly and has saved the loss of all emergency services at our hospital.

My other recommendation to the Minister and the Department is on recruitment and staffing issues, which we have heard a lot about already. It was clear during the work that I did that often the guidance from the royal colleges exacerbates some of the issues that we have heard about. My hon. Friend the Member for Thirsk and Malton said that anaesthetists are a case in point. A specialisation has occurred over decades, whereby anaesthetists used to be generalists and now we have sub-specialties. It is very difficult for small hospitals to accommodate those sub-specialties, and we need to look with the royal colleges at what safe staffing models might work to ensure the sustainability of our services.

I must commend the South Tees trust, because after repeated efforts from my hon. Friend the Member for Thirsk and Malton and me, it has focused fully on ensuring the future of the Friarage. I thank Simon Stevens for visiting the hospital in his previous capacity and understanding the challenges, and the pervious Health Secretary, my right hon. Friend the Member for West Suffolk (Matt Hancock). Since then, thanks to the philanthropy of the late Sir Robert Ogden, we have a new Macmillan cancer centre, which is providing fantastic care, a new diagnostic centre, an MRI scanner, a dialysis unit and an ophthalmology unit, all of which save my constituents a round trip of up to four hours to the much larger James Cook hospital. They are all delivering fantastic care closer to home.

I will give the Minister another example of innovation from the local team. James Dunbar came up with a new ambulatory care unit, which means that we can do emergency treatment on the same day. In the first year of its operation, it saved over 4,000 overnight stays, so it is not just a model for rural hospitals but a beacon for how the NHS can work more broadly to reduce the pressure on our bed capacity.

Most recently, I am delighted that the Government and the Minister responded to my long-running campaign to get new investment in our operating theatres. They date back to the second world war and are in urgent need of refurbishment, so I am delighted that the Government have said that they will provide £30 million of investment to refurbish all the operating theatres to the latest and greatest standards. That will have several benefits. Most importantly, it will send a very strong signal to my community about the future of the Friarage. It is very clear that the Friarage is not going anywhere and people can have confidence in its future, which helps with recruitment and retention, as we have heard. People are attracted towards working at smaller hospitals when they know that their career will be something they can bank on and that there is interesting work to do. This investment will absolutely secure that and ensure that we can attract the nurses, doctors and other staff that we need.

The Friarage also serves as a model for how we will tackle the backlogs more generally, because the hospital will be a new surgical hub with all the associated auxiliary services that are required. That means that we can now double the amount of elective surgery and do it closer to people’s homes. In the scheme of what the NHS spends, that investment will provide a very high rate of return by increasing the amount of surgical throughput. The doctors and nurses I saw just the other day—chief medical officer Dr Mike Stewart, chief surgeon Matt Clarke, and theatre nurse Sarah Baker—are all incredibly invigorated by what they can now do for our community, and that will help more broadly serve us to get the backlogs down faster, which I know is a Government priority.

I say to the Minister that it is important that small hospitals are recognised, which is something that is said very clearly in the five-year plan. It is important that the NHS continues to deliver on that. My experience locally is that that is happening, and I ask her to take on board some of my suggestions. I will close by paying tribute to the incredible doctors, nurses and staff at the Friarage, and to the Friends of the Friarage charity. I said to them when I was first elected that they would be my No. 1 priority, and they will continue to have my full support.

[Mr Philip Hollobone (in the Chair)]

We now come to the Front-Bench speeches. I call Feryal Clark for Her Majesty’s Opposition.

Mental Health Units (Use of Force) Bill

Rishi Sunak Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[Rishi Sunak (Richmond (Yorks)) (Con)]

It is a privilege to be called to contribute on this important topic. Many constituents wrote to ask me to participate in this debate, so they will be delighted that I have the opportunity to highlight some of the issues they raised. I commend the hon. Member for Croydon North (Mr Reed), not only for securing this debate and championing the Bill but for the constructive and consensual way he has gone about it.

So much has changed about our understanding of mental health. There was a time when we thought of mental health problems as something that happened to other people, away from ordinary life. Now, how many of us have a friend, a colleague or a family member who we know has suffered from mental ill health? That is because more people rightly no longer feel any shame about a mental health problem. Because society is on a journey of understanding, attitudes are changing and stigmas are breaking down.

We all recognise that good mental health is no less important than good physical health, but there is still so much more for us to do. The Bill is the next step in our national journey towards ending the injustices that those who experience mental health problems still face. It is for that reason that I congratulate the hon. Member for Croydon North, who has spent many years working with the family of the late Seni Lewis as they fought for the truth about what happened to their son. It is crucial that we learn the right lessons from what happened to Seni, which is why I am pleased to be able to discuss the important changes that the Bill will make to transparency in mental health units.

I wish to highlight three issues: first, I shall discuss how young people in particular are affected by mental ill health; secondly, I shall discuss some of the measures that the Government have already put in place to improve diagnosis and treatment; and lastly, I shall touch on just a few of the vital changes that the Bill will introduce.

I shall start with the topic of mental health and young people. I am passionate about helping young people to get the best possible start in life. Children and young adults should face no barrier to making the most of their unique talents and enjoying their lives to the full. Often in this Chamber, we think of the obstacles that young people may face in terms of social mobility, access to a good job or apprenticeship, or getting the right education. We are right, however, to highlight today that mental health merits no less of our attention. If we are to ensure that young people can make the most of the opportunities they have and deserve, mental health provision for them must be as accessible and high quality as possible.

The sad truth is that mental health issues disproportionately affect young people. Many of us in the Chamber are all too familiar with the negativity and hurtful comments that some people choose to spread via social media. I ask hon. Members to put themselves in the shoes of a young impressionable teenager or primary school student. One in 10 young people say they have been a victim of cyber-bullying. It is hard to imagine how difficult it might be for a young person when their smartphone or social media become ways for bullies to reach them.

I commend Google, with which I recently participated in a workshop in my constituency talking to primary school children about internet safety and how young people can protect themselves online from unwanted and hurtful attention. Google, I believe, is rolling out this project across the country, and I would urge hon. Members on both sides of the House to work with it when it comes to their constituencies, visits their schools and talks to young people about the importance of protecting themselves online.

[Bob Stewart (Beckenham) (Con)]

That is fascinating. Will parents be able to put some sort of inhibitor on Facebook, or just the child?

[Rishi Sunak]

My hon. Friend makes an excellent point. The workshops provide packs for teachers to give to children to take to their parents so that parents become much more engaged with their children’s online presence, which is something that I, as a parent of young children, am becoming more aware of, as I am sure many others in the House are. We all must be aware of what our children do online, just as we are careful when they cross the street or go to the park.

[Alex Chalk (Cheltenham) (Con)]

My hon. Friend is right to draw attention to the sensible measures being put in place to help potential victims, but we have to go beyond that: perpetrators of vile abuse have to understand that there will be consequences for them. The onus should not always be put on the victim: the perpetrator must expect to be punished too.

[Rishi Sunak]

My hon. Friend makes an excellent point—and one he has spoken about before. My hon. Friend the Member for North West Hampshire (Kit Malthouse) has also spoken passionately in the House about what more we need to do to protect children online and ensure they have a safe space to play and learn about the world around them.

[Oliver Dowden]

My hon. Friend rightly pays tribute to the work of our hon. Friend the Member for North West Hampshire and makes an important point, which pertains to mental health, about children needing a safe architecture in which to grow up. Just as we, as parents, give them safety and security in the physical world, so they must have safety and security in the online world, where they spend increasingly more of their time.

[Rishi Sunak]

My hon. Friend is absolutely right and puts it better than I could myself, so I will move back to the physical world, if I may.

Sadly, the evidence is that self-harm among young people is on the rise. It is right, therefore, that the Government have responded by improving mental health training in schools. Many colleagues have already mentioned the importance of appropriate training for those dealing with children—or adults—with mental health issues. This vital training will help teachers and staff at schools not just to identify but to assist at-risk children.

[Helen Whately]

My hon. Friend is talking about mental health treatment for children and young people, where we know a huge amount of work is needed to improve services and meet rising demand, but does he welcome, as I do, the fact that last year an extra 21,000 children were treated by children and young people’s mental health services? We are making progress in this area.

[Rishi Sunak]

I thank my hon. Friend for her comment, and I know that she is a tireless advocate for healthcare services, especially mental health services, in this place. I did not know that particular statistic, but it is indeed very welcome and will be welcomed, I am sure, by hon. Members on both sides of the House.

Furthermore, it should be our aim that children are not sent out of area to be treated for general mental health conditions. Representing a large and sparsely populated rural constituency, I am particularly focused on this issue of accessibility. Right now, the local mental health trust is looking to shift in-patient services away from our excellent local hospital, the Friarage, in Northallerton, to places as far afield as Darlington, Middlesbrough and Bishop Auckland, which will mean more than an hour and a half’s drive for some patients. This is of considerable concern to me and no doubt an issue that other colleagues will have experienced themselves. Against that background, we owe it to young people to ensure that mental health services are safe and transparent, so that when young people seek help, as Seni and his family did, they will receive it, secure in the knowledge that they will receive the high standard of care we all expect.

Secondly, I turn to the action that the Government are already taking on this important topic. Legislating for parity of esteem was a landmark step in the journey to tackling the injustices faced by people suffering from mental health problems. As we all know, however, making this parity of esteem a reality in everyday life will require not just effort but determination. We cannot, however, be in any doubt about the Government’s efforts, led by a Prime Minister passionate about this issue and determined to do more than ever before to bring about real change and to tackle what has aptly been described as a burning injustice.

The Prime Minister has overseen a £1 billion increase in the funding available for mental health and, as my hon. Friend the Member for Torbay (Kevin Foster) mentioned, championed a reduction in the number of people suffering a mental health crisis who end up in a police cell rather than a place of safety in the healthcare system. The whole House eagerly anticipates the conclusion of the review led by Professor Sir Simon Wessely, who is looking at why detention rates under the Mental Health Act are increasing.

[Afzal Khan (Manchester, Gorton) (Lab)]

I congratulate my hon. Friend the Member for Croydon North (Mr Reed) on bringing the Bill, which I support, to the House. I wish to make two points. First, constituents of mine, including professionals working in this field, have pointed out to me that racism causes people from black and minority ethnic backgrounds to experience mental health issues. We have heard statistics today showing that BME groups—especially black Caribbean people, who are also over-represented in hospitals and as detained patients—are more likely to be admitted to hospital. Secondly, unconscious bias among clinical professionals affects how mental health services respond to and meet the needs of people from different racial and religious backgrounds. Does the hon. Gentleman agree that it is right that the Bill will increase data and transparency on this issue?

[Rishi Sunak]

The hon. Gentleman’s intervention was timely, for I was just about to say that we should examine the important, complex and sensitive issue of whether minorities are disproportionately suffering poor mental health treatment or outcomes. We should be careful, however, about reaching for the knee-jerk—and potentially mistaken—conclusion and labelling the problem as one of institutional racism.

In that regard, I hope that Sir Simon Wessely takes note of the arguments made forcefully by Munira Mirza, the former Deputy Mayor of London, who has cited Professor Swaran Singh, a social and community psychiatrist with, I think, 30 years of clinical experience in this area, who has argued that institutional racism in his profession is not the primary cause of BME communities’ being disproportionately affected by these issues. He cites academic studies showing that BME communities and migrant groups are more exposed to mental health risk factors. We should tackle those underlying risk factors as a matter of priority. They include things such as family breakdown, substance abuse, poverty, living in areas with low social cohesion and, of course, the personal experience of migration and prior instances of racial prejudice. It is a sensitive area. The headline numbers obviously pose difficult questions for our public services, but we should get to grips with the underlying data before reaching for conclusions that may well be incorrect and that may not pay tribute to the work that people are doing with the best of intentions.

We must be more ambitious and use every opportunity available to further our efforts. Programmes such as mental awareness courses in the National Citizen Service or the £150 million that the Government are investing to support teenagers with eating disorders are practical, and will ensure that discussing mental health is not something that we do only in isolation or that happens only in a clinical setting.

[Helen Whately]

Does my hon. Friend agree that the recent announcement that 1 million people will be trained in mental health first aid is a huge step forward in raising the skills and awareness of those who help people with mental health issues?

[Rishi Sunak]

As ever, my hon. Friend makes an excellent point and displays her knowledge of this area. It is absolutely right that we bring help to people wherever they need it and in as many settings as possible. I very much welcome the extraordinary increase in the number of people being trained.

Indeed mental health provision needs to be part of an ongoing conversation about the development of young people and the issues that they face. I am confident that we as a society are now heading in the right direction. However, as I have noted, despite that substantial progress, we can in no way believe that the job is done. That is why I will now turn briefly to a few provisions in the Bill and say why they will make a real difference to the transparency in treatment of young people across the country.

The Bill will establish the requirement that mental health units must publish how and when they use force. That appears to be an eminently sensible change. All of us will be familiar with the detailed reports from Ofsted and the Care Quality Commission. The information that they publish gives us a window into how our public services are being run. Making information available about the strengths and weaknesses of organisations gives us the transparency that is needed to know what improvements need to be made. I see no reason why this should be any different with data on the use of force. This transparency is needed not just by the general public, but by the families of patients against whom force has been used. Of course, sometimes, health professionals will make the difficult judgment to use proportionate force in certain circumstances, but it took seven years for the Lewis family to get the full truth about the event that led to their son’s death. No family should be put in that position ever again.

The Bill also establishes a duty on the service provider of a mental health unit to record any instance of the use of force on a patient, in addition to recording several demographic characteristics. Added together with the requirement for police officers attending units to wear a body camera, the Bill will help us to be much clearer about how force has been used, against whom and why.

I wish to highlight the provision which says that, in the event of the death of a patient who was subject to the use of force, the Government will appoint an independent investigator who will produce a report on the incident in a timely fashion. Families who undergo such a tragic loss will have the official help that they need to get to the truth about what happened to their loved one. Those are essential changes that I hope will ensure that, in future, no family will have to fight as hard as the Lewis family did to get the truth that they deserve.

In conclusion, as many as one in four of us will experience mental ill health at some point in our lives. This is an issue that is simply too profound for us not to ask ourselves as legislators in this place, “What more can we do to prevent injustice occurring? What barriers must the House help to break down?” That is why, once again, I commend the hon. Member for Croydon North for his long-standing efforts on behalf of both the Lewis family and, more broadly, the many people across the country who suffer from mental health problems. The provisions in this Bill will give families and the public the transparency that is needed to ensure that force is used only when necessary. It is part of the journey that we are on as a nation to ensure that people with mental ill health are viewed no differently to those with physical ill health. I commend the Government for backing this vital piece of legislation, and I have been delighted to speak in favour of it today.

Oral Answers to Questions

Rishi Sunak Excerpts

Tuesday 4th July 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I would be happy to agree to such a meeting, and I know this issue has support on both sides of the House.

[Rishi Sunak (Richmond (Yorks)) (Con)]

T8. Last week I met doctors and nurses at the Friarage, an excellent small hospital serving a rural population spread over 1,000 square miles. Will my right hon. Friend urge South Tees Hospitals NHS Foundation Trust to do everything it can to ensure the continued provision of emergency care clinicians and anaesthetists at this vital local hospital?

[Mr Dunne]

I am aware that my hon. Friend has taken a strong interest in the number of consultants and anaesthetists available at the Friarage hospital. I will be happy to meet him to discuss his concerns in person.

Oral Answers to Questions

Rishi Sunak Excerpts

Tuesday 7th July 2015 Commons Chamber

[Jane Ellison]

I thank the hon. Gentleman for his interest in this important subject. As he knows, we are looking at care right across the diabetes pathway, with a view to building on the first ever at-scale national diabetes prevention programme. I will take up the issue he raises and look at it in the context of all the other aspects of diabetes care we are examining.

[Rishi Sunak (Richmond (Yorks)) (Con)]

Last week, Reeth medical centre in my constituency received an “outstanding” Care Quality Commission rating. Will my right hon. Friend join me in congratulating it and recognise that small practices in rural areas are still an important part of our healthcare system?

[Alistair Burt]

I am always ready and very willing to congratulate rural practices and general practices anywhere on the work done by our family doctors and those in primary care. It is so important and it is nice that they get a big boost and a thank you every now and again, which they do not get nearly often enough. My dad would be really pleased, thank you.