Oral Answers to Questions

Ruth George Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Matt Hancock]

Technology and the data that show these inequalities are an important part of the answer, but of course it is much broader than that, and tackling health inequalities is an underpinning part of the long-term plan for the NHS; it is absolutely critical in order to address the sorts of inequalities that the hon. Lady rightly raises.

[Ruth George (High Peak) (Lab)]

Life skills courses can be key to helping people out of depression, loneliness and isolation, and into work and training, yet the course in Glossop in my local area has been cut by the county council, in spite of it having a £2.8 million underspend this year. Do Ministers agree that local authorities should be looking to spend the public health money that they have, and to use it effectively?

[Matt Hancock]

Yes, emphatically we do, and there is a drive across the country for more of the sort of social prescribing that the hon. Lady talks about. The clinical solution to many people’s health issues, and in particular mental health challenges, is often about changes in behaviour and activity, and the support people are given, rather than just drugs. On the face of it, the project the hon. Lady mentions sounds very good; of course I do not know the details, but I would be very happy to look into it. However, we wholeheartedly and emphatically support the broad direction of travel of helping people to tackle mental illness both through drugs where they are needed and through activity and social prescribing.

Oral Answers to Questions

Ruth George Excerpts

Tuesday 18th June 2019 Commons Chamber

[Matt Hancock]

We are working closely with that trust, and it was good to visit and see just how hard working the staff are. They are dedicated to the cause and well supported by their MPs. My hon. Friend is quite right to make that case, and we have a direct package of support for the Worcestershire Royal Hospital and the trust more broadly because it faces unique challenges, some of which are not at all of its own making. The staff at Worcester are working incredibly hard to deliver for their local citizens.

[Ruth George (High Peak) (Lab)]

My constituents find it very difficult to access their GP, as we have a recruitment shortage in the constituency. The “General Practice Forward View” pledged to boost the GP workforce by 5,000 by 2020. Are the Government on course to meet that target?

[Matt Hancock]

We retain that target of 5,000 more GPs. We have managed to increase the number of staff working around GPs, because a GP does not need to do everything in primary care, so we have a more mixed workforce with physios and practice nurses working alongside GPs. There is more work still to do, and the NHS long-term plan sets out how we will make that happen.

Healthcare: East Midlands

Ruth George Excerpts

Tuesday 30th April 2019 Westminster Hall

[Karen Lee (Lincoln) (Lab)]

I beg to move,

That this House has considered provision of local healthcare in the East Midlands.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am glad to have secured this crucial debate, which gives me and my east midlands colleagues a great opportunity to highlight the healthcare crisis in our constituencies, our region and across the country. I must stress in everything I say that I do not blame the hard-working and dedicated staff for any of it; the fault lies fairly and squarely with Government cuts. Our constituents deserve better than the past decade of under- funding, which has created a postcode lottery in local healthcare. It has had particularly detrimental implications for my constituency of Lincoln: local healthcare centres have been forced to shut, more general practitioners’ services are at risk of closure in the coming months, and local hospitals are in need of considerable funding and support.

Our healthcare infrastructure in the surrounding region of Lincolnshire has also been put under considerable pressure over the past nine years. In July last year, the chief inspector of hospitals recommended that United Lincolnshire Hospitals NHS Trust, which has a deficit estimated at £80 million, should remain in special measures. The latest figures show that the trust missed its A&E waiting time target by 32% and has not met the national standard since September 2014.

The east midlands reflects the national picture of a health service in crisis. The Government have spent nine years running down the NHS by imposing the biggest funding squeeze in its history, with massive cuts to public health services. Social care has been slashed by £7 billion since 2010. Our NHS is short of 100,000 staff, including 41,000 nurses and nearly 10,000 doctors. That has had a detrimental knock-on effect on performance: waiting lists are at 4.3 million, more than 500,000 patients are waiting more than 18 weeks for treatment, and 2.5 million people are waiting for more than four hours in A&E. That is a crisis.

It is clear that the underfunding, privatisation and inadequate staffing of our health service has had a devastating effect on healthcare provision in Lincoln and the east midlands. Government decisions have had terrible consequences for people who need care in the areas that I and many of my colleagues represent. That is typified by the recent announcement that the highly relied-on Skellingthorpe surgery may close.

For those who do not know it, Skellingthorpe is a beautiful village in my constituency. Its doctors surgery provides healthcare to more than 8,000 patients, many of whom are local residents. The national patient survey found that 81.9% of the surgery’s patients felt that their overall experience was good or very good. The Glebe Practice, which runs the surgery, is in the process of proposing its closure to the clinical commissioning group, and the practice’s patients are centralised in its Saxilby surgery. I acknowledge that there are pressures on the service—there could not fail to be, given the Government’s cuts—and that the practice is struggling to recruit clinicians, so centralising its service in Saxilby allows it to maintain quality in one surgery. However, centralising the service restricts my constituents’ access to care. They have told me that it is already very difficult to book a timely GP appointment there.

As many other hon. Members will know from their own constituencies, rural areas are often inaccessible because of limited transport links. If the Glebe Practice’s plan to transfer patients to its Saxilby practice is agreed to, it will mean patients having to travel on public transport—remember, not everybody can drive or has a car—or walk for 90 minutes from the Skellingthorpe surgery. Even the closest surgery is about a 40-minute walk away. Imagine elderly people having to walk for 40 minutes!

This is a shocking downgrade of my Skellingthorpe constituents’ access to care. The proposed alternatives do not offer an acceptable journey length to patients who are in need of health services. Many patients may struggle with mobility issues because of age or illness, while others may not be able to afford to travel other than by public transport.

[Ruth George (High Peak) (Lab)]

My hon. Friend is making an excellent speech that sets out the challenges to healthcare in rural areas such as Lincolnshire. Just this week, the wound service in one of our local clinics in High Peak has shut. Elderly patients with open wounds are having to travel for four hours each way, on three buses, to access the clinic that they are supposed to go to. Does my hon. Friend agree that that is absolutely unacceptable?

[Karen Lee]

Yes, I do. I hope that everybody in this Chamber would agree that that is really unacceptable.

Rather than reducing access to one-to-one healthcare, we should be outlining how we can help groups such as the Glebe Practice by implementing effective national programmes that incentivise recruitment in rural areas. There is a major workforce crisis: as a report co-authored by the Nuffield Trust, the King’s Fund and the Health Foundation has found, the NHS could be short of 7,000 GPs within five years. Rural areas will be the first to be hit. As access to GP services in the east midlands is reduced, I urge the Minister to take action to address the staffing crisis.

Before the surgery closes, Lincolnshire West CCG intends to hold a public consultation—but the people of Lincoln have been there before, very recently. Lincoln’s walk-in centre on Monks Road closed last year after an allegedly meaningful public consultation, 94% of respondents to which were opposed to the closure. Protests were held outside Lincoln County Hospital and along the high street. Both Conservative-led Lincolnshire County Council and Labour-controlled City of Lincoln Council formally objected to the closure, as did I, but not a bit of notice was taken—the centre was still closed. The justification was similar to the one being given now for the Skellingthorpe closure: we were told that there would be sufficient alternative provision to ensure the same level of care. After researching that claim, we found that no substitution would come anywhere near the accessibility of the walk-in centre, so I am afraid that my constituents’ faith in any local consultation is pretty limited.

Appointment-only slots will not meet the needs of my constituents who rely on short-notice, timely access to care. Inevitably, they will only add to the pressure on the overworked A&E department at Lincoln County Hospital and East Midlands ambulance service.

I am very concerned that a trend is emerging: the implementation of cuts to healthcare services, in direct opposition to local people’s wishes and needs. It is deeply worrying that CCGs are not listening to residents’ concerns before closing local health services. I completely acknowledge that there have been sustained budgetary pressures on the healthcare system over the past nine years, and that it is the CCGs that are expected to deliver large-scale cuts, but in a transparent health governance system we cannot allow cuts to be rubber-stamped against such clear local opposition.

I ask the Minister to consider these cases and contact me to provide substantial reasoning to explain why another closure in my constituency is considered acceptable. The information that I and my constituents have been afforded has led us to the opinion that neither the walk-in centre nor the Skellingthorpe surgery should have been considered for closure. I am sorry, Minister, but passing the buck to the CCG is not good enough for my constituents.

It is not just local GP practices and health centres that have been put under debilitating pressure over the past decade. In my constituency, Lincoln County Hospital serves the city of Lincoln and the north Lincolnshire area. Due to funding and staffing pressures, the latest Care Quality Commission inspection has found that Lincoln County Hospital is below the national standard and requires improvement. It is important to stress that, as is the case in hospitals throughout the UK, this substandard performance is in no way the fault of the dedicated and hard-working staff. I speak from experience: when I was a nurse there, we often used to stay up to an hour late. In theory we got our time back, but in practice we did not.

The staff give a lot—it is not their fault. I worked as a nurse at Lincoln County Hospital for 14 years and I know how much energy and care all the staff, from porters to doctors, put into their challenging work. That is supported by the CQC report, which concluded that the hospital requires improvement in four out of five areas: safety, effectiveness, responsiveness and management. The only area rated as good was the caring nature of the hospital. As the report states repeatedly:

“Patients were treated with compassion, dignity and respect.”

I pay credit to the hard-working staff for that, but they are being let down by a Government who have consistently neglected our health services. I have been through their cuts myself.

The inspection found that nurse staffing numbers were often insufficient to keep people protected from avoidable harm and that the hospital relied heavily on agency and locum staff. I know that at first hand: my friends who are still nurses there tell me that that is true even now. Most worrying was the fact that adequate levels of nurses were observed on only four of the 28 days that the CQC reviewed. It is hardly surprising that there are such drastic staffing shortages. Since 2010, there has been a 19% real-terms fall in weekly earnings for full-time nurses. Nursing degree applications have dropped by one third since the Government scrapped nursing bursaries, without which I would not have been able to train. I go on and on about the nursing bursary, and I will not stop. We need to bring it back; we will not have enough nurses until we do.

The Health Foundation has also found that the number of nurses quitting because of a poor work-life balance almost tripled between 2011 and 2018. Our NHS staff should be celebrated and supported. Their kindness and commitment should not be taken advantage of by a Government who strip away the security of their profession. Lincoln County Hospital demonstrates the devastating way in which avoidable staffing shortages affect vulnerable patients in our communities.

The CQC report also found that patients could not always access care and treatment in a timely way. Waiting times were worse than the England average and did not meet the national standard. Some 60% of ambulance handovers were delayed by 30 minutes or more, and 47% of patients in A&E waited longer than the recommended 15 minutes to be triaged. I went out with an ambulance crew about a year ago, and I saw that at first hand.

That shows how hard-working, committed NHS staff in Lincoln are being put under intolerable pressure by decisions made in Whitehall. That is not unique to Lincoln. In July last year, England’s chief inspector of hospitals recommended that United Hospitals Lincolnshire NHS Trust should remain in special measures after visits to Lincoln County Hospital, Pilgrim Hospital, County Hospital Louth and Grantham and District Hospital. Pilgrim Hospital in Boston, which serves my constituents, is a particularly worrying case. It received an overall rating of “inadequate” in this year’s CQC inspection. The report found that there was no allocated corridor nurse. Corridor nurse—really? Should people be in corridors on trolleys? One nurse was caring for up to 21 patients at one time. When I was a nurse, the average was about six or eight. On a bad day, if someone did not come in, it could be 10 or 12, but 21—really?

It is clear that at the local, regional and national level, healthcare provision is not working. Vulnerable people who need care in Lincoln, the east midlands and across the UK have a right to access the health provision that they need. That requires a properly funded and staffed NHS service, from local GPs to county hospitals. Although I welcome the Government’s planned funding increase for the NHS, most health experts agree that it is barely enough to keep the NHS afloat, let alone reverse nine years of severe funding cuts. Areas such as Lincoln and the east midlands need and deserve much more than a plan that will barely keep afloat a system operating on a shoestring budget.

As someone whose job used to be to provide local healthcare, I am lifted by the fact that everyone can access healthcare as a human right in this country, but that universal right is threatened by policies that do not enable an effective health service in which everyone can access care based on their need, not on the austere policy decisions of the Government of the day.

--- Later in debate ---

[Ruth George (High Peak) (Lab)]

It is a pleasure to speak in this debate about the issues that specifically affect the east midlands. I thank my hon. Friend the Member for Lincoln (Karen Lee) for bringing the debate to Westminster Hall and the hon. Member for Bosworth (David Tredinnick) for expounding on some of the local and national issues in his area.

High Peak in Derbyshire is on the very north-west tip of the east midlands, which brings its own pressures to a very rural area on the edge of two other regions that provide most of our acute healthcare: Greater Manchester and Sheffield in the Yorkshire region. We are highly dependent on other regions for our acute healthcare. People can find it difficult to access our local healthcare services. It is important that they are able to access the best possible healthcare locally, to prevent their problems from becoming more serious and so that they do not have to travel much longer distances to access acute care.

When I was first elected, I had an indoctrination of fire on healthcare matters. A consultation by our North Derbyshire CCG had been ongoing for two years. It was called “Better Care Closer to Home”, so its aspirations sounded marvellous: people would receive the care they sought closer to home or in their own home, rather than having to travel anywhere. In practice, it meant an announcement in July 2017, just after I was elected, that our local gold-standard dementia ward, the Spencer ward at the historic Cavendish Hospital, was to close.

The ward had 10 beds and took the most seriously ill patients with dementia, whose families were no longer coping with them at home. Often, they had got to the stage of being violent and abusive, fighting against the illness and against the people trying to care for them. It is a tragic illness and I have seen members of my own family go down with it, and at that stage families need all the support they can get.

The Spencer ward would take those patients whom no one else could cope with and, within six weeks and with no drugs whatever, manage them and their families into getting them home again. The staff claimed it was the shepherd’s pie that did it, but it was down to years of skill, expertise and kindness. The patients could be cared for at home, which everyone had thought was impossible, instead of having to go into specialist dementia care housing with high-level nursing care, which often costs six-figure sums for each patient. The ward closed in February last year, and it was an absolute tragedy for the patients and their families—even more so for the patients now coming through with dementia.

We were told that the 25 skilled staff would be transferred to a dementia rapid response team, a group who would be able to visit patients in their own homes, giving support to the families and enabling continued care at home. In practice, however, I am afraid that has not happened. The response team is located 20 miles from some of the areas in my constituency that most need it, and only one of the 25 skilled Spencer ward staff members went to work in that team. Others were left with no jobs in the health service; they went into retail and their skills were lost. That was a tragedy not just for patients but for staff and our whole community, because once those skills are lost, once those jobs have gone and people have left the NHS, it is almost impossible—without years of training and dedication—to put that service back together again.

That is why I am so committed to fighting for services in High Peak that are being let go because of years of cuts to our CCGs, which have to make very short-term decisions based on balancing the books by the year end. NHS England does not let them look at any longer-term measures or decisions that could put the investment into the preventive health measures talked about by the hon. Member for Bosworth. That cannot be the case.

In 2016-17, the formula was changed for the CCGs. Our CCG went into deficit and then special measures under NHS England. The chief executive said that he and his board were prepared to make £12 million of cuts in north Derbyshire, but NHS England said that that was not good enough. It insisted on £16 million of cuts within six months, so the chief executive left. In the year just gone, 2018-19, the cuts have come on. With a deficit of £95 million for all the Derbyshire CCGs, which are looking to band together to achieve some efficiencies of scale, they had to make £51 million of cuts. We are constantly being told about the NHS 10-year plan and the £20 billion of funding coming into the NHS. I do not know where that is going, but our CCG will not see it. The Minister may smile, but I do not find it funny that over the next four years Derbyshire, the area I represent, will experience £270 million in cuts to health services, which are already stretched almost to breaking point.

Like my hon. Friend the Member for Lincoln, I went out with the East Midlands ambulance service. I saw how stretched it was, having to travel vast distances and out of area, sometimes leaving little or even no cover, with patients perhaps having to wait five hours after a stroke, or being lost because of the cuts. The ambulance service has experienced five years of cuts, year on year.

Last year we had a Westminster Hall debate about the East Midlands ambulance service, which was attended by many of the Members present. I was delighted that another £20 million was invested in the service, but there is an issue with recruitment—once the skilled paramedics have left the service, recruiting them back again is very difficult. Meeting the targets for that extra £20 million will be extremely difficult for the service, through no fault of its own.

The issues in our local area put pressure on acute service providers as well. The hospitals in Macclesfield and Stepping Hill, which serve the north Derbyshire end of my constituency, have staffing problems and can shut their doors to High Peak patients because they are out of area—we are not in their region. The Macclesfield cardiology, gastroenterology and general surgery departments were shut to my local patients. Just before Breast Cancer Awareness Month in October, Stepping Hill shut breast services to patients from north Derbyshire, who therefore faced having to travel 30 miles for the follow-up to a mammogram. That is a huge distance for people in rural areas to travel; often, there is no transport available for them, so they are reliant on lifts. Yes, there is community transport, but that has been cut, too.

Our voluntary services have been cut because the clinical commissioning groups have to make their cuts by the end of the year, and one area they can cut is grants to external organisations. The voluntary sector has had cuts to social care, befriending services and community transport. As the hon. Member for Bosworth has said, a sustainable health service needs such services in order to provide preventive care and to enable communities to come together and support each other, particularly the most vulnerable. That needs a framework, but voluntary sector services are being cut time and again, as I said in a debate in September. Some £300 million of cuts have been made to voluntary sector services in Derbyshire.

Health service cuts are being made alongside those to social care. Derbyshire County Council has made huge cuts to services, resulting in care workers’ shifts changing from a two-shift to a three-shift system. It wanted more efficiencies and was struggling to fill some shifts, but working early, late and night shifts is almost impossible for anyone with caring responsibilities, which most social care workers have. I am sure my hon. Friend the Member for Lincoln, who worked in nursing, will sympathise with that and will know the destructive effect on people’s lives. It is one thing to do that for a nurse’s salary, which is a professional salary, but it is very different to ask people to do that for the minimum wage—it was a living wage under the Labour-led Derbyshire County Council, but now it is less than the national living wage. Asking people to work a three-shift system for that sort of money is simply not worth it, so they have left in droves.

Our care home fees have been frozen while at the same time the minimum wage, pension costs and business rates are all increasing. The care homes are not prepared to take any elderly residents with any sort of additional needs. There are no nursing homes whatsoever in the High Peak area, so we have to go out of area. It is an increasingly difficult situation for families, who struggle to visit patients and keep family ties going. It is heartbreaking that, at the end of a long life, residents are taken out of their area, away from the people they know and love and their communities.

That is the impact on rural areas of years of cuts to health and social care and to the young people’s services provided by the county council. Both older and younger people are being squeezed. A couple of weeks ago I held a debate in the main Chamber on young people’s mental health, because of the low-level support being given. Derbyshire CCGs have cut the contract for counselling services with the third sector and there is no longer a service in place. The number of school nurses, who support young people through difficult times in their lives, when they have anxiety and are distressed, has been halved. There is an 18-month wait for access to child and adolescent mental health services. I hear from young people and their families who are desperate. Often, parents feel they have to stay with their child 24 hours a day, seven days a week, because they are so scared of the harm that the child may do themselves and the risk of suicide that the hon. Member for Bosworth mentioned.

Why are we letting it get to this stage? Why are we letting our young people suffer in silence? Why are we sending our older people away from their families? It comes down to the failure to look holistically at our health and care services in the long term. NHS England still has Derbyshire CCGs in special measures. They have been told to meet a target of between £50 million and £70 million of cuts over each of the next four years. They have to identify those cuts behind closed doors. There is a lack of scrutiny, as my hon. Friend the Member for Lincoln has said.

Often, so much of the impact is on patients and GPs, who have to pick up the pieces. The strain on GPs is almost intolerable. Buxton has only about half the GPs we need. There are shortages in other areas, too. At my surgery, patients have to phone two weeks in advance to even try to get an appointment with a GP. If they do not phone early enough, they cannot get an appointment in those two weeks and they have to try the next day. That leads to an increase in people going to A&E and an increase in admissions to acute care and costs to the NHS as a whole. That is not a cost-saving process.

Budgets that do not look at the whole picture, to try to help primary care and to support people’s conditions, are leading to an increase in the need for acute care. Because of the lack of social care, once people are in a hospital bed it is hard for them to get out of it. The number of beds at Fenton ward in Cavendish Hospital—the one rehabilitation ward left in my constituency—has just been reduced from 18 to 10. That was going to happen in October but I managed to persuade the hospital that it might need some rehab beds over winter. It kept them open but it is now down to 10 beds. There is a waiting list of six or seven patients, who are stuck in hospital, taking up hospital beds because the rehab beds have been cut. That is a false economy.

I hope the Minister will look at how the system has an impact on the health professionals who are trying to deliver a service, and most of all on the patients who are suffering under it. Yes, there is price for rationalisation in any service, but we also have to look at the long term. As the laudable aims of the NHS 10-year plan set out, we need to work with our communities, support our professionals and help our patients to care for themselves. Unless this financial system changes, that NHS plan will be simply hot air.

--- Later in debate ---

[The Minister for Health (Stephen Hammond)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. As you know, I have met the chief executive of the team from Kettering, I have visited Kettering and I have responded to you on the Floor of the House about Kettering. Kettering and its requirements for the A&E are therefore not far from the forefront of my mind.

I congratulate the hon. Member for Lincoln (Karen Lee) on securing the debate and I thank all hon. Members for their contributions. I intend to spend some time going through a number of the areas raised this morning. I am bound to say that the long-term plan, which a number of Members welcomed, is a substantial step forward, and the funding commitment—the biggest ever in peacetime—is a key to ensuring that that can be delivered. The number 100,000 has been trotted out, but clearly that does not represent posts unfilled, nor does it take any account of the actions that the Government are undertaking. More than that, the simple fact is that, compared with eight years ago, there are 14,700—over 15%—more doctors, 10,300 more nurses, midwives and health visitors and, in addition, over 15,900 more nurses on our wards.

I also point out that of those vacancies that several hon. Members mentioned, well over 80% are being filled by a combination of bank and agency nurses. Of course no one wants that situation to persist, but there has been a consistent decline in the number of agency staff, and since the transfer from the bursary to the loan system, much has been done working with nurses to ensure that courses are filled. We are seeing more applications than previously: this time around UCAS reported over 4,000 more applicants. Last year, my predecessor announced a fund to provide an increased package for postgraduate nursing students starting courses in 2018-19 in terms of employment in learning disability, mental health and district nursing roles, which are the key vacancies that need to be filled.

I will try to answer a couple of specific points raised by the hon. Member for Lincoln. She rightly voiced concerns about the closure of Skellingthorpe health centre in her constituency. As she pointed out, were there to be a closure, the CCG would be required to conduct a proper consultation. I spoke to the CCG yesterday and I understand that as yet—she may wish to correct me—there has been no formal request for closure. Equally, the CCG tells me—I hope this is right—that it will meet the hon. Lady later in May to discuss this matter, and that, were there to be a request, it would immediately inform her and offer her a meeting with it and the lead GP at Skellingthorpe to see what action could be undertaken. The CCG has also confirmed —she will understand this—that it appreciates that this is a rural community, and that there are additional challenges for local residents, so it is working not only with Skellingthorpe to understand the challenges and how they may be met, but to ensure that the rural network of GPs might work together.

The hon. Lady rightly expressed concern about CQC inspections, and I will go on to speak about those if I have time. She mentioned the recent inspection that took place on 25 February at Pilgrim Hospital, with a report published on 3 April. Although “requires improvement” remains the rating, there were marked improvements in certain areas, including in the standard of care, numbers of staff and nursing provision for children, and a real improvement in the triage time. She will appreciate that the trust is receiving substantial support from NHS England, including to help the hospital get out of special measures.

My hon. Friend the Member for Bosworth (David Tredinnick), chair of the all-party parliamentary group for integrated healthcare, spoke passionately about the health and wellbeing partnership. He is absolutely right, and the Government support the integration of healthcare services and recognise the good work being done by that partnership in Hinckley and Bosworth. The Secretary of State enjoyed his visit to Hinckley, and was particularly pleased to get a real impression on the ground of the improvement in services that will come from the £8 million investment. My hon. Friend reminded me of his Christmas present to me, and I was pleased to read some—although not all—of his report over the Christmas period. You will not be surprised to hear, Mr Hollobone, that I was also intrigued to hear his comments about India. I sometimes think that the “Ministry of Calm” in India could benefit many people in this place.

The hon. Member for High Peak (Ruth George) spoke about “Better Care Closer to Home”. That reminded me of when I was a councillor 18 years ago and a different Government wanted to do to local services in my area the things that she described. The issue was only resolved some years later, in 2015, when a new medical centre was built. She rightly mentioned the East Midlands ambulance service and—most importantly —its paramedics. I visited that service earlier this year, and spoke not only to the management but to the medics who deliver those services. There are clearly challenges regarding location, and not all the standards have been met. It is also true, however, that there are 67 new ambulances—an increase of 27—and response times have improved, which is to be welcomed. I recognise the problems with CAMHS that the hon. Lady raised. That is clearly an issue nationally as well as in the east midlands, and it is right for the long-term plan to recognise that. The commitment to mental health diagnosis and treatment times is a significant change from the previous situation.

[Ruth George]

Mental health services were allocated £1.2 billion, but that money was not ring-fenced. That is the problem that CAMHS has had with the cuts. Will the Minister commit that any additional funding for mental health services will be ring-fenced, so that it goes where it is needed?

[Stephen Hammond]

There is a commitment to treatment and the funding that backs it in the long-term plan, and that money is dedicated to that commitment. That is pretty clear.

[Ruth George]

indicated dissent.

[Stephen Hammond]

The hon. Lady is asking me to use the word “ring-fenced”, but if I say that the money is there and allocated for that matter, then it is specifically ring-fenced for it.

My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) gave us a valuable insight into the NHS, given her experience as a consultant. She is right to say that we must tackle a number of workforce issues, and morale is undoubtedly key to that. I was pleased to see that set out in the initial workforce plan; and Baroness Harding, chair of NHS Improvement, has been asked to consider a stream of work about making the NHS the best employer. That work will consider a number of issues about retention and the culture and morale of staff. I look forward to the publication of that report, and I hope my hon. Friend will join me in welcoming the new ideas it contains.

My hon. Friend was right to mention the pensions of a number of GPs and other NHS staff. She will not be surprised to hear that I am continuing to persuade Treasury colleagues to accept the Department’s proposed solution for that issue, and I hope we can make progress and make an announcement on that soon, which will be reassuring to many. I encourage my hon. Friend to write to me about the dispensing service she mentioned, and I will consider what issues we can take up. Finally, she was right to talk about the orthopaedic services at Grantham. “Getting It Right First Time”—GIRFT—is led nationally by Professor Tim Briggs, who was lead clinician at the Royal National Orthopaedic Hospital. That is making a huge difference, not only to the concentration, specialisation and number of operations being undertaken, but—equally importantly—the great improvement in safety and reduction in infections is leading to hugely better care for patients.

The hon. Member for Washington and Sunderland West (Mrs Hodgson) mentioned A&E performance, and she is right to say that it fails to meet the target. However, she is wrong to say that this year has seen the worst performance ever, as there has been an improvement on last year. Over the past months, United Lincolnshire Hospitals NHS Trust has seen a huge increase in attendances compared with the previous year. That reflects the wider NHS, where demand is up by 6%, yet more than 4,700 patients per day are treated within the four-hour waiting limit. The hon. Lady mentioned Public Health England and Health Education England, but funding for those bodies was designed to be dealt with in the comprehensive spending review that will take place in the autumn. It was never intended to be tackled inside the long-term plan and spending commitment.

The hon. Lady mentioned money, but this is a transitional year for funding. The funding provided is enough to work on the deficit, and given the analysis being done, the Government’s commitments, and the work on efficiency in the health service, it is surprising that Labour Members who recognise the benefits of much of the long-term plan are not prepared to welcome the financial settlement that backs it up and will deliver it.

Briefly, let me mention another east midlands MP, my hon. Friend the Member for Erewash (Maggie Throup). She was not able to speak today as she is my Parliamentary Private Secretary, but she has done great work in pointing out the benefits of Ilkestone Community Hospital, which I intend to visit in the near future. May I just say that—

Mental Health Support: Young People

Ruth George Excerpts

Tuesday 9th April 2019 Commons Chamber

[Ruth George (High Peak) (Lab)]

I applied for this debate because of the cases of young people struggling to receive mental health support in my constituency of High Peak and in the county of Derbyshire. However, since last week, when the debate was announced, hundreds of parents, support workers, teachers and young people themselves have contacted me from across the country with heartbreaking stories of young people suffering with little or no support.

Their families suffer, too: like the mum of an 11-year-old boy in my constituency who has been severely mentally ill since last September. He suffers from panic attacks and his mum says he hardly eats or sleeps. He is unable to leave the house. He is very depressed and anxious all the time, and has been destructive and suicidal on many occasions. Mental health services will not support him, in spite of a referral from the GP, because they will not do home visits for a boy who is too ill to leave the house.

There is the six-year-old who is at risk of being excluded from school due to his behaviour. He has suspected attention deficit hyperactivity disorder or autistic spectrum disorder, but 18 months after referral the family are still waiting. Without a diagnosis, he can get neither the health nor education support he so desperately needs. His mum is trying online courses in child behavioural psychology, but she cannot help him without a diagnosis to access the medication and/or therapy he needs. The stories are similar from around the country and I thank all the people who have contacted me on this issue.

[Mr Ivan Lewis (Bury South) (Ind)]

Does my hon. Friend agree that young people with autism who have mental health problems and their families have particular challenges in accessing appropriate services? Does she agree that Ministers need to look specifically at the needs of young people with autism who also have mental health problems? My experience in my constituency is that access to emergency support when there is a real crisis is often non-existent or inappropriate. There is then the question of transition for young people from being a teenager to being an adult. Does she agree that that needs a distinct approach?

[Ruth George]

I absolutely agree with my hon. Friend. There are so many areas of children’s mental health where support is needed, but with ASD a diagnosis is needed as well, which can delay the support they so desperately need.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for giving way. I did seek her permission to do so beforehand. I congratulate her on bringing this issue to the House today for an Adjournment debate. It is a critical issue and we are all very aware of it. Does she agree that the world young people face today, in which they have little privacy and so much exposure, is just so difficult? There is no place to go to get out of the reach of bullies or social media. This pressure sees so many young people struggling with self-esteem and self-worth. There must be more early intervention support for these young people to provide affirmation and tools for parents to help at an early stage and not let self-harming or suicidal thoughts begin.

[Ruth George]

I absolutely agree with the hon. Gentleman. I will come on to some of the additional stresses that young people are facing at the moment.

[Hugh Gaffney (Coatbridge, Chryston and Bellshill) (Lab)]

I met the Teenage Cancer Trust, which talked about young cancer victims who have mental health problems. They, too, do not have enough support, so I thank my hon. Friend for securing this debate.

[Ruth George]

I agree.

[Mark Tami (Alyn and Deeside) (Lab)]

rose—

[Ruth George]

I have personal family experience of this, as does my right hon. Friend.

[Mark Tami]

Does my hon. Friend agree that with cancer, we cannot treat just the physical illness? We need to treat the mental side of dealing with it. That needs to be part and parcel of treatment and not just some sort of add-on that people seek afterwards.

[Ruth George]

I absolutely agree with both my right hon. Friend and my hon. Friend the Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney). I know that even long after the physical experience of cancer has left young people, children and adults, the mental scars can linger, particularly for families.

The number of children and young people overall with a mental health disorder has increased to nearly one in eight, according to the children and young people prevalence survey in November. That is around 1.25 million young people, yet only one in four young people with a mental disorder is seen by a mental health specialist. Over 400,000 children and young people are not getting any professional help at all in England—that is almost 1,000 young people and their families suffering in every one of our constituencies. The lack of support leads to their condition worsening.

In 2017, 46.8% of young people with a mental health disorder had self-harmed or attempted suicide at some point, and over a quarter of 11 to 16-year-olds. The threshold to access child and adolescent mental health services has become so high that local teachers in my constituency are asked to provide evidence that a child has sought to take their life before a referral will be accepted. It is not enough to be told that they have tried to take their own life—CAMHS wants evidence, and these are schools with children up to the age of 16. Even when young people are accepted, the waiting time for treatment from CAMHS in my constituency is over 12 months, and sometimes 18 months. That is not unusual. It is no wonder that children are driven to more and more desperate measures just to get heard.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

The hon. Lady is making some powerful points in a powerful speech. I speak as the father of four children between the ages of 22 and 11. Any family in the modern era has to face these problems. Does she agree that parents need more support to understand these issues and to learn how to deal with them more effectively to try to help our children?

--- Later in debate ---

[Ruth George]

As a parent of four children aged between nine and 27, I agree that there are strains from modern life, but when parents need support, they find it far too difficult to access.

[Rachael Maskell (York Central) (Lab/Co-op)]

The waiting times in York are also horrendous. The funding, which has, in fact, gone down in the last year, is just £40 per child. Is not that so insufficient to match need?

[Ruth George]

Absolutely. It will not surprise my hon. Friend to hear that I will come to the issue of funding later, but that is a chronically low figure for the number of young people and children who are suffering.

The number of suicides of teenagers has risen by two thirds since 2010. I pay tribute to my constituent, who says that she is too scared to leave her 14-year-old daughter alone anymore. Having seen her daughter try to take her own life using paracetamol, my constituent is campaigning for the sale of paracetamol to under 16-year-olds to be banned. I ask the Minister to look into that.

We should do what we can to prevent access to the means for young people to take their own lives, but even more, we should look at stemming the reasons why they are driven to such desperation and making sure that treatment can reach them far earlier. Our children are suffering under the weight of demands at the same time as the people who have always been there to support them are disappearing.

Young people suffer from exam pressure, driven by school league tables. An 11-year-old in my constituency, who had always been perfectly happy and is incredibly intelligent, had a panic attack before his standard assessment tests. He said that the children knew that if they did not do well in their exams, their small village school could be driven to close through a lack of parents applying for places. Pressures on children aged 10 and 11 are just too much. My secondary schools say that children come to them in year 7 bearing such a weight of emotional stress that it is almost impossible to support.

There are higher numbers of children with special needs at our schools and less support for them as school cuts bite. There are exclusions from schools, with thousands of children taken off the roll. With fewer support staff in our schools, there is more opportunity for bullying. As the hon. Member for Strangford (Jim Shannon) said, social media enables the continuation of that bullying throughout the day and the night.

[Chris Elmore (Ogmore) (Lab)]

My hon. Friend will be aware of the work that I have been doing—indeed, with the Minister—on social media and the need for more research into it to gain understanding. She mentioned the data on increased self-harm and suicide. Another correlation is that, in the past decade, social media use has rocketed and that is having an impact on our young people. The Government and the devolved Administrations need to conduct more research on the impact of social media so that we can look at early intervention and, where possible, prevention, to support young people who are addicted to social media platforms.

[Ruth George]

Absolutely. I pay tribute to my hon. Friend for his work on the matter. I hope that the Government will take up the recommendations in the report that the all-party group on social media and young people’s mental health and wellbeing, which he chairs, has produced.

We are seeing not just online but physical bullying, and rising violent crime, especially among young people. I spoke to teenagers at a college yesterday who told me that they are actually scared of the gangs of 13 and 14-year-olds who roam the streets in my area. Of course, young people are more likely to be victims of violent crime than anyone else.

Even in quiet rural areas such as mine, county lines gangs put pressure on more and more teenagers to become involved in crime. When I visited my local youth centre and talked to teenagers there, they said that, for one night a week, it is the one place they can go to escape the gangs and their peers who put pressure on them to get involved in drugs, aged just 13 and 14.

[Jim Shannon]

Will the hon. Lady give way?

[Ruth George]

I really need to make progress—I am sorry.

At the same time, more parents are working longer hours and spending more time travelling to work. We have the longest commuting times in Europe. Those parents have less time to spend with their children. There are more demands for flexibility from employers, especially at weekends, in the evenings and in school holidays—the times that parents most need to spend with their children.

There are new demands from the state for parents to be in full-time work, whether to access free childcare places from age three or through the demands of universal credit from age 12. At the same time as parents are working harder and longer, there is an increase in child and family poverty. Increasing numbers of parents face money worries and debt and have to visit food banks—strains that their children all too often see.

Alongside all those pressures on families and our young people, the number of professionals who are there to support them is reducing. Class sizes in schools are increasing and there are fewer teaching assistants, so school staff have less time for each child and growing pressures to prove academic achievement. Our schools do a fantastic job and I pay tribute to the staff who go above and beyond to support the young people in their care, but they cannot help with the sustained, one-to-one counselling and professional support that is so often needed. On top of that, child and adolescent mental health services have huge waiting lists and are still underfunded.

Our clinical commissioning groups spend 14% of their budget on mental health, but just 0.9% on children’s mental health. Even when the Government put additional funding into CCGs, it was not ring-fenced and, too often, not spent. Although an extra £250 million a year was allocated to CAMHS, in the first year only 36% of CCGs increased their spending by as much as that allocation. In the following year, 2016-17, only half of them did so, and last year, 2017-18, the spending stayed roughly the same. In 2018-19, it increased by just £50 million. Only a small fraction of the £1.25 billion that the Government had invested in children’s mental health services and CAMHS actually reached the front line.

CCGs are under huge pressures. Derbyshire’s CCGs have had to cut their spending by £51 million this year, and, despite the promised extra £20 billion for the NHS, they face further spending cuts of £270 million over the next four years. Mental health services are on the target list. The number of psychiatrists working in CAMHS at all levels fell by 3.7% between 2011 and 2018, although the number of referrals has almost doubled, as has the number of children admitted to A&E with mental health problems. At the same time, councils are cutting their spending.

School nurses spend a great deal of time supporting families and young people on the CAMHS waiting list who are going through the agonising wait of 12 to 18 months while experiencing suicidal thoughts, but they too are being subjected to cuts because of cuts in public health spending. We are losing half our school nurses in Derbyshire. As for “early help” support for families, 200 staff are being made redundant, and there is nowhere for families to turn for support. At all levels, support services are being underfunded. The Government have made a commitment to providing more counsellors in schools, which is often the right place for them, as children may need access to support. However, the target of extra provision in just a quarter of schools in five years’ time is not good enough. Our children are being failed, and their families are being failed.

Investment in mental health support for young people would actually save the Government money—not just in the health service, which would be able to nip mental health problems in the bud, but in the education, social services and criminal justice sectors. Our young people are crying out for help. The Government have some laudable aims in the 10-year plan, but they have not enough concrete plans to implement those aims, to fund CCGs to deliver them, or to invest in the training of the staff who will be on the front line.

The huge number of people who have contacted Parliament, and me personally, about this debate shows how much concern exists out there about the terrible cases of young people who are driven past the point of despair and the families whose lives are turned upside down. This is a cry for help on behalf of all of them. I ask the Minister please to listen, and to tell us how the Government will act.

--- Later in debate ---

[Jackie Doyle-Price]

There will be cases when it comes down to a clinical decision on whether a referral to a mental health professional is needed. However, we need to ensure that mental wellbeing is embedded throughout our health services.

[Ruth George]

In my area CAMHS are supposed to accept referrals from some of the young people on level 2—that indicates their level of need—and all of the young people on levels 3 and 4. As it is, they do not have time to accept even those children on level 4, which has the highest priority. That is a result of resources, not clinical judgment.

[Jackie Doyle-Price]

That is not borne out by the figures from the Derby and Derbyshire clinical commissioning group, which show that 31% of children and young people with mental health needs were seen by NHS-funded mental health services. I come back to the point that it is not acceptable for children to be told that they are not yet ill enough to receive treatment, which is why we are investing in more provision. We expect at least an additional 345,000 children and young people aged nought to 25 to be able to access more direct support.

Draft Food and Feed (Chernobyl and Fukushima Restrictions) (Amendment) (EU Exit) Regulations 2019 Draft Food and Feed (Maximum Permitted Levels of Radioactive Contamination) (Amendment) (EU Exit) Regulations 2019

Ruth George Excerpts

Thursday 14th March 2019 General Committees

[Steve Brine]

I can absolutely assure the hon. Gentleman that that is the case. The draft regulations are an import from EU regulations. The European Union (Withdrawal) Act 2018, which I referred to, is a housekeeping piece of legislation, not a changing piece of legislation. If we wished to make changes either way—to strengthen or to weaken such regulations—they would come through the House and be examined by it. I am sure the hon. Gentleman and the good people of Slough would rightly take an interest and have something to say about them—as, indeed, would I.

[Ruth George (High Peak) (Lab)]

My constituency hosts children coming over from Chernobyl and Ukraine. Children as young as three are already getting cancers, so although levels of radioactivity in foodstuffs may have declined, we are still seeing a much larger prevalence of cancers in that area, particularly among children. Does the Minister agree that it is important not only to encourage such exchanges, so that children can come and eat uncontaminated food and breathe fresh air in this country, but to ensure we keep our country protected from such levels of radioactivity?

[Steve Brine]

The hon. Lady has put that point very well; I could not disagree with a syllable of that.

This instrument also makes alterations to similar European legislation, regulation 2016/6, which imposes special conditions on the imports of food from areas of Japan that were affected by the Fukushima accident, which was in 2011. In this case, eight years after the accident, higher levels of radioactive contamination are limited to only certain areas of Japan, and affected products include—believe it or not—wild mushrooms again, and other wild vegetables. Wild game may also show high levels of contamination, but those products are not eligible for import into the UK under food safety measures that are not related to these regulations.

As the regulations relate to specific contamination incidents, as radioactivity naturally decays, and since natural and human activities remove contamination from the environment, it is right that the regulations are regularly reviewed to ensure that controls are fit for purpose. The legislation relating to the Chernobyl accident has an expiry date of 31 March 2020—next year—while the legislation relating to the Fukushima accident must be reviewed before 30 June 2019. That is what is stated in the regulations that we are importing.

I raise this point because I want to be clear with the Committee that we will be bringing over those review dates into UK legislation. It is the same point that I made when I responded to the hon. Member for Slough about standards: we are not going to drop the ball in any way on their being reviewed. It is important for those two communities and those two countries that we do that as well as ensuring that we review the safety risk in this country.

The second statutory instrument in this bundle, the Food and Feed (Maximum Permitted Levels of Radioactive Contamination) (Amendment) (EU Exit) Regulations 2019, ensures that regulation 2016/52, the legislation covering the application of maximum permitted levels of radioactivity in food and feed following a nuclear emergency, continues to function effectively after exit. The first statutory instrument is about Chernobyl and Fukushima; the second looks ahead to what we hope will never happen—possible future incidents.

EU law in this area establishes maximum permitted levels of radioactive contamination in food and feed that would come into effect following a nuclear accident or any other case of radiological emergency, which could be an accident involving a medical use, a domestic power incident or, indeed, an aggressive act that led to some form of nuclear accident—although that would not be an accident. The regulation therefore acts as a framework that can be enacted promptly to apply emergency levels of radioactive contamination in food and feed to protect consumers.

If those levels were exceeded, it would have a detrimental effect on human health from the consumption of food contaminated by radioactivity. Applying the levels would assist the response to a radiological incident. Currently, the European Commission holds a range of powers under European legislation that enable it to respond in the event of such an accident or another radiological emergency. Those powers allow the Commission to put in place measures in the form of emergency implementation regulations that apply the maximum permitted levels set out in regulation 2016/52, and so prevent potentially contaminated food from getting on to the marketplace.

Let me emphasise again that there are no changes to policy in these instruments beyond making the minimal changes necessary to rectify the deficiencies in what will be retained EU legislation. I am confident in saying that consumers in the UK will benefit from high standards of food and feed safety. We are committed, as I said to the hon. Member for Slough, to maintaining those.

The instruments will transfer responsibilities from the European Commission to Ministers in England, Wales, Scotland and the devolved authority in Northern Ireland. In addition, the instruments will change references regarding import into the European Union to references regarding import into the United Kingdom—perfectly logical.

To be clear, the draft instruments will not introduce any changes in how food businesses are regulated or run, unlike previous SIs we have discussed in this sequence, nor will they introduce any extra burdens. The instruments provide continuity for businesses, protect consumer interests and ensure that enforcement of the regulations continue in the same way. They will ensure a robust system of control, which will underpin UK businesses’ ability to trade domestically and internationally.

It should be noted that the draft regulations will apply only following a nuclear accident or other radiological emergency, as I have mentioned. They are not intended for routine activities, which are governed through regimes such as those under the domestic Ionising Radiation Regulations 2017 or the Environmental Permitting (England and Wales) Regulations 2016, which the Health and Safety Executive owns.

It is important to note that the devolved Administrations have provided consent for the draft instruments. We have engaged positively with the DAs throughout the development of the regulations, and the engagement is warmly welcomed—as before, I place that on the record.

The regulations therefore constitute a necessary measure to ensure that our food legislation relating to food and feed safety and radiological protection continue to operate effectively after EU exit day. That is the case both for the historical Chornobyl and Fukushima regime and for the future. I urge hon. Members to support both sets of regulations.

Draft Food and Feed (Chernobyl and Fukushima Restrictions) (EU Exit) Regulations 2019 Draft Food and Feed (Maximum Permitted Levels of Radioactive Contamination) (Amendment) (EU Exit) Regulations 2019

Ruth George Excerpts

Thursday 14th March 2019 General Committees

[Steve Brine]

I can absolutely assure the hon. Gentleman that that is the case. The draft regulations are an import from EU regulations. The European Union (Withdrawal) Act 2018, which I referred to, is a housekeeping piece of legislation, not a changing piece of legislation. If we wished to make changes either way—to strengthen or to weaken such regulations—they would come through the House and be examined by it. I am sure the hon. Gentleman and the good people of Slough would rightly take an interest and have something to say about them—as, indeed, would I.

[Ruth George (High Peak) (Lab)]

My constituency hosts children coming over from Chernobyl and Ukraine. Children as young as three are already getting cancers, so although levels of radioactivity in foodstuffs may have declined, we are still seeing a much larger prevalence of cancers in that area, particularly among children. Does the Minister agree that it is important not only to encourage such exchanges, so that children can come and eat uncontaminated food and breathe fresh air in this country, but to ensure we keep our country protected from such levels of radioactivity?

[Steve Brine]

The hon. Lady has put that point very well; I could not disagree with a syllable of that.

This instrument also makes alterations to similar European legislation, regulation 2016/6, which imposes special conditions on the imports of food from areas of Japan that were affected by the Fukushima accident, which was in 2011. In this case, eight years after the accident, higher levels of radioactive contamination are limited to only certain areas of Japan, and affected products include—believe it or not—wild mushrooms again, and other wild vegetables. Wild game may also show high levels of contamination, but those products are not eligible for import into the UK under food safety measures that are not related to these regulations.

As the regulations relate to specific contamination incidents, as radioactivity naturally decays, and since natural and human activities remove contamination from the environment, it is right that the regulations are regularly reviewed to ensure that controls are fit for purpose. The legislation relating to the Chernobyl accident has an expiry date of 31 March 2020—next year—while the legislation relating to the Fukushima accident must be reviewed before 30 June 2019. That is what is stated in the regulations that we are importing.

I raise this point because I want to be clear with the Committee that we will be bringing over those review dates into UK legislation. It is the same point that I made when I responded to the hon. Member for Slough about standards: we are not going to drop the ball in any way on their being reviewed. It is important for those two communities and those two countries that we do that as well as that we ensure that we review the safety risk in this country.

The second statutory instrument in this bundle, the Food and Feed (Maximum Permitted Levels of Radioactive Contamination) (Amendment) (EU Exit) Regulations 2019, ensures that regulation 2016/52, the legislation covering the application of maximum permitted levels of radioactivity in food and feed following a nuclear emergency, continues to function effectively after exit. The first statutory instrument is about Chernobyl and Fukushima; the second looks ahead to what we hope will never happen—possible future incidents.

EU law in this area establishes maximum permitted levels of radioactive contamination in food and feed that would come into effect following a nuclear accident or any other case of radiological emergency, which could be an accident involving a medical use, a domestic power incident or, indeed, an aggressive act that led to some form of nuclear accident—although that would not be an accident. The regulation therefore acts as a framework that can be enacted promptly to apply emergency levels of radioactive contamination in food and feed to protect consumers.

If those levels were exceeded, it would have a detrimental effect on human health from the consumption of food contaminated by radioactivity. Applying the levels would assist the response to a radiological incident. Currently, the European Commission holds a range of powers under European legislation that enable it to respond in the event of such an accident or another radiological emergency. Those powers allow the Commission to put in place measures in the form of emergency implementation regulations that apply the maximum permitted levels set out in regulation 2016/52, and so prevent potentially contaminated food from getting on to the marketplace.

Let me emphasise again that there are no changes to policy in these instruments beyond making the minimal changes necessary to rectify the deficiencies in what will be retained EU legislation. I am confident in saying that consumers in the UK will benefit from high standards of food and feed safety. We are committed, as I said to the hon. Member for Slough, to maintaining those.

The instruments will transfer responsibilities from the European Commission to Ministers in England, Wales, Scotland and the devolved authority in Northern Ireland. In addition, the instruments will change references regarding import into the European Union import into the European Union to references regarding import into the United Kingdom—perfectly logical.

To be clear, the draft instruments will not introduce any changes in how food businesses are regulated or run, unlike previous SIs we have discussed in this sequence, nor will they introduce any extra burdens. The instruments provide continuity for businesses, protect consumer interests and ensure that enforcement of the regulations continue in the same way. They will ensure a robust system of control, which will underpin UK businesses’ ability to trade domestically and internationally.

It should be noted that the draft regulations will apply only following a nuclear accident or other radiological emergency, as I have mentioned. They are not intended for routine activities, which are governed through regimes such as those under the domestic Ionising Radiation Regulations 2017 or the Environmental Permitting (England and Wales) Regulations 2016, which the Health and Safety Executive owns.

It is important to note that the devolved Administrations have provided consent for the draft instruments. We have engaged positively with the DAs throughout the development of the regulations, and the engagement is warmly welcomed—as before, I place that on the record.

The regulations therefore constitute a necessary measure to ensure that our food legislation relating to food and feed safety and radiological protection continue to operate effectively after EU exit day. That is the case both for the historical Chornobyl and Fukushima regime and for the future. I urge hon. Members to support both sets of regulations.

Community and Voluntary Services: Derbyshire

Ruth George Excerpts

Friday 8th February 2019 Commons Chamber

[Ruth George (High Peak) (Lab)]

I rise to pay tribute to our community and voluntary services across Derbyshire. They are the fabric that holds our rural and often isolated society together. In my own constituency of High Peak, we have four offices—in New Mills, in Whaley Bridge, in Buxton and at the Bureau in Glossop. They organise volunteers, provide services for frail, elderly and isolated people, and give the volunteers a sense of purpose and wellbeing.

One of the volunteers told me that his volunteering

“gives me a purpose, a reason to get up in the morning. It makes me feel like I’m giving something back, rather than being an outcast. I’d lost my wife who died from cancer and my job on the same day. I was her carer for 18 months until she died and I had a breakdown.”

Now, however,

“I can hold my head up high… I’ve reduced my medication for depression”,

and he feels

“part of a family again and feeling stronger and more confident.”

That is what our voluntary sector can do for us as a society. Another volunteer said:

“While I’m here it takes my mind off what’s happening at home. I care for my wife and my son. My wife has mental health issues and my son has ADHD and neurofibromatosis.”

These are very giving people. They give in their life at home to their family, but they are also prepared to give to others.

A befriender from my constituency said:

“The person I befriend has become so much chattier, less depressed and healthier in general since we have been seeing each other. I honestly believe befriending and regular companionship is the remedy to loneliness, and if this service is cut then it’s going to be devastating for those who rely on their befrienders for social contact, and feeling like someone cares. My ‘friend’ has told me about how it feels to be lonely: they don’t speak for days at a time and they haven’t been touched by another human being for weeks, until they go to the shop and the cashier gives them their change, or until the nurse gives them an injection. It is heartbreaking because these lonely people have so much left to give and no one to give it to, and it is something that is all too common in today’s disconnected society.”

That is why I and communities across Derbyshire are so devastated that our community and voluntary services are facing more than half a million pounds of cuts—part of £51 million of cuts made by Derbyshire clinical commissioning groups, more than £100,000 of which fall on the High Peak and Dales CCG. Those cuts led all affected GP services in High Peak to write and raise their concerns about the decision of the new clinical commissioning group to make cuts of almost £100,000 to the community and to voluntary health and care provision. They say that the cuts will affect many of our patients, in particular the elderly, the frail and the isolated.

There is a night sitting service—the only one available—and it supports carers when patients come out of hospital. Without it, more patients will wait in hospital when they could have come home. The “home from hospital” service, which also faces cuts, has the same effect wherever it operates. Community transport is facing cuts, even though it is often the only option for patients to attend medical appointments where there is no public transport and they cannot afford a taxi. I have already heard about patients who sent in a sample for bowel screening but were not able to attend the follow-up appointments. They say that the next time they will not bother doing the screening because they cannot get to the follow-up appointment. Community transport drivers offer companionship as well as a driving service, and they keep an eye on frail patients.

As I have set out, the befriending service is appreciated by people who are isolated and lonely. Their regular social contact gives them something to look forward to and helps to prevent depression, which affects their physical as well as their mental health. GPs say that providing activity and support also helps volunteers, and it gives them a sense of purpose and wellbeing in helping to care for people who value their support and company. That is especially helpful for people who are newly retired, who live on their own, or who are recently bereaved, because it helps them to keep well.

The cuts will impact on GPs and already over-stretched health and care services, yet there has been little to no direct consultation with individual GPs or their practices. The services are extremely cost-effective, and although the cuts bring short-term gain, they will cost the NHS considerably more in the long term. Our GPs believe that the cuts contravene the aims of better care closer to home and the proposed model of community services that support health and care. If the cuts go ahead and our voluntary services are drastically reduced, it will be extremely hard to set them up again to support localities, as envisaged by the NHS 10-year plan.

Ironically, on the 70th anniversary of the NHS, all voluntary sector organisations across Derbyshire received letters stating that their funding from clinical commissioning groups was to be cut. The voluntary sector provides friendly, personalised local care for far less than any other service could. For example, last year the night sitting service supported 93 people with more than 2,000 hours of care, at a total cost of just £34,000—on average, just £369 per person for three nights of support each. Just one of those nights in a hospital could have cost the CCG more than that.

The CCGs have themselves calculated that for every £1 spent on voluntary services, they save £8. On that basis, the £500,000 saved this year will cost £4 million in extra care next year, and every year thereafter. That comes on top of all the other cuts to health and social care in Derbyshire. We have seen our county council lose more than half its revenue support grant since 2010, so in large swathes of High Peak, it is impossible to get a care package and the only help is from the voluntary sector.

My constituent Debbie has a son with autism who wanted to live independently but needed the support of a care package. The package could be provided only by the voluntary sector, but the CCG cuts meant that it could no longer be afforded, so they were facing the prospect of residential supported care, which would have cost far more, until I intervened.

The lack of care packages means that people are stuck in rehabilitation beds, such as an 82-year-old constituent of mine with a muscle-wasting disease. She could not walk unaided and could not get a company to bid for her care package, but she received four letters from the CCG and her social worker, telling her that she was no longer able to stay in the rehab ward. They reduced her to tears. That ward is the only one of its kind in my constituency—Fenton ward in Buxton—but it is due to lose more than half its beds, despite a waiting list of patients in our acute hospitals needing those beds, even during the summer months.

We have seen the loss of our local dementia assessment and support ward in Buxton, a gold-standard service that took the most difficult patients with dementia and helped them back into care in their own home in an average of less than six weeks. We are seeing community hospitals across Derbyshire facing the loss of 84 beds. Anyone would think that we are seeing a reduction in the number of patients with dementia, or elderly and frail people who need rehabilitation to get them home from hospital. Of course, we are not. Instead, there has been an explosion in need for those services, at a time when our NHS is being forced to make short-term cuts, by the end of March, that will have long-term implications for the care of our patients and for the skilled staff we need to keep in the NHS. At the same time, we are seeing cuts to our voluntary sector services, which provide care much more cost-effectively.

Given all the rhetoric from the Department of Health and Social Care about sustainability, why is that happening? Why are short-term financial decisions impacting so hard on frontline health services and on voluntary services, which are vital for that long-term sustainable service and for the frail and vulnerable people who need them?

What is happening in North Derbyshire is in stark contrast to what is happening in the other part of my constituency, in Glossop, which is part of the devolution of health in Tameside and Greater Manchester, where the Bureau is providing a fantastic social prescribing service that is assisting people across the area. That is in stark contrast to what is happening in North Derbyshire, which has not seen the devolution of healthcare or a Labour council supporting local services to deliver much more cost-effectively. We are seeing our healthcare needs rise at 3.5% a year, but our CCG says that it will have to cut costs by 5% a year, and not just this year but for the foreseeable future, despite the long-term plan for the NHS. That will have a devastating impact on our health services. Without our voluntary services, they will be even harder hit.

In my debate in September, the Minister told me:

“It is unhelpful to scare local people ahead of those consultations, because those decisions have not been taken.”—[Official Report, 4 September 2018; Vol. 646, c. 62WH.]

She said that there would be full consultation with patients, GPs and other stakeholders, but, as GPs have made clear to me, that consultation has not happened. The decision to cut £500,000 of voluntary sector funding was made just before Christmas.

How can our NHS deliver a low-cost model without our voluntary sector? As one of my constituents asked me:

“Please put up a good fight for these services! I doubt any of the people making the decisions have ever been as lonely as my friend has been, it takes only a smidge of empathy to understand why these services are vital. I am really passionate about combating isolation and loneliness … however, this latest news feels like a big step backwards.”

That is why I am asking if the Minister is prepared to meet me and local GPs in High Peak to discuss all the cuts that are being made across health, social care and the voluntary sector in High Peak and across Derbyshire to make sure that we can get a sustainable service that delivers for local people on the ground without the sort of suffering that the cuts will create.

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

I thank the hon. Member for High Peak (Ruth George) for bringing forward this important matter for debate.

First and foremost, I would like to reiterate the vital role that the voluntary sector plays in ensuring that people have access to the services that they need in the places where they live. Indeed, I go much further: I am an extremely firm advocate of encouraging NHS commissioners to commission services from the voluntary sector to get much better coverage nearer people’s homes and achieve better outcomes for patients at good value for money. I defer to no one in my support for the voluntary sector. The principle of making use of and commissioning services from the voluntary sector is a key theme in the long-term plan, and we will be investing at least an extra £4.5 billion a year in primary care and community health services.

This is the first time in the history of the NHS that real-terms funding for primary and community health services is guaranteed to grow faster than the rising NHS budget overall. Clearly, that is not reflected in the comments that the hon. Lady has just made. I understand her concerns about the cuts in funding for services in Derbyshire. I am advised by the CCG that it has confined the cuts to those services that are not associated with delivery of their statutory services and that of a potential £1.25 million that was earmarked as meeting those criteria, only £300,000 has been cut. It is worth putting into context why that is.

Clearly, the Derbyshire CCGs have a duty to ensure the long-term sustainability of health services in the area. In the light of well-known financial challenges, that CCG has had to make difficult decisions on where to prioritise funding. As part of asking taxpayers to contribute £20 billion more a year to the NHS, it is right that we ask how effectively that money is spent and that we ensure that local areas are not running at a deficit. This is absolutely essential if we are to have an NHS that is financially sound and sustainable in the long term. Owing to their financial position, all Derbyshire CCGs are required to scrutinise their financial spend to ensure the best outcomes for patients for the investment made and to deliver financial balance. They have been working on that in close collaboration with NHS England. The joint saving plan agreed with NHS England states that if the CCGs make savings of £51 million, the remaining £44 million will be absorbed by NHS England. It is very much a joint approach to tackling the financial position in which the Derbyshire CCGs find themselves. None the less, they need to live within their means, and that is why they have had to review the overall spend and identify where savings can be made. It is challenging, but I have been assured that the absolute top priority of the CCGs is to minimise the impact that cuts have on patients.

I listened with sympathy to some of the points the hon. Lady made about spending on services provided by the voluntary sector that keep patients out of hospital and support them to live independently, and clearly I want to encourage all CCGs to commission exactly those services. I am reassured that those services that continue to be funded by CCGs, rather than remaining with grants, have been issued with NHS commissioned contracts—that has been done for stroke support, eating disorder and bereavement services—and I am satisfied with the efforts of CCGs in that area.

[Ruth George]

The Minister says that the cuts are to services that do not deliver such good statutory support. How does she think that community transport does not deliver for patients struggling to get to, say, follow-up appointments for bowel screening?

[Jackie Doyle-Price]

The advice I received from the CCGs was that they had reduced grants only for services not part of their statutory functions, which fall to other agencies, particularly local authorities, with which they are working closely to make alternative funding available for some of the organisations that have been cut. I cannot answer the hon. Lady’s specific question about transport, but I understand that the total cut to transport amounts to £24,000 out of £300,000, so we are talking about quite a small part of what have been significant savings of £44 million that the CCGs have had to find. Support for local transport and accessibility normally falls to local authorities.

The voluntary and community sector has been an important part of the health system for many years, and partnership working between the voluntary sector, local government and the NHS is crucial to improving care for people in their communities. I expect all local CCGs to build much stronger relationships with local authorities to better join up all support services for patients. I welcome the scrutiny of this process by the health overview and scrutiny committees. I appreciate that it has been extremely political, but it is important that those decisions be taken transparently.

We also recognise the important role the community can play in helping people to maintain their health and wellbeing. Social prescribing is crucial. We are encouraging CCGs to look much more at such solutions, and not just at the medicalised solutions, and we will be using part of the £4.5 billion investment set out in the long-term plan to recruit more than 1,000 social prescribing link workers. I hope they will be able to work with the voluntary sector in the hon. Lady’s constituency.

We will also be looking at funding expanded community multi-disciplinary teams, meaning that in five years all parts of the country will have improved the responsiveness of their community health response services to deliver crisis services within two hours and reablement care within two days.

I appreciate that it will always be difficult to tackle a financial deficit of the size of that of the Derbyshire CCGs, and I welcome hon. Lady’s engagement in that process and the public scrutiny. I also pay tribute to the work of my hon. Friend the Member for Erewash (Maggie Throup), who has been representing the concerns of her constituents in this respect. I am assured and satisfied, however, that the Derbyshire CCGs have done the best they can to support funding for the voluntary sector where it has been delivering a valuable service to the rest of the health sector. Indeed, one of the overriding criteria for making decisions regarding these cuts was that it would not lead to additional demand on health services and additional spending elsewhere, and I am satisfied that the decisions have been taken on that basis.

[Ruth George]

The GPs on the CCG themselves stood up in the meeting and said there was a recognised risk that these service cuts would create cost pressures on other areas of services, so I am sorry, Minister, but it is simply not guaranteed at best, very likely at worst.

[Jackie Doyle-Price]

I say respectfully that we expect the CCGs working with NHS England to properly interrogate the implications of their decisions, and they have done that; I have been given that advice, and I stand by the advice I have received from them on that.

I recognise, however, that those local commissioners in Derbyshire have had to make very difficult decisions, and we do believe that they are best placed to make those decisions. They have access to the local expertise and clinical knowledge needed to make an informed decision.

While I recognise the hon. Lady’s concerns, I hope she can reassure her constituents that the local CCGs are working to provide sustainable services that meet the needs of the people living in Derbyshire. The Government will continue to work with the local CCGs and NHS England to help progress with ongoing work and to help create those sustainable services for the future.

Question put and agreed to.

World Cancer Day

Ruth George Excerpts

Wednesday 30th January 2019 Westminster Hall

[John Lamont]

I absolutely agree. We need to do much more to promote awareness of those conditions. I will come on later to the availability of drugs.

The Scottish Government recognise that the high number of vacancies is a problem, but missed their target for increasing the number of nurse endoscopists by 40%. In England, nurse vacancies are similarly too high. The availability of drugs is also an issue that concerns charities and patients alike. The most high-profile example is the breast cancer drug Perjeta, which was rejected for use three times in Scotland but was finally approved just a few weeks ago. Quicker and more cost-effective access to the latest and best treatments must be a priority in future.

I know that colleagues will want to press the Minister on what the UK Government are doing to tackle cancer in England, but all these issues need to be addressed across all parts of our United Kingdom. As a Scottish MP, I am conscious that the Minister is not directly responsible for the cancer waiting times and treatments for my constituents. However, UK-wide approaches should be taken to help us tackle cancer head on, together.

World Cancer Day is all about recognising that cancer knows no boundaries, and that individual Governments cannot address these challenges in isolation. That gives rise to the question: are the UK Government and devolved Governments working as well together on this issue as they should be? For example, should we buy some drugs and equipment on a UK-wide basis? Current practice is that four separate bodies approve new drugs across the UK. While that allows different parts of the UK to make their own decisions, surely a UK-wide approach would make sense in some cases. We could make ultra-orphan drugs more affordable or use economies of scale to deliver common drugs at lower cost.

I am therefore interested in the Minister’s views on this suggestion. Have there been any discussions with the devolved Administrations about this possibility? Are health boards across the UK as good as they can be at talking to each other and sharing best practice? Representing a constituency on the border with England, I all too often see examples of that border acting as a barrier to co-operation. I certainly hope that that is not the case when it comes to cancer treatment.

I hugely welcome the extra funding coming the NHS’s way, which will of course mean an extra £2 billion a year for the Scottish Government to spend on health, if they choose. Will the Minister outline what that means for cancer treatment in England, and how much of that extra funding will be used to improve treatment and reduce cancer waiting times?

Can we do more to support families with the cost of cancer treatment? Parents spend an average £600 a month in additional expenses as a result of their child’s active cancer treatment, much of that on travel costs. Young people in my constituency often have to make a 100-mile round trip to Edinburgh for tests and treatment. Children’s cancer charity CLIC Sargent is calling for a cancer patient travel fund, as well as a review of the disability living allowance and personal independence payments, to backdate young cancer patients’ financial support to their day of diagnosis. I certainly think that these are reasonable suggestions.

[Ruth George (High Peak) (Lab)]

As a parent who supported a child through cancer, I know at first hand how much a child going through cancer costs and the financial strain, as well as the emotional and physical strain, on parents and families. Universal credit does not take account of the cost of cancer; both parents often have to give up work to support one child in hospital and other children at home or at school. Does the hon. Gentleman agree that that is absolutely crippling for those families?

[John Lamont]

I am grateful to the hon. Lady for sharing her experience. This all needs to be looked at. As I said, DLA and PIP should at the very least be backdated to the date of diagnosis. Additional support, particularly for parents like those in my constituency who have to travel such long distances to access treatment, should be factored into the calculation of how much they might be entitled to. We need to ensure that the system at least recognises those extra financial pressures.

--- Later in debate ---

[Ruth George (High Peak) (Lab)]

As I mentioned earlier, I have personal experience of cancer, both as a parent and a child; my mother died of breast cancer when I was five years old. From a very young age I have seen the impact of cancer on families. I have also seen treatments improve over the decades, from the time that my mother was suffering and had what appeared to me, at that young age, to be fairly rudimentary treatments, to what are now much more sophisticated treatments, which are available to children and adults in centres of excellence such as the Christie Hospital in Manchester.

The support has also evolved greatly. I pay tribute not only to the very brave people going through cancer, and their families who support them, but to amazing organisations such as Mummy’s Star, a national charity set up in my constituency to support families with children whose parent is dying or has died of cancer. It does amazing work counselling children and helping them through the process of treatment and grief, and often bereavement as well.

I also pay tribute to our hospices. Blythe House Hospice in my constituency has a brilliant “Breast Friends” group, which I have visited and spoken to. They are very brave survivors of cancer, often two or possibly even three times over. The support they get from the local hospice and community really helps them to keep going through the emotionally and physically gruelling trauma of cancer treatment.

We have very particular concerns in High Peak. At the end of last year, just after Breast Cancer Awareness Month, breast services for patients in north Derbyshire were withdrawn from our local hospital. As that is our nearest hospital, it was incredibly traumatic for patients and families, who were faced with possibly very long distances to travel for treatment. It is extremely difficult to drive and no public transport is available. That is exceedingly worrying for them, on top of the worry and trauma of their diagnosis and treatment.

Services were also withdrawn from gastroenterology patients in Macclesfield Hospital in north Derbyshire—our other nearby hospital. On both occasions, that was due to staffing shortages; there are 42,000 vacancies for registered nurses. I urge the Minister to look at the amount of investment that is going in to support not just the nurses, but the radiotherapists and radiologists who are so important in cancer diagnosis and care.

Early diagnosis is important for people’s outcomes. We do not want to see any more people than have to going through treatment, and we certainly do not want them to find out about their cancer at a late stage, when it is much more difficult for them to recover and when the prognosis is much worse.

I echo the comments of the hon. Member for Central Ayrshire (Dr Whitford) about the costs of cancer. Again, universal credit is an extremely complicated system for people—not just the parents of children with cancer but cancer sufferers themselves—to go through. It took six hours at a computer for one young man, Neil, who is cited by Macmillan Cancer Support, to complete the claim form for universal credit while suffering from the treatment for a brain tumour. We are putting cancer patients through an absolutely sub-human system when they should already have as much support as possible.

I ask the Minister to speak to colleagues in the Department for Work and Pensions about the strain and lack of support available to parents of children with cancer or to cancer sufferers in claiming universal credit. At the moment, almost one in five patients with cancer struggles to pay their bills, which should not be the case for people who need to put all their efforts and energy into getting well.

Oral Answers to Questions

Ruth George Excerpts

Tuesday 27th November 2018 Commons Chamber

[Steve Brine]

My hon. Friend is spot on, as always. Just last week, I spent time with the heads of all 19 cancer alliances in England, which are doing so much to deliver the strategy on the ground, including his Thames Valley cancer alliance, led by Bruno Holthof of Churchill Hospital in Oxford. The alliance was clear that we need more people across the board in “team cancer”, as I call it, and that is right. We especially need more radiographers, and we are working through that with Health Education England in the beyond 2021 plan.

[Ruth George (High Peak) (Lab)]

Today’s report on the amount of police time spent dealing with emergency mental health cases without support from mental health professionals is echoed by police in my constituency, who say that it takes up almost 40% of their time. Will the Government recognise that this crisis should not be dealt with by police officers, far less in cells, and sort it out?

[Jackie Doyle-Price]

First, I pay tribute to the work that the police do in dealing with people who are in mental health crisis. They view it as part of their core work, but clearly they should not be picking up the slack where services do not exist. I am working closely with the police service and other interested parties to ensure that we have sufficient crisis care, to enable the police to discharge their responsibilities adequately and in a safe way. We will continue to do that.

Oral Answers to Questions

Ruth George Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Matt Hancock]

Absolutely central to this is ensuring that we address cancer at the earliest possible opportunity. The earlier the diagnosis is made, the greater is the likelihood of survival, so we want to see more cancers diagnosed earlier across the board.

[Ruth George (High Peak) (Lab)]

22. At the start of October, which is Breast Cancer Awareness Month, my local hospital, Stepping Hill, had to shut its doors to breast care patients in my constituency, because its two-week urgent waiting times had risen to five weeks owing to chronic staff shortages and underfunding. What will the Secretary of State do to improve outcomes for constituents like mine who cannot access those services?

[Matt Hancock]

The announcement the details of which I have just set out comes with £1.6 billion of the £20 billion uplift we are putting into the NHS written into the long-term plan, so the funding is there to deliver on this policy, too.