Universal Health Coverage

Debate between Tim Farron and Alistair Burt

Wednesday 10th July 2019 Westminster Hall

[Alistair Burt]

Indeed. Once again, the hon. Gentleman anticipates something I will come to later. Our 16% uplift in relation to the Global Fund is remarkable in itself, but of course it should be an example to others.

Efforts to build sustainability and to encourage and work towards health system strengthening around the world are really important. Although there will always be a need to respond to outbreaks or emergencies, basic healthcare and steady improvement are achieved not by continual external intervention, but by dedicated work to build, train and equip those who take national responsibility for their nation’s health. A DFID brief puts it as follows:

“Countries need strong health systems if they are to achieve Global Goal 3, and ‘ensure healthy lives and promote well-being for all ages’”—

that is SDG 3—

“and the target of UHC aimed at reaching the most excluded and living in the most remote locations, leaving ‘no one behind’.”

That determination to ensure that responsibility for health is rightly taken by a nation itself, and our view that our role is to enable such a transition in health to take place, helps us to explain in this country why UK aid and development assistance works, and why our commitment to spending 0.7% of gross national income is so important. Few question the role the UK plays in immunising millions of children around the world, including some 8 million victims of the war in Syria.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Something like 5 million refugees from the Syrian conflict are in camps in the countries around Syria. Will the right hon. Gentleman reflect on the impact on the physical and mental health of people of all ages, particularly the 1.5 million children, of being in camps, rather than in settled communities, often for many years?

[Alistair Burt]

We could spend another 20 minutes reflecting deeply on that. Like others in the Chamber, I have had the good fortune to visit refugees in various locations. Some are in camps. The majority in Lebanon, for example, where a quarter of the population are Syrian refugees, live on the outskirts of other communities. The hon. Gentleman is absolutely correct.

Although, understandably, there used to be a concentration on the basic needs—shelter, food and water—there is now a clear recognition of the damage that is done, particularly but not exclusively to children, over a longer period. Of course, one area of concern is education. It is reckoned that perhaps a third of refugee children lose primary education, and perhaps two thirds lose secondary education. There are also the limitations on their action and the impact of that on mental health. Some time ago, the UK and DFID stopped seeing mental health as a nice add-on to support and saw it as essential. We have put money, effort and support into putting workers in to protect against mental health problems.

Of course, if the wars were not occurring, such problems would not be there. That encourages us to redouble our efforts in conflict prevention and peacebuilding in the areas most at risk.

Refugees and Human Rights

Debate between Tim Farron and Alistair Burt

Wednesday 24th January 2018 Commons Chamber

[Alistair Burt]

The hon. Gentleman should keep in direct contact with the Home Office in relation to that case. In 2016, the UK transferred more than 900 unaccompanied asylum-seeking children from Europe to the UK, including more than 750 from France as part of the UK’s support for the Calais camp clearance. I have some figures to give later about the 49,000 children who have been settled in the United Kingdom since 2010, including a number in the category that the hon. Gentleman has raised. However, processes have to be gone through, and I am quite sure that the Home Office intends to carry out its resettlement work as swiftly as possible. We have resettled a substantial number—that number is often not appreciated by the public at large—and I will talk more about that in a moment.

[Tim Farron (Westmorland and Lonsdale) (LD)]

When we are talking about the dignity of people seeking asylum, is it worth considering, and will the Government consider looking again at, the current rules denying asylum seekers in this country the right and the ability to work during the year, or perhaps even longer, when they are seeking asylum? Would that not save the taxpayer a lot of money and put an end to much of the indignity—and, frankly, the destitution—that exists in our asylum-seeking community?

Contaminated Blood and Blood Products

Debate between Tim Farron and Alistair Burt

Thursday 24th November 2016 Commons Chamber

[Alistair Burt (North East Bedfordshire) (Con)]

I begin by congratulating my friend, the hon. Member for Kingston upon Hull North (Diana Johnson), on her consistency on this issue and the work that she and the all-party group have done over a long time. I thank the Backbench Business Committee for allowing the debate to be held. I also welcome my hon. Friend the Minister to the Front Bench. We know that this matter is not among her responsibilities—it belongs to our noble Friend Lord Prior—and I know how difficult it is to deal with something that is not in one’s own portfolio, but I am sure that she will communicate faithfully to the Government the points raised in the debate, although she will not be in a position, I think, to answer all our questions. However, the fact that we are again raising these questions in the Chamber is an important point for her to take back to the Secretary of State and other colleagues.

I want to pick up on a couple of points arising from the speech made by the hon. Member for Kingston upon Hull North. I agree with her about who should administer the scheme. This is not an area in which we should be looking to outsource for ideological reasons. There is an important concern at the heart of this issue. Given everything that we have learned from the United States, we know that the profit motive involved in selling the blood in the first place was a primary source of everything that has happened since. It is really important that we recognise that and show some sensitivity to the fact. I actually think that Government can run some things, and it is good to run some things publicly. We have to choose. In our political lives, we have lived through the Government running British Telecom, British Airways and so on. Things have changed, but it is important that some things be publicly owned, run and dealt with, and this is one of them. I therefore join her absolutely in saying that the Government should think again about how the scheme is administered. They should keep it in public hands where there is at least some democratic accountability. Above all, as she said, we need a group that will act on behalf of the beneficiaries, rather than solely in the Government’s interest. It would have to be very carefully put together.

[Tim Farron]

The right hon. Gentleman is making some really important points. Does he agree that one area in which the private sector could and should be playing a part is in contributing to the compensation? Is there not an analogy—an off-the-shelf scheme we could consider—in how the thalidomide victims were supported through a composite of public funding and funding from the drug companies responsible? Like the Scottish scheme, that system has introduced annual payments and allowed people struggling with conditions that they contracted because of thalidomide to have some security throughout their lives. The same could be afforded to the survivors or the loved ones of those who passed away because of contaminated blood.

[Alistair Burt]

I am sure that the hon. Gentleman will develop that point in his own speech. Of course, the thalidomide compensation was based on a clear line of accountability as the company admitted responsibility. The situation has not been quite the same in this case, for reasons that we all know, but perhaps I can come on to financial matters in a second. I will now move on from the speech made by the hon. Member for Kingston upon Hull North, the majority of which I supported wholeheartedly.

It is a matter of some despair that we are here again. I remember those friends who came to the public meetings in the House of Commons a couple of years ago saying they were actually sick of coming here as they had done so so often over the years. I would be grateful if the Minister could relay to the Government—I have not been able to get this point across—that this drip, drip approach over the years is just not working. The Government can find money at various times for some big affairs. If there is a natural disaster, a dramatic crisis or a banking collapse, vast sums suddenly appear. We have not been able to give this issue the same priority, but it cries out for it. That we are here again is proof that these concerns are not going away and cannot be dealt with drip by drip. Somebody has still not grasped the fact that, for the many reasons that I know colleagues will raise, a settlement is of the highest importance.

I will not rehearse the history, because colleagues indulged me when I raised it in a Back-Bench debate a couple of years ago, so I will not go into it at such great length again. Neither will I cite the accounts of individuals who have come to us because, frankly, I find it too difficult to read them into the record. I have done that before, but I am not able to do so again. Instead, I want to make a couple of personal points and three comments about where we might go from here.

I campaigned on this issue for many years—in government and in opposition; and when I was a Minister and not a Minister. I was pleased that the hon. Lady mentioned David Cameron, because his response to my contribution at Prime Minister’s questions in October 2013 began the current chain of events and continued the progress made over many years. I was grateful that he met me, a constituent and a dear friend of ours. He seemed to understand where we were going, and more money has come into the scheme, which I appreciate.

In June 2015, I was re-invited by the then Prime Minister to join the Government in the Department of Health, at which point I went quiet on campaigning as far as the public were concerned. I know that some people misinterpreted that. My position in the Department of Health was not conditional on the fact that I had been involved with contaminated blood, and neither was my positon in the Foreign Office or my decision to leave the Department of Health of my own accord earlier this year. However, the ministerial convention is clear: Ministers say only what the Government’s position is. We cannot have two colleagues firing away on the same issues, so I did indeed go quiet publicly for a period. Inside the Department, I made my representations to the then responsible Minister, and I want to put on record my appreciation for what my hon. Friend the Member for Battersea (Jane Ellison) sought to do with the scheme. She worked extremely hard, saw a lot of people and tried to do her best.

I think that I made a mistake when the original proposals that the current scheme is based on came forward in January this year. I sat beside my hon. Friend on the Front Bench and while I understood the general thrust, I had not fully grasped the detail, which became clear only in the consultation. My mistake was to think at that time that we had solved the problem—we clearly had not. I got that wrong, but I hope that I have tried to contribute to the debate since, both inside and now outside the Department, as we try to deal with the present proposals. As the hon. Member for Kingston upon Hull North said, they move us on from where we were, but we are not yet there, so perhaps I could say a couple of things about where I think we might go.

First, we got the issue of discretionary payments wrong in the original proposals. A number of discretionary payments have effectively become fixed and people have become dependent on them. That should have been known to the Department, but clearly it was not known in enough detail, which has accordingly led to uncertainty and to people feeling that they might not be financially compensated to the extent that they are at present. That cannot be the case, and I am certainly not prepared to support anything that will make my constituents worse off than they are at present. That was not the intention, so we must make sure that those discretionary payments are included in the new scheme.

Kentmere Mental Health Ward, Westmorland General Hospital

Debate between Tim Farron and Alistair Burt

Monday 13th June 2016 Commons Chamber

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

There is no pressure here, then. I thank my friend, the hon. Member for Westmorland and Lonsdale (Tim Farron), for securing this debate and for his vigilance in raising such an important subject, which matters a great deal to his constituents. I put on record my appreciation for the work done by the NHS in Cumbria and I thank the staff for their hard work and commitment to patients. In doing so, I acknowledge what the hon. Gentleman said about the police. As we in the Chamber who know about these matters are aware, the police do a great deal of work in this area. The crisis care concordat, which was piloted by the right hon. Member for North Norfolk (Norman Lamb), has made a considerable contribution to the way in which we look after those with mental health issues at times of crisis, and the police have been intimately involved. I fully accept what the hon. Gentleman has said about the amount of such work that the police in south Lakeland are involved in.

I am fond of South Lakeland. Bury Grammar School had a house at Helsington, near Brigsteer, which I am sure is in the hon. Gentleman’s constituency. I remember the place extremely well. It is a beautiful area, and its constituents are entitled both to good service from an MP and to the best quality services.

Let me turn immediately to the subject of the debate. Cumbria Partnership, the provider trust, announced in May its decision to close Kentmere unit following information from the CQC that highlighted the environmental constraints on the unit. Kentmere is an old mixed-sex unit with no access to outdoor space. The hon. Gentleman’s concerns and comments about the decision have been widely reported. As he knows, and despite what he said at the conclusion of his remarks, this is a matter for the local NHS. Neither I nor any other Minister have a role in the decisions that are taken. The hon. Member for York Central (Rachael Maskell), who spoke forcefully about Bootham Park in York, also knows that well.

However, I understand, as the hon. Gentleman rightly says, that the NHS now says that the unit will not close as announced and that decisions will depend on further work. It is, therefore, worth setting out the background and indicating the interest that I have in making sure that the best possible services are provided, while recognising that the old levers of Ministers and the NHS are not quite as they were.

Mental health services for Cumbria are commissioned by the NHS Cumbria clinical commissioning group. Cumbria Partnership NHS Foundation Trust is the provider of mental health services for patients in Cumbria. The CCG has been working on a new mental health strategy for Cumbria for some time. It is fair to say that one of the problems that the NHS, in common with other public services, faces in Cumbria is the geography. The largest towns are at the northern and southern ends of a region that covers a large area, and it is difficult to travel between the smaller towns because the roads are often slow. This means that the NHS has to make difficult decisions about where and how to provide services. To put it bluntly, everything cannot be available in every local community. While cost is a real factor, the main problem is maintaining quality. It is not about saving pennies; it is about making sure that the quality of service is high.

Like everyone else, NHS clinicians learn and improve through experience. Skills that are not being used will decline. Facilities seeing only a few patients tend to lack the patient throughput needed to ensure that services remain of high quality. The cost of employing staff is the main factor driving the cost of services, and providing services from a greater number of locations means that more staff are needed. There are only so many staff to go round. The NHS invariably finds that larger units do better in terms of patient outcomes, but the question is where those larger units should be located. Inevitably, decisions taken by the NHS will disappoint those areas not chosen.

NHS services in Cumbria overall—not just mental health services—are facing a range of challenges, and in many cases the reasons are the same. The northern part of the area is part of a success regime aimed at improving all patient services; the issues at the University Hospitals of Morecambe Bay NHS Foundation Trust in recent years are well known. It is against this background that the NHS is considering what should happen at Kentmere and what is best for the hon. Gentleman’s constituents. Cumbria Partnership announced on 17 May that the Kentmere unit would close from the end of June 2016. At the same time, it was announced that the adjoining health-based place of safety would close at the end of May. The trust said that the decision was a result of quality and safety concerns raised by the Care Quality Commission. The CQC had inspected the unit in November 2015 and its report was published in March. However, the CQC says that the decision to close the ward and the health-based place of safety is not a necessary outcome of the findings of the CQC inspection, to which the hon. Gentleman referred. In short, while it did identify problems, the CQC report did not recommend the closure of the unit.

The report clearly highlighted concerns about the ward environment, which it said placed service users at risk and did not support good care and treatment. Something does need to be done about those concerns. The unit, which treats men and women, does not meet minimum standards on single-sex accommodation and has poor access to outside space. As I understand it, one issue is that privacy for bathing and sleeping cannot be guaranteed on the mixed ward. That poses an obvious risk to patients.

On 25 May, the trust gave a reassurance that the closure would be temporary and that timescales for the closure would be reviewed. I now understand that, following discussions with the CQC and with commissioners, any decision on closure will be delayed to allow further exploration of what improvements can be made. More needs to be done, and I will say a bit about that later. It says here that the trust accepts it did not get its messages right on the closure, and I think that hon. Members will probably agree strongly with that. Many hon. Members will be aware of similar experiences in other areas, and I think the NHS needs to think carefully about how it communicates with patients and the public, particularly when the news is not good. The facts need to be clearly set out, and it is important not to rush to announcements prematurely.

These circumstances reminded me of the closure last year of Bootham Park Hospital in York, in the constituency of the hon. Member for York Central. There are differences, in that the CQC recommended the closure of Bootham Park on patient safety grounds, which is not the case here. But the report produced on the closure by NHS England makes a number of observations about how difficult processes such as this need to be handled by the NHS. I have discussed this matter with the hon. Lady and I would be happy to discuss these matters further with the hon. Gentleman if we get an opportunity to do so. These are difficult decisions to get right—safety considerations really matter and when things are identified as needing to be put right, they must be put right—but the question then becomes how to do it, on what timescale and what the options are. I will come to that in a moment. The difficulty of handling such decisions, and the way in which they have not been handled well at Bootham Park, reminds us of the importance of getting such decisions right. The report on Bootham Park, particularly in relation to owning and communicating decisions, has been made public, and I have placed a copy of the report in the Library.

As I have said, in relation to Kentmere ward, we have moved in the space of a few weeks from a permanent closure to a temporary closure, and then to the unit remaining open while more work is completed. The safety of patients has to be the primary concern, and we would be failing patients if the NHS continued to tolerate the risk to the quality and safety of care that the environment at Kentmere places on local services. Something needs to be done, and it is up to the local NHS to decide what that is, but I do not think it will do so on its own. That is where the hon. Gentleman and his friends come in.

The CCG recognises that mental health services in Cumbria need to improve and it has already involved service users, their families and carers on this project. Much of the work so far has shown, not surprisingly, that patients want better services closer to home in their local community. Later this year, NHS Cumbria CCG will therefore be consulting about the future configuration of adult in-patient mental health beds across Cumbria. That will ensure it has the right beds in the right place, with a sustainable service that the local NHS can staff for the future. The CCG has already said it will not support any permanent service change at Kentmere without full public consultation.

In preparation for this, the CCG is looking at the current configuration of adult in-patient mental health beds, benchmarking how it is managing mental health needs across Cumbria with other mental health providers and advising on areas where the NHS needs to develop services to meet future needs. The CCG also needs to make sure it has the right kind of beds in place—for example, facilities for children and young people, older adults and psychiatric intensive care beds.

[Tim Farron]

There is not much time left, and I am very grateful to the Minister for giving way. I want to point out to him, first, that there is not a single tier 4 adolescent or child mental health bed in the whole of the county of Cumbria, and secondly, that the 12 beds on Kentmere ward are nearly always full and the majority of them are for people under a section, so there is no opportunity for community options. It is not the case that there is a lack of demand.

[Alistair Burt]

I take the hon. Gentleman’s point. I cannot be as au fait with the situation as him, but I fully understand the point in general. Whereas there is a tremendous move towards improving community services, which is important and vital in its own right, that cannot be a total substitute for the in-patient acute beds that are needed. I understand his point, and that is my view and the Department’s. Getting the right balance is important, but the one is not a cheap substitute for the other. Such services are an important component, because it is important that more is done in the community to keep people away from acute beds and make sure they do not need them, but I entirely take his point.

NHS Cumbria CCG is working with its providers—mainly the foundation trust, as well as clinicians, service users and carers—to help develop the model of care it will need in the future to deliver its vision of improved mental healthcare and sustainable services. I am told that public consultation will be carried out in line with best practice and the latest Government guidance. There will be sessions for stakeholders and the public to share their views, ideas and concerns in communities around the county. I spoke to health service chiefs this afternoon in preparation for this debate, so I know how seriously they take the point about the need for consultation, as well as that they recognise the communication difficulties in relation to how they have got to where they are and that they are open to such a consultation. I therefore urge the hon. Gentleman and his constituents to involve themselves fully in that consultation, which will shape whatever happens to Kentmere in the long term.

Tempting as it is to follow the hon. Gentleman’s suggestion that I should decide on the configuration of services, I am afraid that I cannot do so because that would be outside my authority. I wish him, the hon. Member for York Central and other Members in the House good night and good luck.

Question put and agreed to.