NHS Funding Bill

Baroness Winterton of Doncaster Excerpts

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

[The First Deputy Chairman of Ways and Means (Dame Rosie Winterton)]

I remind hon. Members that if there is a Division only Members representing constituencies in England may vote.

Clause 1

Funding Settlement for the health service in England

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I beg to move amendment 2, page 1, line 10, at end insert—

“(1A) The amount spent on mental health services in each financial year set out in the table must be set out in a statement laid before the House of Commons by the Secretary of State no later than 30 June in each year.

(1B) The statement in subsection (1A) must be accompanied by a statement on the Secretary of State’s plans to achieve parity of esteem in mental health services.”

This amendment would require the Secretary of State to report annually on the amount actually spent on mental health services, and on the Secretary of State’s plans to achieve parity of esteem in mental health services.

[The First Deputy Chairman]

With this it will be convenient to discuss the following:

Amendment 1, page 1, line 14, at end insert—

“(2A) For each year in the table in subsection (1), the Secretary of State must specify the amount of the allotment that is for mental health services.”

This amendment requires the Secretary of State to specify the amount to be spent each year on mental health services.

Amendment 5, page 1, line 14, at end insert—

“(2A) For each year in the table in subsection (1), the Secretary of State must specify the amount of the allotment that is for training for staff to improve maternity safety and care for mothers and babies.”

This amendment would require the Secretary of State to specify the amount to be spent each year on improving maternity safety and care for mothers and babies.

Amendment 3, page 1, line 18, at end insert—

“and that the sums set out in the table are not permitted to be augmented by or composed of any virements from NHS capital budgets.”

This amendment would stop the Secretary of State meeting the NHS England allotment for resource spending by using funds from NHS capital budgets.

Clauses 1 and 2 stand part.

New clause 1—Annual report on mental health spending—

“The Secretary of State must lay before the House of Commons an annual statement of the outturn of NHS England spending on mental health services no later than six months after the end of each financial year, beginning with the year ending 31 March 2020 and up to and including the year ending 31 March 2024.”

This new clause requires the Secretary of State to report each year on the actual level of spending on mental health services.

New clause 2—Annual Report on Child and Adolescent Mental Health Services spending—

“(1) The Secretary of State must lay before the House of Commons an annual statement of the outturn of NHS England spending on Child and Adolescent Mental Health Service (CAMHS) no later than six months after the end of each financial year, beginning with the year ending 31 March 2020 and up to and including the year ending 31 March 2024.

(2) The annual statement from subsection (1) must report figures on—

(a) CAMHS expenditure per head,

(b) the percentage of the annual NHS England budget allotted to CAMHS, and

(c) the percentage of the annual mental health budget allotted to CAMHS.

(3) The figures in subsection (2) must be broken down by standard regional units in England or by such territories as the Secretary of State considers appropriate.

(4) Each statement under subsection (1) must include an assessment by the Secretary of State on whether expenditure on CAMHS has met the aims of the NHS Long Term Plan.”

This new clause would require the Secretary of State to report each year on the actual level of spending on CAMHS. It requires figures to be broken down by regional units and for the Secretary of State to include an assessment of whether expenditure on CAMHS is meeting the aims of the NHS Long Term Plan.

New clause 3—Allocation of funding—

“The Secretary of State must lay a report before the House of Commons no later than 31 July each year setting out how much in percentage and in cash terms in relation to the amounts set out at section 1(1) has been spent on mental health services in the most recent year ended on 31 March.”

This new clause would require the Secretary of State to report annually on the amount and proportion of NHS England spending devoted to mental health services.

New clause 4—Annual statement on performance—

“The Secretary of State must make a statement to the House of Commons no later than 31 March each year setting out—

(a) whether in the Secretary of State’s opinion the amount specified in section 1(1) for the following financial year is sufficient to meet the performance targets set out in the NHS constitution, and

(b) if in the Secretary of State’s opinion the amount specified in section 1(1) for the following financial year is not sufficient to meet the performance targets set out in the NHS constitution, what steps Secretary of State is taking to ensure that those targets are met.”

This new clause would require the Secretary of State to report annually on whether the allotment to the health service specified in section 1(1) year is sufficient to meet the performance targets set out in the NHS Constitution and, if not, what steps Secretary of State is taking to ensure that those targets are met.

New clause 5—Inflation—

“(1) The Secretary of State must make a statement to the House of Commons in the event that the annual rate of inflation as set out in the Consumer Prices Index is greater than 3.3% in any six months out of twelve after the date on which this Act is passed.

(2) The statement under subsection (1) must specify whether, and by how much, the allotments to the health service in England set out will exceed the amount specified in the table in section 1(1).”

This new clause would require the Secretary of State to make a statement on the impact of inflation above a certain rate on the allotments to NHS England.

New clause 9—Annual parity of esteem report: spending on mental health and mental illness—

“Within six weeks of the end of each financial year specified in the table, the Secretary of State must lay before each House of Parliament a report on the ways in which the allotment made to NHS England for that financial year contributed to the promotion in England of a comprehensive health service designed to secure improvement—

(a) in the mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of mental illness.”

This new clause would require the Secretary of State for Health and Social Care to make an annual statement on how the funding received by mental health services that year from the overall annual allotment has contributed to the improvement of mental health and the prevention, diagnosis and treatment of mental illness.

New clause 11—Annual review of adequacy of allotment to NHS England—

“The Secretary of State must lay before each House of Parliament within 14 days of the Treasury laying the annual main estimate for the Department of Health and Social Care an assessment of the extent to which changes in the costs of pharmaceutical treatments, medical devices and service delivery since the date on which this Act is passed have affected the health outcomes in England achieved as a result of the amounts in the table in section 1 of this Act allotted to NHS England.”

This new clause would require the Secretary of State to publish an annual assessment of the impact of changes in the costs of pharmaceutical treatments, medical devices and service delivery on the expected outcomes from the allotted amounts under this Act.

[Justin Madders]

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

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

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

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

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

--- Later in debate ---

[Drew Hendry (Inverness, Nairn, Badenoch and Strathspey) (SNP)]

I am grateful to my hon. Friend for allowing me to speak in the English Parliament for the first time. Does he agree that one way to get around this whole EVEL conundrum is simply for the English Parliament to be made officially an English Parliament and then we can all have our own national Parliaments in our own countries?

[The First Deputy Chairman of Ways and Means (Dame Rosie Winterton)]

Order. I am sure colleagues will appreciate that it is important that we actually talk about the Bill.

[Patrick Grady]

I wholeheartedly agree, Dame Rosie. I have addressed the amendments that we have an interest in, and I am contextualising why they are relevant to our constituents, but points are being extremely well made by my colleagues. There is a simple solution to this, which we in the SNP have been promoting for 84 years, since 1934: Scotland can become an independent country and England can have the Parliament that it wants. As my hon. Friend the Member for Airdrie and Shotts (Neil Gray) says, with the greatest respect for the Speaker, it should not be for the Chair or for the Government to decide what does and does not apply to Members from different parts of the UK. My job and that of my colleagues is to look at each measure before this House and determine for ourselves whether it is relevant to our constituents and act accordingly. Today, we are being actively prevented from doing that. There are amendments and new clauses on the amendment paper that we deem to be of interest to people in Scotland, which would take forward commitments in our manifesto, but we will not be able to vote for them. That is not a precious Union. That is not a partnership of equals. That is not leading instead of leaving. It is not something that is going to be sustainable for much longer, and 52% of people in Scotland seem inclined to agree.