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I beg to move amendment 2, page 1, line 10, at end insert—
“(1A) The amount spent on mental health services in each financial year set out in the table must be set out in a statement laid before the House of Commons by the Secretary of State no later than
(1B) The statement in subsection (1A) must be accompanied by a statement on the Secretary of State’s plans to achieve parity of esteem in mental health services.”
This amendment would require the Secretary of State to report annually on the amount actually spent on mental health services, and on the Secretary of State’s plans to achieve parity of esteem in mental health services.
With this it will be convenient to discuss the following:
Amendment 1, page 1, line 14, at end insert—
“(2A) For each year in the table in subsection (1), the Secretary of State must specify the amount of the allotment that is for mental health services.”
This amendment requires the Secretary of State to specify the amount to be spent each year on mental health services.
Amendment 5, page 1, line 14, at end insert—
“(2A) For each year in the table in subsection (1), the Secretary of State must specify the amount of the allotment that is for training for staff to improve maternity safety and care for mothers and babies.”
This amendment would require the Secretary of State to specify the amount to be spent each year on improving maternity safety and care for mothers and babies.
Amendment 3, page 1, line 18, at end insert—
“and that the sums set out in the table are not permitted to be augmented by or composed of any virements from NHS capital budgets.”
This amendment would stop the Secretary of State meeting the NHS England allotment for resource spending by using funds from NHS capital budgets.
Clauses 1 and 2 stand part.
“The Secretary of State must lay before the House of Commons an annual statement of the outturn of NHS England spending on mental health services no later than six months after the end of each financial year, beginning with the year ending
This new clause requires the Secretary of State to report each year on the actual level of spending on mental health services.
New clause 2—Annual Report on Child and Adolescent Mental Health Services spending—
“(1) The Secretary of State must lay before the House of Commons an annual statement of the outturn of NHS England spending on Child and Adolescent Mental Health Service (CAMHS) no later than six months after the end of each financial year, beginning with the year ending
(2) The annual statement from subsection (1) must report figures on—
(a) CAMHS expenditure per head,
(b) the percentage of the annual NHS England budget allotted to CAMHS, and
(c) the percentage of the annual mental health budget allotted to CAMHS.
(3) The figures in subsection (2) must be broken down by standard regional units in England or by such territories as the Secretary of State considers appropriate.
(4) Each statement under subsection (1) must include an assessment by the Secretary of State on whether expenditure on CAMHS has met the aims of the NHS Long Term Plan.”
This new clause would require the Secretary of State to report each year on the actual level of spending on CAMHS. It requires figures to be broken down by regional units and for the Secretary of State to include an assessment of whether expenditure on CAMHS is meeting the aims of the NHS Long Term Plan.
New clause 3—Allocation of funding—
“The Secretary of State must lay a report before the House of Commons no later than
This new clause would require the Secretary of State to report annually on the amount and proportion of NHS England spending devoted to mental health services.
New clause 4—Annual statement on performance—
“The Secretary of State must make a statement to the House of Commons no later than
(a) whether in the Secretary of State’s opinion the amount specified in section 1(1) for the following financial year is sufficient to meet the performance targets set out in the NHS constitution, and
(b) if in the Secretary of State’s opinion the amount specified in section 1(1) for the following financial year is not sufficient to meet the performance targets set out in the NHS constitution, what steps Secretary of State is taking to ensure that those targets are met.”
This new clause would require the Secretary of State to report annually on whether the allotment to the health service specified in section 1(1) year is sufficient to meet the performance targets set out in the NHS Constitution and, if not, what steps Secretary of State is taking to ensure that those targets are met.
New clause 5—Inflation—
“(1) The Secretary of State must make a statement to the House of Commons in the event that the annual rate of inflation as set out in the Consumer Prices Index is greater than 3.3% in any six months out of twelve after the date on which this Act is passed.
(2) The statement under subsection (1) must specify whether, and by how much, the allotments to the health service in England set out will exceed the amount specified in the table in section 1(1).”
This new clause would require the Secretary of State to make a statement on the impact of inflation above a certain rate on the allotments to NHS England.
New clause 9—Annual parity of esteem report: spending on mental health and mental illness—
“Within six weeks of the end of each financial year specified in the table, the Secretary of State must lay before each House of Parliament a report on the ways in which the allotment made to NHS England for that financial year contributed to the promotion in England of a comprehensive health service designed to secure improvement—
(a) in the mental health of the people of England, and
(b) in the prevention, diagnosis and treatment of mental illness.”
This new clause would require the Secretary of State for Health and Social Care to make an annual statement on how the funding received by mental health services that year from the overall annual allotment has contributed to the improvement of mental health and the prevention, diagnosis and treatment of mental illness.
New clause 11—Annual review of adequacy of allotment to NHS England—
“The Secretary of State must lay before each House of Parliament within 14 days of the Treasury laying the annual main estimate for the Department of Health and Social Care an assessment of the extent to which changes in the costs of pharmaceutical treatments, medical devices and service delivery since the date on which this Act is passed have affected the health outcomes in England achieved as a result of the amounts in the table in section 1 of this Act allotted to NHS England.”
This new clause would require the Secretary of State to publish an annual assessment of the impact of changes in the costs of pharmaceutical treatments, medical devices and service delivery on the expected outcomes from the allotted amounts under this Act.
It is a pleasure to see you in the Chair, Dame Rosie. In my speech I will address amendment 2 and, as we are dealing with everything in one go, the other amendments and new clauses submitted in my name and the names of my right hon. Friends.
It seems that Members across the House are anxious that the Government’s laudable aims on parity of esteem for mental health services are given some legislative teeth. The NHS long-term plan rightly calls for more investment in mental health services to give mental health the same priority as physical health. That is the right approach and it is one that we support. However, as we can see by the amendments that have been tabled today, there is scepticism about how that will actually be delivered. Investment in mental health services has been seriously neglected in recent years and mental health patients are some of the people who have been most let down by the Government in the last decade.
No doubt we will hear from those on the Government Benches that mental health spending is increasing, and that the funding set out in the Bill will benefit mental health services, but the reality is that on this Government’s watch, we have seen a mental health crisis emerge. We are not getting the investment at the level required and services are simply unable to keep pace with demand. As a consequence, the number of people living with serious mental health problems is rising. Patients are unable to access vital psychological therapies within six weeks and often have to wait over 100 days for talking therapy treatments. Thousands of mental health patients continue to be sent hundreds of miles from home, because their local NHS does not have the beds or the staff to provide the care they need. These are often young people in desperate circumstances being sent away from their family and friends—their support network, as it were—and that to me sounds a long way away from parity of esteem. We know that adults in need of help with eating disorders are waiting more than three years for treatment, while hospital admissions for eating disorders increase year on year. The number of people living with serious mental health problems is continuing to rise and suicide levels are at their highest since 2002.
Even against this awful backdrop, however, it is children’s mental health services that are suffering most from the chronic lack of funding. Children’s mental health services account for just 8% of total mental health spending, and the Government’s continual failure to prioritise children’s mental health has led to services for children effectively being rationed. We know that on average, children and young people visit their GP three times before they get a referral for specialist assessment. They then have to wait more than six months for treatment to start. Suicidal children as young as 12 are having to wait more than two weeks for beds in mental health units to start treatment, despite the obvious risk to their lives.
Three out of four children with mental health conditions do not get the support they need. With over 130,000 referrals to specialist services turned down, despite children showing signs of eating disorders, self-harm or abuse, the problem has become so bad that some children and families are being told by their GPs to pretend that their mental health problem is worse than it is to make sure they get the help they need. Four hundred thousand children and young people with mental health conditions are not receiving any professional help at all—400,000. That is a scandalous figure. We know that mental health conditions in adults often begin in childhood, so it is not only an outrageous dereliction of duty to our young people; it will also end up costing the NHS and society far more in the long run.
I do not want to detain the hon. Gentleman too long, because he is making a very good speech and very important points, but I just wonder whether he has any views about the setting of this debate in the Legislative Grand Committee, the de facto English Parliament. SNP Members are excluded from voting in this debate and excluded from tabling any amendments, yet the Bill will have a fundamental impact on the health funding of Scotland through Barnett consequentials. I am interested in his views on that process, so will he say something about them? Can we have Labour support, so that this nonsense stops and we go back to one class of MP in this House where everybody can participate equally?
I thank the hon. Gentleman for his intervention. I understand his frustration absolutely. I think he has a very fair point, Dame Rosie, that because of the Barnett consequentials there is a role for SNP Members—indeed, all Scottish and Welsh Members—in this debate. Clearly, that is a separate issue to the whole English votes for English laws process, but the fact is clear that on the face of the Bill there are Barnett consequentials, which mean that the devolved nations ought to have a say.
It is really no wonder, given the background I have just set out, that children are reaching a crisis point before getting the support they need, and that the number of children attending accident and emergency for their mental health in a situation of crisis is increasing year on year. That is not inevitable. With real investment, we could reverse the trend of long waits, rationed treatment and inadequate care if we allocated more of the NHS budget to mental health. As we know, mental health illnesses represent 23% of the total disease burden on the NHS, but just 11% of the NHS England budget. That is a long way off the parity of esteem that we all seek to achieve.
We know that the Government plan to put in an extra £2.3 billion a year by 2023-24, but that is not enough. The Institute for Public Policy Research has said that to achieve parity of esteem for mental health services, funding for those services needs to grow by 5.5% on average not just next year, but over the next decade. The NHS plans to spend £12.2 billion on mental health funding in 2019, but the IPPR estimates that that needs to reach 16.1 billion by 2023-24 alone.
Of course, we support the increased funding for mental health in the Bill, but we know the NHS has to live within the 3.3% uplift provided under the Bill. The Institute for Fiscal Studies, the Health Foundation, NHS providers, the British Medical Association and many of the royal colleges say that health expenditure should rise across the board by 3.4% just to maintain current standards of care. By definition, there will actually be less money for funding in other areas. That means there is a risk of further raids on the mental health budget. In previous years, money allocated to mental health services, particularly children and adolescent mental health services, has been diverted back to hospitals to deal with the crisis there.
Labour would have done what was desperately needed. We would have put in an extra £1.6 billion a year immediately into mental health services, ring-fenced mental health budgets and more than doubled spending on children’s mental health. That is why we are seeking to amend the Bill to ensure mental health services do not lose out because of other financial pressures in the system. We are calling on the Government to ensure that guarantees for mental health funding are protected by ring-fencing mental health funding. We also seek to require the Secretary of State to come to the House annually to report on the amounts and proportion of funding allocated to mental health services, and on their plans to achieve parity of esteem for mental health services.
On the Labour Benches we are not convinced that mental health is a priority for this Government, despite what they say. They may want to position themselves as the party of the NHS, but as long as they continue to neglect mental health and push services deeper into crisis, they will not come near that aim. We intend to push amendment 2 to a Division, because we want to hold the Government to account. We want transparency on mental health spending and we want a clear road map from the Secretary of State on how he intends to make parity of esteem a reality.
I wonder if I could raise with my hon. Friend an example that I think makes his point, which is the state of NHS finances in north-west London, in particular of the acute hospital that serves my constituents, Northwick Park Hospital, and the clinical commissioning group. Both the trust and the CCG are over £30 million in deficit. As a result, they have cut back on community mental health services and, indeed, on a range of other things. Unless there is parity of esteem and unless there is a significantly higher funding boost for the NHS in north-west London than that currently being suggested by the Conservative party, I fear that mental health services, as he so rightly says, are likely to be cut even further.
My hon. Friend sets out very clearly the challenge that the Government face from the debt situation in the NHS. Both in-year deficits and total debt to Government have not been addressed adequately or taken into account in the Bill and that is clearly of huge concern.
Amendment 5 deals with patient safety, which should be front and centre in the NHS. When things go wrong, as they sadly do from time to time, it can have tragic consequences for patients and their loved ones. When three in four baby deaths and injuries are preventable with different care, it seems particularly tragic when things go wrong during birth, leaving families devastated by the loss of a child or having to cope with the long-term impact. There have been many things over the years that I have disagreed with the previous Secretary of State—Jeremy Hunt—about, but on Second Reading he raised the important issue of maternity safety training, calling on the current Health Secretary to reinstate the maternity safety fund. We absolutely agree with him on that, which is why we have tabled amendment 5.
Improved maternal health is one of four priority areas in the long-term plan for care quality and improved outcomes, and it includes action to achieve 50% reductions in stillbirth, maternal mortality, neonatal mortality and serious brain injury by the middle of the decade. As a party, we have pledged to legislate for safe staffing and to increase funding for NHS staff training, including reinstating the maternity training fund to help to improve maternity safety in our hospitals. The leaked interim report of the Ockenden review last year exposed widespread failures in maternity care at Shrewsbury and Telford hospital trusts and demonstrated, sadly, that Morecambe Bay was not a one-off.
An evaluation of maternity safety training from 2016 found that it had made a difference and improved patient safety, yet it was still axed. Just two years later, the “Mind the Gap” report found that fewer than 8% of trusts were providing all training elements and care needs in the “Saving Babies’ Lives” bundle and called for the maternity safety training fund to be immediately reinstated to address, as it said, the
“clear…inadequate funding for training”.
Given the clear evidence of the need for the training fund’s reinstatement, I very much regret that it is not within the scope of the Bill for us to submit an amendment to include its reinstatement. However, with the amendment we seek to put a greater spotlight on the issue, and hopefully, that will require the Government to set out how much they are spending on improving maternity safety and care for mothers and babies each year in order for them to demonstrate their commitment to improving maternity and foetal safety. I believe that that will enable us to judge and evaluate their commitment to those aims.
It is not within the Bill’s scope to press the Government on the need to have funding restored to smoking cessation services so that they can have multimedia campaigns to reduce smoking in pregnancy and smoking generally. Does my hon. Friend agree that it is a shame that the Government cannot address that at this time?
My hon. Friend is absolutely right: it is a matter of some regret that public health has not been included in the Bill. As we have said repeatedly, we have to look at the health system in the round and include public health and, of course, social care. We cannot deal with those matters in isolation and I believe that it was a mistake for the Government to restrict the Bill in this way.
Despite the many tragedies that we know about in maternity care, it is worth restating that we still have fantastic midwives and fantastic maternity care in this country. That is to be celebrated, but we also need to ensure that when things go wrong—when there are failures and safety issues—we address them and lessons are learned so that no more families have to experience such tragedies.
Amendment 3 is about genuinely giving trusts the certainty that the Bill only purports to do, as well as beginning to tackle the appalling maintenance backlog that has arisen on the Government’s watch. As we know, trusts are around £14 billion in debt to the Government and are currently predicting a £571 million in-year deficit. That is a truly shocking and unsustainable situation. Only short-term fixes have prevented the situation from getting even worse. Such fixes are a symptom of structural long-term underfunding, and like most short-term fixes they create bigger problems further down the road.
We have been absolutely clear that the funding settlement proposed in the Bill is inadequate and that it will not be enough to keep up with demand. As I said, that analysis is shared by just about every major health expert, including the Institute for Fiscal Studies, the Health Foundation, most royal colleges and NHS providers, and the BMA.
In that context, we are concerned that there will be a temptation, as there has been, to dip into capital budgets to paper over the cracks on a day-to-day basis. We have seen that happen five times in the last decade. This means that we now face a maintenance backlog that has spiralled out of all control, topping £6.5 billion. That is an 8% increase on the previous year, when the cost was just under £6 billion. In dollars, that might get us one Steve Austin, but it is not enough to fix the NHS—I suspect that that reference might not mean much to anyone under 40, although I understand that there will be a reboot later this year, so it might become a bit more relevant. However, the point is that this figure has been rising each year for the last six years and it is now 60% higher than it was in 2013-14. It is very clear that the backlog has risen much faster than the resources that have been made available to tackle it.
Over half the backlog represents high and significant risk. That accounts for an increasing proportion of the total backlog figures. High and significant risk represented about 34% of the backlog in 2013-14, but last year—2018-19—it had gone up to 53%. It is getting bigger and all the time, it also becomes riskier.
In support of the case that my hon. Friend is making, I again mention Northwick Park Hospital, which serves my constituents. It has a huge maintenance backlog. Since the cancellation of the Government’s “Shaping a Healthier Future” NHS reform plan for north-west London in June last year—that programme of reform had been going on for seven years —there has also been no replacement money identified for investment in intensive treatment beds, an extra 30 of which are needed to help to tackle some of the problems in A&E at Northwick Park Hospital.
My hon. Friend is again showing what an assiduous and determined constituency MP he is. He might want to look at the NHS providers’ report today, which sets out some of the challenges from the lack of a long-term capital investment programme. As we have heard, including from him and in relation to other various examples around the country, this is not just about a lick of paint, but about really vital work that impacts on patient care.
When my hon. Friend talks about capital, I think of the hospital that was cancelled for my constituency by the Tory-Lib Dem Government 10 years ago. Does he share my opinion that when it comes to the capital programme and NHS funding, the Government should consider the life expectancy in different areas? In my constituency, it is 14 years lower than in the Prime Minister’s constituency, so I desperately need a new hospital for my area.
I am sure that if my hon. Friend continues with his determined campaign, he will see that hospital appear. His point about health inequalities is really important. It is absolutely scandalous that we see such disparity in this country, and we want to see further and more determined action from the Government on that.
Patients ultimately pay for the increasing backlog. Between 2017-18 and 2018-19, there was a 25% increase in clinical service incidents. These incidents are caused by estate and infrastructure failure that leads to clinical services being delayed, cancelled or otherwise interfered with.
The hon. Gentleman is making some very fair points about the importance of investing in hospital infrastructure. A number of years ago, we were promised a paperless NHS, but the reality today is very different. In fact, NHS IT infrastructure is creaking at the seams. There has been a complete failure to invest adequately in that infrastructure, which is compromising patient care. Far too many staff hours are lost on IT systems that are not fit for purpose. Will he join me in urging the Government to take that issue very seriously, because it is about improving patient care as well as improving productivity and better using staff time?
The hon. Gentleman makes an important point. We have all heard horror stories of workers in the health service having to turn on seven or eight different computer systems and use fax machines and pagers— there were so many fax machines in the NHS I used to think the previous Health Secretary was sponsored by Rank Xerox. It is a serious point though. If we are to improve patient outcomes, we will need to move with the times and get the benefits of technological improvements.
My hon. Friend will agree on the importance of the Countess of Chester Hospital to his area and mine. It is quite a unique hospital, in that it was built to serve the people of Deeside in north Wales as well as Chester and the surrounding area, so is it not strange that, although many in my area rely on it, I will not be allowed to vote on the Bill today?
My hon. Friend makes a pertinent point. Both my parents are residents of north Wales but on occasion use the Countess of Chester Hospital. This process does not take account of the reality on the ground. As I said before, the fact that there will be Barnett consequentials from the Bill suggests that we have made a serious error in not allowing those from the devolved nations to vote on it.
We know what some trusts have told us about the lack of capital investment and what that means on the frontline: Morecambe Bay has said it has “unsuitable” environments for safe clinical care that have led to the closure of its day case theatre; the Queen Elizabeth Hospital in King’s Lynn has warned of a direct risk to life and patient safety from the roof falling in; and at the Royal Derby Hospital, a failing emergency buzzer system in the children’s ward means that staff would be unable to warn colleagues if something went seriously wrong. That is not acceptable.
The capital maintenance backlog will not be addressed unless the Government take note of what NHS Providers says in the report that came out this morning. It talks about the need for the NHS to have a multi-year capital settlement and a commitment from the Government to bringing the NHS capital budget in line with those in comparable economies, which would allow the NHS to pay for essential maintenance work and invest in long-term transformational capital projects of the kind we have touched on. One of our criticisms of the Bill is that capital allocations have not been included in the figures in clause 1, so in order to protect those allocations we have tabled amendment 3, which we hope to push to a vote, to stop the Government’s continual sticking-plaster approach.
I move now to performance targets and our new clause 4. We all know about the record investment and record patient satisfaction levels that the last Labour Government bequeathed to the Conservatives, but another part of their legacy was the NHS constitution, introduced as part of a 10-year plan to provide the highest quality of care and services for patients in England. It included a clear statement of accountability, transparency and responsibility, and standards of care for accessing treatment. These are the figures we often trade across the Dispatch Box.
Only last month, across this very Dispatch Box, the Prime Minister gave us assurances on performance. He said:
“We will get those waiting lists down”—[Official Report,
Vol. 669, c. 1015.]
We would all like to see that, but we should remind ourselves of the Government’s sorry record: the target for 95% of patients being seen within four hours in A&E has not been met since July 2015; the target for 92% of people on the waiting list to be waiting fewer than 18 weeks for treatment has not been met since February 2016; the target for 1% of patients waiting for more than six weeks for a diagnostic test has not been met since November 2013; and the NHS has not met the 62-day standard for urgent referrals for suspected cancer treatment since December 2015. I fail to see how the Prime Minister can drive down waiting lists when the level health expenditure he is proposing is not enough to meet existing demand.
I note the statistics the hon. Member has shared with the House, but how do they compare to the outcomes that my constituents in Wales face? I would suggest they fare much worse.
Across the piece, some areas in Wales are actually performing better than areas in England. The direction of travel is the right one. If the right hon. Member is so interested in the performance in Wales, he should stand for the Welsh Assembly; he will have the opportunity to do so in the not-too-distant future. I am sure he was aware when he stood for this place that health was a devolved issue.
I want to raise again the example of Northwick Park Hospital, which serves my constituents. It has not met the four-hour A&E target since August 2015. One of the latest issues responsible for the increasing pressure on waiting times at Northwick Park is the closure of our walk-in services, which were one of the great reforms of the previous Labour Government. Alexandra Avenue, which served my constituency, closed in November 2018, and Belmont health centre, which served the constituency of Harrow East, closed in November 2019. The last walk-in service in the London Borough of Harrow, the Pinn medical centre, which currently is in the constituency of David Simmonds, is also due to close, and yet it is increasingly difficult to get an answer to a request for a meeting to discuss that closure with Ministers or the chief executive of NHS England.
There has to be a correlation between the number of closures my hon. Friend is seeing and his CCG’s debts, which he was referring to earlier. The pressure on frontline services is making these decisions, which it is more and more likely can only impact on performance. I hope that when the Minister responds he will be able to give him the satisfaction of at least a meeting to discuss the issue further.
The funding in the Bill is insufficient to reverse the decline in recent years, let alone deliver the aspirations set out in the long-term plan. It is not just the opinion of Her Majesty’s Opposition that the performance targets cannot be met; NHS England has also made it clear that the core treatment targets cannot be met because of the funding settlement imposed by the Government. And who loses out month after month when performance targets are missed? It is patients. Whether for pre-planned surgery, cancer treatment, diagnostic tests or emergency care, our constituents are waiting longer and longer, often in pain and distress, to access the health services they need. The figures do not lie.
We must remember that the figures are also real people. They are real people stuck on waiting lists: the total number of people on waiting lists in England is now 4.41 million, which is the highest since records began, and up from 4.1 million, when the right hon. Member for West Suffolk first became the Secretary of State. They are real people waiting for treatment: the target to treat 92% of patients within 18 weeks has not been met for four years—not since February 2016—and obviously has never been met by the current Secretary of State. They are real people waiting for cancer treatment: the Prime Minister himself agreed last month that it was unacceptable that the target for treating cancer patients within 62 days of urgent GP referrals had not been met for five years. That is five years of failure. They are people waiting on hospital trolleys: the number of people waiting four hours or more on hospital trolleys reached 98,452 last December, which is not only a 65% increase on the same point the previous year, but the highest on record.
As we heard on Second Reading, the failure to meet these targets has real consequences. Research from the Royal College of Emergency Medicine shows that almost 5,000 patients have died in the past three years because they spent so long on a trolley waiting for a bed in an overcrowded hospital. As we have said several times during our consideration of the Bill, the true increase in funding is about 4.1%—I will not list again all the bodies that agree with that figure—yet the money in the Bill will not be enough.
This is all before last week’s news about the Chancellor looking for 5% savings in all Departments, including this one. That might not affect the figures in the Bill, but there might be cuts across the wider Department that do have a knock-on impact on service delivery. Let us take a look at A&E. There is increased demand on our A&E services, for many reasons, including the years of cuts to social care, but that is not covered in the Bill. Will the 5% cut come from there—if it does, more and more people will be forced into A&E by a collapsing social care system—or from public health, as we have heard previously, which would inevitably store up problems in the short and longer term?
None of this can be said to be likely to have no impact on performance targets, which for too long have been treated as a poor relation by this Government. The Government have widely ignored them, to the extent that they are spending more time dreaming up ways to get rid of them than to meet them. We say that patients deserve better. We will push the new clause to a vote, because we believe it is clear that the Secretary of State will not be able to drive down waiting lists or drive up performance with the level of health expenditure that he proposes to enshrine in law.
Rather than presenting the Bill as a panacea, let us ensure that the Secretary of State and the Prime Minister are held to account for the promises that they make, and that the Secretary of State comes to this place every year to tell us whether, in the Government’s opinion, the funding allocated for that year will be sufficient to meet those performance targets. If it is not, the Government must set out what they are going to do about it. It is simply not good enough to continue, year after year, to have a Government who treat the targets as an inconvenience. If those standards are to mean anything to patients, and if the Government are serious about persuading us that they mean something to them as well, they will have to come here every single year and tell us, unambiguously and with reference to the funding package for this year, how they intend to meet those targets.
Let me now say a few words about new clause 5 and inflation. I am conscious that a number of other Members wish to speak, so I will be fairly brief. The new clause is a safeguard to deal with a mistake made in the Bill. Because the amounts are presented in cash rather than real terms, the figures may not end up being as big as they at first appear. While inflation is now relatively stable and within a reasonable range of the Bank of England’s target, I do not think that anybody—particularly at this time—can confidently predict the rate at which it will be running at in two, three or four years’ time.
Is that not the most critical weakness in the Bill? Given that inflation is expected to rise after Brexit, the figures for 2023-24 are just guesswork. There should be a commitment to £20 billion by that year, in real terms.
There are indeed many weaknesses in the Bill, which, given that it is so short, is quite an achievement on the Government’s part. That is the point of the new clause. We cannot say with any certainty what the rate of inflation will be in a few years’ time. It is important for funding that is seen as adequate now—at least by Conservative Members, if by no one else—not to be downgraded further as a result of economic turbulence. We have had no guarantees that a different economic picture will change the Government’s stance. Indeed, when on Second Reading we sought assurances that the NHS would still receive the real-terms increases envisaged in the Bill should inflation run at unforeseen levels in the future, no commitments were forthcoming. When pressed by my hon. Friend Lilian Greenwood, the Secretary of State could not give the cast-iron commitments that are needed by those delivering the services. Even if this is an unsatisfactory settlement, they deserve some certainty that the sums involved will not be eroded by spikes in inflation.
As the Secretary of State said on Second Reading,
“The crucial thing in this Bill is the certainty.”—[Official Report,
Vol. 670, c. 560.]
We are not sure whether he meant certain failure, because we know that the sums set out in the Bill are not enough to keep up with demand, but the new clause seeks to ensure that the NHS is, at least to some extent, insulated against unforeseen economic shocks. It would act as a safety net in the event that inflation ran above 3.3% for more than six months in any 12-month period. It also requires a statement from the Secretary of State about whether any additional funds will be made available to supplement the sums set out in the Bill. That would at least provide some clarity and certainty about whether there will be any real-terms reduction in funding as a result of a sustained rise in inflation.
Let me finally say a little about new clause 11, and the adequacy of the allotment to NHS England. As I have already made clear, the Bill sets NHS expenditure for the next four years at a level that is not sufficient to put the NHS on a sustainable footing or to improve performance. That is why we are seeking to ensure that the impact of unforeseen changes in the costs of pharmaceutical treatments, medical devices and services—possibly as a result of our leaving the European Union, or of the trade deals that we sign—are reviewed by the Government so that adequate funds are available to meet any uplift, and so that there is no negative impact on health outcomes. Much has been said about the possibilities in new trading arrangements, but not enough about the risks, of which this is only one.
It is a great pleasure to follow Justin Madders. We were on opposite Front Benches for many years, but I always had great respect for his detailed understanding of healthcare issues and the integrity of his approach. He once wrote me a private letter. I will not divulge its contents; suffice it to say that it demonstrated his recognition that we are human beings on this side of the House. That was a rare admission from a member of the Labour party, and I am very grateful to him for it.
I will not be supporting the hon. Gentleman’s amendments and new clauses, but I think he is right to raise the issues that he has raised, and I want to propose some different ways of achieving his objectives. I am very pleased that he has raised the issue of mental health and mental health funding, and I therefore wish to speak to amendments 1 and 2 and new clauses 1, 2 and 3.
I think that all hon Members have knocked on the doors of constituents—I did as Health Secretary—and been confronted by people who have been given a totally inadequate service in relation to their mental health or that of their children. One person I met, who was not a constituent, was a very remarkable gentleman called Steve Mallen. He had a son, Edward, who had an extraordinarily promising life in front of him. Edward had secured a place at Cambridge, he was very musical, he had friends; and then, in the year before he was due to go up to Cambridge, he had a six-month period of severe mental illness and ended up killing himself, five years ago this Sunday. I think that all of us have to have people like Edward Mallen at the back of our minds, and to remember, as we enjoy a normal weekend, that for Edward’s family Sunday will be a very, very challenging day.
I believe we could all come up with stories like that. I mentioned Steve Mallen because he has chosen to relive the grief that he feels for his son Edward. He made a promise at Edward’s funeral that he would campaign to ensure that other people received the mental health provision that Edward did not receive. He subsequently set up the Zero Suicide Alliance with an inspirational NHS chief executive called Jo Rafferty, who runs Mersey Care. It is a fantastic project, and I am pleased to say that the Health Secretary has agreed to a meeting to discuss continued funds for the alliance. As we think about people like Edward, it is important to understand just why funding for mental health has not increased at the rate at which it should have, and why we do not have the service provision that we should have.
Does the right hon. Gentleman share my concern about the fact that the mental health charity Combat Stress has said it is unable to accept any more new cases? Support for the charity, which helps military veterans, has fallen in the last few years, and 90% of its income consists of public donations.
I am well aware of the fantastic work done by Combat Stress, and I think it is important for it to receive the funds that it needs. However, when we look at the root cause of the problems in mental health funding, we see that on both sides of the Committee there is some culpability, and that on both sides it was completely unintentional. I hope that the shadow Secretary of State, Jonathan Ashworth, will forgive me if I start with the other side.
The truth is that when targets were introduced in the 2000s for A&E and elective care waiting times they were hugely effective, but they were introduced only for physical healthcare. As a result, during the austerity period when the budgets of clinical commissioning groups or primary care trusts were under pressure, money was sucked out of community and mental health services. That is at the heart of the problem that has bedevilled mental health care. The position changed in 2012, because a Labour amendment to the Bill that became the Health and Social Care Act 2012 instituted parity of esteem between mental and physical health. We were the first country in the world to do that.
As a Conservative, I am always deeply sceptical about legislating for principles, because I am not totally convinced that it ever changes anything, but that amendment did bring about a significant and very practical change, which I discovered myself as Health Secretary. No Health Secretary and no NHS chief executive ever wants to have to say publicly that the proportion of funding going to mental health has fallen on his or her watch, because that would be a direct contradiction of the principle of parity of esteem. That is why, since this became law, we have seen the proportion of funding of the entire NHS budget going into mental health either stabilised or starting to go up. That should put to rest some of the Opposition’s concerns about the risk of a decreasing proportion of NHS funding going into mental health, but it does not solve the problem.
The issue when it comes to mental health services for our constituencies is not about political will or funding; it is about capacity. We have an enormous number of ambitious plans on mental health. I unveiled one—in 2016, from memory—that said we would treat 1 million more people by 2020 and increase spending by several billion pounds. The mental health “Forward View” had some very ambitious plans, and we had the children and young people’s Green Paper. There are also targets to increase access to talking therapies, which are essential for people with anxiety and depression. But if we do not increase the capacity of the system to deliver these services, in the end we will miss the targets. For example, the children and young people’s Green Paper is an incredibly important programme, with a plan for every secondary school in the country to have a mental health lead among the teaching staff who would have some of the basic training that a GP would have to spot a mild mental health illness, anxiety or depression, or a severe one such as OCD or bipolar, and therefore know to refer it—[Interruption.] I am getting a look. I understand, and I will draw my comments to a close—
Thank you. I am sorry—I am new to this Back-Bench stuff. Apologies for not facing the Chair. I will now do so more diligently.
The point I wanted to make, Dame Rosie, is simply that the children and young people’s Green Paper requires an increase in the children and young people’s work- force of—from my memory as Health Secretary—9,000 additional people. The CAMHS workforce is actually only 10,000, so the Green Paper alone requires a near doubling of the mental health workforce. Far be it from me to teach experienced Opposition Members how to scrutinise the Government or hold them to account, but if they really want to know whether we are going to deliver on those promises, looking at the workforce numbers in children and young people’s mental health in the CAMHS workforce is the way to understand whether we are going to be able to deliver those extra commitments.
Is not that the key point? Young people’s experience of CAMHS on the ground is that they just cannot get an appointment. Rather than being seen in the early stages, as they should be, they often get seen only when they have become suicidal or have tried to commit suicide. That is the wrong way round.
The hon Gentleman is absolutely right. On both sides of the Chamber, we are totally committed to the NHS and totally committed to transforming mental health services, but I am afraid that young people are regularly turned away from CAMHS and told, “You are not ill enough yet. Come back when things get worse.” Why is that such a tragedy? Because half of all mental health conditions become established before the age of 14, and the way to reduce the pressure on the NHS is to intervene early. That is what does not happen.
In support of what my right hon. Friend has said, I think that one of this Government’s great initiatives in respect of children’s mental health in the past decade has been the work done through the health and wellbeing boards. I know that this was strongly supported by him when he was Secretary of State and by other Ministers since. Every local authority, using its connections with the schools and general practitioners in its local area, has a plan that reflects local need. This has evolved over the years to change the commissioning priorities at local level, which is reflected in what is purchased from NHS providers to address local need. I offer as an example an online counselling service that has been introduced to serve my constituents. The feedback from young people is that it is tremendously more accessible than what was there previously, and it is a lot less expensive than the type of services previously being commissioned. That demonstrates the commitment we have on the Government Benches to addressing children’s mental health.
My hon. Friend has huge experience of this in local government, and he is absolutely right. The big surprise for me when we were conceiving of the children and young people’s Green Paper was the willingness of NHS professionals to accept that the people who know the kids best are their teachers, rather than GPs, because the teachers see them every day and are probably going to be better at spotting a mental illness and being able to do something about it.
I would like the right hon. Gentleman to consider whether he supports an important proposal that we put forward at the general election. It was that there should be a trained counsellor in every school to spot mental health problems. Putting that burden on to teachers and others in the teaching profession is the wrong way forward. In Wales, we have the experience that having trained counsellors in schools relieves the pressure on CAMHS. If we want to take children’s mental health seriously and relieve the pressure on CAMHS, we should do this. I have a couple of schools in my constituency that have trained counsellors, and it really helps. The other thing that we proposed was to have a mental health hub in every local authority area, so that children and their families in crisis would have somewhere to go where there would be professionals and charities that work in mental health. Those ideas that we put forward really should be considered, and I wonder whether the right hon. Gentleman supports them.
They are both interesting ideas. The plan at the moment is that resource will be given to schools for a teacher to volunteer to devote a proportion of their time to this, and that there will be funding for them to do so, similar to the way in which schools have a special educational needs co-ordinator who is a teacher devoted to the special needs of the pupils in that school. I personally would have no objection if that were a separate counsellor, but this needs to be a resource inside the school—someone who is regularly at the school and who knows the children there. That is the important thing.
With permission, Dame Rosie, I would like to comment on some of the other amendments and on some of the comments made by the hon. Member for Ellesmere Port and Neston. He rightly talked about the issues around maternity safety, and I agree that it is vital that we continue the maternity safety training fund. That is not directly the subject of one of his amendments, but it is indirectly connected to it. Twice a week in the NHS, the Health Secretary has to sign off a multi-million pound settlement to a family whose child has been disabled for life as a result of medical negligence. What is even more depressing is that there is no discernible evidence that that number is going down. The reason for that is that when such tragedies happen, instead of doing the most important thing, which is learning the lesson of what went wrong and ensuring that it is spread throughout the whole country, we end up with a six-year legal case. It is impossible for a family with a child disabled at birth to get compensation from the NHS unless they prove in court that the doctor was negligent. Obviously, the doctor will fight that. That is why we still have too much of a cover-up culture, despite the best intentions of doctors and nurses. This is the last thing they want to do, but the system ends up putting them under pressure to do it. That is why we are not learning from mistakes. I am afraid that that is the same thing that was referred to in the Paterson inquiry report that was published today: the systemic covering up of problems that allowed Mr Paterson’s work to carry on undetected for so long. The hon. Member for Ellesmere Port and Neston is absolutely right on that.
I think it is a fair assessment of safety in the NHS to say that huge strides have been made in the past five or six years on transparency. It is much more open about things that go wrong than it used to be, and that is a very positive development. But transparency alone is not enough. We have to change the practice of doctors and nurses on the ground, and that means spreading best practice. Unfortunately, that is not happening, which is why, even after the tragedies of Mid Staffs, Morecambe Bay and Southern Health, we are facing yet another tragedy at Shrewsbury and Telford—I see my hon. Friend Lucy Allan in her place, and she has campaigned actively on that issue. The big challenge now is to think about ways to change our blame culture into a learning culture.
I declare an interest in that, a long time ago, I was a personal injury barrister, including in cases of medical negligence. Does my right hon. Friend think a possible solution to the resistance to blame in the national health service might be the adoption of a no-fault compensation scheme much like that in the personal injury sphere in New Zealand, for example?
My hon. Friend makes an important suggestion. We considered such a thing when I was at the Department of Health and Social Care, but we decided that it would be very expensive. One of the tragedies is that many people who suffer actually make no legal claim because they are so committed to the NHS, so we have a system that gives huge amounts of money to one group of people and nothing at all to those who decide that they do not want to sue the NHS.
We need to look at tort reform, because most barristers and lawyers working in this field want the outcome of their cases to be that the NHS learns from what went wrong and does not repeat it. Unfortunately, that is not what happens with the current system. The involvement of lawyers and litigation causes a defensive culture to emerge, and we actually do the opposite. We do not learn from mistakes, and that is what we now have to grip and change.
I want to say something positive, because if we do change that we will be the first healthcare system in the world to do it properly. We are already by far the most transparent system in the world, mainly because people in this place are always asking questions about the NHS—and rightly so. Healthcare systems all over the world experience the same problem. It is difficult to talk openly about mistakes because one can make a mistake in any other walk of life and get on with one’s life, but if someone dies because of the mistake, that is an incredibly difficult thing for the individuals concerned to come to terms with. That is why we end up on this in this vicious legal circle.
On capital to revenue transfers, I was a guilty party during my time as Health Secretary. There were many capital to revenue transfers because we were running out of money, so capital budgets were raided. I fully understand why the Opposition wanted to table amendment 3, but I respectfully suggest that the trouble is that it would result not in more money going into the NHS but in more money going back to the Treasury from unspent capital amounts. The real issue of capital projects is getting through the bureaucratic processes that mean that capital budgets are actually spent.
I congratulate the right hon. Gentleman on securing the chairmanship of the Health and Social Care Committee, and I look forward to joining him on the Liaison Committee. He is a former Secretary of State, so he surely understands and appreciates that this Bill has a significant impact on Scotland, because it will affect our budgets through the Barnett consequentials. Does he think it is right that we are excluded from tabling or even voting on any amendments?
I do, because this Bill about the NHS in England. It would be nice if we occasionally had a word of thanks, because the Bill will result in a lot more money being made available for the NHS in Scotland. The hon. Gentleman should, if I may say so, welcome that, because I think that will be as welcomed among the Scots as it will be welcomed by the English.
My point about capital to revenue transfers is that it is a big deal to get a hospital building project off the ground. So many get delayed because hospital management teams are very busy. They may have struggling A&E departments and are trying to meet other targets and to deal with safety issues—whatever it is—and they do not have the management resource to invest in putting together the case that, quite rightly, the Treasury and the Department of Health and Social Care demand is extremely rigorous and thorough. That is why things get delayed. If we want to ensure that these 40 hospitals get built, the Government should consider a central team at the Department of Health and Social Care to put at the disposal of hospitals that we want to build extensions or new buildings, so that they can actually navigate those hurdles—[Interruption.] I am getting nods from the very capable Minister for Health, my hon. Friend Edward Argar, so that might be under consideration.
I am grateful to the former Secretary of State for giving way. I admire his admitting his role in converting capital to revenue, and I am sure he regrets that he was unable to build the hospital we need in Stockton to close the health inequality gaps in our society. If he has any influence left in Government, perhaps he will have a word in some ears and say, “They really do need a new hospital in Stockton-on-Tees.”
I can be honest with the hon. Gentleman and say that I regret not being able to build lots of hospitals around the country in that period, because funding was short. Now, however, we are in a different situation. It is important that we build these extra hospitals, but there will be some big challenges in ensuring that we do so.
I thank the right hon. Gentleman for giving way. I welcome his suggestion of a central design team, because the NHS is over 70 years old and we seem repeatedly to reinvent the wheel. Does he recognise that it is not just about building new hospitals, because maintenance has also been allowed to slide? There are leaking roofs and leaking sewers, and patients are still in hospitals that are basically not fit for use. Maintenance is most urgent.
I agree with the hon. Lady. Maintenance is a big issue in many hospitals. A number of hospitals are still essentially prefab buildings that should have been torn down a long time ago, and there are others where maintenance can solve the problem. I think we have to attack all of that, and I welcome the fact that there is a real commitment from the Government to do so.
Finally, I want to talk about new clause 4, which relates to whether the Government are giving enough to the NHS to meet the current waiting time targets for elective care, A&E, cancer and so on. I welcome the Opposition’s focus on this matter, because the public absolutely expect us to get back to meeting those targets. It was an important step forward for the NHS that we did bring down waiting times, and I have often credited the previous Labour Government for that happening, as I hope the Labour party will credit this Government for the focus on safety and quality in the wake of Mid Staffs. However, as we focus on safety and quality, I would not want to lose the achievements that were made on waiting times, because it is fundamental to all patients that they do not have to wait too long for care. Indeed, waiting times themselves can be a matter of patient safety.
My right hon. Friend mentioned targets and people getting access to care. Gareth Thomas referenced Pinn Medical Centre, which is in my constituency, and the impact on Northwick Park Hospital in his constituency. This is a really good example of when the issue is not with the total sum of funding but with how the NHS is spending it. If the system can afford £300 to pay for each A&E attendance, I am sure it can afford £70 for those patients to attend a walk-in centre instead. This is not about an arms race and who can spend the most, but about who can bring the most focus to spending the money in the way that benefits patients and our constituents the greatest.
My hon. Friend neatly makes the point that I was hoping to make next. I will elaborate on the brilliance of his insight and simply say that when we think about waiting times it is very important that it is not just a debate about money. I appreciate that the Bill is about money, and that is why amendments have been tabled about money, but I want to give the example of the annual cycle of winter crises that we seem to have in the NHS now. I looked up the figures and, over the past five years that I was doing the job, in the first year I gave the NHS £300 million to avoid a winter crisis; in the second year, £400 million; in the third year, £700 million; in the fourth year, £400 million; and in the fifth year, £400 million. In four of those five years, we still had a winter crisis. That is because in the end it is not about money as much as it is about capacity.
If we do not have the additional doctors and nurses available to provide the care that we want to be provided, money will disappear very quickly and we will not see any benefit for it. If we want to get back to those waiting time standards—and no one would want to do that more than I do—we have to look at the issue of capacity, and in two areas in particular.
First, are we actually training enough additional doctors and nurses? I introduced some big increases—a 25% increase in doctors being trained—and of course because it takes seven years to train a doctor, they will not start to come through until towards the end of this Parliament. The Government have announced a big increase in the number of nurses that they want to recruit, but training new nurses takes three years. Looking at whether those numbers are right will be absolutely essential if we are to break the cycle of winter crises. Essential to that is to ensure that we have an independent estimate of the number of doctors, nurses, physiotherapists and allied health professionals that the NHS actually needs and a Government who sign up to training those numbers.
If that number is the result of a negotiation between the Treasury and DHSC, the Treasury will negotiate those numbers down because it always sees training more doctors and nurses as building up a cost pressure for the future. Actually, it is the opposite: if we do not train enough doctors and nurses, the NHS ends up having to pay extortionate agency rates and locum doctor rates, and it ends up costing the NHS more. I would like an answer to the question of whether we are even now training enough doctors and nurses, and I would like to know what the NHS actually believes is the answer to that question. I would also like to know that the Government are committed to doing that, and I very much hope that when we have the people plan, there will be an independently audited projection of the number of doctors and nurses required.
The final point I wanted to make is about—
It was always the final point, and it is very much the final point.
The other area that is essential for capacity is the social care system. My hon. Friend David Simmonds talked about how money can be wasted. One of the biggest wastes of money is that we pay for people to be in hospital beds, which cost three times as much as care home beds, because we do not have the capacity in the social care system. It is very important that we encourage people to save for the future and protect people against losing their homes, but if we want to see a change in the NHS in the next five years it is fundamental that we increase the ability of local authorities to deliver adult social care to people who cannot afford it. At the moment, they do not have enough to do that, and we must put that right.
Finally, here we are, in the English Parliament after all these years. Isn’t it great? The Mace is down, the signs are up, and the dream of David Cameron has finally been realised. For the first time since 1707, English Members of Parliament will get to vote on English legislation to the active exclusion of the rest of us. I wonder if the Minister could have even dreamed, when he and I were but lowly Back-Bench members of the Procedure Committee back in 2015 and scrutinising the EVEL processes, that this is where we would end up today.
I wonder whether, like me, my hon. Friend feels that this English Parliament is actually pretty similar to the usual Westminster Parliament that we do all our business in. Does he agree that the English votes for English laws procedure has been about the most divisive, disruptive and useless procedure ever put into this House? It makes distinctions between classes of Members of Parliament in this House, and what we are doing today is disallowing us to vote on issues that are vital to the Scottish health service. Does he agree that it is a disgrace, and that it must go?
Yes; I absolutely agree. My hon. Friend is right: I barely noticed the difference as this place magically transformed itself into the Legislative Grand Committee (England). Incidentally, I do not know whether he remembers, from his time here, whether the Scottish Grand Committee was ever permitted to meet in the Chamber of the House of Commons. I fear it was not, so quite why the English Grand Committee enjoys that privilege and does not have to meet elsewhere in the building or elsewhere in England is kind of beyond me. But my hon. Friend is right that those of us from seats in Scotland and Wales and Northern Ireland are, for the first time, being actively excluded from the opportunity to vote on amendments.
Mark Tami may also have been a member of the Procedure Committee back in the day; I certainly seem to remember points about the cross-border hospitals being raised. He has constituents in Wales who use hospitals in England that will be affected by this legislation, and he is unable to vote on or amend those provisions.
My hon. Friend’s secondment to the English Parliament is going rather well so far, although it is rather similar to the UK one. Does it not distil the ridiculousness of the EVEL procedure that we have before us a Bill that clearly impacts on the funding of the NHS in Scotland, as the former Secretary of State mentioned, and yet the Government have put the Chair in the invidious position of deciding on the issues that we can or cannot vote on, instead of our making that decision about the issues that are important to our constituents?
There we go. We have now had as many Welsh and Scottish Members contributing from the Floor, as Members from elsewhere in the United Kingdom. These points were raised back in the day, on the Procedure Committee, even if it was not the hon. Gentleman who gave that evidence.
This morning, the Prime Minister turned up at the Science Museum in London to launch a conference that is taking place in Glasgow. That probably tells us all we need to know about the Government’s concept of how the United Kingdom works. Four days after the UK leaves the European Union, and the Tory Government choose to display their love for the precious Union on these islands by creating two classes of Member in the House of Commons—those who can amend legislation and those who cannot. Well, as the Chair of the Health Committee asked us to say, “Thank you.” Thank you so much, because the polls are showing that support for independence in Scotland has reached 52% and growing, and that support will not go away. Constituents in Scotland will be watching today’s proceedings, wanting to know why their Members of Parliament are not allowed to vote on amendments that could increase health spending, not just here in England but throughout the United Kingdom.
Labour’s new clause 5 rightly calls for the Government to analyse the effect of inflation on the figures set out in the Bill.
Does my hon. Friend agree that, as I mentioned earlier, the fact that inflation could make these cash rises meaningless makes it very difficult for the Scottish Government to predict what Barnett consequentials they can count on in 2023 and 2024, so it should be committed to in real terms, not just cash terms?
Yes; my hon. Friend is absolutely right, and we would be very happy to support new clause 5 if the procedures of the House allowed us to. It is absolutely crucial to what the Bill is trying to achieve.
We know it is a showpiece Bill anyway, but the Government are getting a showpiece English Parliament out of it as well. Of course, the terms of the money resolution are so restrictive that amendments intended to amend the figures in the Bill are completely out of order. The Labour party tried that—that point was raised by more than one Opposition Member at Second Reading, and I am not sure that Ministers could answer it.
Labour’s amendment 3 prevents capital funding from being transferred to revenue streams. That is hugely important as well, because any increases in the revenue funding—the figures on the face of the Bill—have to come from new money. Otherwise, the whole thing is pointless: it is just shuffling things around. It is new money that would give rise to Barnett consequentials, and that is where our interest comes in.
New clause 4, on performance targets, makes exactly the same point, and we support that as well. That is also relevant to us.
It is often cast up here that the Government in Scotland are not spending all the Barnett consequentials on health, but they do. The problem is that although the Government here keep talking about the rise they are giving to the NHS, there are cuts to public health and social care, and there have been cuts to education and training. In Scotland, we still take the whole responsibility of a health Department seriously.
My hon. Friend is absolutely right on that. The Scottish National party has always pledged—we have done this throughout our time in government—that any Barnett consequentials that arise from health spending in England get passed to the NHS in Scotland. Any time the figures set out in this Bill increase, those Barnett consequentials would be expected to fall to the Scottish block grant, so it is well within the interests of Members from Scotland, Wales and Northern Ireland to seek to amend this Bill. Our own unselectable suggestions that appear on the amendment paper require analysis of what would happen if health spending per capita in England and Wales was raised to the level in Scotland. That was part of our manifesto commitment; by raising health spending in England, we would also raise spending across the United Kingdom. But here and now, on the Floor of the House of Commons, in the UK Parliament, that idea cannot be tested, voted on or even, technically, discussed.
Does my hon. Friend agree that “per capita” is a much more informative way of describing spending, because demand is increasingly rapidly, with an ageing population that is not ageing healthily, and just talking about the headline numbers does not show whether the amount provided for each person is sufficient to provide their services?
I thank my hon. Friend for that. The contributions she is making demonstrate precisely why Members from Scotland should have been allowed to participate fully in this stage of the Bill and the whole process.
If the official Opposition choose to press any of their amendments this afternoon, we will seek to express our views, on behalf of our constituents, by walking through the Lobby. We will walk past the signs that say, “England only” and if the Tellers from the Government Whips team choose not to count us, that will be their decision. Of course they will also have to discount any of their own colleagues from Scotland and Wales who deliberately or accidentally end up in the Lobby; perhaps that is also an argument for getting rid of this ridiculous voting Lobby system, but I appreciate that that is for another day.
The Government could have avoided this situation, by allowing proper time for a Report stage, where Members from Scotland and elsewhere could move amendments. They could have committed the Bill upstairs to a Public Bill Committee, but they chose to convene an English Parliament here in the Chamber of the House of Commons, which is supposed to represent the whole of the UK.
My hon. Friend has taken over the EVEL mantle with great aplomb. I understand that the “England only” signs are already in the Lobby, and this in the UK Parliament of Great Britain and Northern Ireland! What does that say to people from Scotland? What does it say, given that this Bill determines so much of our health spending in Scotland? Surely the days of EVEL have to come to an end. We cannot go on like this. This is the Parliament for everybody across the United Kingdom; it is not their Parliament to squat in.
It really does not feel like that at the moment, does it? Hear no EVEL, see no EVEL, speak no EVEL should be the mantra, because my hon. Friend is right; this might not be the last time.
I am grateful to my hon. Friend for allowing me to speak in the English Parliament for the first time. Does he agree that one way to get around this whole EVEL conundrum is simply for the English Parliament to be made officially an English Parliament and then we can all have our own national Parliaments in our own countries?
I wholeheartedly agree, Dame Rosie. I have addressed the amendments that we have an interest in, and I am contextualising why they are relevant to our constituents, but points are being extremely well made by my colleagues. There is a simple solution to this, which we in the SNP have been promoting for 84 years, since 1934: Scotland can become an independent country and England can have the Parliament that it wants. As my hon. Friend Neil Gray says, with the greatest respect for the Speaker, it should not be for the Chair or for the Government to decide what does and does not apply to Members from different parts of the UK. My job and that of my colleagues is to look at each measure before this House and determine for ourselves whether it is relevant to our constituents and act accordingly. Today, we are being actively prevented from doing that. There are amendments and new clauses on the amendment paper that we deem to be of interest to people in Scotland, which would take forward commitments in our manifesto, but we will not be able to vote for them. That is not a precious Union. That is not a partnership of equals. That is not leading instead of leaving. It is not something that is going to be sustainable for much longer, and 52% of people in Scotland seem inclined to agree.
I rise to speak to new clause 9, tabled in my name and those of Dr Whitford and my hon. Friend Sir Charles Walker. I am pleased that Scotland will have its say, at least with regard to this new clause.
Conceptually, the Bill will absolutely do the right thing, because for long-term decision making we need some clarity as to how much money there will be. As I said on Second Reading, my concern is about whether or not the figures are right, and at that point I proposed a formula that would enable the figures to be flexed to properly determine the need and whether the figure would to be sufficient to meet it.
New clause 9 deals specifically with the issue of mental health. There is agreement among all parties that it is crucial that we get mental health right. It is crucial that it is properly respected and properly resourced. Members from all parties have talked about and supported parity of esteem between physical health and mental health. It might be useful—this is not in the new clause, but we are talking about the issue more broadly—if at some point the Government could give some clarity on, if not a formal definition of, what parity of esteem means.
Parity of esteem is not as simple as how much we spend on physical health and how much we spend on mental health. That is clearly a guide and an easier thing to measure, but it seems to me that if we really mean parity, we should look at not only at the inputs—the money we put into the system—but the outputs. Are we seeing an improvement in access to mental health services? Are we seeing fewer people not being referred with the speed that they and the system expect? What outputs should we look for, and should they not be measured in some way in an annual statement?
New clause 9 would go further than the Opposition amendment, which looks to measure inputs and money, and would require the Government to do something broader and ultimately more meaningful to the British people, whichever quarter of the United Kingdom they come from.
We have discussed today, and on many other occasions, the issues relating to child and adolescent mental health and the pressure that young people are under right across the UK, and training for teachers to support them in schools was mentioned. In Scotland, we are putting 350 counsellors into schools. Does the hon. Lady recognise that putting that level of investment into education, where these young people are, would reduce the pressure on CAMHS, and that any assessment would need to include that? If children end up in CAMHS who do not need to be there and who could have been helped earlier, that is also a failure.
The hon. Lady makes an apposite and correct point. We cannot talk about mental health just within the health and care bucket, so to speak. What do we do to help young mums? What do we do in the school environment for youngsters, who are increasingly put under huge pressure, with cases of stress and depression growing daily? What are we doing in the workplace? Historically, mental health has been something that we do not talk about; indeed, people almost dare not to for fear of being demoted and losing their job. There are many aspects of mental health that need to be taken into account if we are truly to deliver parity of esteem. I would like to think that the Government, and perhaps the Minister when he responds to the debate, would acknowledge the breadth of the need to work together across Government Departments so that we look properly at the outcomes and at the different pieces that affect those outcomes, which go well beyond the Minister’s particular brief.
I thank my hon. Friend for giving way. She is making some very good points. An interesting amendment has been tabled by Munira Wilson on the need for greater transparency more generally in mental health funding. It is difficult to understand properly what level of investment is currently going into mental health services, be it CAMHS or general adult mental health services. Would it not be a good thing if the Government took on board the spirit of that amendment and published data on mental health spend on an annual basis across all mental health services, from CAMHS and general adult to older adult and learning disability services? That would help to make the argument that money is actually going into what has been a Cinderella service for far too long.
My hon. Friend is right in that the things that are relevant to mental health cannot exclude the budgets in other parts of the system. He is absolutely right, as Munira Wilson is, that these things need to be looked at together. Yes, I certainly agree that a written report that sets out what money is being spent where would be very welcome, but I guess that my amendment goes beyond that and says that we should be sure that we are getting something for that money, rather than simply putting in that money and not having any grasp as to whether it is actually making a difference, which is crucial.
I should like to reinforce that point. I in my constituency, as she in hers no doubt, have need that should be tackled and that requires support and treatment, but it is important that it is worthwhile treatment under the right protocol so that things get better. I would value much more information on who is being treated and whether the treatment is working rather than more information on money.
That point is extremely well made. Let me say, if I may, that there is also a challenge for any Government to be able to properly ascertain what the actual need is. There is a lot of hidden need. In rural communities such as mine, the real challenge lies with isolated elderly people and with lone workers—whether it be a farmer or a policeman. We know that farmers have the highest rate of suicide of any profession. Much of that mental health challenge is not understood or measured, which makes it critical that we look at that need and then, as my right hon. Friend sets out, make sure that what we do properly meets that need. He is absolutely right.
I agree with the hon. Lady’s point about measuring outputs as well as inputs, but does she agree that one of the big challenges with CAMHS is the real dearth of data? There are many gaps in the data that is collected. I make this point advisedly, because there is another challenge in gathering more data. I have been lobbied in my own constituency by a charity supporting children and young people with mental health issues. Its funding has been put under threat by NHS England unless it starts to report the date of birth of the young people accessing its service and other information, which then undermines the anonymity that it guarantees to those children and young people, so reporting on the outputs is not actually that straightforward.
The hon. Lady makes a very good point—I think there are probably two points there. The first is what we should be measuring and when, and the second is about data and the privacy issue. The points are related, but separate. The first one, which is about measurement, is a point very well made. Certainly, the point at which my constituents are counted as being in the box and in need and being referred for mental health can be very far down the line from their first presentation. The figures will often not properly represent the number of people who are actually in need, so I think she is right that we need to be clear at what point we measure an individual coming into the system. I am not clear from what I have heard anecdotally that it is. Some clarity and perhaps an investigation into that would be very helpful. The hon. Lady’s point about privacy is a much broader issue, and I think it would be beyond the scope of this debate to look at it now. The point was well made, but it is a much bigger point for another day.
Through new clause 9, I am asking for an annual report that would show how mental health provision has improved. Such a report would state how we identified what we included in the mental health bucket that I mentioned; how we identified who is in need; how we measured whether that individual received an intervention, and whether any such intervention was timely; whether the individual’s condition has improved or got better; and how any improvement has been assessed, because that can be a very difficult question. I appreciate that for many individuals with mental health concerns, these are lifelong conditions. We would therefore not simply be measuring whether somebody is “cured”, but looking at the level of improvement and the extent to which the intervention has helped—or not helped—that particular individual. It is very complicated.
My new clause would require the Government to look specifically at how we are going to measure the extent to which we have been able to prevent mental health problems. Specifically, we need to start looking at the support we give in schools, to pregnant mothers and in many other situations. This provision would also require information on how we have diagnosed mental health problems. Too often in constituents’ cases, I find that it is only when a diagnosis is finally and formally made that there is any intervention or help. I have heard from a number of parents of young children and teenagers who have faced problems such as eating disorders and attempted suicide, but much to my concern and that of the parents, as no diagnosis has yet been made—because they cannot get an appointment and so on—the individual youngster who is self-harming is not yet considered to have a mental health problem. The consequence is that they do not get the support and assistance they need, so diagnosis is very important.
I support what my hon. Friend is saying in her new clause about outputs. This is an issue that I tried to address—and failed, I readily admit—when I was the primary care Minister. She will be aware of the NCT’s Hidden Half campaign, which aims to improve the six-week postnatal check. Does she agree that there are opportunities for the NHS to make an intervention and assessment, but that those opportunities are currently missed? For example, we should be changing the GP contract so that when new mums go for the six-week check with their babies, they get a maternal mental health check at the same time. There are already opportunities, but we are missing them.
My hon. Friend makes an excellent point. Just like physical health checks, which are very much part of the standard GP system, mental health checks should equally be a part of the standard checks that take place when people present at surgeries. I entirely agree.
Does the hon. Member recognise that we all know what we should be doing to look after our physical health—there is a handful of five key points—but that most of us have no idea what we should be doing to look after our mental health? As well as talking about primary care in schools and workplaces and public campaigns, we should all be being taught how to develop our own resilience and how to look after our own mental health better.
That is one of the best points that I have heard in this debate, and it is extremely well made. However, it is a real challenge trying to help individuals to accept even that they might be vulnerable to mental health problems, because it has been such a taboo—let alone the second stage of learning what we can do to try, as the hon. Lady says, to make ourselves resilient. I am pleased that we are having mindfulness classes across the House, not just for MPs but for our researchers. That is not the total solution, but it is at least a step in the right direction. However, her point is about something much bigger than just an intervention—it relates to a big piece missing from this whole agenda. We spend a lot of time talking about illness and not enough time talking about wellness.
Is it not particular to mental health that when we use the phrase “mental health” we actually mean illness? We all have mental health, sometimes good and sometimes bad. If we changed the language, it might be easier for people to talk about.
The hon. Lady is absolutely right. The challenge, as she recognises, is how we change the language in a way that is accepted and becomes the norm. Part of this is having a much greater focus, as I hope the Secretary of State and his team ultimately will, on wellness, because that is absolutely as important as dealing with the illness when it happens.
We need to remember that in terms of stages of intervention, the whole lifecycle is not just about birth, education and the workplace; it is also about the elderly and veterans, for whom there is often not as much done to identify need and provide support. An older person in a rural area will often have the need but because they are simply out of scope—under the radar—they will, for a very long time, suffer in silence to a point beyond which they cannot be helped. The challenge of mental wellness/illness for older people needs to be a specific focus.
For all that we say, and rightly, about the importance of ensuring that our veterans are properly diagnosed and properly supported, I am certainly conscious of veterans in my constituency who are struggling to get help and support, or even an initial diagnosis. Sometimes the support they need is so complex that they can only get it in London. For somebody who does not have good mental health, the journey from Devon right the way up to London is something they simply cannot conceive of and make a reality.
I am extremely grateful to the Minister for sitting and listening to my thoughts, and for understanding my approach in terms of looking at this in a much more holistic way and seeing how we might measure and report on it so that we can demonstrate to people that we are making progress on parity of esteem. We should look at inputs as well as outputs. I look forward with a great deal of interest to his reply on the points that have been made, particularly on outputs in mental health.
I rise to speak to the amendments in my name and the names of my colleagues.
As we have all heard, our NHS needs to be properly resourced in both physical and mental health, but far too often patients are losing out under this Government, with longer waiting times, a huge increase in cancelled operations, and crumbling hospitals. Colleagues have already raised these important issues. I urge the Government to accept the amendments in the name of the Leader of the Opposition as a real signal of their intent to reverse the damage that their party has done to our national health service over the past 10 years.
My amendments focus specifically on mental health. The Government have made much of the need to ensure parity of esteem. This would mean us valuing mental health equally with physical health and adopting an approach that tackles it using the same standards that we expect for physical health patient treatment as a template for treatment that we provide for mental health patients.
I have heard warm words from the Prime Minister, the Secretary of State and Ministers about the importance of mental health and the growing need to tackle mental ill health as an urgent priority, but I have not yet seen that wholehearted commitment manifest itself in actions to tackle the situation we are in. The British Medical Association found that the mental health workforce has had little growth over the last 10 years. The Royal College of Psychiatrists found that the rate of unfilled NHS consultant psychiatrist posts in England has doubled in the last six years. The first briefing paper from the Centre for Mental Health’s Commission for Equality in Mental Health found that mental health inequalities are closely linked to wider injustices in society. Far too many patients with a mental illness are still being sent hundreds of miles away from home.
By accepting the amendments in my name, the Government would show that they are willing to be transparent about the way they go about achieving their long-stated aim of parity of esteem. The Government have already shown, with the presentation of this Bill, that they think it is a good idea to commit, in law, to a minimum allotment that the Secretary of State will make to the health service in England in each financial year for the next four years. That is designed to show that their promise is legally binding and can be scrutinised by Parliament and the public if they do not reach those targets.
To ensure that our mental health services are properly resourced and truly responsive to the various complex conditions that people present with, the public need to know how much is being spent, including how much is being proposed, and what happens in practice. That is all my amendments seek to do—they would provide Parliament and the public with the opportunity to compare the proposed allotment with the final allotment across different years.
Of course, that is not enough, and it is clear that additional resources for mental health services are only one part of the answer to tackling the mental health problems in this country. We know that education and training services are essential to bring about the necessary increase in the workforce. We know that local government provides significant elements of mental health support through public health, youth services, housing and social care, and two thirds of schools fund their own mental health support. We also know that the Government’s roll-out of universal credit will exacerbate mental health inequalities, which all too often relate to people’s economic and social circumstances. This is not the time to go into those in detail, but I urge the Government to remember the need for those essential services to have a long-term funding settlement and, in the case of social care, an agreed basis for future financing. With ambitious targets to meet in the long-term plan, there is a risk that resources will be diverted from other areas of mental health support to achieve compliance.
I would like to invite colleagues across the House to join me on Thursday for my adjournment debate on Children’s Mental Health Week, which is this week, to discuss these issues further. I know what a commitment to transparency on mental health spending would mean for all those suffering mental ill health and those fighting for them. I hope that the Secretary of State will accept amendment 1 and new clause 1, to ensure that mental health services get a fair deal from the legislation and that pledges made by the Government and NHS England are realised in practice.
It is a pleasure to speak in this debate, because it is a rare one in so far as there is quite a lot of agreement across the Committee on the substance of it. There appears to be agreement—I await an intervention if anybody disagrees with this—that increasing funding for the NHS is a good thing, that it is good that mental health is a Government priority and that it is very important to establish what parity of esteem means in practical terms.
I would like to take this opportunity to describe what I have seen in my constituency in terms of the importance of mental health and how the increased funding will make a practical difference. One way in which the funding will make a difference is with mental health support teams. There are mental health support teams in 25 areas in the country. Hertfordshire was picked as one of those 25 areas, and we have two teams—one in my constituency, and one just outside it—that effectively piloted a hub-and-spoke model. As Preet Kaur Gill said, it is Children’s Mental Health Week, and the aim of that model is to ensure that young people get better mental health support in and around their school, working in conjunction with the NHS.
As I have seen in my constituency and everywhere I go, when I speak to young people, one of the first things they ask me is, “How can we improve mental health?” Whenever I have spoken to young people, their teachers or local NHS staff, they say this model has the potential, as it is rolled out and developed over the coming months and years, to make a real, fundamental difference. If people are looking for the practical impact of our increased funding for mental health, these teams are one way in which we are already starting to make a difference, not just in my constituency but across the country.
I would like to mention a couple of charities I am involved with that are starting to work in an integrated way with the NHS in improving young people’s mental health. There is a charity called GRIT—a word in politics that we should all remember—or Growing Resilience in Teens. It was set up by a fantastic doctor in Hitchin called Dr Louise Chapman, and it does what it says on the tin: it is about growing resilience in mental health.
As politicians, when it comes to legislation or speaking to each other in the Chamber or outside, we think often about pounds and pence and talk about structures such as hospitals and stuff that can be measured in a very easy way, or at least what we think is an easy way. However, growing resilience is one of the things we need to ensure the NHS does more effectively. Not just in mental health, but particularly in mental health, growing resilience in our young people is an integral part of prevention. The former Secretary of State, my right hon. Friend Jeremy Hunt, talked about that in his speech, saying that half of mental health problems are established before a young person is 14.
We need to grow resilience among young people to future-proof each and every one of us, and our communities and our society, against serious mental health problems in the future, at the same time as investing in mental health services such as CAMHS, which has already been mentioned several times in this debate. However, we need to do both: to grow resilience and to improve the institutional frameworks. Again, that is what the money this Bill is providing will go towards.
Another charity is called Tilehouse Counselling, which again is based in Hitchin. I do not mean to say that Hitchin has all the charities in my constituency, but in this area Hitchin is a real regional leader and, indeed, a national leader. Tilehouse Counselling provides counselling services to young people, and young people often find themselves at Tilehouse when CAMHS does not have the capacity.
I urge the Under-Secretary of State for Health and Social Care, my hon. Friend Ms Dorries, who is on the Treasury Bench—she knows this because everybody knows how much she cares about the NHS, how much she knows about it and her own personal experience in it as a professional—to use the money provided by this Bill to increase the workforce and to improve the state of CAMHS so that it can treat more people. Again, that means helping the mental health hubs to work with young people and the education system to improve prevention and, when mental health intervention is needed later on if things have got more serious, making sure that CAMHS has more capacity. Again, the money in this Bill will help to provide that.
Another new organisation in my constituency is called GoVox. It has already been in discussions with NHS Digital, and NHSX, about online ways of improving mental health for young people. Increasing funding matters, and it is always worth stating and restating in the Bill that these are minimum numbers, not maximum numbers. This money is hugely needed, and it should make a big practical difference.
On the pleas from Opposition Members—in relation to new clauses 1, 2 and 9, and a few others, which say that the Government must report on this or must do that—I urge the Minister for Health to commit in his response to showing how he and the Government will improve the existing reporting procedures and mechanisms so that the House can be kept fully informed. My right hon. Friend John Redwood spoke about how Members of Parliament often feel distant, not from information about funding, but from outcomes. Will the Minister explain how the Government could improve that delivery mechanism, as that would allay some concerns across the Committee?
New clause 10 is fairly ridiculous as it is a rehash of the argument that we had at the back end of last year—[Interruption.] It has not been selected. You agree with me, Dame Rosie, so I do not need to talk about how ridiculous it is. [Interruption.] Forgive me. Dame Rosie has no view, and it is important to put that on the record.
In the context of the Bill, we must remember what we are here for. I speak with generosity to Labour Members who I know care deeply about the NHS, but we are not here to try to score points; we are here to improve the state of our NHS. Everybody recognises that this is a good Bill, yet many of the amendments appear designed to create some sort of artificial dividing line between Members on this side of the Committee and that side, regarding who cares the most about the NHS or mental health. I urge all hon. Members to remember that the purpose of this Bill is to increase funding to our NHS and improve our mental health services, and I therefore do not support the amendments.
I wish to speak to new clause 2, which is tabled in my name and those of my Liberal Democrat colleagues. As you know, Dame Rosie, I intended to push the new clause to a vote, but I understand that time pressures will not allow me to do so. I am disappointed by that, but I will be pressing the Government on this issue time and again. I want them to make it a high priority and to put it at the forefront of their policy making and commitments to the mental health of children and young people.
It is a pleasure to hear such a unified voice across the Committee about the importance of mental health, and there is a clear commitment to parity of esteem and to ensuring that mental health across the board gets the funding it deserves. I am therefore encouraged by the amendments, many of which I and my colleagues will support.
New clause 2 focuses specifically on the crisis—I used that word advisedly—in the provision of child and adolescent mental health services. It places a spotlight on the chronic underfunding of CAMHS, and seeks to encourage the Government and NHS England to deliver on their promises and improve transparency and accountability on those priorities.
Before I arrived in this place, I was aware of this significant and pressing issue. Less than two months since my election, however, I am utterly horrified by the cases of children and young people in crisis that cross my desk on a weekly basis—or more often—either through my surgery, my inbox, or anecdotally when speaking to acquaintances and contacts in my constituency and well beyond. New clause 2 seeks to make the Government and NHS England more accountable for the funding that they provide annually to CAMHS. That is very much in the spirit of the Bill. The Government are seeking to codify their promised expenditure on the NHS, and the new clause seeks simply to do the same thing in this important area, given that a number of welcome commitments have been made about CAMHS spending.
There are concerns that that funding is not reaching the frontline. Indeed, the evidence is clear. Just last week a report by the Children’s Commissioner stated that many CCGs are spending less than 1% of their mental health budget on children and young people. In 2017, the CQC revealed that CCGs have prioritised adult mental health over CAMHS because of the need to ration services. Other amendments seek to talk about mental health more broadly, but that is the reason why we need a particular spotlight on children and young people’s services.
The phrasing of new clause 2 seeks to ensure accountability against the ambitions of the long-term plan. Subsection (2) would help to demonstrate whether the promises on the growth of CAMHS spending outstripping mental health spending, and NHS spending across the board, are kept.
Subsection (3) shines a spotlight on regional variability. The Children’s Commissioner’s report last week talked about the enormous postcode lottery of spending on services. The numbers cited were staggering. In terms of low-level services, they ranged from 72p in some areas to £172 per child. On specialist services, they ranged from £14 to £191. We all expect some level of variation, but I am sure the Government would agree that that level of variation is utterly unacceptable. It needs to be tracked very publicly, so that spending and services can be improved to meet need.
Why is that so critical? As has been stated by various Members, half of all mental health problems are established by the age of 14. We know that 1.25 million children and young people had a mental health disorder in 2017. We have heard that since 2010 there has been an increase of 330% in admissions to A&E of children and young people diagnosed with a psychiatric condition. We know that only one in four children and young people is being seen by a specialist when they need to.
It is very easy to cite statistics, but behind them are individuals: children and young people and their stories. The stories I have heard are of teenagers self-harming, teenagers who are suicidal, teenagers who are a danger to themselves and their families, and young people who are excluded from school or are taking themselves out of school because of their mental health conditions. One piece of correspondence I received from a parent talked about her 17-year-old being referred for specialist treatment last November. He might be assessed, if he is lucky, in March and he will not get treatment for four to six months after that. That cannot be right. This child has at times been suicidal. I have also had a case of a 10-year-old with tier 3 needs waiting a similar amount of time for the initial choice assessment, who will be waiting a similar amount of time again for treatment.
We have had many plans, many vision documents and many strategies setting out wonderful lofty ambitions for the NHS. As I said, the long-term plan has some very laudable commitments on CAMHS. The Bill seeks to put into law what the Government promise on NHS spending. New clause 3 simply seeks to put into law the Government’s promises on spending on children and young people’s mental health disorders. I cannot press new clause 3 to a Division, but I very much hope that the Government will accept the spirit of my new clause and look to see what measures they can put in place to improve transparency and accountability. We owe it to those children and young people, because this really is a crisis and they need us to step up to the plate.
I will end my remarks with a quote from the mother of the 17-year-old I referred to earlier, because she puts it far better than I could:
“All these young people are our future and if we do not help them now, we are looking at a bleak future as these young people will end up being isolated from society, lack skills for work and relationships, find employment hard, perhaps even get into crime and ultimately will end up not having fulfilled lives and maybe end up being yet another statistic. We have not got this right and it is not just about the budgets or party politics;
we need all of you to work together on this and treat this as an emergency.”
What a pleasure it has been to listen to so many excellent speeches. In particular, I want to say how much I value the contribution of the former Secretary of State for Health, my right hon. Friend Jeremy Hunt—I am sure that Ministers will have listened to what he said. I thank everybody who has tabled amendments, which are very thoughtful and well considered. I am particularly grateful for the amendment on patient safety, and again, I am sure that Ministers will have heard what has been said on that issue.
It is a pleasure to speak in a debate where we are not politicising something that matters so much to our constituents and where we are coming together to contribute our experiences, either in our constituencies or professionally. For that reason, I am delighted to be speaking.
I do not support the amendments, however well intentioned, well formulated and well thought out many of them are. However, I would like to speak to the amendment on capital budgets because there are some learning opportunities for the Government in how they spend significant capital investment on hospitals, upgrades and reconfigurations of hospital services. Those upgrades and reconfigurations are indeed happening now, as was set out in the manifesto, but they were also happening before that. My constituency and the county of Shropshire have experienced significant capital investment, but there has been a very difficult, painful and protracted process in trying to bring that forward as something that will benefit the whole community and improve patient care across the county.
I raise that issue because I hope that Ministers will take away from that experience the fact that it is fundamentally wrong to have significant capital investment where local communities are pitched against one another, as has happened in Shropshire. We saw local CCGs propose that Telford should lose all its acute services and be stripped of its A&E and women and children’s services, with them being transferred to another community some 20 miles away that is significantly more affluent and has better health outcomes. In addition, it was intended that that community would also receive £312 million of capital investment in new facilities. I am sure that hon. Members can imagine how that would make our community feel, particularly when it is disadvantaged in many respects. It is a growing new town that will have 200,000 residents in the next 10 years. We have to provide services with equal access for all, because as this Government have said, they are about one thing: levelling up. They are about narrowing health inequalities and ensuring that there is equality of access to health services across our communities. Of course, the NHS has always been about need. Funding in the NHS should follow need.
I will not delay the House too much with further discussion of the situation in my constituency because I believe that my CCGs, after six years of debating this issue, have had another thought about how they might resolve the problem. It will require more Government funding, but they have already made it clear that the proposal that is currently on the table will also require more Government funding. It will provide a fantastic opportunity for us to resolve this situation, which has been ongoing for so long. So, if the Minister is listening to pleas for more capital funding, may I ask that we complete the proposal in Telford, which will be of such value to our community?
There are other learning points that come from the capital investment programme. CCGs and health trusts have a duty—indeed, the Secretary of State has a statutory duty—to narrow health inequalities. We see that across the country where there have been controversial reconfigurations of local hospital trusts and hospital builds. It is not just in Shropshire either; many MPs on both sides of the House have spoken of the need to narrow health inequalities and to ensure that more affluent communities do not benefit at the expense of more disadvantaged ones. This new Government could not tolerate that continuing in areas of disadvantage.
My third and final point is another that many colleagues on both sides of the House have made already. The CCGs, which make these decisions on behalf of communities, are accountable to no one and, regrettably, take no notice of what local communities say. They might conduct a consultation, as with the Shropshire reconfiguration, but they take no notice of what local people say. They certainly take no notice of local representatives—of the MPs and local councils—and sometimes they appear disinclined to take much notice of the Secretary of State. I am very grateful to him for spending a great deal of time trying to resolve this issue, although the CCG was not particularly impressed with his proposal, which I thought was excellent and would have benefited my community.
CCGs often operate as if they were directors of a FTSE 100 company, with all the trimmings but without the checks and balances that shareholders provide. Without accountability we see abuses of power, conflicts of interest and a failure to serve local communities. It is almost impossible to remove a non-performing chief executive or board, and in any event they just pop up somewhere else with their golden handshake and gold-plated pension still intact.
I genuinely believe that we now have a window of opportunity to solve the Shropshire reconfiguration, and I deeply hope that Ministers can help us to bring it to a long overdue conclusion. If we can learn anything from our experience, it is that we have a decision-making structure in the NHS that does not serve the communities it is intended to serve and which is not accountable to us, and if it is not unaccountable to MPs, to local councils or to individual residents and patients, there is a problem. We need a full examination to ensure that what has happened in Shropshire does not happen again. I am hopeful for my constituents and neighbouring Shropshire MPs that there is a solution on the horizon, and one that would be a positive outcome for all our communities.
That said, our communities should not have had to resort to crowdfunding a legal action against the CCG or the Government, or to protests, marches and petitions, and they should not have had to endure six years of uncertainty or to write thousands of letters to their MP. As the Government embark on this welcome capital expenditure programme—a truly historic investment programme that we all welcome on both sides of the House—I hope they will look at what has happened in the NHS Future Fit process in Shropshire and learn the lessons of that experience so that those mistakes are not repeated.
To conclude, I reiterate what a pleasure it is to take part in a debate where everybody is trying to get the best outcome for their constituents, the country and the NHS in terms of the service it delivers to all our constituents.
You, Dame Eleanor, were not in the Chamber when Patrick Grady indicated that SNP Members might pass through the Lobby, although of course they will not be counted. I seek your help. I want to make sure that the Government Whips do not get confused by my accent and count my vote on behalf of the people of Stockton North when I support the amendment.
The hon. Gentleman asks for clarification and raises a point that I have many times had cause to raise myself, so I am in total sympathy with him, and I am quite sure that his plea has been heard.
I am very grateful, Madam Deputy Speaker.
Amendment 2 concerns spending on mental health services and the Secretary of State’s plans to achieve parity of esteem. Mental illness is often not viewed as a risk to human life, but it is exactly that. In 2018, according to the Samaritans, 6,507 deaths in the United Kingdom were registered as suicides—an increase of 10.9% on the previous year. That means that nearly 7,000 people did not believe that there was help, or another way out of what they were going through.
It can be hard for adults to talk about the feelings that come from being mentally unwell. The words are in their vocabulary, and it may be simple enough to string them together into a sentence, but it is incredibly difficult to say them out loud. I can only imagine how hard it must be for children to express how they are feeling when something is not right. Perhaps they do say the words that are in their heads, but they are not taken seriously. It is a scandal that there are suicidal children as young as 12 who are having to wait more than two weeks for a mental health bed. By not viewing mental illness as life-threatening, we are letting generations down.
There is much debate about what causes mental illness and what is the best form of treatment, but it can take several visits to a GP for people to be taken seriously about not being OK—although many GPs, of course, respond immediately. When parents are fighting for their unwell children to be taken seriously and receive the urgent care and treatment they need, it is horrifying for that to be delayed.
At this stage I should pay tribute to my former colleague Paul Williams, who was the Member of Parliament for Stockton South. He is a GP, and as a member of the Health Committee he spoke extensively about health matters, but locally he took on the child and adolescent mental health services. He knew, as I did because we shared the same area, that it was taking well over two years for young people to be seen by CAMHS. As a direct result of his work, that ended, up to a point, because some children who were due to be seen quickly were actually seen when they should have been. However, those long waits still exist in our area. As we heard earlier from Jeremy Hunt, the former Health Secretary, sometimes children are just not taken seriously.
It is right for the Secretary of State to answer to the House on exactly what the Department is doing, because this is a matter of life and death. Not only the House but the country needs assurance and answers. The state of mental health services will only get worse unless we take action to deliver what is required. The additional money is more than welcome, but I see the amendment as the first, necessary step to provide the funds that are so desperately needed. Equally important is the ability to monitor what those funds are being spent on, and how.
There are many other services on which people depend heavily, including some that we may take for granted, such as smoking cessation services. There is widespread concern about existing funding for services to help people stop smoking. Nearly a third of local authorities no longer provide specialist “stop smoking” services. Stopping smoking is not just a matter of nicotine patches or vaping; people need behavioural support as well, particularly pregnant women, children, and people who are already unwell. One ward in my constituency has some of the highest incidences of smoking in families—whole families smoking—but we also have some of the highest incidences of smoking during pregnancy, and that is not good for the unborn child.
We cannot afford to lose the progress that we have made. We have made tremendous progress over the years, but we need local services that are effective and properly funded. The Government also need to return to funding the multi-media approach to smoking cessation services. I was particularly pleased to learn last week that research has shown that the ban on smoking in cars when a child is present has produced a 75% drop in children being exposed to cigarette smoke in a car. I led on that issue during my first few years as an MP, through private Members’ Bills and a ten-minute rule Bill. The Bills were unsuccessful, but I was delighted when the Government adopted my clause a few years later. We still need to be ambitious and bold about helping people to quit smoking, but services need the resources. I hope the Minister will commit to ensuring that such services are provided, whether for mental health or for smoking cessation, and that they are fully funded so that we can continue to make real progress in that area.
Finally, I shall turn to the matter of capital. The Minister has already heard me talk about the needs in my own constituency. In one ward—the same one I referred to earlier: the Town Centre ward in Stockton—men live 14 years less than those in the Prime Minister’s constituency. His constituency is getting a new hospital, but there are no plans yet for us. However, I have good news for the Minister, because the plan for our hospital is still sitting there. I met the chief executive of North Tees and Hartlepool NHS Foundation Trust just two weeks ago, and she told me that they were ready to dust off the plans again and see how we could provide a hospital. At the time we asked for £100 million from the Government as a guarantor in order to make the project work. The numbers do work, and the health inequalities need to be addressed.
We need to be able to attract the best doctors and clinicians that we can to address the problems in our society. The heart problems are higher on average than anywhere else in the country. We have smoking problems, as I have mentioned, with their related lung and respiratory problems. We also have the legacy of our heavy industry on Teesside, where men who have now retired are in extremely ill health but sometimes cannot get the support they need because we do not have the experts locally to provide it.
In my final sentences, I appeal to the Minister to meet me and the trust members so that we can sit down and talk about this project.
I am glad that he is nodding his head. Ten years ago, the Tory-Lib Dem Government cancelled the project, despite the fact that it was a priority for the country and for the national health service, so I hope that we can now have a meeting and actually start to motor on this. I am pleased to see the Minister smiling, and I hope that he can leave me smiling as well.
I rise to speak in favour of the clauses in the Bill and against the amendments. I do not think that the latter add anything material, and they ignore the vast improvements in mental health under this Government in recent years. One in four adults will experience mental health illness in their lifetime, and that is obviously a high incidence of mental health illness. It shows the growing concern around this issue as well as a growing awareness, and, I have to add, a growing commitment by today’s Government, but we cannot ignore the fact that there are many challenges in the system and many areas for improvement.
I want to talk briefly about the Government’s record. I fully support their commitment to providing funding for mental health services, which will mean that those services’ funding will increase faster than in other areas of the NHS. I hope that much of that funding will go towards the frontline in teaching and education. Perhaps the Minister will address this in his closing remarks.
I meet many education professionals in Fareham who report an increase in the incidence of mental illness among their young people and finding the cost of providing counselling and support an additional burden on their budgets.
It is important to note that by 2023-24, under the proposals in the Bill, at least an additional 345,000 children and young people under 25 will be able to access support via NHS-funded mental health services. That is a welcome aim, and I am confident that we will meet that target under this landmark funding commitment. That progress is hugely welcome, and I am glad that the Government have made children and young people’s mental health a top priority within the NHS, which is halfway through a major programme to improve access to specialist services, supported by £1.4 billion of funding. I congratulate the Front-Bench team and the Government on that work.
I want to talk about some of the incidents that I have come across in Fareham over the past few months. Tragically, several young people took their own lives last year. As I said earlier, I recently met educational professionals who are increasingly worried about how long it is taking young people to access mental health support, counselling or other support through CAMHS. Children or young people are presenting with problems such as anxiety, low-level depression or self-harm, but they are not necessarily meeting the eligibility criteria required by CAMHS, so they are not being accepted for treatment by the services on offer. That leaves them to fall into a treatment gap, which is a problem in Fareham and around the country. Young people are presenting with complex needs that do not necessarily fit into the diagnostic box, and I hope that measures are in place to provide more accessible lower-level care and treatment to meet that demand.
The other issue that young people, their families and teachers, and medical professionals in Fareham are reporting to me is the time it takes to get an initial counselling or therapy session through CAMHS. Young people sometimes have to wait months before an initial meeting, which can have a devastating effect on someone who might be fragile or facing challenges. They may end up dropping out of school, for example, but they may have stayed in school had there been some intervention, or they may increase their level of self-harm or become suicidal within that timeframe. It is tragic that systemic challenges mean that we are unable to reach maybe the easier-to-treat cases in an appropriate timescale. It is incumbent upon me to highlight the challenges we are facing in Fareham, but I am glad that this funding and this commitment to mental health, particularly children and young people’s mental health, will go towards improving some of those systemic problems, such as resources and waiting times.
Turning to some good news in Fareham and the progress being made to address the treatment gap, I am pleased to welcome a new community support project in Fareham and Gosport that has been set up to supplement the existing health service. It is run by the Southern Health NHS Foundation Trust and the Princess Royal Trust For Carers, and a consultation is under way to assess how it can focus more on day-to-day mental health challenges and provide lower-level support for people who do not necessarily fulfil the eligibility criteria that I set out. That might be someone who has lost a job or is facing some financial difficulty, and this support can help them to get through a troubled time and prevent them from deteriorating.
The project will support people on a one-to-one basis and will serve to ease pressure on other services. It aims to nip mental health problems in the bud before they get worse, with a focus on prevention and on flexibility. I really welcome the initiative and hope that if it is successful in Fareham and Gosport it will be rolled out further afield in Hampshire.
I also want to talk about the Southern Health NHS Foundation Trust, which provides mental health services in Fareham. I want to update the House on the good progress that Southern Health has been making. I have been campaigning for many years—in fact, it was one of the first issues that hit my in-tray when I was first elected in 2015—about the systemic and structural problems endemic in the health trust, which was, frankly, failing its patients back in 2014 and 2015. Its leadership has been overhauled and it has had huge interventions from NHS Improvement, as well as a lot of monitoring from the various regulatory bodies in relation to its history of treatment of people with serious mental health problems or with disabilities, including avoidable deaths. Several inquests have concluded that Southern Health did bear blame for those deaths.
I am very glad to report that last week the CQC reported that Southern Health trust should be rated as good, and that is a vast improvement on previous years. It is a vote of confidence in the leadership team, and it is a real step forward in providing confidence to the thousands of people who work for Southern Health, and of course, above all, those patients who are under its care. In terms of leadership, safety, caring responsiveness and the extent to which it is patient-centred, Southern Health was rated as good. I have to say, however, that some areas still require improvement—for example, the effectiveness of services.
I have worked with many families whose young relatives have taken their own lives under the care of Southern Health, and I know they have been significantly involved with helping to get improvements in Southern Health. I know that they will be pleased by last week’s CQC rating, and I want to congratulate those families on all their input and their work on this issue. I also congratulate the leadership team at Southern Health.
Lastly, I want to talk briefly about Fareham Community Hospital in Fareham, which has been my pet project. It is a wonderful facility in the heart of our community, but it is sadly under-used. Last year I conducted a wide-ranging consultation with hundreds of local residents and many stakeholders, and I authored a document on the conclusions: the Minister is welcome to read a copy, maybe tonight or tomorrow, if he would be interested. It sets out a plan, based on the results of that consultation, for how we can better use Fareham Community Hospital. One of our recommendations is that it would be a brilliant location for a mental health hub in our community. We have a great facility, which is well located and in good condition, but in the light of the demands and challenges in the local area with young people’s mental health there is a great opportunity here for more funding and more co-ordination so that Fareham Community Hospital can be better harnessed, so that our young people, and also other people who need mental health support, can use the facility and capitalise on it in the most effective way. I hope that bosses at the CCG and those who make the decisions will that bear in mind.
I applaud the Government for their commitment to the funding in the Bill, and I oppose all the amendments.
Members across the House have spoken about the importance of unanimity of purpose on mental health and maternity, but I want to speak against amendments 2 and 5, for the simple reason that this funding, although so welcome and necessary in my constituency—and those of Members across the House—will be useless to my constituents unless it results in improved outcomes. Rather than talking about ring-fencing funding for specific things, we should be talking about outcomes—what they mean for our constituents, and how we make their healthcare better.
My hon. Friends the Members for Newton Abbot (Anne Marie Morris) and for Hitchin and Harpenden (Bim Afolami) raised similar points. Justin Madders rightly drew attention to the ambitious targets in the NHS long term plan. Those are the targets that we should be tracking ourselves against. Those are the targets that we should be talking about, and we should monitor whether the improved funding has enabled us to make progress against them. We should not just talk about whether to put a certain amount of money into a certain pot; on its own, it makes no sense and will not make anyone’s life better. The main point I want to make is that we should focus on outcomes rather than forever tracking inputs that do not improve our constituents’ lives.
The NHS long term plan has some very ambitious targets for maternity and mental health. I shall dwell on the target to achieve 50% reductions in stillbirth, maternal mortality, neonatal mortality and serious brain injury by 2025. It is incredibly important, and it is crucial that the House is updated on our progress against it. We shall do that, yes, through funding, but funding linked with policies that will drive that outcome and drive improvements.
I want to focus on midwives and maternity care. Under the coalition Government, a commitment was made to give each mother a named midwife. That is obviously extremely important, both for the mental health of the mother and for her care, because it means that there is someone who, throughout, is observing how that woman is doing—understanding how she has changed from one appointment to the next. It is not just a tick-box exercise, with a person who has never met the mother before looking at a list and saying, “Have you actually done this? Then you must be fine.” It is a person looking at the woman and thinking, “Actually, is this someone who needs a bit of help—whose mental health has deteriorated since the last appointment, who is looking a little bit more anxious?” Ring-fencing the funding is not enough in itself.
In addition, the long term plan talks about the shortage of neonatal capacity. As someone who has had the misfortune to have to use a neonatal unit recently, I know the tragic and immense strain that the movement of babies can put on parents who have to use neonatal units. We absolutely must put this money into expanding capacity in our neonatal units, and try to ensure that parents are assured that when they move into high-dependency units, they will never be downgraded because of capacity. That is incredibly important.
My hon. Friend Lucy Allan spoke very movingly about the issues that she had in her trust. Moving forward with policies such as these will prevent any repeat of such issues.
On a linked issue, it is important that we look at outcomes for multiple births. Neonatal capacity is part of that, but in addition the Twins Trust has been doing fantastic work in terms of a maternity checklist, which has been piloted by a number of trusts but not yet all. We can look at funnelling some of the money into increasing those trials. That will drive outcomes, which is what we are all here to ensure.
Finally, I want to mention money for anaesthetists. We talk about mental health outcomes for mothers. Part of the problem has been that, according to frightening reports, women who are in terrible need of pain relief during childbirth have not been able to get it. That is a cultural issue in some trusts. They seem to view childbirth as different from having an operation on one’s leg. I would like to see anyone who would undergo an operation on any other part of their body without pain relief, but that seems to be something that some trusts believe women are able to do, and it is wrong. Investment in anaesthetists, and funnelling money into that area of the NHS, is incredibly important.
To summarise: outcomes, please, not just pots of money. That will make everyone’s constituents’ lives better.
It is a pleasure to follow my hon. Friend Laura Trott, not least because her last sentence is what the next 10 minutes of my speech are about. [Interruption.] I am sure many Members probably want me to sit down now, but I will continue none the less.
May I welcome the Bill in general before dealing with the amendments I wish to speak about? It provides useful and good clarity for all the hospitals around the country, which need to ensure that they have appropriate funding in the coming years. I also welcome the clarity on the revenue side for hospitals such as Chesterfield Royal Hospital, which serves my constituency. It is looking for additional support on not only the revenue side, but the capital side, although I know that this is not the debate for that. I will not be supporting amendment 3, but there was a lot of merit in it, if only to ensure that if we do get our urgent care village at Chesterfield Royal Hospital, we could thus ensure that the money is in place and is ploughed into proper capital upgrades for the hospital in the future, for the benefit of everybody in north Derbyshire and my constituency.
I also welcome the Government’s commitment in recent months to the output point that my hon. Friend the Member for Sevenoaks outlined. That was done to some extent during the general election campaign, and I look forward to the continuation and extension of that in the coming months and years. I am pleased that we are in a debate on the NHS and healthcare that, as my hon. Friend Lucy Allan said, has been relatively friendly and has come away from the usual histrionic fireworks that sometimes accompany this issue. It is helpful for us occasionally to step back and have this kind of debate on the NHS, given that we are all committed to improving healthcare in our constituencies.
I wish to discuss two of the amendments briefly, picking up on this point about outputs. Justin Madders, speaking from the Opposition Front Bench, was right about the need for accountability and the need to ensure that the money being committed in this Bill is spent wisely and appropriately, as was my right hon. Friend Jeremy Hunt, who is no longer in his place but who talked about this not just being about money, and my hon. Friend Anne Marie Morris, who is also no longer in her place but who was also keen to highlight the importance of outputs. For reasons I will talk about if I have time at the end, it is particularly important for me, on a personal level, that we focus on outputs.
First, let me turn to new clause 4, which I am keen to examine. I congratulate the Opposition Front-Bench team on beginning the long road back to sense—I hope they do not mind my describing it as such—with their welcome return to an interest in healthcare outputs rather than solely in inputs or methods. That is something to welcome, but the problem, and the reason I cannot support these proposals tonight, is that the Opposition continue to mix up the point about targets and outputs. Targets are not ends in themselves. Targets are indicative, much as we wish them to be hit and important as they are, to ensure that they give us good guides as to what is happening in our hospitals and healthcare system. They are different from outputs. In time, I would be keen to see Opposition Front Benchers moving further down that metaphorical road towards recognising that the outputs are the most important thing: people getting well, staying well for longer; going home and living longer and more meaningful lives with their families and within their communities.
The new clause also slightly misses the point. I infer, as clearly one can, that it starts from a position of directly relating the requests made to set out things from the perspective of money. I do not doubt that money is vital in this discussion, which is why we are bringing forward this Bill, but it does slightly become a blunt instrument. An opportunity is missed to recognise that this is not simply about money. The inputs into our healthcare system are incredibly important, but so are the structure, the model, the operations, the behaviour within it, the technology and the prioritisation chosen by all that vast behemoth of bureaucracy around the NHS. We have to ensure that there is a recognition of the importance of that, and that there is a real effect on the output at the end and on making sure that people stay better for longer. On that basis, I cannot support new clause 4.
New clause 11 is a similar attempt by the Opposition to ensure annual reviews of the adequacy of the financial movement forward. My challenge is that there is a definitional problem. The new clause would require the consideration of
“an assessment of the extent to which changes in the costs of…service delivery” affect outcomes. There is an interesting question about the definition of “service delivery”, whether it is a rather narrow assessment or could encompass everything that the NHS ever does, and whether that would provide any benefit to the House or anybody who used the assessments. There is also a question about the complexity of analysis of service delivery in the first instance and how that can be defined and assessed. As a former management consultant, I am all in favour of complex analyses, but ultimately they have to provide a utility appropriate to what we are trying to do and to the ultimate objective and end point.
Although I again compliment the Opposition on moving closer towards output-based consideration, new clause 11 also starts from the position that money alone is the ultimate arbiter of whether our healthcare system is successful. Again, it is not just about money, as important as that money is; it is about organisation, people, motivation, workforce, demand, prioritisation, processes and how technology and innovation are changing things. If we do not recognise that, we are missing out a substantial portion of the debate that will be vital in the next 20 years to ensure that our healthcare system is fit for purpose.
Ultimately, why does this all matter? Why does speaking at a relatively technical level about outputs, structure or processes matter as much as inputs and money? Because, as other people have said, this is about real people—it is about making sure that people live for longer. We have all seen examples, when people come to see us at our surgeries, of where the NHS works wonderfully, but in our heart of hearts we all know examples of where the NHS has worked less well. That focus is sometimes as important as the money.
Let me give the House a personal example. My family, including myself, have had three occasions or reasons to get involved in the NHS over the past few years—indeed, over many years. The NHS saved my life on multiple occasions when I was growing up, and it also saved my father’s life when he had a double heart bypass around 10 years ago. It did less well with my mum when, a few months after I came to this place in September 2017, she was diagnosed with ovarian cancer, about which I have spoken in Westminster Hall. That was an error, errors happen—there are humans in the process—and we have not taken it any further because of that. My mum is still here and I am very happy about that, but ultimately my mum did not have a good experience. If we just focus on money, we miss out on cases such as my mum’s.
We have been lucky in my family, but ultimately there will be constituents of ours who are not lucky. That is the point: I am grateful for the money that is going in, but it has to be well spent. If this place does not consider the outputs—if this place does not understand where the money is going and how it is used—there will be people who do not get through it in the way that we want them to. We all want to stop that, which is why it is really important that we focus on outputs as much as inputs.
I am grateful to my east midlands colleague, my hon. Friend Lee Rowley, for that excellent speech. He made some important points, particularly about outputs, the specific healthcare that is needed and the support required throughout the NHS.
I am grateful for this opportunity to speak to amendments 1, 2 and 3. The funding in the Bill will be administered by NHS England. The Bill guarantees long-term funding to implement the NHS long-term plan. It commits the Government to a £33.9 billion increase for the NHS by 2023-24, bringing the total spend to £148.5 billion. It also provides certainty through a double-lock agreement that places a legal duty on the Secretary of State and the Treasury to uphold this level of funding as a minimum over the next four years.
We are putting our money where our mouth is. Our manifesto clearly stated that
“within the first three months of our new term, we will enshrine in law our fully funded, long-term NHS plan”.
Since our success in December, we have consistently put forward and agreed steps to meet the commitments in our manifesto. We are delivering on the promises that we have made.
One of the most important aspects of the NHS long-term plan is its approach to mental health. It is crucial that people have access to mental health services where and when they need them. I, therefore, welcome the fact that the plan commits to ensuring that mental health receives a growing share of the NHS budget, which will be worth at least a further £2.3 billion a year in real terms by 2023-24. This will enable further service expansion and faster access to community and crisis mental health services for adults and particularly for children and young people.
Given that many people living with mental health issues may need to access health services more often, the NHS long term plan also allows for better and more consistent working between all parts of health care and voluntary elements of the sector. As we have seen in west Leicestershire, for example, primary care networks have formed, grouping GPs and other partners together to the benefit of their patients.
As NHS England sets out, primary care networks build on the core of current primary care services and enable greater provision of proactive, personalised, co-ordinated and more integrated health and social care. Clinicians describe this as a change from reactively providing appointments to proactively caring for the people and the communities that they serve.
Linking this local working together with the benefit and knowledge of vanguard projects from across the country and giving experienced local trust leaders, who have a deep understanding of the physical and mental health needs of their local area, the freedom to make appropriate funding decisions will improve the overall experience of the patient and provide better health and lifestyle outcomes. That is to be welcomed and celebrated, and I ask my fellow colleagues to support the Bill and reject the amendments today.
On a point of order, Dame Eleanor. I notice that it is now 5.10 pm and that the Minister is about to get to his feet. If the knife falls at 5.30 pm, while the Minister is still speaking, or a Division is under way, can you confirm that that means there will be no Report stage, and no chance for the SNP amendments to be tabled or voted on?
The hon. Gentleman is absolutely right in regard to the procedure. If we finish this part of the procedure before 5.29 pm, there will be a very short time for the next part of the procedure. If this part of the consideration of the Bill goes to 5.29 pm, there will indeed be no time for the Report and consideration stage. That is correct, as is normal in any Bill, but I am grateful to him for pointing it out so clearly.
In the 15 or so minutes remaining to me, I will endeavour to address all the points that have been raised. First, I thank Members on both sides of the House for their contributions and for the amendments that have been tabled. I particularly thank the shadow Minister for his typically reasonable tone in making his case forcefully. This Committee debate has been a wide-ranging and important one.
I will turn in detail to the amendments shortly, but, in the interests of time, I will swiftly address the requests for meetings or visits. Alex Cunningham was right when he said that he saw me nodding. I will be very happy to meet him, my hon. Friend Matt Vickers and the chief executive of his hospital trust to discuss the issues that he raised. I will also be very happy to meet Gareth Thomas separately to discuss the issues that he raised.
The Minister is in a very accommodating mood. Does he accept that this Bill has funding implications and consequences for health spending in Scotland?
As has been very clear throughout the progression of this Bill so far, there are Barnett consequentials, which will be dealt with in the usual and appropriate manner.
I will turn to the detail of the amendments in a moment, but before I do, let me say that my hon. Friend Lucy Allan addressed the debate in Westminster Hall just before the general election. In that, I said that if her constituents wanted a strong voice in this place, they should vote for her. I am very pleased that they did exactly that. Her speech shows exactly why.
This legislation is a simple Bill of two clauses. The substantive clause—clause 1—puts a double-lock duty on the Secretary of State and Her Majesty’s Treasury to ensure that NHS England will receive, as a minimum, £33.9 billion extra a year by 2024, enshrining in law the NHS England revenue budget rise in line with the Government’s manifesto commitment. The Bill has deliberately been drawn narrowly to focus on that core commitment.
New clauses 4, 5 and 11 focus on whether the allocations are sufficient. At their heart is the question of whether the quantum is appropriate and will meet the needs of the NHS. Although I understand the sentiment behind these new clauses, they are unnecessary. The chief executive of the NHS said in 2018, after the announcement of the settlement:
“As the NHS turns 70, we can now face the next five years with renewed certainty. This multi-year settlement provides the funding we need to shape a long-term plan for key improvements in cancer, mental health and other critical services.”
We are giving the NHS the funding that it believes it needs.
There is already a clear duty on the Secretary of State for Health to lay before Parliament and publish an annual mandate to NHS England. The mandate sets objectives that NHSE must seek to meet in the year ahead, and its budget for doing so. That budget includes funding to meet all of NHSE’s statutory duties, including duties under the NHS constitution. The Secretary of State has a further duty to keep performance against the mandate under review, and must also publish his annual assessment of this performance in Parliament, with Parliament entitled to table debates and questions on the matter as it so wishes. Therefore, although I appreciate the purpose behind these new clauses, they would serve no useful additional purpose. Parliament already has ample opportunity to review NHSE’s budget, to consider whether it is sufficient to deliver on the objectives that the Government have set and to hold the Government to account. I will touch a little more on this when addressing new clauses 9 and 2 later.
I turn to new clause 5 and the concerns that the Bill enshrines the NHS budget in cash terms—a point that the shadow Minister has reasonably put to me and to the Secretary of State on previous occasions. Like Government departmental settlements, the NHS budget is set in cash terms. This is essential to deliver certainty and predictability. However, responding to changes or fluctuations in expected inflation rates is part of the normal course of business, and would be addressed and scrutinised as necessary through fiscal events such as Budgets. We do not need to legislate for that separately. Furthermore, the House should remember that what we are proposing is a floor, not a ceiling. We are retaining the flexibility for an increase in funding in a range of scenarios. Nothing in the Bill prevents that at any future point.
My hon. Friend is a sound and vocal champion for her constituents in Stafford. I am sure that she will continue to champion their cause, and I am happy to meet her to discuss the specific issue she raised.
I turn to amendment 3, in respect of capital-to-revenue transfers. Clause 1(2) ensures that the funding specified in the Bill can only be used for NHSE revenue spending, meaning that day-to-day spending for the NHS is protected. As we have highlighted in the House previously, the Government have made a range of capital commitments to the NHS, including the commitment to 40 new hospitals. Nevertheless, going to the point in the amendment itself, we have been clear that the transfers from capital revenue should have only been seen as short-term measures that were rightly being phased out, and we are doing so. My right hon. Friend Jeremy Hunt, the former Secretary of State, did, however, set out why a degree of flexibility is required, and we would not believe that a blanket ban set in legislation was the right approach.
I will not, if the hon. Gentleman will forgive me, as I only have 10 minutes or so left.
There are sometimes very good and logical reasons why adjustments between capital and revenue are needed. As the former Secretary of State highlighted, in some cases, for perfectly good reasons a capital pot may not be spent fully within a year and there is an opportunity to achieve patient good from transferring it. While I take his point and believe it is right that we should continue to move away from such transfers, I would not wish to see that rigidly set in legislation.
Amendments 2 and 1, and new clauses 1, 2, 3 and 9, relate to mental health services both for children and adults, and accountability to Parliament and reporting mechanisms. We have rightly seen considerable interest in mental health in this debate, so I will seek to address both those points together. I begin by paying tribute to Paul Farmer of Mind, Sir Simon Wessely, Professor Louis Appleby, the Mental Health Foundation, Rethink Mental Illness, YoungMinds, the Royal College of Psychiatrists, and a host of other individuals and organisations up and down the country, for their fantastic work in making mental health such a feature in our debates and in the public consciousness. It is absolutely right that they have done so.
I pay tribute to the Under-Secretary of State, my hon. Friend Ms Dorries, and her predecessor, my hon. Friend Jackie Doyle-Price, who brought to the role of mental health Minister passion, dedication and a determination to make a difference. I should also reference some former Members of this House: Norman Lamb, who did so much in this area; the former Prime Minister, David Cameron; and of course my right hon. Friends the Members for South West Surrey and for Maidenhead (Mrs May), who ensured that it was front and centre of this Government’s commitment.
I want to be totally clear that the Government are fully committed to transforming mental health services. That is why we enshrined in law our commitment to achieving parity of esteem for mental health in the Health and Social Care Act 2012. As my right hon. Friend the Member for South West Surrey said, that is driving real change on the ground. We have also committed to reforming the Mental Health Act 1983 to provide modernised legislation. I would also highlight that at £12.5 billion in 2018-19, spending on mental health services is at its highest ever level.
We have made huge strides in moving towards parity, but there is still so much more to do. We are ensuring, through the NHS long-term plan, that spending on mental health services will increase by an additional £2.3 billion by 2023-24. This historic level of investment in mental health is ensuring that we can drive forward one of the most ambitious reform programmes in Europe. It will ensure that hundreds of thousands of additional people get access to the services they need in the lifetime of the plan. I flag that up because we can and will always strive to do more, and it is right that we are always pressed by this House to do so. While proposals for a ring fence in mental health spending are understandable, the approach that this Government have already set out, with long-term commitments to funding, is already driving the results we wish to see.
I now turn to new clause 9, tabled by my hon. Friend Anne Marie Morris. If I may, I will also address new clause 2 in this context because there is a degree of overlap. I welcome my hon. Friend’s new clause. Although I hope that, as she indicated, she will not press it to a vote—and I heard what Munira Wilson said in respect of hers—the sentiment behind it is a good one, particularly the focus on outcomes and outputs rather than simply inputs and the amount of money going in, and on adopting a holistic approach. I know that my hon. Friend the Member for Newton Abbot recently met the Secretary of State to discuss the matter, and I am happy to meet both her and the hon. Member for Twickenham. While we do not believe it is the right approach to set additional reporting mechanisms in legislation over and above the different reports that NHS England and the Secretary of State already make to Parliament, which offer opportunities for debate, we are happy to consider whether, within the existing reporting mechanisms, there is a way to better convey to the House and the public more widely the progress we are making against those targets.
The NHS long-term plan represents the largest expansion of mental health services in a generation, renewing our commitment to increase investment faster than the overall NHS budget in each of the next five years. Not only will spending on mental health services increase faster than the overall NHS budget as a proportion, but spending on CAMHS will increase at an even faster rate. The hon. Member for Twickenham was right to highlight the importance of CAMHS. In our surgeries, we have all had constituents come to see us who are deeply worried and concerned about the mental health and welfare of their children, be that in relation to eating disorders, which I focused on when I came to this place, or a range of other factors. We are committed to delivering the NHS long-term plan to transform children and young people’s mental health services, with an additional 345,000 children and young people being able to access those services.
While we are deeply sympathetic to the spirit behind the amendments on mental health spending, we do not believe that putting a ring fence into the Bill is the appropriate way forward, given the work already being done, the money already being spent and the outcomes already being delivered. We believe that the reporting requirements are already extensive and varied. They already give the public and Parliament the opportunity to scrutinise the work of the Department and NHS England. We are happy to look at ways in which those reports might be more accessible and include different metrics, but we believe it would be wrong to legislate on them at this point.
As I said on Second Reading, this is a simple Bill. It has two clauses, of which one is substantive. It has a single, simple aim: to enshrine the funding settlement behind the NHS long-term plan in law. It delivers the funding that the NHS said it needed and wanted, and it delivers on this Government’s pledge to do so within three months of the election. In the light of that, while the amendments are clearly well intentioned and we appreciate the spirit behind them, they are unnecessary additions to the Bill, and I urge their proposers not to press them to a vote. I appreciate that Members have indicated their intention to press some amendments to a vote, I urge them, in the short period remaining before Committee ends, to reflect a little longer on whether they might reconsider and not move their amendments to a vote.
Three hours having elapsed since the commencement of proceedings, the debate was interrupted (Programme Order,
Under the programme order of
I will put the Question on amendment 2, which has already been proposed from the Chair. I will then call a member of the Legislative Grand Committee (England) to move amendment 3 to clause 1. When he has done so, I will put the Question on that amendment. I will then put the single Question that clause 1—or clause 1, as amended, if it has been so amended—and clause 2 stand part of the Bill. I will then call a member of the Legislative Grand Committee (England) to move new clause 4. When he has done so, I will put the Question that the new clause be added to the Bill.
I could, but we might get to the stage where there are no votes at all.
When the proceedings in the Legislative Grand Committee (England) on the Committee stage of the Bill are concluded, I will resume the Speaker’s Chair for the Whip to report the Bill from Committee. As the three-hour knife has now fallen, there are no amendments for consideration on Report, as Patrick Grady rightly pointed out in his point of order earlier.
The House will again resolve itself into the Legislative Grand Committee (England) to give consent to the Bill as a whole. I will call the Minister to move the consent motion formally, and I will put the Question on the consent motion forthwith. I can see that everybody understands this a lot better now. When the proceedings in the Legislative Grand Committee (England) on the consent motion are concluded, I will resume the Speaker’s Chair and call the Minister to move the Third Reading of the Bill.
I remind hon. Members that, if there is a Division in the Legislative Grand Committee, only Members representing constituencies in England may vote. All Members may vote on the Third Reading of the Bill.
On a point of order, Dame Eleanor. I am very sorry, but although I was listening very carefully, I did not quite catch all of that. Do you mind repeating it once again, please?
I fully appreciate that the hon. Gentleman may not have caught all of that, but I happen to know that he is one of a handful of people in this House who does actually understand this procedure. I hope that I am one of the others, and everyone else will pick it up as we go along.
The Chair put forthwith the Question already proposed from the Chair (
On a point of order, Dame Eleanor. I think that we should mark this moment. This is the busiest that the English Parliament has been since 1707. I have never seen so many people so keen to take part.
I am interested in the numbers that have just been read out, Madam Deputy Speaker, because 163 for the Ayes seems very low to me. Just by means of a headcount, I counted a significant number more than that. In fact, according to my calculations, at least 46 Members from Scotland, Wales and Northern Ireland were in the Lobby just now. Can you tell me whether the number that was read out in the House accurately records the number of Members of Parliament who wished to express their view on the amendment?
I am grateful to the hon. Gentleman for expressing his concerns in such an articulate fashion, and I note the words that he has used. I can confirm to him that, although his count of the number of Members who wished to express their view might well be correct, the numbers that I have announced to the House and on which I will rely from the Chair constitute the number of Members who have a right to vote on this matter. As the hon. Gentleman knows, under the procedures set out in Standing Order 83W—with which he, if not the rest of the House, must of course be familiar—Members who do not represent constituencies geographically situated in England do not have a right to vote in these particular Divisions.
On a point of order, Dame Eleanor. Perhaps you can enlighten me. Is this indeed the first time that Members from Scotland have had their votes discounted in this place? What conclusion should we draw, Madam Deputy Speaker, when an item such as this Bill will have spending consequences for Scotland, and yet Scottish MPs are locked out of this place? Can we not draw our own conclusion that this is indeed the English Parliament? The answer to the people of Scotland is very clear: if you want your votes to be counted, we had better become an independent Parliament in Scotland.
I am afraid that the right hon. Gentleman does not quite explain the situation as it really is. You see, this Parliament, as the Parliament of the United Kingdom, passed certain rules some time ago, and it is not correct to say that Members from Scottish constituencies are locked out; far from it. Members from Scottish constituencies, and constituencies in every part of the United Kingdom, have not been locked out. They have been allowed to participate in the debate, but not to vote in it. Members from Northern Ireland constituencies and from Welsh constituencies are similarly categorised for the purpose of these particular Divisions.
Further to that point of order, Dame Eleanor. Is it not the case that health is a devolved matter, and that the NHS in Scotland is the responsibility of the Scottish Parliament? Is it not the case that, therefore, Members of this House have no votes on, or say in, what happens in the NHS in Scotland, and is it not appropriate to point out to SNP Members that while they stage these stunts here, the Royal Hospital for Sick Children in Edinburgh, for which they are responsible, remains closed, and cases of poisoning in hospitals in Glasgow for which they are responsible remain undealt with? Until the Scottish Government make sure that the health of the people of Scotland is looked after, the people of Scotland will regard this as a transparent stunt on the part of people who, instead of representing their constituents, seek to manufacture grievance.
I fully appreciate the point—[Interruption.] Order. This will not degenerate into a shouting match.
The right hon. Gentleman has expressed his view with his usual rhetorical flourish. My only comment must be that this is a very narrow Bill, specifically making provision for the funding of the health service in England. I have to go with what it says on the Bill, and it is therefore correct for it to be administered in this way.
On a point of order, Dame Eleanor. I have due regard for your judgments. When I first rose to speak in the House in 2015, I said to the then Speaker that, while I was no Unionist or home ruler, I would stand shoulder to shoulder in defending the role of the Speaker. My concern, if this is the Parliament of the United Kingdom of Great Britain and Northern Ireland, is that this Bill has Barnett consequentials for the nation of Scotland, the nation of Wales and the communities of Northern Ireland. Therefore, I am gravely concerned that the EVEL system is being used to exclude the notion that there are Barnett consequentials. You may wish to clarify this for the Members of the Conservative and Unionist one nation party.
I fully appreciate the point that the hon. Gentleman raises, and there may well be Barnett consequentials—[Hon. Members: “Ah!”] There may be further opportunities when further legislation about these matters comes before the House, but this particular Bill is a very narrow one, and therefore the ruling is quite clear. I appreciate what the hon. Gentleman says about protecting the Chair and rulings from the Chair. In this case, there is no grey area. Under
On a point of order, Dame Eleanor. I know that Mr Speaker has strict rules about the use of promotional material in the Chamber of the House of Commons, and I am sure that, quite unintentionally, some Members might be displaying material that perhaps would be inappropriate. Will you point out that there are strict rules on that, and that it should not be done in the way that it has been done?
I am grateful to the right hon. Lady. I must say to her and to the Committee that I was hoping that I would not see any promotional materials—[Interruption.] Oh no! I see one! I was hoping that such an occurrence would not happen right now. No promotional materials should ever be displayed in the Chamber. For the avoidance of doubt, I refer hon. Members to paragraph 21.29 of “Erskine May”—Mr Blackford, you will like this one—which states clearly that
“all Members should be sufficiently articulate to express what they want to say without diagrams”.
The Chair then put forthwith the Questions necessary for the disposal of the business to be concluded at that time (
Amendment proposed: 3, in clause 1, page 1, line 18, at end insert—
“and that the sums set out in the table are not permitted to be augmented by or composed of any virements from NHS capital budgets.”—(Justin Madders.)