Mental Health Act: CQC Report

Stella Creasy Excerpts

Tuesday 27th February 2018 Commons Chamber

[Jackie Doyle-Price]

We absolutely should do that. I often think that when we are challenging each other in this place about things that are poor, we end up talking our services down, but it remains the case that the NHS is the best health service in the world, and we should always celebrate that fact. Also, the fact that we are putting mental health services under such scrutiny is in itself driving an improvement in performance, because, as we all know, sunlight is the best disinfectant.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

Further to that response, the CQC says that it has seen limited or no improvement in the key concerns that it has raised in previous years. The problems are long-standing and they have been raised by the quality regulator in previous reports to Parliament. Does the Minister not understand, when she tries to tell us that sunlight is the best disinfectant, that all we are seeing in our mental health services right now is clouds?

[Jackie Doyle-Price]

I would say to the hon. Lady that this report represents sunlight, not clouds. It is very transparent, and these are exactly the things that I will be holding myself and NHS England to deliver to address these points.

Oral Answers to Questions

Stella Creasy Excerpts

Tuesday 19th December 2017 Commons Chamber

[Jackie Doyle-Price]

As my right hon. Friend identifies, training is key, and another central point is GPs’ ability to signpost people to appropriate treatments and therapies, which is exactly why we are investing in specialist care.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

23. If we are talking about concerned professionals and outcomes, can we add headteachers and teachers into the mix? One from my area has written to me about a child whom she referred to CAMHS last summer term only to be told that they were 63rd on the list and faced a 14-month wait for help. That is much longer than the month-long waiting time target that the Government have set. With a shortage of child psychologists, just how are the Government going to keep kids in my constituency safe?

[Jackie Doyle-Price]

The hon. Lady raises exactly the point that we are trying to address through the Green Paper. We are committed to delivering on the four-week waiting time by 2020, which will make sure that we treat over 70,000 more children with mental health issues that need to be addressed. I will be quite honest: this is not where I want us to be, but that is exactly why the Government have made it a priority and we will deliver by 2020.

North-east London STP

Stella Creasy Excerpts

Friday 16th December 2016 Commons Chamber

[Mike Gapes (Ilford South) (Lab/Co-op)]

Changes to our national health service are being planned all over the country, which are going to have profound implications for the quality of health, the availability of both primary and secondary services and for the size and location of our hospitals. There has been justified criticism of the secrecy with which this process of producing so-called sustainability and transformation plans has been carried out. The Department of Health has produced a five year forward view and a very large number of plans. I want to focus on the north-east London sustainability and transformation plan draft, which was published on 21 October, and on the eight delivery plans supposedly to implement it.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

I want to put on record my personal gratitude to my hon. Friend on behalf of all the residents of Walthamstow, because we know that these plans are not going to be subject to parliamentary scrutiny. The fact that my hon. Friend has secured this debate today might be the only opportunity we have in Parliament to look at something that will fundamentally transform their local healthcare services.

[Mike Gapes]

I am grateful to my hon. Friend, who spends a great deal of time, as I do, campaigning with her local council to improve the NHS locally. Throughout our sub-region of north-east London, we are all concerned about what we are facing.

The King’s Fund reported in November that the speed of development of these plans means that

“patients and the public have been largely absent”

from the process and that NHS England has instructed that freedom of information requests should be “actively rejected”. Locally in north-east London a freedom of information request for the financial and working detail of the STP was rejected in November on the basis that:

“Disclosure would be likely to inhibit the ability of public authority staff…to express themselves openly...and explore extreme options…Deliberation needs to be made in a ‘safe space’ to develop ideas and to reach decisions away from external interference which may occur if there is premature public or media involvement.”

My local council, Redbridge Council, has been concerned that it has not been adequately involved in the process. It has made it clear that it will act in the interests of our local community and that Redbridge will not be signing off or endorsing the STP unless we are satisfied that it is in the interests of Redbridge residents

I understand that the STP programme boards are not required to hold meetings in public, and no agenda or minutes are published. The secrecy surrounding this process has not been helpful in building public trust and has caused suspicion within communities all over the country—I speak particularly from local experience—as to the intentions of the proposals.  In many respects what could be a reasonable response in the circumstances to the crisis we face in terms of future funding, the ageing population and other challenges to the NHS, is being undermined because of process issues. The NHS needs to learn from these experiences about how better to engage with the public and key stakeholders, including elected local representatives.

We are fortunate in Redbridge and north-east London because there are good working relationships within the NHS and local government, and there is already a model of collaborative working.  However, the problem with the STP is that it brings a top-down process into this situation and potentially undermines the joint-working that has been voluntarily established over recent years.

Redbridge along with neighbouring authorities will be strongly arguing that the developing STP governance structures should not stifle or negatively impact the local work that is happening. Redbridge and its partners in Barking and Dagenham and in Havering have over a number of years been developing cross-borough, collaborative approaches on the integration of health and social care. Redbridge is arguing that STP governance needs to ensure that this subsidiarity to the local level is taken as a model for the future, and is not undermined by the STP approach. We need to ensure democratic accountability if we are to get public buy-in, and we do not have that at present. Public engagement needs to be enhanced and improved.

The north-east London October STP draft is subtitled “transformation underpinned by system thinking and local action”. It says, however, that

“the system partners may not be able to work together collaboratively to deliver the plans.”

Today we have seen news about the reality we face in our NHS: large numbers of hospitals with dangerously high bed-occupancy levels and little or no flexibility. The CQC’s chief executive recently talked about hospitals being dangerously full. On 26 November, a leaked memo from NHS England revealed that hospitals were being banned from declaring so-called “black alerts” and told to prepare for the winter crisis by passing on scheduled surgery to private hospitals and discharging thousands of patients to get bed occupancy down from a national average of 89% to 85%. 

However, north-east London’s population is massively increasing. The report states that the population of north-east London boroughs will increase by 18% over the next 15 years—equivalent to a new city—and yet there is no plan for an additional hospital to cope with that change. In fact, page 20 of the draft policy states that building an additional hospital is “not practical or realistic.” Indeed, the situation is worse than that. Not only is there no extra hospital, there is the planned closure of the A&E at King George hospital in my constituency. The plan is to stop overnight ambulances sometime next year, with a total closure in 2019. The STP is calling for that not only because it would meet some savings and restructuring requirements, but also because there are unsustainable costs. The previous Health Secretary announced in 2011 that the A&E at King George would close in “around two years”. That has not happened because it was deemed unsafe and because there is insufficient capacity at Queen’s hospital in Romford or at Whipps Cross university hospital in Waltham Forest to cope with the increased demand.

Despite our excellent and hard-working staff, all the hospitals in north-east London are in crisis. With pressure for early discharges, but inadequate social care and community support, we have large-scale bed blocking and delayed discharges. Sick patients then get readmitted because they cannot get GP appointments due to the pressures that exist in that sector. The STP sees out-of-hospital and integrated community care as the way forward. However, Dame Julie Moore, who in 2014 chaired a commission on hospital care for frail elderly people, said:

“As much as it suits us all to have one nice neat solution to the problem of our growing, ageing population… the truth is that as a catch-all answer it is simply wishful thinking. Integrated community care is a good thing… but this can never be a substitution for hospital care.”

We still need hospitals and acute care. Plans to transform care in the community are good, but that requires a transformation of primary care, which needs resourcing. The STP projects a 30% shortfall in nurses by 2021, and we know that many GPs plan to retire over the next few years. Both are difficult issues.

Problems also exist in the potential financial situation, and one such issue is the estates strategy. The STP delivery plan highlights sites such as Goodmayes hospital, which is a large mental health hospital, and King George hospital as places where land could be sold. Contractual issues and other matters mean that that is probably an optimistic approach.

[Stella Creasy]

My hon. Friend is making an incredibly powerful case about why we must involve the public in some incredibly difficult decisions. We know that the financial situation we are facing is particularly dire. He has just mentioned the sites at Goodmayes, but in addition Whipps Cross has a large private finance initiative debt, where it is paying out a huge amount of money. No wonder the suggestion is being made that we need £578 million to bridge the gap.

[Mike Gapes]

My hon. Friend has given the figure I was about to cite. The STP executive summary states:

“Our total financial challenge in a ‘do nothing’ scenario would be £578m by 2021. Achieving ambitious ‘business as usual’ cost improvements as we have done in the past would still leave us with a funding gap of £336m by 2021.”

Those are eye-watering figures. The claim is made that

“we have identified a range of opportunities and interventions to help reduce the gap significantly”.

However, the £240 million gap between the “business as usual” case model and the actual predicted figure requires a series of other measures, including significant funding from the sustainability and transformation fund, reductions and changes in specialised commissioning, and what is called

“potential support for excess Public Finance Initiative (PFI) costs.”

That covers Whipps Cross hospital, Queen’s hospital, Romford, and, to some extent, King George hospital. “Potential”, what a lovely word. So this is not real and it is not even planned—it is just “potential”.

These plans are based on unrealistic, heroic, Soviet-style assumptions. This is a truly Stakhanovite model of over-estimation of potential, yet the STP still proposes it can transform a deficit of £578 million in 2021 into a potential surplus of £37 million—and improve the services. That will not happen. The plans are also predicated on totally unrealistic assumptions about savings from closing the A&E services at King George hospital, and there is a lack of clarity as to when this will happen and how much we are talking about. I have been told that tens of millions would be invested in the sites at Queen’s and Whipps Cross, but I have been told that at least £75 million is needed to do that, and there is no sign of where this capital is coming from in the Department of Health. So wards are being closed in one hospital and then millions are being invested in rebuilding wards or constructing wards at other hospitals, for no real net gain.

There is also a problem about what process will be involved in this closure at King George hospital. I am conscious that I do not have limitless time, but let me say that my local Redbridge Council is very concerned about this, because King George is supposed to be transformed from an acute hospital into an urgent care centre and so the local community needs to be involved. Redbridge is requesting that it should be involved, and I note that it has recently been agreed that it will be involved on the transformation board. However, Redbridge wants an independent chair of that board, because it is important to involve a person of public trust so that there is no controversy. There needs to be a transparent, open process as we discuss the options for the future of King George hospital, so that we can challenge the business case and take account of the fact that the assumptions on which this model is based are 10 years old. They go back to the misnamed “Fit for the Future” plans of 2006. The population growth that we have had and the growth that is yet to come, the young population that we have in the area and the movement in population means we have to look at these issues with great doubt and concern.

We need to assess the implications of all those issues. As Redbridge says, it wants to know how the reconfiguration to an urgent care centre assists primary care, community health services, adult social care, public health, and public health prevention and education. An opportunity exists in the changes, but we need public engagement in those changes, and we do not have that at the moment.

There will be enormous pressure on my local council because of budget problems, and I am worried about the situation. I am glad that the STP highlights the social care challenge, but it needs to be taken seriously by the Government if we are truly to have an effective health and social care system. The statement in this House yesterday did not offer a solution to my borough. It did not answer the challenge that boroughs such as Redbridge are facing. These boroughs are already ahead of the game in the integration of health and adult social services and are working with neighbours to take up the challenge by being a pilot for the development of an accountable care system.

Yet with all that transformation, Redbridge still faces a huge social care challenge. That is made worse by a triple whammy of public sector funding reductions to local government—my borough has lost 40% of its income since 2010—chronic underfunding of adult social care by the Government and the fact that Redbridge does not get a fair funding level in the first place. There is, potentially, a major problem. We face a shortfall of about £4 million in social care and the 1% extra on council tax raises less than £1 million. The responses that we have heard from the Government in recent days have been inadequate—indeed they have been worse even than the silence from the Chancellor in the autumn statement. They offer no real solutions to the growing crisis that will impact on some of the most vulnerable in our society.

I conclude with this plea: please will the Government look at the situation in north-east London and will the Minister meet me to discuss the fact that this plan is unrealistic, incredible, unachievable and will lead to disaster?

--- Later in debate ---

[Stella Creasy]

It is good to hear the Minister say that she wants to see local people involved in these plans. Will she therefore commit not just to a conversation but a consultation with teeth to give people confidence that the very difficult decisions that we all know have to be made about changing the NHS can be done with their consent, and not simply given to them as a fait accompli?

[Nicola Blackwood]

Perhaps if the hon. Lady lets me continue with my speech, she will hear a little more about how the process will go forward.

The geographies have been determined not by central bodies, but by what local areas have decided makes the most sense to them. In the case of the constituency of the hon. Member for Ilford South, that has involved five providers, seven CCGs and eight local authorities covering the whole of north-east London. Each area has also identified a senior leader, who has agreed to chair and lead the STP process on behalf of their peers. In north-east London it is Jane Milligan, the chief officer of Tower Hamlets CCG, who is co-ordinating the development of the plan.

I was concerned to hear what the hon. Gentleman said about local authorities not feeling as involved as they should. It is important to emphasise that local authorities must play a role in developing these plans. Reflecting the social care needs of an area, which councils are obviously best placed to represent, will be key to the success of the NHS in the coming years, so they must be closely involved.

The plans offer the NHS an opportunity to think strategically and open up the public discussion about how we will meet the challenges facing the NHS in terms of demand and rising costs. It is inevitable that debate will become heated; it is simply a reflection of how important local NHS services are for us all. By planning across multiple organisations—both commissioners and providers—STP footprints can seek to address in an holistic way the health needs of an area and all the people within it in a way that we have never had the opportunity to have before.

We all know that the NHS faces tough choices about how we will design future services to meet rising demand, rising costs, and more chronic and complex illnesses. Choices have often previously been postponed again and again because they were too hard and because the discussions are too uncomfortable. I do not think anyone in the Chamber would think it is fair or safe for our local populations for us to keep putting them off in this way.

In north-east London, as elsewhere, that has meant having an honest conversation about the best way forward for services that are unsustainable as well as how to integrate services to give patients a clearer route through the system. All those conversations will help ensure that patients maintain access to high-quality care.

As I understand it, the north-east London October STP draft looks at these challenges in a number of different ways. The hon. Gentleman has described some of them. It also proposes embracing integrated services, from urgent and emergency care to mental health care and support as well as public health, which is important to me as the Minister for Public Health. The STP is also exploring how to improve patient outcomes through community-based care and preventive measures, which must be important if we are to manage demand. For example, the proposals include utilising initiatives to provide adequate housing in the area, and using new models of care to give health education. It also highlights three enablers for change for the area—workforce, digital enablement and infrastructure—and investigates how to improve its position with each.

I share the view of the hon. Gentleman and the hon. Lady that the public, key stakeholders and elected representatives should be closely involved in the development of STPs. With the plans now published, preparation for STP implementation must begin in the new year. Now is the time for STP leaders to reach out actively and engage patients and the wider public, and I expect nothing less. That means having frank, engaging and iterative conversations across areas, as well as some potentially difficult conversations about what the NHS could and should look like. Simon Stevens and Jim Mackey—the heads of NHS England and NHS Improvement—have written an open letter to STP leaders making that expectation absolutely clear. The letter reiterated that now is the time for local engagement to help develop the proposals and for those involved to make it clear that these plans must have a real benefit to patients.

I should also be clear that, nationally, all reconfigurations must meet the four tests mandated by the Government to NHS England in 2010, which require all local reconfiguration plans to demonstrate support from GP commissioners, strong public and patient engagement, clarity on the clinical evidence base, and support for patient choice. We would not expect any proposal to move forward that has not met all four tests. Patients must be at the heart of the NHS, and no plan can be successful unless they are fully engaged.

I close by saying that the hon. Gentleman has raised some very serious questions around details of his local STP plan and the quality of public consultation. I will ask the Minister responsible for community health—the Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat)—to meet him and the hon. Lady to discuss the details to ensure that they are properly ironed out and that the public consultation and discussion are of the highest possible quality.

Question put and agreed to.

Leaving the EU: NHS Funding

Stella Creasy Excerpts

Tuesday 15th November 2016 Commons Chamber

[Stella Creasy (Walthamstow) (Lab/Co-op)]

My hon. Friend is making a powerful case. This is such an important point for our economy, as we know in my part of London, where the Barts trust has the largest predicted overspend in NHS history. Does he agree that it is vital that those who campaigned on the pledge that this money would be provided are held to account, because communities such as mine are suffering without investment in the NHS?

[Mr Umunna]

I agree absolutely with my hon. Friend. When I had the pleasure of visiting her constituency the other week, I saw for myself the situation that she describes.

--- Later in debate ---

[Mr Umunna]

The right hon. Lady pre-empts what I am about to say; I shall come on to that precise point.

To be clear, I want the Minister, on behalf of his Department, to give the same commitment that we are asking the Treasury to make, and to outline how his Department will make good on this pledge. I shall explain why this is a pledge that the Government should deliver. The Minister might give a number of reasons, perhaps echoing the right hon. Member for Broxtowe (Anna Soubry), to explain why the promise given by his ministerial colleagues during the referendum should not be treated as such. I will deal with each of the main possible reasons in turn.

First, there are those who claim that this was not a pledge at all. Nigel Farage, the interim leader of the UK Independence party, said that it was one of the mistakes that he thought the leave campaign made. The current Transport Secretary, who was also a member of the Government at the time of the referendum, has said that Vote Leave’s specific proposal was, in fact, to spend £100 million a week of the £350 million for the NHS that was originally hoped for, commenting that that would be an “aspiration” to be met. Let me tell the Transport Secretary that the poster that the Vote Leave supporters all stood next to did not say that this was an “aspiration”; it was a pledge—pure and simple. There was no qualification on the poster or on the big red bus. This statement was made, and the people who made it should be held to account for it.

Secondly, many leave campaigners deny ever using the £350 million figure. One of them said:

“I always referred to Britain’s net contribution of nearly £10 billion—some £200 million a week…rather than £350 million.”—[Official Report, 5 September 2016; Vol. 614, c. 20WH.]

It is true—my hon. Friend the Member for Ilford North (Wes Streeting) touched on this—that the Office for National Statistics said that the £350 million figure was misleading, but the head of the Vote Leave campaign said:

“the £350 million figure is correct and we stand by it.”

Vote Leave, whose banner Government Ministers campaigned under, carried on citing the figure, as my hon. Friend said, and those Ministers must now be held to account.

[Stella Creasy]

I take my lead from the right hon. Member for Uxbridge and South Ruislip (Boris Johnson), who sadly does not appear to be in this Chamber. He was one of the most prominent members of the Vote Leave campaign and said that Brexit must give the NHS a boost. In my part of town, a boost to the NHS is the vital funding that we need to get our NHS back on track. Does my hon. Friend agree that we should listen to the right hon. Member for Uxbridge and South Ruislip about that point?

[Mr Umunna]

I shall come on to him shortly.

A further thing that is said—again, I think this has been touched on—is that not all the people who made these pledges were members of the then Conservative Government. Perhaps that could be said of the right hon. Member for Uxbridge and South Ruislip (Boris Johnson). Well, of the five current members of the Cabinet whom I mentioned, three were members of the then Government and one—the right hon. Member for Uxbridge and South Ruislip—attended the political Cabinet at the time. Yes, the Secretary of State for International Trade was sitting on the Back Benches, but countless other Ministers from outside the Cabinet at the time who are now serving more than make up for that—for instance, the hon. Members for Portsmouth North (Penny Mordaunt), for Camborne and Redruth (George Eustice) and for Stockton South (James Wharton). I could go on. Those are just a few of the people who posed by those posters and next to that big red bus, and they must be held to account.

Finally, it is said—this is the crux of the argument advanced by the right hon. Member for Broxtowe—that the commitment was given by one side in a referendum campaign, not by a Government. I am sorry but that simply will not wash. Many of those people were put up to appear in the media and to campaign on Vote Leave’s behalf precisely because they carried the authority that attaches to Government Ministers. That was why they were used. That was why they were asked to stand by that red bus, and to stand by those posters.

All those key Vote Leave campaigners, whether they were Ministers or not, were Members of this House. If our democracy is to mean anything, it must mean that Members are answerable to the electorate for their policies, and held to account in the House for the things that they say. People cannot go around the country casually promising the world and betraying people by failing to deliver, but then expect to get away with it. We will not forget; we will not let up. It was in the name of parliamentary sovereignty that those Ministers campaigned, and it is time that the House, on behalf of the people whom we are elected to represent, took back control, if we want to use that phrase, and made those Ministers answer.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

I congratulate the hon. Member for Streatham (Mr Umunna) on securing the debate, and on the points that he made. Like him, I voted and campaigned for the remain side, and, like him, I accept the result. I am now part of a Government who are responsible for delivering what was democratically decided by the British people. I should say at the outset, however, that I am speaking today for the Government and not for the leave campaign. If the hon. Gentleman feels that he is taking part in the wrong debate, I apologise for that in advance.

I will, however, address some of the points that have been made about the impact of Brexit on the NHS, because valid points were made about staff morale, the level of funding and the exchange rate. All those are variables, and I think it is good for us to spend a bit of time talking about them this evening. I will also talk about what stage I think we have reached on the pledge and the amount of money that we will no longer be giving to the European Union when we leave—although, as the hon. Gentleman knows, that depends on how we leave, and on the nature of the agreement that we eventually reach.

Let us begin by agreeing on one point. The single most important thing that the NHS needs to be properly funded is a strong economy. To the extent that Brexit may have positives and negatives, that fact is relevant, but the NHS is properly funded at the moment. We have heard some stuff about budgets and all the rest of it, but let me tell the hon. Gentleman that the OECD’s analysis of health and social care spending in every OECD country shows that we are now above average, although that has not always been the case. We are possibly 1% lower than the best of class, including France and Germany. That figure was for 2014, and the gap is likely to have been filled because this year we gave an increase to NHS spending of three times the rate of inflation and we have pledged that NHS England’s budget will increase in real terms by £10 billion between now and 2021. I do not believe Brexit will make any difference to that; indeed it is a commitment and priority of this Government that it will not.

We do know, however, that there are issues in how that money is allocated within the NHS. We are broadly at the average point of the OECD, and we do and could spend that money more efficiently and effectively. We could spend more on primary care, cancer and mental health than we do, and those are Government priorities, and we hope the sustainability and transformation plan process will help to deliver that because at the moment we spend too much on acute care.

Of course we can find efficiencies, too. Agency staffing is too high and we need to address that. There is a lot we can do on procurement—Carter and new care models and all that go with that.

[Stella Creasy]

The Minister could also work to renegotiate the private finance initiative loans that are crippling our NHS, and not use PF2 to do that. In order to do that, we need money in the NHS to be able to renegotiate. Surely the £350 million would help get us to that place; it would help us to renegotiate our debt, get our constituents back into work and get our NHS fit for purpose in the 21st century?

[David Mowat]

Nobody in this House would be more pleased than me if we did not have the PFI millstone around our neck. The hon. Lady talks of renegotiation; this is real money, and these are real contracts that were signed more or less entirely by the last Labour Government. There is no magic wand that enables us just to set those PFI contracts aside, although I wish there was; that is not how the commercial world works.

Junior Doctors Contracts

Stella Creasy Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

As ever, my hon. Friend speaks very constructively on this issue. She is absolutely right to say that the departments at most risk are emergency departments, maternity departments and intensive care units. Those are the areas that we are most keen to ensure will maintain critical doctor cover over the two strike days that are planned. I really hope that the BMA will co-operate with NHS England as we identify where we think the gaps might be. We will share that information with the BMA and I hope very much that it will help us to plug those gaps with junior doctors, because in the end no one wants there to be any kind of tragedy. We all have a responsibility to work to ensure that that happens.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

The Secretary of State will be aware that, when it comes to a medical diagnosis, words and clarity matter. The same applies to us as politicians. He has said today that he is imposing a contract, in contrast with what his legal team are saying to the doctors. For the avoidance of doubt, will he set out explicitly what legal powers he thinks he has to do that?

[Mr Hunt]

I am very happy to do so. We are introducing a new contract from this August, and it will be for all junior doctors. It will go progressively through the different ranks of junior doctors and, over the course of the next year, the vast majority of new doctors will move on to the new contracts. The reason that we did not use the word “impose” in the original statement was not a matter of semantics. We are proceeding with this new contract and everyone will move on to it, which is the gist of what most people mean by this. What we are not doing is changing existing contracts, so when people move trust or move to a new position, they will move on to a new contract. That is why we have used the term “introduction” of new contracts. However, it would have been much better if the introduction of the new contracts had been done through a negotiated process. That is why we took such trouble: we went to 75 meetings and made 73 different concessions in order to try to do this on a negotiated basis. Very regrettably, that proved not to be possible, which is why we took the difficult decision to proceed with these new contracts anyway.

NHS Trusts: Finances

Stella Creasy Excerpts

Monday 1st February 2016 Commons Chamber

[Ben Gummer]

I thank the right hon. Gentleman for his co-operation and help in trying to form the future of the NHS in Devon. This will work only if there is a cross-party effort, and the same is true of the national level. We have particular, urgent problems in Devon, and that means that the deficit will increase unless we take significant local action. That action needs to be led by local clinicians, and I am very glad that they are talking constructively. My job and that of the right hon. Gentleman is to provide support in the coming months so that we can have one plan that we can then implement.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

Let me give the Minister an example from my constituency of how some of the challenges are affecting patients. My local hospital of Whipps Cross ended up downgrading the nursing bands in an attempt to save money. As a result, it now has a big crisis in staff morale, the CQC has intervened because of the quality of care, and it has a massive agency bill. Moreover, Whipps Cross University hospital is part of Barts Health NHS Trust, which has the largest private finance initiative deal in the country. It is due to pay back £7 billion on a £1 billion loan, and last year alone it paid out £148 million—half of which was interest—on its PFI deal. What is the Minister doing to help trusts renegotiate such costs and tackle these legal loan sharks of the public sector?

[Ben Gummer]

To ask about PFIs signed by the previous Government is a brave line of attack. I have held a number of meetings about Barts with the hon. Lady’s colleagues, and I completely understand the difficulty that she and they—and, indeed, the trust—find themselves in. I had a meeting about Barts this morning. I also had two last week, and I shall be having a further two this week and next week, precisely because I want to see the transformation she needs in her area. I am very happy to discuss that in greater detail with her. In fact, I will convene a meeting of local MPs in the near future.

NHS Bursary

Stella Creasy Excerpts

Monday 11th January 2016 Westminster Hall

[Paul Scully]

I would hope that it decreased. I will touch on some of the costs of recruitment later. Students who receive bursaries under the current structure have less to live on than other students, despite the fact that their courses are longer. They face particular financial hardship in the final year, when funding is reduced. In one London university in 2012-13, 63% of the entire hardship fund went to NHS-funded students, which goes to show how much the system is of concern, and in need of investigation and reform.

Funding for nursing and physiotherapy degrees is lower than for any other subject in higher education, even though the courses put much greater demands on universities than many other courses in areas such as quality assurance, laboratory space and simulation kit. Universities receive less than the courses cost to deliver in many instances. There is a cap on the number of bursaries, and more than half the people who want to train to be nurses are turned away.

In changing the system from a bursary to a loan structure, the Government propose to remove the cap on places, and they expect the reforms to provide up to 10,000 additional nursing and health professional places during this Parliament. Some people who are concerned about the withdrawal of the bursary are worried about students having no money. Even now, many students, especially in London, with its high housing costs, say that the bursary nowhere near covers their living expenses.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

One thing that concerns many of us is the fact that the students we are talking about are not the same as many other students. They tend to be women or people who are returning to nursing. Does the hon. Gentleman agree that the cost of living issue—especially as those people are more likely to have dependents or existing commitments that they are trying to fund while studying—makes the change to the bursary system all the more worrying, because it will prevent even more people from being able to study to become nurses?

[Paul Scully]

I thank the hon. Lady for that intervention. In a little while, I will cover some of the issues that particularly affect nursing, and look at why some of the concerns about the nursing course are acute for those people. Let me conclude the remarks I was making a minute ago. The loans system, according to the Government, will cover the cost plus more, increasing the money available for living costs by about 25%. Looking at the structure, it seems that there are two avenues of concern. Some issues are particular to nurses, as the hon. Member for Walthamstow (Stella Creasy) suggested, but there is also a general student loan debate—rehearsing the student loan debate the House had some years ago, before I was elected. The issue has not affected some prospective nurses, although some have completed a first degree, and I will come on to that in a second.

I will touch on the student loan debate, although it is not something that we need to go over again, having discussed it at some length in various media and in the House a few years ago. When I talk about the debate, I always recommend that people look up Martin Lewis, the financial expert who runs the MoneySavingExpert.com website. He is not uncritical in his acceptance of the current tuition fee regime and loan structure, but he comes up with some interesting mythbusters. For anybody considering the prospect of taking out a loan before studying, he is well worth a read. He talks about not confusing the cost and the price tag of a degree because the main practical issue is how much people have to pay having graduated, rather than the top line figure of the debt. I will go into that in a second. Repayment is effectively based on salary, and repayment costs are 9% of everything someone earns above £21,000. For example, a nurse on a band 5 salary would pay about £5.73 a month in student loan repayments. It is not an up-front cost.

--- Later in debate ---

[Wes Streeting]

Those statistics concern me greatly. I should probably have said at the outset of this debate that I am a member and supporter of Unison. I also draw the House’s attention to my entry in the Register of Members’ Financial Interests. For completeness, I should also say that I am a former president of the National Union of Students and have a long-standing interest in such issues.

It concerns me that there might be a detrimental impact on recruitment, particularly given that my local NHS trust had to fly nurses over from Portugal to fill vacancies. I have no problem with those Portuguese nurses coming over to help plug the gap, but we have plenty of home-grown talent in the form of nurses who would welcome such a job opportunity. That is felt strongly by local people in my area.

[Stella Creasy]

My hon. Friend is a near neighbour to Barts hospital trust, which is currently spending £10 million a year at Whipps Cross university hospital, our local hospital, such is the shortage. A hospital that is £941 million in debt due to its private finance initiative loans clearly needs to save money, yet it is having to pay £10 million for agency nurses. Does he think that the policy will make that easier or harder to deal with?

[Wes Streeting]

I am grateful to my hon. Friend for that intervention, and I believe it will make it harder. That concerns me, because Barking, Havering and Redbridge University Hospitals NHS Trust covers part of my constituency and the other half is served by the Barts Health NHS Trust. Both trusts are in special measures, and one issue that has contributed to that has been the inability of both trusts to recruit and retain the staff necessary to provide the timely and quality care that residents in Ilford North and other parts of north-east London have come to expect.

Barts Health NHS Trust

Stella Creasy Excerpts

Thursday 19th March 2015 Commons Chamber

[Jane Ellison]

I pay tribute to my hon. Friend’s remarkable work in this Parliament on campaigning for transparency in patient safety. He is exactly right to say that these are important features of the inspection regime. As I have said, work has already begun to strengthen the management arrangements at Whipps Cross, but he is right to say that patient safety must be the predominant concern of the management when they come to address failings such as these.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

Whipps Cross is my local hospital. I have been a patient there and my family have been patients there, as have friends and neighbours. I join the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith) and my hon. Friend the Member for Leyton and Wanstead (John Cryer) in being horrified at what I am sure they would see as the Minister’s insulting response to this issue. She is playing politics with the hospital that serves our community. We all want to put on record our support for the patients and staff who spoke out and demanded that the CQC should come back to the hospital, despite the assurances from the management and the Government that all was well there. They were begging the CQC to return to look again at Whipps Cross, and when we read the report, we can see that they have been vindicated. The lead inspector has rightly expressed his concern that front-line staff will feel even more demoralised following the report, and that their welfare needs to be our priority. What assurances can the Minister give me that, rather than playing party politics, she will listen to the inspectors and heed that warning?

[Jane Ellison]

The hon. Lady is quite right to say that patients would be concerned, but they should also be reassured that this inspection regime has exposed some of the issues, and now is the time for them to be addressed adequately. The additional support that the trust will receive as part of the special measures is part of what will help it to make the necessary improvements for patients. The chief inspector of hospitals has highlighted the scale of the challenge ahead, but this is an opportunity to ensure that the trust has the extra support to meet that challenge. That is exactly why the regime exists—[Interruption.] I am sure that, like me, the hon. Lady will have been concerned to read of the culture of bullying and low morale, which is not acceptable. Part of the transparency regime that this Government have put in place involves ensuring that staff can speak out, and I am glad that some of them did. It is never acceptable for staff to feel unable to speak out on the issue of poor care, so I am glad that this report has given them the chance to voice their concerns. Those concerns must now be properly addressed.

Women Entrepreneurs

Stella Creasy Excerpts

Wednesday 18th March 2015 Westminster Hall

[Stella Creasy (Walthamstow) (Lab/Co-op)]

It is a pleasure to serve under your erudite chairmanship and beady eye this morning, Mr Robertson; you will ensure that all of us are well-served this morning.

I congratulate my hon. Friend the Member for Feltham and Heston (Seema Malhotra) on securing this debate. I know that this is a subject she is really passionate about. She has done a lot of research on it, which really shows in the insight she offers into it and the things that we can do about it.

I also want to put on record my interest in and support for the fact that there are a number of MPs here. May I venture to say to the hon. Member for Upper Bann (David Simpson), who sadly has now left Westminster Hall—

[Jim Shannon]

He will be back.

[Stella Creasy]

I am pleased that the hon. Gentleman will be back, because it is good to see male MPs supporting the idea that there is a gender gap that needs to be addressed. However, may I venture to say that that is not necessarily a concern because of his wife but because when 51% of the population are not fully utilised it is a concern for us all that we are missing out on the contribution that they could make? Frankly, sorting this issue out would help a lot of men, because it would help our economy, and therefore it perhaps has less to do with his wife and more to do with his constituents. It is because of them that he should be concerned about why we have such a gender gap. In particular, my hon. Friend set out well the particular gender gap that we see in the UK, because the situation is not the same in other countries, which should be very telling about what we can do in this country to address these issues.

A number of Members have already pointed out that there would be many more businesses if women were starting up businesses at the same rate as men. However, it is worth considering the situation in other countries. It is not only America that has a higher level of female entrepreneurship than the UK but countries around the world. Therefore, there is something happening in the UK. It is also worth noting that we have a higher rate of churn in the UK, so even when women start up businesses here they are failing more often than in other countries. Women entrepreneurs here are also less likely than elsewhere to attribute the closure of their business to business failure and more likely to cite personal reasons as one of the reasons why their businesses were not successful.

Why does this issue matter to us all? It is because equalising the labour market participation rates of men and women would boost the UK economy by an average 0.5 percentage points every year, with a potential gain of 10% of GDP by 2030. Given the recession that we have just gone through and given the fact that our recovery appears to be beginning to slow, getting more women into business and into leading more businesses would clearly make a tremendous difference to us all and our future economic position. Indeed, the Royal Bank of Scotland has calculated that boosting female entrepreneurship could deliver an extra £60 billion to the UK economy.

[Seema Malhotra]

As always, the shadow Minister is making an excellent speech. She raised the issue of female participation in the labour force and the important contribution to the economy that could be made by boosting the number of women entrepreneurs. Does she also see this situation as an opportunity for us to see women not only as entrepreneurs but as the employers of the future, who employ others and make changes as their businesses start to grow?

[Stella Creasy]

My hon. Friend has pre-empted one of the points that I was going to make, namely that this issue is not just about women employing themselves. Indeed, all the evidence suggests that on the whole women’s businesses tend to be better at creating jobs than men’s businesses, because women’s businesses are generally more labour-intensive than men’s businesses. Again, I go back to my initial theme that it would do men, and not just women themselves, a big favour if we could get more women into business.

Therefore, it is worth asking ourselves why we are not seeing that kind of progression in the UK, given that we need it within our economy to make it more stable. My hon. Friend set out the admirable record of the previous Government in bringing forward this agenda and I am very proud of the previous Government for making women’s business a priority for all, and not just for women. However, as the hon. Member for Cambridge (Dr Huppert) rightly said, we have all seen that the progress on this issue has been too slow. Since 2008, the percentage of small and medium-sized enterprises run by women in this country has only gone from 14% of the total number of SMEs to 20%, which is a 6 percentage point increase in that time period. That is simply not good enough. As a result, women own only about one business in five in this country. When we compare that with America, where women are twice as likely to be entrepreneurially active as women in the UK, even though the rates of entrepreneurship for men are very similar for both countries, that tells us the problem that we face here.

In that same time—the period since 2008—it is also worth reflecting on just how quickly women’s employment in and of itself has changed. Not only have women been hit disproportionately hard by the Government cuts but in terms of unemployment. Therefore, it is not a surprise that in the boom in self-employment that we have seen in this country in the last five or six years, women have accounted for much of that growth. Women account for under a third of those who are in self-employment in our country, but more than half of the increase in self-employment since 2008 has been among women. In fact, between 2008 and 2011 women accounted for an unprecedented 80% of the new self-employed people within our economy, which means about 300,000 more women going into self-employment since the economic downturn.

What sort of businesses might those new businesses be? I am sorry to see that the Members from Northern Ireland in Westminster Hall have now shrunk down to one—the hon. Member for Strangford (Jim Shannon)—but I hope that it is a case of quality not quantity. The hon. Gentleman himself talked about online shopping and women using their interest in that to drive business. What we have certainly seen is a boom in the internet economy and the opportunity not so much to shop online as to sell online; we have certainly seen that women have been taking advantage of that opportunity. I would wager that that is not so much because of women’s interest in shopping but because of the reduction in barriers to entrepreneurship that online activity creates. The fact that now someone needs only a few hundred pounds to set up a business rather than several thousand pounds, because it is possible to sell online, changes our economy in substantial ways. Indeed, online businesses have accounted for almost a quarter of total UK growth in recent years, and much of that has been driven by new entrants into the market, including women benefiting from the fact that they can combine work around some of their other commitments to get into that online business.

[Seema Malhotra]

The shadow Minister is making an excellent point and I am reminded of the excellent phrase in the book, “A Woman’s Place is in the Boardroom”, by Peninah Thomson, in which she talked about the “customer being queen”, because of the fact that women are responsible for more than 80% of retail purchases, or decisions about them. Does my hon. Friend agree that that highlights even further the need to focus on women and what they can bring to our economy through setting up enterprises? The fact is that when women make decisions about what to purchase for themselves and their families, they understand the market so much more than men, and when they come forward and start businesses they are often filling niches and going on—just as Anita Roddick did with the Body Shop—to be hugely successful.

[Stella Creasy]

Again, my hon. Friend shows her experience in this area. What we are certainly seeing is that women who start businesses tend to bring forward new products, as opposed to men who start businesses, who tend to bring forward competitor products. So women are certainly driving innovation.

My point in referring to the online economy is to set on the record that Labour thinks this issue is less about women bringing their previous experience of purchasing to business so much as their ability to use the opportunity that online behaviour offers to open up markets to people. When someone is bringing a new creative product to the market, having a window that sells to millions of people rather than perhaps having a window just in their local high street opens up the potential for greater success, and it is important that we consider that and ask ourselves how, for example, we can support more women to learn skills, such as coding, to be able to sell online.

A number of Members today have obviously focused on women themselves and what might be stopping them from getting into business. Certainly, one of the issues that people have come up with is child care. So let us be very clear that there probably is an issue around child care and helping women to be able to juggle, which suggests men are holding women back, because, after all, it takes two to have a baby. One thing that I would be interested to hear the Minister’s view on is how we can make men hold up their part of the bargain in looking after children, so that their wives can be the successful entrepreneurs that they want to be.

Labour’s child care proposals will probably help a lot of women entrepreneurs. For example, there is our proposal to increase the number of hours of free child care that are available. With child care costs rising by up to 30%, there could be many parents—for example, the women who want to be the next Anita Roddick or Laura Tenison—who find their ability to be entrepreneurial being hampered as a result of this Government, because they find they cannot afford the child care necessary for them to spend the time setting up a business.

Today, therefore, I will set out four areas that I would like to hear the Government’s response about. They are less to do with women and more to do with the environment that we are asking women entrepreneurs to enter.













First, hon. Members talked about finance. Clearly, finance matters. The evidence shows us that women start businesses undercapitalised, and with not just less finance, but fewer human resources and less social capital. That puts them at a disadvantage by comparison with their male counterparts. Not having the same level of resource is a factor in respect of confidence and risk-aversion among female entrepreneurs. It is important to say that it is not always a bad thing that women are risk-averse, but we should recognise it when they do not have the same resources, and so cannot take the same risks, as their male counterparts. We must consider how to ensure that they have access to more resources, rather than encouraging them to take more risks, and we should recognise that their lack of confidence may not be misplaced and that they might not have the resources to succeed.

How much of a barrier is finance? Some 10% of female entrepreneurs say that access to finance is their only barrier to entrepreneurship, and that it is a particular challenge in respect of expanding in the way they would like to. Again, that appears to be a bigger problem in the UK than in other countries, particularly in Europe. Women in Europe are much more likely to be able to access finance to start and run their businesses than their UK counterparts. Some 20% of women in the UK have tried to get money to start a business but have been turned down, compared with only 11% of European female entrepreneurs.

My hon. Friend talked about the Aspire fund, which was set up in 2008 to try to deal with this challenge and ensure that there was a dedicated pot of money to support women in business. As she said, as of last year only £4.7 million of the £12 million had been invested. It is worth comparing that with other forms of start-up finance backed by the Government to see what the difference is. For example, in the same period, the enterprise finance guarantee scheme, set up to provide assistance to small businesses with an annual turnover of less than £41 million, has offered £2.6 billion, and £2.3 billion has been drawn down. The regional growth fund, which matches private finance with public assistance, has awarded £2.6 billion, of which £1.15 billion has been drawn down. There is a differential. It would be interesting to hear the Minister’s view on why the Aspire fund has not been as successful in promoting and supporting women’s businesses as some other start-up funds.

Research by Strathclyde university states that decisions regarding women and finance are based on the interaction between women, who may lack confidence—perhaps because they recognise that they do not have the same level of resource to start a business—and those offering them finance, who may have a certain attitude and approach. There is an interesting challenge for us: if we can change the attitudes of those offering finance—for example, through the Aspire fund—will more women go into business?

Secondly, we have to acknowledge the issue of confidence. I challenge slightly the vicious circle that the hon. Member for Strangford mentioned: he said that dedicated schemes for women could undermine their confidence. I assure the hon. Gentleman that the other way of looking at that is that it recognises that they are a priority. Dedicated schemes, with mentoring and support for women, recognising that there is a gap, and bringing other women forward are helpful and supportive.

Some 38% of women in the UK, compared with just 3% of women in Europe, take advice from Government business support projects. Women are more likely to use all forms of business support than men, whether public or private, and are more likely to access support from professional services. It is important that mentoring schemes exist. It matters that other women are in business, because you cannot be what you cannot see. It is a simple principle, but seeing other women being successful in business offers a road map for women, showing them how they could be successful.

I pay tribute, as other hon. Members have, to a women’s business forum in my constituency. I venture to say that that forum, run by the amazing Jo Sealy, is more successful than our general business forum.

[Jim Shannon]

I just want to go back one sentence, with the hon. Lady’s permission, and talk about confidence. I was saying that we all have different natures. I have a different nature from other gentlemen in this Chamber, and the hon. Lady is different from other ladies here. It is important, when encouraging ladies to take a job up or move forward with their idea for entrepreneurship, that it is done in such a way that their confidence is encouraged. It is not that what is happening is not right; it is right for some, but perhaps not right for all.

[Stella Creasy]

I thank the hon. Gentleman for his clarification. My point is that he was querying whether a gendered approach to mentoring might not be counter-productive. I wanted to reassure him that such an approach is important for a lot of women, because it shows them a road map of where they could get to.

I also pay tribute to Simone Roche of Women 1st, Kate Hardcastle of Insight with Passion, Bev Hurley of Enterprising Women, Heather Jackson of An Inspirational Journey, and Margaret Wood of Opportunity Plus, who supports older women entrepreneurs. There are a number of schemes out there, and what they all have in common is that they were set up by women volunteering. Some of them have become social enterprises. I share the concern of my hon. Friend the Member for Feltham and Heston that, over the last couple of years, the work to support women doing that work has been downgraded. My second question for the Minister is: does he share our concern and think there should be a renewed effort to support and prioritise those mentoring networks, not just in local enterprise partnerships?

My hon. Friend and colleague the Member for Feltham and Heston is a fan of the work of the national Women’s Business Council, which was set up for a year as an independent body. Does the Minister think there is a case for making that a perpetual scheme and for considering how it could support mentoring, using and drawing on the experience there?

Thirdly, with regard to women finding it hard to see other women whom they might aspire to be, does the Minister share my disappointment and concern about the slow pace of progress in getting women into leadership positions in business across the piece? He must be disappointed with the slow pace of change, given the diversity dividend that comes from getting more women into boardrooms. He must also share the disappointment of his colleague, the Minister for Business and Enterprise, about the decisions of many businesses to appoint women to non-executive positions. The vast majority of women who have gone into leadership positions on business boards during the past couple of years have simply been appointed as non-execs and have not been in decision-making positions. I know that the Minister will be worried about that unacceptable situation, because it sends a message to women entrepreneurs that there are not women to trade with. Does he think that there is now a case for getting on with looking at what quotas could offer us, in respect of non-exec and exec positions, and the way that businesses are working with women?

My final questions to the Minister are about women to trade with. There is a slow pace of change when it comes to not just women in boardrooms and in entrepreneurship, but women to trade with. In a world economy, the way our businesses work with other businesses could provide huge opportunities for women entrepreneurs, but at the moment, women-owned businesses are winning less than 5% of corporate and public sector contracts.

The Government’s adviser has called for the Government to collect data on diversity in procurement processes, and said that the pre-qualification questionnaire should ask about women-owned business. Is the Minister concerned that the talk about removing the pre-qualification questionnaire for contracts smaller than €250,000 may mean that we will not see that level of engagement with the question of whether the Government are selling to women and doing all they can, through their own supply chain, to promote women’s business?

Although UK Trade & Investment measures women-led firms that export, we do not measure women being sold to and traded with in our economy. The Government have dismissed the idea of having a quota for tenders and the idea of measuring the number of women being sold to, although clearly that would help us understand the scale of the challenge and whether the Government are doing what they can. If the Minister wants insight into what difference that could make, he should look no further than that socialist utopia, the United States of America, where some 30% of all businesses are majority female-owned and the number of women-owned businesses continues to grow at twice the rate of all US firms. Women are increasing their economic clout and driving the American recovery. That is not happening by accident; it is being driven by the US Government’s deliberate choice. The USA Women’s Business Ownership Act 1988 put in place long-term infrastructure to support women’s enterprise development. The quotas and targets set by the US Government for women in their supply chain are changing the behaviour of companies in America.

In 1994, the federal Government established a 5% spending goal for federal agencies to encourage contracting with women-owned small businesses. That target has not yet been met, but it is almost being met and it is making a massive difference to women entrepreneurs in America. Indeed, it is changing the debate not just in the public sector in America, but in the private sector. Companies such as Walmart—again, not perhaps seen as a socialist leader, if the Minister is worried about that—have introduced “women-owned” labels since last year, allowing consumers to clearly identify products created by women-led businesses and buy accordingly. That company sees a commercial interest in this.

The Minister may be worried that I am talking straight away about bringing in a direct quota for selling to women. I recognise that first and foremost we have to ask the question, so will the Minister commit the Government to asking, in the public sector, about selling to women and to starting to monitor just how women’s businesses are being traded with in this country? Through that, we can understand the gaps in the industry. Perhaps there is a role in that for the Women’s Business Council and that dedicated lead on women’s entrepreneurship and business that my hon. Friend the Member for Feltham and Heston set out so clearly as being required.

Ultimately, if we want to give women confidence that their businesses will be supported, that they will be successful and that we can bridge the confidence gap, we have to show that the issue is a priority. The Opposition are committed to that; I hope that the Minister will show a similar commitment, so that we can all benefit from the increase in economic activity and productivity that bringing more women into the UK economy would offer.

--- Later in debate ---

[George Freeman]

The process of evaluating the BIS portals has been taking place only in the past few months. Perhaps I could come back to the hon. Lady with the latest details of that assessment.

[Stella Creasy]

Will the Minister give way?

[George Freeman]

If I can just finish this section of my speech, I will happily give way.

We have invested in the women’s start-up project to provide opportunities for young women studying in the creative industries and the leisure and tourism sectors to start their own businesses. This pilot project, in partnership with Young Enterprise, will see the Government provide funding of up to £50,000 for teams of young women aged 19 to 24 studying at undergraduate level to set up and run their own businesses. We have also provided £2 million for small grants of up to £500 for those wishing to set up new child care businesses—help with child care is of course a major part of support, and I will say more about that in a moment. In the autumn statement, the Chancellor announced that that scheme would be extended until March 2016, with a further £2 million made available for next year.

As a number of colleagues have mentioned, we have provided a £1 million women and broadband challenge fund to help women to move their business online and take advantage of superfast broadband. Sixteen local authorities have been awarded a grant to support actions to encourage women’s enterprise in areas where superfast broadband is being deployed. I want to touch on the particular challenge faced by women entrepreneurs in rural areas such as my own.

[Stella Creasy]

Will the Minister give way?

[George Freeman]

I will just finish my point, then I will give way.

The Government are actively addressing a number of additional barriers for women in rural areas. We have provided £1.6 million to support women’s start-ups in rural areas, including improved access to transport links, virtual assistants for those in the most remote areas, online help, and local business support through mentoring, skills training and networking.

[Stella Creasy]

Before the Minister moves on from discussing Government support to women’s business, I want to press him on the Aspire fund—I hope that he has just received a note on it from his officials. He mentioned a number of different pots of money that are being given out to support women in business in various ways—for example, the broadband challenge. The Aspire fund was set up with £12 million to support high-growth women-owned ventures, but six years on, only £4.7 million has been invested. Will he say more about why that is the case and what the Government are doing to reduce the gap? If that money is there to support women’s business, surely we should ensure that it gets to women in business.

[George Freeman]

With her typical prescience, the hon. Lady anticipates the next paragraph of my speech. We recognise that the sector needs particular support, which is why we are so keen on the Aspire fund, which makes equity investments of between £100,000 and £1 million on a co-investment basis and is designed to help female-led businesses that aim to grow. The fund invested £1.3 million and supported £5.5 million of investment in 2013-14, and it has a total of £12.5 million to invest.

It is worth remembering that the fund was not intended to fund a large number of businesses; it is there as a beacon project to support women-only businesses and catalyse the sector. I am delighted that we have also made additional investment available to businesses led by women, as well as those led by men, through the £100 million business angel co-investment fund. We must not forget that although we are catalysing and driving women-only entrepreneurs, the whole range of business support mechanisms we have put in place—including the seed investment enterprise scheme and the expanded enterprise investment scheme—are all available to women entrepreneurs.

[Stella Creasy]

Will the Minister give way on that point?

[George Freeman]

I just want to finish this point about funding.

Without the right funding, it would be hard for anyone to realise the potential of their ideas. The Aspire fund is one of a much larger range of measures. Women are also benefiting from the full range of start-up loans and the new enterprise allowance. More than 25,000 loans worth more than £160 million have now been made, with 37% going to women. The 25,000th loan was given to a female entrepreneur.

To help more parents to start their own business, from autumn 2015 tax-free child care will be available to nearly 2 million households to help with the cost of child care. That will enable more parents to go to work and, unlike the current scheme—employer-supported child care—it will be available to self-employed parents.

[Stella Creasy]

There is a £7 million gap between the £12 million that has been made available for women’s businesses and the money that has actually been drawn down. I take the Minister’s point, and I am not suggesting that that is the only funding available for women entrepreneurs, but compared with other Government-led schemes, there is a substantial disparity. Why does he think that is? Why has the Aspire fund not been able to lend at the same rate as the other available start-up funds? Will he commit the Government to monitoring across the piece the gender of those to whom they are lending through start-up schemes? The Government have not always monitored that, but they must do so to truly understand what we might have to change about finance for women to ensure that they all get the support that they need.

[George Freeman]

It is important to realise that we do not want the investment funds that take equity stakes simply to shovel the money out of the door irrespective of the quality of the bids. The decisions have to be based on proper investment criteria, and it is not for me or the hon. Lady to second-guess such judgments. I am pleased to see that after an initial period during which the rate of investment was slower, it has picked up. We are actively monitoring and supporting the fund, and our ambition is for it to be spent and invested, but it is important that we send a signal that the money is going into high-quality business propositions.

As we have all acknowledged this morning, there is a challenge in trying to observe the wider cultural point made by my hon. Friend the Member for Cambridge (Dr Huppert). He said that we must promote world-class, aspirational, high start-up businesses that are capable of receiving that sort of venture capital. It is not for us to signal that the money should be pumped out of the door irrespective of the quality of the bids. It is for the fund manager to ensure that they are picking the right investments.

I have tried to be generous in giving way, but time is running out, so I want to complete my remarks. For all the reasons I have outlined, and because we agreed that we must do more, in April 2014, my right hon. Friend the Secretary of State appointed my hon. Friend the Member for Solihull (Lorely Burt) to the role of women in enterprise champion, to promote the support available to women starting a business. In February, she presented her report on how the Government could boost support for female entrepreneurs, and we agree with much of the thinking and analysis it contains. I cannot be expected to commit the Government to agree with every single one of the recommendations, but we are actively looking at them and working on an implementation plan.

I want to pick up on some of the comments. My hon. Friend the Member for Cambridge focused in particular on science and start-up companies. I join him in paying tribute to the people in the high-tech and life sciences sector, which we both know well from Cambridge, and to entrepreneurs such as Julie Deane of the Cambridge Satchel Company. He made a number of interesting points about cultural attitudes and the need to ensure that, in what can sometimes be the quite macho world of finance, the quality of women entrepreneurs and of women in science is properly recognised.

My hon. Friend also talked about the importance of getting schools better connected to businesses. We can all do something about that in our own constituencies. Tomorrow night, the Norfolk Way is launching our first innovation awards for Norfolk, linking up science teachers and students in schools with local businesses in the area. He made an important point about 8% of venture capital funding but 41% of crowdfunding going to women-led businesses. That sends a signal about the power of some of the new financing mechanisms to support women’s businesses. Although the Enterprise Research Centre has shown that there are no specific obstacles to access to finance for women, strong perceptions have a powerful effect, and that is something we need to monitor.

My hon. Friend made a particular point about STEM. Since 2009-10 the number of women starting engineering in manufacturing apprenticeships has increased threefold, which is a real success for the coalition’s apprenticeships policy in that we are getting more and more women in the STEM subjects. More action is necessary, but with the apprenticeship ambassadors STEMNET programme we are making progress. The Your Life “Call to Action”, part of the campaign launched by the Chancellor and the Secretary of State for Environment, Food and Rural Affairs, has brought together employers, educators and the professions to make concrete pledges to increase the number of women in engineering and technology. I am delighted that more than 200,000 organisations have now pledged to create in excess of 2,000 entry-level positions, including apprenticeships, graduate jobs and paid work experience posts, as well as action to support their female work force.

[George Freeman]

I absolutely join my hon. Friend in paying tribute to another beacon project that is sending out such a powerful signal to girls and women about opportunities available to them. I am delighted, too, that we allocated a further £20 million in the engineering skills fund to help employers to tackle skills shortages in engineering, including to develop women engineers.

Finally, my hon. Friend made a point about enterprise education. I am delighted to confirm that we are working actively with schools, colleges and higher education institutions to encourage and promote entrepreneurial attitudes and skills training, as well as providing mentors and role models and improving access to finance support.

I want to deal with the questions about child care and women on boards. A number of colleagues asked about child care support. The Government have increased the number of funded hours of free child care from 12.5 to 15 hours a week for all three and four-year-olds, saving families an additional £425 a year per child. Since September 2014, we have funded an additional 15 hours a week of free child care for the 40% most disadvantaged two-year-olds, saving families £2,500 a year per child. We have also increased child tax credit well above inflation to £2,780 a year, which is £480 more a year than at the beginning of the Parliament. All families under universal credit will be able to receive 80% support for child care costs, which is up from 70% under the existing working tax credit system. The introduction of tax-free child care could also save a working family up to £2,000 a year per child. In addition, we have committed an extra £50 million to introduce a new early years pupil premium in 2015-16 to support the most disadvantaged three and four-year-olds to access Government-funded early education. That is important if we are to support our entrepreneurs and innovators in all walks of society and to ensure that entrepreneurship is not the preserve of the well-off.

Women on boards is an important subject. A lot of our entrepreneurial companies do well and go on to become substantial, significant companies quoted on the stock market. We are ensuring that, at that point, women continue in leadership roles. Following Lord Davies’s recommendations in the 2011 “Women on boards” report, the Government are committed to achieving the target he set for the end of 2015 of 25% of FTSE 100 boards being women. We also want to increase the number of women on FTSE 250 boards. The graph that I have in my hands shows a line slowly climbing from 2004 to 2011, but then turning sharply upwards, going from 12.5% of women on the boards of FTSE 100 companies to 20.7% at the end of 2014. We are making a real impact and we must continue to do so. I am delighted that now 22.8% of FTSE 100 board members are women and that women now account for 28% of FTSE 100 non-executive directorships and 8.5% of FTSE 100 executive directorships. There is much more to do, but we are making real progress.

[Stella Creasy]

Does the Minister share the view of his colleague, the Minister for Business and Enterprise, that it is unacceptable that boards are only appointing women to non-executive positions and that what we need therefore is a target not only for women on boards, but for women in decision-making positions? Also, will the Minister answer the questions about the Women’s Business Council and about the supply chain? It would be incredibly helpful to hear his response on those issues as well.

[George Freeman]

I do share the ambition and desire of my fellow BIS Minister, my right hon. Friend the Member for West Suffolk (Matthew Hancock), to see a continuing increase in the rate of women being appointed to the boards of our top companies. The hon. Lady is right to highlight that we do not want women only to be in non-executive roles; they must be in executive roles as well. That is why I was saying that we are very much focused on that. We are pleased with the progress, but we need to go further—not, I hasten to add, because of a politically correct desire to hit some quota, but because women are talented and represent more than half of our work force. By not giving women fair representation in the leadership positions of our great companies, we deny those companies their talents. We are being hard-headed and not only concerned with social justice. It is in the interests of the country in every way. I am glad that we agree on that.

In closing, I want to return to the point with which I started. Many of the arguments used in the Chamber today relate to the economic contribution of women in entrepreneurship and start-up businesses and to the need to unleash the talents of women, because that is so important to our economy, but I want to highlight the importance of a small business and entrepreneurial economy to the wider stock of social capital and the ties that bind us. I am absolutely certain that if we are to rebalance our economy in the broadest sense, we need to create one in which small business not only contributes to economic success, but helps to bring communities together. Give me a deal between two small companies any day of the week and I will show people a deal that includes not only an economic deliverable, but a contribution to social capital and to building trust between communities. In many of our small towns, neighbourhoods, villages and inner-city communities, small businesses working together produce and deliver so much more than just economic growth. It is vital that we build women into that network as well.

For those reasons, I am delighted that, while there is not a shred of complacency in the Government, we are making real progress. We now have 1.45 million women enjoying the freedoms and flexibilities of self-employment, which is 42,000 more than in the previous quarter and 281,000 more than in 2010. We also have 900,000 SMEs run by women, more than at any time in our history. I am not complacent, but the Government are making progress.

[Stella Creasy]

Before the Minister closes, I wanted his response to two specific questions about the future of the Women’s Business Council and the supply chain. His own Government adviser on women-led businesses has suggested that the Government should monitor women in the procurement supply chain. Will he commit the Government to that, yes or no?

[George Freeman]

I have taken a lot of interventions and questions, but I will happily get back to the hon. Lady in detail. She made an interesting point about procurement. Through the work of the Cabinet Office, we are driving hard to ensure that we use every procurement power to support innovation throughout the economy. That is an important part of it and I will happily come back to her on it later.

The 900,000 SMEs run by women in our economy, the highest number in history, suggests that we are making real progress. I am not complacent for a moment, but we are on the right track.

GP Services

Stella Creasy Excerpts

Thursday 5th February 2015 Commons Chamber

[Stella Creasy (Walthamstow) (Lab/Co-op)]

I congratulate my hon. Friend the Member for Halton (Derek Twigg) on securing what, for me, is an incredibly important debate. I am pleased to follow the hon. Member for Henley (John Howell), because he and I have probably been doing the same thing in going to talk to people in our local community about local health care. I must say that my experience is of a very different health care system—one that is under real pressure and, frankly, very much in danger in my local community.

I wanted to speak in this debate to put my concerns on the record and to ask the Minister and officials at the Department of Health to look at my area, because I am so worried about these issues. As an MP, I see it as my job first and foremost to help the patients of Walthamstow—my neighbours, as well as my family and friends in the area—who can see how our services are falling apart. As their MP, my very real worry is that, as much as I have tried to raise such concerns, all I hear is that those problems are for someone else or for some other organisation to resolve. I want to put on the record some of the issues, and to explain the situation in our local community and how it is having an impact on doctors. By doing so, I hope to convince the Minister to pay special attention to Waltham Forest.

There are 45 GP member practices in Waltham Forest CCG. We have one of the fastest growing populations in the country, but many of the practices are in poorly maintained buildings and are single-handed. They serve a community that has a very high incidence of what we might call lifestyle diseases—diabetes, heart disease, cancer—and GP access is absolutely critical to the outcomes achieved for patients.

[Mr George Howarth (Knowsley) (Lab)]

Will my hon. Friend be a bit more specific? Type 2 diabetes is lifestyle-related, but type 1 is not.

[Stella Creasy]

I apologise for using shorthand. My right hon. Friend is completely right. I am talking about type 2 diabetes. For example, many people from the south Asian community in my constituency have type 2 diabetes.

We are told that our local GP work force needs to grow by 40% by the end of the next Parliament if it is to serve the community I represent. However, I can already see very real problems with our local community service, and that is bad for the patients and for the rest of the NHS. We know how difficult it is to recruit and retain doctors, but in my part of town, with the high cost of living in London, it will get even harder.

Since 2011, complaints about GP access have rolled into my constituency office. Let me give the Minister some examples. Just the other day, a resident rang me and said: “Look, the receptionists were perfectly polite. They said call at 9 o’clock or queue up before the surgery opens to get an appointment, but the line was constantly engaged from 9 o’clock. My phone shows I called 28 times between 9 am and 9.30 am, and I could not get through. When I did get through, it was only to be told that there were no more appointments left.” That is not unusual in my community.

Little wonder that residents in Walthamstow routinely report that it takes two weeks to get an appointment with a doctor. Nationally, we know that one in four people wait a week or more. The problem—this is why I disagree with the hon. Gentleman—is that it is very hard for people to know whether or not they need to see a doctor, especially if they are worried about a child.

Let me give another example of a complaint I received just the other day: “I have had constant problems trying to get a GP appointment for my 13-month-old daughter since she was born. A couple of times, even only last week, I was asked by reception staff at the doctors why I hadn’t gone to A and E.” That is the constant question for residents in my local community when they cannot get through to the surgery—should they wait or should they go to A and E?

I agree with the hon. Gentleman that not everybody needs to see a doctor, but another resident told me: “I fell and cut my hand deeply on glass. I went to the doctors to ask if a nurse could check that there was no glass left in. They told me to go to hospital. The cut was really not that bad. But they said they don’t have any nurses on a Friday and I would have to make an appointment to see a nurse—two weeks as usual, no doubt—so I just left it, as I do with most pains, coughs or small lumps, and hoped it would sort itself out. My hand is healing now and seems to be glass-free. I hope so anyway.” That is not unusual in my area. At least that elderly lady could have seen a nurse, but many constituents tell me that they do not bother to see a doctor because of how long that takes, and they take the risk of waiting.

[Douglas Carswell (Clacton) (UKIP)]

I am very interested in what the hon. Lady is saying, because it sounds ominously like the situation in Clacton. Indeed, in one Frinton surgery in my constituency, one doctor was trying to serve 8,000 patients. She is absolutely right to avoid the temptation to blame the patients or to suggest that they are the problem. Does she agree that part of the answer is to ensure there are far more attractive terms for would-be GPs? That does not necessarily mean higher salaries—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Mr Carswell, interventions are meant to be short, not speeches. I am sure you have got to the point.

[Stella Creasy]

It is unusual for me to agree with the hon. Gentleman, but I agree that we need to look at how we can attract and retain doctors. We also need to look at what these problems do to the rest of the NHS.

Let me tell the hon. Gentleman about a constituent of mine who had a problem with his eyesight that was caused by high blood pressure. Because he could not get a doctor’s appointment, he left the condition alone. He has now gone blind in one eye and his other eye is at risk. His elderly wife came to me because she did not want to bother the doctor. We have to change that culture and to consider the consequences of not using our resources to deal with those early problems. When we leave somebody like that and they end up going blind, the cost to all of us to help them is much greater than if they had been able to access a GP. We must look at the terms of the job, but also at where the resources are not going. I have been raising those questions with local health care providers.

[Michael Fabricant]

I am very interested in what the hon. Lady has to say. She said that in her constituency—she must tell me if I have got this wrong—there are a large number of single-doctor practices. Does she not think that that is the cause of the problems, and that the Government should encourage practices to consist of a number of doctors working together?

[Stella Creasy]

Although I am a doctor, I am not a medical doctor, so I warn the hon. Gentleman that if he needs treatment, he should not come and see me. However, I could tell him why he has no friends—that is the sort of doctorate I have.

There are many issues and the number of single practices might be one of them. My point is that nobody has got a grip of this issue over the past couple of years, despite the fact that I, as the Member of Parliament, have raised concerns. In 2011, the complaints about access to GPs started coming in. I went to the primary care trust, but because of the reorganisation of the NHS, nobody was interested in the case that we were trying to make. The PCT said, “Wait until the CCG is organised.” I tried the new CCG, but six months after saying that it would look into the repeated complaints that I had raised, it said that this was not its issue and told me to go to NHS England.

Initially, NHS England told me that I could not raise the issues on behalf of patients because of patient confidentiality. It could not respond to any of the concerns that I was raising because they related to patient records. It then tried to say that unless the residents had complained to the GPs about GP access, it would not look into the issue, even though I had a binder full of complaints, which showed that it was a problem not just with an individual practice, but with many local practices in my local community. There was widespread concern. The problem continued and, eventually, NHS England came back to me and said, “It’s all right. We’ve spoken to the practices and they have said that if people want an appointment, they can ring up and get one.” It was a circular and deeply frustrating experience.

[Mr Bellingham]

Will the hon. Lady give way?

[Stella Creasy]

I will happily give way one last time, but then I want to get on.

[Mr Bellingham]

I understand the hon. Lady’s annoyance and frustration with her CCG and local health service. In my patch, the CCG is chaired by a GP. It has been incredibly responsive to my concerns and has worked with GP practices. I am just sorry that she has not found that in her patch.

[Stella Creasy]

I appreciate that that is the hon. Gentleman’s experience. This is precisely my point: why is nobody taking a strategic view of these issues?

I will give the hon. Gentleman an example and it goes to the heart of what the hon. Member for Henley was saying. One concern that people have raised is about missed appointments. The appointments that doctors give people do not always match the times when people need to see them. There is no recording of missed appointments because of the fragmentation of the NHS. Who should take responsibility for that?

A snapshot survey that my CCG did, possibly because of nagging from me, showed that on average 10% of appointments are missed in my local community. However, that is an average. In one surgery, 40% of appointments are missed and in another only 12% of pre-booked appointments are used. Irrespective of whether that is just because patients are missing appointments or because appointments are not at the right time, it is a waste of resources. Surely there is a public interest in having a central co-ordinating body that looks at these issues and at where there are problems in the NHS. It is a waste of money for everyone concerned. Crucially for my constituents, it means that they are not getting access to doctors, even though there may well be the facilities to see them.

Even if people can get access to a doctor, the quality of the practices in my local community is very poor. I know that other Member have raised similar concerns. That might be one reason why it is difficult to retain doctors. I have one practice that has been waiting 25 years to be rebuilt. It serves 12,000 patients. Because of the poor quality of the facilities, it cannot offer some basic services such as blood tests. It has not had central heating since January 2014. That is not an acceptable environment in which to provide a health care service.

The problems with GPs in Walthamstow are not just about the facilities. Since becoming an MP, I have worked with a group called WoWstow, which is a group of women who are fighting to get basic sexual health care services in Walthamstow, because we do not have them. When I talk about basic sexual health care services, I am talking about the provision of contraception, the provision of the coil and the provision of basic facilities to help women maintain their public health. We have doctors who refuse to prescribe such things, and then people wonder why my local area has a level of sexually transmitted diseases that is significantly worse than the national average.

There have been widespread complaints about other doctors, to the extent that the General Medical Council is involved. As far as I can see, there is little concern about how we deal with patients who are asked to go to doctors in respect of whom there are known to be concerns about the quality of care that they provide. Nobody is picking up the pieces. Nobody is gripping the issue to ensure that we do not see health care problems in my local community, which very much needs to be able to access GPs.

As my hon. Friend the Member for Halton has set out, all of this means that there are pressures on my local hospital, Whipps Cross university hospital. There are concerns about Whipps Cross itself. One resident wrote to me to say, “All I want is to be able to get an appointment for my child and not have to worry that if she or another member of my family ended up at Whipps I would have to fear for our lives, and that is not an exaggeration.” Barts Health, which runs my local hospital, is a large provider of acute services. It serves a population of 2.5 million in north-east London. The Care Quality Commission has taken enforcement action against it in the past couple of years because of the quality of care.

The CQC pointed out that if patients in my local community had access to an urgent care centre, they would be able to see somebody and it would improve the quality of care. However, I have just been told out of the blue that the commissioning process for more urgent care centres has been paused because of a lack of remaining bidders. Again, that is a separate part of the NHS from the GP surgeries and the hospitals that is also trying to deal with patients. The system is fragmented and piecemeal, and that is causing problems in a community that needs health care. Without the urgent care centres, there is a risk that many of the health care services in Walthamstow will simply collapse.

I have written to the Secretary of State about GP access. I have raised it with the CCG and NHS England. We have even organised local patients to act as mystery shoppers and go to doctors’ surgeries to ask to join their patient involvement groups. Not one of those people has been able to join a patient involvement group. That is a problem.

In 1958, Nye Bevan spoke in this place about the point of the NHS:

“Many people have died and many have suffered not because the knowledge was not there, but because they did not have access to it. To all the suffering which attends illness, there was always added the bitterness that, if the poor could have had access to the knowledge available, they might have been saved or, at least, might have been helped. It was this situation that the National Health Service was intended to put right.”—[Official Report, 30 July 1958; Vol. 592, c. 1383.]

Sixty-seven years later, the same concerns remain for a new generation of patients facing lifestyle diseases. I am making an open plea to Ministers at the Department of Health urgently to review the provision of health care in Waltham Forest. Please, let us not make early diagnosis a provision only for the rich in this country.

--- Later in debate ---

[Dr Poulter]

I am encroaching on the House’s time and have been generous in giving way, so I will bring my remarks to a conclusion.

As the Prime Minister has said, a strong NHS needs a strong economy. As a result of this Government’s prudent economic policies and long-term economic plan, we have been able to proceed with several major investments in general practice and primary care more broadly. Between 2012-13 and 2013-14, the total spend on general practice increased in cash terms by £229 million. Many hon. Members, and the hon. Member for Walthamstow (Stella Creasy) in particular, raised concerns about the quality of GP premises. On top of the increased funding, therefore, we recently announced a £1 billion investment in primary and community care infrastructure over the next four years. It aims to improve premises, help practices to harness technology, give them the space they need to offer more appointments and lay the foundations for more integrated care to be delivered in community settings.

[Stella Creasy]

Will the Minister give way?

[Dr Poulter]

I will give way one last time, but then I will have to conclude.

[Stella Creasy]

In my contribution I specifically asked the Minister whether he would commit to a review of GP access in Walthamstow because of the combination of problems—the two-week wait for appointments, the poor quality of surgeries and the single-practice GPs. Will he make that commitment today to the people of Walthamstow?

[Dr Poulter]

I hope that I have given the hon. Lady some reassurance about the Government’s commitment to invest £1 billion in primary and community care infrastructure over the next four years, which will help many local GPs. I also gave a reassurance to her hon. Friends earlier in the debate. I will certainly ask my noble Friend Earl Howe to look into the matter and write to her. He might also be available for a meeting, if time permits, before the end of this Parliament.

Integrating care is of course a priority for the Government. The better care fund has already made headway by combining £5.3 billion of existing funding into local authorities and the NHS—combining health and social care pots, which will be of great benefit to the frail elderly and people with long-term conditions such as dementia and heart disease. In addition, we have backed the new models of care set out in NHS England’s “Five Year Forward View”, with a £200 million transformation fund. That will allow the NHS to pilot new models, such as multi-speciality community providers, which aim to provide more proactive, person-centred and joined-up care.

In conclusion, the initiatives that I have described are geared around not only increasing the cash and resources available for general practice in the short term, but radically transforming the way we deliver care, which will ensure that we have GP services fit for the future.