Gosport Independent Panel

Ruth Cadbury Excerpts

Wednesday 21st November 2018 Commons Chamber

[Matt Hancock]

My hon. Friend is right. The grief over the loss of a loved one whose life has been foreshortened is compounded if that is not acknowledged by the authorities, and we therefore acknowledge it once again today. As for the police investigation, the timings are of course a matter for the police themselves, who are rightly independent. The process currently under way is the reviewing of all the evidence to establish what and whether prosecutions should be brought forward. That will continue into the new year, and the police will then make a statement on the next stages of their investigation.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

On 10 October, my constituent Bridget Reeves submitted a petition with more than 100,000 signatures to the Government to trigger a parliamentary debate. Today is the anniversary of her grandmother Elsie Devine’s death at Gosport War Memorial Hospital. She died after concerns had emerged from staff at the hospital.

I thank the Secretary of State for his statement and for his commitment to addressing many of the problems that have already been identified and are emerging from the various inquiries. The families want justice, among other things, but they will not get it until the outcome of the fourth police investigation—and I welcome the fact that it is being carried out by a different police authority.

I have two questions. First, will the Secretary of State meet the families face to face? Secondly, while I acknowledge his points about concerns of culture in the NHS, I am concerned about the culture in the coroner service, in relation to not just this case but others, including one that I met constituents to discuss this morning. There is a governance issue relating to when the coroner service needs investigating in the case of some inquests. Will the Secretary of State work with the Attorney General and pick up the concerns that Members expressed about a number of inquests?

[Matt Hancock]

The point about coroners is a matter for the Ministry of Justice, but I am pleased to see that the Under-Secretary of State for Justice, my hon. Friend the Member for Charnwood (Edward Argar) is present. He would delighted to meet the hon. Lady to take up that point—

Gosport Independent Panel: Publication of Report

Ruth Cadbury Excerpts

Wednesday 20th June 2018 Commons Chamber

[Mr Hunt]

I think that that is actually an excellent point, and we should definitely look at it. Big hospitals have clear lines of accountability—boards, chief executives—but those often do not exist in community hospitals and there is no one who can say they are the boss of that trust, so we should look at that.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

The grandmother of one of my constituents died in Gosport War Memorial Hospital in January 1999—in other words, after concerns were being raised by families and by staff at the hospital. The family believe that her morphine dose was well above that needed for her reported pain. I thank the Health Secretary for the tone of his statement, and I also thank Bishop Jones for the work he did on this inquiry. Does the Secretary of State believe that this report shows a need for tightening the draft Health Service Safety Investigations Bill?

[Mr Hunt]

I thank the hon. Lady for her comments. I do not want to jump to a conclusion about any changes to the draft Bill. However, we should definitely reflect on any legislative changes that might be needed as a result of this report, and that Bill could be a very powerful vehicle for doing so.

Mental Health Act: CQC Report

Ruth Cadbury Excerpts

Tuesday 27th February 2018 Commons Chamber

[Jackie Doyle-Price]

The hon. Gentleman is absolutely right. We have seen impressive and rapid rates of decline in the detention of patients in police cells, and I congratulate police forces and police and crime commissioners for helping to achieve that, but he is right that we need to make sure that, when people are taken to places of safety, suitable facilities are available for them.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

Yesterday some of us were present when Esther Rantzen told us that calls to Childline from children with suicidal feelings had risen in 10 years from virtually none to over 22,000 last year, and the CQC report yesterday found that young patients are not receiving the mental health care they need. So can the Minister explain why only 7% of the overall mental health budget is spent on children, when children make up 20% of the population and 50% of enduring mental health conditions materialise by the age of 14?

Charing Cross Hospital

Ruth Cadbury Excerpts

Wednesday 1st November 2017 Westminster Hall

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

I congratulate my hon. Friend and constituency neighbour on securing this debate, and on his leadership in the campaign on the future of Charing Cross. The great fear among my residents—particularly in the eastern half of my constituency—and among people from a far wider area is about the loss of the full-scale accident and emergency service at Charing Cross, which would potentially mean downgrading many in-patient and out-patient services linked to it.

[Andy Slaughter]

I am grateful for the clarity that my hon. Friend brings on that point. What is proposed is the loss of all consultant-led emergency services—type 1 A&E services. The site will therefore lose blue-light ambulances, emergency surgery and emergency consultant services. That is a very substantial change to the health facilities available.

The change came under the heading, “Shaping a healthier future”, which I am afraid my constituents regarded as a rather Orwellian title. That programme has now been subsumed within the sustainability and transformation partnership proposals, which are now nationwide, but essentially the meat of the proposal has not changed over that time. I do not deny—I look for points of agreement if I can—that some of the objectives are perfectly laudable, such as specialisation and the bringing together of expertise on a particular site, as has happened with stroke services, major trauma, renal services and so on, even within the three hospitals in the Imperial trust. That is to be commended. No one objects to improvement to primary, social and community care, which may in time lead to less pressure on acute services. If the consequence is not just better health outcomes but a saving for the public finances, we do not object. The problem, and the reason why there has been a breakdown of trust, is that the changes are being advanced before we know the consequences.

Young People’s Mental Health

Ruth Cadbury Excerpts

Thursday 27th October 2016 Commons Chamber

[Tim Loughton]

The hon. Lady and I have the same objective, but I am always sceptical about a solution that means making something another compulsory part of the curriculum. Sex and relationship education is an interesting case in point. Some of the best SRE that I have seen has been from outside youth workers and others who can empathise with young people and talk to them in a way that they will appreciate, respect and learn from. Making it another subject taught by Mrs Miggins the geography teacher, who happens to have a free period on a Thursday afternoon and so can be in charge that term, can cause problems. More schools should automatically want to have well-informed mental health education in whatever form is appropriate to engage their children. It is in their children’s best interests. I do not think that my objective differs from the hon. Lady’s, but we can have a debate about how we can most effectively achieve it.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

The hon. Gentleman makes a good point about the importance of having appropriate, properly trained, empathetic people—specialists—delivering mental health education to young people. He suggests that youth services could provide such education. The problem is that local authorities are cutting those services because they are non-statutory. Many schools that have been providing support and bringing in specialist experts to help young people and teachers in this curriculum area are also facing cuts. Headteachers are having to pare back services as they deal with reduced budgets.

[Tim Loughton]

I hear what the hon. Lady is saying and that is a subject for another debate. It is an issue on which I have campaigned for many years, and indeed I chaired a commission looking into the role of youth workers in schools. Some really good examples of best practice are available, often in academies, which have appreciated the value of youth workers, because they can empathise with young people better, and brought them into schools. That is missing in so many other places. I have been advocating giving other roles to youth workers, who, sadly, are no longer being employed, particularly in local authorities, because this is not a statutory requirement and therefore has fallen by the wayside. So I have a deal of sympathy with that view, but it is for another day and debate.

I wish briefly to deal with a couple more points, the first of which relates to the last one: the importance of resilience and character education in the well being agenda in schools. Recent Education Secretaries have begun to take that on board, and a lot of this subject lies within that area. Another issue to consider is how this is monitored, and another good recommendation in the report is that Ofsted should have a role in that. Ofsted now has a role in assessing behaviour in schools, but that should extend to how it copes with mental health problems among pupils—that should be on the checklist. We are really bad in this country at disseminating good practice, but I have seen many examples of it. I recall visiting a school in Stafford and sitting in on some of the sessions held by their full-time counsellor. The teachers had confidence in her, would refer to her children about whom they had some doubts, and the children would speak frankly to her. Such people can prevent a lot of problems from occurring later on in the schools that have them, but not enough schools do—again, there is a debate to be had about why that is.

We also have to address the issue of cyber-bullying and the role of social media. The report gives examples about websites that promote self-harm, which are a huge scourge. We need to be much more aggressive in tackling these sites, particularly where they relate to anorexia and self-harm. People are going to them to seek advice and find a solution because they have feelings about self-harm or problems with anorexia, but these bizarre websites are promoting those things. As the report suggests, we need some form of verification scheme and, as has been mentioned, a much more responsible and bigger role for our social media companies. They are huge companies employing many thousands of people, yet the numbers in their scrutiny and enforcement departments are woefully low. As Members of Parliament with Twitter accounts, most of us have blue ticks to show we are who we say we are. Can there not be some form of verification scheme, described in the report as a “kitemarking scheme”, so that young people, particularly those who are vulnerable and impressionable, have confidence that the sites they are accessing are there to give them support, not to encourage them to do harmful things to themselves? This applies to so many different areas, including in respect of radicalisation sites.

Body image has been mentioned, and Girlguiding, which regularly revisits the issue of body image and young girls’ perceptions, has recently produced a report on the subject. It is always so alarming and petrifying to see the number of young girls as young as 13 whose aspiration is to have plastic surgery. Despite the fact that their bodies are not even fully formed and that they are still growing up mentally, they are being conditioned to think that this is the ideal to which they must aspire. That is wrong, and these influences on our young people are at the root of so many of the weaknesses and vulnerabilities leading to mental illness and, in the most tragic cases, to suicide. In the old days, a note passed across a classroom with the words “Sealed with a loving kiss” might, at worst, end up on a playground floor. At the worst extremes, in the case of a form of sexting, the equivalent these days goes viral and ends up on social media in perpetuity, where it is open for millions of people to see. That is the difference between the note in our playground days and the casual, ill-advised text on social media these days.

Finally, the report makes recommendations about young people wanting to relate to people their own age, rather than old men in suits, which I guess takes in quite a few of the hon. Members here today. [Interruption.] Okay, I was talking about myself and my hon. Friend the Member for High Peak. They say that taking such an approach makes it easier to receive the right message, hence the recommendation that

“a consultation group of young people, both with and without a mental health history, be set up to work on and contribute to the anti-stigma campaign, and that someone is identified to ensure this happens.”

I completely agree with that.

My final point is that when I was a children’s Minister, I had four reference groups within the Department for Education, each of which came to me on a three-monthly basis: one comprised children who had been adopted; one comprised children in foster care; one comprised children in residential care homes; and one comprised children who had recently left care. They came to me in the Department without adults, we sat around the table and they told me exactly what was going on. They challenged some received wisdoms, and I got some of the best information that I ever got from any experts by speaking to those young people. This report has been produced by young people and by reference to many thousands of young people, many of whom have suffered and are suffering the sorts of problems that I and many other hon. Members have mentioned today. We need to listen to the voice of these young people, to act on their recommendations, and to include and involve them in the solutions. That is why this report is so important to them, but it needs to be equally as important to us, to this House and to this Government.

--- Later in debate ---

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

I apologise to the House for missing the start of the debate—it started a little earlier than I anticipated and I was sitting on a bus in Millbank—and thank you, Madam Deputy Speaker, for calling me. I also thank my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes), and I congratulate her on leading this debate and the Backbench Business Committee on delivering it.

I am speaking towards the end of the debate, so I will try not to repeat the many excellent contributions that hon. Members have already made. Like so many other Members, I have had parents contacting me in great distress at the lack of adequate acute services when their children are in crisis. I had one parent who was worried about her daughter having to spend yet another weekend—this was not the first period of crisis she had had—in the children’s ward of the local hospital, as no specialist beds were available. The children’s ward is not a safe place for a young person in a mental health crisis, nor is it fair on the staff or children in the ward to have to support her either. She needed to be in a specialist bed, but in London there are too few tier 4 beds for young people.

I had another distressing experience, where a young man needed to go to hospital urgently, but because of a disconnect between the police, the ambulance services and the other services, it took two attempts on the same day to draw him from his house and get him to the safe place he needed to be in, leading to added trauma and distress and worsening his already critical health situation. To be fair, we are seeing some improvements locally, and we are promised additional tier 4 beds and better joined-up thinking between services, but I have to say that this is a small increase from a very low bar.

An additional problem is the break in consistent service when a child in crisis suffers further as they hit their 18th birthday. They lose one set of services and the adult services may or may not pick up at the same place, which does not make it easy for the child, the family and those trying to support her.

I pay credit to those working in the public and voluntary sector who support and heal these young people, but whose job is being made difficult because of the funding situation and lack of adequate joined-up thinking. In common with all Members here today, I want to thank the Youth Select Committee, the British Youth Council and the many Members of the Youth Parliament across the country for their work.

Earlier this year, I met Hounslow’s MYP, Tafumi Omisore, who told me about the history of this debate and how young people across the country had voted mental health as the top agenda issue for discussion among MYPs and the top issue that they wanted to bring to our attention. Tafumi told me:

“The future of tomorrow cannot possibly get to a stage where young people can rise to their full potential when they are being failed by this current generation”,

by which I think she means us. She continued by saying that they

“lack the support they need for Mental Health. Every time we say we need more support, Mental Health services simply get cut.”

National campaigns for the Youth Parliament come along only once a year, so we have to treat young people’s demands seriously. Tafumi will be holding sessions in her school to promote more education on this subject—and all credit to her.

Earlier in July this year, I met a group of primary and secondary school heads, and I expected them to raise with me the issues of funding, recruitment and retention and testing, which they did. What I had not expected was that they raised their concerns about children’s mental health and the state of the services available to them as being equally important. They were concerned about the increasing incidence of mental health problems, self-harming, disruptive behaviour and so forth. These headteachers had feelings of inadequacy when it came to supporting those children. They felt that they could not get them through a good-quality education and make them ready for the world of work or higher education unless they could give those young people better mental health support.

These headteachers said that the capacity of CAMHS was overstretched and that there were long waiting lists. They had real concerns about inadequate early intervention. They pointed out that more children were vulnerable for many and varied reasons, including mistreatment and abuse at home, and that more families were living in chaotic circumstances. They noted that more families were living in uncertain, insecure and poor-quality housing, which was exacerbated by austerity, particularly in respect of benefits and tax credits. Most parents and families were working, but they had suffered as a result of the changes to the benefit and tax credit system. Increasing numbers of families could not find enough money to pay the rent and put food on the table. This stress impacts on children—it could not fail to impact on them. The head of Kingsley Academy, who has been at the school only a year, told me that during her tenure, three of her children have been sectioned. Some of her children were self-harming and not enough support was available. The social work team could not cope either.

Some solutions were identified. Most of our schools either commission the Hounslow youth counselling service to deliver counselling or employ in-house counsellors. Strand on the Green runs a programme called “theraplay”, which combines therapy and art for children. It is very successful, but there is no funding left to allow it to continue indefinitely. The school heads concluded that not enough support was being provided.

An excellent youth counselling service serves the borough of Hounslow, and has done so for many years. Its counsellors strongly believe that Government cuts have led to the increased need for counselling. Less money means higher criteria for early entry to tier 1 services, and—as other Members have pointed out today—when tier 1 services pull out, young people enter the system when they are in crisis and need tier 3 and 4 services, which are extremely expensive. The Hounslow youth counselling service, like many others, is a tier 1 service, and is there to provide initial counselling and support. It is not a therapeutic service; it cannot be, and it is not funded to be. It does not have the necessary professional advisers. However, it is often the only option for young people, because higher-level services such as CAMHS will not see them for many weeks, and often for many months.

The Hounslow counselling service says that skilled and experienced staff are being replaced by others who are less skilled and experienced, which has made it difficult to maintain important standards in certain departments. It also says that there is no sign that the increase in the number of young people requiring counselling is slowing down, and that further cuts could worsen the situation. It is a voluntary service organisation, funded mainly by local government and the NHS, which are cutting support for the voluntary sector as their own funding is cut. It says that it is likely to see at least 3,000 young people per year and that the number is growing, but it is highly unlikely that it will be able to grow as well in order to meet that pressure. Its waiting lists will lengthen, and young people who are referred by schools or parents, or who refer themselves, will have to wait even longer for counselling.

Our experience in our borough reflects the experiences that other Members have described today. Children and young people are under ever greater pressures from social media, family poverty, housing crises and identity questions. Services are already stretched, and some face an uncertain future: as school and voluntary sector cuts are made, many are closing or have already closed. There is a lack of early intervention. Different services have different priorities, and there are reports of the decommissioning of early intervention services as a result of reductions in spending on social services.

We could do things differently. It is not just a question of funding, although we cannot fail to discuss that issue. My hon. Friend the Member for North Durham (Mr Jones) made an excellent suggestion, based on experience of the armed forces covenant. The establishment of the covenant under the Labour Government was led at Cabinet level, but it filtered through a range of services into local government. I was a councillor in Hounslow at the time, and we adopted the covenant, which filtered into several of our services and priorities. Could we not do the same for children’s mental health?

As many Members have said, we need to do more as a country, and the Government must lead. We must do better. We must listen to young people. We must deliver joined-up services, and we must deliver them early. By doing that, we will save money, but, more important, we will save our young people’s future.

NHS Sustainability and Transformation Plans

Ruth Cadbury Excerpts

Wednesday 14th September 2016 Commons Chamber

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

I draw attention to my entry in the register of interests. My husband is a non-executive board member of Chelsea and Westminster Hospital NHS Foundation Trust.

Like many Members, I have had a very large mailbag about today’s debate because so many of my constituents rely on the NHS to keep them and their families in good health, and they want the NHS to carry on providing good, appropriate services that are accessible and timely, and free at the point of entry. They want funding not only to address the deficit, but to invest in improvement of services. Those who work in the NHS care deeply about its future and want to be able to do their best for their patients.

Like the constituents of my hon. Friend the Member for Hammersmith (Andy Slaughter), people in my constituency are deeply concerned about the future of Charing Cross hospital—a large general hospital with a busy A&E department in the neighbouring seat which serves many of my constituents. The hospital’s future has been uncertain for at least five years, since the north-west London NHS first proposed closing A&E there and in four other north-west London hospitals.

People are extremely worried about the travel times from Chiswick to the nearest A&E, about the inevitable downgrading of the other services on that site once A&E goes, and about the capacity of neighbouring hospitals to cope with the inevitable additional pressure. The issue has been ongoing for a while for us.

The STP comes at a time when we have a £1 billion funding gap in north-west London. It is proposed to close 500 beds and a 40% cut is proposed in face-to-face consultations. This is against a background of rising population and increased health needs and in the context of our services currently missing many targets.

Social care cuts are crucial to the argument. How can STPs have any credibility if the NHS cannot plan nationally when the other main services relevant to people’s long-term health are funded and controlled in a different place and in a different way and are being cut and cut and cut?

The north-west London STP, as I said, proposes cutting beds. We all want treatment to be less dependent on spending nights in hospital beds, and some reduction in acute beds is inevitable with changes in modern health provision, but 500 beds is a staggering number proposed to be cut in west London, where the population is rising and ageing.

I will end by responding to Members on the Government Benches about the funding gap in the NHS. The NHS would not have a funding crisis if this country matched the health funding per head of similar countries. The King’s Fund has shown that the UK public purse spends a smaller proportion of GDP on healthcare than countries such as Portugal, Japan and the Netherlands. If those countries value health in this way, surely so can the UK.

NHS in London

Ruth Cadbury Excerpts

Thursday 24th March 2016 Westminster Hall

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

I beg to move,

That this House has considered the NHS in London.

I thank the Backbench Business Committee for granting this debate, and I thank the London Members from three different parties who supported my application.

Our consideration today of the NHS in London is timely because there are reorganisations—or reconfigurations, as they are called—going on all over the city. I will address on the situation in north-west London in particular. In Ealing, the NHS was the main issue in the election campaign, and it continues to be a preoccupation, as I can see in my inbox and postbag. I shall talk today about matters such as the junior doctors contract negotiations we hear so much about; A&E closures; changes in maternity and paediatrics, which affect us in Ealing; community pharmacies and some of the other allied services, such as optical services; and staff morale. I have several specific cases from my surgery, including those of whistleblowers. I have a constituent who was sacked and has been effectively blacklisted from NHS employment ever since exposing bribe taking at Ealing hospital. I have raised her case three times on the Floor of the House, but nothing practical seems to be forthcoming for her.

There have been two important reports relating to the health service in north-west London. Most recently, the Independent Healthcare Commission for North West London, chaired by Michael Mansfield QC, was set up in response to the NHS’s “Shaping a Healthier Future” programme to reshape hospital and out-of-hospital health and care services in north-west London. The proposals in “Shaping a Healthier Future” are euphemistically called changes, but they are actually cuts—we know what they really are—and they include nearly halving the number of hospitals in our local area with a proper 24-hour A&E service. There were nine, but that is going down to five.

The London Borough of Ealing is around the same size as cities such as Leeds, but it will have no properly functioning A&E services at a hospital. The nearest four hospitals to my constituency—Central Middlesex, Hammersmith, Ealing and Charing Cross—are set to be downgraded to minor hospitals with no A&E. Instead, there will be urgent care centres.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

I congratulate my hon. Friend on securing this debate. She is obviously concerned about the loss of services in her constituency, as are other colleagues about theirs. Is it not true that many people, including my constituents, are concerned about the pressure on the remaining hospitals, such as West Middlesex University hospital, when all the surrounding hospital services are closing? There is no guarantee that the remaining hospitals will have either the capital or the revenue funding they will need to cope with the inevitable increase in demand when services such as those at my hon. Friend’s hospital close.

[Dr Huq]

rose—

--- Later in debate ---

[Andy Slaughter]

That is exactly the document I have been discussing. In some ways, Clare Parker’s embarrassment comes through in that letter. She is a good officer. She is the officer primarily responsible for delivering “Shaping a Healthier Future” and is effectively running five CCGs in that capacity. I think she would like to be more candid with us than she is in that letter. I urge the Minister to encourage people in CCGs, trusts and the Department to be more candid. She might find that there is more understanding of the problems than she thinks.

The question is—I discussed it with Clare Parker only a few weeks ago—where are we going with this programme? If the Treasury is putting out alarm signals about whether it can fund the programme, and principally the rebuilding of St Mary’s and Charing Cross, what will happen? The strong rumour is that reductions in service will have to take place, because services have a financial cost. The type 1 A&E and other services will have to go from Charing Cross, with the hospital effectively becoming a primary care and treatment centre, and the situation will be similar at Ealing.

Rather than the demolition, clearing and part sale of those sites, followed by rebuilding, which would cost hundreds of millions of pounds, we may just mothball the existing buildings, which are on the whole ’60s and ’70s buildings, with part of them not being used at all and the rest being used for the new facilities. In some ways, that would be the worst of all worlds, although it would at least preserves the sites and the capacity for future Governments to reactivate them. That has certainly not been denied to me, although I think it was said that that is a more advanced plan at Ealing than at Charing Cross, where it is still plan B. In other words, demolition is still on the cards, but there has to be a fall-back position if the Treasury does not fund it.

There is another factor. Even if the NHS does not move on, the rest of the world does. My hon. Friend the Member for Westminster North (Ms Buck), who could not be here today, is pressuring strongly for the facts in relation to St Mary’s hospital, which serves her constituents, as I am for Charing Cross. Because of the grandiose scheme to build the “Pole”, or the new Shard, which would take up some of the land on the St Mary’s site, the existing plans will no longer be possible. Instead of the A&E, there will be a nice piazza outside a 95-storey office block, which I am sure is much more useful to constituents. Such fundamental changes will mean that the land is more valuable, the building costs are greater and the substantial plans for the modernisation of St Mary’s will not be able to go ahead, at least as planned. Yet many of the buildings there are listed, so what is happening? I like to think that something is happening, but I would also like to be told about it. It is unacceptable for three years to pass without any information being put on the record or given out.

Anne Rainsberry also said that we are still maintaining the Keogh principles, as if that would be a surprise or we would not welcome it. Many of the changes that have happened are, of course, improvements to the service. The hyper-acute stroke unit at Charing Cross has been classed as the best in the country. It is a fantastic unit that saves a lot of lives. The stroke unit from St Mary’s has just been moved to Charing Cross. Of course, the costs associated with that and with ensuring that it operates properly will apparently be wasted, because in four or five years’ time, the intention is to close it, demolish it and move it all back to St Mary’s again. I just cannot follow the logic, and I begin to lose confidence in the NHS’s ability to plan.

We have been through all this about three times in west London. We went through the whole Paddington basin fiasco and other schemes to do with merging Hammersmith and Charing Cross hospitals. In that time, demand has changed. The latest figures show that demand for A&E at Charing Cross has gone up by 13%, and none of the hospitals is meeting its A&E waiting target. There is massive population expansion, and I was pleased to be told by NHS England that when the business plan is produced, it will be based on the latest figures, so we will not be relying on the population statistics from five years ago.

The population is growing astronomically. When people drive through west London, they can see building going on on every street corner. The anticipated growth in population runs to tens or hundreds of thousands over a very short period, yet whenever I look at the plans—I assure hon. Members that I look at them all, as I monitor demographic changes—I never see any increase in public services. I never see the new schools, hospitals or GP surgeries, I just see massive blocks of luxury flats being put up everywhere. Even people who live in blocks of luxury flats get ill sometimes, although I have genuinely been told that it will mostly be wealthy young professionals living there and they will not need hospitals, so I do not need to worry too much about them.

[Ruth Cadbury]

Skiing injuries.

[Andy Slaughter]

Well, perhaps. The situation does not give us a lot of confidence in the plans that are being made.

I hope that I have given a flavour of what is happening. I cannot do much more than that, because I do not have the information available. This is the No. 1 issue for my constituents, yet when I look back to see how often I have raised it—I have made one speech on it since the election and asked a few questions to Ministers—I am sorry to see that on the whole, I get pretty dismissive answers. I do not think that is how this Minister would wish to behave.

I ask that sooner or later—sooner, preferably—we get the business plan so that we can see what changes are being proposed and what the timetable is. I also ask for a realistic reassessment of the need for acute hospital services, because I do not believe that “Shaping a Healthier Future”—2010 or 2012—will be the appropriate mechanism for doing that. If the Government are prepared to do that, I am sure that all Members, irrespective of party or of the proposals for their local hospital, will be prepared to sit down and negotiate.

--- Later in debate ---

[Paul Scully]

I am grateful to my hon. Friend for making that point, and he is absolutely correct. It is why we need some degree of certainty. For many years now, we have had such things as “Better Healthcare Closer to Home” and “Better Services Better Value”—an alphabet soup of NHS changes, with no degree of certainty for residents or staff in that hospital. A lot of the BSBV review was clinician-led, but it was based on the premise that they wanted to concentrate consultants in certain places—in my case, at St George’s hospital in Tooting—because they did not have enough consultants in each of the different hospitals seeing enough of the more unusual cases; they wanted to concentrate expertise.

Imagine a whole load of politicians in Sutton telling residents time and again that the hospital is about to close, as my hon. Friend just said. Where would a newly qualified consultant want to go and practise? Would they want to go to a hospital that they are being told is about to close down, or would they go just up the road to one that receives all the plaudits and which has all the concentration of expertise? I know what I would do. If people talk down their local hospital and healthcare, it may become a self-fulfilling prophecy. They may be in danger of getting a result that is exactly the opposite of what they seek.

[Ruth Cadbury]

The hon. Gentleman is making a point, but some services have moved or closed without political problems because the people who used them and valued them realised that change was necessary. I suggest that the change in stroke and trauma services in recent years was right—fewer, larger, better. I also suggest that the opposition to changes the hon. Gentleman describes is caused by genuine worry that the solutions will not provide the adequate future service that we all want for London. In addition, in recent years we have seen a significant rise in population in London. We do not oppose that per se, but the health service in all its facets should be seen to be growing to accommodate that rising population.

[Paul Scully]

The hon. Lady makes some interesting points. There have been changes and closures in Sutton. The stroke service was one, and it made sense to provide immediate treatment at St George’s although it was further away, because those first few hours are crucial. Several smaller hospitals also closed over many years. However, I return to the changes and closures of A&E and maternity services to concentrate them at St George’s. Although it is only a few miles away, in rush hour traffic it takes those without the ambulance service’s blues and twos a long time to get to St George’s. If politicians were concerned, I would have thought they would do a more effective job than just trying to get tens of thousands of signatures on a petition aimed at the primary care trust. It took so long that the petition was still being presented two and a half years after PCTs were abolished in favour of CCGs. Effectively it was a data-harvesting exercise to extract a whole lot of email addresses that could be used in a political campaign and as a political football. The NHS is inherently political, but sometimes we must take the party politics out of it and focus on healthcare and what we have to do to best treat patients in a local area.

As I was saying, the St Helier building is fast becoming not fit for purpose, with 43% of the space having been deemed functionally unsuitable. That is no way to provide 21st century healthcare. The hospital predates the NHS by some time. The huge white building on a hill was used by German fighters to line up as they were coming to London on their bombing raids.

I look forward to plans being produced, using any capital funding we can attract from the Government in a cost effective way, so that it is not too onerous for the Treasury, to make use of all the component parts of the Epsom, St Helier and Sutton hospital sites. Businesses, the Royal Marsden hospital and the Institute of Cancer Research are sited there and the NHS is planning an exciting project—a London cancer hub—to attract even more world-class research. The Institute of Cancer Research and the Royal Marsden have a world-class reputation and it would be fantastic to expand it, but the Royal Marsden needs acute facilities to support treatment there. If we can use that huge space for healthcare for the borough as well specialist healthcare, that would be brilliant.

The “Save St Helier” campaign is great in theory, but there are some holes in the plans and there may be unintended consequences resulting in the opposite of what we want. With the “Better Services Better Value” campaign, the fact that St Helier sits between Kingston hospital, St George’s hospital, Croydon University hospital and Epsom hospital means it is always at threat because of the way the catchment area is designed. The trust is acutely aware of that. We want St Helier to be meshed into the London cancer hub with an integrated approach.

We have heard that the NHS can be somewhat bureaucratic. A few years back, I was at a hospital that closed—Queen Mary’s hospital for children. It was eventually sold for a secondary school and housing in Sutton, but it took two years and £1 million in legal fees for two public bodies, the local authority and the NHS to agree terms. The lawyers got the money and children were not educated there for another two years at a time when there was a shortage of school places. Cutting through that bureaucracy and making sure we get the healthcare we want without having to go through the 11 tiers to which my hon. Friend the Member for Harrow East (Bob Blackman) referred would be fantastic.

We have heard a little about the difficulties of getting GP appointments and how infrastructure in London does not always keep up with planning and the need for housing. Sutton is no different. Worcester Park is one of the densest wards on the border with Kingston and has two vets but no GPs. I am not sure what that tells us about Worcester Park, but there is certainly a lack of planning somewhere.

I live in Carshalton and the one Liberal Democrat MP who was here is my MP. There is a health centre and it is a good example of how we might roll things up across Sutton and other areas. Two practices have come together in a purpose-built building with a shared practice, so it is slightly easier to get an appointment, although it may be not with one’s named doctor, but with one of their colleagues. People can wait to see their named doctor, or they can get a reasonably quick appointment if it is an emergency; they can have blood tests, antenatal care and vaccinations. I recently had a rabies vaccination there—for a trip to Burma, not because of the prospect of facing hostile Opposition Members. The range of facilities helps to keep people away from A&E.

I have visited several pharmacies in my local area. They are concerned about closures, but the Minister has talked about putting in extra funding and integrating the pharmacy service as an alternative first port of call.

NHS Bursary

Ruth Cadbury Excerpts

Monday 11th January 2016 Westminster Hall

[Paul Scully]

It is beholden on us to explain the system to mature students, because I see no reason why they should be discouraged.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

The hon. Gentleman says that he sees no reason for mature students to be discouraged, which perhaps demonstrates that the Department has not done a full impact assessment. What impact assessment did the Department do before the Chancellor made these proposals in the autumn statement?

[Paul Scully]

The hon. Lady is asking the wrong person. Perhaps the Minister will respond to that question a little later.

The idea of placements came out of our discussion prior to the debate with the student nurses, who have taken time out to come to London today from as far as Liverpool and elsewhere. We talked about bursaries, and it would be a more honest description to call them a salary because these people are working hours in what are supposed to be supernumerary positions but are often not. There are student nurses sitting in the Public Gallery, and we have one person here from Brighton who explained how he was saving children’s lives prior to Christmas—it is not a supernumerary position when someone is working with babies. We have other people in critical roles who are working with patients on a range of issues, so we need to be straight about the pressures on nurses and how we reward them.

--- Later in debate ---

[Maria Caulfield (Lewes) (Con)]

I welcome the opportunity to speak in such an important debate. I acknowledge that the changes affect all sorts of healthcare professionals, including midwives, physios and speech therapists, but I will keep my remarks mainly to student nurses because I am a qualified nurse and have worked in the NHS for more than 20 years—I was even working as a full-time NHS nurse until just after the last general election.

I trained under the bursary scheme. I was one of the second intake, after the scheme was introduced in the early ’90s, so I have first-hand knowledge of how it works. I have met student nurses, the Royal College of Nursing—the RCN—and qualified nurses to discuss some of the issues that the changes raise. I have also met the Minister to express my concerns, and have been reassured that alternatives to a student loan mechanism for entering nurse training are in the pipeline. These might be better than the nurse bursary scheme, and they will certainly be better than the proposed student loan scheme.

Let us not pretend that the bursary system is ideal—I speak as someone who went through that method of training. It started in the early ’90s as a replacement for the old-style nurse training system in which student nurses were part of the workforce and were on the payroll. Let us be honest though, the students were used as a spare pair of hands and often there was not a huge opportunity for them to learn on the job. At that time, there were two ways for someone to become a nurse. They could do a two-year course to become a state-enrolled nurse, in which role they could do only so much, or they could do a three-year course and become a fully qualified state-registered nurse, taking on all aspects of the role of a registered nurse. The bursary scheme, when it was introduced, was a move to make nursing more academic, and to create supernumerary student nurses. Or rather, that is what is supposed to happen. As my hon. Friend the Member for Sutton and Cheam (Paul Scully) pointed out, in practice, student nurses are still used as a spare pair of hands and are rarely supernumerary when they are on placement.

Student nurses were, however, taken off the payroll and the bursary scheme was introduced as a sort of income to acknowledge that, although the students were not counted as part of the workforce, they still had to do a huge number of hours while on placement, including night shifts and weekend and evening work. The bursary was supposed to compensate the students for their loss of income, but a bursary is not a wage, and it certainly does not reflect the number of hours student nurses put in during their training.

Let us not miss the point. Someone can do a three or four-year academic nursing degree, but unless they do the clinical placement hours, they cannot register as a nurse. That is the crux of the matter. In addition, a bursary certainly does not reflect the increase in experience and skills that students gain as they go through their training. A first-year student nurse gets exactly the same bursary as someone who has almost qualified and is practically working—under the supervision of a qualified nurse—as a qualified nurse.

The bursary system undervalues the contribution that student nurses make, and it means that student nurses across the country live on little more than £3,000 a year. The system has changed over time—it was not means-tested when I was doing my training, but it is now. Let us not pretend, therefore, that the system is ideal. The bursary has never adequately supported student nurses, and I welcome the chance to change it. Let us look at other professions. I certainly do not want people sitting in the Public Gallery to suddenly rush out and change profession completely, but a trainee police officer has a starting salary of £19,000 and a trainee firefighter starts on £21,000. Airlines are now moving to in-house training. A new pilot with no flight experience training with British Airways is on £23,000 and Virgin has a similar policy, with Richard Branson saying that he welcomes those with no experience to be part of the Virgin family from day one. Yet for student nurses, who take similar life and death decisions every single day, we propose not just that they work in clinical areas for free but that they pay for their training as well.

I believe Ministers when they say that this is not a cost-cutting exercise, because the money will instead increase the number of student nurse placements. Currently, more than 50% of people who apply to become student nurses are turned away simply because the places are not there in the universities. The RCN’s figures from only last year show that there were 57,000 applications, of which 37,000 were rejected.

[Ruth Cadbury]

Will the hon. Lady give way?

[Maria Caulfield]

I will not, if the hon. Lady does not mind, just because I know that so many Members want to speak.

Although not all of those 37,000 will have been rejected because of a lack of places, a significant number of them will. The current system restricts the number of student nurses that enter the profession so, in theory, the changes should increase the numbers of qualified nurses in a few years’ time. From my clinical practice I know, however, that what works in theory will have the opposite effect in reality.

My main concerns about moving from a bursary scheme to a student loan scheme are, first, that many nurses go into a degree system simply because there is no other way to become a nurse. They do not necessarily want a degree in nursing; they want to be a qualified registered nurse. If we commit to a student loan scheme, we are committing them to take on debt for years to come. As we have heard, many of them—more than 30%—are mature students, and by mature students we do not mean people in their 40s and 50s. They are people in their mid-20s and early-30s. They have young families; they are single mums; and they have a first degree and have to take on a second one just to become a nurse. It is a crazy situation. For someone who already has a student loan, and/or a mortgage and/or childcare to pay for, the thought of taking on more debt will definitely put them off entering nursing, and to say otherwise is madness.

The difference between student nurses and other undergraduates is that the starting salary for a nurse is £21,000. Most nurses will only ever be a band 5 or 6, and the maximum they can earn as a band 6 is £34,000—that is if they do not have a break to have children or go part time for some other reason. They will never be in a position fully to pay off their student loan. Student nurses are different, therefore, from other undergraduates, and that has not been recognised in the debate. An issue in the wider debate about graduates is that a graduate is, on average, £100,000 better off than a non-graduate, but that is not the case with nurses. Other graduates earn, on average, more than £40,000 a year, but nurses do not earn anything like that and that difference needs to be recognised when decisions are made.

We have heard how much time student nurses spend on clinical placements—more than 50% of their course, including nights, weekends and evenings—which makes it almost impossible for them to get any other income from part-time work. We must recognise that. Being dependent on a loan is not a great way of life either, but other students are able to supplement their loans by working in pubs and shops, and doing other evening work. Student nurses are not in a position to do that.

My second concern is that, if I am completely wrong and we suddenly have a huge increase in the number of student nurses, the placements will not be able to cope. To qualify as a student nurse, not only does someone have to pass their exams and essays and do the required hours, they also have to be clinically assessed by a registered nurse—not just any old registered nurse, but someone who has done their mentoring and assessing course. I know that there are student nurses now who struggle to find placements because there are not enough qualified nurses able to assess them. That needs to be taken into account as well. It is not just about increasing the numbers; it is about having the support services in place.

When I met the Minister, I was hugely reassured by what he said about other schemes that are being proposed. My plea is that he outlines those schemes so that student nurses are reassured that, in order to qualify, they will be able to use schemes other than the student loan system. Routes such as nursing associates and nursing apprenticeships are being proposed. I am probably getting a little old now—

Southern Health NHS Foundation Trust

Ruth Cadbury Excerpts

Thursday 10th December 2015 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. It is worth saying that the tragedy that sparked this report happened before the new CQC inspection regime had got under way. The old CQC regime was rather a tick-box approach, partly because the people doing the inspections were often not doctors who could make peer-review judgments about the quality of services. If someone is not a doctor, there is a tendency to want to tick yes or no in reply to a question rather than to deal with the underlying issues. Having judgment in our inspections will be a very important step forward.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

This investigation would not have happened if it had not been for the tenacity and work of Sara Ryan, Connor Sparrowhawk’s mother. Is it right that the family’s legal representation was funded by crowdsourcing?

[Mr Hunt]

I think it is tragic when anyone has to resort to the courts to get justice. Sara Ryan is one of many who have had to go to huge out-of-pocket expenses to get justice and the truth with respect to their loved ones. Last week, I went to the launch of James Titcombe’s book. He campaigned for years and years to get justice and the truth about the death of his son, Joshua. That is exactly what we have to change.

Oral Answers to Questions

Ruth Cadbury Excerpts

Tuesday 17th November 2015 Commons Chamber

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

I thank my hon. Friend, who is right to raise the issue of end-of-life care, which is central to our plans to provide better care across the NHS. Indeed, it was a manifesto commitment of ours at the general election. NHS England is looking at a more transparent, fairer and clearer funding advice formulae for CCGs. I encourage her CCG to look very carefully at that and to copy the example of some CCGs such as Airedale, which have put this at the centre of the work they do looking after local patients.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

T2. I strongly associate myself and my colleagues with the remarks of the Secretary of State about the atrocities in France this weekend. What assessment has the right hon. Gentleman made of the impact of housing problems on the difficult task of recruiting and retaining clinical staff, particularly nurses in London and London’s NHS?

[Mr Hunt]

I do think it is a serious problem. People find it hard to live near to the hospital at which they work, particularly where housing is very expensive. This is an issue that we are looking at closely.