House of Commons
Wednesday 9 December 2015
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Business before Questions
The Vice-Chamberlain of Her Majesty’s Household reported to the House, That the Address, praying that Her Majesty will appoint Anna Carragher to be an Electoral Commissioner, with effect from 1 January 2016, for the period ending on 31 December 2020, was presented to Her Majesty, who was graciously pleased to comply with the request.
The Vice-Chamberlain of Her Majesty’s Household reported to the House, That the Address, praying that Her Majesty will appoint Rob Vincent to be an Electoral Commissioner with effect from 1 January 2016, for the period ending on 31 December 2020, was presented to Her Majesty, who was graciously pleased to comply with the request.
Local Government Boundary Commission for England
The Vice-Chamberlain of Her Majesty’s Household reported to the House, That the Address, praying that Her Majesty will appoint Professor Colin Mellors as chair of the Local Government Boundary Commission for England, with effect from 1 January 2016 for the period ending on 31 December 2019, was presented to Her Majesty, who was graciously pleased to comply with the request.
Independent Parliamentary Standards Authority
The Vice-Chamberlain of Her Majesty’s Household reported to the House, That the Address, praying that Her Majesty will appoint Sir Robert Owen and John Thurso to the office of ordinary member of the Independent Parliamentary Standards Authority, with effect from 1 January 2016, for the period ending on 31 December 2020, was presented to Her Majesty, who was graciously pleased to comply with the request.
I have to inform the House that, as required by section 144 of the Representation of the People Act 1983, I have received the certificate from the judges appointed to try the election petition relating to the Orkney and Shetland constituency election on 7 May 2015. The judges have determined that the petition be dismissed, and have certified that the right hon. Member for that constituency was duly returned at the said election.
I shall lay the certificate on the Table, together with the shorthand writer’s notes, and will cause the full text of the certificate to be entered in the Journal. Members wishing to read the certificate for themselves will find it set out in the Votes and Proceedings for today, which will be circulated with the Order Paper in tomorrow’s vote bundle, available online and from the Vote Office.
Oral Answers to Questions
The Minister for the Cabinet Office was asked—
Individual Electoral Registration
The Electoral Commission will publish its assessment of the first full registers under individual electoral registration next spring. In the meantime, I am delighted to inform the House that the transition to IER is now complete. Ghost entries of people who have died or moved house have been removed. We now have a register that is clean, more accurate and less vulnerable to fraud than ever before. This is a vital foundation stone as we move on to the next big challenge: finding people who are legally entitled to vote, but have never been on the register, such as expats, students and people in private rented accommodation, and persuading them to sign up.
I think the hon. Lady and I may mean slightly different things by block registration, but there is common ground, in that some very useful and effective new work is being done in places such as Sheffield, which is dramatically improving student registration rates. With any luck, we can take its example and persuade others to do the same.
The Electoral Commission states that 51% of 16 to 17-year-olds are registered, compared with 95% of those over 65. The Government have opposed votes for 16 and 17-year-olds in the upcoming EU referendum, and they will not even ensure that young people have a voice. Why are they so indifferent to a whole generation?
We addressed that issue at some length yesterday when discussing the European Union Referendum Bill. This is the third or fourth time that the House has addressed that idea, and each time it has returned pretty solid majorities against it. The vote yesterday was because we did not think it sensible to change such a fundamental piece of the franchise for just one vote. That would leave us open to the charge of trying to sway the franchise for the EU referendum to favour one side or the other—something that I am sure no one would support.
May I encourage my hon. Friend to consider postal voting? Leaving aside what may or may not have happened at the recent by-election, is it the case that registering for a postal vote is far too easy these days, which renders the whole system open to serious abuse?
My hon. Friend is entirely right, and large numbers of people are concerned about that issue. I am happy to tell him that my right hon. Friend the Member for Brentwood and Ongar (Sir Eric Pickles) is at this moment considering a report, and if my hon. Friend has any suggestions about what should be in it, he is welcome to make them.
I am glad the Minister noticed that there was a parliamentary by-election in Oldham last week. When he carefully studies the figures he will see that there are 1,814 fewer voters in Oldham West and Royton than there were at the general election. If those figures are extrapolated across the country, they show that more than 1 million fewer people are registered than were a year ago. That was predicted; it has happened intentionally. By design, this Minister is responsible for silencing the voices of more than 1 million voters in Britain. How does he feel about being the only Minister in British history to disfranchise 1 million people?
I see that the conspiracy theorists are out in force this morning. The entries that will have been crossed off the register as a result of the introduction of individual elector registration—a measure that was supported in principle by the Labour party—will be those for people who have died or moved house. Anybody who is a legitimate elector and who has a pulse will have been confirmed on the electoral register. If anybody is worried that they may not be registered, they can register online before May—it takes under three minutes, which is less than the time needed to boil an egg—and they will get their vote.
Government Digital Service (Welsh Language)
Mae’r fonheddiges anrhydeddys yn gofyn cwestiwn pwysig.
The Government Digital Service is committed to ensuring that the needs of Welsh language speakers are recognised and met. For example, the introduction of gov.uk now gives every Government organisation the ability to publish web content in Welsh. GDS has helped to produce exemplar Welsh language versions of the new digital services, such as the “register to vote” service, and it has put forward its digital design recommendations for Welsh language Government services.
Diolch yn fawr iawn am y rhagymadrodd—roedd o’n arbennig o dda ac yn gynsail pwysig i’r Ty yma.
I thank the Minister very much for his introduction in Welsh. However, considering that not a single gov.uk departmental website states on its homepage that services are available in Welsh, people do not know that they can use Welsh. When will the digital service stop preventing Government Departments from fulfilling their legal duty to Welsh speakers?
I acknowledge that the hon. Lady’s Welsh is more fluent than mine, and I look forward to her giving me a lesson or two at a future date. The Government are doing a huge amount to ensure support for Welsh digital services in Departments, and importantly, that is about quality, not quantity. She will know that every page of direct.gov.uk—the predecessor to gov.uk—was translated into Welsh. That ran to nearly 4,000 pages, but 95% of them were seen by fewer than 10 people per month, and half received no visits whatsoever. For gov.uk we are starting with user need, and working with Departments to ensure the best service for the user.
Diolch yn fawr iawn, Mr Llywydd. May I congratulate the Minister on the positive sentiments he is echoing, both literally and figuratively, with regard to the Welsh language? May I remind him that as we are the party that set up Sianel Pedwar Cymru and passed the Welsh Language Act 1993, there is absolutely no doubt about our commitment to the language of heaven?
Were the Minister to go to the Llyn peninsula and do a six-week Ùlpan course, he would learn fluent Welsh, I can tell him. Having served in 1993 on the Welsh Language Bill, of which our party can be very proud, I know how important it is that it be clearly laid out whether things are in English or Welsh. Sometimes they are in Welsh and then in English, and sometimes in English and then in Welsh. May we have a systematic approach across Government?
My hon. Friend will be pleased to know that we are doing a lot from the centre to encourage Departments to support better the needs of Welsh language speakers. Earlier this year, together with the Wales Office, we conducted user research into their needs, and as a result we are helping Departments to identify a set of Welsh language end-to-end user journeys, such as online self-assessment, that could be better supported by gov.uk.
The UK has made great strides in digital government, but there is much more to do if we are to remain world beating. We set aside a total of almost £2 billion in the spending review for work to be led by the Government Digital Service to make this happen.
I agree that Departments must work together to enable people to use digital technology safely and efficiently, but will the Minister also give an example of how Government are working together to meet increased demand for cyber-security, including by engaging with citizens and businesses?
Alongside digital transformation, it is vital that we have secure online activity, and our almost doubling of the budget for cyber-security over the Parliament will be a vital part of protecting not only Government services but the whole of the UK to ensure that people are safe online.
The social value portal is an innovative way to provide advice and insight for communities, public bodies and business about the best way to achieve social value. Will the Minister outline how his Department is encouraging other Departments to take advantage of digital initiatives, such as the social value portal, to ensure greater implementation of the Public Services (Social Value) Act 2012?
Digital transformation can not only improve government and the economy but strengthen civil society, and the social value portal is a good example of working across Government to deliver some of the changes in the Public Services (Social Value) Act. There are eight funded projects, and I look forward to working with my hon. Friend and others to make them happen.
Many of us on the Opposition Benches applauded the Cabinet Office’s innovative work in the last Government, but will the Minister comment on reports that the lack of resources and leadership in the Cabinet Office now means we are going backwards, rather than forwards, on digital innovation?
The hon. Gentleman obviously missed the autumn statement, in which we doubled the funding for the Cabinet Office’s world-beating Government Digital Service. We are providing £450 million over the Parliament to ensure not only digital transformation within Departments but strong leadership from the centre.
Given the recent media reports of cyber-security breaches in the private sector right across the United Kingdom, what steps are being taken ensure there will be no repeat of such breaches, particularly on data protection issues, in relation to Government Departments?
Our country, both in government and the private sector, is under constant cyber-attack. We need to make sure we step up our game to respond to that. We are bringing in a national cyber centre, a single place of expertise under the GCHQ umbrella, which will clearly be able to co-ordinate and talk to wider society and business. This will ensure that the expertise is all in one place and properly funded to take this fight on.
The Electoral Commission will publish its assessment of the 2015 annual canvass in spring next year. In the meantime, there is a growing acceptance that while the annual canvass is an essential tool in maintaining complete and accurate registers, the processes and techniques we use to undertake it look increasingly out of date. They were developed from an analogue, not digital, world. As I said in my speech to the Policy Exchange in October, we will look to give electoral registration officers more discretion to adapt their canvass activities in order to make the canvass more efficient and effective in future.
Only 6.4% of homeowners are not on the electoral register, yet for those living in rented accommodation this figure is a massive 36.7%. The Government have made, and are making, it harder for generation rent to get on the property ladder, or obtain a secure tenancy. Is that why the Government do not want to hear the voices of private renters in our democracy?
We absolutely do want to hear everybody’s voice in our democracy. One of the things we are aiming to do with the new approach, as I said in the speech I mentioned in my initial response, is look at other ways to make better contact with groups that are under-represented, and to make sure more of them use their voice and their democratic right.
Autumn Statement (Community and Voluntary Sector)
I am glad to be able to tell the hon. Lady that the autumn statement significantly increased the funding for the voluntary and social sector in the Cabinet Office. That has enabled us to expand the National Citizen Service and our efforts on social impact bonds. I am delighted to see that in the hon. Lady’s constituency, Kirklees Council has issued a very good compact with the voluntary and community sector, showing how the council can collaborate with them. I very much hope that the sector can take advantage of the extra funds now available.
As the Minister will be aware, our country is in the grip of a growing social care crisis, with significant funding shortfalls projected by 2020. There are huge pressures on families, carers and the NHS in my constituency and nationwide. Will he say what specific plans he has to support those charities that are currently plugging the gap in terms of care, but are under enormous strain?
The charity sector as a whole has an income of about £40 billion a year, which is broadly stable. I have been looking at the council accounts for the hon. Lady’s area. It turns out that Kirklees Council has £200 million in useable and unused reserves. The problems to which she refers are not real ones.
Tackling complex needs effectively has been something of a holy grail out of the reach of previous Governments, so I welcome the commitment in the autumn statement to £105 million in social impact bonds to tackle complex needs and perhaps get us closer to that holy grail.
I very much agree with my hon. Friend, who has been a passionate advocate, as I and others have been, of social impact bonds. This is a huge change in the way our country is organised. We can get to the point where we are actually paying for outcomes, not inputs. We lever up the amount the Government put in on behalf of the taxpayer, with huge contributions from the private sector and from those double bottom line investors. We can see a huge transformation in public services.
Last week, the Minister said that the Government were committed to a flourishing civil society, but in the recent spending review it was exposed that the Office for Civil Society is to be hollowed out to just a handful of civil servants, and is now described by the sector as just a “name on a door.” Does the Minister agree that this is a clear admission that the big society agenda is now dead, was never anything but a cover for cuts to public services, has served its purpose, and is now to be wound down?
I am sorry that the hon. Lady did not take in what I said in my earlier answer. The funding for the voluntary and community sector increased significantly in the autumn statement. I pay tribute to officials in the Office for Civil Society, which answers to my hon. Friend the Minister for Civil Society. In my experience, those officials are among the finest in Whitehall. They will continue their work, and with that increased budget, they will be able to do more, not less.
The Cabinet Office is responsible for increasing the efficiency of government and for delivering the Government’s agenda. I am happy to say that, with the help of the fine civil servants to whom I just referred, we are doing just that.
My hon. Friend is absolutely right. The Government are totally committed to the social enterprise sector. That is partly about leading by example, which is why, in common with many of my hon. Friends, I serve in my village community shop—we all undertake these things. More than that, however, it is about creating the framework within which social enterprise can flourish. That comes back to the point made earlier by my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) that social impact bonds offer a whole new future for the social enterprise sector.
Many volunteers in the emergency services, particularly the fire and rescue services, were again heroically leading the rescue efforts in the flooded north-west region this week. The service has been at the receiving end of some savage cuts on the frontline, resulting in untold pressures. In Cumbria alone, 87 jobs have been lost. Is it not time that as part of a modern civil contingency and emergency national strategic plan, the Government agreed that flood rescue should be made a fully resourced statutory duty of the fire and rescue service? Can he say whether this issue of national importance was discussed at the Cobra meetings last week?
I welcome the hon. Gentleman to his place, and look forward to many exchanges with him on this and other matters. The fact of the matter is that we not only protected the budget for the police in the recent statement, but the fire service has done a fantastic job of reducing the amount of damaging fires over the last Parliament, improving its efficiency while all the time delivering its vital work to keep people safe.
Gov.uk is one of the first parts of the work that we have done to ensure that government is digitally enabled, making citizens’ lives easier by making it easier for them to interact with government. The number of hits is far higher than anybody expected, which is a tribute to the work of the people who put it together. [Interruption.]
T6. According to a survey this month by Tungsten Network, 12% of the UK’s 5.2 million small and medium-sized enterprises still have to wait more than 90 days to get paid by suppliers. Will the Minister update us on his Government’s progress on meeting targets on prompt payments to suppliers? (902503)
We changed the rules last year to ensure that when the Government buy from the private sector, payments must be made within 30 days—and that cascades all the way down the supply chain. I can also report that we have hit our target for a quarter of all Government procurement to go to small businesses, and we now want to increase that target from a quarter to a third.
We are fully committed to bringing more under-represented groups into electoral participation. That is why we are working with Operation Black Vote and other such groups to bring people in from the black and minority ethnic communities. I also draw my hon. Friend’s attention to the very interesting experiment being tried at Sheffield University to nudge the student population to sign up for an automatic registration system. We are looking very carefully at that.
T7. If it does indeed transpire that there are fewer people on the new electoral register after the introduction of independent electoral registration, will the Government consider that to be a success or a failure? (902504)
I think what the hon. Gentleman is missing is the fact that, as a result of the measures that have been taken, people who were not at the addresses at which they had previously been registered will be eliminated. The creation of an accurate register is an aim of democracy, not a defect of democracy.
My hon. Friend has asked a very important question. If the civil service is to work to support the whole country, it needs to reflect the whole country, so we are taking steps across the board to increase social mobility as well as other kinds of diversity. One of the most exciting aspects of that is the huge apprenticeship scheme that now allows and encourages people from all backgrounds to pursue successful careers in the civil service.
The Prime Minister was asked—
The Prime Minister is visiting Poland and Romania, and I have been asked to reply.
This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall have further such meetings later today.
The Chancellor will know that, as Christmas draws closer, people who are having difficulty in making ends meet will not experience much good will in the season of good will if they fall into the clutches of loan sharks as they try to buy presents for their families, so why is he choosing now to cut the budget of the Birmingham-based England illegal money-lending team by a third, although it has helped 24,000 loan shark victims to get £63 million of illegal debts written off? Will he have a word with his friend the Business Secretary, who seems to be refusing to answer questions from the Daily Mirror on the subject?
Of course we take very seriously the issue of illegal loan sharks and, indeed, that of excessive interest charges on payday lending, which is why it was Conservatives who introduced the first ever cap on payday lending. As for the hon. Gentleman’s specific question about funding for illegal money laundering and loan shark teams, we are considering the imposition of a levy on the industry to meet the requirements that he has identified.
Q2. Following last week’s vote, can my right hon. Friend give us an update on action against the genocidal jihadists who not only attack Christians, Yazidis and Muslims, but pillage their churches, shrines and mosques? I welcome the announcement of £30 million to protect cultural heritage, but can we also ratify the Hague convention sooner rather than later? (902484)
I thank my hon. Friend for raising this important issue. Let me briefly update the House on the military action that has taken place since we met last week. We have 16 aircraft conducting strikes, as well as our Reaper drones. The Royal Air Force has flown 11 missions and conducted four strikes, principally against the oilfields, and we are also supporting Iraqi security forces. My right hon. Friend the Foreign Secretary will be in New York next week for talks on trying to bring an end to the horrendous conflict in Syria. As for the damage that is being done to the cultural artefacts in the area, we are providing £30 million as part of the cultural fund—I have discussed that with the director of the British Museum—and as for the Hague convention, that process is now moving apace.
Thank you, Mr Speaker. It is nice to be given such a warm welcome.
Our hearts go out to all those who are suffering the consequences of the severe flooding in the north-west this week. Given that thousands of families are affected, the priority must be for the Government to give immediate help to all of them. Yet one year on from the 2013-14 floods, it emerged that only 15% of those affected had received payments from the Government’s repair and renew scheme. Does the Chancellor agree that that cannot possibly be allowed to happen again? These people need urgent help now, so will he today give the House a guarantee that people will receive the help they need, and quickly?
First, let me welcome the hon. Lady to her place and the warm support she has on the other side. I join her in expressing the sympathy of the whole House to those who have been affected by these terrible floods. A record rainfall has hit Cumbria and Lancashire. The update is that we have just one severe flood warning still in place, power has been restored to 168,000 homes and the west coast main line is open, but we have to be there for the long term for these families.
We continue to support the immediate rescue efforts, and the military have deployed. On recovery and the question the hon. Lady asks, I can today announce a £50 million fund for families and businesses affected in the area. That will be administered by the local authorities to avoid some of the administrative problems to which she alluded in her question. When it comes to rebuilding the infrastructure of Cumbria, Lancashire and other areas affected, we are assessing now the damage to the flood defences and to the roads. Funds will be made available. One of the benefits of having a strong and resilient economy is that we can help people in need.
I thank the Chancellor for that answer but, from listening to him, you would not think that he has cut flood defence spending by £115 million this year. After visiting the floods in the Somerset levels in 2014, the Prime Minister told this House that
“money is no object in this relief effort”——[Official Report, 12 February 2014; Vol. 575, c. 840.]
and that whatever money was needed would be spent. I welcome the announcement that the Chancellor has just made, but will he confirm that the same will apply this time?
Absolutely. The money will be made available to those affected and to the communities who have seen their infrastructure damaged. Up to £5,000 will be made available to individual families to repair their homes and protect them against future flooding, and we will provide money to businesses that have seen their businesses ruined. There have been heartbreaking stories—we have all seen them on television—about businesses that have been affected. That money is available.
Because we have a strong and resilient economy, we are increasing the money we spend on our flood defences. It is just not the case that that has been reduced. The last Labour Government spent £1.5 billion on flood defences, and we will be spending £2 billion on flood defences and increasing maintenance spending. It is something we can do and we can help these communities precisely because we took the difficult decisions to fix our economy and public finances.
I thank the Chancellor for that, and we will hold him to account on the promises he has made today. However, I note that the Government’s own figures show that their planned capital investment in flood defence will only protect one in eight of those households at risk.
I see that the Prime Minister cannot be with us to answer questions today because he is visiting Poland and Romania on the latest leg of his seemingly endless European “renegotiation tour.” He has been jetting all over the place. No wonder we had to buy him his own aeroplane. So can the Chancellor tell us: how is it all going?
I have to tell the Chancellor that many of his own Back Benchers are pretty unimpressed with how it is going so far. The hon. Member for North East Somerset (Mr Rees-Mogg) has described the Prime Minister’s renegotiation efforts as “pretty thin gruel”, the hon. Member for Harwich and North Essex (Mr Jenkin) has called them “lame” and “trivial”, and yesterday the hon. Member for Richmond Park (Zac Goldsmith) told the Press Gallery they were “not all that impressive”. The Chancellor is well known for cultivating his Back Benchers, and there is absolutely nothing wrong with that, so may I ask him the question his own side want answering: given that the Prime Minister has pre-resigned, does he really aspire to be Britain’s first post-EU Prime Minister?
I am not sure I would be quoting the views of Back Benchers if I was speaking for the Labour party at the moment. Most opposition parties are trying to get momentum; they are trying to get rid of it. We are fighting for a good deal for Britain in Europe, we are fighting to make the European economy more competitive for everyone and we are fighting to make sure that Britain, as a country that is not in the euro, gets a fair deal from the eurozone. That is what we are fighting for, but in the end this is something that we will put to the people of Britain in a referendum. The only reason that referendum is happening at all is that the Conservative party won the general election.
Instead of obsessing about issues in the Labour party, the Chancellor should be condemning the appalling activities in Conservative Future and attacking the Tory bullying scandal. I notice he did not answer the question about his own prime ministerial activities; I am not sure, but he might be worried about somebody a few places down from him on the Treasury Bench. [Interruption.] She knows who she is. If the Chancellor will not listen to the doubts of his own Back Benchers, perhaps he will listen to someone who has written in. I have got here a letter. It is from Donald of Brussels. He writes:
“Uncertainty about the future of the UK in the European Union is a destabilising factor.”
He’s right, isn’t he?
Since the Conservative party announced its policy on a referendum, we in this country have received the lion’s share of investment into Europe. That is because we have built a strong economy, we stand up for Britain’s interests abroad and we have made this a competitive place to grow and build a business. While we are quoting missives, let me tell the House that someone called Tony has been writing today. He happens to be the most successful Labour leader in history, and he describes the current Labour party as a complete tragedy. May I suggest that the hon. Lady asks some serious questions, about the health service, the economy, social care? She can ask any of these questions. She has got one more question; let’s hear it.
I prefer this quote from Tony:
“Just mouth the words ‘five more Tory years’ and you feel your senses and reason repulsed by what they have done to our country.”
We all know that the Chancellor is so preoccupied with his own leadership ambitions that he forgot about the day job, and that is why he ended up trying to slash working families tax credits in the Budget. Is it not about time that he focused on the national interest rather than his own interest? Three million UK jobs are linked to trade with the EU. Half our exports go there. That is what they are putting at risk by flirting with Brexit, and that is why we on this side of the House know that Britain is better off in.
I thought that the Labour party voted for the referendum when it came before the House of Commons. We are fighting for a better deal for Britain in Europe. The truth is that this week we have shown that we have an economic plan that is delivering for Britain. Whether it is well-funded flood defences, putting money into our national health service, backing teachers in our schools or introducing a national living wage, we are delivering security for the working people of Britain. Their economic and national security would be put at risk if the Labour party ever got back into office.
Q4. I recently visited the apprentice workshop of David Wilson Homes and saw at first hand the work the construction industry is doing to support apprenticeships in Hampshire. What more can schools do to promote apprenticeships as a valuable alternative to post-16 academic study? (902486)
My hon. Friend raises an important point. Schools have a legal duty to provide pupils with information on the full range of training and education available. Schools in her constituency can tell their pupils about the increase in the number of apprenticeship places—3 million in this Parliament—we are funding. That is a huge commitment to young people in this country and a big commitment to the construction industry. We want homes to be built. One of the challenges is getting skilled people into that industry, and no doubt that was raised by the business she spoke to, but the 3 million apprentices will help.
Absolutely—that co-operation is expected. Perhaps the right hon. Gentleman is talking about the transportation of nuclear materials from the Faslane base on the Clyde. I have met the local teams and seen how they transport the nuclear materials. If he has something else he wants to ask me about, go ahead.
There are growing reports in the north of Scotland about plans to transport on public roads dangerous nuclear material, potentially including nuclear weapons-grade uranium, from the Dounreay nuclear facility to Wick airport. It is believed that from there it will be flown to the United States. What will that nuclear material be used for, and has the Chancellor or any of his colleagues spoken with a single Minister in the Scottish Government about this?
The transportation of nuclear materials across this country has happened over many decades. There are established procedures for that, and the Royal Marines and the police service in Scotland provide the security. If the right hon. Gentleman has specific concerns about the plans for that transportation, he can raise them with us. As I say, arrangements are in place to ensure that we protect the public.
Q5. The Chancellor will know that the Prime Minister said in his recent conference speech that we have to get away from the “lock ’em up or let ’em out” mentality in respect of prison reform. That has to be right because the prison system is costing our constituents a fortune. Does the Chancellor agree that the time for rehabilitation that works is now, and that we should not be afraid to look at other jurisdictions to find examples and new ideas to tackle this ongoing state failure? (902487)
My hon. Friend is right to raise prison reform. People who commit crimes should go to prison, but prisons should be suitable places to rehabilitate prisoners. Some of our Victorian prisons are not suitable, which is why we will close them, knock them down, build desperately needed housing in our cities, and build modern prisons on the outskirts of our cities. I am incredibly proud that a Conservative Government are taking on this progressive social reform.
Q3. They are a great British institution and earn billions for our economy, so I am sure the Chancellor will share my concern that two curry houses a week are closing due to Government policies and the fact that the proposed specialist colleges have failed. As a fan himself, will he review the situation? He once likened the elements of a strong economy to those of a good curry, so will he take action to head off the coming curry crisis? (902485)
Q12. My right hon. Friend is well aware, from my repeated representations to him and his colleagues, of the need for a southern relief road and eastern bypass for Lincoln, which have been delayed by bureaucracy for nearly 100 years. He and his Government colleagues are well acquainted with the need to drive growth and local economic wellbeing by utilising appropriate infrastructure improvements to fuel the midlands engine. What would he say to my constituents, should he visit the beautiful city of Lincoln, other than to tell them that any new road is eventually better than no road? (902494)
I congratulate my hon. Friend on securing £50 million of extra funding for Lincoln and ensuring that a bypass will go ahead. I have spoken to him. I know he has concerns that the bypass will not be big enough and that it should be a dual-lane bypass. Let us continue to have those conversations. We both need to ensure that local authorities agree with his assessment, and I am happy to help him with that task.
Q6. Since the Chancellor’s Budget in July, I have asked time and again how he intends to make women prove, in order to qualify for tax credits, that they had their third child as a result of rape. Will he now admit that his abhorrent, vile policy is completely unworkable, and will he drop the rape clause? (902488)
It is perfectly reasonable to have a welfare system that is fair not just for those who need it but for those who pay for it. We have identified the specific cases that the hon. Lady refers to in her question, in which women have been victims of domestic abuse—or, indeed, rape—and that is why we are consulting and discussing changes to protect vulnerable women.
Q14. More than 4,000 apprenticeships have been created in my constituency since 2010, and I recently met representatives of In-Comm Training and a group of small local businesses to discuss skills and apprenticeships. What are the Government doing to help small businesses to help people into training and employment, thereby securing the economy of the midlands engine for future generations? (902496)
The great news is that jobs are being created in the midlands engine, including in my hon. Friend’s constituency, and we are investing in infrastructure there as well. We are also investing in the skills of the next generation through the apprenticeships she mentions, and we are backing small businesses by cutting the corporation tax they pay and by increasing employment allowance so that they can take on more people without paying the jobs tax.
Q7. Médecins sans Frontières reports that despite giving GPS co-ordinates several of its hospitals have been bombed by coalition and, in particular, Assad forces in Syria, Yemen and Afghanistan, killing medics as well as patients. With so many forces involved in airstrikes, will the Chancellor explain how the Government propose to avoid this happening in future? (902489)
The hon. Lady mentions the tragic bombing of the hospital. A review is going on to ensure that the coalition has accurate information for its strikes. When it comes to Yemen, we are working with the Saudi Government to make sure that they can review this information and that it is accurate. I am afraid we have no control over the Syrian Government and Assad, which is one of the reasons we would like to see Assad go.
Q15. The regeneration of Dunsbury Hill Farm in my constituency will create up to 3,500 new jobs, which is good news for an area where unemployment has halved since 2010. Will the Chancellor commit to continuing investment in the Solent regional economy, an area that much prefers his big Red Book to any other type? (902497)
I am delighted to hear about the regeneration of Dunsbury Hill Farm. It is part of the good news in my hon. Friend’s area, where, thanks to local businesses and to his work as a new MP in attracting infrastructure and investment into his constituency, the claimant count is down by 25% in the past year alone. I am glad he likes the Red Book of the Government and does not have so much time for the little red book brandished by Opposition Members.
Q8. During the autumn statement, the Chancellor casually removed vital bursary support from student nurses. I have since spoken to a number of nurses and some of the 4,000 nursing students at my local university, all of whom say that they would not have been able to study nursing without vital bursary support from the Scottish Government. What will he say to the aspiring nurses across the rest of the UK who may be prevented from pursuing their dreams of becoming a nurse? (902490)
Currently, two thirds of people in England who apply for nurse training courses are turned down. That cannot be right, as it means hospitals increasingly rely on agency staff or overseas nurses. We are reforming the education of nurses so that those who apply for nursing places are much more likely to get them.
Carlisle and Cumbria have experienced a traumatic few days, with the devastating floods. It was good that the Prime Minister saw at first hand the tremendous work of the emergency services, the issues relating to the flood defences and of course the direct impact of those floods on local families. As part of the recovery, Cumbria Community Foundation, a highly respected, county-wide charitable organisation, has launched a flood appeal. I wrote to the Prime Minister asking for the Government’s support for the appeal, as it would help many affected people right across the county. Would the Chancellor be able to offer such support from the Government towards this much-needed fund?
First, everyone here would pay tribute to the people of Carlisle, the extraordinary resilience they have shown and the acts of friendship that neighbours have shown to those affected by the terrible floods. Before the Prime Minister left for central Europe this morning, he asked me to make sure we would be able to help on the specific point my hon. Friend raises, and did raise with the Prime Minister, and I can say that we will support the work the Cumbria Community Foundation does and we will match, by up to £1 million, the money it is raising for its local flood appeal.
Q9. When the Chancellor tripled student tuition fees, he set the repayment threshold at £21,000. He has now frozen the threshold, and the Institute for Fiscal Studies tells us that many students will bear many extra thousands of pounds in repayments. Given that he has broken his promise, will he send students an apology or just the bill? (902491)
There seems to be collective amnesia among Labour Members: they introduced tuition fees and the payment threshold was £15,000. We have increased it to £21,000, which enables us to fund the lifting of the cap and more people who are qualified to go to university. I would have thought, and I would have hoped, that on this day the hon. Gentleman welcomed the big investment we are making in Cambridge, not least with the renovation of the famous Cavendish laboratory.
The Bexhill-Hastings link road will finally open this month, delivering a business park, new homes for a new labour market and a countryside park. The road has been talked about for decades but it has been commissioned and built in the past five. Will the Chancellor join me in welcoming new business to relocate to Bexhill and Hastings, and to expand?
I would certainly encourage businesses to relocate to my hon. Friend’s area. He is right about the link road: for decades people called for it, and although for all those years there was a Conservative MP for Bexhill, there was a Labour MP for Hastings for many of those years and nothing happened. Now that we have Conservative MPs in both Bexhill and Hastings, we are getting the investment the local area needs.
Q10. On 7 September, the Prime Minister told me that he could not remove refugees from the migration target because of the requirements of the Office for National Statistics, but I wrote to the ONS and it told me that in fact this would be possible. Can the Chancellor therefore demonstrate that Britain will do its bit and remove refugees from the migration target? (902492)
Let me say something surprising: we talk to each other in this Government! The Cabinet actually gets round the table and has meetings. We discuss things, we agree, and then we move forward—the Labour party should try it.
The Office for National Statistics is independent, but Britain is doing its bit by taking 20,000 refugees from the Syrian refugee camps. We have always provided a home for genuine asylum seekers.
Under current toy regulations, small children can be engulfed in flames by 3 cm in one second. Will the Chancellor encourage my right hon. Friend the Prime Minister to intervene to see whether the Business Secretary can introduce a statutory instrument to improve the flammability of children’s play and dress-up costumes?
My hon. Friend is right to raise that case. We all saw the tragedy that befell the family of the “Strictly Come Dancing” presenter and the campaign that her family have undertaken to change the regulations. It is true that we do not have the same flame-retardant regulations for children’s fancy dress costumes. That seems wrong. I know that my right hon. Friend the Business Secretary is looking at the matter and will ensure that that changes.
Q11. Will the Chancellor take this opportunity to correct the bizarre claim made yesterday by Donald Trump about parts of London being no-go areas for the Metropolitan police? Will he point out to Mr Trump that relationships between the Muslim communities of London and the police are in fact excellent? (902493)
The right hon. Gentleman speaks for everyone in this House. The Metropolitan police do a brilliant job, and they have fantastic relations with British Muslims. British Muslims have made a massive contribution to our country. Donald Trump’s comments fly in the face of the founding principles of the United States, which have proved such an inspiration to so many people over the past 200 years. The best way to defeat such nonsense is to engage in robust, democratic debate and make it very clear that his views are not welcome.
Cornwall Hospice Care, which has one hospice on the border of my constituency, is well appreciated and respected by my constituents, but it cannot run to capacity because it receives only 11% of its funding from the NHS. Will the Chancellor work with me and my other colleagues in Cornwall to see what more money can be put into our hospices, and Cornwall Hospice Care?
I know that my hon. Friend is a strong champion of his community and of the hospice he mentions. We have taken steps to help the hospice movement, not least by removing the VAT it paid in the previous Parliament. We want to get the right balance. It is good that our hospices are funded in part by local charities and supported so strongly by the local community, but they also need the backing of the NHS. Of course, as we have a strong economy, we are now putting that money into the NHS so that it can help the hospice movement.
Q13. If business rates are localised without equalisation, my own authority of Gateshead will lose £9.4 million a year on top of the proposed severe cuts to the revenue support grant. The seven north-east local enterprise partnership authorities will lose £186 million a year and the combined 12 authorities in the north-east £223 million a year. Meanwhile, the City of London will gain £222 million and Westminster £440 million. How does that help the Chancellor’s vision of the northern powerhouse? (902495)
The top-up and tariff system will apply as we devolve business rates to reflect the discrepancies the hon. Gentleman identifies. I would have thought that the Labour party supported the devolution of business rates. It is a massive opportunity for local areas to grow and to see the benefits of that growth. When it comes to the northern powerhouse, we have the fantastic announcement today of the new train franchises, which mean more than £1 billion going into new trains, faster journeys, and better journey experiences for people in the north of England. He should get behind it.
An important report was published today showing that the TV debates at the general election were a great success, engaging people who are not normally interested in politics, particularly young people. Will the acting Prime Minister—I know he might have a personal interest in this matter—encourage TV debates at the next general election?
I understand that the Home Secretary has banned 84 hate preachers from entering the UK. Will the Government lead by example and consider making Mr Donald Trump the 85th?
I think that the best way to confront the views of someone like Donald Trump is to engage in a robust, democratic argument about why he is profoundly wrong about the contribution of American Muslims, and indeed British Muslims. That is the best way to deal with Donald Trump and his views, rather than trying to ban presidential candidates.
Point of Order
On a point of order, Mr Speaker. The Secretary of State for Environment, Food and Rural Affairs was questioned on Monday about the availability of funds from the EU solidarity fund to help constituents, such as mine in Cumbria, who are suffering the after-effects of the floods. She was not aware of the fund at the time. Have you since received any representations from Ministers indicating that they wish to make a statement to the House on how the Government can claim funds from the EU solidarity fund to help those constituents?
I am grateful to the hon. Gentleman for his point of order, and I well remember the exchange to which he alludes. The short answer is that I have received no indication of any wish on the part of a Minister to make a statement on that matter. However, the hon. Gentleman’s assiduity, and indeed his ingenuity, are as close to legendary as makes no difference. Therefore, if he is dissatisfied in days to come, I have a hunch that he will try to ensure that the matter can be aired, not with me, but with a Minister.
Armed Forces Covenant (Implementation) (United Kingdom)
Motion for leave to bring in a Bill (Standing Order No. 23)
I beg to move,
That leave be given to bring in a Bill to establish an armed forces covenant scheme; to make provision about the requirements and obligations upon public authorities and agencies in relation to serving and former members of the United Kingdom’s armed forces contained within that scheme; to establish a means of providing audit and accountability in relation to the performance of the scheme against its objective; to amend the Equality Act 2010 and section 75 of the Northern Ireland Act 1988; and for connected purposes.
Our armed forces are one of the institutions that bind the United Kingdom together. The sacrifices that they have made over generations are a common loss that presents us with an obligation towards those who have volunteered to put themselves in harm’s way on our behalf. Memorials in every art and part of the United Kingdom stand as a sad testimony to their sacrifices. For these reasons, the fulfilment of the military covenant should be a cause that demands our wholehearted support.
The concept of the covenant is not a new one, but the legacy of the terrorist campaigns in Northern Ireland, the Iraq wars and the Afghanistan conflict have led to renewed focus on what it means and how it is to be delivered. The term “moral” is rarely used in these post-modernist times, but it is right to describe the covenant as a “moral obligation” to members of the armed forces and their families. That is exactly what it was, is, and forever will be. Therefore, it is an obligation that should be fulfilled in letter and in spirit across the United Kingdom. Sadly, it is not, and that is why I present this Bill today.
At this point, I pay tribute to Mrs Brenda Hale, a DUP Member of the Northern Ireland Assembly who lost her husband in Afghanistan and who has championed this cause on behalf of all servicemen and ex-servicemen and women in Northern Ireland.
In Northern Ireland, by the Government’s own admission, the military covenant is not being fulfilled. The Northern Ireland Office has claimed that 93% of it is being fulfilled. That figure has not been independently assessed, and when I outline some of the problems, Members may wonder how the NIO reached it. However, for the moment, let us take its word and ask two simple questions. When in battle, does a member of the Royal Air Force, the Royal Navy or the Army risk 93% for their country and their comrades? Of course they do not: they risk everything; they risk all. When in battle, does a member of the Royal Air Force, the Royal Navy or the Army who comes from Northern Ireland or lives in Northern Ireland risk only 93% while those in Great Britain risk 100%? Of course they do not: they risk all, just the same as servicemen based in other parts of the United Kingdom.
So where are we failing in our moral obligation? There are four primary areas in which the covenant is not being fulfilled. The first area is priority of treatment in the national health service for wounded, injured and sick veterans. Subject to the clinical needs of others, wounded, injured and sick veterans in Great Britain are entitled to priority national health service treatment for conditions that are attributable to their service in the armed forces. Priority treatment is not available in the same way for veterans in Northern Ireland, not only because they are often reluctant to declare previous armed forces service on security grounds, but as a result of restrictions contained in section 75 of the Northern Ireland Act 1998.
The second area is priority for social housing. Local authorities in Great Britain are required to consider service leavers as having a local connection, and they are given points accordingly. In addition, further priority is often given to veterans on the waiting list for social housing in Great Britain. Again, this is not the case in Northern Ireland because of section 75 of the Northern Ireland Act.
Thirdly, provision for in vitro fertilisation treatment is not available on the same grounds for veterans who require such treatment because of service-related injuries. There are three entitlement cycles in Scotland and England, but only one is available in Northern Ireland. Each cycle costs about £3,500, although the numbers involved are small.
The fourth area is the waiving of domestic rates or council tax for unoccupied property. In Great Britain, local authorities offer a 50% discount on council tax in respect of empty properties owned by service personnel who live in Ministry of Defence property elsewhere as a result of serving in the armed forces. This valuable concession is not available in Northern Ireland.
In looking at issues as important as health and housing, it is legitimate to question how a failure rate of only 7% is arrived at by the Northern Ireland Office. This failure of delivery is not simply due to a slow or disconnected bureaucracy, but to the particular circumstances in Northern Ireland, especially the section 75 provision which requires that key groups are entitled to protection and is now interpreted as a legal barrier to the implementation of the covenant in Northern Ireland.
Lord Ashcroft’s review of the veterans policy, which was commissioned by the Prime Minister, recognised that barrier and proposed that Parliament amend section 75,
“to enable Service Leavers and veterans to receive the recognition and provision they deserve.”
Neither the Ministry of Defence nor the Northern Ireland Office has acted on that recommendation so far, despite the fact that section 75 was amended to include Travellers. It is hard to understand why members of the travelling community should be regarded by the Northern Ireland Office as being more worthy of preferential treatment than members of the armed forces. That is why I and my party have chosen, through this Bill, to highlight the inaction.
Lord Ashcroft’s proposals would fit with the approach taken in the United States of America, where the landmark Civil Rights Act 1964 provided specific protection for Government action for veterans. Alternatively, my party’s Westminster manifesto proposed that, rather than exempt action for veterans from section 75, they should be afforded the same protections as section 75 groups. That proposal is not universally accepted in Northern Ireland, and I have no doubt that that is one of the reasons for the NIO’s reluctance to make changes to the 1998 Act.
Sinn Féin and the Social Democratic and Labour party have opposed the changes needed to enable the full implementation of the military covenant. Many find their attitude disappointing and disgraceful. Those signing up to join the armed forces are not exclusively from the Protestant and Unionist community. The services recruit from all areas, faiths and political allegiances in Northern Ireland, yet both Sinn Féin and the SDLP seem happy to abandon them.
In conclusion, a moral obligation is not met unless it is wholeheartedly and fully met. In Northern Ireland, it is not being met, and thus the moral obligation is not being fulfilled in the United Kingdom as a whole. Today I have shown the failures and offered this House solutions. This Parliament must now commit itself and act to fulfil the moral obligations to members of the armed forces and their families.
Question put and agreed to.
That Sammy Wilson, Mr David Nuttall, Kate Hoey, Jim Shannon, Gordon Henderson, Mr Gregory Campbell, Mr Jeffrey M. Donaldson, Tom Tugendhat, Mr Nigel Dodds and Ian Paisley present the Bill.
Sammy Wilson accordingly presented the Bill.
Bill read the First time; to be read a Second time on 29 January 2016, and to be printed (Bill 106).
[12th Allotted Day]
I beg to move,
That this House believes that mental health should be treated with the same priority as physical health and recognises the importance of promoting good mental health from childhood through to adulthood; believes that not enough progress has been made in translating this House’s commitment to parity of esteem between mental and physical health into practice; notes with concern that the King’s Fund has reported widespread evidence of poor-quality care across mental health services, and the latest available figures show a rise in suicide rates and the number of detentions under the Mental Health Act 1983 increasing by 10 per cent in the past year alone; further notes the delay in the publication of NHS England’s Mental Health Taskforce report; notes the concerns that have been raised with the Scottish Government regarding the rate of inappropriate admissions of young people to non-specialist facilities for mental health treatment which have increased by 38 per cent since 2011; is concerned by the absence of data on NHS spending on mental health services since 2011-12; opposes the Government’s decision not to enshrine the right to psychological therapies in the NHS Constitution; and calls on the Government to urgently rectify this systemic inequity in entitlement to treatments, reinstate the annual survey of investment in mental health services and develop and implement in full a new strategy to improve the Government’s cross-departmental response to mental health.
It is a privilege to open this debate as the first shadow Minister for mental health. The fact that we are having this debate is testament to just how seriously the Opposition consider mental health. The issue affects one in four of us every year, yet it has been neglected for far too long. Mental health has come out of the shadows in recent years, and I know that many Members on both sides of the House feel very strongly about this issue. There have been many important steps forward, but talk to anyone with a mental health condition and they will tell you that they still face stigma, prejudice and discrimination. Sadly, there remain many areas in which there has not been the progress for which we had hoped.
Labour Members have deep concerns about our nation’s mental health and the services and support that are available. Three years ago, my Labour colleagues in the House of Lords won the fight to ensure that the Government wrote parity of esteem between mental health and physical health into law. However, the gap between the rhetoric we hear from this Government and the reality for patients on the ground is growing wider.
I am sure Members on both sides of the House have many constituency cases that echo such concerns. In my first few months in this position, I have been struck by the thousands of messages I have received from people up and down the country. They are desperate to see a change in how our society approaches mental health. This strength of feeling is not surprising. On this Government’s watch, there has been an increase in the number of patients who report a poor experience of community mental health care. More patients have to travel hundreds of miles just to get a bed. The number of children being treated on adult wards, which the Mental Health Act 1983 rightly says should not happen, has risen again this year. The number of people becoming so ill that they had to be detained under the Mental Health Acts leapt by 10% in the past year. The level of suicides, particularly among men under the age of 45, has been at its highest since 2001.
Does my hon. Friend share my concern about the scale of the stress—by common agreement, often inappropriate stress—on the police as a consequence of the pressure on emergency mental health services? My local police have advised me that they sometimes spend half a shift with severely mentally ill patients who are queuing for access to acute mental health hospitals. That is bad for the police and bad for the patients, and is a reflection of the terrible pressures on the acute mental health sector.
I thank my hon. Friend for making that very important intervention. There are too many stories of our blue light services—not just the police, but our ambulance and fire services—being under incredible pressure in contending with such issues. I believe that the Government must do more to address that issue.
I am pleased the hon. Lady has called this debate. Does she share my view that yesterday’s report on perinatal mental health makes incredibly disturbing reading? Many women have lost their lives because of the absence of services. We must commit to making sure that every part of the country has good services to ensure people get through such difficult times.
I will come on to the very serious issue of perinatal mental health that the right hon. Gentleman raises. Again, we should all be very concerned about that issue.
I am very concerned that there has been a psychiatry recruitment crisis, with a 94% increase in vacant and unfilled consultant posts. The NHS constitution treats mental health and physical health differently. The Government claim to be increasing mental health budgets, but patients and professionals tell a different story. Ever since Ministers discontinued the annual survey of investment in mental health three years ago, we do not have an accurate picture of spending on mental health in our country.
My hon. Friend is making an important point about the transparency of spending. Last June, I asked the then Health Minister, the right hon. Member for North Norfolk (Norman Lamb), who is in his place, when figures would be published, and he told me that the Government were working with NHS England to provide meaningful data. Last month, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) tabled a question for written answer asking when the information would be available. It is still not available. Does my hon. Friend agree that the Government should come clean?
The hon. Lady is of course right that this subject is vital. The Government are working hard on it. Will she join me in welcoming the Government’s promise and commitment to bringing in an extra £600 million for mental health services, as set out in the autumn statement?
My concern partly rests on the fact that, given the cuts we saw during the past five years, we are only returning to the levels of spending on mental health that we had back in 2010. I have asked a number of questions about how the £600 million might be presented, but I am waiting for the answers to see how the Government will allocate that money. I will come on to the pledges that the Government have made and what is actually happening in reality.
I will make a little progress, because I have my speech to get through and I am conscious that many Members on both sides of the House want to contribute to this debate.
We are calling for three things that we believe will make a difference. First and foremost—several interventions have referred to this—we are asking the Government to restore transparency to address the murky picture of mental health funding. Secondly, we are asking Ministers to address the fundamental inequality that currently exists in our NHS constitution. Finally, we are asking the Government to prioritise prevention and to implement a fully cross-departmental plan to prevent mental health problems from developing in the first place.
Does the hon. Lady agree that transparency is known to be a very effective lever for the Government to use to improve quality? Does she welcome the steps taken by the Government to increase transparency in the performance of mental health services?
I do not share the hon. Lady’s view. Just in the last week, I have written down a list of 10 things about which I have asked the Government for figures, but about which I have been told that they do not hold information centrally. Many of the statistics that were available previously are no longer available. The central request we are making today is to restore the transparency, particularly on how much is spent on mental health, which the Government took away in 2011-12. Many Members on both sides of the House would like to know those figures.
My hon. Friend is making a very powerful speech. On prevention, is she as concerned as I am that a recent report by the University of Liverpool has estimated that an additional 590 suicides were associated with the work capability assessment process, a Government policy, between 2010 and 2013?
I am fully aware of the research that my hon. Friend mentions. It was carried out by a number of academics from the University of Liverpool, including one of my constituents. I have studied the research very carefully. It highlights many areas of concern, particularly the changes and reforms made by the Department for Work and Pensions that have had a negative impact. I will address the very point she raises later in my remarks.
Nowhere is this gap between Ministers’ rhetoric and the reality more evident than when we look at investment in our mental health services. Only last year, funding for mental health trusts was cut by 20% more than that for other hospitals. In 2011-12, total investment in mental health dropped for the first time in a decade. Perhaps unsurprisingly, in the same year the Government stopped publishing how much they invest in mental health.
Last year, I had to use freedom of information requests to get to the bottom of how much clinical commissioning groups were allocating to mental health: 67% of those who responded spent less than 10% of their budget on mental health, despite the fact that mental health accounts for 23% of the total burden of disease. This year, the Minister for Community and Social Care promised to do something about this. He said he would ensure that investment in mental health by clinical commissioning groups increased in this financial year in line with the increase in their overall budgets. However, as the Government do not publish a central record of these data, I had to use the Freedom of Information Act to find out for myself. Over the past summer, I found that more than one in three CCGs were not meeting the Government’s expectation. That is just one of many Government pledges on mental health that have not been translated into reality.
The hon. Lady is making an important speech, but may I encourage her to be as bipartisan or as all-party in her approach as possible on this vital issue? It is very good to see the Leader of the Opposition and the Heath Secretary in their places, both of whom have a long-standing interest in this issue. Will the hon. Lady at least accept that the all-party campaign led by the right hon. Member for North Norfolk (Norman Lamb)—very substantially assisted by Alastair Campbell, who has some considerable expertise in this area—was successful, beyond the scenes, in persuading the Chancellor to produce an extra £600 million for mental health? All of us will try to ensure that that money is spent well, but let us try to do so with an all-party or bipartisan approach.
I know that the right hon. Gentleman has worked hard on these issues, as have many Members across the House. My job is to hold the Government to account for the promises they have made, and that is what I am endeavouring to do. Where there are opportunities for us to work together we should be keen for that to happen, but the Government have not delivered on their previous pledges. I am keen to know the detail of how that £600 million will be allocated and over what period, and we look forward to that information coming forward.
The spend of clinical commissioning groups is just one pledge on mental health that has not translated into reality, and—unfortunately—another is the commitment to spending £250 million on child and adolescent mental health services this year. In response to a parliamentary question, the Government have admitted that there will be a £77 million shortfall on what they have pledged to spend this year. With those spending promises so far unfulfilled, Labour Members are concerned about the lack of transparency on mental health spending. That is why we are calling on the Government to reinstate the annual survey of investment in mental health services.
It is not only in funding that equality for mental health has yet to be achieved, because a huge disparity remains at the heart of our NHS. The NHS constitution sets out the rights to which patients, the public and staff are entitled, and the pledges that the NHS is committed to achieving. The constitution enshrines our rights to access drugs and other treatments, but it does not extend that right to talking therapies. Recently, the Government consulted on adding a right to psychological therapies to the NHS constitution, but they decided not to include it in its latest version. That decision reinforces the existing bias in the system against mental health, and if the Government are serious about fair access to cost-effective mental health treatment, they must address that fundamental disparity.
I am disappointed with the tribal attacks on the Scottish health service in the motion, and it does not say much for the new politics promised by the Leader of the Opposition. Has the hon. Lady reflected on the situation in Wales—the only part of the UK where the Labour party is in charge—because the Academy of Medical Royal Colleges in Wales, which represents 16 colleges and facilities, said last month that mental health services in my country face significant inequalities? How will the hon. Lady respond to those concerns?
I have heard from my colleagues in Scotland about the challenges that they face with mental health services, and it is right that we should raise that issue during this debate. I have also had the opportunity to meet my colleagues in Wales and see the fantastic work that they are doing. Their pioneering piece of mental health legislation, which came into force in 2012, is the first for any developed country in terms of how it treats mental health, and it ensures that patients have a proper dedicated plan that considers not only their health needs, but their support, personal care, wellbeing, education and training. I look forward to working with my colleagues in Wales and to supporting them in the fantastic work that they are doing.
My hon. Friend made an important point about access to talking therapies. One of the biggest consequences of not having such access is the fact that the only option available to clinicians is medication—often in very inappropriate circumstances—which can lead to people becoming dependent, sometimes for a long period of time. This is not just a minor matter about whether this provision is in the constitution; that lack of access leads to inappropriate intervention that can have a lifelong effect on many people.
I thank my hon. Friend for his important intervention. I am sure that too many of us hear from our constituents about how that sort of experience has been replicated across the country. We know that the number of prescriptions issued for mental health issues has risen exponentially and is into the millions for people who have to access drugs. Sometimes that is because they cannot access talking therapies, which should be of serious concern to us all.
Does the hon. Lady welcome the Government’s commitment to introducing waiting time standards so that patients do not have to wait a long time to get access to a talking therapy? This Government introduced that measure, but the Labour Government did not.
The Labour Government created the services in the first place. In order to introduce a waiting time standard those services have to exist, which was not the case previously. We had to address the chronic underfunding of mental health that existed pre-1997, and we introduced the improving access to psychological therapies programme, of which we are incredibly proud. As things develop, it is right that those waiting time standards come forward. The Labour party had waiting time standards in place for all consultant-led services, which included physical and mental health. I am proud of that fact but disappointed that in too many cases the same equality is not also applied to mental health. If the Government are serious about fair access to cost-effective mental health treatment, they must address that fundamental disparity. That is why we are calling on the Government to commit to ensuring that all patients, regardless of whether they need a drug, a physical health treatment or a psychological therapy, have the same rights.
I hope the hon. Gentleman will forgive me but I will make some progress as I am conscious of time.
Ensuring that people have access to help early on is critical to preventing people from becoming ill, but in recent years, short-sighted cuts to key prevention, early intervention, and community services have been having a devastating impact. When the number of children with a mental health problem who turn up at A and E has doubled in recent years, when one person in prison takes their own life every four days, when a young person who is self-harming is told that because they are not suicidal they do not meet the threshold for help, and when a woman with an eating disorder is turned away from specialist services because her body mass index is not low enough, it is clear that people are not getting the right help early enough.
Too often, mental health problems are ignored, and it is only when they reach crisis point that they receive attention. More and more I hear from mental health professionals across the country that their middle-tier community services, psychologists and counsellors are being stripped out. Apart from the obvious devastating human cost, which impacts on people’s ability to hold down a job, keep a tenancy, pay the mortgage and maintain relationships with partners, friends and family, those decisions will cost our NHS and local authorities more as they struggle to deal with the consequences of serious ill health that could have been prevented. That cost is not insignificant. Recent studies have put the cost of mental ill health to our society at a staggering £105 billion a year. How can the Secretary of State and this Tory Government justify that? Ensuring that people can access support when they need it is an urgent priority, but if we are to ensure that our services are sustainable into the future, we must do much more to prevent people from becoming ill in the first place.
The right hon. Member for North Norfolk (Norman Lamb) mentioned perinatal mental health problems, which affect up to 20% of women at some point during pregnancy and/or the year after the birth of their baby. Left untreated, perinatal mental health problems cost our economy £8 billion a year. Is it not appalling that even if those women seek help, they are not always guaranteed the specialist support they need? The number of mother and baby units has dropped since 2010. The Government’s pledge to spend £15 million on perinatal mental health this year was welcome, but as of this month— according to an answer I received to a parliamentary question—the Government have spent just one fifteenth of what they promised. That is a bitter disappointment because intervening early in perinatal mental health does not just help to improve the health and wellbeing of the mothers affected, but it also improves that of their children.
May I take the hon. Lady back to her point about the IAPT programme that was introduced by the previous Labour Government and is an illustration of where both parties have delivered success? It may be good to enshrine psychological therapies in the NHS constitution, but we need to build more capacity in the system to deliver on access standards. This is not something that we can just write into the constitution; we need to increase choice and access to psychological therapies across the country.
I do not think it is an either/or situation; it is about how we do both, and I will come on to that in the rest of my remarks.
We know that 75% of people who have mental health problems in working life first experienced symptoms in childhood or adolescence, yet only about 6% of the mental health budget is spent on child and adolescent mental health services. We need to do more to focus attention on children, young people and, crucially, prevention, and here we must look to our places of learning, our workplaces and our communities. We need schools and colleges that promote good mental health. We need to ensure that all children have access to high-quality social and emotional learning so that they acquire the skills to express how they feel and develop an understanding and awareness of good mental health. We were concerned to read the 2013 Ofsted report on personal, social, health and economic education, which stated that mental health education was often omitted from the curriculum owing to a lack of teacher training. The Government have funded the PSHE Association to publish guidance and lesson plans to support teaching about mental health, but how are the Government ensuring that schools are actually using it?
We need communities that promote good health and wellbeing. Poor housing, fuel poverty and neighbourhood factors, such as overcrowding, feeling unsafe and a lack of access to community facilities, can have a harmful impact on mental health. These, along with abuse, bullying, trauma, deprivation and isolation, are just some of the levers of mental distress in our communities that we must address.
I congratulate my hon. Friend on setting out such a strong case. Does she agree that the pressure on local government over the last few years has had a negative impact on community cohesion in relation to mental health and led to a growth in loneliness and other such things that spawn mental health problems?
My hon. Friend’s intervention brings me neatly on to my next remarks. I am enormously concerned about the impact of the Government’s deep cuts to local authority budgets over the past five years, of the additional £200 million in-year cuts to public health and of the cuts coming further down the line. I am concerned about their impact on our communities and the services that serve them, such as our libraries, drop-in centres, leisure centres, befriending services—my hon. Friend talked about loneliness—children’s centres, which support parents and young children, and citizens advice bureaux, which support people early on. They are the glue that support and keep our communities together, and I am concerned about what might happen over the next few years.
We need a social care system that is integrated with our physical and mental health services, and we will continue to push the Government to address the fragmentation across these systems. Billions have been slashed from social care budgets and the number of people receiving social care support for mental health has fallen by a quarter since 2009-10. This is seriously impacting on mental health trusts’ ability to discharge their patients. I hear that time and again when I visit mental health trusts across the country. They have patients they cannot move out because the social care is not available for them to move into.
We need workplaces that promote a good work-life balance and where mental health is recognised, understood and supported. Some 70 million working days are lost every year owing to stress, depression and other mental health conditions. Mental health problems cost employers in the UK £30 billion a year through lost production, recruitment and absence. As the chief executive of NHS England has rightly pointed out, the NHS has to get its own House in order. Across the health service, staff tell me they are concerned about their wellbeing and that of their colleagues. Longer hours, fewer resources, greater demands and an incredible amount of goodwill are creating a perfect storm within the NHS. The figures from the NHS staff survey show that the proportion of staff reporting work-related stress has increased from 29% in 2010 to 38% in 2014.
In the spirit of bipartisanship touched on by my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell), will the hon. Lady accept the clear evidence showing a link between good mental health and employment and comment on the number of jobs created over the past five years, which, I have no doubt, has helped to promote good mental health?
I am interested in the hon. Gentleman’s intervention as I am about to talk about employment and unemployment support. I am concerned by the number of constituents coming to see me about the increase in precarious employment and their ability to budget and sustain themselves from week to week.
For those who are unemployed or lose their job because of their condition, the hope of getting back into work under the Government is unjustifiably slim. The latest statistics reveal that fewer than 9% of people with mental health conditions receiving employment and support allowance have been helped back into work by the Work programme. In fact, 83% of people surveyed by the charity Mind reported that the Work programme had made their mental health condition worse. How can it be right that programmes that are supposed to help people into work are doing the opposite?
These issues alone cover the work of at least five Departments, and it does not stop there: the arts have long played an important role in helping people with mental illness; the Ministry of Justice must do much more on mental health in our prisons; and all front-line professionals, especially those in our police and emergency services, need training and support in how to respond to mental health issues.
I come now to our third and final call: we urge the Government to implement a truly cross-departmental plan to improve their response to mental health issues within our society. “No Health Without Mental Health”, published in 2011, promised to be a cross-Government outcomes strategy for people of all ages, but we are fast approaching its fifth anniversary and progress has been limited. We need a new strategy with teeth that will co-ordinate work across all Departments and set priorities, measure progress and evaluate success. We have been eagerly awaiting NHS England’s taskforce report, which was due to be released this autumn, yet we heard the other week in the Chancellor’s autumn statement that it has been delayed until next year, when the NHS England planning guidance will already have been issued. What influence or impact do the Government hope the report can have if the NHS guidance for the coming year will not take it into account?
In conclusion, mental health matters—in our schools, our workplaces and our communities. It matters to our fulfilment as individuals and to the economic success of our society. There have been important strides forward, which we welcome, but we are also concerned that too much is at risk. We hear too often that our mental health system is in crisis. We are concerned that the right help and support is not there for people when they need it; we are worried that not enough is being done to prevent people from having to turn to these services in the first place; and we are anxious that, in some areas, changes taking effect across Departments are making things worse for our nation’s mental health. Much needs to change, and we are asking for three things that will make a difference. I commend the motion to the House.
I congratulate the shadow Minister on securing this debate. She spoke powerfully about the shortcomings in mental health provision, and although she was reluctant to recognise the progress being made, she deserves credit for having secured her first debate on her new portfolio.
President Obama recently talked of the need to bring mental health out of the shadows, and I would like to start by congratulating hon. Members on both sides of the Chamber on their bravery in doing exactly that. I recognise the bravery of my hon. Friend the Member for Broxbourne (Mr Walker), who has spoken powerfully about his obsessive compulsive disorder and its impact on his family life; of the hon. Member for Barrow and Furness (John Woodcock), who has talked about his treatment for depression; of the hon. Member for North Durham (Mr Jones), who has also spoken bravely about his battle with depression; and of my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell), who is part of the new cross-party campaign, and who opened up about his mental health challenges during a difficult period in his life.
I also thank my hon. Friend the Member for Croydon Central (Gavin Barwell) for his private Member’s Bill, supported by the Government, that repealed the laws preventing people with mental health conditions from being Members of Parliament, jurors or company directors. I also thank my hon. Friends the Members for Vale of Clwyd (Dr Davies) and for Eastleigh (Mims Davies). I thank the hon. Member for Ashfield (Gloria De Piero) for her leadership of the all-party group, and I thank the right hon. Member for North Norfolk (Norman Lamb)—no one has done more in the House to campaign for mental health. In particular, I would like to recognise the bravery of his son, Archie, who spoke about his mental health challenges. Anyone who saw the joint interview on ITV News will have been extremely moved. I would also like to recognise someone who is not a Member and is not usually praised by Conservative Members: Alastair Campbell is a very powerful advocate for mental health; his bravery and openness is a reminder to us all that depression affects people in all walks of life.
Hon. Members have sent a strong message to the public: when it comes to mental health conditions, you are not alone. One in four adults experiences mental health problems every year. They affect everyone, including our elected representatives. By speaking out, hon. Members send a message to other parliamentarians who may be suffering in silence. Despite the incredible privilege of working in this place, public life can be incredibly stressful. It can destroy not just people’s hopes but their marriages, relationships and families. Being an MP does not make us immune to the pressures that affect everyone. With the support of wonderful campaigning organisations such as Mind, Rethink, the Samaritans and Young Minds, this kind of courage has made a real difference.
In the past couple of years, we have seen huge determination from those on both sides of the House to improve mental health provision. One reason for that is that society’s understanding has improved a huge amount in the past decade. We should celebrate the fact that we know much more than we ever did before about the workings of the brain, the causes, treatment and prevention of mental ill health, and links to other societal issues, such as debt, unemployment and family breakdown. As a result, between 70% and 90% of those treated for serious mental illness see a reduction in their symptoms and an improved quality of life. That percentage is even higher if the illness is caught earlier. The best example is early intervention for psychosis, which can reduce suicide risk from 15% to just 1%.
We should also recognise the progress made on depression. The World Health Organisation describes depression as more disabling than angina, arthritis, asthma or diabetes, but we know it can be treated as successfully as any of them. The BMJ’s research, published today, mentions that talking therapies for moderate and severe depression can be as effective as drugs. Our own programmes of talking therapies have a 50% recovery rate, post-treatment.
I appreciate the way the Secretary of State is addressing this subject. We are all on a journey on this. He will remember that last October we published a document that painted a vision of achieving genuine equality by 2020; that was not rhetoric. Central to that was introducing comprehensive waiting times standards, so that there was a complete equilibrium of rights: the same right to access timely treatment for both physical and mental health problems. Does he remain committed to that absolutely critical principle?
I am committed to that principle. As the right hon. Gentleman knows—we have discussed this many times—access to treatment is vital, but so, too, is the quality of treatment at the start of the process. We need to make sure that we keep a close eye on both. I think it was right to ask Paul Farmer of Mind to lead an independent review of the best way to make progress towards parity of esteem during this new Parliament. I want to wait and see Paul Farmer’s recommendations before we decide how to implement the vision that the right hon. Gentleman played such an important part in developing.
We all know that one Department’s policy can cause pressures on another area. I read today that the Secretary of State for Justice is announcing a reduction in prison sentences, with more people perhaps serving their sentences in the community. I would not necessarily disagree with that, but will there be discussions with the Department of Health about what pressure that would put on community mental health services? Mental health issues, as well as addiction issues, are often behind offenders’ criminal behaviour. I implore him to look at how one Department’s policy will have a knock-on effect on an already pressurised mental health service.
The right hon. Lady makes a very important point. I reassure her that there are very good and close ongoing discussions with the Ministry of Justice. The mental health of the prison population is another area in which we have failed to do as much as we need to. There are so many obvious things that we could do that would be of huge benefit, not just to the individuals concerned, but to the rest of society through reducing reoffending rates. We are absolutely committed to making real, tangible progress on that.
Set against improvements in the potential of mental health treatment are troubling societal changes that increase the demand and need for mental health support. Globally, there has been an 80% increase in those living alone since the turn of the century. In the UK, the percentage of households in which people live alone has risen to nearly a third. For children and young people, there is not just exam pressure and insecurities around body image, but the risks of social media. The Office for National Statistics found a clear association between more time spent on social networking sites and child mental health problems. Children who spend more than three hours a day on social media are twice as likely to suffer poor mental health.
The Secretary of State talks about the pressures on children. One in five children is in need of treatment and is being turned away, including from A&E. There is a real crisis in service provision, with £200 million reduced from the mental health budget. As he reflects on how big a challenge this is, does he not think his Government’s response is completely inadequate? That is not good enough, despite the good efforts being made. He needs to step up and improve the situation, particularly for young people.
I accept that we need to improve the provision of mental health services for children, but I do not accept the hon. Lady’s characterisation. She will know that in the final Budget before the general election, the previous coalition Government committed £1.25 billion over this Parliament to improving child mental health provision and perinatal mental health support. That has been honoured by this Government, and we are in the process of working out how to roll that out. It is something that the Minister for Community and Social Care, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), spends a lot of time thinking about.
Before we discuss precisely what things need to happen—I think they should be done in a bipartisan spirit—we should recognise that really important progress has been made in recent years. I want to start with some of the achievements made by the previous Labour Government, who increased funding for the NHS and, within that, for mental health services. They oversaw a significant expansion of the mental health workforce and big improvements in in-patient care, with 70% of mental health patients being seen in private rooms. They increased the use of new drugs and therapies, including psychotherapy. Those were important steps forward.
Under the coalition Government in the previous Parliament, we saw a record investment of £11.7 billion in mental health services at a time of huge pressure on public finances. We passed the parity of esteem clause in the Health and Social Care Act 2012, something we Conservative Members are incredibly proud of. The first access targets were set for talking therapies for psychosis. We are starting to end the distortion that the right hon. Member for North Norfolk talked about, which saw targets for physical health access sucking resources away from local mental health provision over a sustained period.
We have seen particular progress in two areas. It is important to mention them; it provides encouragement that when we decide to focus on improving specific areas of mental health provision, we can make real progress. First, on talking therapies, the NHS is now recognised as a world leader. The number of people getting help from talking therapies quadrupled from 182,000 people starting treatment in 2009-10, to 800,000 starting treatment last year. The total number of people helped in the previous Parliament was 3 million, compared with just 226,000 people helped in the Parliament before that—a thirteenfold increase.
We are hitting the new access target to reach 15% of those needing it, although we are not quite hitting the recovery target; I hope we can put that right soon. That model is being looked at very closely by Scandinavian countries, and a pilot, based on what we have done here, is starting in Stockholm. We can be very proud of that important progress.
The last Parliament saw a 50% increase in dementia diagnosis rates, up from 41% at the start of the Parliament to 67% at the end of the Parliament—the highest dementia diagnosis rate in the world. We have 1.3 million dementia friends and 120 dementia-friendly communities. We have seen a doubling in funding for dementia research, with a new ambition to find a cure or disease-modifying therapy by 2025. In the spending round, the Prime Minister announced funding for a new dementia research institute; that will be another important step forward.
The Secretary of State talks about the amount of money put into dementia research for very good reasons, but is there not a strong argument for building a research and evidence base around mental health? We need a commensurate investment in research on mental health, so that we can understand more about prevalence.
My hon. Friend is absolutely right, and I commend him for the work he does on the all-party group. The truth is that it is still early days when it comes to a proper understanding of mental illness. According to the latest Times Higher Education league table, this country has five of the top 10 health research universities worldwide, so we have a huge contribution to make to that research; he is absolutely right to make that point.
I have already mentioned the 590 suicides associated with the work capability assessment. In addition, the Royal College of Psychiatrists has raised concerns about the cut to the employment and support allowance work-related activity group, given that many of those affected have mental health or behavioural disorders. According to the RCP, there is potential for exacerbating mental health issues and self-harming, and even for people to take their own lives. Will the right hon. Gentleman meet the Secretary of State for Work and Pensions to deal with this matter?
We have close working relations with the Department for Work and Pensions, which I shall come on to explain. I would urge caution, however, on the issue of suicide rates. The BMJ study said that no conclusions could be drawn about cause and effect from it. When it comes to work, we need to remember the many studies that talk about the improved health and wellbeing that comes from being in work, and the tremendous progress made, with 2 million additional jobs created over the last Parliament.
I acknowledge the progress made, but let me tell the Secretary of State that what really winds up people outside this place is the rhetoric-reality gap. When they hear politicians on all sides making grand statements about access to treatment, but the reality is different, it damages the integrity of politics. There are two options for the Secretary of State. The first is using political will at a national level to say to local commissioners that they have to prioritise mental health and close the gap in terms of parity of esteem. The second is to address the fact that commissioners on the ground do not have adequate resources; they have to make impossible choices because sufficient resources are not being made available.
Order. Before the Secretary of State answers the intervention, let me say that long interventions are not appropriate on a day when so many Members wish to speak. If Members wish to make a speech, they may do so, but an intervention has to be short.
If the hon. Gentleman has listened to what I have been saying, he will know that I have been very honest about the problems and about the gap between what we want to deliver and what we are delivering. I shall come on to talk about some solutions, but it is important that Opposition Members recognise that we have had a real and specific focus on mental health over the last five years, during which very important progress has been made. If we continue to broaden out our focus, we hope we can make progress in other areas as well.
Let me talk openly about where more progress needs to be made. First, we have far too much variation in the quality of services across the country, and opacity about where services are good and where they are unsatisfactory. It is wrong that I, as the person responsible for the health service, cannot tell people in simple terms the relative quality of mental health provision in North Shropshire versus South Shropshire or in Cirencester versus Sheffield. We need to know that. We know from other areas of the health service that once we can be transparent about the variations in care, people will measure themselves against their peers and huge improvement can be made.
My right hon. Friend deserves great praise for not only the content but the tone of his speech. Further to the point made by the hon. Member for Bury South (Mr Lewis), does my right hon. Friend agree that while any gap between reality and rhetoric is to be regretted, what really irritates our constituents is the making of bogus party political points on the subject? I hope that he will ensure that his tone and his content are reflected by his Department. I wish him every success in working with the hon. Member for Liverpool, Wavertree (Luciana Berger), who clearly cares deeply about this matter, to ensure that we have an all-party approach to it.
My right hon. Friend is, of course, absolutely right, and I think we do a great disservice to the many people suffering from mental health conditions if we allow this to become a partisan issue. Of course Oppositions must hold Governments to account for their promises, but we should never try to suggest that one side of the House cares more about this issue than the other or that the efforts on one side have somehow been compromised by a lack of interest in or commitment to the issue. It is clear from the number of Members of all parties speaking in today’s debate that the determination to improve mental health provision is shared right across the House.
We urgently need to address other issues, including the increase in eating disorders such as anorexia, which can be a killer. Between 5% and 20% of anorexia sufferers tragically die, and we have to do something urgently about that. We need to deal, too, with the pressures on child and adolescent mental health services, with which all Members will be familiar through their constituency surgeries. Referrals were up 11% last year, and we need to make sure that CAMHS is able to deal with that extra demand, as well as looking at what can be done to improve early intervention so that we reduce the increase in those referrals.
Let me make some progress, and I shall give way later.
We need to look at the use of police cells, which has often been spoken of here. We have seen a 55% reduction in the use of police cells over the last three years, but they were still used 4,000 times last year. Particularly for children, that is totally inappropriate, and it is often inappropriate for adults, too. Out-of-area placements for non-specialist care are another issue, and the Minister for Community and Social Care is working extremely hard and is committed to implementing a plan to turn this around by March next year.
The Secretary of State talked about cross-party support for action to tackle suicide and related issues. In our debate on assisted dying, there was a lot of support for doing more to tackle the problems of anyone who suggested that they wished to commit suicide. Why, then, does the right hon. Gentleman refuse to acknowledge the impact of benefit cuts and changes in assessment processes, as mentioned by my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams)?
The BMJ was very clear in saying that conclusions about cause and effect should not be drawn, but let me make a broader point about suicide. Suicide rates—under the last coalition Government and the previous Labour Government—have been above and below the 20-year long-term average, but I think they are an important bellwether of the effectiveness of mental health services. I think we should be bold and ask whether we could have a zero-suicide ambition. No country in the world has delivered that, and it would require a big rethink of the way we approach mental health services. Nevertheless, I think that we should be bold and ambitious and think in terms of that objective, and then think about all the factors that may contribute to people being in a highly distressed state and unable to get the support that they want.
We are working very closely with the Department for Work and Pensions to improve mental health provision for people who are looking for work—not just those who are experiencing difficulty in finding work because of stigma and bias among employers, but those who are in work but may fall out of the workforce because of a mental health condition.
We cannot do everything, in this area of health provision as in others, but that does not mean that we should not make tangible and measurable progress towards the ambitions that are shared by Members in all parts of the House. The first important step involves funding. The Chancellor delivered a record settlement for the NHS in the recent spending review, confirming a £10 billion real-terms increase in its funding over the course of this Parliament. That is very significant for mental health, because not only will there be a rise in the baseline funding of the clinical commissioning groups that hold local health budgets, but those CCGs are committed to increasing the proportion of their funding that goes into mental health.
I will proceed with my speech for a little longer, if I may.
We are seeing the prospect of very real progress, and we as a Government need to give careful thought to which areas to prioritise. We do not have a monopoly of wisdom in this area, which is why we set up the independent mental health taskforce that is led by Paul Farmer, the chief executive of Mind. We will receive its report early in the new year. It will follow a successful independent report produced by the cancer taskforce, chaired by Harpal Kumar. I think that it is a good way of uniting the Government, Members in all parts of the House, and the mental health campaigning charities, so that we can decide together on the key areas that we want to transform in the coming years.
We are still working on the detailed planning, but we have already announced the provision of £2 billion of additional mental health funding over the course of this Parliament, which will benefit CAMHS, perinatal mental health treatment, the treatment of eating disorders, and talking therapy. Some of that funding is a result of promises made by the coalition Government which we have said we will honour, and some is a result of promises that we ourselves have made.
I agree with the hon. Member for Liverpool, Wavertree that as we increase investment in mental health, we need greater transparency in respect of the way in which that money is spent. I am pleased to say that next June, following consultation with the King’s Fund, there will for the first time be independently assured Ofsted-style ratings that will tell us very simply, CCG area by CCG area, whether mental health provision in the health economy as a whole is outstanding, is good, requires improvement, or is inadequate. As far as I know, ours is the first country in the world to do that. The hospital sector underwent the same process in the wake of Mid Staffs, and, on the basis of that experience, I believe that it will lead to a dramatic reduction in variation and an improvement in care as people are given independent information about how their services compare with those of their peers. That increased transparency will also mean the development of a new mental health data set, which will enable us to collect more and better data and then share them with the House, debate them, and learn what needs to be learnt.
I recognise the thoughtful case that the Secretary of State is making in saying that things are not good enough but they are getting better, but I must say to him—in a non-partisan way—that when it comes to funding, the stories about funding in my area do not match what we are hearing from him today. There is a story on the Manchester Evening News website about a £1.5 million cut in Greater Manchester.
We, as a Government, make commitments and choices in terms of where we want resources to go, and we then have a duty to ensure that they are followed up locally. As we know from our experience of the health service, sometimes—under all Governments—that advice is followed, and sometimes it is not. The introduction of proper independent ratings, area by area, will enable us to expose the areas that are not making the commitment to mental health that they should be making. As has been pointed out many times by Members in all parts of the House, failing to invest what is needed in mental health is a false economy. It stores up problems for accident and emergency departments and for the providers of mental health services, because late intervention means more expensive intervention, and it is of course a very real human tragedy for the individuals concerned.
I believe that we will be able to do that, but I will write to the hon. Lady to clarify exactly what we think we are able to do. I am certainly committed to ensuring that the House is given information about the quality of provision throughout the service, and investment is a factor in determining whether the standard of that provision can be as high as we want it to be.
The hon. Lady rightly spoke of the importance of cross-Government work. We have established an innovative unit with the Department for Work and Pensions, and have set up a series of pilots to help people with mental health conditions to get back to work. We urgently need to do more to reduce the stigma perceived by employers. According to the findings of one survey, up to 40% of employers would avoid hiring someone with a mental health problem. We also want to help those who are at risk of leaving work because of mental health problems. We are working closely with the Department for Education as well. We have launched a pilot programme to create a single point of contact for schools that are concerned about pupils with mental health challenges. It now covers 22 areas and 27 CCGs.
If we are to tackle this issue, however, we need to achieve something that the Government alone—indeed, the House alone—cannot deliver. We need further progress throughout society in reducing that stigma. Bill Clinton once said:
“Mental illness is nothing to be ashamed of, but stigma and bias shame us all.”
Let me end by paying tribute to the Time to Change movement, founded by Mind and Rethink, and the Dementia Friends movement, led by the Alzheimer’s Society. I also pay tribute to Members in all parts of the House who have participated in mental health campaigns, and reassure them that they have the Government’s full support as we try to change attitudes on this vital mission. Someone once said that the greatest cruelty was our casual blindness to the despair of others. Let us resolve today that when it comes to mental health, no one can ever say that about the House of Commons.
I congratulate the hon. Member for Liverpool, Wavertree (Luciana Berger) on initiating such an important debate. It is a privilege to contribute to it.
I must begin by declaring a professional interest, having worked as a forensic and clinical psychologist for 20 years in the NHS and beyond, specialising in mental health, at consultant level for 10 of those years. I continue to maintain my skills and engagement in line with the professional requirements of my registration with the British Psychological Society and the Health Care Professions Council. Earlier in the year, I had the privilege of contributing to the evidence taken by the Youth Select Committee during its inquiry into child and adolescent mental health services.
I want to say a little about three topics: the adult mental health service and strategy, child and adolescent mental health services, and mental health services for veterans. Mental health is an extremely wide field, ranging from major mental illnesses such as psychosis and depression and anxiety disorders to trauma and eating and adjustment disorders. Developmental disorders such as attention deficit hyperactivity disorder and autistic spectrum disorder are also sometimes included in the sphere of mental health, and I would welcome future debates about those important conditions, because I fear that we shall not have time to do them justice today.
The British Psychological Society has reported that one in four people in the UK will experience a diagnosable mental health problem, with mental health problems accounting for up to 23% of all ill health in the UK and being the largest single cause of disability. In Scotland the figures are currently one in three. Mental disorders are strongly related to risk of suicide, and it should be known that high levels of comorbidity with substance disorder and physical ill health are prevalent.
Mental health services across the UK are not the finished article wherever you go. We are continually striving towards improvement, and that should always be guided by patient need and by research underpinning most effective clinical practice.
When I started practising in the 1990s in Scotland, the funding of mental health services severely lagged behind other areas of NHS funding. That resulted in far too few practitioners and what seemed to be never-ending waiting lists for both patients and clinicians. At the start of my career, patients routinely waited to see psychologists in mental health specialties for six to 12 months, and in some areas for over a year. That was clearly ineffectual, often meaning that problems were exacerbated over time and that a mainly medical model persisted. That is not what patients wanted, nor did it fit with best practice; evidence indicates that patient recovery is improved with access to talking therapies alongside medical management. That is evidenced clearly in National Institute for Health and Care Excellence guidelines.
In 2014, the HEATs—health improvement, efficiency, access targets—were adopted in Scotland and across the UK, meaning that patients should be seen from referral to assessment in 18 weeks. In Scotland in 2014, 81.6% of patients were seen in 18 weeks and the number of people seen was 27% higher than in the same quarter the previous year. Demand is increasing, which is a good thing: it means that we are starting to tackle stigma and that access is improving.
Matched stepped care involving psychological therapies and practitioners at differing levels, depending upon clinical effectiveness of therapy type for different disorders, was rolled out in all boards within NHS Scotland, and NHS Education for Scotland took a primary role in workforce capacity modelling and training. Use of self-guided help has also been developed. Technological advances are important in terms of access for patients in this modern world and in relation to early prevention. Suicide rates have been brought down and the target met of training high levels of front-line staff in suicide prevention and risk identification. Quality ambitions have also been developed as benchmarks in relation to person-centred, safe and effective care.
I fear, however, that demand on mental health services will continue to increase dramatically. Evidence suggests that recession increases mental health problems, including depression, suicidal behaviours and substance abuse. Unemployed individuals, particularly the long-term unemployed, have a higher risk of poor mental health compared with those in employment. Stress is now the most common cause of long-term sick leave in the UK and the more debt an individual has the more likely they are to suffer a mental health problem. A social and policy climate of austerity, affecting the most vulnerable to a greater degree, is a likely aggravator of mental ill health.
I welcome pledges from both the Westminster and Scottish Governments to increase spending on mental health significantly: the figure is £100 million in Scotland. Mental health services, however, have not achieved parity with physical health services over the decades since I started in the field and we need to be clear that much more is needed to fill the gap. I commend Ministers and MPs to visit mental health services and spend quality time with clinicians on the front line. Managerial statistics often occlude a multitude of issues and it is only with that front-line insight that the true patient journey and daily clinical barriers can be identified. Those often include excessive paperwork, repeated reviews and service changes that diminish morale.
Mental health problems in childhood are extremely serious. They can destroy educational potential at worst and impede it when problems are less severe. Difficulties must be assessed and recognised at an early stage. HEATs for child and adolescent mental health services were set at 18 weeks as of December 2014. NHS Scotland data suggested a significant reduction from 1,200 waits of over 26 weeks in 2008. In the quarter ending June 2015, 76.6% of CAMHS patients were seen in 18 weeks and the average wait was nine weeks. In the past two years, there has been a 35% increase in demand due to productive work completed on stigma and in improving access, and since 2009 £16 million has been invested in the CAMHS workforce; it is at its highest ever level. To improve waiting times further, £15 million more has been pledged to CAMHS in Scotland. Widespread staff training has been undertaken in modalities such as cognitive behaviour therapy, family therapy, interpersonal therapy and specialist interventions such as for eating disorders, with a focus on seeing patients as close to home as possible. More progress is required across the UK and in Scotland to meet the 90% target.
I must say that in-patient treatment for children and adolescents should be a last resort. It takes children away from family and pathologises their difficulties. Best practice highlights intensive outreach approaches enabling children to be seen at home and treated in their natural environment, so maximising key family and peer supports. Children who need in-patient services suffer psychosis, intractable eating disorders, severe obsessive compulsive disorder and a variety of neurological conditions and neuro-developmental disorders. Currently there are 48 beds available in Scotland and this year £8 million was pledged to build a unit for children and adolescents with mental health problems in Dundee. My clinical experience suggests a lack of available beds in forensic and in learning disability child and adolescent mental health services. Constituents who have contacted me have also suggested that further work needs to be done to improve access to specialist eating disorder in-patient care outwith the private sector.
Increases in the number of children presenting with self-harm and receiving brief overnight admission have been high. Clinically, this is quite a difficult decision. Often, clinicians are faced with the issue of sending adolescents for a brief stay miles and miles from their home—which makes it difficult for carers and parents to visit them—or admitting them briefly overnight. Surely the optimum treatment would be to see and assess them and to ensure that children are safe and able to go home with the strongest possible package of care as quickly as possible.
I value greatly the contribution from the hon. Lady, who has huge expertise. I get the feeling that there is much medical expertise to come from the paper she may have been citing a lot in her speech. As the Front-Bench spokesman for her party, could she explain whether she thinks the points made in amendment (a) were valuable? In the absence of that, does she support the motion as it stands? How does she urge Members to vote today?
I do not support the motion and how it reflects Scottish Government care. As I have said, for children who have mental health difficulties, clinicians have to make a sensitive judgment regarding the length of potential stay, and whether the problems are intractable and the children should be admitted to a specialist unit, which can often be some miles from their home. Many of cases of self-harm attempts require psychiatric assessment and monitoring, overnight care and monitoring, and then a package of intensive home care to try to reduce the chance of another such incident. I hope that answers the hon. Lady’s question.
Recommendations, however, do have to be made in relation to CAMHS. They include having a wider appreciation of children’s mental health beyond any problems, providing education and awareness in schools, and having access potentially to mental health clinicians in school settings and not just clinics. As with diet and exercise, good mental health should be normalised. Those are all fundamental living skills that impact on all aspects of functioning and deserve more of a health and well-being slant, rather than a pathologising label.
Does my hon. Friend agree that it is invaluable to have these services in schools as that normalises the feelings of low self-esteem that many of these young people are experiencing, and does she also agree that to have counsellors based in the school is very important for young people’s mental health?
Yes, access to such mental health services in schools is certainly merited, as well as mental health awareness and training, and particularly training for staff in schools so that they can pick up at a very early stage if someone is experiencing a mental health problem and then try to access services at that very early stage. Specialist training for teachers would be a positive step forward so that they recognise the signs of mental distress in children. We also need to modernise our approaches to mental health for children and adolescents and embrace the IT and social media method of communicating with young people, because that is the modern world and that is often where they communicate from.
There is a project in Scotland called SafeSpot, an application, website and school intervention to promote positive coping skills, safety planning and access to information about mental health services for young people. The project is going very well and the app is freely available on iTunes and in Android stores. The SafeSpot app and website will be used within Greater Glasgow and Clyde health board, and Dundee health board is also looking at access to it. It was designed by a clinician, Dr Fiona Mitchell, specialist registrar in child and adolescent psychiatry, and I commend her on her innovative work in that regard.
There remains a lack of empirical data regarding effective interventions for young people with comorbidity issues, by which I mean mental health coupled with learning difficulties or substance use, and that requires to be built upon. Looked-after and accommodated children are some of the most severely disadvantaged in terms of services and magnitude of difficulties, particularly those who also may have violence-risk needs or self-harm needs. Further service provision for specialist groups and underpinning research will be crucial.
Given that the weight of evidence for child and adolescent mental health services is in favour of psychological, rather than pharmacological, interventions for the majority of child mental health presentations, clear structures should be in place to support the delivery of effective, evidence-based psychological therapies for children and adolescents. Those from socially disadvantaged backgrounds have always tended to have a poorer uptake of CAMHS. An assertive outreach may be required so that some of the most vulnerable and disadvantaged children and families do not slip through the net.
Specialist service delivery in areas of developmental disorder such as autism, children in the criminal justice system, and children with comorbidity requires to be thought through and planned, so that those children and their families are able to access facilities without feeling they are being passed from pillar to post. It is extremely difficult for families in particular to access early diagnosis of developmental disorders such as for those with autistic spectrum disorder, which means that their needs can go unmet for years and their attainment may diminish.
I continue to believe that the mental health of veterans is an area that is underfunded across the UK and that those who have been willing to lay down their lives for their country should have consequent health, including mental health, needs prioritised. The Minister agreed a few months ago during my Adjournment debate that much more would be done. I would like to have a statement on what more is being, and will be, done, particularly as we are now in a new conflict and the numbers of those in our armed services who witness or experience trauma will increase.
As a clinician in mental health, I make the following plea to the House. To me, mental health services are beyond party politics and it is crucial we tackle this meaningfully in a cross-party manner that brings about real continued progress on the ground for service users and staff, and that we share best practice across the UK and a “what works” philosophy.
I welcome the announcement of improved access to data, which is also crucial in terms of taking forward and ensuring best practice. I say in conclusion that I sense a real note of collegiality across the House and a will to take this important issue forward. I look forward to fully partaking in that, and my party wishes to see mental health services continue to improve in Scotland, the UK and beyond.
One of the ways in which we can measure how civilised a society we are is how well we deal with our most vulnerable citizens, and there are few groups more vulnerable in our society than those who suffer from mental illness, yet from when I began working in the health service as a doctor back in the early 1980s to right through my time as a Member of Parliament, mental health services have been the Cinderella subject in the national health service. Let us be very frank: we would never accept the level of care in cardiac disease, orthopaedic disease or cancer for our constituents that we are forced to accept in the treatment for mental illness.
There can be few areas where our advocacy role as Members of Parliament is more important than mental health, because the people involved are very often among the least able and least willing to stand up for themselves in the debate about how the NHS cake is going to be divided.
We have a role, also, in dealing with what the Secretary of State and the Opposition Front Bencher, the hon. Member for Liverpool, Wavertree (Luciana Berger), talked about as the last taboo. We do have to make societal changes and we can be instrumental in that, and I pay tribute, as the Secretary of State did, to our colleagues in this House who have used their often painful personal experiences to give colour to our debate and to take this issue forward. In all 23 years that I have been in the House of Commons, I cannot remember an attendance as high as that today for a mental health debate. That is indicative of how far we have come.
I very much welcome the Government changes both in terms of the funding they are proposing and the attitudes that have been fostered in recent years, not least, I have to say, during the coalition Government—it was one of the great achievements of that coalition Government that they put mental health much further up the agenda. I am particularly pleased at the announcement the Secretary of State has made about transparency on clinical commissioning group outcomes, because it is not the spending that we need to see, it is the outcomes. That is the crucial element, and I look forward to the details he will be bringing forward on that.
However many rights we give patients, it is the capacity-constraints that will ultimately determine what those outcomes are, and I want to deal with just two or three of them. The Government’s IAPT—improving access to psychological therapies—programme is a great programme. Getting access to talking therapies is, as the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) said, extremely important, and I was asked to do a short piece for the “Victoria Derbyshire” programme on the BBC in which we looked at the difference between the best and the worst in the provision of talking therapies.
It is unacceptable, in a national health service that is funded from the single basis of taxation, that in some parts of the country 100% of patients are seen within the Government’s target time, whereas at the other end of the scale, in East Cheshire, which is the worst area, only 4.6% of patients are seen within that time. We can accept something of a discrepancy between the best and the worst, but we cannot accept that level of discrepancy in a health service that is supposedly funded on an equal basis across the whole country.
As the hon. Member for Liverpool, Wavertree and others have said, experience suggests that when there is better access to talking therapies, doctors are less likely to prescribe medication, including antidepressants. That is an extremely positive development, because one thing that has worried me about the lack of capacity in mental health services is what I would describe as the medicalisation of unhappiness. Because medical professionals simply do not have the time to talk to patients about the causes of their symptoms, they deal with the symptoms themselves. That is not good medical practice.
The second area that I am concerned about is child and adolescent mental health services. In the 23 years that I have been in the House of Commons, Government after Government of both political persuasions have told us that those services will improve, but I have seen very little sign of it. That matters because about 70% of adult mental health problems will have presented by the age of 17. One would have thought that, knowing that, we would prioritise healthcare early on to minimise the damage that is caused by untreated illness, yet we are still not fulfilling our duty on that front.
The biggest problem we face is that of in-patient capacity. When we debated the closure of the old Victorian asylums, it was very personal for me because I worked in one of those old hospitals. It was genuinely a Dickensian nightmare. There was a great fashion, which was supported right across the House, to move towards care in the community. However, the consequence of not having adequate capacity in the community was that a lot of patients fell through the net. The point has already been made about the large population of those with mental illnesses in our criminal justice system. In effect, we closed one type of inappropriate institution and ended up with patients in a different type of inappropriate institution, and called it progress. That is simply not good enough and we need to do much more to prevent patients who are mentally ill from being incarcerated in our criminal justice system, when they should be treated appropriately for their illness.
We also see patients being put in police cells because there is inadequate capacity in in-patient care. How would we feel if women with breast cancer or diabetic patients were put in police cells because we could not find beds for them? It would be on the front page of every newspaper and lead every news bulletin in our country.
No, I will not.
I would love the money that is being made available for mental health by the Treasury to be ring-fenced in CCGs. If that money is not ring-fenced, it will go elsewhere, for the very reasons I have set out. We need to ensure that the money that is rightly being made available for mental health treatment ends up there and is not siphoned off into areas where the voice for spending is stronger. I would love us to give more support to the wonderful mental health charities out there, such as Marjorie Wallace’s SANE and Mind. All those charities are hugely important.
In closing, I ask the Secretary of State to look at one thing: the incipient crisis of suicide among men in the United Kingdom—a subject that is not hugely talked about. The culture of our society often makes it difficult for men to admit that they are unable to deal with the stresses of life, anxiety and depression. The statistics relating to the worst manifestation of that—suicide—are deeply worrying. British men are three times as likely to die by suicide as British women. Suicide remains the most common cause of death in men under the age of 35. More than a quarter of the 24 to 34-year-old males who die take their own lives, compared with 13% among women. That is a huge national scandal and we need to give priority to it.
Success or failure in dealing with mental illness in the 21st century in the world’s fifth richest country is not just a judgment on the Government or the NHS, but on our society as a whole and on our basic humanity.
I am sorry to have to say, not for the first time in this House over the last few years, that in spite of all the warm reassurances from the Government that our mental health services are getting better, the experience of my constituents as users of the service, people who work in the service and those who manage the service is completely different.
It is extremely welcome that mental health has risen up the political agenda in recent years. I pay tribute to the many people outside and inside this House who, by speaking of their own experiences, have helped to achieve that. However, the higher public profile has not yet translated into delivery on the ground. In my area, the public are still experiencing services being cut and are still having to wait an unacceptably long time for talking therapies and other treatments.
In spite of the repeated warnings about the scandal of people being sent out of area in recent years and the assurances we have received, there was a 23% increase in the number of patients sent out of area last year, taking it up to more than 500. In Devon, which is one of the worst performing parts of the country, 45 patients were forced miles away from their friends and families.
I recently experienced that problem for myself, when the bright and previously happy teenage daughter of a close friend of the family had a crisis. While on the waiting list to receive treatment, her crisis escalated rapidly and she had to be admitted. There were no suitable beds at all in London, where she and her family live. She was first sent to Southampton, only for the unit there to be deemed unsuitable. She was then sent to Manchester.