End of Life Care

Robin Walker Excerpts

Wednesday 2nd March 2016 Commons Chamber

[Maria Caulfield (Lewes) (Con)]

I thank my hon. Friend the Member for Totnes (Dr Wollaston) for her excellent work in leading the Health Committee. I will not repeat points that a number of Members have raised, but there is a consensus that the issue of end-of -life care is growing in prominence and importance. The debate on assisted dying last September drove that discussion, and since then a number of Adjournment debates have focused on why end-of-life care is so important.

We know that 480,000 deaths a year occur in England and according to Macmillan Cancer Support, only 53% of people die in a place of their choice. We know that there are gaps in provision—not just in access and quality, but also according to disease type. As a cancer nurse, I was fortunate to have access to excellent palliative care, not just locally but for patients nationally. However, for those suffering from many other diseases, such as multiple sclerosis, Parkinson’s or Alzheimer’s, there is little or no access to good end-of-life care. As a result, there have been a number of reviews. We heard about the “Choice” review, which identified gaps and gave some solutions for meeting them, and last year the Health Committee delivered its report on how end-of -life care could be improved. The report by the Parliamentary Health Service Ombudsman, “Dying without dignity”, identified the same gaps. We know what the problems are, and now we need to deliver the solutions.

As this is an estimates debate, I will flag up the figures in those reports. We must invest £400 million annually in NHS community services to move end-of-life care out of hospitals—where most people do not want to die—and into the community, and we need roughly £100 million each year for local social services to provide the social care to back that up. That would deliver a saving of £370 million for the NHS and the acute services that are now picking those people up, but from my experience I think the savings will actually be much higher.

In the short time I have been an MP, many constituents have written to me, including an elderly gentleman of 92, who, a couple of weeks before the last Christmas that he would spend with his family, was stuck in hospital—not because of symptom or pain control, but for the lack of a feeding pump. He had a feeding pump in hospital, but because he wanted to go home to die and the community did not have one, he had to stay in hospital. That cost thousands of pounds a day, but more importantly it took precious time away from him and his family, just for the lack of a feeding pump. Such things cost a few pounds—I would have given the money myself if that is what it would have taken.

We know that £500 million would deliver district nurses to provide care, pharmacists, social services, and not just the seven-day-a-week NHS that we are proud we want to achieve, but the 24-hour care that most of those patients need. That would improve care and choice for those patients, and once that initial investment had been made, just £130 million a year would help to sustain it for health and social care. It would be money well spent if we could find it.

I bring good news for the Minister: we do not just need money. I make a plea for him to consider the Access to Palliative Care Bill that is currently finishing its passage through the other place, sponsored by Baroness Finlay. It shows that such an approach has a proven track record of delivering end-of-life care without needing a huge amount of investment, because it forces local CCGs to commission palliative care. That is what we are missing at the moment. Placing such care in the hands of CCGs makes them locally accountable, because what will deliver good palliative care in a London borough is very different from what will work in a rural constituency such as mine. It is important that CCGs take on that responsibility. I know from working in acute cancer care that unless something is commissioned and paid for, it does not happen.

[Mr Robin Walker (Worcester) (Con)]

My hon. Friend is making some excellent points. Does she recognise that there is a particular challenge when commissioners can seem almost to get something for nothing, with local hospices taking on more and more responsibility? It is important that local commissioners—wherever they are in the country—recognise that the services they rely on from hospices need to be paid for. As those services have increased in recent years, commissioners need to think about allocating more of their budget to them, which could then make savings for the other services that they commission.

[Maria Caulfield]

Absolutely. Those commissioning services realise their value. Hospices have taken up a lot of care. We all value our hospices, but that work is not necessarily valued financially. From working in cancer care, I know that my trust was commissioned to deliver day services, chemotherapy and radiotherapy. It was paid on a case-by-case basis. As soon as someone had finished their treatment and needed end-of-life care, however, everyone washed their hands of the responsibility because no one was getting paid for it. That is the reality of the situation. We need commissioning for end-of-life care to happen.

The Access to Palliative Care Bill, which has just gone through the other place, establishes four clear guidelines that would greatly improve end-of-life care without the money needed to back it up. First, on pain and symptom control, we should have an evidence base of what works for each disease and make sure that that is what happens. Secondly, there should be education and training for all staff and not just for those in end-of -life care. There is a huge amount of palliative and symptom control that staff, whatever their speciality—intensive care units, cardiac units, renal units and so on—can provide without needing specialist knowledge. All staff need to know is the point at which they need specialist advice. Simple education and training would enable that to happen and improve greatly the care that patients receive.

Research is the third guideline set out by Baroness Finlay in the Bill. Never underestimate the difference that research can make to end-of-life care. When I was a new nurse in the early ’90s, patients with hypercalcemia were admitted all the time. Hypercalcemia is when there is too much calcium in the bloodstream. Patients are confused and dehydrated, and they spend their last few days and weeks unable to communicate with their relatives. However, with research and the advent of bisphosphonates, it is very, very rare to see a case of hypercalcemia. Research into end-of-life care made that difference. Finally, as my hon. Friend the Member for Totnes pointed out, having the CQC inspect end-of-life care would make a huge difference, not just in the acute setting but across the board.

Other Members want to speak on this important subject, so I will just say that if the £500 million needed to implement the “Choice” review is not available, that should not stop us from improving end-of-life care. Many of the aspects of the Access to Palliative Care Bill would make a huge difference to patients and their families. I urge the Minister to consider them in his closing remarks.

William Mead: 111 Helpline

Robin Walker Excerpts

Tuesday 26th January 2016 Commons Chamber

[Mr Hunt]

I gently say to the right hon. Gentleman that when 111 was set up it had the support of the Opposition. The shadow Health Secretary at the time looked at the risk register. The number of calls has increased dramatically partly because demand for NHS services has increased dramatically. That does not mean to say that there are not important things that need to be improved. We need to look honestly at what went wrong. The 111 service was one of the four areas where we should have done better. I am happy to look carefully at what is happening with 111 in the south-west. One improvement is that, in many areas, we are integrating the commissioning of 111 with the Ambulance Service, and that is something that happens in the south-west. On the whole, that has been a positive experience, but I know that there have been problems in the south-west, and I am happy to look further at them.

[Mr Robin Walker (Worcester) (Con)]

May I associate myself with those who have paid tribute and expressed condolences to the Mead family? Given the seriousness of this case, which we learned about today, what more can the Secretary of State do to reassure us about the clinical input and expert oversight of the NHS 111 service and its methods?

[Mr Hunt]

All 111 services have clinicians present at call centres, so it is about not the availability of clinicians, but the speed with which they are involved in cases where they can make a difference. It is also about the training of those clinicians so that they can recognise horrible infections such as sepsis quickly. It is a combination of things. The important thing here is that if we are to give the public confidence in a simpler system where they have a single point of contact—albeit a phone line or a website—they need to be confident that if they are not immediately speaking to someone who is clinically trained they will be put through to such a person if it is necessary. We have not earned that confidence yet, which is why it is so important that we learn lessons from what happened in this tragic case.

Oral Answers to Questions

Robin Walker Excerpts

Tuesday 5th January 2016 Commons Chamber

[Mr Jeremy Hunt]

We absolutely will work with the medical profession to have proper seven-day services throughout the NHS in England. I hope that the hon. Gentleman and Scotland, which has the same issues with weekend mortality rates, will follow the lead of NHS England.

[Mr Robin Walker (Worcester) (Con)]

May I thank the Minister for his helpful answer to my hon. Friend the Member for Wyre Forest (Mark Garnier)? Further to that question, having recently met the clinical leadership at Worcester Royal hospital, they are adamant that they want permanent management in place at the hospital. The Care Quality Commission report said that the number of interim directors was one reason why it was put into special measures. Can the Minister reassure me that he will be doing everything he can to put in place permanent long-term management at the Worcestershire Acute Hospitals NHS Trust as quickly as possible?

[Ben Gummer]

I can assure my hon. Friend of precisely that.

Mental Health

Robin Walker Excerpts

Wednesday 9th December 2015 Commons Chamber

[Luciana Berger]

My concern partly rests on the fact that, given the cuts we saw during the past five years, we are only returning to the levels of spending on mental health that we had back in 2010. I have asked a number of questions about how the £600 million might be presented, but I am waiting for the answers to see how the Government will allocate that money. I will come on to the pledges that the Government have made and what is actually happening in reality.

[Mr Robin Walker (Worcester) (Con)]

rose—

[Luciana Berger]

I will make a little progress, because I have my speech to get through and I am conscious that many Members on both sides of the House want to contribute to this debate.

We are calling for three things that we believe will make a difference. First and foremost—several interventions have referred to this—we are asking the Government to restore transparency to address the murky picture of mental health funding. Secondly, we are asking Ministers to address the fundamental inequality that currently exists in our NHS constitution. Finally, we are asking the Government to prioritise prevention and to implement a fully cross-departmental plan to prevent mental health problems from developing in the first place.

--- Later in debate ---

[Mr Robin Walker (Worcester) (Con)]

It is a pleasure to follow the right hon. Member for Exeter (Mr Bradshaw). Like him, I want to talk about concerns raised by my constituents. However, I also welcome the £2 billion of extra funding that the Government have put into mental health, and the fact that we have put parity of esteem into law. My right hon. Friend the Member for North Somerset (Dr Fox) made a powerful case for the need to invest in in-patient capacity. In Worcestershire, I welcome the improvements made in the Holt ward in Newtown hospital, but there is clearly a need for more investment of that kind. It is also essential that we take on the remaining stigma around mental health, and I echo the words of support for brave colleagues who have spoken out on this issue.

Members of the Worcestershire Youth Cabinet have, over the last year, set themselves the challenge of raising awareness of mental health issues, combating stigma and providing better signposting and co-ordination for young people with mental health problems, and I commend their collective effort in this regard. In particular, I commend the passion with which my young constituent, Darian Murray, has spoken out on this issue, and the leadership he has shown in bringing together different groups from around the county.

[Maggie Throup (Erewash) (Con)]

Does my hon. Friend agree that young people are probably more able than older generations to talk about mental health issues?

[Mr Walker]

I agree with my hon. Friend. The way in which young people have spoken out about these issues is very impressive. As in many other areas, perhaps they are showing us the way in relation to taking on that stigma.

In that vein, I also welcome the excellent work done for people with learning difficulties by members of the Worcestershire People’s Parliament. In the hustings they organised during the general election, and in their subsequent campaigns on mental health, they have attracted cross-party support in Worcestershire. Attitudes towards mental illness have changed for the better in recent years, and I hope we will see further progress in the years to come.

I welcome the fact that the Under-Secretary of State for Disabled People, my hon. Friend the Member for North Swindon (Justin Tomlinson), has held a reverse jobs fair in his constituency to help people with disabilities of all kinds, but particularly with mental health issues, to find work. I am planning to copy his idea in the new year, and to work with local charities and businesses to promote opportunities for people with mental health and learning difficulties.

I have some concerns about a recent consultation carried out by the Worcestershire Health and Care NHS Trust on vocational centres for mental health. In Worcestershire, we have three such centres providing therapeutic support, re-enablement and support to people who might otherwise have difficulty getting back into work. One of the centres is in my constituency at the Shrub Hill workshop. Another is in the constituency of my hon. Friend the Member for West Worcestershire (Harriett Baldwin) at Link Nurseries. The third is in the constituency of my hon. Friend the Member for Redditch (Karen Lumley) at Orchard Place. Earlier this year, the trust launched a consultation on the future of those services, saying that the commissioners were reducing their budget by a third and implying that they were considering moving from three centres to two.

Many of my constituents contacted me to express their strong support for Link Nurseries and the Shrub Hill workshop, and a number of people gave examples of how the services had helped them to turn their life around. I have no doubt that my hon. Friends in neighbouring constituencies will have heard similar stories from their constituents. It became apparent that it was not necessarily the best use of resource for the trust to run the centres itself, and that there were many charities doing excellent work in that space that it could commission to do that. My hon. Friend the Member for West Worcestershire has been working with staff and supporters of the very popular service at Link Nurseries to see whether the service could be taken over as a social enterprise by staff, who could continue to deliver the service that has been offered with such success.

That is an approach I would support, and I have written to the trust and spoken to local commissioners to encourage them to explore it. I was pleased to see in an update from the trust today that the matter is under active consideration. It is, however, a matter of great concern that although the initial consultation suggested a move from three centres to two and a greater focus on outreach, the trust’s latest thinking appears to involve closing all three of the centres and replacing them with a single one as part of a hub-and-spoke model. It is small comfort that the proposed single hub would be in my constituency. We all recognise the benefit of having more outreach, but I have to question the whole approach of a consultation that appears to be cutting back on an important service, valued by service users, at a time when demand is apparent and the overall budgets of health commissioners are being increased. I urge the Minister to look into this matter and see whether he can do anything to encourage the commissioners to have another look.

Another aspect of mental health provision in Worcestershire that causes me concern is support for A&E. We piloted 24-hour mental health liaison for the A&E at the Worcestershire Royal hospital, and the acute trust and the health and care trust found it incredibly helpful. At the end of that pilot, both trusts asked for that support to continue. I note that the crisis care concordat calls for people to be given access to support 24 hours a day before crisis point, and to be given urgent and emergency access to mental health care. As the Secretary of State said, it is welcome that, since the concordat, the number of people going through mental health crises who are held in police cells has halved nationally. However, I am afraid that in south Worcestershire, the commissioners decided early in 2014 that the 24-hour cover was to be withdrawn, and replaced with a specialist nurse during the daytime and access to telephone support overnight. The Minister has given a helpful reply to written question on this matter.

[Helen Whately]

My hon. Friend mentions psychiatric liaison in A&E. Does he agree that it is incredibly important for hospitals to have a comprehensive psychiatric liaison service, so that when people go to A&E, there is a specialist capable of giving them the right help?

[Mr Walker]

I wholeheartedly agree with my hon. Friend. The provision of specialist care in those situations is vital.

The Minister replied to my written question in July, saying that the Government’s mandate to NHS England states that access to crisis services for an individual must be

“at all times as accessible, responsive and high quality as other health emergency services.”

Does this mean that he has the power to mandate that mental health support to A&E services be provided by practitioners, rather than merely through phone support? I urge Ministers to consider the case for all emergency departments, especially those as busy as the one at the Worcester Royal hospital, having 24-hour access to mental health experts.

I draw the Minister’s attention to the case of a constituent who, as a result of the absence of this support early in 2014, went through an acute episode, having left A&E without receiving the help she needed. This involved the calling of multiple police cars and ambulances. That use of the emergency services incurred far greater cost than simply having the support in place would have done. Any savings made from the failure to commission overnight cover would, in my view, be a case of being penny wise and pound foolish. As the Secretary of State said, not investing in mental health can sometimes be a false economy.

Overall, however, I welcome the progress made. I welcome the additional investment, including in my constituency. I hope that the Minister can respond to my concerns.

Male Suicide and International Men’s Day

Robin Walker Excerpts

Thursday 19th November 2015 Westminster Hall

[Philip Davies]

I am sorry that the hon. Lady feels like that. Again, it is part of the politically correct culture that we have in this place that the moment anybody raises anything that affects men, people are accused of being misogynists. That is part of the problem; the hon. Lady is part of the reason why these issues never get debated. It is raised to try to deter anybody from ever raising their head above the parapet. Many people in her constituency are affected by these issues. Perhaps she ought to go and consult some of her constituents about the problems they face in these areas. She might learn that it is right to raise these issues in Parliament. It is not misogynistic to raise the issues faced by some fathers in her constituency who are having trouble getting custody of or access to their children. If she does not think that that is a problem, she needs to get out more, frankly.

[Mr Robin Walker (Worcester) (Con)]

Will my hon. Friend give way?

[Philip Davies]

I will.

[Mike Gapes (in the Chair)]

Order. I say to hon. Members: please can we conduct this debate in a civil manner, without it degenerating into an argument of that kind? I ask all Members, please, can we get back to the subject of the debate?

Mr Walker wanted to intervene.

[Mr Robin Walker]

I did; thank you, Mr Gapes. My hon. Friend has never been afraid to put his head above the parapet. We may not all agree with every point that he makes, but he is raising important issues about family breakdown and suicide. Does he agree that reforms to create equal parental leave are important in fostering men’s role in the family? It is vital that the Government continue to pursue such initiatives as the family test to ensure that we take every opportunity to avoid the causes of family breakdown, which is a great problem for men as well as women.

[Philip Davies]

I agree with my hon. Friend that we need to do more to make sure that we have genuine equality, and not the “equality when it suits” agenda. We need to do as much as we can to help families stay together, wherever possible.

I will move on to talk about violence. In this House, we always seem to be hearing about strategies for combating violence against women and girls—in fact, there have been debates in the House on that very subject—so people might be forgiven for thinking that there is a special problem of violence against women and girls, and that it does not apply to men and boys. Some might think that far more women and girls than men and boys must be victims of violence, but the reality does not always match people’s concerns. It is a fact that in this country, men are much more likely than women to be victims of violent crime. The most recent biennial statistics from the Ministry of Justice on the representation of females and males in the criminal justice system confirmed that 1.4% of women interviewed in the crime survey reported being a victim of a violent crime, compared with 2.3% of men.

It is not just when it comes to violence generally that men do worse than women. Women accounted for around 30% of recorded homicide victims between 2006-07 and 2012-13, while men were the victims in the remaining 70% of cases. The picture emerging is that men and boys are far more likely than women and girls to be victims of violence and murder, but there is little or no mention of men and boys in our debates and strategies relating to females. I asked the Secretary of State for Education in Parliament last November

“what her policy is on educating children about violence against men and boys.”

I also asked

“what her policy is on educating boys about domestic violence against men and boys.”

The reply from the Minister for Schools was:

“Education has an important role to play in encouraging young people to build healthy relationships, and to identify those relationships which are unhealthy. Pupils may be taught about violence against men and boys in personal, social, health and economic (PSHE) education.”

I will just leave that there for people to reflect on.

There has been a lot of talk about the female victims of domestic violence. Figures from the Office for National Statistics show that 8.5% of women were victims of domestic violence in 2013-14, but so were 4.5% of men. That is equivalent to 1.4 million female victims and about 700,000 male victims of domestic violence. That figure refers not to partner abuse, but to all abuse in a domestic setting, including among families. When we look at the figures for partner abuse, we see that 5.9% of women and 2.9% of men report being victims. It is quite clear that around one in three victims is a man.

--- Later in debate ---

[Mr Robin Walker]

One issue that we have not touched on much in the debate is homelessness. Men are more likely to be homeless and sleep rough: I think that 87% of rough sleepers are men. A constituent of mine, Hugo Sugg, has talked about how sleeping rough drove him to thoughts of suicide. He now wants to campaign for a better attitude towards youth homelessness and how we encourage people to look at those who are suffering from homelessness, to give them a chance to turn their lives around, working with some of the fantastic charities in this space. Will the Minister join me in paying tribute to the charities and organisations that campaign on homelessness for the job they do in saving men from suicide?

[Alistair Burt]

My hon. Friend is absolutely right. Those connected with housing increasingly recognise the relationship between housing, mental health issues and suicide. When I was with my hon. Friend the Member for Derby North, I met the lady responsible for the YMCA there and its housing outreach, and she made some pertinent comments. Housing and homelessness are closely connected with the problem we are discussing, and I commend the constituent that my hon. Friend the Member for Worcester mentioned.

We know that men are often reluctant to talk about mental health problems. Many colleagues have referred to men’s attitudes, so I do not think that I need to labour that point. They are reluctant to seek help when they need it. In part, we know that is because some men feel that it may be a form of weakness. We need to assure men that that is not the case, as many colleagues have said. We, along with the charities Mind and Rethink Mental Illness, are seeking to reduce the stigma around mental illness through the Time to Change campaign.

Time to Change aims to empower people to challenge stigma and speak openly about their own mental health experiences—particularly men—and to change public attitudes towards those with mental health problems. The campaign has improved the attitudes of more than 2 million people. However, we know that men can be a particularly hard-to-reach group, and we are looking at further ways to improve reach in that area.

We know, tragically, what the outcome of unacknowledged mental ill health can be for a person. When someone bottles it up—that phrase was used in this Chamber today—their condition can worsen and may, in the worst cases, increase the risk of suicide. As I mentioned earlier, suicide rates in England remain low compared with in other European countries and other UK administrations, but I am concerned, as we all are, to see that rates have been rising in recent years. We anticipated that after the global financial crisis in 2008, and it has been seen in other countries around the world, as the hon. Member for York Central said. We know about that, but it is important that the inevitability of that does not go unchallenged. We can appreciate that such times bring extra pressures, but we need to ask what we can do when we know they are coming.

We know that the recent rise in suicide rates has been driven by an increase in male suicides, which is what led my hon. Friend the Member for Shipley to call for the debate in the first place. The threefold difference between male and female suicide rates has increased further, and we know that is a common experience in other countries around the world. It is right, therefore, that preventing suicide is dominated by efforts to prevent male suicide, but we recognise that this issue affects everyone. Whether men or women, boys or girls, when it happens it is an immense tragedy.

The greater risk of suicide among men is a complex issue. Many of the clinical and social risk factors for suicide are more common in men. Cultural expectations that men will be decisive and strong can make them more vulnerable to psychological factors associated with suicide, such as impulsiveness and humiliation. It is critical that, in addressing those issues, we provide information and support in a way that suits men’s needs and behaviours, and that we provide services that are appropriate for men, which may include moving away from traditional health settings.

What are we doing about it, and what will we do about it? We published the cross-Government suicide prevention strategy for England in 2012, and I am committed to implementing it by working across Government and with our partner organisations in the NHS and other sectors such as transport and the community, voluntary and charitable sectors. I will also be speaking to our partner organisations soon to discuss how we can review and strengthen the national suicide strategy. I want to make it clear that I see that as a dynamic and flexible instrument, not as something that we will do and then I will see how it works and make some decisions in years to come. We are looking at it now. It needs to be reviewed and refreshed now. It is an ongoing process, and I am committed to it.

The objectives of the strategy are to reduce suicide and to support the people bereaved or affected by it. It is right that men are identified in the strategy as a high-risk group for whom our suicide prevention activities should be and are prioritised. The strategy also recognises that schools, social care and the youth justice system have an important contribution to make in suicide prevention by promoting mental wellbeing and identifying underlying issues such as bullying, poor self-image and lack of self-esteem.

As well as having the strategy, we continue to provide financial support for the National Suicide Prevention Alliance, which brings together our key partners across Government and the community, voluntary and charitable sectors with expertise in suicide prevention. I am particularly pleased to say that many of the organisations that campaigned for the debate are members of the NSPA. It has been working with all those organisations to develop its strategy for delivering improvements in suicide prevention, which I welcome. My Department of Health officials are helping with that work. Those organisations make tremendous individual contributions to suicide prevention. The Campaign Against Living Miserably, which was prominent in calling for this debate, works tirelessly to target men specifically, and to support them, so that they feel able to talk about mental health issues. The Department of Health provided financial support to CALM in its early days, and I am proud to see how it has grown in size and profile.

I have had a variety of meetings on the issue since I took office; I have mentioned some already. I went to see the Samaritans bereavement centre in Peckham for World Suicide Prevention Day, and to mark the launch of a new initiative between Cruse Bereavement Care and the Samaritans. I met the British Transport police and saw the extraordinary work they do with Network Rail. I saw some of the triage work going on in Birmingham, including placing a mental health professional in the police control room 24 hours a day to help provide necessary information. I held a meeting on suicide prevention on 29 June, with researchers, the Samaritans, and representatives from areas such as Merseyside, the east of England and the south-west.

We have started to look at something called zero suicide. I have an interest in the concept and ambition of zero suicide. It was pioneered in Detroit by a college acquaintance of mine from many years ago, Ed Coffey, and I am very interested in his work. We can follow part of it, although some things are different in the States and will not be pertinent here. The whole concept of zero suicide—recognising that as an ambition, and challenging the inevitability of suicide—is really important and has very much grabbed my attention. Public Health England also recently published the refreshed “Help is at Hand” document, which provides compassionate support and information to people bereaved by suicide.

I will conclude by saying a little about research and data, as it will cover a number of issues raised by colleagues. One of the key drivers for improving our approach to suicide prevention is investing in research and data. I want us to lead the world in suicide prevention research, and to be at the forefront of service delivery, using the best knowledge and information to provide the best care. We have invested over £1.5 million in suicide and self-harm prevention research since bringing in the national suicide prevention strategy, to inform and target our strategy for reducing suicide rates. I will have a look at whether that is enough, and at what more needs to be done.

The hon. Member for Bridgend mentioned longitudinal studies. We are committed to carrying on the work on that. We have provided the Multicentre Study of Self-harm in England with £300,000 this year. I will very much bear in mind the opportunities that there might be for us to do more.

The zero suicide ambition I mentioned is being piloted in three areas: Merseyside, the south-west and the east of England. Early learning from the pilots has identified some innovative practice, which I am sure will help other areas to develop innovative plans for reducing suicide in their communities. There will be more research that we can work through to find whether it could have applications elsewhere.

Oral Answers to Questions

Robin Walker Excerpts

Tuesday 13th October 2015 Commons Chamber

[Alistair Burt]

Between 2010 and 2015, £400 million extra was found in order to provide respite for those who are caring for others. Any support that goes into local government, or indeed the NHS, is predicated on a decent economy and decent economic principles in order to fund it—I believe from what happened last night that that has been abandoned by the Labour party. We have to have the resources in the first place. That is what we are seeking to ensure and that is what the work is being done for.

[Mr Robin Walker (Worcester) (Con)]

12. What steps his Department is taking to manage and meet demand for A&E services in Worcester.

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

Last month, the Department approved a £4 million capital improvement loan for the expansion of the A&E department at Worcestershire Royal hospital and the development of a dedicated discharge lounge. Worcestershire Acute Hospitals NHS Trust and the local health system will also receive practical support via the emergency care improvement programme to help the trust to address the challenges it has faced in meeting the four-hour A&E waiting time standard.

[Mr Walker]

I thank the Minister for his reply. I warmly welcome his recent decision to approve the £4 million interim investment in A&E capacity and a new discharge suite at the Worcestershire Royal. As he knows, demand remains very high, and the number of patients being admitted to hospital is close to record levels. May I urge him and his colleagues to look very carefully and urgently at plans for further upgrades, which could deliver much-needed capacity over the coming years?

[Ben Gummer]

I assure my hon. Friend that we will do so, but he will be conscious that capital plans are the responsibility of individual trusts. I urge his trust to take part fully in the Worcestershire acute review and in other reviews of the west midlands health service. There are challenges, and we will fix the problems only if there are locally sourced solutions, which we will then seek to support.

Children’s Palliative Care

Robin Walker Excerpts

Tuesday 3rd March 2015 Westminster Hall

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I am grateful to have secured this debate and glad to have the opportunity to serve under your chairmanship, Mrs Main. I first became interested in this area through the work of Acorns children’s hospice in my constituency, which provides a valuable service to children and families from all over Birmingham. I cannot praise its work too highly.

I begin by acknowledging that I believe the Government are genuine in trying to establish a clear funding path for children’s palliative care and hospice services. I understand that the major change envisaged by the Government is the new per-patient funding system. It would be helpful if the Minister said more about how it will work and how he plans to ensure that it is properly monitored and reviewed. I also want to raise the issue of short breaks and bereavement care, as these elements are not included in the per-patient funding strategy.

The children’s hospice movement supports the principle of per-patient funding for children’s palliative care as a means of providing more sustainable, transparent funding through an NHS currency, commissioned by clinical commissioning groups and designed to complement NHS England’s commissioning of specialised children’s palliative care services.

I understand that the third strand of Government thinking is that local authorities should continue to be responsible for commissioning necessary elements of social care and that together this should create an overarching system where all elements of the care—clinical and non-clinical aspects, short breaks and bereavement support—are all provided for.

My purpose in seeking this debate is to address a genuine fear that the impending general election and uncertainty over the new system could lead to a funding hiatus that could have a damaging effect on the children’s hospice movement. If I have understood it correctly, the per-patient system is designed to reimburse providers according to the activity they undertake, and to incentivise both commissioners and providers to deliver palliative care in a child’s home, community or hospice setting, if that is consistent with the wishes of the child and the family, and clinically appropriate.

The idea of the currency is set out in NHS England’s 2014 document, “Developing a new approach to palliative care funding: A revised draft for discussion”, in which it is argued that the currency should make it easy for clinical commissioning groups to understand the specific needs of children with life-limiting conditions. It should also be possible for clinical commissioning groups to have a better understanding of what constitutes palliative care and of the potential cost drivers for commissioning.

What steps have the Government planned to ensure that those elements of palliative care not covered by the new per-patient funding system will be properly funded by local authorities and clinical commissioning groups? This new system is the product of hard work and, as I have indicated, the sector is generally favourable towards it, but it is worried about a number of aspects. For example, how will the costs incurred by providers during the transition be met, including costs of setting up new systems to record activity and of ongoing data collection demands?

The Government-commissioned palliative care funding review by Hughes-Hallett, Craft and Davies in 2011, was clear that introducing and implementing the new system should be cost-neutral to the sector. What support does the Minister envisage for the voluntary sector providers to enable them to implement this new approach?

It would be useful if the Minister outlined any plans to provide models of practice that show how the currency will work, especially in situations for children and young people subject to continuing care packages and personal budgets, as introduced by the Children and Families Act 2014. It would also be useful to understand how the data quality will be monitored and how comparisons of models of care and outcomes will be assessed.

It is not clear to me how the new system will deal with the issue of transition from child to teenager to young adult.

[Mr Robin Walker (Worcester) (Con)]

I congratulate the hon. Gentleman on securing this important debate. Acorns children’s hospice serves my constituency as it serves his. It has a fantastic hospice in Worcester. It has done some important work on transition space and supporting the many people who, because of advances in medicine, are living longer. Does he agree that it is vital that the Government engage with it on this work, to make sure that transition is properly supported by the future funding system?

[Steve McCabe]

Yes, I agree. That is exactly the point. It is fantastic that so many children now survive for so much longer. That creates new demands and service needs that have to be considered. I should be grateful if the Minister said what work is being undertaken, both within Government and the NHS, to ensure that these transition issues are being considered in any new funding plans. I concur with the hon. Gentleman on that. The Care Quality Commission report, “From the pond into the sea: children’s transition to adult health services”—that is its title, I kid you not—also indicated that this focus is important.

We are moving towards the election, so it would help if the Minister clarified where we are with all these plans. As I have said, I acknowledge that the intention is to create a fair and sustainable framework, but we are now in March—the projected launch date for the introduction of the new non-mandatory currency is March—and as yet, unless I have missed something, we do not know the Government’s intention. What I would really like to know, and what I think the hospices would like to know, is what is going to happen with the hospice grant? Is the intention that it should continue during 2015-16 and beyond? I am sure that the Minister appreciates that not knowing is a real source of anxiety and a blow to any attempts at long-term planning.

Almost 96% of children’s hospice organisations are worried, according to the Together for Short Lives survey, that CCG funding will be less than their existing grant and harder to access. That grant covered about 13% of the care costs incurred by children’s hospices and existing clinical commissioning group funding represents about another 12%. Uncertainty over almost 25% of previously guaranteed funding is a difficult basis from which to operate.

I am sure the Minister knows that these bodies rely massively on public generosity and fund-raising efforts, but they also need some core guaranteed funding. If the grant ceases and is not matched by equal funding elsewhere, 89% of children’s hospice organisations could be forced to reduce their services. Areas at risk include short-break services for 60% of users.

Oral Answers to Questions

Robin Walker Excerpts

Tuesday 24th February 2015 Commons Chamber

[Mark Menzies (Fylde) (Con)]

6. What assessment he has made of the implications for his policies of the most recent rates of cancer survival.

[Mr Robin Walker (Worcester) (Con)]

13. What assessment he has made of the implications for his policies of the most recent rates of cancer survival.

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

This Government inherited the worst cancer survival rates in western Europe and, as we have just heard, we have invested a record £450 million in improving early diagnosis, which means that record numbers of people are being tested and record numbers of people are being treated.

--- Later in debate ---

[Mr Hunt]

We absolutely can. In fact, we are carrying out about half a million more diagnostic tests for cancer every year than we were four years ago. The result is that, over the course of this Parliament, 700,000 more people are being admitted for cancer treatment in our hospitals than was the case in the previous Parliament, saving 12,000 lives every year.

[Mr Walker]

I welcome the Secretary of State’s answers. Improvements in radiotherapy have been a key factor in improving cancer survival rates and quality of life for patients. This month, Worcestershire is celebrating the delivery of a state-of-the-art radiotherapy centre at Worcestershire Royal hospital. I visited that £25 million oncology centre last week. With some of the most advanced equipment in the country and eight new consultants recently recruited, does my right hon. Friend agree that the centre will be a key asset in taking forward the fight against cancer?

[Mr Hunt]

Absolutely. It was a fantastic development for Worcestershire Royal hospital. My hon. Friend campaigned very hard for it, and it is fantastic for his constituents. Cancer treatment is expensive, which is why we can only fund developments in cancer if we have a strong economy. That is what this Government are committed to doing for our NHS.

A and E and Ambulance Services

Robin Walker Excerpts

Thursday 18th December 2014 Commons Chamber

[Mr Hunt]

I am happy to do that. Staff will have been extremely disappointed at the efforts of the Labour party to try to turn into some sort of political football the services that they offer under a lot of pressure and with much hard work. Members of the public just need to look at the Chamber right now, and they will see which party believes in the NHS and which party does not.

[Mr Robin Walker (Worcester) (Con)]

Tomorrow I will be visiting the Worcestershire Royal hospital, part of the Worcestershire Acute Hospitals Trust, in which there are 144 more nurses, midwives and health visitors as a result of investment by this Government. Hospital staff tell me that winter pressures are added to by the number of long-term dementia patients who are staying on wards. Does my right hon. Friend agree that we need to keep increasing investment in that area to ensure that we get better dementia care?

[Mr Hunt]

My hon. Friend is absolutely right. One of the most heartbreaking things is to see someone with advanced dementia arriving in an A and E department. People do not know anything about their medical history and the best care that they need, and it becomes very difficult for the hospital to discharge them in that situation. Having proper personalised care wrapped around those individuals will normally mean that hospital is not the best place for them to go. Indeed, to echo the comments that have already been made, the key to that is knowing where they would like to die. Very often it is not hospital, so we need to be much better in that regard.

Foetal Alcohol Syndrome

Robin Walker Excerpts

Tuesday 14th October 2014 Westminster Hall

[Mr Sheerman]

My hon. Friend is absolutely right. I love that sort of idea, because it is holistic. We have to go right across the piece—mentors, health visitors and GPs. GPs should wake up. For goodness’ sake, what are they doing if they are not telling pregnant women, “Do not drink when you are pregnant.”? I despair when I see the level and quality of advice from some GPs, who should be telling women in very firm terms about the damage they could do to a little child.

[Mr Robin Walker (Worcester) (Con)]

I apologise for missing the opening comments in this important debate. The hon. Gentleman mentioned GPs. Does he agree that it is important that there should be clinical leads on FASD in each part of the country? I met the clinical lead on FASD in Worcester, along with Richard Procter of the FASD Trust, to talk about the issue. We should build up clinical leads, so that they can make sure that best practice is shared among GPs and other health groups. That is one way we can make sure that there is a better approach to this issue.

[Mr Sheerman]

The hon. Gentleman is right, but he tempts me to make the political point that getting a message to local health people now is very complex. I used to be able to pick up the phone to one person—the trust’s chief executive—and have a conversation about health in Huddersfield. Now, I have to make about seven phone calls to get any sense of a holistic approach to anything. I admit that that is a bit of a snide reply, but we must make things as holistic as possible.

We must get the drinks industry involved. Why do we not have the sign that my hon. Friend the Member for Sefton Central mentioned—the red slash across the pregnant woman with the glass of wine? Why can we not, as we did with the tobacco industry, get industry, the pubs and the restaurants on our side? Why can we not get the schools on our side? Where are the schools in all this? We must tackle this issue across the piece, and we must have one consistent message: do not consume alcohol, drugs or tobacco when pregnant.