NHS Commissioning Board

Valerie Vaz Excerpts

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

This Government will ensure that there is no unfair competition, such as existed under the previous Government, whereby private providers got handed guaranteed income on a plate, irrespective of whether or not they did the work. I am clear that nothing in our legislation will prevent a real drive towards integrated care, to which the hon. Lady and I share a commitment.

[Valerie Vaz (Walsall South) (Lab)]

Will the Minister say whether there was a mistake in the instructions given to parliamentary counsel in drafting these regulations? Will he also tell us which Minister signed them off?

[Norman Lamb]

This comes down to a question of the legal drafting and a legitimate concern that the regulations did not meet the policy objectives set out clearly in the Health and Social Care Act and during the course of the debates on it in Parliament. We simply want to ensure that that objective is faithfully met.

Backbench business

Valerie Vaz Excerpts

Thursday 14th February 2013 Westminster Hall

[Norman Lamb]

I am nervous about treading on other ministerial toes, but I am sure that in one way or another we can get the issue addressed properly. I am grateful to the right hon. Gentleman for informing me so well.

The hon. Member for South Derbyshire (Heather Wheeler) made a helpful contribution and discussed the need to raise awareness of eating disorders. She mentioned personal, social, health and economic education in schools. All schools are encouraged to provide young people with good, age-appropriate education about sex and relationships, but we are reviewing PSHE to establish how teaching can be improved. There is clearly a need to improve the teaching in many schools.

The hon. Member for North Tyneside (Mrs Glindon) mentioned her local service, NIWE, and the important work that it is doing. She spoke about the number of people who are not diagnosed but who none the less suffer from eating disorders, and about the fact that they have the highest mortality rate of any mental illness. She said that early intervention was important.

I was struck by what the hon. Lady said about recovery groups. This morning I spoke at a conference on mental health. I spoke specifically about recovery and a new way of looking at mental health. We must move from trying simply to treat the condition to working collaboratively with professionals and people experiencing the condition, and we must focus on recovery. Fantastic results are being demonstrated from that shift in approach. It is frustrating that in some parts of the country, great things are happening, but it is patchy, as many hon. Members have said, and improvement is needed. She also made the point that mental health is the poor relation, as I have acknowledged. That must change.

I pay tribute to the hon. Member for Enfield, Southgate (Mr Burrowes), who has had to leave, for the work that he has done on addictions, focusing on treatment and recovery. He has been committed to improving the experience of people suffering from a range of addictions. He, like other Members, discussed the growing prevalence of the condition among teenage boys, which should worry us all. My hon. Friend the Member for Wells (Tessa Munt) spoke movingly. She mentioned the cult of celebrity, pressure on youngsters, variability of services around the country and access to those, the quality of care being variable and the need for much improved training and for multidisciplinary teams.

Interestingly, my hon. Friend mentioned issues of consent, a difficult area about which there are strong views on both sides. I am acutely aware of the horrible position of a parent wanting to help, but being unable to because of the legal constraints that prevent them from making an effective intervention. We need to think more about that, and the Children’s Minister is also involved in the discussion.

My hon. Friend the Member for South Basildon and East Thurrock got it right. Fascinatingly, he talked about his discussion with his children last night. I am so pleased that his television is broken, because it has led to our being given a valuable insight that we might otherwise not have had. He mentioned the increasing prevalence among males, including among gay men, which is a real concern. He also talked about the need for help for parents in understanding the condition much better.

The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), was right to talk about holistic care and the need to look at the whole individual. I will mention other things that he said as I go through my speech. I wish his son a happy birthday today, as he enters his teenage years.

The hon. Gentleman asked a couple of questions. On collating national statistics, we have a long way to go on the collection and interpretation of data relating to mental health. I have a fortnightly meeting on mental health in my office, so that we maintain an absolute focus on achieving tangible improvements. We talked specifically about data yesterday. The Health and Social Care Information Centre is getting more data but is not yet able, with the resources available, to interpret those. I want the same resources applied to mental health as to physical health. That is a challenge that I have made to the system.

The hon. Gentleman mentioned National Institute for Health and Clinical Excellence guidance. NICE is independent. I do not know whether there is a need for a review—a renewal—of the advice. I am happy to talk further to him about that.

This is an occasion on which we should not just raise awareness of the issue as part of eating disorders awareness week, but send a clear message to people with eating disorders, their loved ones and families: we hear you when you talk about your concerns. I am determined, as the Minister responsible for mental health, to do what I can to help.

I pay tribute to the work of Beat, based in Norwich in my county of Norfolk, which does brilliant work. Hon. Members have also mentioned Anorexia and Bulimia Care and the fantastic work that it does.

Eating disorders can be tremendously dangerous and damaging conditions. The UK has the highest rates of eating disorders in Europe. But it is a disease that is often hidden, as hon. Members have said. Sufferers are often unwilling to seek help or to recognise they have a problem. Reported cases are the tip of the iceberg. It is a disease that often strikes at the young. In 2009, the adult psychiatric morbidity survey showed that 20% of 16 to 25-year-olds admitted to having “a problem with food”. That is a significant percentage.

According to the Health and Social Care Information Centre, in 2011-12 the biggest increase in hospital admissions for eating disorders was among girls aged 10 to 15. The shadow Minister, the hon. Member for Denton and Reddish, mentioned admissions of those under 10, as well—shockingly, more than 50 children under 10 were also admitted.

[Valerie Vaz (Walsall South) (Lab)]

I apologise for not attending earlier, Mr Walker; I was in another debate in the main Chamber. I congratulate the hon. Member for Romsey and Southampton North (Caroline Nokes) on securing this debate.

The Minister mentioned young people. Will he say what services are available for 17-year-olds in terms of continuity of care, as they move to adult services?

[Norman Lamb]

I will talk about that later. In so many respects, we have problems with people falling through the gap between children and adolescent mental health services and adult services, and that is matched in other areas, as well. There is a need to deal with this. The draft Care and Support Bill deals with the transition from teenage to adult services. I will return to that matter. I thank the hon. Lady for her intervention.

A generation of young people is growing up depressed and unhappy with their relationship with food. I want to tell hon. Members about a case in my constituency. Charlotte Robinson was a bright, outgoing young woman who was about to secure straight As at A-level and had dreams of going to Cambridge—between Duke of Edinburgh’s awards and learning to fly helicopters—but tragically, Charlotte was a victim of anorexia, stolen from her family in her prime, with her whole life ahead of her. That is what I meant when I said that for some, thankfully, there is life after anorexia—but not for everyone.

Charlotte’s parents, Christopher and Pauline, who are remarkable people, have campaigned tirelessly to help others. Pauline even ran the London marathon in pink wellies, such is her commitment. They are fantastic people and their attitude was that they did not want other families to experience the same horror that they have gone through, so they have been determined to change things in their county of Norfolk. They discovered that there was no specialist commissioned service at all in their own county. This is what we find. Hon. Members have talked about the enormous gaps in services around the country.

As a result of Christopher’s and Pauline’s fantastic determination, there is now a specialist commissioned service, but it took their efforts to achieve it. Their efforts have helped to fund local centres and a helpline in Norfolk, working with NHS Norfolk and the charity Beat, which I have mentioned. Their focus is on early intervention, helping people like Charlotte—helping children, young people and adults as soon as they need help. Charlotte’s decline was dramatic and rapid and the wait, although nothing like the nine months that we have heard about, still was too long for her.

Speedy access and early intervention are critical. That is why our mental health strategy prioritises early intervention and demonstrates how timely action can help.

In many cases, eating disorders stem from low self-esteem or are linked to stress and emotional problems. That is why our support for local organisations in improving mental health services locally is so important. Our mental health and suicide-prevention strategies both include actions that local organisations can take to improve mental health in their areas: ensuring that children and parents get mental health support from birth; that schools and colleges promote good mental health, alongside targeted support for those at risk of mental health problems; that public services recognise people, of all ages, at risk of mental health problems and take appropriate, timely action; and that health services step in early if there is psychosis or a crisis, to stop more serious problems occurring.

The right hon. Member for Knowsley and my hon. Friend the Member for Romsey and Southampton North raised the problem of transition—moving from being a young teenager at home to a young adult. Often the problem is exacerbated by moving to university, where people suddenly lose contact with services that might have been available to them at home. As my hon. Friend mentioned specifically, that is where things can break down. Away from friends and family, in a new and often stressful environment and, crucially, registering with a new GP, young people can often enter a spiral of decline. The problem must be addressed.

I will now outline some of our ambitions for services. From this April, the NHS Commissioning Board will commission specialist services for eating disorders for adults and children. Having one specialist group to ensure that specialist services are commissioned everywhere has the potential to improve the position in many parts of the country where such services are inadequate or missing. The Commissioning Board will develop a national service specification and encourage better planning, access and outcomes, helping to bridge the gap when someone moves and raising the level of care throughout the country.

We want clinical commissioning groups to commission services with early intervention in mind. We also expect adult social services to work alongside CCGs to focus existing support on early intervention, integration, personalisation and recovery. Social services have a role to play, involving service users as equal partners in commissioning and monitoring services, ensuring that services are designed for the people who use them.

Public health services can articulate the many benefits of good mental health and, because of their pivotal role in the new system, they can talk about mental health directly with members of the public. The transfer of public health to local government, alongside children’s services, social care and other services, with a seat on the health and wellbeing board, potentially gives it a prominence that it has not had in the past. The funding settlement for public health has also surprised many people, with significant real-terms increases this year and next. There is great potential for a focus on public mental health in a way that we have not had in the past, so I hope that we can take advantage in the best possible way of that opportunity.

Of course, the problem cannot be fixed by tweaking the system. A huge stigma remains around mental health, which means that in too many cases children and young people are not getting the support that they need. That is particularly the case with eating disorders, and people affected often feel marginalised and excluded, unable to talk about their suffering. The problems can be compounded if the sufferer is a man or suffering from a less stereotypical but no less serious eating disorder, such as atypical anorexia or a binge-eating disorder. Personal testimony and the courage of individuals in speaking out send a powerful message, and challenge that stigma.

The Department of Health is therefore funding Time to Change, a brilliant campaign that was started under the previous Government but continues now. We are providing £16 million between 2011-12 and 2014-15, the first time that Time to Change has had central Government funding. It will also get a further £4 million from Comic Relief, the second time that that charity has awarded its largest UK grant to Time to Change. Run by the charities Mind and Rethink Mental Illness, Time to Change is England’s most ambitious programme to end the stigma and the discrimination against mental health through activities ranging from education to publicity. It aims to reach 29 million members of the public, explaining mental health and helping them to understand conditions, including eating disorders, that might at first seem alien or scary.

I was delighted that two young women from Time to Change came into the Department of Health recently to speak about their own experiences of mental health. They spoke about how talking about their own mental health had empowered them. One said that it had, “given me my life back”. Their stories were both moving and inspiring and I pay tribute to all those who find the courage to open up and to talk to others. Time to Change aims to increase the confidence of 100,000 people with mental health problems, helping to give them the self-belief that they need to recover.

The Time to Change campaign also works with schools to support children and young people facing problems of integration and bullying that can be caused by mental health issues. I have not only signed up to committing the Department of Health to be an exemplar employer on mental health, but made the commitment to try to get every other Department to sign up as well. We cannot encourage others to behave in the right way unless we practise what we preach. That is a challenge for Government, and I have not yet achieved that aim, but I am determined to pursue it.

The reasons for eating disorders are complex, as has been made clear in the debate this afternoon. Biology and genetics play their part, but so too does the pressure from our celebrity culture and the media. A recent controversy ignited by stick-thin La Perla lingerie models erupted only last week, and it is important to send out the message that organisations that do this sort of advertising have a responsibility; they cannot opt out. Government cannot do everything on its own. Everyone in society has a responsibility to get the right messages out. I was pleased to hear the shadow Minister’s reference to Vogue, which has made a good commitment to avoid getting out the wrong images.

Epilepsy

Valerie Vaz Excerpts

Tuesday 29th January 2013 Commons Chamber

[Kate Hoey]

Although things may have improved, the position in education authorities across the country is patchy. I hope that the Minister might refer to that in his speech.

I am pleased that my hon. Friend the Member for Walsall South, who introduced a ten-minute rule Bill on this matter, is now in her place. I know that she will want to say something at some stage.

I referred to the Epilepsy Action report, and it is important that people look at it because it showed some worrying results. I am sure that the Minister will have read it. Two thirds of the clinical commissioning groups—66%—do not have or do not intend to produce a written needs assessment of the health and social care needs of people with epilepsy. Only 27% of the 113 out of 149 local authorities that replied included a section in their joint strategic needs assessment mentioning the care of people with epilepsy. Only 17% of the clinical commissioning groups have appointed a clinical lead for epilepsy and only 20% of acute trusts stated that the average waiting time for an adult with suspected epilepsy to see an epilepsy specialist consultant was two weeks or less.

Crucially, only half of the people interviewed by Epilepsy Action told the interviewer that they had seen an epilepsy specialist nurse. I cannot overestimate the importance of specialist epilepsy nurses, and I am sure that other hon. Members will agree. Specialist nurses are vital and there is still concern that there are not enough of them. In its guidance, the National Institute for Health and Clinical Excellence said that they should be an integral part of the medical team providing care to people with epilepsy, but it seems that in 2013 half of our acute trusts and primary care trusts in England still do not have that provision.

The report contains many more worrying statistics, but I shall not go through them all. All in all, however, there seems to have been no major improvement in services although I stress that, as with so many other matters, the provision is patchy, with some excellent services in some parts of the country. My local trust, Guy’s and St Thomas’, does an excellent job with the resources it has. Dr Michael Koutroumanidis leads the team and as well as running the tertiary clinic runs a first-time seizure clinic once a week. Much more could be done, however, with more resources and if greater priority were given to those services.

I have some questions for the Minister. If he has read the report, perhaps as his bedtime reading last night, he will be aware of some of them. Will he ask the Secretary of State for Health to refer the whole of epilepsy services to the National Audit Office and invite it to conduct a value-for-money inquiry? That is one of the key requests from Epilepsy Action. Way back in 2007, the all-party group estimated that the avoidable cost of providing the current poor NHS service was £189 million a year based on the NICE figures. The main reason that such money could be seen as wasted is the shocking misdiagnosis rate, which is 20% to 30%, and the poor access to specialist skills. The financial consequence is that patients receive inappropriate, costly and ineffective treatment at the expense of the NHS and the public, never mind the personal consequences of their true condition not being treated. I hope that the Minister can say that that might be a useful piece of work for the Audit Commission.

I ask the Minister to ask the NHS Commissioning Board to include outcomes indicators in the NHS framework. I hope that people can get to the bottom of what all these terminologies mean. The hon. Member for Beckenham (Bob Stewart) has previously referred to the NHS using terms that mean little to the average member of the public, but it is important that we have the statistics to address the unacceptable number of avoidable deaths and the still unacceptable rates of seizure freedom.

Another issue that I want to ask the Minister about is the revised NHS constitution, where the word “pledge” will be used. We want to give people the right to involvement in discussions about the planning of their care and the right, as opposed to a pledge, to be offered a written record of that agreement. Again, published research shows that only 14% of people with epilepsy have a care plan. All those things are important. If the current review of the NHS constitution recommends making care planning a pledge from the NHS to patients, that should be toughened up to encourage a programme of care planning and by making it a right for people.

The Minister could ensure that as a matter of urgency the chief executive of the NHS raises the lack of engagement by the clinical commissioning groups in assessing the needs of people with epilepsy. It seems that that has been ignored by many of them, or lumped together with a number of other health issues that do not necessarily cover epilepsy’s particularly special nature.

There is a whole debate to be had about children with epilepsy, and not just in relation to their school education. There is a long history of children with epilepsy not achieving their full educational potential, yet with the right support there can be huge improvements. Epilepsy can affect the child’s education either because of the underlying cause or because they might have to miss lessons or interrupt them to take medication.

[Valerie Vaz (Walsall South) (Lab)]

I thank my hon. Friend for securing this debate, and I congratulate Epilepsy Action on producing the report. This is a wonderful opportunity to remind the Minister of my ten-minute rule Bill, in which I ask for two simple things. First, immediate referrals from GPs to specialists are needed. That is where the costs arise—both monetary costs and the cost in lives. If people can be referred directly to a specialist, they need not go through an interim stage to someone who is not a specialist. This covers a wide range of conditions, although it manifests itself as epilepsy—other related conditions might not manifest themselves at all—so anyone might have absences, and they need to know why. Secondly, we need an action plan for children in schools that is similar to that under the Autism Act 2009.

Oral Answers to Questions

Valerie Vaz Excerpts

Tuesday 15th January 2013 Commons Chamber

[Mr Hunt]

My hon. Friend has mentioned the issue to me before, and I am happy to look into it in detail for her.

[Valerie Vaz (Walsall South) (Lab)]

How will the Secretary of State assess the effect of the cancer drugs fund on cancer survival rates?

[Mr Hunt]

It will be very easy to look at the number of lives saved. We will be able to see the impact of the fund, because it only started in 2010.

NHS Commissioning Board (Mandate)

Valerie Vaz Excerpts

Tuesday 13th November 2012 Commons Chamber

[Mr Hunt]

There is something critically important in the mandate that will do that, which is that by making the NHS operationally independent we are giving commissioning responsibilities to local GP-led groups for the first time, and GPs understand the importance not just of primary care but of prevention. So I think we will see much more innovation, along with the co-operation that the NHS has with local authorities and the new health and wellbeing boards, to make sure that there is a much bigger focus on prevention than there has been in the past.

[Valerie Vaz (Walsall South) (Lab)]

Will the Secretary of State confirm that if there is an underspend in the NHS Commissioning Board financial allocation, that will stay in the NHS and not go back to the Treasury?

[Mr Hunt]

As the hon. Lady knows, we manage our finances extremely carefully but we do have underspends. We try to minimise them and there has been a real-terms growth in spending—actual money spent in the NHS, compared with Labour’s plans. In the first year of the review there was a real-terms increase and we will continue to manage NHS finances with a commitment to protecting the budget, which did not ever happen when the right hon. Member for Leigh was in post.

Oral Answers to Questions

Valerie Vaz Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Hunt]

May I reassure my hon. Friend that we are absolutely committed to the “no cherry-picking” provisions of the Act? We think that we have found the right way to achieve that in the NHS, and I will write to him to explain exactly how we will do that.

[Valerie Vaz (Walsall South) (Lab)]

Given the apparent increase in spending in the NHS and the £4 billion surplus, will the Secretary of State look at lifting the pay restraint for lower-paid workers, to increase morale and boost productivity?

[Mr Hunt]

The £12 billion increase in spending on the NHS under this Government, which the right hon. Member for Leigh (Andy Burnham) thought was irresponsible, means that we will be able to do a lot more for patients, but there is also rising demand. If we do not have that pay restraint, we will not be able to meet the needs of an ageing population.

Business of the House

Valerie Vaz Excerpts

Thursday 6th September 2012 Commons Chamber

[Mr Lansley]

I am pleased to hear what my hon. Friend has to say, and I welcome what he said about Holmfirth high street. Indeed, we have accepted and implemented virtually all Mary Portas’s review recommendations. I hope that the pilots will show how we can extend some of the lessons further to invigorate high streets across the country—something that, as my hon. Friend illustrates, can be achieved.

[Valerie Vaz (Walsall South) (Lab)]

I welcome the Leader of the House to his new position and place on record my thanks to the right hon. Member for North West Hampshire (Sir George Young) for the helpful and courteous way in which he dealt with Back Benchers. I hope that that will continue.

Can we have an urgent debate on the Sunday trading laws, given that the announcements outside this House are at variance with the undertakings given inside it? If there is any consultation, will the Leader of the House ensure that retail staff, the unions, the Churches and the Association of Convenience Stores are included?

[Mr Lansley]

I am grateful to the hon. Lady for her kind words about my predecessor. I do hope to emulate in many respects the way in which he fulfilled his responsibilities so wonderfully. As to Sunday trading legislation, however, I do not accept the premise of her question. I do not think there is any variance between what the Government said when we introduced the legislation about the extension of Sunday trading hours during the summer and what has been said subsequently.

National Health Service

Valerie Vaz Excerpts

Monday 16th July 2012 Commons Chamber

[Mr George Howarth]

rose—

[Valerie Vaz (Walsall South) (Lab)]

rose—

[Mr Burns]

I shall make a little more progress.

Let us not stop at waiting times. The £600 million cancer drugs fund that has helped more than 12,500 patients to access the drugs previously denied to them, the screening programmes for breast and bowel cancer, potentially saving an extra 1,100 lives every year by 2015, the world-leading telehealth and telecare whole systems demonstrator programme, which saw a stunning 45% fall in mortality and is set to transform of 3 million people with long-term conditions over the next five years—

--- Later in debate ---

[Mr Burns]

My hon. Friend is right. As he would probably expect, I shall deal with that issue later in my speech. While I am responding to his intervention, let me say that not only was his hospital fortunate in having that fantastic equipment to look after his constituents, but I had the pleasure last week to be in his constituency to visit Elekta and Varian, which are world leaders in making equipment to help with radiotherapy.

[Valerie Vaz]

The Minister is very fond of statistics. Can he say whether GP referrals have gone up, and whether A and E admissions have gone up or down?

[Mr Burns]

The hon. Lady will know that GP referrals have gone down slightly, but the referrals to A and E have risen slightly.

NHS Annual Report and Care Objectives

Valerie Vaz Excerpts

Wednesday 4th July 2012 Commons Chamber

[Mr Lansley]

One reason why the NHS continues to deliver such significant improvements in performance is that through the transition, we are increasing clinical leadership, which will make an important, positive difference, and can already be shown to have done so. For example, we are managing patients more effectively in the community, and reducing reliance on acute admission to hospital. The number of emergency admissions to hospital in the year just ended went down, which is a strong basis on which to develop services in future, and that is happening not least because of leadership in the primary care community. I hope that my hon. Friend from Cornwall, along with other Members, supports the assumption of clinical leadership through clinical commissioning groups by those clinicians.

[Valerie Vaz (Walsall South) (Lab)]

Like my right hon. Friend the Member for Rother Valley (Mr Barron), the former Chair of the Select Committee on Health, I have not had sight of the report, but will the Secretary of State say what the cost to the public purse of the pause and the reorganisation will be?

Oral Answers to Questions

Valerie Vaz Excerpts

Tuesday 12th June 2012 Commons Chamber

[Mr Speaker]

On both the Front Benches and the Back Benches in all parts of the House, I suspect.

[Valerie Vaz (Walsall South) (Lab)]

How do the Government intend to ring-fence the public health money that will be given to local authorities?

[Anne Milton]

Quite literally, by putting it in a ring fence. That money can be spent only on improving public health among the local population. There are 66 supporting indicators in the outcomes framework. The money will be given to local authorities on the basis that they will make progress towards achieving those outcomes.