Leaving the EU: NHS Funding

Wes Streeting Excerpts

Tuesday 15th November 2016 Commons Chamber

[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.

[Wes Streeting (Ilford North) (Lab)]

My hon. Friend is absolutely right that the claim of £350 million a week for the NHS was at the centre of Vote Leave’s campaign. Leave campaigners were given a number of opportunities to review, qualify or disown the claim, including following strident criticism from all members—remainers and leavers—of the Treasury Committee. The fact they chose not to distance themselves from the claim surely demonstrates that this is a promise that ought to be delivered. If it is not delivered, they will have some explaining to do.

[Mr Umunna]

I completely agree with my hon. Friend. As he said, it was significant that the Treasury Committee came to its conclusion, since it is a cross-party Committee whose members include leavers and remainers.

As my hon. Friend the Member for Walthamstow (Stella Creasy) said, we know that the NHS needs extra cash. The Minister also knows this. As members of the Health Committee pointed out last month, the deficit in NHS trusts and foundation trusts in 2015-16 was more than £3.5 billion.

NHS Funding

Wes Streeting Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right about that, which is why we need to make difficult efficiency savings—around £22 billion during this Parliament. We made about £18 billion to £19 billion-worth of savings in the previous Parliament, so I think it is doable. It will not be easy, but she is right in what she says.

[Wes Streeting (Ilford North) (Lab)]

If things are as rosy as the Secretary of State is making out, why is the London Borough of Redbridge, where I am an elected Member, suffering from public health cuts and, even while charging the social care precept, is still barely able to cover the costs of wage increases, let alone improve the service? He should have been lobbying the Chief Secretary this afternoon, not painting this ridiculously unjustifiable rosy picture.

[Mr Hunt]

I do not think the hon. Gentleman was listening to my statement, which said clearly that the NHS is under unbelievable pressure. It does not really work for the Labour party to campaign for increases in the minimum wage, which we read about today, and then to criticise the increasing costs in the adult social care system caused by the national living wage that was introduced by this Government.

Young People’s Mental Health

Wes Streeting Excerpts

Thursday 27th October 2016 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

It is a pleasure to follow the hon. Member for Bexhill and Battle (Huw Merriman), and I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) and the hon. Member for South Cambridgeshire (Heidi Allen) on securing this debate. My hon. Friend is having quite a week: she has pressed the Prime Minister about the serious issue of historical child sexual exploitation in her constituency; she is here today; and tomorrow she will help lead the charge on the Homelessness Reduction Bill. I am delighted that she has found time to lead this afternoon’s debate.

As one of the elected honorary presidents of the British Youth Council, I am particularly delighted that this debate arises from the Youth Select Committee’s report, “Young People’s Mental Health”. I hope that the fact that Members of Parliament have taken the initiative to make sure that we are debating it in the House of Commons reassures the UK Youth Parliament, youth councils and young people generally that their voice is being heard. Our challenge now is to make sure that their voice is listened to by Government.

It is also worth saying that much of the profile that the UK Youth Parliament enjoys in the Houses of Parliament, particularly the annual sitting, which will next take place in this Chamber on 11 November, arises from the personal support of Mr Speaker. I know that I speak on behalf of so many people involved in BYC and the UK Youth Parliament in thanking him for his consistent championing of young people’s voice in democracy.

My interest in young people’s mental health and the reason I am here partly stems from my time as deputy leader and cabinet member for health and wellbeing in the London Borough of Redbridge. However, the main reason I have chosen to be here instead of in my constituency on a Thursday afternoon is my experience, both as a councillor and as a Member of Parliament, of listening directly to young people talk about their concerns and issues, and those of their friends and peers, with mental ill health. Redbridge has a fantastic youth council, which, like the national UK Youth Parliament, has prioritised work on mental health. I will come on to talk about that.

While sitting in Redbridge Council chamber listening to young people from across our borough, I was struck by the way in which they talked in such an open, candid and courageous way about their own struggles with mental ill health and what they have seen in their classrooms and communities. Although much of what they described was harrowing and of concern from a public policy point of view, it is hugely encouraging that this generation of young people seem to be far more at ease with discussing mental health and have normalised discussing it in such a way that it is similar to how they discuss physical ailments. That gives us hope for the future when it comes to changing the culture surrounding mental health, which my hon. Friend the Member for North Durham (Mr Jones) has mentioned.

Recently I chaired a meeting of the all-party parliamentary group on youth affairs about mental health, and it was hugely encouraging to see young people from across the country pack one of the largest Committee Rooms of the House of Commons. The key message that came across was the failure of public services and health services to address concerns that many of those young people had experienced personally.

We know from so much of the research, particularly the excellent briefings we have had from charities such as YoungMinds ahead of this debate, that there are significant and well-known problems nationally with regard to mental ill health affecting children and young people. As my hon. Friend the Member for Dulwich and West Norwood said at the start of the debate, one in 10 children and young people has a diagnosable mental health condition. That is the equivalent of three children in every classroom. We also know that a great many more suffer periods of anxiety, emotional distress and ill health because of the growing pressures of childhood. That should give us all pause for thought and cause for concern.

Three quarters of young people with mental ill health may not get access to the treatment that they need. I am particularly concerned about the statistic that my hon. Friend shared showing that CAMHS is turning away nearly a quarter of children referred for treatment by parents, teachers and GPs. Those children have been referred by people who, to be frank, have expertise, and to turn such a high proportion of them away is wholly unacceptable.

[Lilian Greenwood (Nottingham South) (Lab)]

My hon. Friend is making a powerful contribution, as have many others. This summer, Healthwatch Nottingham published the results of its survey of young people about their experience of seeking help and treatment. It found that 26% of young people had not sought any help or treatment at all, despite feeling that they suffered from a mental health problem. That was twice as likely among black and minority ethnic young people. Does he agree that we need to do more to raise awareness of the help that is available, which needs to take account of the needs of all young people?

[Wes Streeting]

I agree strongly. That leads me neatly on to a point I wanted to raise about the provision for young people. It is not just young people generally who are having trouble accessing mental health services. The Government and the health services need to look carefully at the profile of the young people affected. During my time as head of education at Stonewall, we published “The School Report”, a piece of research undertaken with young people by the University of Cambridge. It found exceptionally high and extremely worrying levels of mental ill health among lesbian, gay, bisexual and trans young people. The alarming rates of self-harm and suicide, to which many hon. Members have referred, are even higher for that particular group. More than half of LGBT young people are self-harming. Around a quarter have attempted suicide or considered taking their own life. Those levels are of epidemic proportions. That points to a crisis among LGBT young people, which is a symptom of wider poor provision.

[Lilian Greenwood]

My hon. Friend will be interested to know that the same report says that young people who identified as homosexual or bisexual were most likely to have experienced a mental health issue in the past or currently, and that their experiences when seeking treatment and support were more likely to be negative. Does that not give more credence to what he is saying about the need to deal with their specific needs?

--- Later in debate ---

[Wes Streeting]

It really does. One of the things that concerns me most about young people’s poor experience of mental health services—this was reflected at the discussion by the all-party group—is that it is not just GPs and headteachers who recognise that young people are being failed and turned away; young people themselves recognise that. I cannot imagine what it must be like to be a young person who is suffering from anxiety, depression or another form of mental ill health, who knows they have a problem, seeks help and is left to feel ignored, dismissed and unsupported. I have mentioned the proportion of lesbian, gay and bisexual young people who are affected, and it is even higher for trans young people.

I represent a constituency that is highly diverse ethnically and religiously. It worries me that Asian communities seem to be far less likely to seek access to mental health services. There is a job to do there to tackle stigma and to make the services more accessible. People from African-Caribbean communities face inequality. The failures of public policy on African-Caribbean people should shame our country. It is a further indictment that the majority of African-Caribbean people who come into contact with the mental health system seem to do so through the criminal justice system. That is a terrible state of affairs. Therefore, the issue of access and support is crucial if we are to deal with the problem.

This is partly about funding. We have had a good-natured debate this afternoon, so I do not say this to be objectionable or churlish, but on Wednesday, three or four Members on both sides of the House raised the issue of mental health with the Prime Minister, and her response was, to put it politely, inadequate. Beyond general statements about parity of esteem, she seemed unable to point to any meaningful actions her Government were taking on the issue of mental health.

I am sure that the Minister has come better briefed this afternoon, but the Prime Minister also needs to make this a priority. Much of this is about joined-up government—this will be a theme of mine this afternoon—and that requires leadership from the centre. It is not good enough for the Prime Minister to be sure-footed, although wrong-headed, when it comes to home affairs issues, but completely blind-sided on issues outside her comfort zone. We need stronger leadership on mental health from her and I was genuinely disappointed with what we saw during Prime Minister’s questions this week.

Parity of esteem is not about sentiment—it is about resources. About 11% of the NHS budget is spent on mental health and just 6.36% of that 11% is spent on children’s mental health. I recognise that the Government have made a commitment to invest £1.4 billion in child mental health in the next five years, and I welcome that, but I urge the Government to ensure that that funding is delivered sooner rather than later. Locally—other Members have referred to this—budgets are being cut or frozen in three in four mental health trusts. Seven in 10 CCGs and local authorities are freezing their budgets because of pressures from central Government reductions. My hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) has, through written parliamentary questions, highlighted that decisions coming down the track will make that picture even worse.

In the London Borough of Redbridge, the council is doing fantastic work with limited resources. However, I can say from first-hand experience—I declare an interest as an elected member of the council—that local government cuts are biting. The picture is compounded by the state of our local health economy. Both our NHS trusts are in special measures, although I hope one of them will be leaving special measures sooner rather than later. I hope that they will both leave, but I suspect one is nearer to the end of that journey than the other. Primary care is creaking, it is fair to say that our clinical commissioning group is struggling, and our community health trust has a rating that requires improvement. The challenge for Redbridge is not simply the funding reductions that affect my borough, but the fact that the funding formula does not lead to a settlement for Redbridge—for the local authority and for the wider health economy—that genuinely reflects the needs of our population. I urge the Minister to look carefully at how Redbridge has been disadvantaged through the funding formula, particularly in public health funding, and at what can be done.

[Huw Merriman]

I do not wish to get into a skirmish on funding, but does the hon. Gentleman agree that, as in my area of East Sussex, the way to find the efficiency savings that the NHS is required to make, in addition to the £10 billion that this Government have put in, is to have a “better together” organisation so that hospitals and all the other healthcare providers—at county level and so on—can talk together? That would not only save money, but mean that everyone is joined up, which is the way forward on such issues, as he has rightly said.

[Wes Streeting]

I very much welcome the hon. Gentleman’s intervention. He has anticipated some of my closing remarks about looking to the future. I will have some positive words to say about the direction of Government policy in that respect.

This issue is not simply about funding, but about leadership and accountability. I must say that the damning CQC report on the Brookside unit in the constituency of my hon. Friend the Member for Ilford South (Mike Gapes) has more than raised eyebrows. Some of its judgments about this facility for children’s mental health provision were:

“The ward environments were not safe, clean or suited to the care of children and young people… The wards were not adequately staffed… There was a high usage of restraint and rapid tranquilisation at the unit… The ethos of the unit was containment rather than therapy… Care plans reviewed were not recovery orientated and more behaviour orientated… During the inspection we saw staff refuse to facilitate the requests of young people… Young people stated the food was of poor quality and cultural and religious foods were not available”—

and those who know the London Borough of Redbridge will know how totally inappropriate that is. My question for the North East London NHS Foundation Trust is very simple: why did it take a damning inspection by the Care Quality Commission for sufficient action to be taken? From what I can see and from my conversations with colleagues in the local authority, there is clearly a road to improvement. It should not take inspectors coming in to highlight the fact that we have failed some of our most vulnerable young people in such a gross and unforgivable way.

Among my worst experiences as a constituency MP—these are universally my worst experiences—are in my surgeries on Friday afternoons when I see absolutely awful cases of people who have been very badly failed by public services. One case I will never forget was that of Simon Harris, a young man—he was 30 years old—who was failed by Goodmayes hospital because he was insufficiently cared for. While under the care of the NHS, he was allowed to take his own life, although he was in the very place that his family thought would keep him safe. I never again want to have a conversation with a constituent like the one I had with his incredibly stoic and courageous grandmother, Brenda. That is the consequence of mental health failure: it is simply the difference between life and death. I do not think that young people like Simon should ever be failed in such a way by the services that are there to keep them safe and well.

This subject is not just about public service provision, but about celebrating the work done by the voluntary sector. In the past year, I have visited a number of programmes in my constituency. I have visited Audacious Veg, a social enterprise that involves helping people suffering from mental ill health to set up their own social enterprise, growing and selling vegetables. This wonderful project runs in conjunction with the Forest Farm Peace Garden, another environmental and sustainability project, which gets people with mental ill health outside, interacting with others and active.

I cannot commend strongly enough to the Minister the importance of social prescribing. Here, public policy has a role to play. When Redbridge Youth Council, for example, commissioned the Redbridge Drama Centre to design and deliver a play on mental health to reach young people, 5,000 young people and counting across the London Borough of Redbridge were reached by that fantastic way of engaging young people in conversations about mental health.

Music can play a powerful role in therapy, as can sport. One of the most impressive projects I have visited in the past 12 months was Coping With Football, sponsored by the London Playing Fields Foundation and run in conjunction with the North East London Foundation Trust. Again, that project got young people outside, interacting and developing their skills and, most importantly, their self-esteem.

That brings me on to looking to the future, and I will press the Minister to take policy in a few directions. I have asked her to look at Redbridge’s funding formula, on public health in particular, and I hope she will undertake to do so. I also ask her to work with her colleagues in Government to think about funding nationally. The hon. Member for Bexhill and Battle talked about the value of joining up services locally, in particular local government and the NHS. I commend the approach being taken by the Government through the introduction of the accountable care organisations. In the pilot with Redbridge, the London Borough of Barking and Dagenham and the London Borough of Havering, that approach is bringing the local authority together with stakeholders from across the local health economy to join up public service provision. That will bear fruit.

We also need joined-up Government nationally, however. Other Members have made a compelling case for the Minister to fight her corner in public health, because investment in public health and early intervention is a money saver—and not just across Government; within her own Department we can reduce A&E admissions and the pressure on urgent and primary care if we get public health funding right.

The Minister also needs to make the case, along with the Secretary of State, across Government. For example, it is no good the Treasury making cuts to local government if that leads to cuts in public health funding and undermines the work of the Department of Health. It is no use cutting mental health provision if that leads to a spike in crime, an increase in the prison population and greater demand on the criminal justice system.

In education, it is no good asking Ofsted to inspect schools on mental health provision if school referrals to CAMHS are going unheard. We need to make sure the services are there to support schools. We also cannot continue with the postcode lottery on sex and relationships education and personal, social and health education. I hope we can revisit the issue of compulsory SRE and PSHE.

Finally, and most importantly—it is the reason we are here this afternoon—I urge the Minister and her colleagues in Government to listen to young people. That she is here this afternoon shows the importance the Government place on this report and the views of young people. My hon. Friend the Member for Dulwich and West Norwood talked about the importance of co-production and involving young people in the design of public services, and that is absolutely critical. But the Youth Select Committee has made a whole series of other recommendations that deserve not just the serious attention of this House but the response of Government. If that happens, we will get better public policy, and, I hope, we will have a generation of young people whose voices have not just been heard but, most importantly, listened to.

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[Nicola Blackwood]

I think I have already answered those questions. The Government have been clear that we think that mental health funding for children and young people, as well as for other areas of mental health, needs to increase. That is why we have increased mental health funding to local areas and we are putting in place measures to improve accountability and transparency, and the STPs, to make sure that that can be tracked locally. We are going to see how it works in the first instance.

[Wes Streeting]

rose—

[Nicola Blackwood]

I must continue.

Another issue that was raised is the fact that children and young people want to know where to find help easily if they need it. I want to make sure that I respond to all the issues that have been raised, otherwise it will not be fair to the young people who wrote the report. Children want to know that they can trust such help when they find it. Young people are clear that they want a choice about where they can get advice and support; they want to be able to get it from a welcoming place, based on the best evidence about what works; and they want the opportunity to shape the services they receive. Many colleagues have spoken about co-production.

“Future in Mind” committed to sustaining a culture of continuous evidence-based service improvement, as well as improving transparency and accountability across the whole system, as I have mentioned. A big part of that is producing the datasets that I have mentioned, which will give local areas the ability to hold their CCGs to account. Those datasets will include information on funding. As the hon. Member for Neath (Christina Rees) told us so eloquently—Matthew’s maiden speech has made its mark on all of us—young people want, as we all do, to tell their story only once rather than having to repeat it lots of times to lots of different people. We are committed to delivering a much clearer and more joined-up approach, with services coming together and communicating more effectively.

As numerous other colleagues have said, young people do not want to have to wait until they are really unwell—until they have reached a higher threshold—to get help. Asking for help should not be embarrassing or difficult. They should know what to do and where to go. If they do have to go to hospital, they should be on a ward with people around their age and close to home. So we are delivering a step change in how care is provided and ensuring that access is improved so that children and young people can easily access the right support from the right service at the right time, as close to home as possible. I recognise that this is a process.

“Future in Mind” is more than just a report. It is more than just words. It has already brought together key players, focused efforts and given us a clear trajectory for improving services. It is only the start of the journey, however, and we need to maintain the effort, focus and political momentum from this place and in our local areas.

In February 2016, the “Five Year Forward View for Mental Health” set out the start of a 10-year journey to transform NHS care across all ages. The hon. Member for North Durham (Mr Jones) was absolutely right to say that similar problems can be tracked across to adult services. The report was clear:

“The NHS needs a far more proactive and preventative approach to reduce the long term impact for people experiencing mental health problems and for their families, and to reduce costs for the NHS and emergency services”.

A lot of it is simply common sense. The five year forward view for mental health is underpinned by additional funding, which I have already spoken about, and the NHS England implementation plan sets out in detail where and when that money will become available. It builds on the foundation of local investment in mental health services and the ongoing requirement, which I have referred to, to increase that baseline by at least the overall growth in allocations.

“Implementing the Five Year Forward View for Mental Health” sets out clear objectives, which will support improvements to the services that young people will receive. I think it would be helpful if I say exactly what they will be, as they will make practical changes. The first is a significant expansion in access to high-quality mental healthcare for children and young people. At least 70,000 additional children and young people each year will receive evidence-based treatment. By 2020-21, evidence-based community eating disorder services for children and young people will be in place in all areas, ensuring that 95% of children receive treatment within one week for urgent cases and four weeks for routine cases. By 2020-21, in-patient stays for children and young people will take place only when clinically appropriate; will have a minimum possible length of stay; and will be as close to home as possible, to avoid inappropriate out-of-area placements. Inappropriate use of beds in paediatric and adult wards—this has already been referred to—will be eliminated.

All general in-patient units for children and young people will be commissioned on a place basis by localities, so that they are integrated into local pathways. That is designed to address some of the concerns that have been raised today. As a result, the use of in-patient beds should reduce overall, with more significant reductions possible in certain specialised beds.

Those objectives are supported by a refresh and republication of the local transformation plans, which have been mentioned. The plans set out how local areas will work together to improve services for children and young people with mental health problems across the whole care pathway. The plans are, in fact, the richest source of information available to date about the state of children and young people’s mental health services across England.

NHS England has also commissioned a number of thematic reviews as part of an analysis of the LTPs. In July, it published the children and young people’s mental health LTPs, which provide a summary of the key themes. It is fair to say that, essentially, they found that there was a lot of variation in local areas in terms of approaches, quality and priorities. We have heard about that in some of the stories that have been told today. The LTPs are a starting point. They are living documents and are not designed to just go in a drawer. They are reviewed and refreshed at least once a year, and we are clear that children, young people, families and carers must be involved in the process, for the exact reason given by the shadow Minister, which is to increase accountability and effectiveness and to make sure that the plans actually work.

A number of key themes have emerged from the report recommendations and the LTPs. Recommendations 5 and 6 comment on the need to support the workforce. We acknowledge the need to address the capability and capacity needs of the workforce—from GPs and A&E, to the mental health specialist—to deliver on our ambition to transform mental health services. In line with the eight specific workforce recommendations of the taskforce report, we will work with Health Education England and others to develop a five-year mental health workforce strategy, which we will publish in 2017. That is a serious response to a serious problem, and it is designed to address a lot of the challenges that have been raised today.

As many Members have rightly said, access to services is a priority area and we need to address it. We know that young people do not want to wait until they are really unwell to access services, and we do not want that to be the case, either, so we are tackling the issue. In August 2015, NHS England published an access and wait standard for children and young people with eating disorders, as I have said. From January, compliance with that standard has been monitored via the data collected through the mental health services dataset. It is, therefore, being held accountable and the aim, as I have said, is that 95% of young people will be seen within a clinically appropriate timeframe by 2020. That is just the first of the waiting time standards.

NHS England has commissioned the National Institute for Health and Care Excellence and the National Collaborating Centre for Mental Health to develop a new evidence-based treatment pathway for children’s mental health. The project will report in March, recommending maximum waiting times for referral to treatment. An England-wide quality assessment will then be used to establish a baseline and trajectory to achieve those national waiting time standards in local areas. The matter was also raised by the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who is no longer in her place.

We are also taking action on particularly vulnerable groups of children and young people. In April, Alison O’Sullivan and Professor Peter Fonagy were appointed as the co-chairs of the expert working group for looked-after children, established to lead the development of models of care for looked-after children’s mental health, which has historically been a blind spot. The expert working group is about practical outcomes—not just what is needed but how it should be delivered, without jargon, proposing concrete milestones and measures. We expect that work to conclude by October 2017.

However, ensuring access to services will not be enough if young people do not feel confident and safe seeking help. All children and young people should feel able to go for help when they need to, without fear of discrimination or stigmatisation. We have made a lot of progress in tackling stigma in recent years. The fact that young people have been willing to tell their stories demonstrates that.

Time to Change is a campaign that aims to tackle the stigma around mental health. In October, it was given £20 million in funding from the Department of Health, Comic Relief and the Big Lottery Fund. We are committed to ensuring that the Time to Change initiative, which is run by charities such as Mind and Rethink Mental Illness, will work with schools, employers and local communities to do more and go further to reduce discrimination and to raise awareness. It is developing a targeted campaign for young people, working with experts by experience.

As “Future in mind” and “The Five Year Forward View For Mental Health” both made clear, co-production is now a fundamental principle in the way we seek to develop and improve services, and anti-stigma campaigns are no exception. However, as many colleagues have said, to make that work, and to see the progress that is so desperately needed, we also have to work closely with colleagues across government, in particular the Department for Education, but not exclusively.

We are determined to continue that collaboration, as recommendation 2 proposes. We have been working closely together to ensure that the vision of “Future in mind” becomes a reality. We are also working together to consider what more can be done upstream to intervene early—an issue raised by the hon. Member for West Ham (Lyn Brown) and many others—and to provide the right interventions as soon as they are needed. The report’s recommendations will be a valuable resource for us as we do that, including the recommendations on attainment, Ofsted, teacher training and a whole-school approach, which was highlighted by my hon. Friend the Member for High Peak. We know that this is the weakest link in our current process and we are prioritising activity in that area to ensure that young people get the support they need right from the start.

A number of colleagues have mentioned the issue of online pressures and cyber-bullying. That matter has been taken extremely seriously by the Government Equalities Office, which announced in September £4.4 million of funding to tackle bullying. That includes a number of measures to underpin the fact that all schools are required by law to have a behaviour policy with measures to tackle bullying among pupils, and they are held clearly to account for their effectiveness by Ofsted. However, we know that more needs to be done, including to support parents. That is why the GEO has also invested £500,000 in the UK Safer Internet Centre to provide advice to parents on how to keep children safe and provided support to the Child Exploitation and Online Protection Centre to support a national roll-out of parent information through schools.

Today’s debate has been important because it has provided an opportunity not just to reply to the details in the Youth Select Committee report, which is so important, but to test the Government’s commitment to mental health reform. I am grateful to colleagues for the time they have taken today to raise concerns, to champion good practice and to propose innovative solutions. I hope that, in my response, our commitment to reform mental health services is beyond doubt. I also hope that it is clear that I believe that it is only through concerted political will, allied with the extraordinary and selfless determination of the mental health workers throughout this country, that we will have any hope of achieving our goal of mental health services that are accessible when and where they are needed.

I look around the Chamber and I hear speech after speech expressing determination to see a change. It gives me courage because great reform requires long-term vision, non-partisan partnership and fine minds. I have seen all three of those today, not just in the excellent Youth Select Committee report, but in all colleagues’ speeches. That truly is a firm foundation for the tough task ahead.

NHS Bursaries

Wes Streeting Excerpts

Wednesday 4th May 2016 Commons Chamber

[Ben Gummer]

I accept that there are differences—I will come to them in a second—but implied in the hon. Lady’s point is an acceptance that she was wrong in 2010, and she should therefore be more measured in her proposals, or lack of them.

[Wes Streeting (Ilford North) (Lab)]

It has not all been plain sailing since the reforms, not least as regards the impact on applications from mature students, who make up a significant proportion of the nursing cohort. Does the Minister not accept that there is no proposal in the consultation on how to mitigate the risk to good recruits from mature student backgrounds, who make up a significant proportion of the nursing workforce?

[Ben Gummer]

I am afraid that the hon. Gentleman is wrong on both points: more mature students are applying now than in 2010; and there are specific recommendations in the consultation to deal with mature students.

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[Wes Streeting (Ilford North) (Lab)]

I thank the shadow Health Secretary and the shadow Health team for securing this important debate this afternoon, which effectively gives us the opportunity to debate early-day motion 1081, which is set to become the most popular early-day motion in this Session of Parliament. It has been signed by Members from across the House, including Government Members, because of the concerns that people have bravely shown about the potential consequences of the Government’s proposed decision on the NHS bursary.

As I have argued before in Adjournment debates on the Floor of the House and in Westminster Hall, what we are debating this afternoon is the biggest shake-up in the funding of nursing, midwifery and allied health subjects since 1968. It was announced, without adequate evidence and planning, as part of the Chancellor’s Budget rather than being a carefully thought-through policy proposal; that is why the Government are consulting people only through a technical consultation rather than through a consultation of all stakeholders on the principle of the policy, as they ought to have done.

Although I and others will refer to “student nurses and midwives” as shorthand, it is important to acknowledge, as my hon. Friend the shadow Health Secretary did, that this will affect students of all sorts of subjects and vital workers being trained in a range of aspects of the NHS—physiotherapists, occupational therapists, chiropodists, dieticians, podiatrists, radiographers, paramedics, prosthetists and others. That is why more than 100 right hon. and hon. Members signed the early-day motion and thousands of members of the public have spoken out through the online petition.

At present, nursing, midwifery and allied health subjects are not subject to tuition fees and students on these courses receive a non-means-tested grant of up to £1,000 a year as well as a means-tested bursary of up to £3,191 a year. That recognises that students of these subjects have to work considerably long hours during their courses—not just in the libraries and lecture theatres like most students, but on clinical practice as part of a full 24-hour care cycle. Indeed, it is estimated that student nurses work at least 2,300 hours across the course of their degree. I am not sure that many of us with degrees in this House could claim to have put in so many hours when we were at university. We should recognise the effort that such students need to make to secure their qualifications.

Those who work outside course hours to fund their degrees can end up working up to 60 hours, and we should not expect them to do so: it can have a deleterious impact not just on their academic studies but on their approach to clinical practice. Under the Government’s proposals, the changes will mean that students of these subjects will be charged tuition fees in excess of £9,000 a year and, as a result, will be burdened with £51,600 of debt. They will begin paying that back as soon as they graduate, which means that nurses will take on average a pay cut of £900 a year.

As if that were not unacceptable enough on its own, will the Minister explain when he winds up how it can possibly be fair that under the proposed approach there is no recognition in the student support system of the unique demands placed on these students? The NHS bursary, as it exists, alongside the tuition fee remissions that these students effectively receive, at least recognise that for many of the students it is difficult, if not impossible, to take on the sorts of part-time work that I did when I was studying, either during my A-levels at McDonald’s or during university at the now-defunct Comet. For those students, it is simply not possible to fund their degrees in that way.

The student support system should recognise that it is more expensive to study these subjects and that the opportunities to earn extra income on top of taking the courses are not as readily available as they are for other students. It is a real mistake for the Government not to recognise that in their plan.

[Dr Wollaston]

Does the hon. Gentleman also accept that there is a serious problem with hardship on the existing bursaries, particularly given that the amount of the bursary drops in the final year?

[Wes Streeting]

I am grateful for that intervention. I shall come on to thank some of the people who have been in touch, but I will never forget the very first conversation I had with a student nurse in my constituency who sat with me in the Members’ area of Portcullis House and cried because under the existing system she struggled to meet the costs of training to be a nurse, even with the NHS bursary currently provided.

I want the student support system to be more generous for these students because other students like my constituent have dreamed of being a student nurse. It is not right that financial support, or the lack of it, should be a barrier to their taking on this valuable vocation, which does so much for so many.

The Government’s policy is riddled with risk. Earlier the Minister challenged my assertions on mature student numbers. It is a fact that in the wake of the introduction of the coalition’s reforms to higher education, there was a fall in part-time and mature student numbers. The Minister claimed that there were record numbers of mature applicants to higher education; I can only assume that he was referring to last year’s figures. We should not identify a trend from one year’s figures, not least because UCAS figures for the 2016 application cycle published on 4 February 2016 show an increase in 18-year-old applicants, but a fall in most other older age group categories. I am more than happy to look at the data and conduct an evidence-based debate, but let us have an evidence-based debate and not take one year’s worth of figures and claim that there is some sort of trend.

[David Morris]

The figures that the hon. Gentleman cites are welcome, but they are different from those of the shadow Health Secretary.

[Wes Streeting]

No, I do not disagree at all with the figures cited by my hon. Friend the shadow Health Secretary. This is the problem with lies, damned lies and statistics, as Disraeli once said. We need to look at all the data in the round before we identify trends. The Minister singled out one year’s worth of application data to identify a trend.

It is also entirely possible that numbers relating to nursing, midwifery and allied health subjects account for a significant proportion of applicants to higher education and mature applicants to higher education. The Minister was talking about general applications for all subjects. We should probably ask the Library to do some work so that we can get to the bottom of the claims and counterclaims. None the less, most people involved in the higher education debate acknowledge that there are still serious challenges in access to higher education for part-time and mature applicants in the light of the coalition’s reforms. That is one of the reasons why the Government ought to tread carefully in this area.

Against this backdrop, there is a shortage of nurses. In 2011 and 2012 the number of training places was cut to the lowest level since the 1990s. Unison, the trade union of which I am proud to be a member, conducted a survey which found that two thirds of nurses believe that staffing levels were worse now than they were previously, and 63% feel that the numbers are inadequate to provide a safe degree of support on wards. That reflects feedback that I have had from NHS staff in my constituency, and it is something that the Government should take very seriously.

Since I first raised the issue in an Adjournment debate in the House, I have been privileged to meet so many nurses, midwives, other professionals and students of allied health subjects. I am particularly grateful for the campaigning that Danielle Tiplady and Kat Barber have undertaken, not least in meeting the Minister. I thank Unison, the Royal College of Nursing, the Royal College of Midwives, the Royal College of Speech and Language Therapists, and the National Union of Students. I take this opportunity to pay particular tribute to the outgoing president, Megan Dunn, for the effective way in which she has represented students during her term in office.

The reforms reflect a big risk to nursing numbers. At the very least the Minister should commit this afternoon to a further full debate on the Floor of the House and a vote of both this House and the other place before such a radical change as the Government propose is made to the funding of these crucial subjects. There is considerable concern and the Minister should not downplay the issue. I hope he will at least commit to a full vote in the House before the change goes ahead.

--- Later in debate ---

[Daniel Zeichner (Cambridge) (Lab)]

I congratulate the shadow Health team on securing this debate.

Just a few weeks ago, I found myself in a packed lecture theatre in Cambridge. I had been invited there by Giovanna Mead. She is a student nurse, and the room was packed full of her colleagues. They were angry—not for themselves, but for those in the years ahead who should be following in their footsteps. They were absolutely convinced and absolutely sure that if the Government’s changes go ahead, people like them would not be doing as they had done. They would not be embarking on the training that is so essential to the future of our NHS.

Those people are rightly furious that there seems to be a complete misunderstanding about just how different they are as a cohort from other students, and just how different their course is from other courses. There has been a complete failure to understand how their course involves being at work and sometimes, as they explained, going way beyond the call of duty. Being at work is different from just being on a course. The testimonies of these nurses and those of others across the country speak volumes. I pay tribute to the Royal College of Nursing for pulling together hundreds and hundreds of these stories. What makes the Minister so sure that he knows so much better than all these people, who are actually doing nursing and who know and understand the choices that people in their situation are likely to make?

Before I was elected here, I worked for Unison and met many student nurses, so I know that the Government fail to understand the simple truth that nursing, midwifery and allied health professional students are not like other students. One important and fundamental difference lies in the requirement that healthcare students spend a significant proportion of their studies on clinical placements. As the Royal College of Nursing points out, and as others have said,

“student nurses aren’t like other students. 50 per cent of their time is spent in clinical practice working directly with patients and their families and they have a longer academic year.”

Indeed, student nurses must spend a minimum of 2,300 hours on clinical placement during their studies—working, providing care and making a vital contribution to the health service. This often includes early shifts, night shifts and weekend shifts. In practice, the funding changes being driven through will charge students to go to work and to do a job that is desperately needed.

Furthermore, it is clear that these changes are being rushed through without proper consideration of their consequences. The Government say that they will create 10,000 new nursing, midwifery and allied health degree places, which would be welcome if it were to happen—particularly at a time when agency staff are plugging the staffing gap and draining NHS finances. It has not been made at all clear, however, that the resources are in place to support an influx of new students in clinical settings. Put simply, do the placements exist?

This concern is linked to a wider issue about the uncoupling of education commissioning and workforce planning. The potential consequences of a disconnection between university recruitment and NHS workforce planning must be addressed, and I would welcome the Minister’s comments on the risk this uncoupling poses to the ability of the NHS to best assess and plan workforce requirements.

[Wes Streeting]

One of the more interesting aspects of the Government’s proposals is to increase routes through non-degree courses. In view of the report of The Lancet in February 2014, does my hon. Friend agree that the Government should tread carefully here? Based on data across nine European countries, it suggested that every 10% increase in the number of Bachelor degree-educated nurses in a hospital is associated with a 7% decline in patient mortality. Even on the more positive aspects of the proposals, does my hon. Friend agree that the Government should tread much more carefully than they are?

[Daniel Zeichner]

My hon. Friend has made an interesting point, and I hope it is one that the Minister will address.

There are other ways in which student nurses, midwives and allied health professionals are different. As we know, they are more likely to be older, to be women, to come from black and minority ethnic backgrounds, to have children, and to have first degrees already. The average age of a new nurse is 28. Those characteristics matter, because they increase the likelihood that the changes in funding for healthcare degree places will be a disincentive to the undertaking of degrees. According to the Royal College of Midwives, the removal of NHS bursaries means that

“Women with children and those who already have a first degree will be particularly hit hard…many of these women already make up a large proportion of our current midwifery student base.”

Many students take up healthcare studies as a second degree course. Already saddled with repayments of undergraduate debt, they are hardly likely to be enthusiastic about the prospect of taking on an additional debt of £51,600. The starting salary for nurses is only £21,692, and replacing NHS bursaries with loans will mean an average pay cut of more than £900 a year for a nurse, midwife or allied health professional, given current salary levels. We know that debt particularly deters poorer students, single parents and BME students—those who are more likely to be found entering nursing and midwifery.

I think that the people who can best explain what the Government’s decision will mean are those who will be most directly affected. The Royal College of Nursing has collected their testimonials in a huge big blue book, which I have waved around hopefully during a number of Question Time sessions over the last few weeks, and which I commend to the Minister.

Let me end by returning to that packed room in Cambridge, and give some of those students a voice. Sarah from Cambridge says:

“I would not have survived without my bursary. The nurse’s salary is poor and to have debt on top is terrible.”

Amanda says:

“I am an adult learner with a husband and two children. I had my children young so was unable to fulfil a degree at the usual time… If I was to have a mountain of debt at the end it would not have been worth my while! I fear it will put off adult learners entering into the degree programme, which will mean the NHS losing out on valuable, decent people who would make fantastic nurses!”

Maria says:

“By stopping the bursary we are in danger of preventing mature students from entering training as those who already have financial commitments will struggle. This will mean that the NHS loses the chance of recruiting a great resource of potential nurses.”

Another Sarah says:

“I am really disappointed by this change, and nursing is not like any other profession so should be treated uniquely. It is really tough being a nursing student and I think that the proposed bursary changes should be considered carefully to respect the work, commitment and enthusiasm of student nurses.”

She puts it very well. If the Government will not listen to me, perhaps they will at least listen to her.

NHS in London

Wes Streeting Excerpts

Thursday 24th March 2016 Westminster Hall

[Wes Streeting (Ilford North) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Buck, and a pleasure to follow so many contributions from hon. Members from across London. I congratulate my hon. Friend the Member for Ealing Central and Acton (Dr Huq) on securing the debate. I thank the Backbench Business Committee for granting us this opportunity to talk about the NHS across London.

The context is challenging across London, with a swiftly growing population, huge health pressures arising from demographic change and from London lifestyles, and a national health service that across the city is struggling to cope with those myriad pressures. We have seen that across the capital since the 2010 general election. A&E waiting times in hospitals throughout London, referral-to-treatment times and cancer waits have worsened throughout the period. As we have heard, Members from every corner of our capital city are reporting local pressures that reinforce that picture of national health service provision across London.

We feel that pressure acutely in Redbridge. Both the NHS trusts that cover our borough are in special measures: Barts Health NHS Trust, which covers the west of my constituency; and Barking, Havering and Redbridge University Hospitals NHS Trust, which serves patients throughout my constituency. Primary care is an issue, with patients increasingly struggling to get a GP appointment and finding new barriers put in their way, such as telephone consultations before a GP practice will even grant an appointment. There are also service reconfigurations.

We have already heard about service closures across the rest of London, and in Redbridge we remember the Conservative party’s commitment before the 2010 general election that there would be no enforced closures of accident and emergency or maternity units. Well, we lost the maternity unit at King George hospital, and the decision to close the accident and emergency department was taken in 2011 by Andrew Lansley when he was Secretary of State for Health. That decision still stands, although it has not yet been implemented because the NHS is in such a state of crisis locally. Our local A&E waiting times for the last six months show that we have failed at any point to hit the target of 95% of patients being seen within four hours. The worst rate in the last six months was 76.8%, in December, and the best was 92.6%, in February. People living in my constituency will not find that satisfactory. In the last couple of weeks, the chief executive of the Barking, Havering and Redbridge trust has had to apologise to the 1,015 patients who have waited more than a year for routine treatment such as knee operations, which is simply unacceptable.

There are some positives. I have mentioned the chief executive of the Barking, Havering and Redbridge trust. I have confidence in the trust’s leadership. Since they came on board, they have approached the task energetically. They inherited an absolute mess that developed over a number of years, and there are some improvements, but as recent events have shown, there is still a long way to go.

I welcome the work that the clinical commissioning group and GPs are leading on primary care transformation to try to improve primary care services locally, but we are yet to see the fruits of their labour. I also welcome the extent to which the local authority, which is now Labour-led, has been leading the way on integration to help partners across the local health economy. I am pleased to see that my borough is taking part in piloting the accountable care organisation initiative, which I hope will bring real benefits to patients through greater integration between healthcare providers and our local authority. In that context, the cuts to local government spending and, in particular, to public health budgets are a real concern.

I should probably declare that I am still a serving councillor in the London Borough of Redbridge, albeit an unpaid one, so I am excellent value for money for my constituents.

[Andy Slaughter]

They should be the judge of that.

[Wes Streeting]

They may well be the judge, but I am standing down as a councillor in 2018. I was elected to Parliament while serving as a councillor, which is a good indication.

Seriously, the London Borough of Redbridge has the fourth lowest public health grant in London. Given the diversity of our population, and the pressures that that brings, it is a cause for concern. In that context, I was even more disappointed to find that the Government have cut our public health grant in-year. As a former cabinet member for health and wellbeing in Redbridge, and as the former chair of our health and wellbeing board, I know that we were already struggling to meet our statutory duties on public health, not least the new responsibilities we have been given, such as for health visiting, for which the allocation received from the Government was not sufficient. We managed to squeeze some extra funding out of the Government, but we are still struggling.

The reduction is disappointing, particularly in the context of London, where people’s healthcare needs and lifestyles are placing pressures on the NHS. Public health investment is an upfront investment in people’s lifestyles that will reduce NHS costs in the longer term, as well as improving people’s health and wellbeing. I cannot understand why, in that context, preventive budgets such as public health budgets are bearing the brunt of cuts. I hope Redbridge’s public health allocation in particular is something that the Department of Health will revisit.

I have talked about the financial challenge for local authorities, and I will now address the financial challenge facing the NHS and our local health economy. I was concerned, as everyone else was, to read David Laws’s revelation at the weekend that, far from the £8 billion that keeps being mentioned as the hole in the NHS budget, Simon Stevens actually identified a £30 billion hole, of which he said £15 billion could be found through efficiencies and improvements. My maths makes that a £15 billion hole in the NHS budget, and it is a source of concern that the £8 billion promised by the Conservatives at the last election is still not there. We have seen the Chancellor having to shuffle money around. Earlier, my hon. Friend the Member for Lewisham East (Heidi Alexander), the shadow Secretary of State for Health, talked about the reallocation from capital to revenue in terms of the health budget.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Public Accounts Committee recently considered the health budget following a National Audit Office report. There is a £22 billion gap, and one of the key drivers of that is the 4% efficiency savings year on year. Simon Stevens has himself acknowledged that that is too high and that 2% would be more reasonable. The head of NHS Improvement also acknowledged that it is a cause of acute hospitals’ deficits at the moment.

[Wes Streeting]

I am grateful to the Chair of the Public Accounts Committee for giving us that insight, which gives me even greater cause for concern about our local situation in Redbridge. The overall gap in funding for the NHS should be a concern to the whole country.

In my borough in particular, I am concerned by a report produced for NHS England by McKinsey & Company in, I believe, July 2014. The report has just been released by NHS England following a freedom of information request, and it identifies a Barking, Havering and Redbridge system gap of £128 million for commissioners and £260 million for providers. I am concerned by several things. One is that one way in which McKinsey identified that the BHR system will be able to address that gap is through acute reconfiguration of King George hospital, where the accident and emergency department is threatened with closure. I am deeply disappointed that, at a recent meeting of the Ilford North Conservatives attended by the hon. Member for Richmond Park (Zac Goldsmith) for his London mayoral campaign, the Conservatives once again stood up and said, “People should not worry about the accident and emergency department, because we always say it’s going to close and it never does.” The only reason why the accident and emergency department at King George hospital is still there is not because of a positive decision to keep it but because the NHS trust and the local health economy are in such a mess that it would not be clinically safe to close it at this time; the accident and emergency department is still very much at risk.

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

The national health service bureaucracy has been trying to close the A&E at King George hospital since 2006. We are coming up to the 10th anniversary of the misnamed “Fit for the Future” document. My hon. Friend’s predecessor, Lee Scott, and I fought a vigorous campaign to stop the closure at the time, and the closure decision was deemed to be clinically unsound. Now, the Trust Development Authority is in charge, and the A&E cannot be closed because the trust is not out of special measures. My hon. Friend has mentioned the trust’s chief executive, Matthew Hopkins, who was hoping to get out of special measures by the end of the year, but that has not happened. We are still in a period of great uncertainty.

[Wes Streeting]

I agree with my hon. Friend and I welcome him back to Parliament this week after his break. [Interruption.] I know that he has gone to extraordinary lengths to test the resilience of the NHS in London and that he will talk about that shortly. We look forward to it.

In all seriousness, the A&E department is still at risk and many of my constituents worry that it is the financial drivers that are pressing ahead with the closure, rather than the clinical drivers. As my hon. Friend has said, given the length of time since the original case for closure was prepared and since the decision to close was made, it is not unreasonable to ask the Minister to commit to reopening that closure decision and to look at the issue with a fresh pair of eyes, testing whether the evidence base is still there, testing the assumptions that were made when the original closure proposal was put forward and giving people the assurance that it is clinical factors and the healthcare of our residents, rather than financial factors, that are driving this process.

The final thing I will draw upon from the McKinsey report is about meeting the financial pressure within the BHR system. McKinsey observes that to fully close the gap will require further stretch productivity achievement beyond the levels agreed locally, as well as additional private finance initiative support and the closure of the gap to the CCG allocation. The £140 million-odd deficit in 2013-14 was only reached after a £16 million PFI subsidy, and the deficit as a percentage of income is far larger even than it was for Barts at that time.

It is not unreasonable, as part of the wider changes in Redbridge and the work being led by the accountable care organisation, to expect the Government to provide further support in relation to our PFI debt. Many challenges face the local health economy in Redbridge and that debt is like an albatross around our necks. If the Government were to invest now in alleviating that pressure, we may get better outcomes in the long term. I hope that that is an issue the Minister will address when she responds to the debate.

--- Later in debate ---

[Mike Gapes]

The interesting thing is that NHS nurses were not originally on that shortage list. There had to be a lobbying campaign to get them put in because of the stupidity of the people in the Home Office who drew up the list. The fact is that the £35,000 figure will present a problem. Obviously, it will not present a problem in recruiting doctors from abroad, but it is a significant problem in recruiting nurses and other people at lower wage levels. We need to raise that issue, because it will be damaging in the long term.

Of course we need to train more nurses, but to do so the Government need a consistent policy. It takes several years to train a nurse. It is not something that can be switched on and switched off. The other issue is retention. Large numbers of nurses leave our NHS and go and work in other countries. Just as we take nurses from other countries, so British nurses go abroad. There is no reason why that should not be the case; it is a global health economy and the reality is that if we do not pay the lower paid staff in the NHS what they need, we will not recruit sufficient numbers of people to do those jobs.

[Wes Streeting]

In the context of the recruitment and retention challenges for NHS staff, does my hon. Friend share my concern and that of a number of Members from all parts of the House on the plans to charge nurses, midwives and students of allied health subjects full tuition fees and to remove the NHS bursary? Those things will be deeply damaging to recruitment of the very staff that we need to bring into the NHS.

[Mike Gapes]

Absolutely, I do agree. That is why I signed my hon. Friend’s early-day motion today. I am about to put it in so that my name is added, now that I am back.

In conclusion, it is a great pleasure and a bit of a coincidence that this debate was here today, but I could not miss the opportunity to say thank you to those people who saved my life.

NHS Bursary

Wes Streeting Excerpts

Monday 11th January 2016 Westminster Hall

[Wes Streeting (Ilford North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am delighted that, thanks to the response of more than 150,000 people, we are having this important and timely debate, which will allow me to raise some of the issues outstanding from the Adjournment debate that I secured before Christmas and address those that the Government have not yet addressed.

It is encouraging to see three members of the shadow Cabinet here at this debate: the shadow Health Secretary, my hon. Friend the Member for Lewisham East (Heidi Alexander); the shadow Minister for mental health, my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger); and the shadow Foreign Secretary, my right hon. Friend the Member for Leeds Central (Hilary Benn), who has shown an interest during the course of these proceedings. This weekend, the shadow Health Secretary and I, along with other right hon. and hon. Members, joined thousands of students, nurses and supporters marching through the streets of London to raise their concerns about the implications of the Government’s decision. A statement of support from the Leader of the Opposition, my right hon. Friend the Member for Islington North (Jeremy Corbyn), was well received by all in attendance.

I begin by emphasising that, often as shorthand, we have been discussing the implications of the policy changes for student nurses and midwives, but of course the changes extend to a range of allied health professionals, as I said in my Adjournment debate. It is important not to lose sight of that when discussing the Government’s proposed approach.

To recap the Adjournment debate, we are discussing the biggest shake-up in the funding of nursing, midwifery and allied health subjects since the Health Services and Public Health Act 1968. It would mean the end of the non-means-tested grant of up to £1,000, the end of the means-tested NHS bursary of up to £3,191 and the imposition of tuition fees of £9,000 a year, which would burden nurses, midwives and other allied health professionals at the start of their career with huge debts of at least £51,600. Thanks to the repayment threshold, now shamefully frozen at £21,000, they will begin to pay back those debts immediately on starting their career and will face an average pay cut of £900.

Given that such professionals are required to work at least 2,300 more hours across the course of their degree, it is an absolute disgrace that we are seeking to balance the books on the backs of the front-line staff who form the backbone of our NHS. No wonder so many NHS professionals across the board are angered by the Government’s approach. It seems to be a trend under this Government. We are seeing it not just in the treatment of nurses, midwives and allied health professionals but in the Government’s intransigent approach to the junior doctors dispute, in which people could go out on industrial action, not out of choice but out of apparent necessity.

To follow on from the Adjournment debate, a number of questions are still outstanding. My concerns about the Government’s approach involve both the policy content and the process that they are choosing to follow. I asked the Minister during the Adjournment debate whether he could confirm that the Government would consult on the principle of policy changes, not merely their implementation. He told the House that

“we will not consult on the principle, because that has been decided”.—[Official Report, 14 December 2015; Vol. 603, c. 1379.]

Yet, as I will go on to outline, many fundamental aspects of the policy and the detail underpinning it have not yet even been considered by the Government. I am surprised that Ministers are confident embarking on such a radical course of action without having thought through the consequences properly. I have asked the Minister what analysis the Government have conducted of students receiving NHS bursaries for tuition and maintenance costs, but have received no answer. I do not believe that the analysis has yet been conducted. I am sure that it is under way, because he has confirmed that the Government will publish an impact assessment alongside the consultation, which he expects to start next month, but was that impact assessment conducted before the Government embarked on this approach, or is the Chancellor just shooting in the dark to balance his books?

[Louise Haigh (Sheffield, Heeley) (Lab)]

Is my hon. Friend aware of research by the trade union Unison showing that nine out of 10 student nurses surveyed said that they would not have gone into training if the new proposals had been in place? Given that this month London issued a critical alert after its vacancy rate jumped 26% to 10,000, should the impact assessment not cover the impact on the recruitment and retention of nurses in our system?

[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.

[Alex Cunningham]

It is clear that the professionals are very worried about this issue. South Tees Hospitals NHS Foundation Trust has told a midwife in my constituency and her nurse colleagues that it wants to extend their breaks from 30 minutes to 60 minutes, which means they will have to work an extra shift every four weeks. Many of them cannot take their 30-minute break now, and they are really worried that they will have to work even more hours because the trust will not be able to get the staff it needs if the bursary scheme does not continue. Does my hon. Friend agree that for that reason, the South Tees trust should rethink its plan, and that the Government should do likewise regarding bursaries?

[Wes Streeting]

I certainly agree with my hon. Friend. The Government and the NHS underestimate the extent to which staff at all levels are both working beyond their allocated shifts to plug gaps in the service and going without breaks. Given the settings that those staff work in, it is not in the interests of patients, let alone good for the welfare of the staff themselves, for them to be tired and not taking the breaks they ought to take.

[Mr Jim Cunningham]

One critical area at the moment is care in the community. Does my hon. Friend agree that the change to bursaries will have a big impact when we try to recruit community nurses for all sorts of illnesses?

[Wes Streeting]

I am grateful to my hon. Friend for raising that point, which I did not raise in the earlier Adjournment debate. Since that debate took place I have seen an article by Crystal Oldman in Independent Nurse magazine, which expressed concern about our ability to recruit nurses into community-based settings. If we are trying to prevent patients from presenting at accident and emergency, which is important to alleviate waiting times and the burden on A&E departments, it is vital that people can access timely care and support in the community. I do not believe the Government have fully considered that, but I look forward to hearing the Minister’s response.

In my Adjournment debate I also asked the Government whether they thought it was fair that students from the most deprived backgrounds should have their grants taken away while some of the wealthiest people in our society received tax cuts. I am not surprised that I did not receive an answer to that question, but it is a fair one. A lot of people wonder how, in straitened times, it is possible for the Government to find money for tax cuts for the wealthiest, but we cannot find money to ensure that people who perform vital functions in the NHS receive the support they need to get them through their training.

I asked the Minister in that debate how much debt the Government expect to write off because those indebted by the reforms are unable to pay their debts in full. That question was not answered. However, we know that in the case of the tuition fees brought in by the coalition Government, the current Government expect that the majority of students will see their debts written off, at cost to the taxpayer, further down the line.

I wonder about the Chancellor. Following him on economic policy at the moment is a bit like following a drunk driver: one minute he tells us that things are fantastic, and then the next minute he tells us that something called “the global economy” might have an impact on our domestic economy. I am glad that he has finally got that point, but I do not believe that he is currently being straight with the House and the public about how he intends to “fix the roof”, whether the sun is shining or not. It will be no good if some poor Chancellor 30 years down the line has to find huge amounts of money for debt write-off. This Chancellor needs to be clearer about where the money is really coming from.

On that point, I asked in the Adjournment debate which Department—the Department of Health or the Department for Business, Innovation and Skills—would meet the cost of servicing the resource accounting and budgeting charge for student loan debt. That question was not answered, although I am sure the Treasury and both those Departments have a view. It seems that the Government have not reached a clear position, and they really ought to have done so before embarking on this course of action.

I also asked the Minister about the Barnett consequentials for health education budgets in Northern Ireland, Scotland and Wales. He told the House that it was a matter for Her Majesty’s Treasury, but I am afraid that we did not get any real detail about what the impact on those nations would be.

Will the Minister also say how clinical placements will be funded under the current loans system? He tells us that he has started discussions with Universities UK about that, but we would have expected the Government to have those discussions before embarking on a policy of this nature.

I also asked the Government whether they were at all concerned that applications from mature students might fall, given the detrimental impact that the coalition Government’s student finance reforms had on mature and part-time student numbers. The Minister did not give a reply, but we have heard in interventions this afternoon that that is a legitimate concern. We keep being told that all has been well since the coalition introduced the new tuition fees regime, and that student numbers in higher education are excellent. It is true that overall student numbers have gone up, but I do not think that there has been the necessary level of analysis about whether people are being deterred from applying. It is all very well saying that the numbers have gone up, but that does not tell me whether the regime deterred people from applying. However, we know for certain that it has had a particularly detrimental impact on the numbers of mature and part-time students. The issue of mature students ought to weigh heavily on the Government’s mind before they decide to proceed down this course on nursing bursaries, because it is clear that there will be big problems for the nursing profession if mature student numbers fall.

[Nic Dakin]

On that point, it is important for areas such as north Lincolnshire, which struggle to attract new graduates, to be able to grow our own graduates, and mature students are a major part of that. A fall in their number will particularly affect areas such as ours, which new graduates do not see as particularly attractive.

[Wes Streeting]

I absolutely agree with my hon. Friend, and I have another concern. In my Adjournment debate I asked the Minister to confirm whether mature students would be eligible to apply for a second loan, and he confirmed that they would be able to do so. However, that does not reassure me that the change to bursaries will not have a detrimental impact. If a mature student has already taken out a significant loan for a first undergraduate degree and still has some of that loan debt outstanding, given that they are closer to retirement than the stereotypical 18-year-old entrant, will they really want to take on additional debt? There are major question marks about that, and again, the Government ought to have done the research and analysis on it before embarking on this policy direction.

I am conscious of the time and the number of Members who wish to speak, so I turn finally to the question of process. This Thursday, a Delegated Legislation Committee will be convened to debate the abolition of student grants for all students, including the cohort we are talking about today. It is absolutely appalling that the Government are seeking to use the device of delegated legislation to put through such a major change to student finance. Whatever disagreements I had with previous Labour Governments about their higher education policy, at least they were courageous enough to bring their policies to the House of Commons, put them through the House of Lords, justify them and put them in the full light of scrutiny by right hon. and hon. Members.

This use of a Delegated Legislation Committee is part of a wider pattern of behaviour by this Government, who seek to ignore scrutiny. They seem to believe that a majority of 12 on a minority of the vote gives them carte blanche to do whatever they like. The level of public outcry, not to mention the concern expressed by Members from all parties in the House, means that the Government ought to behave far more transparently.

I asked the Minister in my adjournment debate to give the House an assurance that students studying nursing, midwifery and allied health subjects would not see their tuition fees and debts hiked up even further than has been suggested, but I was not answered. We know from newspaper speculation that the Government are considering increasing tuition fees above inflation, and we also know that the Cabinet Office is trying to find ways of avoiding a vote in both Houses, which is shameful.

Similarly, I asked the Minister to give the House an assurance that we would have a full debate and a vote if the Government chose to extend tuition fees to nursing, midwifery and allied health subject courses. The Minister told the House that he could not give us a definite answer to that question yet. I hope that he can do so this afternoon, and that he will confirm that we will have a full debate in the House of Commons and in the House of Lords, and that right hon. and hon. Members and noble peers will have the chance to make their voices heard and to put the issue to a vote.

Finally, I asked the Minister to commit to meeting student representatives to discuss their concerns, and he said that he was happy to do so. I spoke this weekend to one of the organisers of the protest, Danielle Tiplady, who has done a remarkable job in campaigning on this issue and in raising awareness among her colleagues. I hope the Minister will commit today to meeting her and other student representatives, so that he can hear at first hand the powerful testimony that we heard at the demonstration at the weekend.

We should all be concerned about the direction of this policy, and I am glad to see so many right hon. and hon. Members here this afternoon. Given that there are other debates taking place, including on Syria, which is a really big matter that concerns all of us, it is great that we have had such a big turnout this afternoon. I hope that helps to encourage the Government to think again.

[Several hon. Members rose—]

--- Later in debate ---

[Ben Gummer]

I was merely making the point that there is a lot of exciting thinking out there, outside the workforce planning that we are doing. Through our reforms, I hope to be able to encourage more of that. I know that there is some very innovative thinking in my part of the country. People want to get on with it in the NHS and university sectors, but at the moment they cannot, because of the constraints on how nurses are trained and recruited.

I turn to the issues raised by my hon. Friend the Member for Sutton and Cheam, who introduced the debate on the petition. He asked four specific questions. One was on specialist courses, and the shadow Minister repeated that point. Some specialist courses have suffered shortages for many years. For several years, the Higher Education Funding Council for England has been dealing with the wider attribution of training funds and university tuition funds across the sector, and it will take on responsibility for making sure that very small and specialist courses are properly funded and promoted. In liberating the universities sector a little, I hope that we will be able to excite interest in some of the more specialist courses, which have been suffering for several years, and better match foundation trusts’ workforce requirements with universities’ ability to deliver.

My hon. Friend asked whether foundation trusts will be able to pay back loans as an inducement. I do not know whether that will be possible for foundation trusts specifically, but they are free to offer pay premiums to aid their recruitment—they have been able to do so for many years. I imagine that will continue.

My hon. Friend asked about the number of placements and the financing of them. That will be determined by the consultation and in discussions with Universities UK. He also asked about the arrangement for placement expenses, and I have heard his point. I know it is a unique problem that is specific to student nurses—although to some extent, it also applies to student teachers—and again, we want to look at that in detail in the consultation to ensure that we get the implementation right. That is why it is not just a matter of pure detail; it is about how the policy works as implemented.

The hon. Member for Ilford North raised a number of points in addition to the ones he raised in his Adjournment debate. I apologise for not having answered all of them previously; I had a short time and he raised a huge number, with his usual eloquence. However, I hope I can answer some of his specific points on this occasion.

The hon. Gentleman asked about the problems of recruiting into community-based settings. There is a shortage in that specialty, which has traditionally suffered from problems in recruiting. I am well aware, just as he is, of the need to improve recruitment into community settings and primary care settings if we are to get the proper integration of primary and secondary care, and more importantly, of social care and the NHS. That is one of the key challenges facing us in the years ahead. Health Education England has a scheme under way called “Transforming nursing for community and primary care”, which it launched just over a year ago, precisely to incentivise nursing applicants into that specialty. Again, I hope that universities will respond positively, as they have in the case of other courses, so that they step up to the workforce demands placed on them as a result of the reforms that we are making.

The hon. Gentleman asked what the amount of debt to be written off was. The long-term loan subsidy—he will understand the phraseology—remains at 30%. That is the figure that the Treasury has set. As a consequence of that and because of, as he put it, reliable reports from newspapers, which he imputed to be fact, he asked whether there would be an increase in student fees above inflation. I can say to him that there are no plans at all to increase student tuition fees above inflation.

The hon. Gentleman asked whether I would be willing to meet those who disagree with my point of view and that of the Government on this matter. I would, of course, and I have done already. I would be delighted to meet anyone whom he wishes to bring to me, including the demonstrators he mentioned.

The hon. Gentleman began his speech, however, by talking about a burden of debt. It is important for all of us here to remember that the loan is an attachment against earnings, which is time-limited and limited according to the ability to earn, so it is not like debt such as a mortgage. We made the same argument back in 2011 and 2012, and it is important that we use language correctly in this place. We saw an uptake in university courses after the 2012 reforms. Once prospective students understood how the financing worked, how they would pay back the tuition fees and that it was not a debt that would saddle them in the same way that a mortgage or hire purchase agreement might, as was suggested at the time, university applications increased significantly. We all have an interest in this place in making sure that the number of people going into nursing increases. It is important, therefore, that even if we disagree with the policy, we do not misrepresent it.

[Wes Streeting]

After leaving the National Union of Students in 2010 when my term in office expired, I worked with Martin Lewis from MoneySavingExpert.com and the coalition Government to try to communicate the facts behind the tuition fees system, so I endorse what the Minister says about getting the facts across. Martin Lewis and I are concerned that the Government are seeking to apply retrospective changes to the terms and conditions of student loans without a parliamentary debate and vote. We would have a much better airing of all the issues, and this issue specifically, if we had that debate and vote in the House of Commons. Will the Minister commit to that process now?

[Ben Gummer]

The hon. Gentleman knows that I cannot commit other Ministers to debates, but I will certainly represent his concerns to the Minister for Universities and Science, my hon. Friend the hon. Member for Orpington (Joseph Johnson). He makes a strong point. It seems that I am the only person in this Chamber not to have a close acquaintance with Martin Lewis, but I will ensure that the hon. Gentleman’s points, including the one about the Delegated Legislation Committee—I sat on such Committees for a few years and never received anything nearly as exciting as student grants—are represented to the Universities Minister, so that he can answer him directly.

I wish also to address the points raised by the hon. Member for Heywood and Middleton (Liz McInnes), who talked about equality impact assessments. We have worked up an assessment of the impact that the changes will have on recruitment into nursing—of course we have—as part of our policy generation. That will culminate in a full equality impact assessment and a business case, which will be published at the time of the consultation, not long from now. I hope that that will inform the discussions that take place, so that we can have a robust and evidence-based debate.

The hon. Lady talked about housing costs, which was reflected in an intervention by the right hon. Member for Oxford East (Mr Smith). Housing costs are a considerable pressure for many students—not only those applying for nursing courses, but those in high-cost parts of the country. That is partly why we want to increase the amount of maintenance we can provide. To return to my central point, within the current spending envelope we can do that by such a considerable amount—25%—only through a reformed system. To do it in other ways would be prohibitively expensive, and I do not believe the Opposition have proposed that.

The hon. Lady asked about NMC registration fees. At the moment, they are incurred at the point of registration when the university course has finished and are tax-deductible. They have risen in the last year, which I know has caused disquiet among nurses. I have spoken to the regulators, including the NMC, and implored them to keep their fees at a sensible level and to avoid rises whenever possible. The NMC has had to deal with a considerable increase in fitness-to-practise cases, but I hope that with internal cost savings it will be able to mitigate further rises. I have certainly asked it to do that, although it is an independent body.

The hon. Lady cited someone she had spoken to who was, if I understood her correctly, halfway through a degree. It is important to state that the change is for new students only, so those on existing courses will not be affected.

Student Nursing (Finance)

Wes Streeting Excerpts

Monday 14th December 2015 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

I am grateful for this opportunity to lead my first Adjournment debate on the serious issue of finance for student nurses and midwives.

I have a long-standing interest in the issues. I spent much of my career outside this place working for a number of charities to widen access to higher education and to tackle broader educational disadvantage. As deputy leader and cabinet member for health and wellbeing in the London borough of Redbridge, I became acutely aware of the challenges facing frontline staff and managers in both of the NHS trusts that serve my constituents in Ilford North. I am also a proud supporter of Unison and draw Members’ attention to my declaration of interests. I am grateful to Unison, the National Union of Students, of which I am a former president, and many other organisations for their assistance in drawing together the evidence for this evening’s debate.

With just a few lines in the autumn statement, the Chancellor announced the biggest shake-up in the funding of nursing, midwifery and allied health subjects since the Health Services and Public Health Act 1968. By scrapping student bursaries and charging them tuition fees, the Chancellor is passing on the full cost of training to these essential frontline staff for the first time. The scale and potential consequences of his decisions merit further parliamentary scrutiny and public debate, and I hope that tonight will provide the first of many opportunities for that debate to take place.

Nursing and midwifery students currently pay no tuition fees for their studies and receive a non-means-tested grant of up to £1,000 and a means-tested bursary of up to £3,191 to help with the costs of living while they study and train. That is significant because students on both courses are required to work throughout their degrees in clinical practice, where they are subject to the full 24-hour care cycle. They work evenings, nights and weekends. Many will spend 60% of their degree doing that, with nurses required to work at least 2,300 hours across their degree. Even with the current levels of financial support in place, many struggle to make ends meet. Their courses are longer, their holidays are shorter and their placements are demanding. Those who do paid work outside their course can end up working more than 60 hours a week as a result, and they should not be expected to do so.

There has been a public outcry at the planned loss of the NHS bursary, but the Government’s plans go even further. Nursing and midwifery students will not only lose their grant and bursaries for maintenance; they will be expected to take out loans to pay for their tuition fees for the first time. These changes will burden students with eye-watering debts of at least £51,600, which they will begin to pay back as soon as they graduate, because nurses currently earn a starting salary just above the repayment threshold, which, shamefully, is now to be frozen at £21,000. As a result, nurses will on average take a pay cut of £900 a year to meet their debt repayments. That is no way for Ministers to treat the people who form the backbone of the NHS.

Given that the Government see fit to charge students for the cost of their tuition, will the Minister confirm whether he intends to pay student midwives and nurses for the hours they have to put into staffing our hospitals? If a private sector company tried to get workers to work long shifts and to pay for the privilege of working those long shifts while training, they would rightly be condemned. We should be no less outraged by what Ministers propose for nurses and midwives.

The impact of the changes will be felt beyond nurses and midwives; physiotherapists, occupational therapists, dieticians, chiropodists, podiatrists, radiographers, paramedics, prosthetists and other allied health professionals stand to lose out. We are not talking about the highest-paid people in this land; this assault on the living standards of key public sector workers is rightly causing outrage among NHS staff and members of the public who cherish the work they do on our behalf.

Given the scale and significance of the reforms, it is outrageous that the Government chose to sneak them out in the autumn statement. The Chancellor’s statement made an oblique reference to replacing

“direct funding with loans for new students”.—[Official Report, 25 November 2015; Vol. 602, c. 1363.]

The policy decision on page 126 of the Blue Book merely says:

“Students studying nursing, midwifery and allied health subjects from September 2017 will be moved on to the standard student support system, with the details subject to consultation.”

As the Government have placed so little information in the public domain so far and higher education institutions and potential applicants are already turning their minds to the 2017 admissions round, I hope that the Minister can shed some light on the details this evening. Will he confirm that the Government will consult on the principle of the policy changes, not merely on their implementation? What is the full timetable for the decision from consultation through to implementation?

What analysis have the Government conducted of students in receipt of NHS bursaries for tuition and maintenance costs? Will they publish an equality impact assessment for the proposals? What research have the Government conducted into the financial hardship facing existing nursery and midwifery students and students of allied health subjects?

Why do the Government think it is fair that students from the most deprived backgrounds should have their grants taken away while some of the wealthiest people in our society receive tax cuts? How much of this debt do the Government expect to write off because those indebted by these reforms are unable to repay them in full?

Which Department will meet the cost of servicing the RAB—resource accounting and budgeting—charge for the student loan debt: the Department of Health or the Department for Business, Innovation and Skills? What are the Barnett consequentials for health education budgets in Northern Ireland, Scotland and Wales, where different arrangements are in place?

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this issue before the House. I understand that 56,000 students on the mainland, including Scotland and Wales, may be in debt as a result of this change. In Northern Ireland, the Health Minister has committed himself to continuing the bursary. We are doing that in Northern Ireland; perhaps the rest of the United Kingdom should do the same.

--- Later in debate ---

[Wes Streeting]

I wholeheartedly agree with the hon. Gentleman. He rightly points out that this change will open up a postcode lottery across the United Kingdom, as its different parts choose to treat nurses and trainee nurses and midwives in different ways.

In the junior doctors dispute—the Government have belatedly seen sense and decided to reflect on their position—we faced the prospect of junior doctors in my constituency flocking to other parts of the United Kingdom because the situation there was more generous. With great respect to all the people represented in Scotland, Wales and Northern Ireland, I want to keep in my constituency the talented trainee doctors, nurses, midwives and other health professionals living in my constituency so that they can serve my constituents when they work at King George and Whipps Cross hospitals. These are very serious issues.

[Alison Thewliss (Glasgow Central) (SNP)]

The hon. Gentleman is making an excellent speech and excellent points on the significance of nursing to the whole country. He might like to know that the students I have met in Scotland send a message of solidarity to their colleagues in England. They do not want to see bursaries cut, because nurses are under enough pressure as it is. I congratulate him on securing this debate.

[Wes Streeting]

I am very grateful for that intervention and I wholeheartedly concur with the hon. Lady.

Government Members may wear the NHS badge on their lapel, but they are quick to attack the conditions of NHS staff when it comes to taking difficult decisions. [Interruption.] They ask how I would fund it. When we were in government, even when we made changes to higher education student finance, we did not do this. We will take no lessons from the Conservative party on spending plans. It attacked Labour’s spending plans at the 2010 general election because we wanted to halve the deficit and it was promising to eliminate it. Then what did it do? It halved the deficit. When it comes to their record on spending plans, the Government are in no position to hector other parties.

[Angela Rayner (Ashton-under-Lyne) (Lab)]

Does my hon. Friend agree that what is so devastating about these plans is that people from my constituency and from my background—I am a former Unison activist who looked after NHS staff—will not be able to go into the nursing profession? We are crying out for nurses and for people to fill the positions. The NHS has been burdened by the use of agency staff because the staff are not available. This policy will put people from my constituency off going into those positions.

[Wes Streeting]

My hon. Friend speaks with great experience. The Government should heed the points she makes.

I will turn to the other questions I have for the Minister. How will clinical placements be funded under the student loans system? The Government talk about the number of places they can expand, but it is not like expanding a history undergraduate course because occupational placements need to be arranged. The Government should explain how they intend to fund them.

Given the number of mature applicants for nursing, midwifery and allied health subjects, what assessment have the Government made of the likely impact of the reforms on applications from mature students? Are the Government at all concerned that applications from mature students may fall, given the detrimental impact that the coalition Government’s student finance reforms had on mature and part-time student numbers? Given that many people choose healthcare as a second degree and may not be willing to take on more than £100,000 of debt, how will the Government ensure that this route is not closed to such students? Have the Government conducted any evaluation at all that might give us a clue as to the extent of the risk that these reforms pose to recruitment?

The Government suggested in the spending review that half of all applicants to nursing courses are turned away. Do they have any evidence of what stage they are turned away at? If it is really the case that people are flocking to these professions, will the Minister explain why my local NHS trust has been so reliant on temporary and agency staff, including nurses who have been flown over from Portugal, to address the recruitment and retention challenges facing the NHS?

Additional allowances are currently available for students with different circumstances. Will the Minister inform the House whether any changes will be made to additional allowances, such as the extra weeks allowance or the dependants allowance? If so, what are those planned changes and what assessment have the Government made of their potential impact?

Given the press speculation over the weekend that the Government plan to increase the overall cap on university tuition fees, what assurance can the Minister give the House that students studying nursing, midwifery and allied health subjects will not see their tuition fees and debts hiked up even further than is being suggested? Given that the Government seem content to shift the goalposts for existing students and graduates, does the Minister really expect current or future students to believe that the terms and conditions they sign up to will not be changed and applied retrospectively further down the line? At the very least, I hope the Minister will confirm this evening that the NHS will continue to fund the tuition fees for existing students for the remainder of their studies.

When the coalition Government chose to increase tuition fees in 2010, the move was subject to a debate and a vote in this House. Given the media speculation that Cabinet Office Ministers are busy trying to find ways to avoid proper debate and scrutiny of a possible increase in the overall cap on tuition fees, will the Minister give the House an assurance that we will have a full debate and a vote should the Government choose to extend tuition fees to nursing, midwifery and allied health subject courses? Many students have already written to Ministers in the Department of Health and are awaiting a reply. Will the Minister commit to meeting student representatives to discuss their concerns?

It is not hard to understand why the Government’s shift in policy is generating so much concern and anxiety. In recent days I have heard representations from, among others, Unison, the Royal College of Nursing, the National Union of Students, the University of Hertfordshire, the Royal College of Speech and Language Therapists, and the Chartered Society of Physiotherapy. I have been contacted by student nurses and midwives in my constituency, and received messages of support for this debate from those in the constituencies of other right hon. and hon. Members.

Before I conclude, I would like to share with the House some of the stories that I have heard, and I will finish by making a few points about nursing and midwifery students. These are exceptional people and their dedication to others is truly remarkable. They work long hours, often in difficult situations, and they take a direct role in caring for patients when they are at their most vulnerable. Nursing students have told me how immensely challenging their work can be. They hold the hands of patients in their final moments, and comfort them as they pass. They are the face of reassurance to patients, and a bedrock of support for families.

[Jess Phillips (Birmingham, Yardley) (Lab)]

My hon. Friend is making a powerful speech, and I wanted to share my thoughts as someone whose son’s life, and whose own life, was saved by a student midwife. Does he agree that making those people not just work for free but even pay to save the lives of people like me and my son, is simply despicable?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend, and I am grateful to her for sharing her difficult personal experiences.

Nurses care for us in some of our darkest and most painful moments, and the weight of their responsibility carries with it a heavy physical and emotional load. The same is true for our nation’s midwives. One spoke of the difficulties that she faced when a baby was stillborn and she had to comfort the mother, while also taking hand and foot prints so that the parents would have memories of the baby they lost. She will never forget the shift when she spent 12 and a half hours with a mother who miscarried twins. She had five hours of rest, and then came back to do another 12 and a half hours with the same woman. She has supported the delivery of 10 babies, and she feels immense pride in being part of the wondrous moment of childbirth.

As the saying goes “Save one life and you’re a hero; save 100 lives and you’re a nurse.” These people are seeking to qualify into these difficult professions and form the NHS of tomorrow. They deserve our respect, admiration and support, as well as the right incentives to continue or even commence study in the first place. Ministers should listen to the students who are protesting, and to the nearly 150,000 people who have signed the petition to keep the NHS bursary. The Government owe it to patients and students to think their proposals through properly, and I ask them to pause this process. It would be a tragedy if the next Florence Nightingale or Edith Cavell were discouraged from the profession because of these changes. I look forward to the Minister’s response, and I hope that in the coming days, weeks and months, he will listen carefully to the voices of those who form the backbone of our national health service.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

It is a privilege to respond to this debate, and the hon. Member for Ilford North (Wes Streeting) made a powerful speech. I know that he has experience and expertise in student finance. He was on the front line when we had discussions in this place some years ago, albeit outside the Chamber, and he brings passion and knowledge to this debate. He may feel that I am rehearsing points that he has heard previously, but before I address some of the specific and detailed questions that he rightly raised, I hope he will not mind if I run through some of the issues and reasons why the Government feel that this measure is the right thing to do at this time.

The hon. Gentleman will be aware that nursing remains one of the few subjects not within the purview of the current student finance system. To our mind, the current system is not delivering as it should for either students or patients. Simply put, nursing is one of the most oversubscribed subjects in the whole academic range, and the fifth most popular subject that UCAS offers. Last year, there were 57,000 applicants for the 20,000 nursing places available.

I do not wish to go down the route of discussing NHS finance, because it will lead us to a place that is not easy for the hon. Gentleman’s argument and not particularly realistic. There is no way that any Government of any stripe would be able to offer a place to every single person with the necessary qualifications who wished under the current funding system to apply for a nursing place. The question for us is this: how do we change the system to give more people the opportunity to study nursing, and do so in a way that we are able better to supply the nurses and the nursing positions required in the NHS?

The hon. Gentleman asked a very important and pertinent question, which is why in his hospital, which I know from having gone there and from discussing this with him in other debates in this place, he should be seeing a shortage of filled nursing places. It is a function of parts of London that there are problems in recruiting—I was in Hull last week where they have a similar problem, albeit for different reasons—and yet there is an oversubscription for places. He could have added that we almost have a record number of nurses in training at the moment. So how does that add up?

Under the Government, we have seen a significant expansion in the number of nurses in the workplace. The response to the tragic events at Mid Staffs, the subsequent Francis report and the results of the Morecambe Bay inquiry led us to the conclusion that had eluded previous Governments: we needed safe staffing levels on wards that were not, in some parts of the country and in some hospitals, safely staffed. That required a significant increase in nursing numbers, which could be provided in the short term only by agency nurses. That is why we have not only increased the number of nurses in training—clearly, they take a while to come through—but have been required to take action on the cost of agencies taking advantage of the situation. That does not change the fact that it is simply not possible, within the current funding set-up, to satisfy either the demand for or the supply of nursing places.

There are other reasons. Even if we did not need to do something to get a better match between the number of nursing places and what the NHS requires and students want, I would want to push this reform. It is for that reason that I directly disagree with the hon. Gentleman’s assessment of student finance reform. I disagreed with him when we had this discussion in 2011, albeit not in this Chamber. If I may gently put it, I think those on the Conservative side of the House were proved right by those reforms. The simple fact is that we now have more applications from disadvantaged students to higher education than ever before in the history of higher education. We have seen a significant expansion in the number of students full stop going into higher education. Eighteen-year-olds from the most disadvantaged areas were 72% more likely to apply to higher education in 2015 than they were in 2006. It has happened in precisely the opposite way to what he and his friends on the Labour Benches, when they were making the argument in 2011, expected to happen.

[Wes Streeting]

The Minister should look more carefully at what happened to mature student applications following the reforms—they plummeted—and think about the profile of the people applying to be nurses and midwives. Does he accept that the majority of loan debt will never be paid back, including by graduates who will earn far more than nurses?

[Ben Gummer]

I will turn to mature students, but I hope the hon. Gentleman will concede my central point. The significant majority of students going into nursing are doing so at an undergraduate point at 18 or 19 years of age. For that cohort across the rest of the higher education sector, we have seen the most spectacular expansion in opportunity than at any time since higher education was opened up more broadly to people after the second world war. That is something that Members on both sides of the House should celebrate. I know that those on the sensible wing of the Labour party also embrace the reforms and see why they were a good thing.

I disagree with many in the Opposition, but to be direct with the hon. Gentleman, I want to bring those advantages to student nursing. I want to expand the number of places available to people from all backgrounds to give them the opportunity to enter nursing, and I want to secure the advantages that come from bringing people from non-traditional and disadvantaged backgrounds into nursing, in the same way as we achieved in the rest of the higher education sector. I believe passionately in that. Even if the NHS and the students themselves—the 37,000 who applied but did not get a place last year—did not require this change, I would still be making it, because it is the right thing to do for those who otherwise would not have an opportunity. Under the new student financing arrangements, they will have that opportunity.

--- Later in debate ---

[Ben Gummer]

I expect to be held account for this significant reform right the way through the changes that are envisaged. I hope to be able to return to provide good news about progress, as has happened in other student areas. That is why we want to be very deliberative about the way in which we form this consultation, because it is important to get it right.

I have taken note of the careful questioning of the hon. Member for Ilford North, who clearly understands the full gamut of the issues that need to be addressed in this consultation. Let me answer some of the questions he raised, and I shall write to him about any that I do not answer.

The hon. Gentleman asked about the funding of clinical placements. We have already started discussions with Universities UK about that, and it will form part of the wider consultations. The Barnett consequentials will be a matter for Her Majesty’s Treasury, as is the case for everything else connected to Barnett consequentials. I know that BIS officials are discussing the issue in the normal way.

The hon. Gentleman asked about research into financial hardship, and I know that that will form part of the consultation. The Government will be open to any further research beyond the economic impact assessment.

I was asked whether I would be happy to meet students. Of course I would. I have already met Unison and the Royal College of Nursing to discuss the changes I wish to make. I should not pretend to answer for them, but I have had productive discussions with both, especially about the apprenticeship route. I know that we will disagree with both Unison and the RCN about bursaries, but I think there is an understanding, particularly on the part of Unison, of how we are trying to open up different routes to nursing for different parts of the workforce. If we get it right, the apprenticeship model will be a strong one.

The hon. Member for Ashton-under-Lyne (Angela Rayner) made an important point in her intervention about agency nurses, so let me answer that as I am passing. As I alluded to earlier, part of the reason we are looking at that issue is to ensure that we provide a more sustainable workforce throughput, so that we do not need to rely on agencies and bank staff for the peaks in NHS demand. That is why we need to do something about numbers, and I hope that, as a result of the Chancellor’s announcement, we will increase the number by 10,000 over the course of this Parliament—a very significant increase in the establishment of student nurses. In fact, it will be the largest increase in student nurses under any Government since 1948.

I hope I have answered the majority of the questions put by the hon. Member for Ilford North—

[Wes Streeting]

rose—

[Ben Gummer]

Clearly I have not. I will allow him an opportunity to intervene once more, but I do not want to detain the House much longer.

[Wes Streeting]

I particularly welcome what the Minister said about treading carefully and thoughtfully around the consultation. The one issue he has not addressed, however, is whether extending the tuition fees regime to nursing, midwifery and other allied health subject students will be subject to a full and thoughtful debate followed by a vote in this House and the other place.

[Ben Gummer]

I cannot give the hon. Gentleman a definitive answer to that question yet. Let us wait and see the outcome of the consultation, so that the House can be best informed. I imagine that there will be ample opportunities in Backbench Business Committee debates and indeed Opposition day debates, and I know that the hon. Gentleman and his colleagues will want to bring these issues up for further debate. I will reflect the hon. Gentleman’s concerns to the Secretary of State and to the Leader of the House, and I am sure they will receive them with interest.

I genuinely thank the hon. Gentleman for bringing forward this debate, which has provided an opportunity for the Government to explain our plans and the rationale behind them. There will be points on which we will disagree, but I hope the hon. Gentleman will see the force of our arguments about wanting to expand the nursing workforce, to provide different routes into nursing and to provide the sort of opportunities to 18 and 19-year-old undergraduate nurses that have been extended to other parts of the higher education sphere. These are big proposals. They could mean a remarkable and rapid transformation of the NHS workforce, and a significant expansion in the number of nursing students. We need to get it right, and I hope that, through a constructive discussion across the House, drawing on the kind of expertise we have heard from Members in this short Adjournment debate, we will indeed get it right.

Question put and agreed to.

Junior Doctors Contract

Wes Streeting Excerpts

Friday 20th November 2015 Commons Chamber

[Alistair Burt]

As the House is well aware, the Commonwealth Fund said recently that the NHS was the best in the world. NHS staff, by implication, are the best in the world. They do an extraordinary job and junior hospital doctors do a fantastic job. Patient satisfaction is extremely high. We want that to continue. There is no reason to believe that NHS Employers, which is also calling for negotiations to continue and for the strike action not to take place, is not in full view of what staffing it needs to create an even safer health service. Its judgment is that the contract set out by the Secretary of State to be negotiated on provides the best basis for the employment of doctors in the health service.

[Wes Streeting (Ilford North) (Lab)]

The Minister’s statements, even this morning, imply that people have been misled by the BMA. How is it conceivable that 15 heads of royal colleges and 98% of junior doctors have been so badly misled that this unprecedented strike action has been proposed? Instead of patronising people, why will he not accept that trust has broken down, cut out the middle man and go straight to ACAS, so that there can be proper negotiations and a resolution to the dispute? People do not trust the Government.

[Alistair Burt]

I take the hon. Gentleman’s point. One example of why the Secretary of State believes that he is entitled to talk about misleading is that of the pay calculator that the BMA put on its website, which indicated that all doctors would suffer a 30% to 40% reduction in their salary, or something like that. The BMA was forced to take that calculator down when it realised that it did not reflect the truth. As we have seen, the Secretary of State has said that no doctor currently working legal hours will suffer a reduction in pay. There is an 11% pay increase on basic hours, and that is why he feels that there was an element of misleading. The hon. Gentleman is right about cutting out the middle man, which is why negotiations should restart. I am delighted that he supports that approach, and if that does not work, conciliation is there.

Gay Conversion Therapies

Wes Streeting Excerpts

Tuesday 3rd November 2015 Westminster Hall

[Wes Streeting (Ilford North) (Lab)]

I am grateful to the hon. Gentleman for securing the debate and for all the work he does to champion LGBT equality. I am sure that many of us received the Core Issues Trust’s interesting briefing, which suggested a link between homosexuality and same-sex attraction and mental ill health and other forms of physical illness. Has it not got that the wrong way around? It is discrimination and the suggestion that there could be a gay cure that makes all LGBT people, and young people in particular, feel that they are different and somehow alien. That is what causes them mental ill health, not their homosexuality.

[Mike Freer]

The hon. Gentleman has a track record in this area even though he is new to the House and I am sure that he will be extremely vocal on these issues. He is absolutely right. It is the suggestion that homosexuality is a disease or illness that can be cured that drives mental health problems, not the other way around. Frankly, I wasted no time on reading the Core Issues briefing.

I will finish with a couple of comments from esteemed colleagues. On 29 April, in an interview with Pink News, the Prime Minister said, on banning such therapies,

“if we need to go further…we will.”

As far as I am concerned, we do need to go further. The Secretary of State for Education and Minister for Women and Equalities said a couple of weeks ago to Pink News:

“Let me be clear: gay cure therapies have no place in our countries and we must stamp them out.”

I ask my very good friend the Minister if she will agree to explore how stipulated aversion therapies can be banned and whether the voluntary memorandum of understanding should and can be reviewed to put it on a statutory footing.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I thank my hon. Friend the Member for Finchley and Golders Green (Mike Freer) for initiating this debate on this important issue. Let me start by wholeheartedly agreeing with his opening premise. The Government do not believe that being lesbian, gay or bisexual is an illness to be treated or cured. We are concerned, therefore, about the issue of so-called gay-to-straight conversion therapy and we have consistently spoken out against the need for that practice.

I will outline some of the background to the work my hon. Friend touched on and try to respond to some of his concerns, but I suspect that this is the beginning of an ongoing conversation—I am happy to say that at the outset. The UK Council for Psychotherapy first raised its concerns about the perceived increase in this type of therapy with the Department of Health in late 2013. Department officials met with the council to discuss those concerns and agreed to work with it and others to identify ways to eradicate the practice. At that time, we also welcomed the fact that the key professional counselling and psychotherapeutic bodies had already made public statements on the issue.

As a result of the UK Council for Psychotherapy’s approach, the Department agreed to support the publication of a statement that made clear that the major therapy bodies in the UK were united in speaking out against conversion therapy, because they believe that that particular approach is based on the assumption that homosexuality is a mental disorder or that it begins from the preconceived view that the client should change their sexual orientation. As homosexuality is not an illness, as my hon. Friend said, the professional bodies argue that it is both logically and ethically flawed to offer any kind of treatment. The House may be interested to know that the American Psychiatric Association removed homosexuality from its diagnostic glossary of mental disorders in 1973 and the international classification of diseases produced by the World Health Organisation eventually followed suit in 1992.

A consensus statement was published in February 2014 as a result of the exercise we convened. It was initially signed by eight organisations and others added their support later on. The statement is clear: those bodies believe there is no good evidence that such therapy works and that, actually, it has great potential to cause harm. It goes on to say that such approaches are often based on religious interpretations of sexuality rather than on a researched and informed understanding of sexual orientation.

As my hon. Friend said, the Department agreed to host a roundtable event on 2 April 2014 to which we invited a range of interested organisations comprising signatories to the consensus statement as well as royal colleges, the Association of Christian Counsellors, regulators and other counselling bodies. The right hon. Member for North Norfolk (Norman Lamb), who was then the Minister responsible for equalities, was fully supportive of the work and attended and contributed.

I am pleased to say that the meeting was positive and that out of the discussions came agreement that more could and should be done by those present to prevent this kind of therapy from being offered. The participants agreed to develop the memorandum of understanding, which has been referred to. The UK Council for Psychotherapy agreed to lead on the work, in partnership with other bodies and the Department.

The memorandum was published in January and launched at a second roundtable event at the Department. Once again, my former colleague the right hon. Member for North Norfolk was present and publicly made clear his support for the memorandum and its commitments. Its purpose was to set out an agreed framework for activities for all the parties concerned to help address the issues raised by this practice. One such aim is to ensure that the public are well informed about the lack of evidence and the risks of so-called conversion therapy. There are a range of other important professional objectives.

Professionals from throughout the healthcare and psychological professions committed to work together to promote the public interest. Each of the signatory organisations committed to actions appropriate to their function and purpose. To give one example, those with practitioner members agreed to review their statements of ethical practice and consider whether there was a need to publish a specific ethical statement on conversion therapy. Secondly, those with a responsibility for training committed to work together to ensure that training prepares therapists sufficiently, so that they can work effectively with their lesbian, gay or bisexual clients.

The memorandum is owned by the organisations who signed it. They have continued to meet together and to work on those commitments throughout the year. The Department fully supports that work.

My hon. Friend drew attention to the NHS’s part in such therapies. Discussions with the sector uncovered the fact that there were no reliable, up-to-date figures on the use of conversion therapy. However, a 2009 survey of 1,300 mental health professionals found that more than 200 had tried to help at least one client to reduce the attraction they felt for someone of the same sex. A third of those clients were said to have been referred for therapy by a GP and 40% were reportedly treated in the NHS.

The Government are clear that moneys from the public purse should not be used to fund such therapy. Ministers in the previous Administration wrote to NHS England in March 2014 seeking confirmation that such treatment was not taking place on the NHS and I am pleased that we received a robust and supportive response from Simon Stevens. Not everyone in the House may be aware of his response, which was that

“so-called gay-to-straight conversion therapy is harmful nonsense and the NHS should never be funding it.”

[Wes Streeting]

Clearly, the memorandum has been effective since it was introduced, but it concerns me that the briefing from Stonewall suggests the Nursing & Midwifery Council, the Care Quality Commission, the General Medical Council and the Health and Care Professions Council are not yet signatories. Does the Minister agree that they should sign up? It has clearly been helpful for other organisations and is a powerful statement of intent.

[Jane Ellison]

The hon. Gentleman will see, when I propose some next steps, that I might be able to respond to his point.

Simon Stevens went on to say that he would direct NHS England to make that position—that the NHS should never fund such therapy—clear and explicit in all public statements on the issue in future. I cannot be clearer than that. If Members have examples of the NHS funding such therapy, I would be particularly interested to know about them.

Junior Doctors’ Contracts

Wes Streeting Excerpts

Wednesday 28th October 2015 Commons Chamber

[Heidi Alexander]

My hon. Friend makes an important point. The junior doctors I have met are genuinely worried that the proposals make it more likely, not less, that they will be forced to work even more punishing hours. The removal of financial penalties for hospitals that force junior doctors to work beyond their rostered hours concerns them. They are right to be concerned.

[Wes Streeting (Ilford North) (Lab)]

A junior doctor in my constituency made precisely that point. She was an A&E doctor. My hon. Friend knows that there is an A&E crisis in London. The Health Secretary needs to understand that while there is indecision and no conclusion to the negotiations, junior doctors are making decisions about where they are going—and they are not staying in England. That is the point.

[Heidi Alexander]

I am grateful to my hon. Friend. He makes a very valid point about the impact on recruitment and retention of doctors in the capital.