King George Hospital, Ilford

Wes Streeting Excerpts

Monday 10th July 2017 Commons Chamber

[Mike Gapes]

The ongoing social care crisis poses major difficulties. We all know that private care homes are struggling and that there is an issue of quality. It seems to me that one advantage of the King George Hospital site is that it is co-located next door to the facilities of the North East London NHS Foundation Trust’s Goodmayes Hospital and various other facilities that provide support for people with learning difficulties and people with acute, severe and less severe mental health problems. It would seem logical, if we are to have joined-up NHS treatment, to have alongside a hospital facilities for those who need short-term, temporary or longer-term care in transition to or from the NHS facilities next door. The site is big enough to do that and, with imagination, could be a model to be followed.

We also have a third cloud on the horizon, which is the north-east London draft sustainability and transformation plan. The Minister will recall that he and I had a very useful meeting in February, along with his then colleague, Mr David Mowat. We had a useful discussion about the implications of the huge deficit in north-east London—£586 million—the potential huge cuts in the budget over the next four years, and the implications they might have. I raised the issue in detail in a debate on 16 December 2016 and that was why I had the meeting with Ministers.

I am very concerned that the funding gap, even if we have predicted regular savings of about £220 million or £240 million in the NHS, would still be £336 million by 2021. One of the most worrying points about the plan—I understand it is still a draft and has not been signed off—is that I went to a meeting last week when the people involved in the organisation considering the plan were discussing it and senior figures in the London NHS referred to it, saying, “You have to work within the basis of the plan.” It has not been signed off or approved, but the people in the NHS health economy in London are thinking ahead as though it will be.

The plan points out that the population of the north-east London boroughs will increase by 18% over the next 15 years, equivalent to a new city. Normally that level of population increase would require a new hospital, but there is no provision, no funding and no expectation of a new hospital. Instead, the proposal is to downgrade King George Hospital in my constituency and take away its accident and emergency department. That is still in the plan, and it is not a new proposal. In fact, I have been campaigning to save the A&E in my constituency for more than 10 years. But the formal decision was taken by the former Health Secretary, Andrew Lansley, only in 2011. That decision, which was linked at the time to a suggestion of closing maternity services at King George Hospital, provided that those two things would happen in around two years. That was in October 2011.

The reality is that maternity services went to Queen’s Hospital in early 2013—I do not question that there have been improvements—but the A&E could not close as there was no capacity at other hospitals in the region. In addition, it was quite clear that it required huge capital investment, which was not forthcoming. The decision was made in 2011, but in 2013 there was no action and the issue was deferred. The trust then went into special measures three years ago because of a variety of issues, which I have already mentioned.

As the trust comes out of special measures, the question becomes whether it will go ahead with the plans to close the A&E. Practically, it is impossible for that closure to happen soon, but the sustainability and transformation plan still states that the intention is to close the A&E in 2019. The original suggestion was that it would stop the 24-hour service, getting rid of the overnight A&E from September this year. That plan was dropped in January, and I welcome that, but the reality is that it is still in the plan and is still proposed. That cloud still hangs over the trust and all its excellent staff, who have done so much to bring our hospital out of special measures.

[Wes Streeting (Ilford North) (Lab)]

I congratulate my hon. Friend on securing this important debate. In my capacity as a Labour councillor in the London Borough of Redbridge, I currently chair a cross-party working group on the future of A&E provision in north-east London. One frustrating thing is that all the local health leads in the area are working to a decision made by a previous Secretary of State. That ministerial decision still stands and the leads have to work towards it. They do not believe that is achievable or clinically sound. Yet, they point to the Secretary of State when pressed to abandon the plans. I hope that the Minister might be able to reverse that ministerial decision and remove the sword of Damocles from our A&E department.

[Mike Gapes]

I am grateful for that intervention as it saves me from making the same point. During the election campaign, the Secretary of State went to my hon. Friend’s constituency for a private Conservative party function. He was asked by the local paper, the Ilford Recorder, about the plans to close the A&E at King George Hospital. He said that there were no plans to close it in the “foreseeable future”. Now, I do not know how big the crystal ball is. I do not know what kind of telescope the Secretary of State has and which end he is looking through. The fact is that “foreseeable” does not necessarily mean that the A&E will not close in 2019. If it is not going to close in the near future or even in the medium term, why not lift the cloud of uncertainty over the staff and over the planning process? Then we could have a serious look at the draft sustainability and transformation plan for north-east London, which is partly predicated on the closure of A&E at King George Hospital.

In January, the trust wrote a letter saying:

“It is our intention to make the changes by 2019 but please be assured nothing will happen until we are fully satisfied all the necessary resources are in place, including the additional capacity at the neighbouring hospitals, and we have made sure it is safe for our patients. In the meantime, the existing A&E facilities at King George will continue to operate as now.”

The reality is that there is no additional resource in terms of the capital that would be required to provide the beds for 400 patients at King George overall. We face a very uncertain future. If the A&E closed, where would those patients go? There would be a need for capital investment at Queen’s and for big capital investment at Whipps Cross. That would take time and resources, at a time when NHS budgets are seriously pressed. And we still have that huge deficit in our regional health economy.

Why not take that issue off the agenda? Last month, my hon. Friend and I jointly wrote a letter with the leader of Redbridge Council, Councillor Jas Athwal, to the Secretary of State. We requested that he formally reverse the decision taken by his predecessor, to allow certainty and to allow more sensible planning.

Last week, one of our health campaigners, Andy Walker, who put in various questions and freedom of information requests—he is a very persistent campaigner—received a response from the Barking, Havering and Redbridge trust, commenting on this issue. It used the same formulation:

“We have been very clear that no changes will be made until we have the relevant assurances that it is safe to do so and this remains the case.”

That formulation has been used for several years; it is like a stuck record. It is not safe to make the changes. Why not have a new, imaginative approach that says, “Let’s look at social care. Let’s look at the potential for developing the site. Let’s look at collaboration between the mental health services of the North East London NHS Foundation Trust. Let’s look at providing particular forms of housing and support.” This area could be a model for a new way forward.

I know from discussions I have had that people in various NHS organisations are working on such possibilities, but they cannot go any further than possible explorations while this cloud—the threat to close the A&E—still lies on the table. If the Secretary of State would take it off the table, we could have some serious discussions about improvements to health facilities. We could deal with not just the A&E but other issues.

On the King George site at the moment, we also have an urgent care centre. It recently had a Care Quality Commission inspection and was rated as “requires improvement”. That is an indication, again, of the problems we face. I have a lot of inadequate GP facilities in my constituency; I have lots of problems with people coming to me complaining that they cannot get through. Primary care in north-east London faces a crisis of retention, recruitment and standards of services. If we could make imaginative use of the facilities at the King George Hospital site, we could make a big difference to primary care, as well as to the acute services and the mental health services next door.

My plea to the Minister and the Government is this: take the closure of the A&E off the table, and let us then work collaboratively to improve the NHS in north-east London and in my constituency.

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure to serve under your chairmanship, Mr Speaker, and to contribute to another debate introduced by the hon. Member for Ilford South (Mike Gapes). I congratulate him on his tenacity in keeping the subject of King George Hospital at the forefront of Health Ministers’ minds in recent years, not least during my tenure. As he rightly said, he and I had a meeting in February with my former colleague, David Mowat, to discuss many of the issues that he has raised this evening. I therefore hope that he will forgive me if he has heard some of my remarks before. I congratulate the hon. Member for Ilford North (Wes Streeting) on joining us. He obviously has experience of these matters as well, given his role in the local council.

I join the hon. Member for Ilford South in paying tribute to the achievement of all the staff and management involved at Barking, Havering and Redbridge University Hospitals NHS Trust in exiting special measures after what has undoubtedly been a long journey for them over the past three years. I was very pleased that they were able to exit special measures in March of this year. That is a huge tribute to everyone involved in ensuring that they were focused on the areas where the CQC had identified what was not best practice. They have focused on improving the deficiencies, and the fact that they were awarded an “improved” rating enabled us to take the decision we did. I also join him in congratulating the quality of management now substantively in place within the trust, at least one of whose members has himself been a beneficiary of treatment locally; I think it was for a different complaint from the one that the hon. Gentleman was treated for in the intermediate treatment centre. That was a very substantial experience, and all credit to that member of the executive team.

The hon. Gentleman touched on a couple of clouds, as he described them. The first was the intermediate treatment centre, which conducts elective and planned procedures provided by an independent provider, Care UK. As he will appreciate—in fact, this took place under the previous Labour Government, when the independent sector provided capacity to support the NHS in a number of areas—we have had a policy of allowing independent providers to be commissioned to undertake care, and it is a matter for the local commissioners in his area to do so; it is not for me to tell them who are the best providers to be able to undertake care. I am very pleased that he was a beneficiary of some of that care. It will be up to the commissioners, working with the NHS, to decide who is best to provide services in his area as they come up for renewal from time to time.

The hon. Gentleman referred to the social care challenge that exists in north-east London, as it does in many other parts of the country. That is why we decided in the Budget in March this year to inject an additional £1 billion into the adult social care budgets of local authorities across the country and a further £1 billion in the next financial year. Moreover, last week, we announced some measures to scrutinise the performance of local authorities in managing those budgets—in particular, so that they contribute to the patient flow challenge, which we experience in many of our hospitals, including the King George: patients occupying hospital beds in acute settings who have no medical reason to continue to be there, because of the challenge of providing placements in the community. It is important that there is closer integration with social care through the local authorities, but also, as he rightly identifies, through other NHS providers, particularly if they are co-located on the site. He mentioned what he describes as an opportunity for the North-East London NHS Foundation Trust to work alongside Barking, Havering and Redbridge University Hospitals NHS Trust to try to smooth the passage and find other opportunities in the community for more appropriate flow. That is very interesting and I hope he is engaging with the leadership of the sustainability and transformation plan and proposing imaginative ideas, in the hope that they will be assessed appropriately when consideration is given to the provision of the future pattern of healthcare in his area.

The hon. Gentleman focused mostly on the challenge to A&E at King George. I will spend most of the rest of my remarks addressing his concerns as best I can. He will appreciate that, across the country, the NHS is coming together, through the STPs published at the end of last year, to identify the right pattern of care across an individual NHS footprint. North-east London has come together with the STP for that area. Our view is that that is the right way to encourage a more holistic approach to the future provision of NHS services. It needs to be led by clinicians and those responsible for managing NHS organisations, and it needs to work in a collaborative and perhaps more open way than it has in the past with local authorities, which have a part to play, as I have said, in facilitating the passage beyond hospital and back into the community.

We are absolutely clear that any significant service change that arises out of the implementation of STPs, if they get to that stage, must be subject to full public consultation, and proposals must meet the Government’s four reconfiguration tests, which are support from clinical commissioners, clarity on the clinical evidence base, robust patient and public engagement, and support for patient choice. Additional NHS guidance means that proposed service reconfigurations should be tested for their impact on overall bed numbers in the area, which the hon. Gentleman has identified appears to be absent from the STP at present. I urge him to continue to challenge that in his area.

[Wes Streeting]

Will the Minister clarify whether he expects the STP process to now publicly consult on any future proposal to close the A&E at King George Hospital? Furthermore, were the STP to recommend to Ministers that the A&E should remain, will they heed that advice and agree that the STP process should not be constrained by the decision made in 2011by the then Secretary of State?

[Mr Dunne]

I am going to have to disappoint the hon. Gentleman, because I am not in a position to second guess the conclusions of the STP discussions and recommendations. It is appropriate for them to take into account clinical decisions made in the recent past, one of which is the decision about the A&E at King George. It is up to the STP management to decide whether to take that forward as the STP evolves. It is right that the STP management looks at health provision in the round. It will be responsible for delivering healthcare to local residents and it needs to take into account all the information sources available to it. I do not think it is right to say that it necessarily has to re-consult on certain issues. It needs to form a view on the right configuration and then use its available data sources and go through the processes.

I will try to explain to the hon. Gentleman the process that, as I understand it, is now under way in his area. Both hon. Gentlemen are right to say that, in 2011, on advice from the independent reconfiguration panel, which approved the proposal, the then Secretary of State took the decision that the north-east London scheme should be allowed to proceed. The Secretary of State made it clear at the time—it has since been repeated in response to questions about the health authorities in the area—that no changes were to take place until it was clinically safe to do so. I believe that remarks that the Secretary of State might have made when visiting the area recently must be considered in that context.

There have been a number of changes since the decision was made, and there are four elements to the process. First, the STP team is reviewing and revalidating the modelling used back in 2010 to ensure that the proposals that were made remain appropriate, as one would expect the team to do. Secondly, the governing members of the CCG board, the trust board and the STP board will need to agree the business case that arises from the STP recommendations. Thirdly, if that is achieved, NHS England and NHS Improvement will be required to approve the business case. Finally, it is envisaged that a clinically led gateway assurance team—an NHS construct —will manage a series of gateway reviews at different stages of the process from planning to implementation, as the project proceeds, to assure system readiness and patient safety at every step of the way, should the decisions necessary to get there be taken in the intervening period.

[Mr Dunne]

I will have to disappoint the hon. Gentleman, because it is not for me to prejudge how long the process would take. In all honesty, I think it is most unlikely that it would be completed in less than two years. It is conceivable that it would be concluded by the end of 2019, but a two-year process is likely to be required as a minimum.

In the meantime, CQC visits and reports will continue on a routine basis. Now that the trust is out of special measures, those visits will be somewhat less frequent than they were while the trust was in special measures. Any information coming out of that process will inform decisions taken by the trust and the STP area.

In my final comments, I want to reassure the hon. Gentlemen and their constituents that the proposals include a new urgent care centre at King George Hospital to provide emergency support to local residents for the majority of present A&E attendances. Blue-light trauma and emergency cases requiring full support from emergency medical teams would be taken to other hospitals in the area, but the majority of cases currently treated at King George would continue to be treated there. The new urgent care centre would benefit from several improvements, including more space and access for diagnosis, X-ray, blood tests and so on. I hope that that gives the hon. Gentlemen some reassurance that the facilities that remained at King George would continue to provide the majority of their constituents with the care that they would need in an emergency.

[Wes Streeting]

Is the Minister saying that the STP process should not be constrained by the 2011 decision if those in charge of the process think that that was the wrong decision?

[Mr Dunne]

The process should be informed by the decisions taken in 2010, but it will be up to today’s STP leadership to decide what to do.

Question put and agreed to.

Oral Answers to Questions

Wes Streeting Excerpts

Tuesday 4th July 2017 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

The fact is that when the Government chose to charge students record levels of tuition fees and scrap their NHS bursary, the Secretary of State and his Ministers were warned that that would lead to a fall in the number of applications, and what has happened since then? The number of applications for nursing degrees has fallen by 23%. Given that the Secretary of State has already acknowledged that we cannot continue our over-reliance on EU staff following Brexit, when will Ministers understand that the biggest challenge facing nursing recruitment is not our policy on the EU, but the Government’s own health policies?

[Mr Dunne]

The hon. Gentleman is right to draw attention to the fact that we continue to have a surplus of applicants for nursing degree courses in this country. The level of that surplus has fallen somewhat as a result of the change in funding structures. We shall have to see where it ends up, because at present universities are not recruiting directly outside the UCAS system, but we are confident that there will be more applicants than places this year by a ratio of some 2:1.

Agenda for Change: NHS Pay Restraint

Wes Streeting Excerpts

Monday 30th January 2017 Westminster Hall

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

I beg to move,

That this House has considered e-petition 168127 relating to pay restraint for Agenda for Change NHS staff.

It is a great pleasure to serve under your chairmanship, Mr Evans. At a time when the number of deeply concerning and time-consuming issues on the international political agenda is increasing, it is important that we and, most importantly, the Government do not lose focus on our domestic priorities and the challenges affecting our constituents’ day-to-day lives. The national health service is at the very top of that list, so I am pleased to introduce this debate. The way we treat our NHS staff is surely one of the most decisive factors in whether we have the functioning health service that we all need.

The petition is titled:

“Demand an end to the pay restraint imposed on agenda for change NHS staff.”

It has been signed by more than 104,000 people across the country, including 4,500 from my region, the north-east. It reads:

“Agenda for change staff including nursing, midwifery, healthcare assistants and associated healthcare professionals have suffered a pay restraint since 2010. Losing approximately 14% in real terms of their pay, staff are struggling nationwide and many have been pushed into poverty.

The impact of the pay restraint is harsh. Many are sadly leaving the professions they love. There is an NHS staff crisis. In London we lack 10,000 nurses. Yet two fifths of nurses living in the capital plan to leave as they are unable to pay their rent. Staff reporting using food banks and hardship funds is increasing. The pay restraint must end.”

The petition’s creator, Danielle Tiplady, a nurse and supporter of the Royal College of Nursing’s “Nursing Counts” campaign, said:

“Nursing staff deserve a pay award that reflects our knowledge, skill and dedication.”

She added that the interest in her petition

“is a huge achievement, but colleagues are struggling to pay bills and even turning away from the profession, and it’s time Parliament debated why.”

[Wes Streeting (Ilford North) (Lab)]

Danielle Tiplady is one of my constituents, and I am proud that she started the petition. The Royal College of Nursing’s most recent employment survey of its members found that 30% had struggled to pay gas and electricity bills, 14% had missed meals because of financial difficulties, and more than half had been compelled to work extra hours to increase their earnings. Given the demands of the type of work that nurses do, does my hon. Friend agree that our nursing profession is in a terrible place and that the Government surely must act?

Child Cancer

Wes Streeting Excerpts

Monday 28th November 2016 Westminster Hall

[Wes Streeting (Ilford North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Bath (Ben Howlett) for opening the debate so well, and I thank other hon. and right hon. Members who have spoken. We are here this afternoon because of Andrew Barnard, who lost his daughter Poppy-Mai to a brain tumour. We owe a particular debt of gratitude to him for the effort that he put into campaigning on behalf of so many other children whose lives will sadly be blighted, and even tragically ended, as a result of childhood cancer. The theme of families and the courage and bravery that they show in campaigning, not only for their own children but on behalf of so many others, is a theme I will return to.

I want to raise three issues during this afternoon’s debate: first, the extraordinary courage and resilience of families and the need to support them; secondly, the importance of awareness and early diagnosis and intervention; and thirdly and most importantly, the need for research so that we can reduce and even eradicate the number of children dying needlessly from cancers that will be found to be curable.

I am here this afternoon because of my six-year-old constituent, Kaleigh Lau, and her remarkable family, Scott, Yang and Carson. Like most girls her age, Kaleigh is active and fun. She enjoys dancing, singing, swimming and playing with her friends. In April, things changed for her. She complained of double vision, and her family noticed that there was a problem with her eyes. Fortunately, they took immediate action and took her to Moorfields eye hospital. After some initial checks, there was found to be no problem with her vision, so on the same day she was referred to the Royal London hospital for a CT scan and an MRI scan.

When a lump on Kaleigh’s brain was identified, she was immediately referred to Great Ormond Street hospital, where two days later she was diagnosed with a rare form of childhood brain tumour called a diffuse intrinsic pontine glioma. It is a brain stem tumour that mostly, although not exclusively, affects children. It is estimated that fewer than 40 children a year develop them in the UK and that they account for just 10% to 15% of all brain tumours. They are high-grade brain tumours that are fast-growing and can spread throughout the brain stem. As a result, they are difficult to treat and have a poor prognosis. The main treatment offered is radiotherapy. The tumours are not suitable for surgery because of their location in the brain stem, and chemotherapy has been shown to have little effect, but research in that area is ongoing.

[Seema Kennedy]

The hon. Gentleman’s constituent has exactly the same brain tumour as my constituent, Katy. Although only 40 children a year develop such tumours, they are primary school children with a whole lifetime ahead of them. Research in that area would pay dividends, because although 40 is a small number, those children could go on to be productive members of our society. The important point is that they have a lifetime ahead of them.

[Wes Streeting]

I wholeheartedly agree, and I will come on to talk about the personal impact that such a diagnosis can have on families.

As the hon. Lady knows, the prognosis is poor. Only 30% of children with DIPG are likely to survive for more than a year after diagnosis, and 90% do not survive for two years. According to the Minister’s response on 13 September to a written question that I submitted, there has been only one UK trial relating to DIPG. Although there are some great initiatives—particularly the INSTINCT project, which brings together experts from Newcastle University, the Institute of Cancer Research, and the University College London Great Ormond Street Institute for Child Health in London—we have yet to find a cure.

Dr Darren Hargrave at Great Ormond Street is leading a new clinical trial to test three new drugs in 150 children affected by DIPG. Professor Chris Jones and his team at the Institute of Cancer Research have found links between the genetic faults in the DNA of children with DIPG and people with stone man syndrome. Lots of work is being done on the links between DIPG and other diseases, but it has yet to lead to a cure. There is some hope that the work being undertaken by Professor Steven Gill, who is leading a team based at the Harley Street Clinic to develop a treatment known as convection-enhanced delivery, may produce a treatment that leads to an extension of life, as some of the initial experiments have shown. It is hoped that CED might lead to a cure, but the overall outlook for those children is not positive.

As the hon. Lady said, the number of children affected in the UK is relatively small, but the impact on them and their families is simply unimaginable. Without being from a family that has been directly affected by a childhood brain tumour or another form of childhood cancer, it is impossible to know what those families go through. I have been given some insight through the work I have done with my constituent’s family—particularly her father, Scott.

We need early diagnosis. The swift response of Kaleigh’s family and the hospitals that she visited enabled an early diagnosis. I pay tribute to the clinicians and staff of Moorfields eye hospital, the Royal London hospital and Great Ormond Street hospital, and, in particular, to Kaleigh’s family. When families are affected in that way, it has an impact on the whole of family life. So many anxieties, issues and day-to-day challenges are thrown up. Is the cough or cold that the child is experiencing simply a winter condition, or is it something more serious? Most parents would not be worried when their child comes home after a fall or a scrape at school—they dust them off and it is fine—but so many of these parents have to worry about what caused the fall. Was it an innocent childhood accident or something more worrying?

There are some fantastic charities that provide support to the families that are affected. In my constituency, Hopes & Dreams provides dreams to children with life-limiting or terminal illnesses. It enabled Kaleigh and her family and friends to go to Center Parcs, which gave the family welcome respite and gave Kaleigh the opportunity to enjoy herself with her family and friends in the way she normally does.

I have also had to see Kaleigh’s family battle for information—in particular, about accessing some of the experimental treatments that are available. They have had to battle on numerous fronts. They have battled against bureaucracy and tried to navigate their way through the system, and getting partners and agencies to work together to ensure their child is at the centre of health managers’ and clinicians’ thinking has been a particular challenge.

There is also the issue of money. Kaleigh’s family raised considerable amounts of money through both the generous support of family friends and members of the public, and their own finances. I am struck by the concern that her father raised about the families who are not in the same position, do not have access to a network of support and have not been able to find funding. It is simply not right that some families lose out because they do not have the money or are not able to raise the funds needed to access treatments that could lead to an extension of life or a cure. I hope the Minister will address the issue of what we can do to ensure that access to treatment—experimental treatment and clinical trials—is not limited by families’ wealth.

I also want to raise the issue of funding for research. I pay particular tribute to Kaleigh and her family. I am in awe of the fact that, amid all the day-to-day challenges that her condition presents and the battle to ensure that she gets access to treatment that could alleviate her symptoms and extend her life, Kaleigh’s family and Kaleigh herself have engaged so energetically in a campaign for more funding for research into DIPG and other forms of childhood brain tumours. In the past few months, they have engaged a range of celebrities. JK Rowling supported their petition, and for the past two weekends Kaleigh has been touring “The X Factor” studio, signing up a range of the finalists to tweet the petition. She has got members of the cast of “The Only Way is Essex” on board—they are an Essex family, and I am an Essex MP. The cast are supporting our local family, which is fantastic.

I have been overwhelmed by the number of right hon. and hon. Members who have wanted to support Kaleigh’s campaign by having a picture taken with the Kaleigh bear, which has been on tour around Parliament, and by tweeting links to the petition for more Government funding. We have also had great support from our local newspapers—the Ilford Recorder, the Wanstead and Woodford Recorder, the Wanstead and Woodford Guardian and the London Evening Standard. I thank them for their support in raising awareness of Kaleigh’s campaign in search of more funding for a cure.

It is very welcome that the Government have a working group, which we hope will report in 2017, to look at how to increase the impact and quantity of brain tumour research, but however much effort they are putting in, the sad truth is that in the 12 months or so before the report is published and the Government take action, so many children across our country will be diagnosed with DIPG and other brain tumours. The urgency of this task cannot be overstated. A significant amount of money already goes in through the National Institute for Health Research and the Medical Research Council, but much more clearly needs to be done. There are competing demands and pressures on Government budgets, but for so many families in our country today and in the coming days, weeks, months and years, that funding could save a child’s life. I hope that the Minister will make a commitment to see what more she can do within the constraints of the health budget to invest in a crucial area that matters so much to so many families throughout the country.

I urge all right hon. and hon. Members present in the Chamber and throughout the House, as well as members of the public who might be watching this debate, to support Kaleigh’s Trust, to tweet links to the petition and to share it with family and friends, and to continue applying pressure to get more people to understand the impacts of terrible conditions such as DIPG and the urgency to fund and find a cure.

In closing, I again pay tribute to the extraordinary courage and resilience of Kaleigh and her family, and to so many other such families, who in spite of troubling and traumatic times continue to battle on, not only for their children but for others. That should inspire us all to do more individually and collectively.

--- Later in debate ---

[Thangam Debbonaire]

I, too, will be mentioning similar services later in my speech. Absolutely, the last thing parents facing such awful situations need to be worrying about is where they will stay, how they will afford it and how they will afford even to put petrol in the tank.

My nephew was diagnosed at age 12 with osteosarcoma, a very rare childhood cancer. We were all so focused on getting him and his mum, and his sisters and brothers, though that illness that the longer-term impacts felt very much secondary. Specialist units such as the one in Bristol help the family as well as the young person with cancer to see the whole of life as important, to think about the longer-term implications and to prepare for them. I pay very personal tribute to the teenage and young adults cancer unit in Bristol for its work and to the Teenage Cancer Trust for its support of the unit.

As my hon. Friend said, getting the number of units right is difficult. Given the thankfully low numbers of childhood cancer victims, if the units are to be truly specialist, it will not be an easy matrix. To ensure an appropriate number of specialist units, the Government need to be clear with appropriate commissioning guidance and take responsibility for following it through.

In October when I asked the Department of Health in question 50795 what proportion of specialist units were funded by charitable trusts, the Under-Secretary of State for Health, the hon. Member for Warrington South (David Mowat), replied:

“This information is not held centrally.”

For me, that is simply not good enough. Yes, commissioning is done locally, and increasingly commissioning groups and trusts are collaborating, but Government leadership is necessary to work out how many units are needed and how to fund them. Will the Minister commit to gathering that information centrally in order to estimate properly the funding needed to commission appropriately throughout the country? Will she further commit to consulting on and publishing clear commissioning guidance so that the responsibility for commissioning and funding specialist treatment centres for children, young people and young adults is clearly identified, and so that a structure for commissioning across health regions is clear?

On the future of research into childhood cancers, there is clear potential for harm when the UK leaves the EU—I say “potential”, because any such harm can be mitigated, but the Government need to act urgently to address it. Earlier this month in answer to my question 50081 about research, the Minister for Universities, Science, Research and Innovation gave welcome assurances about funding. I welcome those assurances, but he did not mention research cohorts. Thankfully, childhood cancer is rare, so it is vital for UK researchers to be able to collaborate fully with their EU counterparts so that they can carry out clinically adequate research with a sufficiently large enough group of children and young people to provide clinically useful and secure results. Yes, funding is vital and I am grateful to him for those assurances, but it is not enough. My next question to the Minister present is this: will she commit to discussing that with her colleagues in the Department for Exiting the European Union, along with research about other rare childhood cancers?

As my hon. Friend the Member for Alyn and Deeside (Mark Tami) mentioned, children and young people with cancer and their parents often need to travel long distances for specialist treatment. That might always be unavoidable and, in any case, there are other huge financial costs for parents. In September, I was proud to chair the parliamentary launch of a report by CLIC Sargent, which does so much wonderful work to support children and families affected by childhood cancer. The report shows that the costs of cancer are not only emotional, educational and physical, but financial.

One young person at the launch spoke about how he had to prove repeatedly to the benefits agency that he had cancer and that his treatment was still not over nor his recovery complete. Another young person found that her student loan was stopped because she was deemed to be a student no longer, but her halls of residence still charged her rent. A lone parent spoke of her struggles to manage her finances while faced with losing her income from employment and the increased costs of driving her son a long distance many times each month for treatment, as well as the added costs of heating a home all day for a very sick child, which is often overlooked, and the costs of keeping clothes, bedding and house scrupulously clean, which is so important because the risk of infection is extremely high for those undergoing gruesome treatments such as chemotherapy, as other hon. Members have mentioned.

CLIC Sargent and other charities I know help with all those things and more. I have had the privilege of being shown round the CLIC Sargent house in Bristol, located a few minutes’ walk from the Bristol Royal infirmary. That house, run by a wonderful woman who knows all too well what childhood cancer means, provides a haven just when it is needed.

[Wes Streeting]

May I, too, pay tribute to Haven House children’s hospice, which is just outside my constituency and serves many of my constituents? Hospices are often associated with end-of-life care, but as in the case of Haven House, they also provide great support to families whose children may not be near the end of their lives and help them on that journey. They are such a powerful and important source of support, and of course they are all voluntary and rely on the public’s generosity.

[Thangam Debbonaire]

My hon. Friend is absolutely right. There are many charities across the country that do everything they can to try to help the families of children and young people with cancer. I pay tribute to them all, even though I cannot possibly know their names.

The CLIC Sargent social worker is on hand in the Bristol royal infirmary when a family receives a devastating diagnosis and is told that their child needs to start treatment right away. Such families are often many miles from home. They can arrive that night at CLIC Sargent house with nothing and be given somewhere to stay for as long as they need it, clothes and bedding if they have come without them and, when necessary, space for the whole family so brothers and sisters can be with their family and their sibling who is being treated. I am proud to declare an interest in CLIC Sargent: my beloved sister-in-law works for it. She gives her time and expertise to an organisation that has done so much for our family and many others.

Will the Minister commit to discussing with her colleagues in the Department for Work and Pensions the financial impact of childhood cancer on families, and will she use the CLIC Sargent report as a reference point? Will she further consider supporting the provision of such homes for the families of children with cancer? If those homes are essential for allowing children to be treated, we must surely consider prioritising them along with other specialist support for statutory funding, at least in part. I do not believe it is right that such homes, which are so essential, must rely entirely on the generosity of volunteers and charitable giving, although I pay tribute to people who raise money. The Government must consider providing that funding.

As other hon. Members have said, until someone has known childhood cancer in their own family, it can be difficult for them to comprehend its full impact. Yes, there are excellent briefings available from specialist cancer charities—CLIC Sargent, Teenage Cancer Trust, Cancer Research UK and other charities provided briefings for this debate. My family was fortunate. Despite an initially very difficult prognosis, that 12-year-old child is now a happy, well adjusted young man in his 20s with a responsible job and a secure relationship with his partner, but I grieve for those who are not so fortunate. I want to ensure that, whatever the prognosis, no family has to worry about money at that most difficult time. I want us to do everything we can—the Government must lead—to improve awareness, early diagnosis, treatment and support, so that one day deaths from childhood cancer end and we alleviate and reduce, if not completely eliminate, the terrible suffering that it brings. I also hope against hope that one day, no parent will ever have to hear the word “cancer”. I long for that day, as I am sure we all do.

--- Later in debate ---

[Julie Cooper (Burnley) (Lab)]

It is an honour to serve under your chairmanship, Mr Davies. This debate has arisen in response to a petition signed by more than 115,000 people, including 922 from my constituency, following the sad passing of Poppy-Mai, the little daughter of Mr and Mrs Barnard. First and foremost, my thoughts are with that Lancashire family and all the other families who have endured a similar devastating loss of their children. There can be nothing worse than the loss of a child, so this debate is especially important.

It is important that we increase awareness of the scale of the problem facing children and young people who have cancer and their families, and look for ways to tackle the problems. How can we improve diagnosis? How can we improve research? How can we ensure better access to treatments? Ultimately, how can we improve survival rates? The debate, outlined so well by the hon. Member for Bath (Ben Howlett), has given us the chance to search for answers to those important questions.

In the UK every year about 4,000 children and young people under the age of 25 are diagnosed with cancer. Worryingly, research by CLIC Sargent published last year found that 44% of young people and 42% of parents felt that their local GP did not take them seriously when they presented with symptoms, and 53% of young people felt that their diagnosis had been delayed. Clearly that is not an acceptable state of affairs. Inevitably, delayed diagnoses mean delayed treatment, with implications for survival rates.

In an attempt to improve awareness among GPs, CLIC Sargent embarked on a joint project to develop an e-learning module specifically focused on cancers in children and young people. That welcome work will go some way in helping to improve diagnosis and primary care support for children and young people with cancer, but far more needs to be done. It is a fact that children in the UK with a brain tumour can take up to three times longer to be diagnosed than children in other countries, most notably the United States. Reducing the time to achieve an accurate diagnosis improves survival rates and can reduce long-term disability, which many children and young people diagnosed with a brain tumour currently experience. I hope the Minister can give us some understanding of what the Government intend to do to improve diagnosis times.

Recent figures published by Cancer Research UK demonstrate that in the past 20 years we have seen a 32% reduction in the child cancer death rate. We have also seen five-year survival rates increase from 40% in the early 1970s to 82% today. It is widely believed that those improvements have arisen as a result of more research and better treatments. While they are extremely welcome, they go nowhere near far enough, because the fact remains that cancer is still the leading cause of death among children. Five children and young people die of cancer in Britain every week, and those who survive often go on to suffer long-term side effects from their treatment that can continue into adulthood.

A considerable amount of research is carried out each year in the UK by a multitude of organisations including Cancer Research UK, the Brain Tumour Charity, the Institute of Cancer Research, the Institute for Child Health, Great Ormond Street Hospital and the Teenage Cancer Trust. Last year, Cancer Research UK committed to doubling research spending on children’s cancers. That will go some way in helping to discover new treatments. We all thank it and welcome that commitment, because currently only 3% of UK funding into cancer goes to child cancers.

It is important to remind the Government that many of those organisations are charities, which have relied on high levels of funding from the European Research Council. The Brain Tumour Charity stated that the result of the referendum on EU membership has created great uncertainty for charities conducting research into childhood cancers. Post-Brexit, the Government must ensure that the UK medical research community continues to have access to EU funding programmes once Horizon 2020 has ended. Similarly, I seek reassurance from the Minister that any shortfall in research funding as a result of our exit from the EU will be met by the UK Government. If we are to improve outcomes for children with cancer, it is paramount that we have research conducted to understand further these awful diseases.

Following improvements to diagnosis processes and research, we must ensure efficient access to treatment. Children and young people with cancer face a range of barriers in accessing new and better treatments, including drugs not being tested in their age group or in the cancers they are likely to get, even when a drug may be effective in treating their cancer. Simply challenging the age restrictions set on new trials is already increasing participation rates. That should be done in tandem with the provision of age-appropriate information about trials delivered by skilled, specialist staff.

Currently, the cancer patient experience survey does not collect data on cancer patients under the age of 16, and we have seen a 40% decline in response rates from teenagers over the age of 16 and young adults in the past five years. It is unacceptable that little or no progress has been made on this issue. Understanding patient experiences is important to improve future services. The cancer strategy includes plans to deliver a methodology to collect under-16s’ experiences, and NHS England is doing that alongside CLIC Sargent. Will the Minister helpfully update us on that work and tell us when we can hope to see the data being collected?

Achieving viable numbers for clinical trials on child cancers is understandably problematic given the relatively small numbers and rarity of some child cancers. However, we cannot allow that to be used as an excuse for not improving treatments for children and young people with cancer; instead, it should push us to innovate. Cancer Research UK has led the way in challenging the age restrictions on clinical trials, calling for more flexibility when it comes to age and ensuring that researchers justify age restrictions so that they rethink approaches to include children and young people.

[Wes Streeting]

Particularly for rare forms of cancer or brain tumours such as DIPG, it is important that clinical trials take place at scale. Does my hon. Friend agree that, after the UK leaves the European Union, the Government should seek to ensure that there is as much alignment as possible in the regulatory framework between here and the rest of the European Union so that clinical trials on the European level can continue to take place?

[Julie Cooper]

I am grateful to my hon. Friend for making that important point. It is essential that the UK’s exit from the EU does not negatively impact on further research. We must benefit collectively from work done in other countries. To pick up on the point other Members made, we must pool good practice and ensure that our good practice and successful research are shared throughout the world and that we benefit similarly from experience elsewhere.

In the cancer strategy, there were specific recommendations relating to children, teenagers and young adults’ services and how they can be improved. I was concerned, though, that in September the Government made an announcement on wider measures in the strategy but failed to mention anything about the important issue of seeking consent from children and young people for their data and tissue collection to be used in future research studies and the development of services, nor did they include a requirement significantly to increase access to clinical trials for teenagers and young adults with cancer.

Currently 30% of teenagers and 14% of young people aged 20 to 24 enter trials for common cancer types in children and young people. In 30 years there has been no progress in that area. The cancer strategy set a target for NHS England to recruit at least 50% of children and young people in cancer centres or designated units treating teenagers or young adults. That is welcome, but will the Minister give us a progress report and tell us how long it will be before the target is likely to be met?

I pay tribute to the Barnards, to the other families mentioned today and to the children and families across the UK affected by cancer for their courage in the face of this most awful of illnesses. I ask the Government to understand those families’ need for support. We have heard some moving stories today. They need support in a wide sense—from specialist units and through better access to information. Importantly, they also need financial support. Several hon. Members have powerfully made the point today that the costs of cancer are physical and emotional but also financial. We must do more and better.

I want to hear what specific plans the Government have to improve the speed of diagnosis; I want a guarantee that the Minister will protect research funding post-Brexit; and I want to know what plans she has to increase the number of clinical trials, to ensure that access to life-saving treatments is the best possible. Children and young people deserve no less.

--- Later in debate ---

[Nicola Blackwood]

My hon. Friend is absolutely right. It is important to make sure that all different groups and diseases get the attention that they deserve. That takes me on to the issue of patient cohorts and the importance of collaboration across Europe.

For particularly rare diseases or cancers, it is sometimes necessary to look across borders to make sure that research includes the right numbers of patients. That has been a particular focus of the Department, and I am confident, owing to the work that we have been doing, that international—particularly European—networks and data sharing for research purposes will continue. We need to make sure that initiatives that have facilitated research, such as the paediatric medicines regulations, continue. My noble Friend Lord Prior is leading on that area of policy. I know that he is closely involved in all of those issues, and I am going to ensure that the specific concerns that have been raised today are passed on to him and are not dropped.

I assure the shadow Minister that the Chancellor has guaranteed that the UK will continue to have all of the rights, obligations and benefits that EU membership brings, including EU funding—up until the point that we leave, obviously. The Treasury has also committed to underwrite the payment of awards to UK organisations that make competitive bids to the European Commission —for example, for universities bidding for Horizon 2020. In addition to all of the funding I have spoken of, those moneys are protected.

My hon. Friend the Member for Bath made a couple of points about reviewing the work undertaken by NHS England to ensure that more children receive the treatment that they deserve. We will be working closely with NHS England and all partners to make sure that the strategy we have put in place becomes a reality and that the right performance metrics are in place, although that is a challenging process. Our best measure of success will be the cancer survival statistics. Those are currently provisional, but the Office for National Statistics will hopefully be assessed by the UK Statistics Authority in the future.

We have heard from many hon. Members of some deeply moving cases of young people battling cancer. We have heard of their courage and resilience, and of the fortitude of their parents and siblings.

[Wes Streeting]

I am grateful to the Minister for giving such a thorough and thoughtful response to the debate. As I mentioned, Kaleigh’s family are campaigning on DIPG. It would mean a lot to them if the Minister or one of her Departmental colleagues met them to talk about their experience and their hopes for how research funding in this area might improve the search for a cure going forward. Is the Minister able to make that commitment?

[Nicola Blackwood]

I am sure that either I or a Departmental colleague will be delighted to meet the hon. Gentleman and his constituents. It was moving to hear of their campaign.

Holding the Government and the NHS to account in this way could not be more important. I hope that my response has made completely clear not only my personal commitment but the Government’s wholehearted commitment to funding life-changing innovation and research into cancer, to delivering the cancer strategy in a way that transforms cancer care for current and future generations and to improving the long-term quality of life of childhood cancer survivors. That is surely the greatest memorial that we can offer to each and every one of those brave children who, like Poppy-Mai, have lost their battle with cancer. That is our task, and as I look around the Chamber, it is clear to me that each and every Member here will work as hard as they possibly can to make sure that they hold us to it.

Social Care

Wes Streeting Excerpts

Wednesday 16th November 2016 Commons Chamber

[Mr Hunt]

We are absolutely determined to clamp down on employers who do not pay the national living wage. If the hon. Gentleman or any other hon. Member has any evidence at all of that happening, they should let HMRC know. HMRC has a policy of naming and shaming employers who do not do the right thing and rightly so.

[Wes Streeting (Ilford North) (Lab)]

rose—

[Toby Perkins]

rose—

[Mr Hunt]

I will give way to the hon. Member for Ilford North (Wes Streeting) first.

[Wes Streeting]

It is welcome that the minimum wage will increase and that money will hopefully reach the workers we are discussing. Will the Secretary of State acknowledge, however, that the consequence of the increase is that the precept that local authorities charge residents for social care will be eaten up by the wage increase—even in local authorities such as the London Borough of Redbridge, of which I am still an elected member? What will he do to alleviate the very real financial burden on my local authority and others to ensure that everyone gets the quality of care they need?

[Mr Hunt]

I acknowledge the financial impact of the national living wage and will talk about the funding of local authorities.

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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.