House of Commons
Monday 9 January 2017
The House met at half-past Two o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
Work and Pensions
The Secretary of State was asked—
I call Mr Gerald Jones. Where is the feller? He is not here.
The Government support those who aspire to be their own boss. The number of self-employed people in the UK labour market has increased by nearly 800,000 since 2010 and by 129,000 in the last year alone. We continue to monitor and review the impact of self-employment on the wider labour market and benefits system.
A Citizens Advice report in August 2015 said that there were as many as 460,000 people in bogus self-employment, with a cost of hundreds of millions of pounds in lost revenue. Is it not about time that the Secretary of State, rather than hounding disabled people, started tackling exploitative companies, many of which have lucrative public sector contracts, that are forcing people down the self-employment route?
The hon. Gentleman is right that there should be no exploitation of workers, particularly through forced self-employment, but he will have noticed that the Government are on the case, having set up the Matthew Taylor review specifically to explore alternative employment structures and to consider how employment rules need to be altered to keep pace with changes in how people work in the modern economy. If, however, he is characterising the growth of self-employment as harmful to the jobs market, I would disagree. The new enterprise allowance is proving very successful at making sure that people who want to can work for themselves. I am sure that he, like me, welcomes the fact that in his own constituency self-employment is up by 7% since 2015, and that the claimant count in the last year has fallen by 12%.
Happy new year, Mr Speaker.
Does my right hon. Friend agree that rather than denigrating people who become self-employed, we ought to be celebrating the fact that they are prepared to take a risk that many others are not? Will he make it as easy as possible for them to take on new employees and become employers themselves?
I completely agree with my hon. Friend. I have already mentioned the new enterprise allowance, which is designed specifically to help people to stop claiming benefits, set up their own businesses, and then carry on and employ others in a way that I hope everyone on both sides of the House would welcome. This scheme is proving extremely successful. A survey published last year showed that 80% of businesses that started with the new enterprise allowance were still trading, which makes it more than twice as effective as the old jobseeker’s allowance in terms of keeping people off benefits, so it is doing good work.
Happy new year, Mr Speaker.
Will the Secretary of State ensure that there is much closer co-operation between the single fraud investigation service and local authorities on the prosecution of abuse, including on self-employment status, so that councils can be confident that when they report possible scams, including by employers, they are properly followed up?
I am happy to pass on the right hon. Lady’s message to the relevant bodies—councils and the fraud investigation service. Of course, while self-employment is a good thing, fraud involving any kind of employment is wrong, so clearly we must get ever more effective at combatting it.
I am sure that the Secretary of State agrees that online opportunities are giving many people the chance to set up a microbusiness. Does he agree that schemes such as the pop-up shop initiative that Torbay Council ran to help internet micro-retailers to take their first step on to the high street are the kind of thing we should be looking at in terms of self-employment, rather than some of the negative impressions we hear from the Opposition?
I very much agree, and I particularly welcome Torbay’s pop-up shop experiment. I had such a scheme in my constituency a couple of years ago, and it did indeed prove successful in allowing microbusinesses to start and to develop into larger businesses, thereby creating more employment and wealth, so I am delighted to hear what is happening in Torbay.
Happy new year, Mr Speaker.
Many self-employed people do not earn a great deal of money and will be losing out from cuts to tax credits and the introduction of universal credit. Should not the Government be supporting those who become self-employed?
I am sorry, Mr Speaker, that I have not yet wished you happy new year publicly—I have done so only privately—as clearly that is becoming a compulsory part of this question session. I now wish you happy new year publicly.
I do not agree with the hon. Gentleman’s characterisation of self-employed earners and universal credit. Universal credit reduces poverty by making work pay. It supports claimants to enter work, and then to be able to keep some of their benefits while they are at work if they are not receiving or earning very much money. Universal credit actually does the opposite of what the hon. Gentleman says—it helps people who are getting into work for the first time.
But is not the biggest trend in self-employment the massive increase in women who are self-employed, with 70% of those newly self-employed in 2014 being women? Yet self-employment is the area where the wage gap is biggest. According to the OECD, self-employed men earn an average of £17,000 a year, but average earnings for self-employed women stand at £9,800. We know from the Department’s figures that women are less likely to access loans and so forth for self-employment. What is the Secretary of State doing to deal with gender inequality in self-employment?
I agree with right hon. Lady that gender inequality and pay generally are issues that we need to do more about, and self-employment is one part of that. That is why we have introduced measures such as the new enterprise allowance—
Only men take it up.
The right hon. Lady says that only men take it up, but that is patently not true.
It is disproportionately men.
If the right hon. Lady is saying that it is disproportionately men who take the allowance up, I would urge more potential women entrepreneurs to take it up. We are improving the new enterprise allowance later this year to make sure that the mentoring and advice goes on for longer so that more people—men and women—will be able to benefit from the freedom of being able to start, set up and run their own business, which millions of people want to do.
A happy new year to you, Mr Speaker, and to everyone.
Resolution Foundation data show that self-employment accounts for 81% of the net change in employment since 2008. The Government’s plans to abolish class 2 national insurance contributions could leave low-income, self-employed women paying five times as much to access maternity allowance. Given that nearly 2 million self-employed workers earn less than the national living wage, why have the Government decided to make social security support harder to access for so many of Britain’s entrepreneurs?
They have not. Let me update the hon. Lady’s figures, which I know she has quoted before. Since 2010, 29% of the increase has been in self-employment, and in the last 12 months—
I know about 2008; I am giving more up-to-date figures, as I said.
Over the past year, 38% of the increase in employment has been in self-employment, so the figures are not as the hon. Lady suggests. As I said in answer to the hon. Member for Torfaen (Nick Thomas-Symonds), the whole point of universal credit is that people, whether it be through self-employment or employment, are able to keep their income. We have reduced the taper so that less of their income is lost when they go up the earnings scale and get into work. I am afraid that the hon. Lady simply misunderstands what is happening in the welfare system.
Disabled and Terminally Ill Children
This year we are due to spend nearly £1.9 billion on supporting ill and disabled children through disability living allowance. We have special rules in place to grant immediate access to the benefit for those who are terminally ill.
May I also wish you a happy new year, Mr Speaker?
I thank my hon. Friend for her answer. The DWP family resources survey that was published last year showed that there were nearly 1 million disabled children—a 20% increase over the past 10 years. Will she outline what measures the Government are implementing to take account of that increase so that these children can access the support and the specialist equipment that they require?
Local authorities and clinical commissioning groups have a requirement to meet the needs of children with a special educational need or disability, including by providing specialist equipment. In the past few months, my Department has set up a children and young person’s forum so that we can better understand the unmet need that is out there. My hon. Friend will know from the work that I have done with one of the organisations with which she is involved that we are looking to support charities, social enterprises and businesses that are providing these much-needed services.
Many of us who liked some of the elements of the big society when we first heard about it now quite like some of the utterances about the shared society. However, if the programme is to work for children, and not just for those who are terminally ill but people with disabilities—some disabilities are abilities; I am thinking here of autism—it must have teeth, leadership and resources.
Absolutely. The measures announced by the Prime Minister today will be accompanied by additional funding, and every age range in society will be taken into account. There will, for instance, be measures to help children and young people—I have just described what my Department is doing to ensure that their needs are considered—as well as new provision for those in the workplace.
Some children with disabilities receive disabled students allowances. Given that a number of them are not eligible for personal independence payments or disability living allowance, why are the Government cutting DSA?
We are very conscious of the needs of children and young people in particular, which is why we have set up an additional forum. Obviously we are concerned about people in the workplace, but if we get this right for children and young people, including students, we will avoid problems for future ministerial teams. I shall be happy to look into any particular case that the hon. Gentleman wishes to raise.
Health Outcomes: Work
Can you issue a papal bull, Mr Speaker, stating that we do not have to say happy new year—but happy new year anyway?
That is very welcome. We do not need to take up unnecessary time, but I appreciate the spirit of the hon. Gentleman’s suggestion.
I shall not say happy new year again, Mr Speaker.
Evidence shows that being in the right work is good for health, and that being out of work can have a detrimental effect on health. That was why I launched the “Work, health and disability” Green Paper jointly with the Secretary of State for Health. The Green Paper expresses our intention of working with healthcare professionals to help people into employment, and our current consultations ask how we can best achieve that goal.
Helen Stokes-Lampard, the chair of the Royal College of General Practitioners, has rightly spoken about the burden of work on GPs. Notwithstanding that, what analysis has my right hon. Friend carried out of the effectiveness of fit notes in getting people back to work?
I am keen to improve their effectiveness in that regard, and I also take my hon. Friend’s point about the pressure on GPs. In the consultation document we consider the possibility of extending the issuing of fit notes to other healthcare professionals, and I shall be interested to see what response we receive, not just from those who receive the fit notes but from the professionals involved.
I strongly support my right hon. Friend in respect of this specific policy. Does he agree, however, that as the consultants—as it were—to whom patients are referred will be work coaches, it is critical that those people receive training that will enable them to deal with the hardest cases among those who are unemployed, particularly those with pressing mental health problems?
I agree with my hon. Friend and am grateful for his support. I am happy to reassure him that all work coaches will complete specific training for their role, including a course that combines the knowledge, skills and behaviour that they will need to deal with the people with whom they work, particularly those with mental health conditions. Obviously, work coaches will need specific skills to handle the many issues that will arise from such conditions.
Obviously I do not know the details of the individual case, but if the hon. Gentleman writes to me or the Minister for Disabled People, Health and Work, we will look at it. I can assure him, however, that in the vast majority of cases, work coaches do their best and work very hard to help people to make the most of their lives, and to get into employment. That is at the heart of what we do.
After the big cut in employment and support allowance takes place in April and the new Work and Health programme is established, will the Department be spending more or less on employment support for ESA claimants than is currently the case under the Work programme and Work Choice?
I am happy to assure the right hon. Gentleman that as part of the changes there is an extra £330 million support programme for those in that group. We will target support more effectively to ensure that as many of them as possible can get back into work.
There is a huge premium on helping ex-offenders into work for them, their families and their children’s life chances, and for reducing costs to society. Jobcentre Plus now has a dedicated resource of 150 prison work coaches who are helping to support prisoners nationwide.
I am grateful to the Minister for his response. He will know from his own experience, and from the excellent report on supporting offenders by the Work and Pensions Committee, which my own Select Committee would endorse, that getting a job is one of the best means of preventing reoffending. As well as the work that is being done, will he consider what can be done jointly with the Ministry of Justice to ensure there is better collaboration between job centres and community rehabilitation companies so that they are joined up, given that people currently risk the cliff edge to which the report refers?
We work closely with the Ministry of Justice on numerous joint initiatives locally and nationally, and we are supporting the development of the MOJ’s new offender employment strategy, but I recognise that we need to improve opportunities for ex-offenders, so I welcome the continued attention of my hon. Friend and his Committee, as well as the Work and Pensions Committee report, to which we will respond in due course.
Her Majesty’s inspectorates of prisons and probation found that not a single prisoner had been helped into employment by the Through the Gate provision, which is the Government’s flagship programme for achieving a step change in rehabilitation. Did that surprise the Minister, and what is his response?
First of all, my response is that this has been a challenge for successive Governments for many years. We do need to do better, but there is good work going on. Ultimately, to improve the situation, we need more prisoners to be work-ready, and we need more employers to be willing to take the plunge and take on a prisoner. Having governors controlling skills provision in prisons will have a beneficial effect on work-readiness, but we all need to encourage more employers to step forward. Initiatives such as the See Potential programme can play an important part in that, as can Ban the Box and the Employers’ Forum for Reducing Re-offending, but of course we need to do more.
The Minister will be aware that people on the autistic spectrum are disproportionately represented in the criminal justice system and that people with autism have great difficulty in finding jobs. Can he reassure me that when he looks at the consultation on the health and disability Green Paper, he will look specifically at people with autism and ex-offenders with autism, as only 16% of people with autism are currently in employment?
My right hon. Friend highlights an important point. I know my hon. Friend the Minister for Disabled People, Health and Work will be looking very closely at the issue of people with autism. This also highlights that one of the key determinants for post-release employment is what happened with the individual before they were convicted, and it highlights again the importance of making sure nobody is left behind. In our work, we pay particular attention to all these groups who face particularly difficult barriers in getting into work.
Our Work and Pensions Committee report found that reoffending costs £15 billion to the public purse, yet fewer than one in four ex-offenders goes on to find work. Alarmingly, Westminster Council’s report on rough sleeping that was published before Christmas found that one in three of its rough sleepers had come directly from prison. Why is the Department unable to provide proper transitional support for people leaving prison to make sure that they are not on the streets and that they are assisted into employment?
It is vital that ex-offenders and people on release from prison have help with finances, employment and housing. Among the things we have done to help on housing is to ensure that there are no waiting days in relation to universal credit and to keep the housing element in universal credit open for 26 weeks rather than 13 for certain types of prisoner in order to ensure that we can enhance their support.
Mr Speaker, were I allowed to wish you a happy new year, you can be assured that I would do so.
Pension Wise provides guidance to people aged 50 and over with a defined contribution pension pot on their options under the pension flexibilities. We are consulting on a single financial guidance body to provide debt advice and guidance on money and pensions.
In thanking the Minister for his reply, I cannot resist wishing him, and indeed the whole House, a happy new year. Can he tell me what information the Government are providing to let people know about their entitlement to the state pension?
I thank my hon. Friend for his salutations and for his question. The Department for Work and Pensions continues to run a multi-channel communication campaign that includes radio, press and social media to raise awareness of the new state pension. As well as directing people to information on gov.uk and working with stakeholders to deliver key information, our priority has been to provide personalised information to individuals so that they know how much state pension they are likely to get, and from when. Since February 2016, the online Check your State Pension service has had more than 2.1 million views.
The Minister’s warm words will do nothing to reassure the women in my constituency for whom the Government’s advice on pensions has a terrible reputation because of the injustices highlighted by the Women Against State Pension Inequality campaign. The one thing the Government could do to persuade the public to believe their pronouncements on pension entitlements would be to give justice to the WASPI women by looking again at the 2011 changes.
The hon. Lady will be aware, because the WASPI women have been discussed in the House and I have discussed this matter personally with her on many occasions, that the changes affecting them were in the Pensions Act 1995, and that a lot of time and resources were devoted to informing them of the situation, including millions of letters being sent out from 2011.
A happy new year to you and everyone in the House, Mr Speaker, and particularly to the WASPI women. I hope that they have a better year this year.
The leaflet entitled “Ways to save in 2017” recently published by the Treasury mentioned the junior ISA, the help to buy ISA, premium bonds, cash and stocks and shares ISAs and the new lifetime ISA, but it completely omitted to mention pensions. That is an absolute disgrace, and it confirms my fears that the Government have downgraded the role of pensions and are using the gimmick of ISAs to distract attention from pensionable savings. Does the Minister agree that pensionable saving is the best form of saving for retirement? Will he establish a pensions and savings commission to ensure that dignity in retirement is promoted and protected?
I must totally disagree with the hon. Gentleman’s analysis of the importance that the Government place on pensions. A lot of effort goes into communicating with people, on television and elsewhere, about auto-enrolment. The auto-enrolment of so many people has been one of the great successes of this Government and of the coalition, and I hope that that continues.
I know that the Minister agrees with me on the need for greater transparency in the pensions world, particularly around costs. He will therefore be keen to address the widespread criticism of the Government’s failing to act to ensure that people get the best possible returns. The Financial Conduct Authority’s interim report in November highlighted a number of failures in the asset management industry relating to the transparency of costs and charges applied to pension investments, stating that “weak price competition” was having a “material impact” on investment returns. Labour is committed to implementing all the FCA’s recommendations. Are the Government?
Children in Relative Poverty
There are 100,000 fewer children in relative poverty than in 2010 and 557,000 fewer children living in workless households. The forthcoming Green Paper on social justice will identify and address the root causes of poverty, building on the two statutory indicators set out in the Welfare Reform and Work Act 2016—namely, worklessness and educational attainment.
I note that the Minister uses the figures for relative poverty, and I am a little surprised. We know that absolute poverty in this country has been in decline for the past 10 years, except among children. We know that 500,000 more children in this country are living in absolute poverty than was the case in 2010. What responsibility does he think this Government and the previous Government have for that?
The Government have a responsibility to make sure that as many households as possible have work, particularly households with children. Working-age adults in non-working families are almost four times more likely to be living on a low income. The “Child Poverty Transitions” report of June 2015 found that 74% of poor children in workless families who moved into full employment exited poverty. That is what we can do, and are doing, for children who have been in poverty.
The hon. Lady neglected to say it, but there are now 500,000 fewer people living in absolute poverty than in 2010. The key point is about getting people into work. As a reasonable Opposition Member, I hope she would acknowledge that achieving historically low levels of unemployment is actually the best thing we can do for children—it is the best way to get children and the households they live in out of poverty. I am happy to tell her that, in her constituency, the claimant count is down by 47% since 2010 and the youth claimant count has fallen by 2% in the past year.
All of us in the Chamber can learn about the merits of brevity from the right hon. Member for New Forest West, who will not disappoint me.
However the problem presents in my surgeries, scratch the surface and, nine times out of 10, the swiftest cause of poverty is family breakdown, which will be a much harder nut to crack.
Absolutely. That is precisely why this Government, and previously the coalition Government, have decided that having a simple income-based measure and target is not the right way. We need to look at the root causes of child poverty, and having a range of indicators and targets—one of which is on family breakdown—is the best way to make sure that we have as few children as possible living in poverty and that more and more children are able to emerge from it.
A good new year to you, Mr Speaker.
The Secretary of State has focused so far on the value of work in tackling child poverty, but the reality is that the average working family in receipt of universal credit will be more than £1,000 a year worse off by 2020. According to the Resolution Foundation, some working parents will be more than £2,500 a year worse off. With child poverty projected to rise dramatically over the next three years, why do the Government continue to downplay the role of income poverty in determining children’s future health, job prospects and even life expectancy, in spite of all the evidence?
I am not downplaying the role. I am talking about the underlying causes and about making sure that we take a range of measures across the board that help to eradicate child poverty. That is the only sensible way to do it. Simply focusing on individual incomes or, indeed, individual benefits does not represent the whole realistic picture. We need to be much more wide-ranging in our approach.
The Prime Minister has been talking over the weekend about the pressures faced by people who are just getting by on low and average incomes and about our shared responsibilities to them. Those are fine sentiments, but does the Secretary of State not accept that they sound utterly hollow when the Government’s planned cuts to work allowances will slash the incomes of exactly those families who are just getting by? Does he accept that the Government have a responsibility to support parents who are working hard in average and low-paid jobs, rather than cutting their already stretched, precarious incomes?
No. Indeed, I would point out to the hon. Lady that this Government’s introduction of the national living wage last year gave the lowest earners their biggest pay rise in 20 years—an increase of 6%. That is an example of a Government measure introduced by employers. I cannot think of a better early example of the shared society.
What assessment have the Government made of how many more children will be pushed into poverty given the cuts to the work allowance under universal credit?
As I have said to a number of hon. Members on both sides of the House, the solution lies in a wider range of issues, and that is what we are introducing. We have the social justice Green Paper, about which I am sure we will have many discussions in this House and elsewhere. The root is making sure that as many people as possible can earn a salary and work. I am sure that the hon. Lady, like me, will welcome the fact that unemployment has come down by 53% in her constituency since 2010. That means thousands of families who are able to work and control their own lives, possibly working their way out of poverty. She ought to welcome that.
It is a poor Government who fail to understand the value of the nation’s children. In addition to the universal credit work allowance cuts, this Government have abolished the child poverty unit and frozen social security payments, and are removing tax credits from third and subsequent children. Does the Minister think child poverty will go up or down as a result of those measures?
I have already given the hon. Lady a number of figures relating both to adult poverty and child poverty—
Up or down?
Well, the fact is that since 2010 there are 100,000 fewer children in relative poverty. I would hope that the hon. Lady would welcome that and the fact that the child poverty unit is now covering a much wider range of policies and is based inside the Department for Work and Pensions.
This Government are committed to supporting new enterprises. We are building on the success of the new enterprise allowance, which has already supported 96,000 claimants to start a new business. From this year, eligibility for NEA support will be extended to include universal credit claimants who are already self-employed.
Will my right hon. Friend look again at the regulations requiring small businesses and the self-employed to use online systems for their tax affairs? Does he recognise that these people often do not have the equipment, knowledge or broadband capacity to download the complex forms, and that the process often costs time and money?
I am happy to tell my hon. Friend that tax affairs are not my direct responsibility, but the Treasury will have heard what he had to say. What I can say is that Jobcentre Plus is always keen to help small businesses with individual problems they may have, such as with the use of online forms, and I hope that businesses in his constituency would find the jobcentre a helpful place to consult.
In Cornwall, unemployment has continued to fall year on year to record low levels, and the county now has 61,000 self-employed people. Does my right hon. Friend agree that only under a Conservative Government can we continue to increase employment in Cornwall and further improve the creation of small businesses in those communities?
My hon. Friend makes a good point, and I know that in his constituency self-employment has increased by 7.6% since 2010. As I said in answer to previous questions, the UK labour market is in its strongest position for years. Clearly, the best way to promote new growth in jobs is to promote growth in small businesses, and I am delighted to hear it is going so well in Cornwall.
Does my right hon. Friend agree that universal credit can help the self-employed, along with the other forms of benefit the Government are putting forward for them, because it can help people who are working as well as trying to set up on their own?
One difference between universal credit and the previous benefits it is replacing is that people can and do continue to receive it when they are still in work. It is particularly good at coping with people who may have fluctuating earnings, as many self-employed people do, because it can be flexible enough to adjust to that. The introduction of universal credit is another brick of the edifice of helping people to set up their own businesses.
What is the Secretary of State going to do about people who are classified as self-employed because of their contract of employment? They are classified as such not because they have set up their own small business, but because their employer requires them to sign a contract saying that they are self-employed, which means that they get no sick pay and no annual leave. How is he going to help them?
I agree that that is an issue, which is precisely why we have set up the Matthew Taylor review. It is investigating precisely the new types of employment structures that have been set up in recent years and making sure that employment laws keep up with new types of employment.
National Living Wage
The number of people in employment in the north of England has increased by 112,000 over the past year. The national living wage has already given 1 million people a pay rise, helping to build an economy that works for all.
I thank the Minister for his reply, but has he considered the implications of the national living wage coming in so quickly for small and medium-sized businesses, particularly those in the manufacturing sector? What would he say to those businesses that will not be able to adjust in time, or that simply will not be profitable because the national living wage is being introduced so quickly?
Everybody should benefit from a strong economy, but as well as introducing the national living wage the Government have announced plans to reduce corporation tax further to 17% and to increase the employment allowance, which could be worth up to £3,000 a year.
Is it not perverse of the Government to have reduced work allowances and universal credit at the same time as we have seen increases in the national living wage, meaning that the overall benefit to individuals in work is actually reduced?
The Government have done a range of things. Universal credit is completely different from the legacy benefits it replaced, so it does not make sense to make a direct comparison with tax credits. We have to see it in the context of greater help with childcare and the introduction of the national living wage. Of course, the increased income tax personal allowance also means that people get to keep more of what they earn.
When my right hon. Friend the Member for Tatton (Mr Osborne) introduced the national living wage, the Office for Budget Responsibility said that it would cost 60,000 jobs. Does the Minister think that that is a price worth paying, or is that another forecast from expert economists that we should ignore?
My hon. Friend is entirely correct about the OBR’s projection at that time, but he will have noticed that that came in the context of considerably larger projected employment growth.
We are investing significant resources, including increasing coverage of Talking Therapy services by 600,000 people a year by 2020. Mental health is a key feature of our Green Paper “Improving Lives”, on which we are currently consulting. I thank Members on both sides of the House who came to our drop-in event on the Green Paper and who are helping with the consultation.
I welcome the Minister’s response and the Prime Minister’s intervention today on mental health. Does the Minister agree that in order better to support those with mental health conditions into the workplace, we need to transform the way we deliver mental health services for young people before they reach working age?
I agree with my hon. Friend absolutely. When I ask healthcare professionals who work in Department for Work and Pensions services what the single most significant transformative healthcare intervention would be, they say mental health support services for young people. The Prime Minister’s announcement on that was very welcome.
The “Five Year Forward View for Mental Health”, which was published a year ago, contained two specific recommendations for the Department for Work and Pensions, one of which was on employment support. Will the Minister update the House on the progress on that specific recommendation?
There were two targets, but the Department has set out a range of initiatives. Good progress has been made on all fronts, including the development of specific mental health support for the services we run, such as Access to Work. Considerable work has been going on, as the Prime Minister referred to earlier today, but she also said that we need to pick up the pace on this issue, and I agree with her absolutely.
The proposed closure of eight Glasgow job centres will result in increased travel times and introduce further barriers for people with mental health conditions who are seeking help to get into work. How will the Minister ensure that people with mental health conditions continue to receive the help that they need?
My hon. Friend the Minister for Employment has met all the MPs who are concerned about those locations across Glasgow, and my hon. Friend the Minister for Welfare Reform has met Scottish Ministers to discuss the issue. We are aware of the concerns that Members have raised. If the hon. Lady has any subsequent comments to make, she is more than welcome to have meetings with either me or my colleagues.
People with mental health conditions are more likely to fail the work capability assessment and more likely to be sanctioned. At the same time, we know from independent research how damaging work capability assessments and sanctions are for people’s mental health. The Prime Minister made her announcements today, but when will the Government take responsibility for the impact of their policies on mental health and ensure that timely, evidence-based support from trained mental health professionals is available for claimants with mental health conditions? Will the Secretary of State commit to scrapping the work capability assessment and punitive sanctions, as Labour has?
I refer the hon. Lady to three things: the Secretary of State’s reform speech in which he announced that his focus was on the particular issue of sanctions for people with mental health conditions; obviously, the Prime Minister’s statement today; and the Green Paper, a major tenet of which is that we are consulting on the work capability assessment—a Labour policy that is not delivering. I am very pleased that enormous numbers of Labour MPs came to our drop-in on this and will be helping us with the consultation. This is an important issue, and we should get it right.
Contracted-out Health Assessments
Over 93.5% of assessments for personal independence payment and over 90% of work capability assessments for ESA are deemed of acceptable quality through independent audit. Those that are not deemed acceptable are returned to the provider to be reworked. The Department closely monitors all elements of providers’ performance and holds those providers to account through their contracts.
Will the Minister consider introducing and funding the mandatory use of body-worn cameras by all contracted-out assessment providers, which will improve the accuracy and efficiency of the much-disputed health assessment reports and safeguard claimants and assessors, and which is proving to be very successful when used by emergency services across the UK?
There are detailed improvement plans for both PIP and ESA. Another thing that is being considered is how assessments are recorded. If the hon. Lady wants to write to me with any specific suggestions, I will be very happy to look at them.
The vast majority of successful appeals are due to additional late submitted evidence. What more can be done to access and share medical evidence between health professionals and assessors ahead of the appeals decision?
My hon. Friend is absolutely right. He will know that the Department has carried out a number of pilots to look at being more lenient at the early stages of assessment to give people time to get that health care information in front of assessors. That move is paying dividends, and we hope that it will be rolled out.
Order. On this question, I would call on the hon. Member for Ayr, Carrick and Cumnock (Corri Wilson) if she were standing, but as she is not, I cannot.
As she is standing now, I will call her.
Although we are consulting on ESA, the Green Paper consultation affords us the ability to look at PIP assessments in the round and at a person’s whole journey. I have previously said that we are looking at what more we can do in recording assessments. If the hon. Lady knows of cases where people need home assessments and they are not getting them, I urge her to flag them up with me.
In my own constituency of Rossendale and Darwen, those who are waiting for their PIP appeal to go through are having to wait three, six or, in some cases, nine months to have that appeal heard. Given that they receive no benefit during this period and can lose their vital Motability car, will the Minister tell us what efforts the Department will make to speed up the appeal process?
I am sorry to hear that that is happening in my hon. Friend’s constituency. That is a very unusual length of time to be waiting for an appeal. If he would like to give me the details of those cases, I would be happy to look at them.
Motability is an independent charity responsible for its own management information, including what data it publishes. There are 70,000 more people with a Motability car than there were in 2010.
My constituent Evelyn Campbell had her Motability car removed on 20 December following a PIP assessment, leaving her housebound and distressed over Christmas. It will take months for her appeal to be heard. In the meantime, her car has been sold. Is this not another cruel policy from this Government? Given that 60% of PIP appeals are successful and that the cars have to be reprovided, is it not also a totally false economy?
Those who lose their vehicle receive transitional support through Motability, including the right to buy the vehicle and a £2,000 lump sum. Although only a small proportion of PIP decisions are appealed and overturned—
It is 60%.
That is of those going to appeal, not the case load. I am exploring a range of options to support claimants pending appeal, and I will be working closely with Motability on this.
I am encouraged by what the excellent Minister has just said. The key point is that I do not think the car should be withdrawn until the appeal process has finished. As it is only a small number, as the Minister has said, could she be encouraged to look at that route?
We are looking at this issue. We are also looking at those who might wish to travel overseas, for whatever reason, whether for work or a travel option, and we are working very closely with Motability to see what can be done in those instances.
As part of the comprehensive package of reforms to improve mental health support announced by the Prime Minister this morning, my Department will be undertaking an expert-led review on how best to ensure that employees with mental health problems can be supported. That will involve practical help, including promoting best practice among employers and making available free tools to businesses to assist with employee wellbeing. We will also be conducting an internal review of discrimination in the workplace against people with mental health conditions. Those reviews will build on our Green Paper consultation to help to establish the evidence base around mental health and employment.
I welcome the news that 95,000 businesses have been helped by the new enterprise allowance. Can the Minister tell me how many of those are in North Cornwall, or in Cornwall as a whole?
I too welcome those figures. I can tell my hon. Friend that the new enterprise allowance has helped to create nearly 100 new businesses in North Cornwall since it began. We are moving to a second phase, beginning this April, with an improved NEA. Since it began, over one in five businesses supported by the NEA have been started by disabled entrepreneurs, which is an extremely encouraging development.
It was great to hear earlier that there is consensus on the need to implement in full the Financial Conduct Authority’s recommendations on transparency in pension scheme costs. We hope that that will be soon, and we will hold the Government and the Minister to account on that.
Let us try another subject. Labour is committed to the state pension triple lock. Are the Government?
The Government are committed to the triple lock for the whole of this Parliament.
I am happy to give my hon. Friend that assurance. He and I have exchanged correspondence on this—he may not yet have received a letter from me offering a meeting with my hon. Friend the Minister for Employment. We absolutely want to work through any teething issues with local councils.
PIP is slightly different. For example, someone’s needs might increase and they need a reassessment to receive more support under PIP. The Green Paper affords us the opportunity to look at all these things together. I think there are opportunities for PIP perhaps to have a lighter assessment, but we need to get the whole process right.
I would be delighted to have a meeting with my right hon. Friend and her constituent.
As the hon. Gentleman will be aware, the Government have given £1.1 billion of transitional relief for WASPI women. The issue has been discussed in this House very many times and the Government have no plans to do anything further in that respect.
I can give my hon. Friend those reassurances. We are absolutely committed to closing the disability employment gap. We are picking up the pace on the programmes we are running, and asking businesses and employers to do more.
The right hon. Gentleman will know that the disability employment gap has been closing under both this Government and the coalition Government. We recognise that we need to do more, and I think the public sector can do more. Part of that is identifying particular roles that individuals can take up. The Government are picking up the pace on the issue and we are in a much better situation than the one that existed under the previous Labour Government.
I welcome the fact that more than 1 million more women are in employment now than in 2010, but will the Minister confirm what the Government are doing to support women with children who might find it difficult to return to work because of childcare responsibilities?
Our aim is to help parents to get into a job that fits around their caring responsibilities, which is why we are doubling the amount of free childcare offered to working parents to 30 hours a week. Last year, we spent a record £5 billion supporting parents with the costs of childcare and the figure will rise to more than £6 billion by 2020.
As I understand it, the Finnish scheme is a small pilot in a local area. I have read a lot of the literature—it is clearly an interesting idea—all of which suggests that that kind of scheme is fantastically expensive and that some of the losers from it are those who are on the lowest incomes at the moment. The polite response is that I am unconvinced by the proposal.
Seasonal agricultural workers have benefited from auto-enrolment into pensions, but many accrue only very small pension pots. What can the Government do to ensure that the bureaucratic burden does not fall disproportionately on the employers of these vital workers?
My hon. Friend brings up a very good point. The Government have to find a balance between wanting as many people as possible to have pensions, and economic sense when there is an impact on employers. My officials have discussed the issue with the National Farmers Union. We understand it and it will be looked into in the course of the 2017 review.
I think the hon. Gentleman is confused: we are actually putting more resources into these initiatives, and also asking others to do more. Obviously, we are consulting in the Green Paper, but even some of the announcements the Prime Minister made today included additional resource. We very much want to meet that target, and we are putting the resources and the policies in place to do that.
Last month, I asked the Government to introduce mandatory video recording of all DWP employment and support allowance assessments because a constituent of mine in Twickenham was treated with less respect than the character in the fictional film “I, Daniel Blake”. When will mandatory video recording commence?
We are looking at a range of issues to improve the assessment process for PIP and ESA and the person’s experience of it. The recording of assessments is one of those things, so we are looking at that issue.
For many young people, staying in the family home is not an option, so housing benefit is a lifeline not a lifestyle choice. When will the Government finally clarify how their scheme will not see these people lose vital support?
The regulations regarding the removal of housing benefit from 18 to 21-year-olds have yet to be published. We will provide full details, particularly of the exemptions that will be involved, in March.
I would like to say thank you to the scores of businesses in Corby and east Northamptonshire that provide important work experience opportunities for our young people. These introductions to the world of work are crucial, so will Ministers continue to make sure they remain at the forefront of cross-departmental discussions?
We know that one of the most important things in being able to get a job is to have had a job and to have demonstrated employability skills. Specifically on the work experience placements we do through Jobcentre Plus, people spend 49 days longer on average in employment as a result of having done one, so the answer to my hon. Friend’s question is yes.
May I urge the Secretary of State personally to review what is happening to the Motability scheme? Some 41,000 people have had their cars taken away as a result of PIP assessments, including a severely disabled Castleford constituent who now cannot get to work and may be about to lose her job, and a Pontefract constituent with metal rods in her joints who now cannot get out of the house and is at risk of slipping into depression as a result. On the day when the Prime Minister rightly raised the issue of mental health injustice, will he take seriously the serious impact on people’s mental health of being isolated in this way?
I am happy to assure the right hon. Lady that we are looking very closely at the whole Motability scheme, which, as she knows, is an independent charity. We have formed a working group to look at the various issues that gave rise to it, so we are looking at this very carefully.
Following on from the question from my right hon. Friend the Member for Normanton, Pontefract and Castleford (Yvette Cooper), my constituent Ms Brookes, who has limited mobility because of a stroke, received a Motability car last year, and that car was a lifeline. Last week, the car was removed from her, and she is now struggling to get her children to school and then to get to work. She is appealing the decision, and I hope she will win, but in the meantime she is finding it incredibly hard to manage her disability as well as her responsibilities as an employee and, more importantly, a mother. Will the Minister look at this case as a matter of urgency to ensure that my constituent gets the help and support she needs?
I would be happy to look at the particular case the hon. Lady raises. We are looking at that issue in the Motability scheme, but also at other issues that mean that people are perhaps not able to take up work or travel opportunities. We recently met Motability on these issues and have formed a working group with it to work through them. We hope to be able to make some announcements very soon.
Indicators of child poverty are important, as the Secretary of State said earlier, but so are targets. Will he therefore agree to adopt the provisions in the Bill presented by my hon. Friend the Member for Barnsley Central (Dan Jarvis), which would establish statutory targets for the reduction of child poverty?
That old-fashioned approach is not necessarily the best way forward. Having the whole range of issues that can give rise to child poverty addressed by Government policy is the best way to do it. I look forward to the hon. Gentleman’s response to the social justice Green Paper that we will publish in the coming months.
In the London borough of Wandsworth that houses my constituency, last year there was a 25% increase in food bank use. Shockingly, almost 50% of these users are children. Do the Government agree that this is an absolute disgrace, and what will they do to assure us in this House today that the children and adults of Tooting shall no longer have to rely on food bank use?
As I said in response to previous questions, the best route out of poverty is work, and one of the great successes of the economic policy of this Government has been that more people are in work, more women are in work, and fewer children are growing up in workless households than ever before. I just wish that Labour Members would accept that getting more people into work and reducing unemployment is the best attack on poverty that any Government can make.
It is now four weeks since the Employment Minister promised Members of Parliament from Glasgow data on the new boundaries by which he wants to close half the city’s jobcentres—so where is that information?
I met the hon. Gentleman and his colleagues, and we had a Westminster Hall debate as well. I committed to a number of things, one of which was that we would have an online consultation, and that is indeed proceeding. As I said to him and his colleagues when we met, if there is other information that they want to bring forward, I am absolutely sure that they will do so.
There are 13,000 children in my constituency living in poverty—almost a third of the total poverty figure for the whole district—so will the Minister explain to my constituents his decision to close the child poverty unit?
The main function of the child poverty unit was to support Ministers in meeting the Child Poverty Act 2010, which has now been superseded by the Welfare Reform and Work Act 2016, whereby the response specifically to poverty is being led by my Department, so the unit is now working inside the Department for Work and Pensions. That is the straightforward answer to the hon. Gentleman’s question.
Does the Secretary of State have any new year’s resolutions? If not, perhaps I can help him out: he could resolve to make sure that no one is sanctioned at Christmas. Will he review the operations of his Department, as I asked him before Christmas, to make sure that nobody goes without over the festive period?
My new year’s resolution is, as ever, to make sure that my Department continues its successful work in getting ever more people into work, and to make sure that we have a benefits system that helps people to get into work and a pensions system that provides security and dignity in old age.
Domestic Violence Victims: Cross-Examination
(Urgent Question): To ask the Secretary of State for Justice to make a statement on the emergency review to determine how to ban perpetrators of domestic violence from directly cross-examining their victims within the family court.
I am very grateful to the hon. Member for Hove (Peter Kyle) for the chance to update the House on an important issue. To put this in context, the issues at stake in family proceedings are always sensitive and often complex, and the decisions of the court can have far-reaching implications for the individuals involved. The presence of domestic abuse only exacerbates an already traumatic situation, so the Government have already taken steps to make sure that victims in the family justice system have support and protection. We have protected legal aid for individuals seeking protection from abusers. We continue to invest in the court estate to improve the physical security of family courts and the emotional support available for users. We have placed particular emphasis on training for those who work in the family justice system, making sure they understand the nature and impact of domestic abuse and that they act appropriately when they come across it.
However, we know that there is more to do. As the Under-Secretary of State for Justice, my hon. Friend the Member for Bracknell (Dr Lee), made clear when this was debated in Parliament on 15 September, the Government are determined to improve the family justice response to domestic abuse, and we have worked closely with judges and others to consider what additional protections may be necessary. We are particularly concerned about the fact that unrepresented perpetrators of abuse can directly cross-examine their victims in family proceedings. I want to make family court processes safer for victims so they can themselves advocate effectively and for the safety of their children. This cannot happen while a quarter of domestic violence victims face cross-examination by their abusers.
The Lord Chancellor has requested urgent advice on how to put an end to this practice. This sort of cross-examination is illegal in the criminal courts, and I am determined to see it banned in family courts, too. We are considering the most effective and efficient way of making that happen. That will help family courts to concentrate on the key concerns for the family and always to put the children’s interests first, which is what they are supposed to do. This work, which is being fast-tracked within the Department, is looking in particular at the provisions in the criminal law that prevent alleged perpetrators from cross-examining their alleged victims in criminal proceedings, and we are considering how we might apply similar provisions in the slightly different circumstances of family proceedings.
Members will appreciate that such a proposal requires thought, but we want to resolve the matter as soon as possible. We will make further details available shortly, once the work is complete. I want to thank the president of the family division, Sir James Munby, who has argued passionately that this practice should be outlawed for good.
This issue has been wreaking untold devastation on victims of domestic violence. I have now spoken to numerous survivors of abuse whose accounts of torment under cross-examination in the family court—often by convicted rapists—are devastating to hear, but impossible for most of us even to imagine.
I have spoken to a woman who was cross-examined by the man who was in jail for numerous counts of rape and abuse that had left her unconscious and hospitalised. As a result of the family court process, this extremely vulnerable woman needed weeks of medication and months of counselling to recover. She has now suffered such an ordeal three times. I have spoken to the sister of a woman who was abused so grievously that the abuse resulted in her death. The convicted murderer then sued for custody of their child from the prison where he was serving a life sentence for murder. He directly cross-examined the sister of the woman he murdered, even having the grotesque nerve to ask, “What makes you think you can be a parent to my child?” Abuse is being continued and perpetuated right under the noses of judges and the police, the very institutions that should be protecting the vulnerable with every sinew of state power.
On 15 September 2016, in response to speeches by Members on both sides of the House in a Back-Bench debate, the Under-Secretary of State for Justice, the hon. Member for Bracknell (Dr Lee), said that this is a
“scourge, which blights our society.”—[Official Report, 15 September 2016; Vol. 614, c. 1119.]
Yet he made no commitment to review or to change policy. Sadly, it took the excellent coverage in The Guardian during the Christmas break for such a commitment to emerge from the Ministry of Justice.
The source was anonymous, so will the Minister provide clarity in these areas? Lord Justice Munby, the president of the family division, supports measures to outlaw the cross-examination of victims by perpetrators, and he has said that this will require primary legislation. Does the Minister agree with that assessment, and if so, will he make the drafting and introduction of any such legislation a priority? The anonymous source told The Guardian that this was a matter of urgency for the Secretary of State. Will the Minister tell the House when she started the review, and more importantly, precisely when it will be completed? Victims of abuse need to have precision and clarity at this moment of great importance for them. Speed is of the essence, but so is consultation—we need to get this right—so will the Minister tell us what process is in place to enable victims, campaigners and support organisations to feed in their essential experiences and views so that the review is at all times carried out with, not done to, survivors of domestic abuse?
Finally, as I told the House back in September, it is a source of shame to me personally that I got to the age I am today without being aware that such barbarism is being practised within our own legal system. In addition to my lack of inquisitiveness, which I regret profoundly, the secrecy imposed by law on the family court process allowed this to continue without journalistic oversight. Will the Minister consider longer term assessment of the wider operational activity in the family court system? Such assessment should look, in a considered and detailed way, at the overall operation of family courts with a view to ensuring, where appropriate, greater transparency and oversight of the family court process is introduced.
Before we proceed, let me just say this. The hon. Gentleman has raised an extremely serious matter on the back of very considerable knowledge and research, and he has aired it in this House with great sensitivity. I did not wish to interrupt him—not least for that obvious reason—but perhaps I can announce to the House a new year’s resolution: from now on we must, without fail, stick to the established time limits for urgent questions. The hon. Gentleman was notified of the two-minute limit and he took over three minutes. That is the first point. A lot of more experienced Members will be well aware of my second point, but perhaps I can just underline it. The briefest preamble of description is fine, but an urgent question is supposed to be just that: neither a speech nor a contribution to debate, but a series of questions. I know the hon. Gentleman well and he will not, I am sure, take offence. He has raised very important matters. In future, however, doing so must be done in accordance with the proper form and time.
I agree with many of the hon. Gentleman’s points. Judges have always had wide discretion on family proceedings to try to get to the truth of matters, and to protect the interests of the family and so on. Judges have discretion to ask the questions themselves to try to avoid situations arising that are against the interests of justice. In recent years, judges have become more concerned—as the hon. Gentleman has—about situations where abuse is being perpetrated through the proceedings. That is why Sir James Munby has spoken out, why I have made the comments I have made today, and why the Department is treating this as something that should be dealt with as a matter of urgency.
Is it necessary to change the law? The answer is yes it is. Primary legislation would be necessary to ban cross-examination. I also think there are related ancillary matters that would require primary legislation. Clauses, therefore, are required. Is work being done? Yes, work is being done at a great pace to ensure that all these matters are dealt with in a comprehensive and effective way—the urgency is there. I became the Minister responsible for these matters in October, and I have chaired the Family Justice Board, which has become very concerned about this issue over that period. The Lord Chancellor shares that concern, which is why we are moving at speed to try to tackle it.
The extent to which consultation is necessary is something I will consider in the light of the hon. Gentleman’s comments, and perhaps discuss with him privately if he wishes. My feeling is that what is required is pretty straightforward: a ban, and then the necessary ancillary measures to allow cross-examination without the perpetrator doing it. I would question, therefore, the extent to which a wide consultation is needed, but I will discuss that with him.
On transparency in the courts, journalists are now able to attend court and report the proceedings, although there are obvious restrictions to protect children and so on.
The Minister of State and the Lord Chancellor are to be congratulated on moving promptly on this matter. The president of the family division is also to be congratulated on his frankness in relation to the deficiencies he finds within the family jurisdiction. Does my right hon. and learned Friend accept that the simple solution is to adopt, more or less lock, stock and barrel, the criminal procedures under the Youth Justice and Criminal Evidence Act 1999; to use the forthcoming courts and prison reform Bill to put that into primary law; and accept that the very modest public expenditure of a court-appointed advocate to do the cross-examination where justice so requires would be a drop in the ocean compared with the benefits, in the interests of justice, to individuals who are the victims of abuse?
I am grateful to the Chair of the Justice Committee for those comments and agree with a good many of them. There are some differences from criminal proceedings, for example in a case in which an injunction is sought and there is no charge, or a case in which money is being considered but there is a background of abuse. There is a range of issues. For legal aid in cases of domestic abuse in family proceedings, there is a wider list than is available for criminal proceedings, but his basic point is right.
I am not able to give a commitment on the Bill. It depends on how quickly the work is concluded, and I am working on it very quickly.
I thank my hon. Friend the Member for Hove (Peter Kyle) for asking the urgent question and the Minister for his response. I recognise that this issue unites the House.
The practice of unrepresented parties against whom domestic violence is either proved or alleged questioning victims in court has been raised repeatedly in the House and in the media. Many Members on both sides of the House have constituents who have been left devastated by the experience. That the Government are doing something to end that practice is welcome, but there is a clear admission that their legal aid cuts have caused this situation. The Legal Aid, Sentencing and Punishment of Offenders Act 2012 removed much family law from eligibility. Victims of domestic violence struggle to provide evidence of their abuse because they are frequently not believed, and in some cases because medical evidence is difficult to obtain. Their experience is made worse still because their abuser, who is also unable to get representation, is allowed to question them, even when they would be prevented from contacting the person in any other situation. The abuse therefore continues.
It need not be that way. In the criminal courts, cross-examination by an unrepresented party accused of domestic violence is not allowed. Is the Ministry of Justice counting the number of litigants in person in the family courts? How many of those are victims of domestic violence? How many are convicted or alleged to have committed domestic violence? Will the Minister look at the practice in criminal courts? Along with prohibiting cross-examination, will he introduce the greater use of more sensitive procedures? When will the LASPO review finally begin?
On the hon. Lady’s final point, as she knows, the LASPO review has to be concluded by April 2018. It is not overdue, but it is something that the Government have very much in mind, and that we will have to start fairly shortly.
On the hon. Lady’s other points, legal aid is available in cases of domestic abuse. That is why the Government concentrated efforts in legal aid on situations where life or liberty are at stake, and on domestic abuse and housing when homes are at risk. That is not an issue, but I accept that the evidence criteria are important. That is why the Government have allowed a longer period and a wider range of evidence to be used, which has been welcomed.
Cross-examination by litigants in person takes place too much. The hon. Lady asked what the exact number is. It is not clear, but it is certainly a considerable number, which is why the Government consider this to be an important issue to tackle.
I congratulate my hon. Friend the Minister and welcome everything he has said on the Government’s attitude to this long-standing problem. May I urge him please to look at the rules on legal aid? There is certainly strong anecdotal evidence from former colleagues of mine at the family bar and the judiciary that there is a direct consequence and link between the rise in litigants in person and the changes to legal aid, which was begun under the Labour Government. That link between litigants in person and legal aid is causing so much of the problem. If he at least looks at it, he could provide some of the solution.
As my right hon. Friend rightly says, this is a long-standing issue but one that has now become urgent—the cries for help from judges and others have become more urgent—and that is why the Government are tackling it. It is necessary to find a way to prevent litigants in person from using proceedings to continue the abuse, and that is what we aim to do.
May I welcome the Justice Secretary’s emergency review and stress how important it is that we all focus, across the UK, on how to prevent the perpetrators of domestic abuse from using the processes of the justice system to re-victimise the survivors of domestic abuse? In Scotland, the Government are engaged in a significant overhaul of the justice system, ahead of the introduction of new legislation on an all-encompassing offence of domestic abuse that will include all forms of coercive behaviour, but in Scotland legal aid is widely available in both criminal and civil cases. In England and Wales, cuts to legal aid mean that 80% of family cases now see at least one party without a lawyer, while in 60% of cases in the family courts neither party has one. In addition, victims of domestic abuse can only access legal aid in England and Wales if they cross a threshold test that has already been found to be too restrictive in a judicial review case. In addition to this important review, we therefore need a review of the criteria for access to legal aid for victims and survivors of domestic abuse. When will the Government commit to such a review?
Splendid! The hon. and learned Lady elided into a question just in time.
I thank the hon. and learned Lady for that and for her news from Scotland. On legal aid in England and Wales, my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) deliberately decided to concentrate the effort on cases involving people’s life, liberty, home or, as in this case, domestic abuse. Given that it was a period of austerity and decisions had to be made, I believe he got that judgment right. On the criteria for legal aid and the evidence that needs to be provided, it is not as though the Government have said, “This is set in stone”; where criticisms have been made, we have changed the rules to tackle those criticisms. My overall point is that the Government are responding when we should be.
I welcome my right hon. and learned Friend’s announcements today and his work with the Lord Chancellor, but may I draw his attention to a report published last April by the all-party group on domestic violence, chaired by myself and the hon. Member for Birmingham, Yardley (Jess Phillips), that not only picked up on this issue of cross-examination but considered special measures in courts to make it is easier for some of the most vulnerable victims to give evidence without feeling intimidated?
I pay tribute to my right hon. Friend’s work in this area and for the important work of the all-party group, of which the Government and the ministerial committee on violence against women and girls take particular note. On special measures, the family courts have always had available to them a wider set of tools than the criminal courts and their judges have a wide discretion. Such measures as cross-examination by video, which in the criminal courts is provided for under section 28 of the 1999 Act, can be taken in family cases. Family courts can take evidence in a wide variety of ways, so there is a lot of protection. As I said in response to the urgent question, however, we are going further. Measures to do with the court estate, such as ensuring separate waiting rooms, screens and all those sorts of physical aspects, are being covered, as is staff training, through the Children and Family Court Advisory and Support Service and so on. That is very important, too.
I am grateful to the Minister for highlighting the discretion already available, but given that primary legislation might take some time, what steps is he taking now to remind the judiciary of the discretion they have and how they can apply it?
The hon. Lady makes an important point. As she will know, there are practice directions in the family division, and one is being prepared at the moment, so I will make sure that her comments are taken well on board. We do not make the practice directions, but we can certainly pass on her comments.
I and my staff have been struck in my constituency surgeries by the clear feedback on this anomaly around cross-examination. One of my constituents who complained about it was a former police officer. May I urge the Minister to take every step and use every tool possible to get the matter resolved as soon as possible?
We all have examples—I am glad that my hon. Friend was able to get her example on the record—of cases where some form of abuse has occurred in the courts. That is unconscionable and it needs to stop. We are going to tackle this issue very urgently.
On who should be involved and consulted in the review, will the Minister bear in mind that party litigants cross-examining their victims is just one species of the controlling behaviour that lies at the heart of domestic abuse and that, for that reason, there is a real and important role for organisations such as Women’s Aid to have their voices heard in this process?
The right hon. Gentleman makes an important point, and the Department does, of course, listen to what is said by Women’s Aid. It does seem to me that this is a fairly discrete issue—an issue about banning cross-examination by alleged perpetrators and making arrangements to ensure that cross-examination can take place in a suitable way. I would not want to sacrifice speed in tackling that for anything.
Last week, the country was shocked and saddened by the death of my constituent, Jill Saward, who campaigned tirelessly on behalf of victims of rape and sexual violence, following her own horrific personal ordeal. Jill was instrumental in the campaign to change the law, so that accused rapists are barred from cross-examining victims. Will my right hon. and learned Friend join me in paying tribute to Jill and expressing our sincere condolences to her family, and does he agree that it is absolutely right to extend this law to the victims of domestic violence?
I certainly believe it important to pay tribute to Jill Saward, who suffered the most vile ordeal, yet showed through the rest of her life what a wonderful person she was, by campaigning for others and doing a tremendous amount of charity work. She was a model, and someone who set an example of being good. Yes, I would like to pass on the law that applies to criminal cases into family cases, so that we can tackle the sort of abuse that has been described.
I declare my interest as a member of the Wilberforce barrister chambers in Hull, although I am not currently practising. I welcome the Justice Secretary’s position to bring forward a review on this important issue, but the Minister will know that this was created as a result of the Legal Aid, Sentencing and Punishment of Offenders Act 2012. The truth is that the vast majority of people today are refused legal representation in family proceedings unless they can prove domestic violence, which is virtually impossible to prove. The Government should bring forward a review of LASPO, which is not working. They should do something about it.
I do not agree with the hon. Gentleman, but there will be a review of LASPO. It is something that we have promised, and the date by which it has to be completed is April 2018. We are committed to that. As for family proceedings, I think it right that families can come together in many cases and reach agreements, so we do not have the problem that the hon. Gentleman outlined. Where abuse is present for a significant number of individuals, it is important that in those cases the individual who is the victim should not be cross-examined by the alleged perpetrator. That is what we want to solve.
We earlier heard a Cherry, and now we can hear a Berry.
Thank you, Mr Speaker. I congratulate the Minister and the Lord Chancellor on taking action regarding the travesty of litigants in person being able to cross-examine their victims. In his statement, the Minister referred to the problem as urgent and said that it has the utmost priority. When the review is complete, will he commit to bring this forward as emergency legislation? I think that would gain support from both sides of the House, and we could pass the legislation in one day, ensuring that we can bring about the change as quickly as possible.
I think that the importance of that issue is accepted throughout the House. Whether or not my hon. Friend’s suggestion is an appropriate way to deal with it, one thing is clear: it should be dealt with as a matter of urgency, and that is what I am committed to doing.
Perhaps I should have said earlier that there were instances in which this problem arose before LASPO. It is not a new problem, and many people were refused legal aid representation under the Labour Government.
The Minister has said seven times that he is “dealing with it urgently”. When will we see the result?
The answer that Members receive from the Dispatch Box is, of course, “shortly”, and that is what I have said, but it does mean shortly.
The Government’s reforms of the family courts were designed to keep some of these antagonistic cases out of court altogether, but the legal aid changes have undoubtedly led to the involvement of more litigants in person in very sensitive cases. Does my right hon. and learned Friend acknowledge the problems that litigants in person are causing in relation to court resources? They often spin out the time that cases take, with judges themselves requiring constant advice on legal procedures. We really need to do something about that, because it is messing up the family courts.
I fully accept that how litigants in person are helped with court proceedings is important, and the Government are spending £3.5 million on helping them. Let me make another point with which my hon. Friend may agree. Not every case needs to be decided in court; I am a strong supporter of mediation, and I should like to see more of that.
The emergency review is welcome, but cross-examination is not the only way in which perpetrators exploit family court processes to perpetuate their abuse. Will the review consider the ways in which abusers can, for example, string out judicial process in the family courts to continue to abuse former partners and their children?
I should be happy to discuss the issue with the hon. Lady, and to look into it in due course. This, however, is a discrete matter and an important one. I should like it to be tackled swiftly, and I do not intend to widen what we are doing at present, because I want to get on with that.
Women’s Aid has raised this issue on a number of occasions, most recently in its important and hard-hitting report “Nineteen Child Homicides”, which revealed that 25% of women interviewed had been cross-examined and that one woman who had been raped, beaten and abused for six years was cross-examined for three hours. Notwithstanding the need to get it right in the review, will my right hon. and learned Friend introduce legislation as soon as possible to ensure that that can never happen again?
My hon. Friend has highlighted an important case, as well as the work done by Women’s Aid. He is right to say that that issue needs to be tackled urgently.
The need for training of the judiciary goes beyond the family courts. A constituent came to see me because her ex-partner had taken a case about the management of family property to the civil court, and the judge had said it was irrelevant that he had been imprisoned for raping her daughter. That cannot be right. Judges need to be trained as well.
It would not, of course, have been a family justice case; it would have been a civil case. I agree with the hon. Lady that that is an important consideration, and I will look into it.
I welcome what the Minister has said today and his commitment to legislation, but in the meantime will he ensure that the best support is available to vulnerable victims before, during and after the proceedings?
As I said in my initial response, a great deal of effort has gone into training both CAFCASS and court staff to provide the emotional support that is needed.
I think that we all welcome the tone of what the Minister has said today, but this is supposed to be an urgent review, and many women are going through cases of this kind right now. Will the Minister make it clear that the review will be concluded by Easter at the latest and that we can then hope to see improvements in our courts?
I welcome the tone of the Minister’s remarks so far. Does he agree that the point about legal aid misses the fact that some of these perpetrators are almost certainly using the ability to cross-examine their victims as a tactic in the courts? As that is motivating what they are doing, it is even more important that this plug in the law is made to stop this practice continuing.
My hon. Friend and a number of other colleagues are saying that cross-examining the victim in these circumstances is a form of abuse in itself. I agree, which is why we are keen to conclude this review on a short timetable, as I said to the hon. Member for Leeds West (Rachel Reeves).
I am grateful to the Minister for the terms in which he has replied to the urgent question. He has talked this afternoon about the urgency of this issue and I think that he has accepted the words of the president of the family division of the High Court, Sir James Munby, that primary legislation would be needed. What commitment can the Minister give to the survivors of domestic violence and abuse that change to primary legislation will be brought forward urgently?
I can certainly give the assurance I have already given, which is that we are tackling this as a matter of urgency. The hon. Gentleman will be aware that there is a busy legislative timetable with all sorts of matters to do with Europe and the like, and we will have to see what exactly can be achieved in terms of the legislative timetable, but I want to tackle this urgently.
On behalf of my constituent Claire Throssell, whose two children were murdered by her ex-husband, I welcome this review, but in the debate in September that I co-sponsored, the Under-Secretary at the Minister’s side, the hon. Member for Bracknell (Dr Lee), made a clear commitment to overhauling the culture of the family courts and in particular to a review of practice direction 12. Are the Government still committed to that broader set of changes, which we so urgently need?
I pay tribute to the work that the hon. Lady has done on this issue. I chair the Family Justice Board with the Minister for Vulnerable Children and Families. We are committed to improving the overall way in which the courts work and are in the process of introducing a new practice direction in the area of victims. This is certainly a point we are very much alive to.
Everyone who has spoken today, including the Minister, has said the situation is urgent. In view of that and the fact that he said primary legislation will be needed, is there any reason why he cannot commit to the Government presenting that within three or four months?
As I have said, we are keen to complete this review as a matter of urgency. The legislative programme is a complex matter at the moment for reasons I have hinted at, so we will have to see what is possible, but we would like to tackle this urgently.
The focus of questions has understandably been on domestic violence, but can the Minister confirm he is also seeking to implement this protection for victims of emotional and financial control and other forms of non-violent abuse, which the Government have, to their great credit, sought to criminalise in recent months?
As the hon. Gentleman will know, there is a cross-governmental approach to abuse that has its own definitions and so on, but the areas of abuse covered in terms of applications for legal aid are far wider than just physical violence and include sex abuse cases and the like, and we are alive to the need to cover a wider area than simply domestic violence.
While I appreciate the urgency and scope of the investigation, will the Minister give consideration to cases where the Department for Work and Pensions is sharing domestic abuse victims’ information with the perpetrators of the crime when making decisions about benefits claimants? The anonymity of a constituent of mine was taken away from her and the information was passed on by the DWP.
I am sure that the hon. Lady is making an important point. If she wants to write to me or speak to me about it, I would be more than happy to look at it, but this is not what we are doing in this exercise of looking at the cross-examination of victims by perpetrators or alleged perpetrators. We are tackling a discrete, narrow area, and we want to do this urgently. Her point is important, but it concerns a different matter.
Survivors of domestic abuse tell us that they feel re-victimised and re-traumatised by their experiences in the family courts. Will the Minister please give us more clarity on how the voices and views of survivors of domestic abuse will be considered in this emergency review?
My view is that this is a narrow issue involving banning perpetrators or alleged perpetrators from cross-examining victims, as we do in criminal cases. That is a narrow issue on which I think we all agree. The sort of arrangements that will need to be put in place have already been tried in the criminal courts. If the hon. Lady has any particular ideas or concerns, I would obviously be happy to discuss them with her, but I do not think that this is a complicated matter. It is a simple one that needs urgent action.
I am aware that this focuses on the adult victims of domestic abuse, but research from Safelives has shown that an estimated 130,000 children in the UK live in households with a high risk of domestic abuse and a significant risk of harm or death. Thousands more live with other levels of domestic abuse every day. Will the Minister please clarify that, as recommended by Women’s Aid, there should not be an assumption of shared parenting in child contact cases where domestic abuse is a feature?
The hon. Lady makes an important point, and the courts are clearly alive to this matter. We have to give some discretion, however, because family cases involve a wide range of factors. I think that the judges do a good job. I want to put on record that these are not easy cases and that our judges have to have an element of discretion. I would like to ensure that that remains the case, although I acknowledge that she makes a good point.
A constituent who came to see me was extremely distressed because her husband was repeatedly taking her back to the family court over access issues. She was not only undergoing cross-examination but being driven into financial poverty through constantly having to fund her own defence. Will the Minister look at how the courts can deal with the vexatious, repeated requests relating to access that are behind a lot of coercive behaviour and at the financial poverty that families find themselves in as a result?
The hon. Lady makes an important point, and I should like to pay tribute to the work that she does in this area. I am more than happy to raise that point in the Family Justice Board and to look at the matter, but it is not part of the important work that we are doing to deal urgently with the question of cross-examination. Her point bears on that work, but it is not the focus of what we are doing at the moment. We will, however, look into it.
Mental Health and NHS Performance
With permission, Mr Speaker, I would like to make a statement on mental health and NHS performance. This Government are committed to a shared society in which public services work to the highest standards for everyone. This includes plans announced by the Prime Minister this morning on mental health. I am proud that, under this Government, 1,400 more people are accessing mental health services every day compared with in 2010 and that we are investing more in mental health than ever before, with plans for 1 million more people with mental health conditions to access services by 2020.
But we recognise that there is more to do, so we will proceed with plans to further improve mental health provision, including: formally accepting the recommendations of the independent taskforce on mental health, which will see mental health spend increase by £1 billion a year by the end of the Parliament; a Green Paper on children and young people’s mental health to be published before the end of the year; enabling every secondary school to train someone in mental health first aid; a new partnership with employers to support mental health in the workplace; up to £15 million extra invested in places of safety for those in crisis, following the highly successful start to the programme in the last Parliament; an ambitious expansion of digital mental health provision; and an updated and more comprehensive suicide prevention strategy. Further details of these plans are contained in the written ministerial statement laid before the House this morning.
I turn now to the winter. As our most precious public service, the NHS has been under sustained pressure for a number of years. In just six years the number of people aged over 80 has risen by 340,000, and life expectancy has risen by 12 months. As a result, demand is unprecedented. The Tuesday after Christmas was the busiest day in the history of the NHS, and some hospitals are reporting that A&E attendances are up to 30% higher than last year. I therefore want to set out how we intend to protect the service through an extremely challenging period and sustain it for the future.
First, I pay tribute to staff on the frontline. The 1.3 million NHS staff, alongside another 1.4 million in the social care system, do an incredible job, which is frankly humbling for all of us in this House. An estimated 150,000 medical staff, and many more non-medical staff, worked on Christmas day and new year’s day. They have never worked harder to keep patients safe, and the whole country is in their debt.
This winter, the NHS has made more extensive preparations than ever before. We started the run-up to the winter period with over 1,600 more doctors and 3,000 more nurses than just a year ago, bringing the total increase since 2010 to 11,400 more doctors and 11,200 more hospital nurses. The NHS allocated £400 million to local health systems for winter preparedness; it nationally assured the winter plans of every trust; it launched the largest ever flu vaccination programme, with more than 13 million people already vaccinated; and it bolstered support outside A&Es, with 12,000 additional GP sessions offered over the festive period.
The result has been that this winter has already seen days when A&Es have treated a record number of people within four hours, and there have been fewer serious incidents declared than many expected. As Chris Hopson, head of NHS Providers, said, although there have been serious problems at some trusts, the system as a whole is doing slightly better than last year.
However, there are indeed a number of trusts where the situation has been extremely fragile. All of last week’s A&E diverts happened in 19 trusts, of which four are in special measures. The most recent statistics show that nearly three quarters of trolley waits occurred in just two trusts. In Worcestershire, in particular, there have been a number of unacceptably long trolley waits, and the media have reported two deaths of patients in A&E. We are also aware of ongoing problems in North Midlands, with extremely high numbers of 12-hour trolley waits. Nationally, the NHS has taken urgent action to support those trusts, including working intensively with leadership and brokering conversations with social care partners to generate a joined-up approach across systems of concern.
As of this weekend, there are some signs that pressure is easing both in the most distressed trusts and across the system. However, with further cold weather on the way this weekend, a spike in respiratory infections and a rise in flu, there will be further challenges ahead. NHS England and NHS Improvement will also consider a series of further measures that may be taken in particularly distressed systems on a temporary basis at the discretion of local clinical leaders. These may include: temporarily releasing time for GPs to support urgent care work; clinically triaging non-urgent calls to the ambulance service for residents of nursing and residential homes before they are taken to hospital; continuing to suspend elective care, including, where appropriate, suspension of non-urgent outpatient appointments; working with the Care Quality Commission on rapid re-inspection where this has the potential to re-open community health and social care bed capacity; and working with community trusts and community nursing teams to speed up discharge. Taken together, these actions will give the NHS the flexibility to take further measures as and when appropriate at a local level.
However, looking to the future, it is clear we need to have an honest discussion with the public about the purpose of A&E departments. Nowhere outside the UK commits to all patients to sort out any urgent health need within four hours. Only four other countries—New Zealand, Sweden, Australia and Canada—have similar national standards, which are generally less stringent than ours. This Government are committed to maintaining and delivering that vital four-hour commitment to patients, but since it was announced in 2000, there are nearly 9 million more visits to our A&Es, up to 30% of which NHS England estimates do not need to be made, and the tide is continuing to rise. If we are going to protect our four-hour standard, we need to be clear that it is a promise to sort out all urgent health problems within four hours, but not all health problems, however minor. As Professor Keith Willett, NHS England’s medical director for acute care, has said, no country in the world has a standard for all health problems, however small, and if we are to protect services for the most vulnerable, nor can we.
NHS England and NHS Improvement will continue to explore ways to ensure that at least some of the patients who do not need to be in our A&Es can be given good, alternative options, building on progress under way with a streaming policy in the NHS England A&E plan. In this way, we will be able to improve the patient experience for those with more minor conditions who are currently not seen within four hours, as well as protect the four-hour promise for those who actually need it.
Taken together, what I have announced today are plans to support the NHS in a difficult period; and plans for a Government who are ambitious for our NHS, quite simply, to offer the safest, highest-quality care available anywhere, for both mental and physical health. But they will take time to come to fruition, and in the meantime all our thoughts are with NHS and social care staff who are working extremely hard over the winter, and throughout the year, both inside and outside our hospitals. I commend this statement to the House.
I am grateful to the Secretary of State for an advance copy of his statement. I, too, begin by paying tribute to all the NHS staff who are working day in, day out to provide the best possible care to patients during this busy period. Of course we welcome measures to improve mental health services in this country, as indeed we welcomed such announcements exactly 12 months ago, when the then Prime Minister made similar promises. But does the Secretary of State not agree that if this Prime Minister wants to shine a light on mental health provision, she should aim her torch at the Government’s record: 6,600 fewer nurses working in mental health; a reduction in mental health beds; 400 fewer doctors working in mental health; and, perhaps most disgracefully of all, the raiding of children’s local mental health budgets in order to plug funding gaps in the wider NHS? Could he therefore tell us why the Prime Minister was unable to confirm this morning that money for mental health would be ring-fenced to prevent this raiding of budgets from happening in the future? We welcome measures to improve mental health support in schools. Will the Government offer more resources to local authority education psychologists? What provision will be in place to give teachers suitable training for doing this work?
On the winter crisis, this morning the Secretary of State said that things have only been “falling over in a couple of places”. Let us look at the facts: a third of hospitals declared last month that they needed urgent help to deal with the number of patients coming through the doors; A&E departments have turned patients away more than 140 times; 15 hospitals ran out of beds in one day in December; several hospitals have warned that they cannot offer comprehensive care; and elderly patients have been left languishing on hospital trolleys in corridors, sometimes for more than 24 hours. And he says that care is only falling over in a couple of places! I know that “La La Land” did well at the Golden Globes last night, but I did not realise the Secretary of State was living there—perhaps that is where he has been all weekend. Will he confirm that the NHS is facing a winter crisis, and that the blame lies at the doors of No. 10 Downing Street?
Does the Secretary of State agree that it was a monumental error to ignore the pleas for extra support for social care to be included in the autumn statement only weeks ago? Will he support calls to bring forward now the extra £700 million that is allocated for 2019, to help social care? Will he urge the Chancellor and the Prime Minister to announce a new funding settlement for the NHS and social care in the March Budget so that a crisis like this year’s never happens again?
I press the Secretary of State further on the announcement he has just made on the four-hour A&E target. Is he really telling patients that rather than trying to hit that four-hour target, the Government are now in fact rewriting and downgrading it? If so, does NHS England support that move? What guidance has he had from the Royal College of Emergency Medicine to say that that is an appropriate change to the waiting-time standard?
The Secretary of State has made patient safety an absolute priority; in that, he has our unswerving support. I am sure he will agree that one of the most upsetting reports to come out of hospitals last week was that on the death of two patients at Worcestershire Royal hospital who had been waiting on trolleys. Will he commit to personally lead an inquiry into those deaths? Does he know whether they were isolated incidents? When does the trust intend to report back on its investigation? Will he undertake to keep the House updated on those matters?
There is no doubt that the current crisis could have been averted. Hospital bosses, council leaders, patients groups and MPs from both sides of the House urged the Chancellor to give the NHS and social care extra money in the autumn statement. Those requests fell on deaf ears and we are now seeing the dismal consequences. NHS staff deserve better. Patients deserve better. The Government need to do better. I urge the Health Secretary to get a grip.
I am happy to respond to the hon. Gentleman’s comments and, indeed, to the comments of all Members, but I shall first say this about the tone of what he said. He speaks as if the NHS never had any problems over winters when Labour was in power. The one thing NHS staff do not want right now is for any party to start weaponising the NHS for party political purposes. I remind him that when his party runs the NHS, the number of people on waiting lists for treatments doubles, A&E performance is 10% lower and people wait twice as long to have their hips replaced. Whatever the problems are in the NHS, Labour is not the solution.
The hon. Gentleman talked about mental health, so let me tell him what is happening on that. Thanks to the efforts of this Government and the Conservative-led coalition, we now have some of the highest dementia diagnosis rates in the world. Our talking therapies programme—one of the most popular programmes for the treatment of depression and anxiety—is treating 750,000 more people every year and is being copied in Sweden. Every day, we are treating 1,400 more people with mental health conditions and we have record numbers of psychiatrists. The hon. Gentleman mentioned mental health nurses: in this Parliament we are training 8,000 more, which is a 22% increase.
All that is backed up by what we are confirming today, which has not been done before: the Government are accepting the report of the independent taskforce review—led by Paul Farmer, the chief executive of Mind—which commits us to spending £1 billion more a year on mental health by the end of the Parliament. That would not be possible with the spending commitments that Labour was prepared to make for the NHS in the previous Parliament. It is because of this Government’s funding that we are able to make such commitments on mental health.
The hon. Gentleman talked about the NHS and gave completely the wrong impression of what I said this morning. I was completely clear that all NHS hospitals are operating under greater pressure than they ever have. He should listen to independent voices, such as that of Chris Hopson—no friend of the Government when it comes to NHS policy—who is clear that in the vast majority of trusts people are actually coping slightly better than last year. However, we have some very serious problems in a few trusts, including in Worcestershire and a number of others. I can commit to him that we will follow closely the investigations into the two reported deaths at Worcestershire and keep the House updated.
The hon. Gentleman talked about social care, which is where, I think, his politicising goes wrong. Last year, spending on social care went up by around £600 million. At the last election, he stood on a platform of not a penny more to local authorities for social care, so to stand here as a defender of social care is, frankly, an insult to vulnerable people up and down the country, particularly to those living under Labour councils such as Hounslow, Merton and Ealing, which are refusing to raise the social care precept, but complaining about social care funding.
The hon. Gentleman talked more generally about NHS funding, but in the last Parliament it was not the Conservatives who wanted to cut funding for the NHS—it was his party. It was not the Conservatives who said that funding the five-year forward view was impossible—it was his party. Labour said that the cheque would bounce. Well, it has not bounced, and we are putting in that money.
In conclusion, it is tough on the NHS frontline. The hon. Gentleman was right to raise this issue in this House, but wrong to raise it in the way that he did. Under this Government, the NHS has record numbers of doctors and nurses and record funding. Despite the pressures of winter, care is safer, of higher quality and reaching more people than ever before. It is time to support those on the frontline, and not try to use them for party political points.
I welcome the Secretary of State’s statement and the Prime Minister’s focus on mental health in her speech today. She spoke of holding the NHS leadership to account for the extra £1 billion that we will be investing in mental health. Will the Secretary of State set out in further detail how clinical commissioning groups will be held to account for ensuring that that money gets to the frontline so that we can deliver progress on parity of esteem?
Yes, I can do that. It is a very important point. We have had a patchy record in the NHS of ensuring that money promised for mental health actually reaches the frontline. The way that we intend to address this is by creating independently compiled Ofsted-style ratings for every CCG in the country that highlight where mental health provision is inadequate. Those ratings are decided by an independent committee chaired by Paul Farmer, who is responsible for the independent taskforce report, so he is able to check up on progress towards his recommendations. I am confident that, by doing that, we will be able to shine a light on those areas that are not delivering on the promises that this Government have made to the country.
After the Health Committee’s recent inquiry into suicide, I absolutely welcome the extra funding for mental health. I am sure that the Secretary of State remembers some of the discussions that we had in that room.
I also pay tribute to the staff. Obviously, with my background, I know exactly what it is like when A&E is swamped and there is nowhere to put people. The staff across NHS England are not afraid of us discussing this topic and weaponising it. They are in tears; they are exhausted; and they are demoralised. They have never experienced a winter like this. Perhaps the Secretary of State will explain why his figures suggest 19 diverts and only two trusts in serious problems, whereas we are hearing from the Nuffield Trust that that 42 or 50 trusts are diverting, which is a third. That means that the problem is widespread.
I totally agree with the point about people going to A&E when they do not need to be there, but they are not the people who are three-deep on trolleys waiting for a bed for 36 hours—those are people who need a bed and who are there because they are ill. We have discussed sustainability and transformation plans and NHS sustainability on several occasions. The concern that people have is that, because there is not the money for a redesign, there will be A&E closures and bed cuts. I hope that this incident will show that that is simply not possible. It is not possible for the UK, particularly NHS England, to lose any more beds. In Scotland, we face the same problem of increased demand and shortage of doctors, yet 93.5% of our patients were seen within four hours in Christmas week. The president of the Royal College of Emergency Medicine estimates that in areas of England the figure is between 50% and 60%. That difference is down to how it is organised. It is the fragmentation and the lack of integration. There are things that can be done. We can use community pharmacies and GPs, and try to bring the NHS back together.
I hope that the hon. Lady will not take offence—she has vast experience in this field—if I say that her questions must be judged to be rhetorical, because I did not observe any question marks, although I am sure we will in future.
You were handy at that.
Yes, but that was then, and this is now. That was when I was a badly behaved Back Bencher like the hon. Gentleman.
I will try to interpret the questions in what the hon. Lady said. If she was asking whether the problems in England are similar to those in Scotland, I think that we share problems, particularly across the busy winter period. She has observed that Scotland is also failing to meet the target. She is right to say that bed capacity is absolutely critical, and that is something we have not always got right in England. There have been times when beds have been decommissioned and the alternative provision that was promised has not been made, which has big knock-on effects. When it comes to what happens in Scotland and England, I think that Scotland has gone further than England in the use of community pharmacy, which is to be commended, but England has gone further in our plans to reform and increase investment into general practice. That was what the president of the Royal College of General Practitioners was talking about over Christmas when she said that she was keen for Scotland to match the package that we have in England.
I commend my right hon. Friend’s statement. Of course, we all know the work that is done in our local areas by all those working in the NHS at such a difficult time. In relation to mental health, will he confirm that the Prime Minister’s very welcome speech this morning also emphasised the importance of perinatal mental health, and that some of the extra resource will continue the great work on that? Will he also emphasise the point about transparency, because knowing what CCGs are doing assists Members of Parliament not only in calling for extra resource, but in ensuring that our areas do the best they can compared with others, rather than simply making a general point about resources, which is always the easiest point to make?
My right hon. Friend did a huge amount of good work on mental health when he was a colleague in the Department of Health. On perinatal mental health, we know that 20% of mothers suffer some form of pre or post-natal depression, which has a huge impact on the child, with lifetime costs of around £10,000 for every birth in this country, caused by lack of proper mental health provision. The plan announced today means that we will be able to treat an extra 30,000 women better—we think that is the number who need to be treated. He makes an important point about transparency. I would put it like this: funding matters, and we have some of the best mental health provision in the world, but it is not consistent. The only way that we can make it consistent is by shining a light on the relative performance of different parts of the country, so that we can bring all areas up to the standard of the best.
The Minister says that there are 9 million more patient visits now than there were in 2000. Is he aware that in that climate, shutting hospitals such as the Bolsover community hospital, led by the Hardwick clinical commissioning group, makes no sense at all? He turns a blind eye to it. Will he look at this question, because when those hospitals are shut, the beds are gone forever? Get stuck in.
I actually think that broadly the hon. Gentleman makes an important point. It is not just about decisions to downgrade or close A&E departments when there is no alternative provision; it is also about community hospitals, which are very important places for A&E departments and hospitals to step people down to. He is right to say that the NHS—[Interruption.] I am getting comments from a sedentary position. With the greatest respect, this process has been going on in the NHS for decades, and I do not think that we always got it right under both parties, but I think that he is right to say that when there are changes in provision in community hospitals, we need to ensure that we have good alternative plans.
In wishing the hon. Members for Morley and Outwood and for Filton and Bradley Stoke all the best in the weeks and months ahead, I call Andrea Jenkyns.
Thank you, Mr Speaker. First, I echo some of the points made by the Secretary of State regarding mental health support for expectant mothers. As one myself, I have to say that the midwives have been fantastic. Right from the very first appointments at grassroots level, they mention mental health, so we are feeling the support on the ground.
I welcome today’s statement, which shows the Government’s commitment to mental health by making it a centrepiece of the agenda. One in 50 young people in Yorkshire receive care for mental health. How will the new approach address the concerns of the young people and their parents, and what measures are in place to reduce the waiting list for child and adolescent mental health services?
I add to Mr Speaker’s comments my very good wishes and confidence that my hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) will get superb care from the NHS. I thank her for campaigning on patient safety. I am sure she will be pleased to hear that our principal safety campaign this year is on maternity safety.
In bald numbers, the plan will mean that we will treat 1 million more people with mental health conditions a year by the end of this Parliament. Of course, many of those will be in Yorkshire. An additional 70,000 young people will get treatment every single year and I hope that will bring down the CAMHS waiting times. We also want to do work in schools to prevent people from getting on the CAMHS waiting list in the first place.
The YoungMinds survey published before Christmas showed a failure in 50% of clinical commissioning group areas to spend the full amount of extra investment allocated to children and young people’s mental health. That is scandalous. I note the Secretary of State’s point about Ofsted-style ratings, but does he not need to introduce a system that guarantees that the money the Government promised for children’s mental health is actually spent as intended?
The right hon. Gentleman is right to want to ensure that we live up to those promises. He was a Minister when some of those promises were made and they are very important. I would say that we are delivering what he wants. We are on track this year to spend around £1 billion more, compared with two years ago when he was Minister for mental health. It has taken time for the NHS to get the message on mental health, but it is getting through loud and clear.
As a frequent user and admirer of the Red Cross, I regard its claims as being grossly over the top. I join the Secretary of State in his tribute to the wonderful work of the frontline staff of the NHS at a very difficult time. Does he agree that the pressures are not going to go away, and that there must be a continuing drive for reform and to do these things better? What exactly are the impediments in the NHS to the sharing of best practice, and what steps is he taking to create a more experienced and better trained leadership who are more prepared for the exceptional medical and management challenges that the NHS now faces?
My right hon. Friend speaks extremely wisely. I, too, think that we have to be very careful about the language we use in these situations because many vulnerable people can be frightened if we get the tone wrong. The vast majority of NHS services are performing extremely well under a great deal of pressure. His point about leadership is extremely important and one to which I have given a lot of thought. At the heart of the problem is that we do not have enough hospitals being run by doctors and nurses. Around 56% of our managers have a clinical background, compared with 76% in Canada and 96% in Sweden. To put it bluntly, doctors like to be given instructions by other doctors. Exceptional people from a non-clinical background can do it, but it is hard because doctors have many years of training and are highly experienced people. I have put in place measures to try to make it easier for more clinicians to become our managers of the future.
In wishing the hon. Member for Liverpool, Wavertree all the best in the period ahead, I call Luciana Berger.
In her speech today, the Prime Minister made a number of hard-hitting observations. She said:
“there is no escaping the fact that people with mental health problems are still not treated the same as if they have a physical ailment”.
She reported on the increase in self-harm among young people, and she told us about the shocking reality that, on average, 13 people take their life every single day in England. Given that the Conservative party has been in government for almost seven years, and that the Secretary of State has been Health Secretary for almost four of those years, who does he think is responsible for the terrible failures highlighted by the Prime Minister today?
I just think that is a totally inappropriate question—[Interruption.]
With great respect to the hon. Lady—she campaigns tirelessly on mental health, and she deserves great credit for that—that is the same as saying that the last Labour Government should have sorted out every single problem in mental health by 2010, and I am not standing here saying that. The truth is that we have made good progress; if she thinks that it is trivial that we are treating 1,400 more people every day for mental health conditions, she should go and talk to some of her own constituents who are getting access to mental health provision, who would not have been getting that access under the policies of the last Labour Government. We have made big strides in our mental health provision, but there is much more to do, and we are determined to do what it takes.
Recognising that the supply of extra resources for the NHS will be a vital and continuing issue, is my right hon. Friend not exactly right when he says that equal attention has to be given to controlling demand so that people do not simply instinctively make calls on GPs’ surgeries and A&E departments, which doctors themselves believe are avoidable and which could be dealt with in other ways?
My right hon. Friend speaks extremely wisely. At the heart of it, we have a good commitment—the four-hour commitment, which was introduced by a Labour Government. I think it is one of the best things the NHS does: the promise that if someone is ill and needs urgent help, we will do something about it and get them under proper medical care within four hours. However, if we have the situation that NHS England now describes, where up to 30% of the people in A&E departments do not actually need to be there, we risk not being able to deliver that promise for the people who really do need it. That is why looking at how we can control demand from the people who do not need to be in A&Es, such as through the significant increase in investment in general practice and other measures, is going to be vital if we are going to crack this.
The Secretary of State seems to be blaming the public for overwhelming A&E departments, when he well knows that the reason they go to A&E is that they cannot get to see their GP and social care is in crisis. Will he confirm that he has just announced another significant watering-down of the four-hour A&E target, following the watering-down by the coalition in their first year in office back in 2010? What is he personally doing to address the chronic long-term underperformance of hospitals, such as that at Worcester, where two people died on trolleys, and Plymouth, which is one of the hospitals that had to call in the Red Cross over the Christmas period?
I think—probably because of the forum we are in now—the right hon. Gentleman is misinterpreting what I have said, and it needs to be put right. Far from watering down the four-hour target, I have today recommitted the Government to that four-hour target. In just the answer before he spoke—maybe he was not listening—I actually said I thought it was one of the best things about the NHS that we have this four-hour promise. But the public will go to the place where it is easiest to get in front of a doctor quickly, and if we do not recognise that there is an issue with the fact that a number of people who do not need to go to A&Es are using them, and we do not try to address that problem, we will not make A&Es better for his constituents and mine. If he asks what we are doing to turn around hospitals in difficulty, we have introduced the new Care Quality Commission inspection regime and a chief inspector of hospitals—the most rigorous inspection regime in the world, which the Labour party tried to vote down.
I welcome the Prime Minister’s announcement and the Secretary of State’s confirmation of extra support for mental health. I particularly welcome the review to be led by Lord Stevenson and Paul Farmer. As they carry out that review on improving businesses’ ability to support people with mental health problems, will they particularly look at how we can help smaller businesses—those that perhaps do not have the human resource expertise that larger businesses may have—to make sure that people with mental health problems stay in work and are able to get back into work when they fall out of it? They are the biggest single category of disabled people not currently working, and we could make a huge difference.
My right hon. Friend will of course know that from his distinguished time as a Minister in the Department for Work and Pensions. He is right. The central problem we are trying to address is that if someone, for example, stops going to work and is signed off work because of severe depression, that is bad for the individual and also bad for the business. Too often, what happens at the moment is that it then becomes entirely the NHS’s responsibility to get that person back to work; the business says, “Well, it’s not our responsibility anymore because they’re not turning up.” With a little bit of help from the business, we could get the person back to work much more quickly, meaning that they recovered more quickly and the business would not lose someone important. That is what Dennis Stevenson and Paul Farmer will be looking into.
We will never solve the challenges facing the NHS and social care until there is a long-term settlement for funding both. Does the Secretary of State understand that the social care precept is completely inadequate to fill the gap and will increase inequality, because the areas that most need publicly funded care will be least able to raise that money? Will he speak to the Chancellor and the Communities and Local Government Secretary to look again at this issue and get the funding that social care desperately needs?
I agree with the hon. Lady that there are serious funding pressures in social care. We need a long-term solution to this, and we are doing important work on that. The precept is part of the solution. The local government settlement has been adjusted to take account of the different spending powers, or revenue-raising powers, of wealthier counties and wealthier local authority areas compared with other areas. We have to take into account the equality issue, and she is absolutely right to do that. However, if she is saying, “Have we solved the whole problem?”, the answer is no—there is more work to do.
I welcome the statement by my right hon. Friend. May I pay huge tribute to everybody working at Nottingham University Hospitals NHS Trust, especially in A&E, and especially over the nine days between Christmas and 2 January? Admissions almost doubled. At one point in the Queen’s medical centre A&E department there were 180 people seeking treatment—that is a record. There were 395 more admissions than discharges in that nine-day period. I pay huge tribute to everybody who is working in our NHS. Can my right hon. Friend give me an assurance that he will continue to work with our hospital trusts, like NUHT, as they bring forward plans to change schemes —it is not just simply about money—and do everything that he can to support them in these unprecedented times?
I am happy to do that. I echo my right hon. Friend’s praise for the staff at NUHT, which was particularly pressured over Christmas. They have made particular efforts to improve patient safety and quality of care over recent years. She is absolutely right, and of course I will continue to work closely with her trust and others.
At 9.30 am today I received an email from a constituent in Coventry who asked me to bring it to the Secretary of State’s attention; I am delighted to do so. She writes as follows:
“I am a nurse with 26 years’ experience who has always worked full time and has paid my tax and national insurance without ever having to burden the government, social services or the NHS in my lifetime but have gladly served and given 100%”
to it. She continues:
“Unfortunately, my 18 year old daughter has recently become unwell mentally and attempted suicide twice in a 3 week period…I am really sad to say—
this comes from a nurse of 23 years’ experience—
“that the care she has been given has been dreadful. I am somebody who works in the NHS so I understand the strains the service is under but I also expect that as a family who give so much to society that when it is our time of need that we can expect a service that meets our needs.”
I ask the Secretary of State whether he will kindly agree to meet Mrs Hardy and me—Sarah Hardy is the lady’s name—or arrange for her to meet somebody who can give her some sort of reassurance. She continues that she has been waiting six months without any mental health assessment or support from the NHS—six months for a daughter of 18 years of age. Will he agree to do that so that it is not just a case of more hollow words?
I am more than happy to meet Mrs Hardy, but ahead of that I would like to look at the particular issue of why she has had to wait for so long. The hon. Gentleman put it very eloquently, and she put it very eloquently, and we owe a huge debt to such people. What she has described with her 19-year-old daughter’s treatment is just not satisfactory: it is not good enough. That is why the Prime Minister talked this morning about the injustice of having to wait so long for treatment, and that is exactly what we are trying to put right.
The House of Commons Library has calculated that the real-terms increase in health-related spending between 2010 and 2016 was 9.4% in England, yet it was zero in Wales. Not only are A&E waiting times consistently longer in Wales than in England, but waiting times for routine procedures can be as much as two and a half times longer in Wales. I regularly see constituents in tears who are waiting well in excess of a year for hip operations. Does the Secretary of State agree that the Labour party must start to acknowledge the challenges facing the NHS in Wales and accept responsibility for them? [Interruption.]
I think my hon. Friend’s constituents in Wales would be appalled by the reaction we have just had. Labour Members stand on their high horse in complaining about NHS care in England, but when he brings up poor NHS care in Wales, they tut and make noises as though they do not want to hear about it. If they care about NHS patients, they should care about them throughout the whole of the United Kingdom. I am afraid that that just shows the party political agenda. Yes, my hon. Friend is right: NHS care in Wales is worse, and Labour needs to do something about it.
I have been contacted by several constituents who have spent 14 hours in A&E waiting for a bed. As well as by social care cuts, we have been hampered by a shortage of A&E doctors. The Department of Health was warned that that would become a growing problem over five years ago, and the Health Committee warned about it again last year. When will this shortage of A&E doctors be ended by the Government—by the summer, by next year, by the following year? The Secretary of State has had seven years. When will he deal with the shortage of A&E doctors?
Let me tell the right hon. Lady what we have done about A&E doctors. Their number has gone up by 1,200 since 2010, which is an increase of over 50%. The number of A&E consultants has gone up by 500, which is an increase of over 20%. At the same time, we have recruited 2,000 more paramedics. As a result of those changes, our emergency departments are seeing—within the four-hour target—2,500 more people every single day compared with 2010. That is not to minimise the pressures in the NHS we have had over the winter or to say that there is not more that needs to be done, which is why I outlined a number of things in my statement.
The Secretary of State kindly came to see the plans for the emergency room at Worthing hospital and came back six years later to see how it is working and to admire it in operation. I hope that the next time he comes he can look at the Zachary Merton community hospital and the Swandean mental health services as well.
On child mental health care, may I put it to him that a quarter of the 700,000 teenagers going through each stage each year will have bumps and need resilience, and that their parents and teachers need help? Will he make sure that the Green Paper covers advice to parents and teachers so that they know what is in the normal range of behaviours and what is outside that range?
I commend my hon. Friend for his one-man campaign, which I continue to admire on many occasions, against the misinformation put out by 38 Degrees. I thank the staff at Worthing hospital for their fantastic work over the busy Christmas period. As usual, he puts his finger on a very important issue, which is that as we seek to raise the profile of mental health treatment for children and young people, we must not medicalise every single moment of stress. For example, worries before exams are not cause to talk to an NHS psychiatrist. A lot of work on the Green Paper will be looking at how we can promote self-help and at how we can help schools to support people through difficult patches, but we will also look at how we can make sure people get NHS care quickly when it is needed.
It is great to see the Secretary of State here today in the Chamber after enjoying his Christmas recess. While he was away staff on the NHS frontline had to work double shifts, the London ambulance service computer system crashed and we found out that the Red Cross needed to be drafted into our hospitals. Will the Secretary of State tell us which hospitals he visited during the Christmas recess?
I was in touch with what was happening in the NHS every single day throughout the Christmas recess. As someone who has worked in a hospital, the hon. Lady might question whether it is particularly helpful for NHS hospitals to have visits by high-profile politicians right at their busiest periods. I have been very closely in touch. She talks about the problem at London ambulance service. That was a problem staff have been trained to deal with. The staff of her own hospital worked extremely well, but they do not welcome attempts—she is making one this afternoon—to politicise the problems the NHS faces.
On the changes to the four-hour standard that the Secretary of State heralded, what can be done to incentivise and upskill GPs who may wish to take a closer interest in minor and moderate illnesses, including the use of nurse-led minor injury units?
They have a very important role. Some of the most successful and best-performing trusts, such as Luton and Dunstable, have a very good streaming process at the A&E front door, with good alternatives when it is not appropriate for people to go to an A&E department. We need to learn from that. Nurse-led units can be very important. GP-led units can make a big difference, too. It will not be the same everywhere, for reasons of space if nothing else, but there is a solution that everywhere can adopt.
In the past few weeks, we have seen pressures in the NHS that, to a certain extent, the Secretary of State has acknowledged. Given that we are not yet in the midst of a very desperate cold spell, and given that we are not in the throes of a flu epidemic, how can he come here today and complacently suggest he has a grip on our NHS services? Why was he not on top of those trusts he knew were weak? He knew they would be under threat if there was any pressure. What is he going to do when we hit a cold snap and people are suffering from flu in large numbers?
I am afraid that I reject that suggestion. The right hon. Lady wants to know what we have been doing over the course of the year. As I said in the statement, we have 1,600 more doctors than we had just a year ago, over 3,000 more nurses, the biggest flu vaccination programme in our history and 12,000 additional GP sessions booked over the festive period. A huge amount of work has been done, with a particular focus on distressed areas. Many of those distressed areas coped extremely well—not all of them, which is why there is more work to do.
When the Health Committee in the previous Parliament looked at children and adolescent mental health services, one of the main concerns was the distance travelled by patients—sometimes halfway across the country—to get treatment. Will the Secretary of State expand on his plans to reduce attendance at A&E? Does he envisage a new form of gatekeeper and does he intend to try to keep drunks out of A&E?
I would probably use the word “streaming”, rather than gatekeeper, to ensure that we have good, alternative offers for people who do not need to be in A&E. Frankly, it is not safe for an A&E department to have people there for six, seven or eight hours with a minor injury and no urgent health need. It is distracting for staff and can make it more difficult for them to deal with people who have more immediate needs.
On distances travelled, as the Prime Minister said this morning it is completely unacceptable for people to have to go 400 miles for a mental health bed. What is the solution? We are commissioning more beds, but the actual solution is to intervene earlier so that people do not get to that stage in treatment where they need in-patient care. We know that if we intervene earlier we can in many cases head off that need and help people to get better more quickly.
This afternoon, patients at Nottingham’s Queen’s Medical Centre emergency department are waiting on average for more than four hours. In the last month for which figures are available, 3,500 people had to wait for more than four hours in the emergency department. We cannot go on like this, so will the Secretary of State agree to fast-track the capital we need to increase capacity at Nottingham’s emergency department?
I will happily take a look at that. Obviously, when it comes to the allocation of capital, we prioritise any projects that will help us to improve the situation in A&E departments and reduce the stresses.
The Secretary of State has acknowledged that there is a shortage of acute mental health beds. That arises from the decision by many health trusts to close beds in favour of putting resources into services in the community. One effect is that people approaching a mental health crisis find it harder to know where to turn for help. Will he explain more about the crisis provision in which we are investing the extra £15 million? Is there a common way of knowing how one can easily access those vital services?
I am happy to supply more details. The £15 million is for places of safety—it is very specifically focused on support for the police service so that we can ensure that we live up to our legal commitment from this year not to send young people into police cells when they actually need mental health support.
More broadly, my right hon. Friend is right that there is a policy change—most people think it is the right thing—to treat more people in the community where we can. What is not working is the system that divides people up into four tiers, which means that we sometimes say to people, “We can’t treat you because you are tier 3.” People get sent away, which is not acceptable. That is why we are producing a Green Paper. We want to look at a better way forward.
Does the Secretary of State accept that the deepening crisis in the NHS is not solely down to an ageing society, and that failure to provide sufficient funding is the key to the crisis, and therefore that it is possible to address it? What will he do about it?
If the hon. Lady is worried about funding, she might explain why funding for the NHS in England went up by double the rate of funding for the NHS in Scotland over the last Parliament—[Interruption.] I will get her the figures on Northern Ireland, but I say that by way of reference. I apologise for my error.
I agree with the hon. Lady that it is not just about the ageing society; it is about changing consumer expectations and the fact that people want access to healthcare 24/7 today in a way that was not the case 10 or 20 years ago. That in itself is the cause of a lot of the additional pressure.
I welcome today’s announcement on mental health. It is absolutely clear that the Government are serious about improving mental health treatment and prevention. The challenge is to translate ambitions into action. Will my right hon. Friend assure me that he will put in place mechanisms to ensure that the proposals and those in the five-year forward view for mental health become reality? Specifically, will he look at ensuring that no sustainability and transformation plan is signed off without clear plans and funding for improving mental healthcare?
I can assure my hon. Friend that that is happening. Indeed, one of the key metrics by which we will judge STPs is their progress on delivering our mental health targets. She is absolutely right to say that ambitions need to turn into action, but she will find that, because of the comments that she and many other hon. Members have made over the past few years, there is much more understanding in the NHS that mental healthcare is a big priority, and more understanding that we need to stop resources constantly being sucked into the acute sector, as has happened over many years.
The Secretary of State recently announced that the Government were pressing ahead with significant cuts to the community pharmacy budget in the Department of Health in the face of huge opposition from Members on both sides of the House, members of the public and healthcare professionals. Given the evidence that one in five people who would usually see a pharmacist for medical advice say that they will make a GP appointment if their local pharmacist is closed—in areas of higher deprivation such as mine, it is four in five—and with the risk that many of those people in desperation will turn up at the local hospital, are the Government in danger of making an appalling crisis in the NHS even worse?
As with all parts of the NHS, we have to ask the pharmacy sector to make efficiency savings. Some 40% of pharmacies are clustered in groups of three or more, and it does not make sense for the NHS to continue to subsidise pharmacies that are very close to other pharmacies. Our reforms are designed to ensure, however, that where there is only one local pharmacy that people can access, that pharmacy is protected.
Does my right hon. Friend acknowledge the damaging effect that loneliness can have on mental health, and will he join me in welcoming the launch of the Jo Cox loneliness commission at the end of this month?
I am happy to do that and to acknowledge the importance of this issue. The latest figures I have seen are that 5 million older people say that their main form of company is the television, which is not acceptable, and we all have a responsibility to do better. It is not just a moral but a practical issue, as loneliness makes people more likely to need hospital treatment, which is of course expensive and challenging for the NHS.
The Secretary of State has talked a great deal about preventing people from needing to go to A&E by intervening much earlier, yet surely he must recognise that the cuts to local authorities and social care make it much more likely that people will not be picked up earlier in the progress of an illness but will have to resort to the health service in a much more difficult situation. Can he not now have a discussion with his ministerial colleagues, particularly the Chancellor, and tell them that they have got this wrong and that we have to invest in preventive services? That means more funding for local authorities, rather than the 57% cut my authority has had, and investing now in proper social care, not the £5 billion of cuts in social care since 2010, otherwise the pressure on our NHS will just continue.
I actually agree with the hon. Lady’s broad point about the importance of the social care system and its interconnectedness with the NHS. As she well knows—her party’s manifesto reflected this as well—in 2010 we faced a very challenging economic situation, and both parties recognised the need for cuts in public spending. What changed in 2015, however, at least in the Conservative party’s manifesto, was the recognition that we needed to increase funding for the social care system, and with the changes announced by the Secretary of State for Communities and Local Government in December, all local authorities can now increase funding for social care in real terms. I hope that we can start to turn things around.
With the recent Education Committee report on children in care in mind, I welcome the Prime Minister’s refocus on mental health and the Secretary of State’s continued support for action. What practical steps does he have in mind, given our finding that local integration, effective relationships and the teaching of personal, social and health and economic education all help to produce good outcomes?
My hon. Friend is absolutely right—obviously his role on the Select Committee gives him a particular insight—but we do not want to rush to a solution, which is why we have said that we will produce a Green Paper before the end of the year. It is a complex area. Other hon. Members have alluded to the risk of medicalising problems, given that, as we know, all young people at school experience periods of stress, anxiety and worry that are not necessarily diagnosable mental health conditions and which we would not want to make out to be such. This is about thinking through a smart way to improve resilience training and self-help and to educate schools so that they can spot when something is just a temporary thing in the run-up to exams, or whatever, and when it could be something a lot more serious, such as obsessive compulsive disorder, an eating disorder or something else that needs more immediate help. We have today started a big education programme with schools, but we want to go further.
I welcome the extra investment, if that is what it turns out to be, in mental health, but I want to press the Secretary of State on the question asked from the Dispatch Box by my hon. Friend the Member for Leicester South (Jonathan Ashworth) about educational psychology and how it will work. I speak as a mother of a child with SEN issues who has relied on clinical and educational psychology in schools. The school that my children currently attend is increasing class sizes from 30 to 33 and reducing the teaching staff—specifically those who engage with SEN children—because of changes to education funding. How does the Secretary of State think that will affect the mental health of pupils in my children’s school?
The hon. Lady raises a very important issue. Like her, I have had constituents who found it difficult to access educational psychologists and they have not been able to get approval for the plan that they need. We will consider these issues in the build-up to the Green Paper, and I encourage the hon. Lady to participate in that process.
Will the Health Secretary please get the message out there loud and clear to health bosses up and down the country that we need more capacity in our A&Es, so that when my CCG goes to NHS England with a request for £285 million for its appalling plan to downgrade my local A&E, bulldoze Huddersfield royal infirmary and replace it with a small planned care unit with fewer beds, it will realise that that money would be better spent on frontline A&E care in one of the country’s biggest towns.