Oral Answers to Questions

Stephen Phillips Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

We absolutely will take a whole health economy view of that, and look at all hospitals that are affected by the changes.

[Stephen Phillips (Sleaford and North Hykeham) (Con)]

4. What steps he is taking to reduce the burden of administration on GPs.

[The Minister for Community and Social Care (Alistair Burt)]

Before I respond, I should like to thank my two predecessors, who have covered most of this portfolio: my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) and the right hon. Member for North Norfolk (Norman Lamb). They have given me a firm foundation on which to build, and I am grateful to them for their work in the Department. Reducing the burden of administration on GPs is important to all of us in the Government. We have already cut the quality and outcomes framework by more than a third to help reduce administration, but we are looking for ways to do more because we recognise that this is a significant problem.

[Stephen Phillips]

Let me take this opportunity to welcome my right hon. Friend back to the Front Bench. I know that he will want to spend a lot of time in GP surgeries, and we look forward to welcoming him to Lincolnshire in due course.

I want to ask him about the use of information technology and computers during consultations with GPs. I am told by a GP in my constituency that so much time is spent collecting data and inputting them into the computer that there is a loss of focus on the patient, with a possible detriment to patient care. Will my right hon. Friend undertake to look into that and to come to the House in due course to say what can be done to ensure that, during every GP consultation, the focus is always on the patient and not on the computer?

[Alistair Burt]

Notwithstanding the importance of recording information collected during a consultation, my hon. and learned Friend’s constituent is absolutely right that it should not get in the way of the relationship between doctor and patient. We have already removed some of the administrative burdens by cutting a third of the quality and outcomes framework indicators that need to be recorded, but plainly more needs to be done. He is right to say that I am looking forward to seeing quite a lot of GP surgeries in the forthcoming months.

Mental Health Care (Older People in Lincolnshire)

Stephen Phillips Excerpts

Thursday 27th March 2014 Commons Chamber

[Stephen Phillips (Sleaford and North Hykeham) (Con)]

World Health Organisation figures show that mental illness is responsible for the largest proportion of the disease burden, at just over 22%, in the UK. That is greater than that of cardiovascular disease or cancer, each of which stand at about 16%. In our society, mental health simply does not receive the same attention as physical health. People with mental health problems frequently experience stigma and discrimination, not only in the wider community but from services they need to access. This is exemplified in part by lower treatment rates for mental health conditions and an historical underfunding of mental health care relative to the scale and impact of mental health problems.

However this problem may have arisen, it is persistent and the consequences are plain. People with severe mental illness have a reduced life expectancy of 15 to 20 years, even though the majority of the reasons for this are entirely avoidable. I cannot be the only one to think that this can no longer be tolerated in the 21st century. I am glad that the Government have made real progress in promoting the principle of parity of esteem with their commitment to put mental health on a par with physical health in the NHS. Central to this approach is the fact that there is a strong relationship between mental health and physical health, and that the influence works in both directions: poor mental health is associated with a greater risk of physical health problems, and poor physical health is associated with a greater risk of mental health problems.

I sought this debate to raise the particular issue of mental health care for older people in my county, an issue that can only continue to grow in importance as our population ages. The UK is experiencing a significant population shift, with both the size of the older population and projected life expectancies rising considerably faster than previously expected. Significant growth is expected amongst those over 65 in the next few decades, with the oldest age group of those aged 85 and above growing proportionally the fastest. As the population aged over 65 increases, the number of older people with mental health problems will also, inexorably, increase. The largest increase in numbers of any mental health problem will be seen in the rise of the numbers of people with depression, but there will also, undoubtedly, be significant increases in the number of people with dementia.

Surprisingly, perhaps, this will be compounded by co-morbidity with substance misuse in this age group. Although usually regarded as a problem affecting younger adults, abuse is overlooked in the elderly. In the next few decades, there are likely to be increasing numbers of older people exhibiting co-morbid symptoms, as alcohol and drug users from the baby boomer generation reach and pass retirement.

One of my constituents, a community nursing assistant at the Manthorpe centre in Grantham, has spoken to me about his concerns for the future. Although the centre is not in my constituency but in that of my hon. Friend the Member for Grantham and Stamford (Nick Boles), it provides mental health services for older people from all over Lincolnshire. As such, concerns have been raised with me about the reorganisation of services at the centre and elsewhere in the county. The job of a community nursing assistant, as my hon. Friend the Minister will know, is to provide the emotional and practical support needed by elderly patients. Assistants thus deal with a large number of lonely, isolated and vulnerable people. It is not only the mental health diagnoses of those in this group that cause problems, but the simple loneliness. Often, their health care workers are the only people they see or talk to on a regular basis. Indeed, my constituent has told me that he and his colleagues can be the “nearest relative” at funerals, which gives some sense of the acuity of the problem.

It used to be the case that families and communities looked after their older members and supported them, but sadly, as we all know, that is all too often not the case. The disestablishment of those community posts in Lincolnshire is thus causing real concern. Those who fill them save the NHS money by helping those in need directly, without their needing to be admitted to hospital, which is far more costly than being supported while living at home. Yet when I contacted the Lincolnshire Partnership NHS Foundation Trust to ask about these posts, I was told they were intended to provide social intervention rather than health care per se—a function that the trust feels should be carried out by local authorities through their social care staff. So it is that a lack of funding from one part of the system that does not regard itself as responsible for the establishment of these posts runs the risk of costing itself and other parts of the NHS more money in the long term.

I understand from more recent discussions that the trust is now working closely with our local authorities to ensure that patients remain supported, but I understand and share the concerns of many that elderly folk in need may fall through the cracks despite good intentions. Indeed, that is too often the case where NHS care and social care interact—an issue that I know has been raised on numerous occasions in the House by colleagues on both sides. I would therefore be grateful if the Minister told the House what steps his Department is taking to work with trusts that are reducing provision to ensure that robust support networks are maintained and improved for patients with mental health needs.

[Sir Edward Leigh (Gainsborough) (Con)]

The people in Lincolnshire will be grateful to my hon. and learned Friend for raising these issues. Does he agree that they are exacerbated by the rural nature of our county? Frankly, people in a deeply rural county such as Lincolnshire sadly get a worse service than people living in urban areas.

[Stephen Phillips]

I am extremely grateful to my hon. Friend, who makes an important point. All too often, and not just in this area of public service, as he knows, but in so many others, we get a much worse service in rural communities—particularly, it seems, in Lincolnshire —than many other places. That is in part made up for by the fact that we have extremely strong communities, with strong ties between neighbours and families, but as I know he knows, far too often we seem to draw the short straw in this and other areas.

That is in part why I also want to raise with the Minister the apparent disconnect between services for those aged over 65 and those under that age, given our ageing population in the county. In that regard, I have been told that the care provided by the community mental health team in my part of Lincolnshire for those under 65 has been fairly extensive, including a lot of support for those settling back at home after a hospital admission, but that such services are not so readily available for those aged over 65. Why the disconnect and what can the Minister do about it?

I am aware, of course, that the Equality Act 2010 has been vital in shifting mental health services towards age inclusiveness. The Minister will know, and has no doubt acted on the fact, that there is now a duty on health and social care services not to discriminate on age grounds. That ought to mean that older people with mental health problems should have the same access to mental health services that had previously been available only to people under the age of 65. Is this working? No doubt the Minister can tell the House, for there is a great deal of concern, at least in Lincolnshire, that it is not. I understand that the Department of Health has acknowledged the under-representation of over-65s in the IAPT—improving access to psychological therapies—initiative and has made a commitment to undertake various corrective actions to address that in line with the provisions of the 2010 Act. I would be grateful if the Minister could tell the House what his assessment is of the current state of mental health services for those aged over 65 and what steps he is taking to ensure improvements in provision and access in Lincolnshire and elsewhere.

The Royal College of Psychiatrists has said that to integrate older adults’ mental health services into “ageless” services makes no sense. Older people have very different physical, social and psychological issues, which require specialist old-age psychiatrists working in specialist services for older adults. Older people tend to have multiple physical co-morbidities or frailties, which often complicate their mental health treatment. Many older people also have specific cognitive problems, social issues or end-of-life concerns, which may precipitate or sustain mental illness.

It would seem that the key element is flexibility of access. We need to ensure that people do not automatically become ineligible to continue to be treated by a service once they pass the age of 65, so that someone under that age with, for example, early-onset dementia can gain access to the expertise of comprehensive older-adult mental health services. I should be grateful for the Minister’s comments on those points.

The Royal College of Psychiatrists has also identified a “mental health treatment gap”, exemplified by lower treatment rates for mental health conditions, premature mortality among people with mental health problems, and the underfunding of mental health care relative to the scale and impact of mental health problems—the problems that I described at the beginning of my speech. Annual statistics published by the Department of Health on investment in mental health have shown that in 2011-12 there was a 1% decrease in overall investment and a 3% decrease in investment in older people’s mental health services. I know that addressing the funding gap will be challenging—particularly as such underinvestment tends to be exacerbated during times of austerity, when mental health services risk being cut in preference to physical health services—but I venture to suggest to the Minister that things should not go on as they have been.

Given the current challenge to address the high levels of both identified and unmet need, an increasing ageing population will have significant resource consequences for mental health and social care services for older people, which are already struggling to provide care at present. Unless there are major breakthroughs in new cost-effective treatments, or prevention and promotion initiatives succeed in reducing the incidence and prevalence of mental health problems among older people, services will need significant extra resources to meet that demand. In practice, however, mental health spending has in the past followed an erratic pattern nationally, with cuts in some areas and investment in others.

What, ultimately, I want to hear from the Minister tonight is an assurance that he is focusing on this issue, and that enough is being done to ensure that mental health services receive proper funding, in Lincolnshire and throughout the country.

Health and Social Care

Stephen Phillips Excerpts

Monday 13th May 2013 Commons Chamber

[Mr Streeter]

I will not take any further interventions, but let us not hear any further speeches calling for extra spending unless we know where the money is coming from.

As I was saying, before I was so rudely interrupted, there are pressure points in the health system, and urgent care is one of them. This is about not only accident and emergency departments, but GP and out-of-hours services, community nursing, social care, ambulance services and hospital beds—there is pressure on all those points.

The hon. Member for Plymouth, Moor View and I are fortunate to go to Derriford hospital in Plymouth for briefings. I have been going slightly longer than she has—21 years—and I can tell the House that in good times and in bad times Derriford hospital is under pressure. It has a running capacity of about 95%, which means that when there are spikes, as there have been this winter, it can be running at 103% capacity, which puts the hard-working staff under enormous pressure. Even when the Labour Government were spending money as though it were going out of fashion, I have never gone to Derriford hospital and had the staff tell me, “It’s fine. There are no pressure points. Everything is working in our health service. It’s all working well and waiting lists are coming down.” That has not happened once in 21 years.

[Stephen Phillips (Sleaford and North Hykeham) (Con)]

Does my hon. Friend agree that perhaps one problem with the Queen’s Speech, and one of the issues with which neither Ministers nor shadow Ministers tend to grapple, is that there is a real problem in this country with demand? Unless and until we grapple with that, the national health service will always be under pressure.

[Mr Streeter]

I completely agree with my hon. and learned Friend, and I might come on to deal with that point in a moment.

The point I wanted to raise with Ministers is that the funding formula for emergency work needs to be reviewed. As I understand the system, the formula is based on the 2008-09 baseline, and any extra patients who come into an acute hospital over and above that baseline are paid at 30% of the tariff. It costs hospitals 100% to meet the needs of those people coming in, yet they are paid at 30%; the extra 70% is supposed to be spent by other health care agencies in providing alternative centres of treatment, which are intended to divert people away from acute hospitals. I am pretty well plugged into what is going on in my constituency, and I have not seen anything since 2008 that looks vaguely capable of diverting pressure away from Derriford hospital. The system of allocating 30% to the hospital and 70% elsewhere is simply not working. I ask our Ministers to look urgently at that formula and to find out why, if it is not working, we are still using it and to address that. I am not calling for extra money; I am calling for money to be diverted to the acute hospitals, because they are where the pressure points are. In my constituency, there have been no realistic options for treatment other than to go to Derriford hospital. So, such hospitals should be receiving not 30% but 100% of the tariff.

My hon. and learned Friend the Member for Sleaford and North Hykeham (Stephen Phillips) is absolutely right about demand growing exponentially. In 1979, if a man reached the age of 65, they could expect to live until they were 77. If a man reaches the age of 65 now, they can expect to live until they are 88, and of course that age is rising year on year, so the demand is going up.

One thing that we are noticing is that although the number of people admitted to the emergency department at Derriford hospital in the last 12 months has been stable, there is much higher acuteness—in other words, people are much sicker and therefore it requires a lot more effort to treat them. Please, nice Ministers on the Front Bench, may we have a look at that formula for the funding for people accessing acute hospitals on an emergency basis?

My final point, in the one minute of my time that remains, is that 20 years ago or so I made a speech in this House saying that the health service had lots of challenges, issues and problems, but that one of the things we did not need to touch was primary care as it was working fine. I cannot make that speech today. I will not hammer the Opposition again about the GP contract, but in the past few years constituents have been complaining to me in a way that they never did in the previous 15 years to say that accessing their GP is becoming extremely difficult. For someone—whether they are a mum with a young baby, or a senior citizen—to get a surgery appointment when they want it has become a serious issue in the past few years. Addressing that issue does not necessarily require legislation, but may I ask Ministers whether we can please put in place a system whereby GPs give the seven o’clock in the morning to seven o’clock at night, seven days a week service that this country so desperately deserves?

Oral Answers to Questions

Stephen Phillips Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Burns]

I have to tell the hon. Gentleman that the decisions that the Scottish Government and the Scottish Health Department might take with regard to Glasgow is a matter for them. The fact is that we recognise what is commonly accepted among the international community: that the safest way of providing that surgery is by carrying out about 400 operations a year.

[Stephen Phillips (Sleaford and North Hykeham) (Con)]

14. What steps his Department is taking to ensure that confidentiality agreements do not discourage NHS whistleblowers from coming forward.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

The Department wrote to the NHS trusts most recently in January 2012 reminding them that compromise agreements should not prevent information from being disclosed in the public interest. It also said that they should satisfy themselves that their organisational policies are in line with previously issued guidance.

[Stephen Phillips]

I am grateful to my hon. Friend for that answer. She will be aware of the case of my constituent Mr Gary Walker, the former chief executive of United Lincolnshire Hospitals NHS Trust, who has been prevented by a confidentiality agreement from raising his concerns about the effect on patient safety of the previous Government’s targets. I want to hear Mr Walker’s concerns and my constituents are entitled to hear them. I hope that my right hon. Friend the Secretary of State will look into this matter and give a categorical assurance that the concerns that Mr Walker has told us about will come into the public domain.

[Anne Milton]

I thank my hon. and learned Friend for his supplementary question. I cannot comment on the individual details of the case, but I appreciate his concern that NHS staff could be prevented from speaking out by confidentiality agreements. Confidentiality and compromise agreements are allowed in contracts, but the Public Interest Disclosure Act 1998 provides that any clause in that contract or compromise agreement between employer and employee is void in so far as it acts to stop the employee making a protected disclosure.

Oral Answers to Questions

Stephen Phillips Excerpts

Tuesday 8th March 2011 Commons Chamber

[Mr Lansley]

It will not be 6.5%, because things need to change so that efficiencies can be achieved within hospitals. That much is absolutely clear, and we have been clear about that. It does not threaten the future of hospitals, but incentivises to improve the design of clinical services and improve care for patients, providing more accessible care in the right place and at the right time.

[Stephen Phillips (Sleaford and North Hykeham) (Con)]

7. What steps his Department is taking to improve outcomes for cancer patients.

[Mr Stewart Jackson (Peterborough) (Con)]

10. What steps he is taking to improve NHS cancer services.

--- Later in debate ---

[Stephen Phillips]

I am grateful to my hon. Friend for that answer. He and my right hon. Friend the Secretary of State will be aware of the concerns expressed by a number of GPs across the country, including in my constituency of Sleaford and North Hykeham, about the pace of reform in the NHS. What assurances can he give the House that GP consortia will continue to have access to the expertise they need to commission effective cancer services?

[Paul Burstow]

I am grateful to my hon. and learned Friend for that question, because part of that pace is, of course, due to the fact that a substantial part of the country is now covered by pathfinder GP consortia, many of which are actively engaging with their colleagues in cancer networks and developing the expertise and experience that will be essential in taking forward their commissioning responsibilities. We have already made it clear that funding will be available in the coming year for the commissioning networks for cancer and that after that it will be a matter for the NHS commissioning board.