Health Committee

Sarah Wollaston Excerpts

Thursday 16th March 2017 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

(Select Committee Statement): The scale of the avoidable loss of life from suicide is unacceptable. In 2015, 4,820 people in England took their own lives, and across the UK 6,122 people did so in 2014. But those official figures underestimate the true scale of the devastating loss from suicide, which remains the leading cause of death in young people between the ages of 15 and 24, and it is the leading cause of death in men under 50. It is strongly linked to deprivation and is a major contributor to health inequality. However, the key message our Committee heard throughout its inquiry is that suicide is preventable, and we can and should be doing far more to make sure we reduce it. That was the key focus of our suicide prevention inquiry.

First, let me thank all those who contributed to the inquiry, particularly families bereaved by suicide, and those who had experienced suicidal ideation and been users of mental health services. Their evidence was courageous and compelling. I also thank all the voluntary groups and volunteers who are working to provide support for people in crisis, and all our front-line staff. Finally, I thank my fellow Committee members and our Committee staff, particularly Laura Daniels, Katya Cassidy and Huw Yardley.

I shall now move on to what we found in our inquiry. First, let me say to the Government that we welcome their suicide prevention strategy, but as with any strategy the key is implementation. We therefore call on them to go far further in implementing and resourcing it, and to give greater attention to the workforce in order to make the important improvements come forward. We also make further recommendations and we are disappointed that the Government have not gone further in a number of areas. We know that we can take actions to reduce suicide and we highlight a number of these in our report. For example, we know that half of those who take their own lives have previously self-harmed, and we feel it is really disappointing that the experience of so many of those who have self-harmed when they go to casualty departments is that they are made to feel that they are wasting people’s time. We know that liaison psychiatry makes an enormous difference, but there are resourcing issues on that.



We also know that those who have been in-patients in mental health settings should receive a visit within three days of leaving in-patient services, but there simply are not the resources available for that to be put in place. We call on the Government to go further in looking at the workforce and resourcing needed for that to happen. We know of other serious issues, for example, the fact that about a third of people who take their own lives are not in contact with either primary care or specialist health services in the year before their death. We feel that suicide is everyone’s business and we all have a responsibility to reduce the stigma attached to mental health so that it is easier for people to seek help. Again, I pay tribute to all those who are working in this field, reaching out to people in non-health settings and making a real difference. However, many of those voluntary groups are coming under great financial pressure. It is welcome that the Government have announced that there will be £5 million for suicide prevention, although that does not come in until next year, with £10 million in each of the subsequent two years. However, we feel that that is too little, too late, particularly given the cuts to public health grants and across local authorities to those services that can reach out to people who are vulnerable to suicide.

We would like the Government to put a greater focus on adequately resourcing the measures they set out in their suicide prevention strategy. We would particularly like them to look at how those plans are being implemented. It is very welcome that 95% of local authorities have a suicide prevention plan either in place or in development, but there does not seem to be sufficient quality assurance for those plans. We would therefore like a national implementation board to look at how we can move those plans forward, because any strategy, however good, cannot be effective if it is sitting on the shelf and not being implemented. That was one of the key messages we heard from our witnesses, and I know that the Minister will have heard it from the National Suicide Prevention Strategy Advisory Group loud and clear.

We also know that there are things that need to happen when people are in contact with services. It is disappointing that greater focus has not been put on the consensus statement for information sharing. On too many occasions, when someone hears that a loved one has taken their life it is the first time they have heard that their loved one had been in contact with services—nobody had let them know. Understandably, health professionals are concerned about issues of confidentiality and consent, but what the consensus statement makes clear is that if we ask people in the right way, they are much more likely to give that consent to information sharing. We would like to have seen the Government put a greater focus on how we can increase awareness of how health professionals go about sharing information with people’s loved ones, because we believe that will save lives.

We think that measures can be taken across the board both out in the community and within health care settings and specialist settings, but the Minister will know that our inquiry also examines the role of the media. Irresponsible reporting of suicide increases suicide rates, as we know, and far more can be done within the broadcast media, the mainstream media, on social media and on the internet to make sure that we save lives. I was very pleased that during today’s Culture, Media and Sport questions the Culture Secretary agreed to a meeting with me, but I hope that the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), will assure me that she will be liaising with colleagues in the Government to make sure we can save lives in that way.

Finally, I wish to touch on the issue of data. We know that there is an issue relating to the increasing use of narrative verdicts which are hard to code. That results in the official data we have on suicide under-representing the true scale of the avoidable loss of life, and with the huge variation we have around the country this makes it much more difficult to understand what works best in preventing suicide. We would like the Minister to revisit the recommendations in our report on how to provide better training to coroners and how we review the evidential standard and move from using “beyond reasonable doubt” to the “balance of probability” in recording suicide. Only in that way can we ensure that we are doing absolutely everything possible to protect families and individuals in future. I commend the report on suicide prevention to the House and call on the Government to go further in implementation.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Labour welcomes the recommendations in the report, and I join the hon. Lady in thanking Select Committee members and staff for their work.

The Committee visited the award-winning Salford mental health liaison team, which offers 24/7 mental health support at Salford Royal hospital and has been able to halve the admission rates for people with mental health problems. The Royal College of Psychiatrists reminds us that only 7% of emergency departments provide 24/7 liaison psychiatry services, and said it would be difficult to recruit enough psychiatrists and other staff to provide such a service in every hospital—the hon. Lady touched on that in her statement. What does she think the Government must do to ensure that there are enough trained staff to establish and sustain liaison psychiatry services in every acute hospital to help to deliver the suicide prevention strategy?

[Dr Wollaston]

We need to start right back at medical school recruitment and what happens in medical schools and beyond, to encourage more health professionals—not just doctors, but nurses as well—to consider psychiatry and mental health services as a career. One of the key issues is the lack of a workforce. I know the Government are working with Health Education England to improve the situation, but we would like to see them go further. Also, we need to ensure that resources get to the frontline.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

I congratulate my hon. Friend on her chairmanship of the Select Committee and its recent report. She will know that recent studies, particularly one done in Sweden, have indicated that people with high-functioning autism spectrum disorder have a ninefold increased suicide risk. What more could be done to help those individuals and their families? How can we raise awareness among the agencies that intervene with them and their families, and particularly among health professionals, so that they are aware of the heightened risk?

[Dr Wollaston]

I commend the work my right hon. Friend has done over her whole career on autism and to highlight what more can be done to help those individuals and their families. She will know that one of the key barriers is having an assessment in the first place for people who suffer from autism. Too often, they fall between the gaps in mental health services. My key message would be that we must ensure that they receive the services and support that they need and that that is delivered in the right way.

[Philip Boswell (Coatbridge, Chryston and Bellshill) (SNP)]

I congratulate the hon. Lady on bringing this critical issue to the House and I fully support the report. I declare an interest as the patron of Chris’s House, a centre for help, response and, critically, intervention on suicide, and the first 24-hour interventionist suicide support service in Scotland. We set up the centre to offer a safe environment in which people in crisis may have respite from their current unwellness. They can find refuge in Chris’s House and receive an individually tailored programme to offer support and respite throughout their journey to wellbeing. I urge others throughout the UK to look at this more interventionist model and replicate it to the benefit of all UK citizens. I further urge as many people as possible to join us in our Walk of Hope on 6 May 2017 in Glasgow, as we walk from darkness to light to raise awareness about suicide prevention.

[Dr Wollaston]

I thank the hon. Gentleman for his contribution and join him in paying tribute to voluntary groups throughout the country that are doing extraordinary work to reach out to people in crisis. As he will know, the level of variation in support is a key issue, along with the financial challenge faced by people around the UK who are trying to provide proper support.

[Mr David Nuttall (Bury North) (Con)]

I thank my hon. Friend very much indeed for the work that she and her Committee have done on this issue. The suicide rate among men is three times that among women, and the gap has increased since 1981. As she mentioned, suicide is the leading cause of death for men under 50. A particular problem is contagion, whereby one suicide can often lead to a spate of others in the same area. During the inquiry, did the Committee identify how this aspect could be dealt with?

[Dr Wollaston]

I thank my hon. Friend for his important question. We absolutely looked at that issue and specifically mentioned it in our report. He will know that part of the problem is that irresponsible reporting can sometimes lead to contagion. We know that when local areas work together closely to identify suicides, particularly early clusters, measures can be taken—people can go into workplaces, schools and colleges—to provide support and stop it. It does, though, require that we notice it early, so the Committee urges coroners to work with local authorities and public health teams to ensure that they are aware of the high risk of suicides spreading.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the Select Committee and the hon. Lady for the report. The Scottish National party welcomes the recommendations and urges that they are fully taken into account. We particularly urge the Government to commit to rolling out crisis intervention teams and support to prevent suicide, so that people in such circumstances can be followed up directly. Suicidal individuals are not always mentally ill, and lengthy waiting lists for psychological treatment or attendance at A&E are sometimes not the most appropriate options. Liaison psychiatry is under-resourced, and urgent follow-up through crisis support is needed. How will we ensure liaison between services? Only when that occurs seamlessly between health, social care, community services and criminal justice will we prevent suicidal individuals from falling between the gaps.

[Dr Wollaston]

I thank the hon. Lady for highlighting a really important point about the need for communication, not only with families but within services. One problem is that there is what happens in local authorities and what happens in the health service, and too often there is not sufficient communication between the two.

[Chris Elmore (Ogmore) (Lab/Co-op)]

I congratulate the hon. Lady and her Select Committee on their work. She might be aware that in the mid-2000s there was a series of tragic suicides across the Bridgend County Borough Council area, of which my constituency forms part. I obviously was not a Member of this House when those suicides took place, but they are a major part of people’s memories of what happened across those communities.

On media attention, the hon. Lady may be aware that a film was made about those suicides that was not welcomed by the various communities; I am glad she is pursuing the part of the report on tackling the media impact regarding the glorification of suicide, if I can put it like that. Suicide prevention and health policy more widely are devolved to the Welsh Government, but will she consider sharing the Select Committee’s report with the Welsh Assembly’s Health, Social Care and Sport Committee? I passionately believe that if we can learn best practice on tackling suicides from Select Committees in the Scottish Parliament, the Northern Ireland Assembly or, indeed, the Welsh Assembly, we should share that throughout the UK.

[Dr Wollaston]

I would be delighted to meet the hon. Gentleman and share the report, as he suggests, because I agree that we should be sharing best practice throughout the devolved nations and England. On the specific point about the role of the media, the Samaritans has produced really clear guidelines, which I hope all media organisations will look at closely. We should also go beyond broadcast and print media and look at the role of social media and the internet.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I welcome the Health Committee’s report on suicide prevention and congratulate my hon. Friend and her Committee on their work on this very important issue. I join her in thanking those with lived experience who bravely contributed to the Committee’s work; the impact of their contribution cannot be overestimated.

Every death by suicide is a tragedy that has a devastating effect on families and communities, which is why the Government are committed to reducing the national suicide rate by 10% by 2020. We want all areas to learn lessons from organisations such as Mersey Care, with its zero suicide ambition. We were particularly grateful that the Committee published an interim report in December, as it allowed us to address many of its recommendations in our update of the national strategy. These included how we are driving local delivery, addressing stigma, improving suicide bereavement services and increasing awareness of the consensus statement for information sharing for people at risk of suicide. However, we do accept that we need to go further on implementing the cross-Government national suicide prevention strategy, which is why we published the updated strategy to strengthen delivery in key areas, including in implementation. It is also why we will continue to provide further updates.

The refreshed strategy now includes better targeting of high-risk groups and, for the first time, addresses self-harm as an issue in its own right, which is one of the most significant issues of suicide risk. We are working with the National Suicide Prevention Strategy Advisory Group, delivery partners across Government, and other agencies and stakeholders to develop an improved implementation framework.

We are already making good progress in ensuring that all local areas have a suicide prevention plan in place by the end of the year. To date, 95% of local areas have a suicide prevention plan in place or in development. We will also work with local areas to assess the quality of those plans, building on guidance on good practice. We have run a series of suicide-prevention planning masterclasses carried out by Public Health England to improve that quality. We have also published guidance to local authorities in January on developing and providing suicide bereavement services as an important plank of the plan.

Furthermore, we have announced that we will publish a Green Paper this year on children and young people’s mental health and develop a national internet strategy, which will explore the impact of the internet and social media on suicide prevention and mental health. That will address some of the issues that my hon. Friend has raised about the media and suicide. Hon. Members will also know that we are committed to all A&Es having core liaison services by 2020. They have rightly raised the fact that the workforce will be essential in delivering that ambition, and we will imminently be publishing our mental health workforce strategy, the performance of which I am sure that the Select Committee will closely scrutinise. We will carefully consider all the recommendations made by the Committee in this report and respond to them in due course.

My hon. Friend has rightly raised the connection between mental health services and suicide prevention. Does she agree that we cannot think about suicide without considering the broader matter of mental health? Will she and the Committee join me in welcoming the wide range of measures set out by the Prime Minister in January, in addition to the five year forward view for mental health, with a focus on earlier intervention and prevention in mental health services, because those improvements will be essential if we are to make the progress on suicide prevention that all of us in this House want to see?

[Dr Wollaston]

I thank my hon. Friend the Minister for her comments and agree with her absolutely about the importance of prevention and early intervention. I look forward to the strategies to which she has referred and to working with her to do all that we can to improve mental health and to reduce the terrible toll from suicide.

Health and Social Care Budgets

Sarah Wollaston Excerpts

Tuesday 14th March 2017 Westminster Hall

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow the hon. Member for Hackney South and Shoreditch (Meg Hillier). I pay tribute to all the Select Committees and their members for the work that they done and to all those outside this House who made the compelling case that led to the announcements in the Budget. I say to the Minister that I unequivocally welcome those announcements, and I thank the Government for listening to the case that was made, not only about social care but about capital.

However, I would nuance some of that, because the point about social care is that we must not consider it “job done”. The £2 billion over the next three years is very welcome—it is also welcome that it has been profiled to address the back-loading of the previous settlement. However, I would like the Minister to say how we will ensure that it gets to the frontline and is distributed fairly according to need, and also that that reflects the different abilities of councils to raise their own money through the social care precept, because that is important for public confidence about how the money is spent.

I also welcome the announcements on capital—the £325 million for the sustainability and transformation plans that are ahead of time is very welcome. I look forward to the announcements in the autumn Budget about further money, although the Minister will know that £1.2 billion has been transferred to revenue from capital. That is an ongoing issue that is hampering the ability of areas to put effective plans in place. Will he touch on that and say how quickly he thinks we will get to a position where we do not see these capital-to-revenue transfers as being necessary?

Another welcome announcement was about the capital improvements available to accident and emergency departments, although I would caution that this is being linked to putting general practitioners alongside casualty departments through co-location. This is not only about funding; it is about having a general practice workforce that can fund these co-located departments alongside out-of-hours departments and providing routine surgeries on Sundays. I am afraid that we simply do not have the workforce to sustain that activity. I know that there is a commitment to increase the workforce in primary care, but that is alongside a significant retirement bulge in primary care. Something will have to give. As things stand, I simply do not feel that we have the workforce to do that work.

Finally on the Budget, there was a very welcome announcement of a review and a Green Paper in the autumn, which we all look forward to. However, I call on the Government to stop and take stock, because next year will be the 70th birthday of the NHS, and it will come at a time when it is under unprecedented financial pressure. Over the last Parliament we saw a 1.1% annual uplift, against the background of uplifts of around 3.8% traditionally since the late ’70s. This is a sustained financial squeeze, at the same time as an extraordinary demographic change and an increase in demand across the whole service. As welcome as the announcements were last week, I am afraid that they do not go far enough to address the scale of the generational challenge that we face. It is of course very welcome that more people are living longer, but that is happening alongside a shrinking base of our working population who are able to fund that demand.

We simply cannot carry on as we are. If the review focuses simply on social care, we will miss an extraordinary opportunity to address the issue in time for the 70th anniversary of the NHS. I would therefore ask the Minister to go back to colleagues and say, “Can we widen this Green Paper to take in health and social care, and can we try to do that on a consensual, cross-party basis?”, as has been said by many across the House. Notwithstanding the issues about that in the past, the scale of the challenge is so great that we owe it to all our constituents to put that aside and to take nothing off the table in considering the scale of the challenge and the solutions ahead.

We have an opportunity to explain that to the public, because whenever I address public meetings and I ask people whether they would be prepared to pay more to fund our health and social care adequately, I find that the response is almost unanimous. People are ready for this. They understand the pressures, and they value health and social care immensely. That would be my big ask of the Minister: think again, widen the review, make it consensual and explain it to the public. Let us get the consent and move forward.

Health and Social Care

Sarah Wollaston Excerpts

Monday 27th February 2017 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

Today’s debate on the supplementary estimates and the financial position of health and social care matters, first and foremost, because of the impact of that financial position on patient care. I start by paying tribute to our health and care staff across the country and, at this particular time, by noting and thanking those who have come from across the European Union to work in this country.

The current financial position is of great concern. As a result of the wider economic downturn, we are now in the seventh year of the longest financial squeeze in the history of the NHS. Although the Department of Health’s budget has been protected in relation to many others, we cannot escape the fact that over the previous Parliament the average annual increase in its budget was 1.1%, which is far lower than the increase in demand and, of course, far lower than the historical increase of 3.8% since the late 1970s. All that is in the context of an extremely challenging position for social care. Between 2009-10 and 2014-15, there was a 10% real-terms reduction in social care spending by local authorities.

All that has taken place in the face of an extraordinary increase in demand, because of not only a rising population but our changing demographics. To put that into context, over the decade to 2015 there was a 31% increase in the number of people living to 85 and beyond, and we estimate that over the next 20 years we will see a 60% increase in the number of individuals who rely on social care. Over the years there has been an abject failure of Governments to plan for that, although it was entirely predictable. We absolutely cannot just keep ducking the question. We need not only to address the immediate financial problems that face health and social care, but to come together as a House to address the problems for the future.

[Bill Wiggin (North Herefordshire) (Con)]

It occurs to me that this is not a uniquely British problem; it is in fact a global one. I have been trying to find out where in the world social care is best delivered and whether we can learn anything from those countries.

[Dr Wollaston]

My hon. Friend makes an important point. We are all looking forward to the publication of the House of Lords report on future sustainability, because of course we have much to learn from other systems. I pay tribute to the Public Accounts Committee, which today published its report on the financial sustainability of the NHS. We have also seen the final position of trusts at the end of the previous quarter, so we now know that 135 providers ended that quarter in deficit. We are on course for a financial deficit across trusts of between £750 million and £850 million at the end of the financial year.

[Caroline Lucas (Brighton, Pavilion) (Green)]

The seriousness of what we are talking about is demonstrated by how, as the hon. Lady will know, over the past five decades there was a downward trend, with falling death rates, yet new research shows that that trend has reversed since 2011, and that approximately 30,000 more people died in 2015 than in 2014. With such deaths occurring in the context of a massive disinvestment in health and social care, does she agree that the financial cuts are likely to have been implicated in that unprecedented rise in death rates?

[Dr Wollaston]

I have seen the study to which the hon. Lady refers, and I think the Department of Health needs to look at it very carefully.

[Mr Jim Cunningham (Coventry South) (Lab)]

We should look at it in general terms. For example, a local authority cannot deal with bed-blocking because it does not have the resources to provide social workers. The NHS as a whole in Coventry and Warwickshire has to find cuts of £250 billion, which is a tremendous amount of money. If we are not careful, we will create an insoluble problem.

[Dr Wollaston]

I thank the hon. Gentleman for making that point, although I think we should use the term “delayed discharges” rather than “bed-blocking”, because the latter can make older people who are in that position feel as if somehow they might be to blame. Nevertheless, I take his point.

The estimates memorandum seeks a transfer from the capital departmental expenditure limit of £1.2 billion to prop up revenue. It also seeks a £23 million transfer from Her Majesty’s Treasury reserve, a £58.5 million transfer from other Government Departments, and a £6 million transfer to capital from other Departments. Again, we see an unsustainable position, as pointed out by the Comptroller and Auditor General.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I am following closely my hon. Friend’s remarks, which are, as ever, wise. Does she share my concern that if we are to transfer money from capital to revenue, the sustainability and transformation plans, most of which imply a certain level of capital investment in order to save revenue in the long term, will not be possible?

[Dr Wollaston]

I absolutely agree with my hon. Friend and will discuss that later.

The point about the raids on capital budgets over the years—this is the third year in which we have seen transfers from capital to revenue budgets—is that we are talking about the money required to keep facilities up-to-date, and for essential repairs and the roll-out of new technologies. Putting off such repairs and investments means they cost more down the line, so it is a false economy. It is simply an unsustainable ongoing mechanism. The Department of Health has indicated that it would like to see an end to the practice by 2020, but both the Public Accounts Committee and the Health Committee have called for it to be stopped immediately because we feel it is, as I say, a false economy. As my hon. Friend the Member for South West Wiltshire (Dr Murrison) pointed out, it is about raids not only on capital budgets, but on the sustainability and transformation fund. It is increasingly becoming all about propping up the sustainability part rather than putting in place the essential transformation.

[Mary Creagh (Wakefield) (Lab)]

The hon. Lady is making some excellent points. The sustainability and transformation plan for West Yorkshire will take around £1.1 billion out of our health system over the next four years—£700 million from the NHS and £400 million from social care services—as a result of which centres such as the King Street out-of-hours health centre are set to close, putting even more pressure on over-pressed A&E departments like the one at Pinderfields, my local hospital. Does the hon. Lady agree that, by forcing even more pressure on A&E departments, such plans give the words “sustainability and transformation” a bad name?

[Dr Wollaston]

I absolutely agree with the hon. Lady. It is undermining public confidence in sustainability and transformation plans. I shall discuss that in more detail later.

The financial position is starting to create a perfect storm of delayed discharges, rising waiting times in A&E, and rising so-called trolley waits for patients waiting to be transferred to the wards, which has quite serious implications for their safety. There are unsustainable levels of bed occupancy, and increasingly we are hearing stories of not only routine but urgent surgery being cancelled. Worryingly, there have been two cases in which urgent neurological procedures did not take place, resulting in the deaths of two patients. That is extremely serious.

[John Redwood (Wokingham) (Con)]

Does my hon. Friend agree that when we look at the formulae for the distribution of money via councils, we cannot look only at deprivation, which tends to be highly weighted? It is an important issue, but in more affluent areas such as mine we have an even bigger problem with people living a very long time; although that is good news, there is far more demand for services because they live for so much longer.

[Dr Wollaston]

My right hon. Friend makes an extremely important point: it is about not only the overall budget but the distribution. I think we would all agree, on both sides of the House, that deprivation must be properly weighted, but he is absolutely right that age and the resulting need for services is one of the key drivers of need. That is probably not adequately reflected in the way resources are currently distributed.

There is undoubted evidence of the impact of the financial position on patient care. Unfortunately, this whirl of hospitals having to cancel routine procedures has a further impact on their ability to meet their financial targets, because of the reduction in their income. I hope Ministers will not simply consider this as a short-term issue; more importantly, they must look at how we can fund these things sustainably in future. They must not look at health and social care in their separate siloes but see them as a single system and genuinely look at how we are going to take things forward.

If we do not address this problem, we need to be honest with our constituents about the consequences. People talk about a collapse in the NHS. I do not believe that that will happen, but what we will see is a continuing deterioration in performance, with a real impact on the quality of care, which will put lives at risk. The safety, which is essential to our patients and which the Department of Health has prioritised, is increasingly in danger of slipping.

A number of Members have commented on sustainability and transformation plans. In principle, they are extremely important as a way not only of acting as a road map for the Five Year Forward View, but of enabling us to return to a much more logical way of planning for integrated health and care. Hopefully, they will enable us to get away from endless contracting rounds in the NHS and move towards genuine planning. I am afraid that what has undermined them has been inadequate local consultation, inadequate working with local authorities, and, crucially, inadequate funding. If we do not have the funding to put in place the transformation of services, we will see these plans fail. Increasingly, those plans are being seen as a vehicle for cuts—

[Helen Goodman (Bishop Auckland) (Lab)]

They are.

[Dr Wollaston]

I say to the hon. Lady that, genuinely, these plans offer us an opportunity to produce a transformative process, but they are being undermined by a number of critical points, and we should address them.

[Anne Marie Morris (Newton Abbot) (Con)]

Does my hon. Friend agree that one of the key pieces missing from the STP plans is the bit that enables that double running, so that we can move from the existing system to the new system? There is no money anywhere for any transition and double running.

[Dr Wollaston]

I absolutely agree with my hon. Friend and neighbour. As she will know, in our area, we are seeing not only the closure of four much-loved community hospitals, but, on top of those 44 beds lost from community hospitals, the local trust wanting to cut 32 acute beds, at a time when its bed occupancy is already running between 92% to 94%. Unless we have that double running and the communities can genuinely see the change, those plans will be seriously undermined. Too often, the NHS plans for hoped-for demand, rather than actual demand.

[Victoria Prentis (Banbury) (Con)]

I thank my hon. Friend for listening to me on a number of occasions when I have been worried about the situation in Horton general hospital. She has been kind enough to talk me through some options. One of the difficulties with the consultation process is that lay people—of whom I am one—are not given sufficient evidence to enable them fully to engage with the system and to have trust in the trusts that are seeking to engage them.

[Dr Wollaston]

My hon. Friend is absolutely right. It is important that the evidence is available not just to us, but to the local communities. There should also be a sense that consultations are a genuine process. As I have said, it is about the co-design of new services. Time and again, we have reports from the NHS that demonstrate that co-producing new services results in a much better service in the long run, so I thank her for her point.

We are talking about the cuts not only to the trusts, but to the clinical commissioning groups. What we are seeing now is that CCGs are being asked to hold back £800 million of their budgets to offset deficits in trusts. Again, this is about patient care that is being cut back. Alongside that, we have seen cuts to Public Health England and to Health Education England. The idea that we have an NHS that is on a sustainable footing is, I am afraid, simply not the case. I ask Ministers to be realistic about the current position, and I ask our Chancellor, in his forthcoming Budget, to address this matter by urgently giving a lifeline to social care, because that will benefit not just social care, but the NHS. In addition to announcing that lifeline, which I hope he can do by bringing forward the better care fund with new money rather than a transfer from the NHS, I hope that he will promise a genuine review of sustainable future funding covering both health and social care. I call on Members from across the House to agree that, rather than our having the usual confrontational debates, we should see this as a generational challenge that will face whichever party is in power over the coming years. We should all work together, for the benefit of our constituents, to produce a sustainable future for the NHS and social care.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I call the Chair of the Public Accounts Committee, Meg Hillier.

NHS Shared Business Services

Sarah Wollaston Excerpts

Monday 27th February 2017 Commons Chamber

[Mr Hunt]

The hon. Gentleman is reasonable and sensible, but sadly those commendable sides to his character have not been on display this afternoon, not least because I answered a number of his questions before he read out his pre-prepared script. He said that there had been a catastrophic breach of data protection. Let me remind him that no patient data were lost and all patient data were kept in secure settings. I know that it is a great temptation to go on about the privatisation agenda, but may I gently tell him that, since SBS lost this account, this particular work has been taken in-house? It is being done not by Capita, but by the NHS—so much for the Government’s “relentless pursuit” of the private sector.

More seriously, the hon. Gentleman is quoted in this morning’s edition of The Guardian as saying:

“Patient safety will have been put seriously at risk.”

As he knows, patient safety is always our primary concern, but if he had listened to my response he would have heard that, as things stand, there is no evidence so far that patients’ safety has been put at risk. [Interruption.] Well, we have been through more than 700,000 documents, and so far, we can find no such evidence. We are now doing a second check, with GPs, on 2,500 documents—so a second clinical opinion is being sought—nearly 2,000 of which we believe will not show any evidence, and we are now going through the remaining ones.

Let me say that it was indeed totally incompetent of SBS to allow this incident to happen, and we take full responsibility as a Government, because we were responsible at the time. None the less, the measure of the competence of a Government is not when suppliers make mistakes—I gently remind the hon. Gentleman that that did happen a few times when Labour was running the NHS—but what we do to sort out the problem. We immediately set up a national incident team. Every single piece of correspondence has been assessed, and around 80% of the higher risk cases have been assessed by a second clinician.

The hon. Gentleman then went on to suggest that the Government have been trying to hide the matter. If he had listened to what I said, he would have heard that I did not follow the advice that I got from my officials, which was not to publicise the matter. I actually decided that the House needed to know about it. It was only a week after I was reappointed to this job last summer that I not only laid a written ministerial statement, but referred to the matter in my Department’s annual report and accounts. He said this morning that I played down the severity of what happened, but what did that annual report say? It said that a “serious incident was identified”, and it talked about

“a large backlog of unprocessed correspondence relating to patients.”

It could not have been clearer.

This Government have always cared about patient safety. We have listened to the advice of people—as the hon. Gentleman would have done had he been in office—who said that if we had gone public right away, GP surgeries could have been prevented from doing what we needed them to do, which is making detailed assessments of a small number of at-risk cases. That was why we paused, but as soon as we judged that it was possible to do so, we informed this House and the public and we stayed absolutely true to our commitment both to patient safety and to transparency.

[Dr Sarah Wollaston (Totnes) (Con)]

This is undoubtedly a very serious incident, but I welcome the detailed and thorough steps that the Secretary of State has taken to protect patient safety. However, he will know that there are ongoing problems with the transfer of patient records. GPs and hospitals spend endless hours chasing up results, investigations and letters on a daily basis. Is it not time that patients were given direct control of their own records, and will the Secretary of State provide an update on that to the House?

[Mr Hunt]

I thank my hon. Friend for her sensible contribution. She is right that, although the process of sending on these particular documents has been taken in-house, other parts of the contract were taken on by a company called Capita—[Interruption.] The hon. Member for Leicester South (Jonathan Ashworth) cannot stop, can he? Let me repeat that the work in question has been taken in-house. The other work, which is being done by Capita, has had some teething problems, of which we are very aware. We know it has been causing problems for GPs. The Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood) has been meeting Capita and people relating to that contract on a fortnightly basis to try to identify the problems.

My hon. Friend the Member for Totnes (Dr Wollaston) is right that the aim in the long run is to give people control of their records. I am proud that, under this Government, we have become the first country in the world to give every patient access to their own records online. From September, people will be able to do that without having to go to their GP’s surgery.

Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

I will tell the right hon. Gentleman what we are doing about the underfunding. We are raising three times more from international visitors than when he was a Health Minister, and that is paying for doctors, nurses and better care for older people in his constituency and in all our constituencies.

[Dr Sarah Wollaston (Totnes) (Con)]

Given the Government’s stated objective of reducing health inequalities, will the Secretary of State set out how he will guarantee that those who are, for example, homeless or who have severe enduring mental illness—the most disadvantaged in our society, who are unlikely to have the required documentation—will receive the treatment they need?

[Mr Hunt]

I can absolutely reassure my hon. Friend. What we are doing is based on good evidence from hospitals such as Peterborough hospital, which has introduced ID checks for elective care and has seen absolutely no evidence that anyone who needs care has been denied it. This is not about denying anyone the care they need in urgent or emergency situations; it is about ensuring that we abide by the fundamental principle of fairness so that people who do not pay for the NHS through their taxes should pay for the care we provide.

NHS and Social Care Funding

Sarah Wollaston Excerpts

Wednesday 11th January 2017 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I will try to be mindful of those comments, Madam Deputy Speaker, as I follow the hon. Member for Central Ayrshire (Dr Whitford), my colleague on the Health Committee. As always, she made thoughtful and thought-provoking comments, and I would like to endorse her points and expand on some of them.

First, I thank NHS and care staff. We have heard that they are facing unprecedented demand over the winter, but it is not just winter pressures that they face now—the pressures extend into the summer. As we have heard, that is not just about numbers but about the complexity of conditions and the frailty of those presenting in our accident and emergency departments. The Health Committee heard in its recent inquiry that the trusts that are most successful in getting close to the four-hour target are those that see it as an entire-system issue, and in which both health and care staff contribute to the effort, not as a tick-box exercise but because they recognise that it is fundamentally about patient safety and the quality of patients’ experiences. That is why the four-hour target matters, and the Secretary of State is right to endorse it.

The Secretary of State is also right that we sometimes need to be more nuanced about our targets and that he needs to be open to listening to what clinicians are telling him about how we can improve the way in which targets are applied. It would be a great shame if we in this House prevented those sensible discussions from taking place because of political furore. I urge him to continue to have them and to take advice and listen to clinicians about how we can improve the use of targets, but he is absolutely right in being clear that he will keep the four-hour target.

We must talk about this as a whole-system issue. Accident and emergency is a barometer of wider system pressures, as has been pointed out, and I want to focus my remarks on the integration of health and social care.

I agree with colleagues throughout the House who have called for a convention on reviewing funding as a whole-system issue. We have heard that next year is the 70th birthday of the NHS, and what could be a better present than politicians changing the debate and the way in which we talk about the funding of health and social care, so that we do so in a collaborative manner that works towards the right solution for our patients? The consequences of our not doing that would be profound for our constituents, who would not thank us for not being prepared to put aside party differences and work towards the right solution.

Ultimately, this issue is about a demographic change that we are simply not preparing for adequately. In the case of the pension age, we recognised that there had to be a different debate given the change in longevity. Over the decade to 2015, we saw a 31% increase in the number of people living to 85 and older. Of course, that is a cause for celebration, but there has not been a matching increase in disease-free life expectancy.

I welcome the Prime Minister’s focus on tackling inequality, but unfortunately we are not making sufficient progress on that, either. In her very first speech in the job, she talked about tackling the “burning injustice” of health inequality. We in this House have a role in doing that together in a consensual manner.

[Norman Lamb]

I very much agree with the hon. Lady. Does she share my welcome for the Prime Minister’s response today in which she stated that she was prepared to meet us and other Members of Parliament from across the House and my hope that it might start a more constructive approach?

[Dr Wollaston]

Absolutely. It was extraordinarily encouraging to hear the Prime Minister say that she was prepared to consider that and to meet Members from across the House. I urge colleagues who feel that this is a better way forward to sign up to it, speak to their party Whips and make it clear that it has widespread support.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I wonder, on this vital issue, whether the hon. Lady wants to say something about what her own party did on the two previous times we tried to get important cross-party working on health and social care: it made it an election issue, producing posters about a “death tax”; and on the second occasion the Secretary of State just walked away from the talks.

[Dr Wollaston]

I am afraid that that intervention is exactly not the kind of debate we want to be having. Let us look to the future. We are in a different part of the electoral cycle. I accept the hon. Lady’s comments—I was still an NHS clinician when that happened and, like many of those working in health or social care, I looked at the yah-boo debate in this place and thought that surely there had to be a better way—but I ask her to put them aside and to look to the future rather than backwards, otherwise we will not get anywhere. I think our constituents want us, as politicians, to recognise the scale of the challenge and to get to grips with it.

[Mr Jim Cunningham (Coventry South) (Lab)]

Looking to the future, does the hon. Lady not agree that there should be a new funding settlement for the NHS and social care budgets that brings both together? At the moment, there have been cuts of £4.6 billion.

[Dr Wollaston]

That is exactly what I am hoping. We must end the silos of health and social care. We should stop thinking about money as a social care pound or a health pound, and instead think about a patient pound and a taxpayer pound, and how we get the very best from that.

That brings me on to a point I would like to raise directly with the Secretary of State. There is an example of where this has happened: in my constituency, Torbay and South Devon NHS Foundation Trust has formed an ICO—an integrated care organisation. Across health and care, passionate people recognised the benefits and sweated blood to get the organisation off the ground. Torbay’s integration is talked about not just nationally but internationally as a recognised way of doing this better. I regret to say, however, that because of the scale of the financial pressure on the ICO, we are now hearing that next year the NHS will be pulling out of the risk-sharing agreement.

That is totally unacceptable. I hope the Secretary of State will meet me to discuss the pressures facing the ICO, which has achieved exactly what we are talking about in this debate. It is able to pool finances better through risk sharing and to work together to get people out of hospital who do not need to be there more rapidly than happens in other areas. It can put people from social care into hospitals to see how we can speed up that process. Unfortunately, if that risk-share falls apart, one of the key pillars of how we want to improve the flow through hospitals and out the other end will break down. Part of the reason, as I understand it, is that unless the control totals are met the funding it hopes to use to improve the facilities in the A&E department will be at risk. The challenge for Torbay is not how it works together to get people out of hospital; it is the facilities at the front door, and it could do so much to improve the facilities. We have the odd paradox whereby we could end up improving A&E infrastructure but worsening the ability of the system to respond at the point where we are trying to get people cared for in the community.

A certain degree of financial challenge can have the effect of bringing health and social care organisations to work more closely together because they know it makes sense, but when unrealistic targets are set it can go the other way. It can start to mean that people have to retreat to protect their budget silos. I hope that the Secretary of State will look closely at what is happening and meet me to discuss whether we cannot just get this back on track for next year. I am confident that the local authority and the NHS staff across the CCG and the provider trust will continue to work together—they have an extraordinary tradition of doing so—but there are threats, which I hope can be addressed. This is about the entire flow from the front door right the way through to getting people cared for back at home.

More widely, we now have more than 1 million people in communities who are unable to receive the care they need. Mears, the prime provider in my area, is in special measures. These are financial issues. Yes, there is much that the NHS can do that is not about money—we know there is a lot of variation that cannot be explained by financial challenge and demographic changes alone—but finance and the workforce inevitably are the key challenges we have to face, and we have to work together across all political parties to resolve them.

In closing, I would like to raise with the Secretary of State the front page of today’s Times, which is extraordinarily disappointing. This is the second time a major national newspaper has reported briefing against the chief executive of the NHS, Simon Stevens. I invite the Secretary of State or the Minister closing the debate unequivocally to support the chief executive of the NHS. When the chief executive appears before the Health Committee and I, as the Chair of the Committee, ask him to respond to questions, I expect him to be truthful and transparent in his answers. He should be commended for doing so and not find himself the subject of negative briefings. I therefore invite the Minister unequivocally to support him and ask for this to stop.

Mental Health and NHS Performance

Sarah Wollaston Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I am happy to respond to the hon. Gentleman’s comments and, indeed, to the comments of all Members, but I shall first say this about the tone of what he said. He speaks as if the NHS never had any problems over winters when Labour was in power. The one thing NHS staff do not want right now is for any party to start weaponising the NHS for party political purposes. I remind him that when his party runs the NHS, the number of people on waiting lists for treatments doubles, A&E performance is 10% lower and people wait twice as long to have their hips replaced. Whatever the problems are in the NHS, Labour is not the solution.

The hon. Gentleman talked about mental health, so let me tell him what is happening on that. Thanks to the efforts of this Government and the Conservative-led coalition, we now have some of the highest dementia diagnosis rates in the world. Our talking therapies programme—one of the most popular programmes for the treatment of depression and anxiety—is treating 750,000 more people every year and is being copied in Sweden. Every day, we are treating 1,400 more people with mental health conditions and we have record numbers of psychiatrists. The hon. Gentleman mentioned mental health nurses: in this Parliament we are training 8,000 more, which is a 22% increase.

All that is backed up by what we are confirming today, which has not been done before: the Government are accepting the report of the independent taskforce review—led by Paul Farmer, the chief executive of Mind—which commits us to spending £1 billion more a year on mental health by the end of the Parliament. That would not be possible with the spending commitments that Labour was prepared to make for the NHS in the previous Parliament. It is because of this Government’s funding that we are able to make such commitments on mental health.

The hon. Gentleman talked about the NHS and gave completely the wrong impression of what I said this morning. I was completely clear that all NHS hospitals are operating under greater pressure than they ever have. He should listen to independent voices, such as that of Chris Hopson—no friend of the Government when it comes to NHS policy—who is clear that in the vast majority of trusts people are actually coping slightly better than last year. However, we have some very serious problems in a few trusts, including in Worcestershire and a number of others. I can commit to him that we will follow closely the investigations into the two reported deaths at Worcestershire and keep the House updated.

The hon. Gentleman talked about social care, which is where, I think, his politicising goes wrong. Last year, spending on social care went up by around £600 million. At the last election, he stood on a platform of not a penny more to local authorities for social care, so to stand here as a defender of social care is, frankly, an insult to vulnerable people up and down the country, particularly to those living under Labour councils such as Hounslow, Merton and Ealing, which are refusing to raise the social care precept, but complaining about social care funding.

The hon. Gentleman talked more generally about NHS funding, but in the last Parliament it was not the Conservatives who wanted to cut funding for the NHS—it was his party. It was not the Conservatives who said that funding the five-year forward view was impossible—it was his party. Labour said that the cheque would bounce. Well, it has not bounced, and we are putting in that money.

In conclusion, it is tough on the NHS frontline. The hon. Gentleman was right to raise this issue in this House, but wrong to raise it in the way that he did. Under this Government, the NHS has record numbers of doctors and nurses and record funding. Despite the pressures of winter, care is safer, of higher quality and reaching more people than ever before. It is time to support those on the frontline, and not try to use them for party political points.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome the Secretary of State’s statement and the Prime Minister’s focus on mental health in her speech today. She spoke of holding the NHS leadership to account for the extra £1 billion that we will be investing in mental health. Will the Secretary of State set out in further detail how clinical commissioning groups will be held to account for ensuring that that money gets to the frontline so that we can deliver progress on parity of esteem?

[Mr Hunt]

Yes, I can do that. It is a very important point. We have had a patchy record in the NHS of ensuring that money promised for mental health actually reaches the frontline. The way that we intend to address this is by creating independently compiled Ofsted-style ratings for every CCG in the country that highlight where mental health provision is inadequate. Those ratings are decided by an independent committee chaired by Paul Farmer, who is responsible for the independent taskforce report, so he is able to check up on progress towards his recommendations. I am confident that, by doing that, we will be able to shine a light on those areas that are not delivering on the promises that this Government have made to the country.

Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 20th December 2016 Commons Chamber

[Nicola Blackwood]

I absolutely cannot confirm that. The tendering process has not even begun. Therefore, we are not considering any form of company, private or otherwise.

[Dr Sarah Wollaston (Totnes) (Con)]

The Health Committee has just published its interim report on preventing suicide. I thank all those who gave evidence to our inquiry and all members of the Department of Health advisory group. We support the strategy, but the clear message that we heard was that implementation needs to be strengthened. Will the Secretary of State meet me to discuss our report’s recommendations, and will he join me in thanking members of the Samaritans and other voluntary groups around the country who will be working tirelessly over Christmas, as they do every day, to support those in crisis?

[Mr Jeremy Hunt]

My hon. Friend speaks wisely. Christmas can be a very lonely time for a number of people, so we all commend the work of voluntary organisations that do so well. I would be delighted to meet her.

Reducing Health Inequality

Sarah Wollaston Excerpts

Thursday 24th November 2016 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I beg to move,

That this House calls on the Government to introduce and support effective policy measures to reduce health inequality.

In her first speech at Downing Street, the Prime Minister referred to the “burning injustice” of the difference in life expectancy between the richest and poorest in our society, and to her determination to tackle it. The purpose of this debate is to try to assist the Government in making that a reality, but I also urge her to look at the gap in healthy life expectancy. Based on Office for National Statistics data from 2012-13, the healthy, disability-free life expectancy of a woman born in Tower Hamlets is 52.7 years of age, while that for a woman born in Richmond upon Thames is 72.1 years of age. That is a gap of about 20 years. The social gradient for disability-free life expectancy is even greater than that for mortality. I ask the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), to consider the issue not only as one of social justice, but as one that adds hugely to NHS costs and to economic costs more widely. There is a compelling economic and social justice case for tackling it.

What should the Minister do? In a nutshell, she should follow the evidence and start immediately, beginning with the very youngest in society—in fact, she should start with them even before they are born—and take a whole life course approach, following all the wider determinants of health. She should also take a cross-Government approach, with leadership at the highest level of the Cabinet. She needs to take the long view—many of the benefits will become evident in 20 or 30 years’ time—while not ignoring the fact that there will also be quick wins. She needs to look at everything that needs to be done to tackle the situation.

I hope that this will be a consensual debate. I congratulate the Labour Government on the work that they did to tackle health inequalities, which is starting to pay dividends. I also pay tribute to Sir Michael Marmot for his groundbreaking work; the blueprint that he set out in 2010 holds true today and it should be the basis of everything that we do. It is about giving every child the best possible start in life and allowing people of all ages to maximise their capabilities and exercise control over their lives. It is also about fair employment and good work, healthy environments and communities, standards of living and housing.

It is about preventing ill-health as well, and that is what I want to address, because I know that many Members across the House will speak with great expertise about the wider determinants of health. Tackling the issue starts long before people come into contact with health services, but that is still an enormously important part of tackling health inequalities. As Chair of the Health Committee, I will focus on those aspects.

On preventing early deaths, we need to look at lifestyle issues, including smoking and obesity, and at preventing suicide, which is the greatest single cause of death in men under the age of 49. Public health plays a critical role. The “Five Year Forward View” called for a radical upgrade in prevention in public health. Cuts to public health budgets are disappointing and will severely impact on the Government’s ability to tackle health inequalities. The Association of Directors of Public Health surveyed its members in February and found that the cuts to the public health budget were affecting issues such as weight management, drugs, smoking cessation and alcohol, which are key determinants that we need to tackle. In my own area, part of which covers Torbay, cuts of about £345,000 to council public health budgets will result in the decommissioning of healthy lifestyle services. Those budgets affect education and active intervention, and support a network of fantastic volunteers. I regret that those cuts to public health are going ahead, and call on the Government to stop them.

I want to tackle a few key areas. First, smoking is still the biggest cause of preventable death in the United Kingdom. Every year, 100,000 people die prematurely as a result of smoking. In her closing remarks, I hope that the Minister will update the House on the tobacco control plan.

[Sir Peter Bottomley (Worthing West) (Con)]

About 25 years ago I took an interest in how many death certificates mentioned smoking, and the answer was four. The figure may be larger now, but we should encourage medical practitioners to say that the person had been an active smoker, even if it was not the primary cause of death, so that at least people can become more aware of the issue.

While I am talking about this, I will mention two other things, which my hon. Friend may be going to cover. One is nutrition at the time of conception, and the second is that we should learn the lessons of how we cut the drink-driving deaths, which was not by public programmes, but by people doing the things that actually made a difference—that cut down the incidence and cut down the consequences and cut down the deaths.

[Dr Wollaston]

Those are extremely important points. The Government can introduce policies and make sure that there are levers and incentives in the system to make that happen. The drink-drive limit is a very important example.

We are not likely to make a difference to the gap in disability-free life expectancy without tackling smoking, which is a key driver for health inequality and accounts for more than half of the difference in premature deaths between the highest and the lowest socioeconomic groups. Without tackling it, we will not make inroads.

I would like briefly to touch on obesity and on the Government’s obesity strategy, which the Health Committee has looked at. To put the matter in context, the most recent child measurement programme data show us that 26% of the most disadvantaged children leave year 6 not just overweight but obese, as do 11.7% of the least deprived children. Overall, of all children leaving year 6, one in three is now obese or overweight. The situation is storing up catastrophic lifetime problems for them, and we cannot continue to ignore that.

In our report, the Committee called for “brave and bold action”. Although I really welcome many aspects of the childhood obesity plan—such as the sugary drinks levy, which is already having an impact in terms of reformulation—it has been widely acknowledged that there were glaring deficiencies and missed opportunities in the plan.

I would like to have seen far greater emphasis on tackling marketing and promotion. Some 40% of food and drink bought to consume at home is bought under deep discounting and promotion, and that is one of the potential quick wins that I referred to. We often focus in this debate on what people should not do, and this is an opportunity to look at what they should do. Shifting the balance in promotions to healthy food and drink would have been a huge opportunity for a quick win, because one of the key drivers of this aspect of health inequality is the affordability of good, nutritious food. This would have been an opportunity to tackle marketing and promotion, and I urge the Minister to bring that back into the strategy. I also urge the Government to extend the sugary drinks levy to other drinks, including those in which sugar is added to milky products, because there is no reason why it should be necessary to add sugar to such drinks.

I also welcome the mention in the plan of the daily mile, which has been an extraordinary project. I have met Elaine Wyllie, who is one of the most inspirational headteachers one could meet, and she talked about the strategy and about how leadership from directors of public health makes a real difference. I hope that the Minister will update the House on how that will be taken forward. We should think not just about obesity, but about physical activity and health promotion, and about the benefits that they could bring to all our schoolchildren.

The Health Committee stressed in our report the importance of making health a material consideration in planning matters when money is so restricted. I do not think that to do so would be a brake on growth; it would be a brake on unhealthy growth, and it would give local authorities the levers of power when they are making licensing decisions and planning decisions for their communities. That is something that Government could do at no cost, but with enormous benefit.

The Health Committee is actively considering how we reduce the toll of deaths from suicide. The Samaritans have identified that men living in the most deprived areas are 10 times more likely to end their life by suicide than are those in the most affluent areas. Many factors contribute to this—economic recessions, debt and unemployment—but when we try to tackle health inequality, we will not make the inroads that we need to make unless we look at the inequality in suicide, particularly as it affects men. Three quarters of those who die by suicide are men. I hope that the Minister will look carefully at the emerging evidence from our inquiry as the Government actively consider the refresh to the strategy, and that they will do so at every point when they look at how to tackle health inequality.

I would like the Minister to look at the impact of drugs and alcohol on health inequality. The fact that there are 700,000 children in the United Kingdom living with an alcohol-dependent parent is a staggering cause of health inequality, which has huge implications for those children’s life chances and for the individuals involved. Again, alcohol has a deprivation gradient; the two are closely linked.

There is evidence about what works, and we have had encouraging news from Scotland. The Scottish courts, I am pleased to say, have ruled that minimum pricing is legal, although I am disappointed that the Scotch Whisky Association has yet again taken the matter to a further stage of appeal. As soon as those hurdles are cleared, I think it would be a great shame if England undermined the potentially groundbreaking work being done in Scotland by failing to follow suit and introduce minimum pricing at the earliest possible opportunity; if we failed to do so, people would be able to buy alcohol across the border.

[Alison Thewliss (Glasgow Central) (SNP)]

I thank the hon. Lady for giving credit to the Scottish Government for what they have done on minimum unit pricing. I reiterate what she has said: it is disappointing that the matter has been taken to appeal yet again. Does she agree that there is a lot to look at from Scotland in terms of the smoking ban, which England then took up?

[Dr Wollaston]

I congratulate the Scottish Government. It does seem to be the case that where Scotland leads, England will eventually follow. Scotland is particularly good at following the evidence, and I call on us to do likewise. I am particularly concerned that the benefits that will come about when Scotland introduces minimum pricing will be undermined if we do not follow suit here, so I call on the Government to do so as soon as possible.

In summary—I know that many other Members wish to speak—there is a huge amount that we can do, and not all of it has a cost. I urge the Minister, in summing up, to look at all the possibilities. I urge her to stick with the Marmot agenda and to take a cross-Government approach, but to make sure that there is leadership at the highest level. The Prime Minister’s words in Downing Street were hugely encouraging. The Health Committee calls on the Prime Minister to appoint somebody at Cabinet level to take overarching responsibility for health inequalities and to put those fine words into action.

--- Later in debate ---

[Rebecca Pow]

My hon. Friend is right; it has been a Cinderella service.

The solutions that I am outlining are free. I am giving the House ideas for free therapy, because nature is free. It is a beautiful thing, and it really does have power. What could be more relaxing than a walk up to the Wellington monument on the Blackdown hills in my constituency? Hundreds of thousands of people go up there, including lots of people with disabilities, because it is easy to get to and it is all flat. Those walks to the monument are really beneficial. I know that it is not quite relevant to the debate, Mr Deputy Speaker, but the Government raised my spirits yesterday by announcing that they were giving £1 million to the Wellington monument’s restoration project from the LIBOR fund. That will have loads of spin-offs for the public, and health and wellbeing will be part of that. We are going to build a big community project to encourage more people to go up there.

When I was looking for somewhere to live in London—obviously, I have to stay up here during the week—one of my criteria for the flat was that I had to be able to see a tree from my window, and I can. I could not live without one.

[Dr Wollaston]

I congratulate my hon. Friend on the points that she is making. There are good data to back up what she is saying. Public Health England estimates that an inactive person is likely to spend 37% more time in hospital than someone who is active, and that inactive people are 5.5% more likely to visit their doctor. There is a good evidence base for what she is saying.

--- Later in debate ---

[Dr Wollaston]

I thank colleagues on both sides of the House for the extraordinary number of thoughtful contributions to this debate. As we have heard, this issue is everybody’s business, and what we now want is to see the Government translate the ambition and words into action.

Question put and agreed to.

Resolved,

That this House calls on the Government to introduce and support effective policy measures to reduce health inequality.

National Health Service Funding

Sarah Wollaston Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow my hon. Friend the Member for Central Ayrshire (Dr Whitford).

I want to touch briefly on the importance of clear data, the current financial position, and the need to agree on a settlement for the future in this House rather than continuing to have such confrontational debates.

I can see how the £10 billion figure has been arrived at: by adding an extra year, starting from 2014-15, and by transferring budgets to NHS England. When the Secretary of State refers to the NHS, he is actually referring to NHS England. He is not including public health. He is not, for example, including Health Education England. However, it is crucial that they are considered. As my hon. Friend the Member for Central Ayrshire said, when we talk about transferring money from public health to the NHS England budget, we are cutting off our ability to control the increase in future demand. We face significant challenges, which we will not address unless we invest in those future services.

We sometimes talk about public health as if it were not frontline care, but it is. We are talking about, for instance, services to help people with addictions and sexual health services—really important costs for the NHS. There is also the challenge of the reduction in Health Education England’s £5 billion budget, £3.5 billion of which is spent directly on the wages of health service doctors who are undergoing training, but also delivering frontline services. Cuts to Health Education England cut us off from future sustainability, because that is the budget that trains, retains and sustains our existing workforce. This is all crucial to frontline services.

The other way in which the £10 billion figure has been arrived at is by changing the baseline from which we calculate real-terms increases. I would say that it has never been more important than it is now for the public to have confidence in the data that we use. Trying to return us to talking about total health spending is not trying to be awkward; it is trying to be honest with the public. It is difficult to argue that more funding for health and social care is necessary if a £10 billion increase has been claimed. It is important that we continue to use the same consistent baselines that have been used in the past, so that the public can see what has happened to total health spending.

I welcome the front-loading of the settlement, and I welcome the fact that the NHS has been relatively protected in comparison with other departments, but the scale of the increase in demand is extraordinary. When Simon Stevens talked about welcoming the increase that had been granted, he made it clear that it was dependent on a fair settlement for social care and a radical upgrade in public health, and those two aspects are lacking.

I think that both sides are correct. I can see how the Secretary of State has arrived at the £10 billion figure, but whenever that figure is used we should also present a figure that refers to total health spending in the way in which it has always been referred to in the past. I think that that would help to build the Secretary of State’s case for an increase in funding as we go forward.

Like others, I hope that we shall see an uplift for social care in the autumn statement, because the impact of social care on the NHS is now profound. There cannot be a Member in the House to whom it has not been made clear by people who come to his or her surgery that the state of the care system is in collapse and providers are in retreat. Even those who can afford to pay are finding it difficult to gain access to care.

[Helen Goodman (Bishop Auckland) (Lab)]

In my constituency there are some villages where no social care is available because none of the private providers can afford to deliver it. Does the hon. Lady, in her role as Select Committee Chair, know whether that applies in other parts of the country as well?

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[Dr Wollaston]

We know it does, and the CQC report describes social care as being at a tipping-point; it is in a very fragile state and we owe it to all our constituents to try to come together to agree where we go from here. Many have proposed a royal commission to look at future sustainability, but we have had commissions: the Barker commission set out the options, and the House of Lords is looking at future sustainability and the range of options.

I urge colleagues across the House to try to agree, rather than having this continual confrontational debate. The best way forward would be for all parties in this House to agree that this is an enormous challenge. My personal belief is that we should stick with our current very equitable system of state funding of our NHS, look at the various options and agree between us that we need to address this. We cannot keep ducking it; we owe it to all our constituents to adopt a much more constructive tone to our debate.

We know that the current position is unsustainable, and that was reiterated in today’s National Audit Office report. We can continue to shout across the Chamber about how much is spent, but we know this will be a challenge whoever is in power, and I urge all colleagues to focus instead on a different approach. Yes, more can be done within the NHS, but I am afraid that the elastic is stretched far too tight for social care to make any more efficiencies. We now need to work together to see how we can fund this going forward.

--- Later in debate ---

[Mr Dunne]

Mr Deputy Speaker, the facts speak for themselves, as you have just told us: eight Conservative Back Benchers and only six Labour in an Opposition day debate—what a shambles.

I do not question the fact that the NHS faces a significant challenge. Increasing demand for healthcare is a consequence of our ageing and growing population. It is our determination to look after each and every NHS patient with the highest standards of safety and care. These all contribute to the challenge, but, despite increasing pressures, the NHS is rising to meet this challenge, carrying out more than 5,000 operations every day compared with 2010, and handling 780,000 more accident and emergency attendances in the second quarter this year. That is 15.1% more than in the same quarter in the last year that Labour was in office. Today it is the Conservative party that is the party of the NHS. That is why we pledged more than Labour and why we are delivering more funding, with a higher proportion of total Government spending going into health in each year since 2010.

Some hon. Members have drawn international comparisons on spending. I gently remind the more excitable Opposition Members that, according to the OECD, total health spending in the UK for 2014 is 9.9% of GDP, which is 10% above the OECD average of 9% and just above the EU15 average of 9.8%.

Several hon. Members have today also questioned the figures around the rises in funding that we are providing over the term of this Parliament. I welcome confirmation from my hon. Friend the Member for Totnes (Dr Wollaston), the Chairman of the Select Committee, that she can see how the Secretary of State arrives at his figures, and she graciously conceded that both sides are correct. I want to focus directly on the straightforward maths.

[Dr Wollaston]

All I clarified was that the way it had been arrived at is not a way that the public would understand health spending, so I think the Minister is perhaps taking my words out of context, if he will forgive me.

[Mr Dunne]

We never claimed that we were increasing the Department of Health’s budget; we were talking about the increases to the NHS. For complete clarity, in 2014-15 the NHS budget was £98.1 billion; in 2020-21, it will be £119.9 billion. For Opposition Members who cannot do the maths, that is a £21.8 billion increase in cash terms to NHS England, or £10 billion in real terms. We promised £8 billion; we are delivering £10 billion.

We also listened to NHS leaders’ requests for a front-loaded settlement and delivered on that—it was welcomed by hon. Members in today’s debate—with £6 billion of the £10 billion increase coming by the end of this year, including a £3.8 billion real-terms increase in this year alone.

We have also created a £1.8 billion sustainability and transformation fund for the current year to help providers to move to a sustainable financial footing. This fund will mainly be allocated to emergency care provision, which faces some of the greatest demand growth and financial pressures within the system.

This brings me to the next important point I want to address. While more funding is obviously welcomed, hon. Members have drawn attention to rising deficits in the budgets of NHS providers. We recognise that stronger financial management is required to turn this situation around, and we have introduced robust governance arrangements to get things back on track. There are four main elements to this plan: extra investment in the spending review, as I have discussed, and freeing up local government to spend more on adult social care; restoring financial discipline in the short term, through the measures set out by NHS England and NHS Improvement in July, with a wide-ranging set of actions; reducing demand for acute care in the longer term; and driving efficiency and productivity across the provider sector, building on the work of Lord Carter, who has identified large variations in efficiency across non-specialist English acute hospitals, and controlling cost pressures. The need to reduce variations was raised by my hon. Friend the Member for South West Bedfordshire (Andrew Selous) in his very constructive contribution, and by the hon. Member for Strangford (Jim Shannon). We agree that we need to reduce the variability in the poorly performing trusts and bring them up to at least the average standard, if not higher.

We are now beginning to see the first fruits of the plan, with the publication last Friday of the figures for the second quarter deficit, which has been reduced to £648 million, down from £1.6 billion in the same period last year, representing a £968 million improvement. Progress halfway through the financial year is therefore encouraging, but there is no room for complacency. That is why the system needs to stick to its strong financial plan, supported by our investment and by a series of measures set out to help hospitals to become more efficient and to reduce the use of expensive agency staff.

Several hon. Members talked about the sustainability and transformation plans, 28 of which have now been published. The remainder will be published by the end of next month. Half of the Labour Members who spoke in the debate talked specifically about the STP covering Cheshire and Merseyside. It was disappointing that only one of those three Members was able to attend the Westminster Hall debate earlier today in which we discussed conditions in Cheshire and Merseyside. I remind Labour Members that that STP was led by the chief executive of Alder Hey hospital in Liverpool, with whom I would strongly encourage hon. Members who are complaining about a lack of engagement to have a conversation.