House of Commons
Tuesday 8 May 2018
The House met at half-past Two o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
Health and Social Care
The Secretary of State was asked—
Access to Social Care
The health and social care systems are inextricably linked, which is why we need to improve access to the social care system, and we will be setting out plans to do so in a Green Paper.
Age UK says that 1.2 million older people have unmet social care needs. Is it not time that we thought about integration in a practical way, and where we have acute hospitals with land next to them, such as King George Hospital in my constituency, we start to build sheltered accommodation or intermediate care on those sites so that people can easily be transferred into and out of the beds, freeing them up for other people who need them?
That is a wise suggestion, and it is exactly the direction of our thinking in the social care Green Paper, which will have a significant chapter on housing. Integration is not just about integrating health and social care; it is also about other services offered by local authorities. I commend, too, the hon. Gentleman’s local authority of Redbridge: it is No. 1 in the country for user satisfaction with the social care system and No. 4 for carer satisfaction.
One of the most pressing issues for those who depend on social care is resolution of the back-pay issue for sleep-in shifts. Will the Secretary of State update the House with his own estimate of the liability? The independent sector puts this liability collectively at around £400 million. Will he also update us on the progress being made, because he will know that many sectors are handing back their contracts and withdrawing?
I thank my hon. Friend for raising this serious issue, and I can reassure her that a lot of work has been going on inside the Government to work out how to resolve the issue. A court case is due that may have a material impact on those numbers, but we are continuing to work very hard and fully understand the fragility of the current market situation.
In December, the health survey for England revealed that older people in more deprived areas are twice as likely as average to have unmet social care needs. Is this not yet another example of Tory cuts reducing councils’ abilities to meet the requirements of people with care needs?
I welcome the question, but let me also gently tell the hon. Lady what the actual story is with respect to cuts. Yes, the social care budget was cut after the 2008 financial recession, but she may remember that a different party was in power when that happened. Under this Prime Minister, those cuts have been reversed and the social care budget is going up by £9.4 billion in this spending review period.
Inadequate social and primary care provision lies at the root of a great deal of pressure on hospital A&Es, so we need to plan much better for the demand for services at that level. Will the Secretary of State press the Treasury to ensure that receipts from NHS property transactions are retained by local healthcare trusts, so that they can build much larger primary care facilities than those currently planned?
My hon. Friend makes an important point: unless we make it easier for trusts to retain the receipts of property transactions, they will be likely to sit on these properties and we will not get the positive ideas such as that suggested earlier by the hon. Member for Ilford South (Mike Gapes), so we do need to find a way to make sure that local areas benefit when they do these deals.
The Alzheimer’s Society estimates that at least 10,000 people with dementia have been stuck in hospital in the last year despite being ready to leave, and many of the delays were caused by a lack of care in the community for them. There can be no more disorientating thing for a person with dementia than being stuck in hospital when they do not need to be there. So with dementia awareness week approaching, is it not time for the Secretary of State to meet the social care needs of people with dementia fully by meeting the funding gap for social care in this Parliament?
Let me explain what is happening on that front. In the first five years after 2010, social care funding went down by 1.3% a year—we had a terrible financial crisis that we were trying to deal with—but since then, in the current spending review period, it is going up by 2.2% a year, which is an 8% real-terms increase over this spending review period. I completely agree with the hon. Lady that we need to do a much better job. [Interruption.] Opposition Members talk from a sedentary position about priorities; our priority has been to get this economy on its feet so that we can put more money into the NHS and social care system, and that is what will continue to happen under a Conservative Government.
Supporting People with Mental Health Problems
The Department is working with the NHS and across the Government to increase the support available for people with mental illness and on related issues. This includes investing £39 million to double the number of employment advisers in IAPT—increasing access to psychological therapy—as well as reviewing the practice of GPs charging for evidence of patients in debt crisis and the introduction of a duty under the Homelessness Reduction Act 2017 for the NHS to refer people at risk of homelessness to the local authority.
A quarter of people experiencing mental health problems are also in problem debt, and eight out of 10 mental health practitioners surveyed have said that they have less time to deliver clinical care because they are being asked to assist with the task of writing up debt management plans. Does the Minister agree that to ensure the best chance of recovery, commissioning groups require to integrate advice alongside mental health care, particularly for those in problem debt?
The hon. Lady makes a sensible point. Of course it is true that people’s personal circumstances are a symptom and a cause of mental ill health. We are doing more to enable those delivering mental health services to signpost people with problem debt to appropriate services. Clearly, that becomes easier where those services are co-located with citizens advice bureaux. In addition, the Breathing Space programme aims to provide a break for people with debt. I recognise, however, that this is a serious problem and that debt problems will cause mental illness.
Will the Minister explain to the House how the Thriving at Work programme will play a role in improving public mental health as well as benefiting our working lives?
I thank my hon. Friend for his question. It is very much this Government’s view that work is good for people’s health, and the more we can encourage people to live independently and feel in control of their lives, the better their health outcomes will be. We absolutely stand by the Thriving at Work programme.
Is the Minister aware of the growing incidence of mental illness associated with gambling addiction and of the rapid rise in suicides as a consequence? Will she try to ensure that there is adequate psychiatric capacity within the NHS, and will she liaise with her colleagues in the Department for Digital, Culture Media and Sport on preventive action?
The right hon. Gentleman rightly identifies problem gambling as another important contributory factor to mental ill health. When it gets out of hand, it can lead to considerable stress. We will of course work with the Department for Digital, Culture Media and Sport to ensure that we have the right regulatory processes in place, as well as ensuring that we are giving support to those who need it.
Does the Minister agree that, when children and young people have mental health challenges, it is important wherever possible to engage with their families to help them to overcome them?
What my hon. Friend says is self-evidently true. We are putting in more help in schools through the Green Paper, but we also need to ensure that we are engaged with families much earlier than that. We have the health visitor programme, and those visits help to build relationships with parents. We have also taken action on specific issues, including the initiative relating to the children of alcoholics. We will continue to focus support where it is needed.
Order. It is very good to welcome back to the Chamber the right hon. Member for Leicester East (Keith Vaz).
National Diabetes Audit: Mental Health
People with long-term health conditions such as diabetes are at a higher risk of mental health disorders, and we are determined to improve co-ordination between services. That is why the national diabetes audit has started collecting information from GP practices on people who have both diabetes and severe mental ill health.
I should like to declare my interest. As the Minister knows, three out of five people with diabetes suffer from emotional and psychological problems, including depression and anxiety. A survey recently showed that 76% of diabetics were offered no emotional or mental health support. Will she look at the excellent work that is being done by the NHS in Grampian in Scotland, to see whether its programme could be rolled out for the rest of the country?
I would be delighted to look at the progress being made in Grampian, and we are always keen to learn from the experiences of other nations. The right hon. Gentleman makes an excellent point: people with long-term physical conditions are more likely to suffer from mental ill health. As for NHS spending, at least £1 in every eight that is spent on long-term conditions is linked to poor mental health and wellbeing spend. We have also produced a pathway for people with long-term physical health conditions to deliver more effective IAPT—increasing access to psychological therapy—services for them. However, we can always continue to learn about this subject.
Obese adults are seven times more likely to have type 2 diabetes and the associated mental health problems that go with it. Is my hon. Friend that 140,000 obese children would qualify for adult tier 4 bariatric surgery, but there is little available? Should the NHS be fortunate enough to get some well-deserved extra money for its 70th anniversary, may I put in a bid for that area to be considered?
My hon. Friend is right that once children become obese they are going to become obese adults, with all the health problems that come with that. I do not want to steal the thunder of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), but rest assured that we will examine what more we can do to tackle obesity in children.
I declare an interest as a type 2 diabetic. Bearing in mind that three out of five people with diabetes have mental health issues, will the Minister outline what support services GPs should be able to offer at the first diagnosis of diabetes? Early diagnosis is key.
I could not agree more. We need GPs to understand that they must consider a patient’s needs as a whole, not just the condition that is presented at the time, and that message has been sitting behind the guidance that we have been issuing to GPs on how they manage patients with long-term health conditions.
Nursing remains a strong career choice, with more than 22,500 students placed during the 2017 UCAS application cycle. Demand for nursing places continues to outstrip the available training places.
Figures from the Royal College of Nursing show that applications have fallen by 33% since the withdrawal of bursaries. At the same time, the Government’s Brexit shambles has led to a drastic decline in EU nursing applications. How many years of such decline do we have to see before the Secretary of State and the Minister will intervene?
What matters is not the number of rejected applicants, but the increase in places—the number of people actually training to be a nurse. The reality is that 5,000 more nurses will be training each year up to 2020 as a result of the changes.
The NHS already has 34,000 nursing vacancies. Given that there has been a 97% drop in nursing applications from the EU and that studies show that nearly half of all hospital shifts include agency nurses, will the Minister at least admit that cutting the bursary scheme has been a false economy for our NHS?
It is not a false economy to increase the supply of nurses, which is what the changes have done. Indeed, they form part of a wider package of measures, including “Agenda for Change”, pay rises and the return to practice scheme, which has seen 4,355 starters returning to the profession. More and more nurses are being trained, which is why we now have over 13,000 more nurses than in 2010.
I respectfully remind the Minister that this is about recruitment and retention. The RCN says that we can train a postgraduate nurse within 18 months, which is a significant untapped resource, so why are the Government planning to withdraw support from postgraduate nurses training, too?
We have a debate involving postgraduate nursing tomorrow, but the intention is to increase the number of such nurses by removing the current cap, which means that many who want to apply for postgraduate courses cannot find the clinical places to do so. That is the nature of tomorrow’s debate, and I look forward to seeing the hon. Gentleman in the Chamber.
Will my hon. Friend, on top of the degree nursing apprenticeships, rapidly increase the nursing apprenticeship programme so nurses can earn while they learn, have no debt and get a skill that they and our country need?
My right hon. Friend is absolutely right to signpost this as one of a suite of ways to increase the number of nurses in the profession. As he alludes to, there will be 5,000 nursing apprenticeships this year, and we are expanding the programme, with 7,500 starting next year.
This weekend, I had to take a poorly member of my family to Cheltenham General Hospital, and the skill, concern and good humour of the emergency nurse practitioners were fantastic. Will my hon. Friend join me in paying tribute to Cheltenham’s emergency nurse practitioners? Does he agree that we should be doing everything possible, through their pay scales, to reward and retain them?
I am very happy to join my hon. Friend in paying tribute to the nurses at Cheltenham, and elsewhere, for the work they do. As he says, that is exactly why this Government, with the support of the Treasury, have backed nurses with a big pay rise in the “Agenda for Change” programme.
With every reputable independent body showing very clearly that we have a staffing crisis in the NHS nursing profession, can the Minister explain how cutting bursaries actually improves the situation?
I am very happy to do so. We are removing the cap on the number of places covered by the bursaries and increasing the number of student places by 25%, which means that there will be 5,000 more nurses in training as a result of these changes.
The Secretary of State’s removal of the nursing bursary and introduction of tuition fees have resulted in a 33% drop in applications in England. In Scotland, we have kept the bursary, a carer’s allowance and free tuition, which means that student nurses are up to £18,000 a year better off, and indeed they also earn more once they graduate. Does the Minister recognise that that is why applications in Scotland have remained stable while in England they have dropped by a third?
The hon. Lady speaks with great authority on health matters, but, again, she misses the distinction between the number of applicants and the number of nurses in training. It is about how many places are available, and we are increasing by 25% the number of nurses in training. That is what will address the supply and address some of the vacancies in the profession.
Workforce is a challenge for all four national health services across the UK, but, according to NHS Improvement, there are 36,000 nursing vacancies in England, more than twice the rate in Scotland. The Minister claims that more nurse students are training, but in fact there were 700 fewer in training in England last year, compared with an 8% increase in Scotland. The key difference is that in Scotland we are supporting the finances of student nurses, so will the Government accept that removing the nursing bursary was a mistake and reintroduce it?
The distinction the hon. Lady fails to make is that in England we are increasing the number of nurses in training by 25%; we are ensuring that nurses who have left the profession can return through the return-to-work programme; and we are introducing significant additional pay through “Agenda for Change”. As my right hon. Friend the Member for Harlow (Robert Halfon) said, we are also creating new routes so that those who come into the NHS through other routes, such as by joining as a healthcare assistant, are not trapped in those roles but are able to progress, because the Conservative party backs people who want to progress in their careers. Healthcare assistants who want to progress into nursing should have that opportunity.
When defending the decision to scrap bursaries, the Secretary of State said that, if done right, it could provide up to 20,000 extra nursing posts by 2020. Well, that figure now looks wildly optimistic, with applications down two years in a row. Is it not time that Ministers admitted they have got this one wrong and joined the Opposition in the Lobby tomorrow to vote against any further extensions to this failed policy?
If Members vote against the policy tomorrow, the reality is that they will be voting for a cap on the number of postgraduate nurses going into the system, and therefore they will be saying that more people should be rejected—more people should lose the opportunity to become nurses—because they want to have a cap that restricts the supply of teaching places.
Perinatal Mental Health
We are committed to improving mental health support for expectant and new mothers, and GPs are crucial to that. We recognise that specialist services are also required, and I am proud to announce today that NHS England will be spending £23 million on rolling out the second wave of community perinatal services to underserved parts of the country and is on course to achieve full geographic coverage by 2020-21.
Given that 95% of mums surveyed by the NCT said that they had experienced mental health problems, that only 22% said they were even asked about this by their GP and that only 24% of the country has any specialist provision, what more does the Minister think she ought to be doing?
The second wave roll-out will cover the entire geographical spread of the country. This is a transformational programme, so, by definition, it will take time to roll out, but I agree with the hon. Lady that GPs do have a role to play in this. The National Institute for Health and Care Excellence recommends postnatal checks for mothers, and NHS England expects commissioners to undertake that those guidelines are being met. As for any further support by GPs, she will be aware that there is a renegotiation of the GP contract and it will be covered there.
Some young people are mothers and do have mental health problems, upon which important matter the hon. Member for Faversham and Mid Kent (Helen Whately) has Question 19, which, sadly, will not be reached. If she wishes to give the House the benefit of her thoughts now, she is most welcome to do so, but it is not obligatory. [Interruption.] We will get her in later.
Given that children of mothers with perinatal health problems are at much higher risk of developing mental health problems themselves, why does the Government’s Green Paper on mental health not address prevention in respect of perinatal health?
As I have said before, the proposals in the Green Paper on children and young people’s mental health were very much focused on what we were going to be delivering through schools. Alongside that, we have a very ambitious programme on perinatal mental health, where we are spending an extra £365 million on delivering both acute care and more support in the community. Today, I have just announced the second wave of that funding.
Back in 2010, we had 19 mother and baby units across this country, but cuts to those beds resulted in our then having 15 mother and baby units. Back in November 2016, the Government said we were going to see more beds opened. I listened closely to the statement the Minister has just made, but we are still waiting for beds that were announced back in November 2016. What are her Government going to do to ensure that mothers and babies will be kept together and can access the beds they desperately need?
I do not accept what the hon. Lady is saying. We are investing in new mother and baby units and making sure we have sufficiently good provision geographically so that mothers and babies can access them. We are also investing in more support in the community. I am pleased that the programme we are delivering, which is £365 million of additional support, will deliver early intervention for young mothers and babies.
Rural and Urban Communities: Health and Care Needs
The diverse health and social care needs of local communities are considered in this Government’s policy and implementation. We are actively supporting local areas, including through Public Health England’s joint work with the Local Government Association, providing evidence-based recommendations to tackle the different needs of rural communities.
Would the Minister find it helpful to ask the national centre for rural health and care, shortly to be launched, to identify the specific challenges facing the providers of health and care in rural areas?
The centre has already engaged with stakeholders to identify the issues and responses to the challenge of providing health and care in rural settings. The centre will focus on four areas—data; research; technology; and workforce and learning—and will work with partners to identify, scale up and promote the adoption of its activities across the public and private health sector to reduce health inequalities and improve the quality of life for all rural people.
If the ministerial team want to learn about the comparison of health outcomes in urban and rural communities, they should come to Huddersfield, as we have both there. But what we want in Huddersfield is a great hospital, great GPs and a supportive community pharmacy network. When are we going to get them?
I will address the point the hon. Gentleman makes about urban and rural health, as my constituency has the same situation. Obviously, there are specific challenges with regard to sparsity of population, which have to be tackled through the funding formula. The new national centre for rural health and care will address that.
For people in my rural constituency, the value of services at Boston’s paediatric unit could not be higher. Does the Minister agree with me—and with what the Prime Minister said last Wednesday—that we should leave no stone unturned when it comes to making sure that we can recruit the paediatricians we need and sustain the services at Pilgrim Hospital?
I am happy to associate myself with the comments of my hon. Friend and those of the Prime Minister. We should leave no stone unturned in making sure that we recruit enough paediatricians to support the service. I reiterate that every effort will be made to ensure that that happens.
The hon. Lady will understand that the impact on the workforce is of as much interest to us south of the border as it is to her. We continue to engage in representations with colleagues to address such matters.
Northamptonshire has both rural and urban communities, but our biggest pressures are a rapid population increase because of house building and a big increase in the number of people who are, thank goodness, living to more than 80 years of age. Will the Minister ensure that those two issues are addressed in any future funding formula?
My hon. Friend is quite right that when we allocate funds we have to make sure that we keep pace with population growth among both the early years and the older years, which is where the demand comes from.
I call Karen Lee. No? The hon. Lady is a most confusing individual.
I wanted to ask a supplementary to the question about Boston.
Oh, well, blurt it out.
I can add no more to what I have already said in answer to my hon. Friend the Member for Boston and Skegness (Matt Warman). We will do everything we can to make sure that we can recruit sufficient paediatricians for that hospital.
What plans does the Minister have to increase the role of community pharmacies in meeting the health needs of rural and urban communities? In 2016, the Government promised to develop an extended role for community pharmacies. In particular, they committed in the House that the national roll-out of a minor ailments scheme would be implemented by April 2018. Given that it is now May 2018 and that has not happened, and that there has been an overall reduction in services commissioned via community pharmacies in both rural and urban communities, will the Minister tell the House when exactly the Government intend to honour their commitment?
The provision of community pharmacies is an important part of integrated primary care. We will continue to make sure that we direct sufficient resource to address the particular challenges caused by rural sparsity. I remind the hon. Lady of what we have already done: we spent £175 million from the Prime Minister’s challenge fund to transform GP access, and that is increasing access in areas such as north Yorkshire, Devon and Cornwall. We will continue to look into the particular challenges that rural communities face and make resources available.
NHS Dentistry: Funding Distribution
The Department does not issue guidance specifically to NHS England on the redistribution of funding that is recouped from dental contracts. Of course, any decisions on the provision of healthcare are rightly a matter for the local NHS, because local commissioners are best placed to assess the dental needs and priorities among their local population, including the one that the hon. Gentleman represents in Bradford.
People in Bradford cannot get an NHS dentist, child tooth decay rates are soaring, and people are being admitted to hospital because they cannot get dental care. It was announced over the weekend that Bradford will receive an extra £332,000, which I of course welcome, but between 2014 and 2017, more than £300,000 was taken from dental care funding in the district. Is it not the case that the new funding is just a misleading announcement?
I think that is what is known as a back-handed welcome. We have made great progress on improving access to dentistry in England, but we know that there are parts of the country, including the hon. Gentleman’s area, in which we can do more. That is why NHS England in Yorkshire and the Humber—with which I liaise on matters raised by a number of Opposition colleagues—is finalising plans to improve access to dentistry throughout the region, paying particular attention to 20 areas. Bradford East is one of those areas and, as the hon. Gentleman said, will shortly receive additional recouped funding to support his constituents.
Why are dentists, such as my constituent Peter Sharp in Thornaby in Stockton South, funded less per unit of dental activity than his colleagues who are working in more affluent areas? Surely, to reduce health inequalities, it should be the other way round?
That goes to the heart of why we are reforming the dental contracts. Our 73 high street dental practices are continuing to test the preventive focused clinical approach to a new remuneration practice. [Interruption.] Someone on the Opposition Front Bench has just said “when” from a sedentary position. It will be when we have got it right.
The hon. Member for Tonbridge and Malling (Tom Tugendhat) has beetled into the Chamber like a perspiring postman just in time. It is very good to see the fellow.
GP Services: Capacity and Availability
We want all NHS patients to be able to access appointments in the evenings and at weekends. Thanks to our programme, 40% of the population currently do so, and that will rise to 100% next October.
Forgive me for rushing in; I was tied up with Committee matters.
My right hon. Friend has set out a great vision for the national health service over recent years, and I very much welcome it, but does he agree that, in local areas, some of the GP provision could do with a little more work? I am particularly thinking of West Malling in my own constituency where a large element of the community is finding it harder to get access, and there is a danger that the GP surgery may leave the high street.
My hon. Friend is right to draw attention to that issue. He does have, I think, 28 more GPs in the west Kent clinical commissioning group area than in 2010, but there is a particular issue over premises. The need to invest in premises is deterring younger GPs from becoming partners, and sometimes making GP surgeries unviable. We are looking at that problem now.
So many GP practices—no matter what salaries or what terms and conditions they offer—are reporting a reluctance by newly qualified GPs to go into GP practice. What will the Minister do about the hours of work—the time given to consult with constituents—to make it easier for people to see GP practice as a viable opportunity to serve their community?
I do very much agree with the hon. Lady, which is why we are working hard to recruit 5,000 extra GPs into general practice in England. I gently point out to her that the Royal College of General Practitioners says that, while we spend 9.2% of the NHS budget in England on general practice, it is only 7.3% in Wales.
Has my right hon. Friend had time to consider the recent Professional Standards Authority report, “Untapped Resources”, of which the principal recommendation is that practitioners on PSA-accredited registers should have powers to make direct NHS referrals, which would reduce the burden on GP surgeries?
I always look forward to the multiple interesting ways in which my hon. Friend returns to the same subject. We are always open to ideas that reduce pressures on GP surgeries, and I will look carefully at his latest idea.
The Secretary of State knows—because I keep telling him—that Warrington has fewer GPs than its population warrants. What concrete steps will he take to attract GPs to areas that are under-doctored?
Most parts of the country would say that they need more GPs, which is why we are trying to improve the capacity across the country. So, what have we done? Well, very recently we announced six new medical schools, which will have a specific focus on attracting new students into general practice. That is one of a number of measures.
Alcohol: Minimum Unit Pricing
The Government remain committed to tackling all alcohol-related harms, which is why we are developing a new alcohol strategy. As part of that, I am commissioning Public Health England to undertake a review of the evidence for minimum unit pricing in England.
That is welcome news. The Scottish National party Government have taken the lead in this matter by taking the bold step to set a minimum unit price for alcohol as part of wider interventions to help tackle excessive consumption. In particular, they want to end the days of strong white ciders being sold at pocket money prices. The British Medical Association has long called for that, so at what stage will we learn of further progress in the Government’s thinking?
The previous consultation in 2013 found that the evidence, as it stood at the time, was not entirely conclusive. That is still the case, which is why the Government intend to keep the policy under review. Many times in this Chamber we are given the benefit of experience north of the border as to whether a policy has been a success, but it is not always strictly spot on. Given that the policy only came in last week, it is probably premature to say that it is a success, but we will welcome the opportunity to see the evidence emerge from Scotland’s implementation of minimum unit pricing, and we will be watching very closely.
Does the Minister agree that it is significant that major pub companies and brewers such as Greene King, Coors and Tennent’s now support minimum pricing, and that what is good for the nation’s health is good for the nation’s pubs and the promotion of sensible drinking?
We want to get on and tackle all avoidable harms, including alcohol. The vast majority of our constituents enjoy a drink and have a healthy relationship with alcohol, but that is not the case for everybody. Some people can harm themselves, society and, as we have heard, their children. What is happening north of the border in Scotland is very welcome. I think that there will be an early evaluation there at the one-year point, and we will be watching that like a hawk.
Childhood obesity is one of the biggest public health challenges we face, which is why we are committed to reducing the sugar in products consumed by children by 20% over four years.
I recently met my constituent, Professor John Wass, at an Obesity Health Alliance tea, where—the Secretary of State will be pleased to know—no cake was served. Professor Wass shares my concerns about the availability of hospital services for those with established obesity. Will my right hon. Friend set out what plans his Department has to treat those who are already obese?
We recognise the value of bariatric surgery, which is of course subject to the normal waiting time standards for those for whom it is appropriate. However, prevention is better than cure. That is why we are hoping to bring forward shortly further measures to tackle childhood obesity, which is one of our biggest concerns.
Obesity related hospital admissions in York have more than doubled in the last three years. As part of NHS70, we in York are launching a city-wide public health initiative to ensure that we address issues around obesity, diet and exercise. Will the Secretary of State support such work and ensure that we get the funding that we need to run this initiative for the whole constituency and the city?
I am happy to give the project my wholehearted support. If we are going to tackle obesity, we need an approach that goes across all Departments of Government, including local government, and this initiative sounds excellent. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), will be looking into the funding.
Lambert Hospital in Thirsk was bequeathed to the town by Sara Lambert in 1890, and was closed via the back door by South Tees Hospitals NHS Foundation Trust last year. NHS Property Services is planning a sell-off to the highest bidder, despite the fair offer that is on the table from the local authority which could include provision for community use such as public health advice. Does my right hon. Friend agree that there are times when value to the public might outweigh the requirement to maximise a price?
I have spoken to my hon. Friend about this matter, and he speaks powerfully about the community interest in this particular transaction. We have listened carefully to what he has said, and will continue to do so before a decision is made.
This August marks two years since the world’s first childhood obesity plan was published, but the Government’s plan, at just 13 pages, left a lot to be desired. More than 5.5 million children in this country are now officially classed as overweight or obese, with 140,000 classed as morbidly obese, as the hon. Member for South West Bedfordshire (Andrew Selous) mentioned. This is now an epidemic. Will the Secretary of State confirm whether the Government’s second childhood obesity plan—due this summer, we have heard—will include meaningful policies such as restricting junk food advertising and the sale of energy drinks to children?
I agree with the hon. Lady that we need to do more, because this is a very serious issue. I think that she is being slightly unfair on our first initiative. The sugary drinks tax has been responsible for 45 million kg of sugar being removed from the market, which is enormously important for children. There is more to be done and I hope that we will be able to announce plans soon.
The Daily Mile initiative in schools has huge potential in reducing childhood obesity, improving academic attainment, and improving the mental wellbeing of our young people. Will my right hon. Friend look closely at that and have conversations across Government about the benefits it could bring?
That is an excellent initiative from Scotland, and it shows why we all benefit from being in the United Kingdom together. Yes, we will look at it very closely.
In tackling childhood obesity, will the Health Secretary declare his support for Jamie Oliver’s AdEnough campaign and get rid of pre-watershed television advertising of junk food to our children?
That is one of a number of measures that we are looking at. We are absolutely determined to do something about this. One in 10 children starts school obese, and by the time they leave primary school the figure is one in five. We cannot wait any longer.
Stroke Patients: Health Outcomes
Evidence from cities such as Manchester and London is very clear that centralising stroke treatment in hyper-acute stroke units considerably improves outcomes, with patients having access to a specialist at all times and immediate access to imaging and investigative facilities, giving them the best chances in terms of outcome.
My 82-year-old constituent, Freda, is recovering well from a serious stroke, but she has been told that there is an 18-week wait for physiotherapy and that this is the NHS standard. Does the Minister think that that is good enough?
I cannot comment on the individual case, but I can say that NHS England and we at the Department are working closely with the Stroke Association to develop a new national plan for stroke in England which we expect to publish this summer. The hon. Lady’s constituents and mine will benefit from the national policy narrative, but they will also benefit from some brilliant charities that work on the ground with constituents. Yesterday, I saw Chandlers Ford Stroke Support Group at the amazing Funtasia in my constituency. That group does a lot to support people in stroke as well.
In Worcestershire, we are fortunate to have some excellent stroke services serving my constituents across the whole county. Does the Secretary of State agree that the most important aspect of any service is leadership? With that in mind, will he update the House on his progress in appointing a new chair for our trust to deliver stroke services and other services to Redditch?
I am not close to that issue, but I am told that we have some excellent candidates, and I think that my hon. Friend will be pleased.
The most important service that stroke patients need is priority in getting to hospital for the treatment they need. A patient in my constituency recently had to wait five hours for an ambulance, with a GP sitting next to her begging the service to send one. East Midlands Ambulance Service has now had a review and will be getting an increase in its funding, but can that be made faster over the next two years?
The new ambulance standards are designed to do exactly that. I note the hon. Lady’s welcome for that in her area. That is critical, but of course it is critical that people get to the right place and get the right treatment. That is why I said at the start of these exchanges that centralising stroke treatment is not always popular but is often the best thing for clinical outcomes.
Access to NHS dentistry remains consistently high. The most recent figures show that 22 million adults were seen by an NHS dentist in the 24 months from January ’16 to Christmas last year and 6.9 million children visited a dentist last year.
Twelve thousand of those people in my constituency were left without a dentist when the Queensway practice in Billingham, in common with many dentists across the country, ditched NHS work. People are trying to build capacity there, but the funding system for dentists is a major impediment. What plans do the Government have to address the crisis in NHS dentistry, encourage dentists to stay with the NHS, and make dental health a priority?
We have been in correspondence about the Queensway practice, as the hon. Gentleman knows. When a dental contract ends and patients need to find another dentist, NHS England has a legal duty, as he knows, to commission alternative services to meet local need. I understand that that is happening in his area and that he is being kept regularly updated on the situation. In answer to a previous question, I mentioned the dental contract, which is a key part of our reforms to keep people in, and attract people into, the dental profession.
It is shameful that our older and vulnerable residents living in care homes do not have the access to dental treatment that they need. The Minister revealed in a written answer to me that older people living in care homes are less likely to have any natural teeth and are more likely to have serious tooth decay, but still no specific action has been taken. Will the Secretary of State meet me and commit to do everything he can to help prevent serious tooth decay for our older and most vulnerable residents?
As I said, NHS England has a legal duty to commission dental services and primary care dental services for the hon. Lady’s constituents. If she wants to bring a specific example from her constituency to me, I will be happy to look at it.
Social Media: Children’s Mental Health
We are worried about the effects of social media on children and young people, which is why we have asked the chief medical officer to undertake a systematic review of all the international literature, to help us understand what further steps to take.
I recently met a group of headteachers in Halesowen, who expressed real concern about the effects of social media on the health of their pupils. Does the Secretary of State agree that peer-to-peer support among young people in the classroom and in our communities is a vital way of benefiting young people through the positive aspects of social media and combating the negative effects on their mental health?
My hon. Friend is very knowledgeable about mental health, and I totally agree with him. That is why we have given £700,000 to the Anna Freud Centre to train teachers in how to make possible peer support for children having mental health issues.
Durham police tell me that when there is a problem on social media, particularly Facebook, it can take six months between their asking for action and the social media company tackling it. Will the Secretary of State speak to the Home Office to get the system changed and speed it up?
The hon. Lady is absolutely right. I have spoken to the social media companies. They are brilliant technologists, and they have a duty to their customers to make themselves part of the solution, not part of the problem, when these things happen.
Does the Secretary of State agree that some of this is about ensuring that parents use appropriate techniques—for example, having specific screen times and engaging with their children about what they see on social media—and giving them the tools to do so?
My hon. Friend is absolutely right. Parents play a vital role, but social media companies can make it easier for parents like us to do the right thing, and sometimes the tools that parents need to use are not readily available.
Speak to any young person about what is causing child mental health issues, and the No. 1 issue is not social media, but exam and test pressure in schools, as we have found in the joint inquiry by the Health and Education Committees. Will the Secretary of State be as harsh on his colleagues in the Department for Education as he is on the social media companies when it comes to child mental health?
What we actually now have is a record number of children in good or outstanding schools—nearly 2 million more children. That is something we all want for our children, but when it comes to mental health, the NHS has very specific responsibilities, and we of course look into every possible cause.
Folic Acid: Children and Pregnant Women
The Government are looking at existing pre and post-conception health advice, including the use of folic acid supplements, which are recommended to help reduce the risks of neural tube defects in unborn children. We are carefully considering the recommendations in the Scientific Advisory Committee on Nutrition report on folic acid, and the Government will set out their position in due course.
I thank the Minister for that answer, but the UK female diet leaves blood folate levels below World Health Organisation targets, and it was recommended back in 1991 that folic acid should be put into supplements and that flour should be fortified. There are 80 countries around the world where that is happening, and it is reducing cases of spina bifida and other serious illnesses by up to 50%. Will the Minister work with the Department for Environment, Food and Rural Affairs to look once again at the opportunities for fortifying flour with folic acid?
I can confirm that we will continue to look at that. The hon. Lady is right that a large number of countries fortify flour with folic acid, but the UK and other EU countries do not. We have advice that if the intake of folic acid exceeds given levels, that can also bring health problems, but we will continue to look at it.
I would like to give an update on the breast cancer screening failure. I met the Public Health England chief executive this afternoon, and I am informed that 65,000 letters were sent out last week, and the helpline has taken nearly 14,000 calls to date. Further letters are going out this week, and the first invitations to catch-up screenings will go out next week. Due to the lack of clinical consensus about the effectiveness of screening for older women, we will provide advice and support for all who missed scans and support them in making their own decision as to whether to proceed. We will also publish the terms of reference for the independent inquiry shortly, and I can assure the House that no stone will be left unturned in uncovering the truth.
I am grateful to the Secretary of State for that update, but I would like to ask him about the Brexit transition agreement, which cuts the UK out of the European Medicines Agency. Can he give this House a cast-iron guarantee that that will not stop the regulation of new drugs in the UK to help patients, and will not prevent our world-class pharmaceutical companies from basing themselves here to do world-class research and development?
Yes, I can.
We recognise that the Princess Alexandra Hospital estate is in a poor condition. NHS Improvement is working with the trust to develop an estate and capital strategy by summer 2018 to be assessed, with other schemes put forward, for the next capital announcement for sustainability and transformation partnerships. I am very happy to meet my right hon. Friend to have further discussions about it.
I thank the Secretary of State for his update on breast cancer screening. I welcome his letter this morning with respect to patient safety in the private sector, but is not the truth that the best quality of care is provided by a public national health service? Is it not time to legislate to ensure that private hospitals improve their patient safety standards, and if he accepts that levels of safety are not acceptable in the private sector, why is the NHS still referring patients to the unsafe private sector? Should there not be a moratorium on those referrals until these issues are sorted out?
The hon. Gentleman should be very careful in making generalisations about the independent sector, just as he is about the NHS sector, because the truth is that there is too much poor care in both sectors, but both sectors also have outstanding care. I have always said that there will be no special favours for the independent sector, which we will hold to the same high standard of care, through the Care Quality Commission regime, as we do with NHS hospitals. Let me just say to him that if we stopped referring people to the independent sector, 140,000 people would wait longer for their operations, and that is not good care.
We have seen the private sector fail—the NHS is sued by Virgin Care, patient transport contracts have to come back in-house, and Carillion collapses and cleaning contracts have to come back in-house—and now we learn that the hotline for women affected by the breast cancer screening failures is provided by Serco and staffed by call handlers who, far from having medical or counselling training, have had one hour’s training. Do not the women affected deserve better than that? Will the Secretary of State provide the resources for that phone line to be brought back in-house and staffed by medical professionals?
I normally have so much respect for the hon. Gentleman, but I think those women deserve a lot better than that posturing. The helpline was set up at very short notice because, obviously, the call handlers could not do all their training until I had made a statement to Parliament, which I judged was the most important thing to do first. It is not the only help that the women affected will be getting—on the basis of the advice received, they will be referred back for help at their local hospital, with Macmillan Cancer Support or through specialist clinicians at Public Health England—but we thought it was right that that number was made available as quickly as possible.
I call Eddie Hughes. Get in there, man.
I am very grateful to my hon. Friend for raising this matter, and I very much welcome the contribution made by the charity to support teenagers in his constituency with psychological therapies and to help to address their mental health conditions. I join him in extending my congratulations to the mayor for choosing this very important cause and for endeavouring to raise so much money for it.
I will be very happy to meet the hon. Gentleman to look at his local issue.
I welcome the Green Paper on mental health in schools, which was published earlier this year, but it does prompt a question about the mental health of students in further and higher education. Does my right hon. Friend have any plans to look into that issue? If he does not, may I urge him to do so?
I thank my hon. Friend for her question and her continued industry on these matters. As she mentioned, the Green Paper outlined plans to set up a new national strategic partnership focused on improving the mental health of 16 to 25-year-olds. That partnership is likely to support and build on sector-led initiatives in higher education, such as Universities UK’s #stepchange project, whose launch I attended in September. The strategy calls on higher education leaders to adopt mental health as a strategic priority, to take a whole-university approach to mental health and to embed it across policies, courses and practices. [Interruption.]
Order. The hon. Member for Wigan (Lisa Nandy) need not worry; her Zebedee-like qualities will always make her visible. I am saving her for later. We will hear from her shortly.
Obesity has rightly had a strong outing today. We know that it is a leading cause of type 2 diabetes; supporting people to live healthier lifestyles can only reduce the incidence of the disease. So far, more than 170,000 people have been referred to the national diabetes prevention programme. Those who are referred receive tailored, personalised help, including education on healthy eating and lifestyle choices, and bespoke physical exercise programmes.
Is my right hon. Friend aware that following his decision to make the capital allocation to Shrewsbury and Telford Hospital NHS Trust before Easter, that trust has had sufficient confidence to successfully appoint five additional consultants in 10 days in April, thereby improving resilience in acute healthcare in Shropshire?
I very much welcome the progress that my hon. Friend has shared with the House. Many of us will also want to pay tribute to his leadership during his time at the Department in recognising the opportunity for reconfiguration that the capital would unlock and is now delivering.
I can absolutely commit that we are very conscious of the failings of PFI when we have any discussion about NHS capital funding, including the previous question. We are very conscious of the need not to make the mistakes that saddled the NHS with £71 billion of PFI debt.
Dispensing practices are a lifeline in rural constituencies such as Sleaford and North Hykeham. Does my right hon. Friend agree that patients who live far from a pharmacy and attend their local dispensing practice should all have access to that dispensing service?
Yes, I do: dispensing practices are an important part of the widening primary care mix. That is important for constituents in rural areas such as my hon. Friend’s. Community pharmacy and dispensing practices, which she refers to, are increasingly important when they are part of an integrated primary care pathway. That has got to be the future.
This issue has received a lot of publicity in recent weeks. My noble Friend Lord O’Shaughnessy and I wrote to Vertex following that debate and asked it to be reasonable and continue, with vigour, its negotiations with NHS England. That letter was made public, as was the company’s actually quite positive response last week. I urge the company again to come to a reasonable conclusion.
Healthcare delivered by app and other new technologies is increasingly popular with patients. Will my right hon. Friend undertake to ensure that the NHS fully explores the possibilities of new technologies when delivering front-line services?
I will absolutely do that. I congratulate my hon. Friend on the excellent report that he published last week on that very topic. We want to be the first country in the world where all patients can access their own medical record through an app.
Last year we gave more than 4,000 visas for overseas doctors and since I have been Health Secretary we have had nearly 10,000 more doctors, so we absolutely want to address that problem.
My constituent Susan is desperately waiting for the Government to bring forward the remedial order for single parent surrogates. The Joint Committee on Human Rights published its response to the original draft in March. Is there any update on when we will get the next version?
I can reassure my hon. Friend that the Government are giving careful consideration to the implications of the JCHR’s recommendations and what changes may be necessary to address them. It is our current intention that a revised order be laid for JCHR scrutiny before the summer recess.
Patience rewarded. I call Thelma Walker.
Does the Minister agree that eating a nutritionally balanced meal can reduce snacking between meals and therefore help to reduce childhood obesity? If so, will he speak to his colleagues in the Department for Education and ask them to ensure that the 6,400 children in Kirklees who are set to lose out on a well balance nutritious free school meal do not?
I talk to colleagues across Government all the time. The first round of the child obesity plan—it was maligned earlier—contained many good things, such as the sugary drinks tax. A couple of months ago we launched, with Public Health England, changes in relation to the nutrient profiling of foods marketed to children. That is positive for the hon. Lady’s constituents and for mine.
Five years on from the Francis report, how does my right hon. Friend assess patient safety in the NHS?
There are still many things to tackle when it comes to patient safety, but I think the NHS has risen magnificently to the challenges in the report. There are nearly 45,000 more doctors and nurses across the system. Although there is more to be done, much credit should go to the NHS.
This week marks two and a half months since the independent inquiry into child sexual abuse recommended that compensation be paid urgently to children sent abroad by their Government and subjected to the most appalling child abuse. In that time, the Secretary of State’s Department, despite repeated requests for action, has made not a single statement. Many former child migrants have died and others are dying. How many more will have to wait, and die waiting, for justice before this Government get their act together and pay them the compensation that is owed?
We have been quite frank about the fact that the child migration policy should never have happened and this Government have apologised repeatedly for it. I can assure the hon. Lady that I am currently working with officials to come up with a formal response to the committee of inquiry.
Will the Minister update me on the FIT—faecal immunochemical test—for bowel cancer? It has long been promised and we know it saves lives. When will it materialise?
I updated Members on this last week in a Westminster Hall debate. Bowel cancer is the fourth most common cancer in the UK and the second leading cause of cancer deaths. My hon. Friend is right that the FIT has long been promised. There have been a lot of challenges—making sure we get it right and referrals into the secondary sector—but the FIT will be rolled out from autumn.
The European health insurance card enables British citizens to get medical treatment in the EU, including kidney patients who need dialysis. Without it, many of them simply could not go on holiday at all. Will the Secretary of State tell the House whether it remains the Government’s objective to keep the EHIC in place after we have left the EU, and, if so, what progress is being made to ensure that that happens?
It is absolutely our intention. We think it is beneficial for Brits and beneficial for Europeans. We are very confident that we will be able to negotiate reciprocal healthcare arrangements to protect those benefits, but our first preference would be a continuation of the current scheme.
Will the Minister explain how and when the community pharmacy sector will gain access to the pharmacy integration fund? Millions have been promised. When will it be delivered?
The pharmacy integration fund is a great success. It needed to be ramped up and it is being ramped up. Pharmacists, working within general practice, are making a great difference to the multidisciplinary team within primary care.
I feel sure that “ramped up” is the technical term.
The Secretary of State will be aware that the hon. Member for Hazel Grove (Mr Wragg) and I set up an all-party group on the impact of social media on the mental health of children. With all the work the Secretary of State has done to date on that, I wonder whether he and his ministerial team will agree to engage with the all-party group’s inquiry and look at how we find solutions to these problems, including mental health.
I would be delighted to do so.
Splendid. I call Chris Skidmore.
Several of my constituents have contacted me to welcome the Government’s recent announcement of additional investment for prostate cancer funding. Will the Minister update the House on what the money is and what it will be spent on?
Gladly. Prostate cancer survival rates are at a record high, but we want to do even better, so last month the Prime Minister announced £75 million to support new research into the early diagnosis and treatment of prostate cancer. The National Institute for Health Research will recruit 40,000 more patients, which is a lot, for more than 60 studies into prostate cancer over the next five years.
I welcome the recent news that NHS England has committed to redirecting extra funding for dental services to Bradford as an area of need—it comes after a high-profile campaign in the Bradford Telegraph and Argus—but I urge the Minister to recognise the need for long-term reform of the dental contract and for a sustainable funding settlement for all. Will he meet me and others campaigning on this issue to discuss what progress has been made?
Yes. The dental contract has had a good outing this afternoon. I am always happy to see the hon. Lady and I can tick the Telegraph and Argus off my bucket list if they come along as well.
I have been enjoying listening to my colleagues so much that I inadvertently lost track of time, but it seems only right that the final question should go to the Chair of the Health Committee—I call Dr Sarah Wollaston.
Thank you, Mr Speaker. Will the Secretary of State commit to publishing the progress report on sugar reduction and the next steps strategy on the reformulation programme, so that the Health Committee can examine that when Public Health England appears before us on 22 May?
I had a conversation with Public Health England before questions this afternoon, and it committed to publishing that before that hearing.
Learning Disabilities Mortality Review
To ask the Secretary of State for Health and Social Care to make a statement on the learning disabilities mortality review. [Interruption.]
Order. There is a certain amount of chuntering from a sedentary position. The Secretary of State has been with us, but Minister Caroline Dinenage will answer the urgent question, and we look forward to her answer.
The Government are absolutely committed to reducing the number of people with learning disabilities whose deaths may have been preventable and have pledged to do so with different health and care interventions. The learning disabilities mortality review programme was established in June 2015; it was commissioned by NHS England to support local areas in England to review the deaths of people with a learning disability. Its aims were to identify common themes and learning points, and to provide support to local areas in their development of action plans to take forward the lessons learned.
On 4 May, the University of Bristol published its first annual report of the LeDeR programme, covering the period from July 2016 to November 2017. The report included 1,311 deaths that were notified to the programme and set out nine recommendations based on the 103 reviews completed in this period. The Government welcome the report’s recommendations and support NHS England’s funding of the programme for a further year at £1.4 million. We are already taking steps to address the concerns raised, but the early lessons from the programme will continue to feed into our work, and that of our partners, to reduce premature mortality and improve the quality of services for people with learning disabilities.
Mr Speaker, I think it is disgraceful that the Secretary of State has just run out of the Chamber, rather than answering this question himself—it is disgraceful.
Seven years after Winterbourne View and five years since the avoidable death of Connor Sparrowhawk, the findings of the review show a much worse picture than previous reports about the early deaths of people with learning disabilities. One in eight of the deaths reviewed showed that there had been abuse, neglect, delays in treatment or gaps in care. Women with a learning disability are dying 29 years younger than the general population, and men with a learning disability are dying 23 years younger. Some 28% of the deaths reviewed had occurred before the age of 50, compared with just 5% of the general population who had died by that age.
The Secretary of State announced to the House in December 2016 that he would ask the review for annual reports on its findings, so why was a review of this importance published during the recess, before a bank holiday weekend in the middle of local election results, giving Members little chance to scrutinise its findings? When asked about the report on the “Today” programme on Radio 4, Connor Sparrowhawk’s mother, Dr Sara Ryan, said that she was
“absolutely disgusted by the report”
and that the way it had been published at the beginning of a bank holiday weekend
“shows the disrespect and disregard”
there is for the scandalous position of people with learning disabilities shown in the report.
Only 103 of 1,300 cases passed for review between July 2016 and November 2017 have been reviewed. That is a paltry number. The report cites a lack of local capacity, inadequate training for people completing mortality reviews and staff not having enough time away from their duties to complete a review.
If there are issues around capacity and training, what is NHS England doing to rectify this? Sir Stephen Bubb, who wrote the review into abuse at Winterbourne View, said this in response to the report:
“there can be no community more abused and neglected than people with learning disabilities and their families. How many more deaths before we tackle this injustice?”
Dr Sara Ryan said:
“things have actually got worse than they were 10 years ago”.
What action will the Government take to show the families of people with learning disabilities that their relatives’ lives do count?
I thank the hon. Lady for raising this issue; the report makes for very troubling reading.
On the date of publication, the hon. Lady will be aware that this was an independent report prepared by the University of Bristol and commissioned by NHS England, which wanted to look into this really important issue, and because it was an independent report, it did not actually alert us to publication, so we had no more notice than she did. We are investigating through NHS England and others why that happened.[Official Report, 9 May 2018, Vol. 640, c. 8MC.]
As the report clearly identifies, there is still more work to do, and we will work with partners to see how the recommendations may be implemented. We are committed to learning from every avoidable death to ensure that such terrible tragedies are avoided in the future. She mentions Dr Sara Ryan, whose son, Connor Sparrowhawk, died in such tragic circumstances in my own Southern Health Trust area. She and other parents like her are testimony to the incredible dedication of people who have worked so hard to get justice for their loved ones at a time when they feel least able to do so.
We have done several things already. We have introduced a new legal requirement so that from June every NHS trust will have to publish data on avoidable deaths, including for people with a learning disability, and provide evidence of learning and improvements. We are the first healthcare system in the world to publish estimates of how many people have died as a result of problems in their care. Learning from the review is also informing the development of the pathways of care published by NHS England and the RightCare programme, which is tailored to the needs of people with learning disabilities. Pathways on epilepsy, sepsis and respiratory conditions will be published later this year.
We have introduced the learning disability annual health checks scheme to help ensure that undiagnosed health conditions can be identified early. The uptake of preventive care has been promoted and improved, while the establishing of trust between doctors and patients is providing better continuity of care. We have also supported workforce development by commissioning the development of learning disabilities core skills education and training framework, which sets out the essential skills and knowledge for all staff involved in learning disability care.
As I said, the report makes for troubling reading, but we asked NHS England to commission it so that we might learn from these deaths and make sure that trusts up and down the country are better equipped to prevent them from happening in the future.
Every preventable death brings personal tragedy, as was highlighted in a 2016 report by Autistica, the autism charity, entitled “Personal tragedies, public crisis”. Autistic adults with a learning disability are 40 times more likely to die prematurely. That is why I welcomed the Government’s announcement in March that reducing the gap in life expectancy for autistic people was one of the top autism priorities in the “Think Autism” strategy governance refresh under provisions in the Autism Act 2009. How will the Minister implement those provisions?
I pay tribute to my right hon. Friend, whose incredible work over many years campaigning on behalf of autistic people up and down the country has made a magnificent difference. She is right to raise this issue. It is of course unacceptable that people with autism have poorer health outcomes, and we are determined to address this. I meet regularly with representative groups and we take on board all their comments about how they would like to see the situation improved.
The report makes tragic reading. Some of our most vulnerable citizens are four times more likely to die prematurely than the general population, and there have been many avoidable deaths because of systemic failures. The situation cannot continue.
Let me ask the Minister three questions. First, will she look at the Scottish patient safety programme, a national programme that has been running since 2008 and is achieving good outcomes? Secondly, given that the Health and Social Care Committee has heard that learning disability nurses are very scarce, will she redouble the efforts to ensure that training for and recruitment to those roles are prioritised? Picking up symptoms early may be crucial to the prevention of morbidity. Thirdly, staff turnaround in social care is a real issue. Social care staff who know a client well, and can notice early changes such as signs of illness and report them timeously to ensure prevention, are crucial, and consistency in care is therefore critical. How will that be addressed?
The hon. Lady is right to raise those points. The Government are absolutely committed to reducing the number of people with learning disabilities whose deaths might have been preventable had there been different health and care interventions. That is why we set up the learning from deaths programme, and have commissioned an investigation of the issue. We are determined not only to learn from every single one of these tragic and avoidable deaths, but to share that learning with those in trusts up and down the country so that they can take a clear look at what is going on under their noses, and ensure that the terrible incidents that we have seen in the past do not happen again.
The hon. Lady was wise to raise the issue of training. It is important to have specialist practitioners, but it is also important to ensure that all healthcare staff, throughout the country, have the training that they need in order to recognise and support the needs of people with learning disabilities. That is something that we have done very successfully with dementia: we record the number of staff in the country who have received tier 1 and tier 2 training, and we are looking into how we can extend that to address the issues of people with learning disabilities.
In learning lessons from these truly horrific cases, will the Minister commit herself to working closely with the charities that do such incredible work to support people with learning disabilities and their families?
My right hon. Friend is absolutely right. Charities and voluntary organisations all over the country do remarkable work, supporting not only people with learning disabilities but their families and their carers, for whom instances involving their health and wellbeing can be incredibly distressing.
The Minister’s statement quite properly focused on hospitals, but does she acknowledge that charities dealing with people with learning disabilities will be among the worst affected by the £400 million back pay charge? Will she try to ensure that the Government absorb that cost, so that the improvements in hospitals are not upset by a deterioration outside, in communities?
We are looking very carefully at the issue of sleep-ins, and are communicating with social care providers and others. It is important to recognise that we need to support not only the sector as a whole, but the many low-paid workers within it. We will present more proposals on sleep-ins shortly.
The biggest challenge that many learning-disabled people have is simply making their voices heard. Their legal entitlement to advocacy is not always upheld by health professionals, who often misunderstand that entitlement. Will the Minister look into the commissioning of advocacy services, and, indeed, the understanding of the Equality Act 2010 among NHS staff, to ensure that more learning-disabled people have access to organisations such as Speakeasy Advocacy in Basingstoke, which supports more than 600 people with learning disabilities in north Hampshire, helping to give them the voice that they so badly need?
My right hon. Friend is a fantastic champion for equality issues in her role as Chair of the Women and Equalities Committee. I take on board everything that she has said, and I will certainly look more closely at the issue that she has raised.
The true disgrace is that none of this is new and we have been here before. Five years ago the Government set out their promises to tackle this appalling death by indifference, yet we have seen no progress. Can the Minister tell me how many hospitals regularly ask the four questions on treatment of people with learning disabilities set out by Sir Mike Richards, how many clinical commissioning groups check and monitor how many health checks and health plans people have in place, and what Health Education England has done to put the training in place to try to start turning the tide on this appalling situation?
The hon. Lady is right that this issue was identified a few years ago. The report was commissioned in 2015 and has been in the making since then. There was a Care Quality Commission report in 2016 which concluded that bereaved families do not often experience openness and transparency. Everything we have done up until this point—the mortality review, the learning from deaths programme and all the other things we have put in place with regard to the transforming care programme and annual health checks—is geared towards addressing this very issue.
The learning disabilities mortality review programme sets out the stark and unacceptable health inequalities faced by those with learning disability, and I welcome the steps the Minister has set out today. May I press her further, however, on the point about workforce shortfall? What is she going to do not only about recruitment, but about retention of the vital workforce in both health and social care?
My hon. Friend is absolutely right that the workforce in our health and social care system is absolutely fundamental to the way we look after people in our country. We must be able to attract, recruit, retain and bring back into the system people who have left it. We are currently compiling a workforce strategy jointly between Skills for Care and Health Education England, and it will be reporting later in the year.
Parents come to me all the time expressing their grave concerns about what will happen to their children with learning difficulties and disabilities if they are not around to support them. In my constituency I have had reports of instances of bullying from other people in the community, of targeting by drug dealers and of exploitation by private companies such as mobile phone providers and utility companies, and that there are difficulties accessing mental health support. If the Minister is truly keen to show the Government’s desire to improve on the current appalling state of affairs, do not early support and state responsibilities need to be looked at more closely as well?
The hon. Lady is right to make the point more broadly, rather than just about the healthcare outcomes for people with learning disabilities. We need to look at how we protect people more broadly, and this issue must particularly be a terrible worry for the ageing parents. I take on board what the hon. Lady said, and we will definitely feed it into the system to see what more we can do in support.
What should the CQC be doing that it is not doing already?
The CQC conducted an inquiry into this issue in 2016 and has a responsibility to check local healthcare provision to ensure it is up to speed. When local trusts start publishing their learning from deaths data from June, the CQC will be able to inspect them on how they bring the data forward and to judge them on that information.
Societies and Governments should be judged by how they treat the most vulnerable. As well as avoidable deaths of people with learning disability, we have savage cuts to services across the country, so they have no constructive positive activities to participate in, and we have a complete dearth of employment opportunities now for people with learning disabilities. I started my working life 36 years ago working with people with learning disabilities, and we made tremendous progress over a 20-year period. It is a source of tremendous sadness that we have gone backwards in the last 10 years in the support that such people and their families are receiving. It is shameful. We need a cross-Government approach and we need action, not strategies.
It is sad that the hon. Gentleman has sought to politicise this issue. It is nothing to do with funding cuts or cost-saving measures. We have actually invested more money into this programme. We are the first Government in the world to publish a learning from deaths programme so that healthcare trusts are held accountable and have to publish their data on people who die unnecessarily in their care. Making short-sighted party political points is therefore very unfair and does not get to the heart of the issue, which is about supporting people with learning disabilities and making sure that their health outcomes are the same as those of the population as a whole.
The all-party parliamentary group on learning disability, which I have the honour to chair, will be looking at this area of policy later this year. Mencap, which provides the group’s secretariat, has a Treat Me Well campaign, which is about improving the position, and I know it is keen to work with the NHS. Drawing on some of the other questions, may I ask the Minister what she can do to get the NHS and all the providers to act with a real sense of urgency in making improvements in this regard with the speed that we would like?
My right hon. Friend is right to raise the Mencap report, because in many cases it reflects the recommendations that have been put forward in this particular report. The mandate to NHS England requires a reduction in the health gap between people with mental health problems, learning disabilities and autism and the population as a whole, and requests support for them to live full, healthy and independent lives. That is something that NHS England has a mandate to deliver, and we of course support it in doing that.
If it is a crime to politicise the vulnerability of some people and the Government’s cuts, I stand guilty as charged. Further to the question from my hon. Friend the Member for Leicester West (Liz Kendall), what we have seen since 2013 is the complete decimation of services working together on the ground. This is a local government and health issue locally, so may I press the Minister to tell us what action will be taken to make this happen at local level?
It is not about that. This is about inquiring into the deaths of people who have died in our care. Despite all the really difficult decisions we have had to make to deal with the financial challenges this country faced, which the hon. Lady’s party will be well aware of, we have made progress on this issue in terms of transforming care and the healthcare checks on people with learning disabilities, and this very report on the learning from deaths programme proves how absolutely committed we are to ensuring that not one single one of those deaths goes unrecognised or uninvestigated.
Surely the quicker integration of the NHS with social care across the board will help to solve some of these problems. Does the Minister agree with that?
Yes, my hon. Friend is absolutely right. The integration of health and social care services is absolutely vital, and that is why we are so delighted that we have renamed the Department as the Department of Health and Social Care. That has to be more than just a title; it has to be a statement of intent.
Last October, I secured a Westminster Hall debate on supporting and safeguarding adults with learning disabilities, following the horrendous murder of my constituent, Lee Irving. Following that debate, what reassurance can the Minister give me that one of the major lessons coming out of that case—that families must be involved in the decision making about a person’s care—has been learned?
I thank the hon. Lady for raising that case. It was a truly horrible case. The Mental Capacity Act 2005 is all about making sure that we have care that is centred around the individual, and that parents’, families’ and carers’ thoughts are taken into consideration when making decisions about how we care for people.
We can be confident that the right legal framework is now in place, with the Equality Act 2010 and the Health and Social Care Act 2012, but what further steps can the Minister take to ensure that those who work in NHS organisations are aware of them?
Of course it is the responsibility of individual employers to ensure that their staff are appropriately trained and competent to fulfil the responsibilities that we ask of them, but we have commissioned Health Education England, Skills for Health and Skills for Care to develop a learning disabilities core skills education and training framework, which sets out a tiered approach to that kind of training and how it needs to be improved.
This review should shame us all. If we reflect on Sir Stephen Bubb’s final reports from two years ago in 2016, following a report he wrote in 2014 when there had been no progress, we can see that he put forward 10 recommendations. We have seen little or no progress on any of those recommendations. One of them recommended the introduction of the commissioner for learning disabilities, and we need that to happen if we are to see real progress and change. Will the Minister now take that important recommendation forward?
The hon. Lady is right to raise that, but I will point out that we commissioned the review to examine the situation. We are not running away from our responsibilities; we are standing up and facing them. We are allowing them to be entirely transparent and out there in the public domain for people to judge. The deaths that the report covered come from the period starting July 2016, so they are historical, but it is important that they are examined. The hon. Lady is right to mention the issue of the commissioner, and I will look at that.
While the review’s conclusions make difficult reading in some ways, it is welcome that it happened, given that it is a world first and that it gives us the chance to have this discussion. What work will be done with councils and other third sector partners on taking away some of the lessons that can be learned from the review?
My hon. Friend is right to say that this is the first time in the world that such a review has been done. We are the first to have a learning from deaths programme and a Healthcare Safety Investigation Branch, so we take such things incredibly seriously. The whole point of the learning disabilities mortality reviews is that the information will be disseminated to local trusts so that they can make plans to avoid such disastrous, tragic incidents happening in the future.
The gap in life expectancy for people with learning disabilities is deeply troubling. Last week, and at Health questions earlier, the House discussed cancer screening and the need to improve screening opportunities. The Minister will know that screening participation rates among people with learning disabilities are far below those for the general population. What specific actions is she taking to address that gap?
The hon. Lady is right to raise the inequalities of diagnosis of conditions and illnesses for which catching them early can mean the difference between life and death. That is why we have introduced annual health checks for people with learning disabilities. They mark a huge step forward and will help to reduce recognised health inequalities and ensure that reasonably adjusted care needs are much better communicated to other NHS partners.
As a Bristol-area MP, I thank the University of Bristol for its rigorous review, which marks a milestone in increased transparency and in setting out appalling healthcare inequalities. I note with interest that the review recommends efforts to improve awareness of the signs of sepsis and pneumonia in patients with learning disabilities in the NHS. Will the Minister reassure the House that the NHS will take up that recommendation urgently?
Yes. Specific work on early detection of the symptoms of sepsis, pneumonia, constipation and epilepsy and on the effective use of the Mental Capacity Act 2005 in urgent care settings is already under way.
The front page of the report is clearly dated December 2017, so will the Minister clarify and explain why, as she has stated today, her Department did not have sight of it prior to its publication?
I completely hold my hands up. I am not trying to mislead the House in any way. It is an independent document and the University of Bristol decided when it was going to be published. It was published on Friday without permission from or any kind of communication with the Department of Health and Social Care. I do not know what communication the university had with NHS England, but no information was passed to us. The beauty of having an independent document is that it can be published when the organisation sees fit and the Government will have to respond to it.[Official Report, 9 May 2018, Vol. 640, c. 8MC.]
During my career as a paediatrician, I have seen huge improvements in the care of children and young people with severe and moderate learning disability, many of whom have survived into adulthood when that would not have been the case years ago. Owing to the association between severe and moderate learning disability and other medical problems that may limit someone’s lifespan, it is unlikely to ever be equal to that of the general population, but we should always ensure that the care of the most vulnerable in society is as good as it can be, and I welcome the steps that the Minister is taking to ensure that it is. Such people are cared for jointly in hospitals and in the community, so will she confirm that hospitals and community care will work together following such reviews?
This is something that my hon. Friend, as a healthcare professional, obviously knows an awful lot about. She is right that a person having the ability to communicate, understand and identify when they do not feel well is important. These annual health checks, which are available to children from the age of 14 and into adulthood, are important because they enable any healthcare issues to be disseminated and communicated much more effectively between different healthcare and other providers.
Can the Minister guarantee that future publications of such sensitive reports will be done in a timely manner and given proper parliamentary scrutiny?
I will certainly put that request to NHS England. It was not in our interest for the report to be published on Friday. This is an independent review, but it would have been much better for us to have had foreknowledge of its publication. We would then have brought a statement to the House. We will pass on the hon. Gentleman’s comments to NHS England.
Sepsis has already been mentioned by my hon. Friend the Member for Kingswood (Chris Skidmore). Is the Minister aware that the mortality rate for sepsis in the Worcestershire Acute Hospitals NHS Trust has experienced a remarkable turnaround from 49% above the national average to 26% below the national average? Will she look at some of the best practice that is down to the hard work of the doctors and nurses, the awareness-raising campaign and all the other education work happening in that hospital, and disseminate it more widely to benefit such patients?
I thank my hon. Friend for raising that important issue. Sepsis is a silent killer. If not identified early, it can lead to life-changing implications or death. She is right that we have made great steps in addressing sepsis. Only a couple of weeks ago, we launched a new e-learning tool to help healthcare professionals better identify the symptoms of sepsis, particularly in children, so they can tackle it early.
The Minister has spoken a lot about being committed to improvements in this area. Does she think it is acceptable that she did not know a report in this important area was to be published on Friday? Why did she not come to make a statement today, rather than waiting to be summoned to the House by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley)?
What is unacceptable is that people with learning disabilities have poorer health outcomes than the rest of the population, which is why NHS England commissioned this piece of work and why we are determined to address it.
What steps is the Minister taking to ensure that people with learning disabilities can confidently access good quality sexual health services? What work is she doing with her counterparts in the Department for Education to ensure that young people with learning disabilities receive excellent sex and relationships education?
This is an important aspect, and I will get in touch with the hon. Lady with a more detailed answer to her question.
This is a shocking report, and its conclusions demean us all. A lot of people on both sides of the Chamber have asked the Minister and her Department to come up with some actions. Rather than just talking about it, will she commit today to coming back to the House with a specific action plan to prevent and change what has been an absolutely shocking situation for many decades?
The hon. Gentleman is right to say that this has been a shocking situation for many decades, which is exactly why this report was commissioned so that we can learn from past errors and identify how to stop them ever happening again. There are nine recommendations in this report, and we will work with NHS England on how to adopt every single one of them.
Will you bring it back to the House?
G4S: Immigration Removal Centres
(Urgent Question): To ask the Secretary of State for the Home Department if he will make a statement on the renewal of G4S’s contract to run the Brook House and Tinsley House immigration removal centres.
The Government have agreed a short-term continuation of G4S’s contract to run the Gatwick immigration removal centres while further work is carried out to identify a long-term manager. The Home Office will launch a further, full competition later this year, after the outcome of two independent reviews. The contract for the management of Brook House and Tinsley House, which was due to expire this month, was put out for tender in November 2016. However, after careful consideration of the bids, it was decided that G4S would continue with the contract for a further two years. This will provide sufficient time to reflect on the two independent reviews’ conclusions, conduct a new procurement exercise, and mobilise the successful provider. As with any procurement process, the Home Office has undertaken a robust evaluation of all bids, supported by a comprehensive due diligence process.
I recognise that the Government have taken this decision against the backdrop of the BBC “Panorama” programme on Brook House, which was broadcast in autumn last year. The previous Home Secretary made it clear at the time that the behaviour on display from some G4S staff was utterly unacceptable and set out our expectation that G4S would take urgent action to address the serious issues the programme uncovered. G4S has put in place a comprehensive action plan and this has quickly delivered improvements at Brook House. My right hon. Friend the Immigration Minister has met G4S to review progress, and visited the two Gatwick centres on 18 January.
Detaining those who are here illegally and who refuse to leave voluntarily is key to maintaining an effective immigration system. But regardless of status, all immigration detainees must be treated with dignity and respect. Please be assured that we will always demand the highest standards from those we entrust with the safety and welfare of those in detention.
Is the Minister aware of the concern that the Government put out news of the renewal of the G4S contract on the Friday between local elections and a bank holiday? There must be a suspicion that the Government were hoping to escape scrutiny—the fact that the contract was renewed at all is an even greater scandal.
The Minister mentioned the “Panorama” programme, but is she aware of a whole list of scandals in which G4S has been involved? In 2016, the BBC’s “Panorama” programme also uncovered alleged abuse and mistreatment of youngsters at a G4S youth detention centre; in November 2017, an independent report found surging levels of violence were “unsafe”; another G4S facility, HMP Birmingham, was hit by riots in December 2016; and G4S was fined at least 100 times for breaching its contract to run prisons between 2010 and 2016. There is also the very well-known case of father of five Jimmy Mubenga, who died under restraint on a British Airways plane while being deported. Several witnesses said he was held down in his seat for more than half an hour by G4S guards. His cries that he could not breathe were ignored until he actually stopped breathing. A 2011 inquest ruled his death unlawful. We have seen with the Windrush scandal that the public want an immigration system that is fair and efficient, and that bears down on illegal immigration, but they also want an immigration system that is humane. Many will feel that, given what people know about G4S’s record, renewing this contract, even for two years, is not commensurate with a humane system of dealing with migrants.
I thank the right hon. Lady for the urgent question. Let me reassure her that the decision to re-award the contract was taken during purdah and so we announced this on the first available opportunity after polling day on Thursday—the announcement was made on Friday. I hope that assuages her concerns as to why this has not happened more timeously. I am very conscious that I am being scrutinised here in the House, so I do not think the Government can be accused of escaping scrutiny.
As for the re-procurement process, it is precisely because we want to ensure that the long-term contract for these centres is dealt with in the way we expect that we have put in place this short-term continuation, for a period of two years. That will enable us to consider carefully the results of the independent reviews conducted by Stephen Shaw and Kate Lampard, and then build the procurement process. At the risk of striking a tone that is unusual to hear in the Chamber, we can agree across the House that we wish to have an immigration system that respects those who abide by the rules and that treats people fairly and with dignity and respect.
Does my hon. Friend agree that there are serious challenges in both the immigration and the prison custodial sectors, whether run publicly or privately? I wish to go immediately from here to listen to a discussion on substance misuse in prisons that is being held by the drugs, alcohol and justice cross-party parliamentary group. If, like me, my hon. Friend has read the annual report of Brook House IRC’s independent monitoring board, she will have seen that the board in no way at all came to the same conclusions about the merits of G4S as the right hon. Member for Hackney North and Stoke Newington (Ms Abbott).
I note that the independent monitoring board report noted the commitment of staff to the provision of a safe environment and included recommendations to improve the safeguarding of vulnerable detainees. Shortly, my right hon. Friend the Minister for Immigration will write to the chairman of the independent monitoring board, because that board plays such an important part. It is made up of members of the public who independently review these institutions, as similar boards review institutions across other parts of the immigration and prison system. Their role is so important in ensuring that the rules and standards that we expect are maintained by those who are entrusted with such responsibility.
The independent monitoring board also found that the use of force against people in Brook House increased by more than 160% in the two years between 2015 and 2017. Was the Home Secretary aware of that finding in the independent monitoring board’s report before he announced the renewal of G4S’s contract? If so, why did he renew it? These immigration detainees are not criminals, and there is growing anger at the Government’s policy of detaining them in detention centres without any fixed time limit. Will the Minister commit now to allowing Parliament a vote on this inhumane and unjust policy?
The new Home Secretary has reviewed the evidence put before him and agreed with the short-term extension of the contract. We are clear that, following the two reviews that we hope will report over the next few months, we will be able to ensure that the procurement process meets the expectations of the House and of those outside it.
On G4S, as soon as the “Panorama” programme was aired, the Government set out clear expectations in our action plan. We have carried out a range of actions to meet the expectations set in that action plan, including improved training for staff and enhanced staffing levels, with recruitment and training plans in place.
I commend the Minister for the Government’s having taken swift action following the appalling “Panorama” programme. These immigration centres contain many vulnerable people. Feltham young offenders institution became the first autism accredited penal establishment in the world, and it found that that helped greatly. Will the Minister look into the possibility of rolling out that programme, particularly across the immigration estate, so that we can develop and implement standards by which we can protect vulnerable people in a custodial environment?
Of course, my right hon. Friend has campaigned effectively for a long time on the importance of recognising autism and how we should treat it. Stephen Shaw set out in his 2015 report his concerns about adults who were vulnerable or at risk in the custodial environment. Indeed, that is why he has been commissioned to write a second report—a follow-up review—on the welfare of vulnerable detainees. I very much look forward to reading that report and its conclusions in due course.
How much did the abortive tender process cost the taxpayer, and were there any bidders, other than G4S, for the initial contract when it was offered up for renewal?
With regard to the original procurement process, due diligence was conducted, as would be expected, after the bids were received. In the light of the “Panorama” programme, further due diligence was conducted, and, as a result of further due diligence into the process, the Government have decided that the procurement process should be reopened so that all the actors in this field can take into account the two reviews that we are awaiting this year.
Where there is bad practice, it is important that staff are empowered to speak out. Will my hon. Friend tell me what G4S is doing to ensure that secure whistleblowing procedures are in place?
That is one of the requirements in the action plan that the Government set G4S after the programme. We are very clear that whistleblowers are essential to ensuring that problems are brought to light effectively and quickly. As part of the action plan, G4S has reinforced its whistleblowing policy. All staff have been issued with cards featuring telephone numbers to enable them to raise concerns confidentially, and following work with the Jill Dando Institute, G4S has trained staff to become “speak out” champions, promoting and embedding the message that whistleblowing is not just desirable, but a clear expectation when unacceptable behaviour is witnessed. In addition, there is also the introduction of body-worn cameras, which serve, I hope, to reassure the House and others that there is transparency and that, if there are allegations, we can very quickly get to the truth of them.
I welcome the fact that this is a time-limited renewal. The Minister will know that many of those who are detained in these centres are there following the refusal of their applications for asylum. She will have seen the report on the BBC website today where one Home Office caseworker describes that system as being “arbitrary” in its outcomes. When it comes to the point that we renew this contract, or whatever follows it after the reviews, will the Minister give us some guarantee that we will look at not just the detention but the whole system that leads people to that point?
The right hon. Gentleman will appreciate that, last week, the Home Secretary set out in two statements before the House his vision for immigration policy and the principles that he expects to be applied to immigration policy. Taking into account the reviews that are being conducted, I am sure that those principles will be very much at the forefront of his mind.
What is the mode, the mean and the median time spent by the existing cohort of detainees at the Gatwick detention centres?
I think that I am grateful to my right hon. Friend for his question. Let me just put the matter into context: 95% of individuals liable to removal from the UK at any one time are not detained and are therefore managed in the community. With regard to the time that people spend in detention, 63% of detainees left detention in under 29 days in 2017 and 92% left within four months.
Following the Brook House scandal, I asked the Cabinet Office whether G4S had been considered for designation as a high-risk supplier, but I was stonewalled with the answer that such information is not published. Given that what we saw at Brook House was an appalling, comprehensive and systemic management failure, will the Minister explain what constitutes high risk?
I hope that the hon. Gentleman will understand that I am not privy to that set of correspondence between him and the relevant Minister. The action plan put in place with G4S was demanding. Indeed, out of that plan, a new manager was appointed, nine members of staff were dismissed and a range of measures were put in place with regards to staffing levels, body-worn cameras, training and whistleblowing procedures. The company’s drug strategy was also improved as part of the action plan to try to get to the nub of what was shown in “Panorama”, but I want to be absolutely clear that the actions shown in that programme were simply unacceptable.
In the Windrush debate, I think that there is now a growing recognition on all sides that our immigration policy needs to show that it balances humanity with a robust ability to deal with those who are here illegally. The contract with G4S was a short-term award, but does my hon. Friend agree that, when the contract is awarded on a long-term basis, those bidding must demonstrate that they understand that and can deliver it?
Very much so. The competition will be a free and fair one, in that bidders will be expected to show that they can meet the expectations of the Government and others when it comes to quality, financial stability and price.
Incidents of serious violence and cover-ups in G4S-run institutions such as Medway secure training centre go back at least 15 years. Indeed, G4S sold what it called its children’s services business, which seemed like an admission of failure on its part. Why, then, would the Government give the company an extra two-year contract? What other ideas did they consider? Did they think about taking the service back in-house, as they have done in previous cases of failure by private providers?
The hon. Gentleman talks about simply taking matters back in-house, but we have to acknowledge the complexity of providing services to people who often have vulnerabilities. When these people are in the centres, they may well be pursuing live claims on their immigration status themselves. Given the need to continue to provide these services at the standards that we expect, the view was taken that we would extend the current contract by two years, thus enabling a proper procurement process to occur in the light of the two reviews and allowing a decision on the next contract to be taken in good time and with care.
Where there is bad practice, it is of course important that staff who witness it feel empowered to speak out. How has the Minister satisfied herself that G4S has appropriate whistleblowing procedures in place to allow that to happen?
The need for G4S drastically to improve its whistleblowing procedures was part of the action plan. As I have set out already, G4S has taken various steps, including embedding the culture of making available telephone numbers that enable people to raise their concerns confidentially and training staff to be “speak out” champions—promoting and embedding the expectation that staff will speak out. In addition, body-worn cameras help to take the burden from people who may be worried about reporting. Of course, the independent monitoring board has an important role in ensuring that there are people who inspect and are monitoring the behaviour of the staff and organisations in this world.
There was a criminal investigation following the scandal highlighted by “Panorama”. Will the Minister tell us what happened following that investigation? Have people been punished? May I also press her on the question of this House having a vote, so that this country can be brought in line with other European nations where there is a 28-day statutory limit on the time for which people can be held in such facilities? Far too many people detained in such facilities should be in the community, not in detention centres.
On the hon. Lady’s query about police investigations, allegations were passed to the police. I understand that there is one case where an investigation is ongoing. I cannot assist the House further on that, I am afraid. Indeed, given that that is the case, perhaps I should not be commenting on it anyway.
On the wider point about time limits, this is a matter that the Home Office reviews and looks into very carefully. The vast majority of people who challenge the requirement to remove them under their right to remain status are in the community already. The fact that most detainees left detention in under 29 days should, I hope, offer her some comfort, but of course we must always look at how we can improve that figure further.
The Minister will have heard from all parts of the House the shock at these revelations. Bearing that in mind, will she confirm that there have been substantial changes to the practices at Brook House since these revelations have come to light and set out what oversight the Government will have over G4S during the contract extension period?
I thank my hon. Friend for his interest. An action plan was put in place that included appointing a new manager and dismissing nine staff, enhancing staffing levels with recruitment and training plans, introducing body-worn cameras for staff to provide more transparency and assurance, refreshing and promoting whistleblowing procedures, putting in place an improved drugs strategy, and commissioning an independent review led by Kate Lampard to look at the root causes of the issues highlighted that is expected to report this summer. In addition, the Home Office monitors this continuously. Indeed, the Home Office has strengthened its staff numbers at the centres to try to help on a casework basis people who may wish to return voluntarily.
G4S’s performance in how it delivers public contracts is woefully inadequate, and not only in the Prison Service. G4S runs the transport service for my local hospital. Last week, I had to go to rescue a 94-year-old relative from a discharge area full of patients who had been waiting over five hours for G4S to turn up, and this is a regular occurrence. I am a governor of a school where G4S consistently fails to deliver on the school maintenance contract. When are the Government going to get a grip and deal with G4S, because there is something fundamentally wrong at the heart of this company?
G4S is held to account not just by the Home Office but centrally through Cabinet Office reporting requirements. The new procurement process will provide a basis for further progress on all these issues, and the progress of G4S will continue to be monitored very closely.
Morton Hall in my constituency is an immigration removal centre facing significant challenges and issues. Will my hon. Friend update the House on what is being done to improve immigration removal centres including not just Brook House but Morton Hall?
My hon. Friend will know of the issues in her own constituency. Morton Hall is in a slightly different category because it is run by the Prison Service and not by G4S. That reflects the fact that these are people who are being detained in a prison environment awaiting their removal. The Government take very seriously the treatment of people whose immigration status is not to their liking and who have appeals and so on in the process. The fact that the vast majority of people who are liable to removal from the UK are in the community being dealt with through alternatives to detention should, I hope, give comfort to the House.
If “Panorama” shocked the nation with its depiction of racial abuse and choking of detainees at Brook House, the collapse of Carillion like a pack of cards has exposed that the outsourcing model is failing our public services. Why are the Government persisting with this course of action, or on a sunny pre-bank holiday filled with local election results, did they think no one would notice?
I can only assume that the hon. Lady was not in the Chamber when the shadow Home Secretary asked me that question. The answer is that the decision was taken during the purdah period, so the announcement was made on the first available day after purdah. Again, I reflect on the fact that I am standing here at the Dispatch Box being scrutinised.
The fact is that there is a role for private sector involvement in the delivery of services, as long as we ensure that it is about delivering the best public services at the best value for money. I remind the House that this is not a new thing; it did not come about in 2015 or 2017. Private companies have been helping the Government to deliver various services since the 1990s, including under a Labour Government.
May I say to the Minister that this is an urgent question, not a statement that she has come to the House to make? She has been brought here to answer questions. G4S seems to be able to fail in a variety of contracts, without any consequences at all. There have been failures in prisons, electronic tagging, secure units and now immigration detention centres. When are the Government going to get a grip and sort this out?
As I have said, the Government are awaiting the two reviews that are being conducted, and we will consider those results very carefully. The re-procurement process will be started afresh, and from that, expectations will be set and standards will have to be met.
Before I call the hon. Member for Stretford and Urmston (Kate Green), I say not for the first time, and I am sure not for the last, that the hon. Member for Kingston upon Hull North (Diana Johnson) is correct: this is indeed an urgent question, and on the principle that the House and perhaps those attending to our proceedings like to have a bit of extra information, I can vouchsafe to all present that this is the 465th urgent question that I have been pleased to grant.
I have to say to the Minister that a two-year extension—what she calls a “short” extension—to the contract will seem to many like a reward to G4S for its failure. If she is now reopening and rerunning the tendering process, will she take the opportunity to do that in tandem with a review of the tendering and provision of healthcare services in immigration detention centres, which seem to be woefully inadequate to meet the needs of the very vulnerable detainees who have been mentioned this afternoon?
May I explain the reason why two years has been settled upon? The Home Office has taken the view that that is the minimum period required realistically to revisit the specification, to run a full and legally compliant procurement process, to complete all the relevant governance processes and to mobilise the new services. That timetable is not unusual for a procurement of this sort of value. I will ask the Immigration Minister to write to her on the question about healthcare.
Point of Order
On a point of order, Mr Speaker. I wonder if you could help me with a situation that has arisen in Buckinghamshire and therefore may be of concern to you.
We were all delighted when my right hon. Friend the Member for Bromsgrove (Sajid Javid) was promoted to the Home Office and my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire) took over at the Ministry of Housing, Communities and Local Government. However, that has coincided with the potential reorganisation of local government in Buckinghamshire. Because it is quite hotly contested between having one unitary authority or two local authorities, notices have gone out to ask constituents to feed into the Secretary of State their feelings about the “minded to” decision that he announced.
Unfortunately, the email address given out by the Ministry and printed in all the leaflets that have been distributed throughout the county was based on the name of my right hon. Friend the Member for Bromsgrove. We were assured that the address would remain open until 25 May, when the decision is due, but despite the assurances from the Ministry, it appears that constituents trying to put in their representations are now getting a bounce-back message saying that the email has address has been closed. There are no instructions as to who they should now contact and no information given as to why the address has closed. That means that constituents’ views are not getting through to the Ministry on this matter, which, as I know you appreciate, is very important.
What can we do about that? Is there any way we can ask a Minister to come to the Dispatch Box and confirm that the email address will be reopened, or can we ensure that we get an extended period, so that we can put to rights this aberration whereby people have been asked for their opinions, but the wherewithal of giving that opinion to the Ministry has been unilaterally withdrawn without any notice?
I am very grateful to the right hon. Lady for her point of order, and for her characteristic courtesy in giving me advance notice of her intention to raise it. This certainly sounds rum, and it is indeed a very unsatisfactory state of affairs. I am very familiar with the issue because, as she suggests, it is of course a matter of concern to my constituents and to hers, as well as to those in other Buckinghamshire constituencies.
I think the effect of the right hon. Lady raising this matter on the Floor of the House is that the gravamen of her concern will be speedily communicated to the new Secretary of State, and an appropriate change must be made. Technology can be very helpful, but if it is dysfunctional or inflexible, it does not aid but obstruct, which cannot be allowed to happen. If people have been told that they have a certain period in which to get across their views by a convenient means, such a means must be available, and if it ceases to be available, it must be restored.
I do not want to tease the right hon. Lady. I have known her a very long time, so I can probably get away with a bit, although she looks a bit doubtful on that score. I just want to say to the right hon. Lady, whom I have known for a very long time—she has been my county colleague for over two decades—that even though she is now a dame, and therefore even more illustrious than she used to be, she is very much in touch, grounded in her constituency and well aware of these matters. That is in stark contrast, I must admit, to one of my great historical parliamentary heroes, Edmund Burke. I remember that I used to rhapsodise about Burke, until Tony Benn said to me, “John, I wouldn’t overdo it if I were you. Burke may have been a great man, but his visits to his constituency were by way of being an annual pilgrimage.” By contrast, the right hon. Lady seems to know what is being said on her watch. I do not know whether she is happy with my answer to her point of order, but that is the answer she is getting.
Further to that point of order, Mr Speaker. I am most grateful, and I am glad to have given you the opportunity to wax lyrical about one of your heroes. I hope that this will lead to the reopening of the email address, and that the Department will take note so that our constituents can get their message through. [Interruption.]
The right hon. Lady’s hon. Friend the Member for Croydon South (Chris Philp) is gesticulating from a sedentary position to the effect that he is communicating the thrust of this exchange to the Department now. What a whizz kid the hon. Gentleman is. I am most impressed. [Interruption.] They both look frightfully happy with the product of their endeavours this afternoon.
If there are no further points of order, we now come to the ten-minute rule motion, for which the hon. Member for Mansfield (Ben Bradley) has been so patiently waiting.
Protection of Pollinators
Motion for leave to bring in a Bill (Standing Order No. 23)
I beg to move,
That leave be given to bring in a Bill to make provision about the protection of pollinators; and for connected purposes.
This Bill would place a duty on the Department for Environment, Food and Rural Affairs, in consultation with local authorities, to bring forward a mechanism for and plan to deliver a national network of pollinator corridors containing spaces rich in wildflower habitat. It would also encourage public authorities to seek opportunities to contribute to the development and implementation of pollinator corridors. There has certainly been a bit of a buzz about bees and insects in recent years. That was a nice one to start with, and I may reach something of a crescendo with the puns later.
Wild pollinators include bees, butterflies, moths, flies and various other insects such as beetles and wasps. More than two thirds of Britain’s pollinators are in decline, including many species of bumblebee, butterfly and moth. Indeed, 35 of the UK’s bee species are currently under threat of extinction. Although they make the headlines most often, it is not just bees that are struggling: 76% of UK butterfly species and 66% of UK moth species are also in decline. The public are very concerned about that decline—indeed, as many colleagues will attest, they often write to their MPs about this issue. In terms of the volume of emails on a specific campaign, this issue and other animal welfare concerns are always among the most popular. I am sure we have all experienced the enthusiastic campaigns of groups such as Buglife and the Wildlife Trusts at our respective party conferences.
Pollinators are facing unprecedented challenges, including climate change, intensive farming, pests and diseases, pesticide use and urban growth. They need food, water, shelter and nesting areas as well as the ability to roam far and wide—as they would naturally, without the barriers placed in their way as a result of urban sprawl. As the concrete jungle grows, their natural habitat inevitably shrinks.
Dramatic losses of wildflower-rich habitat and the fragmentation of the remaining protected spaces are some of the main threats to the survival of many pollinators. A significant further decline in their population would be a disaster for the UK: devastating for our farmers and our food sustainability. It would also have a huge impact on a wide range of businesses that rely on these insect-pollinated crops; our cider producers and food manufacturers, for example, would be hit hard.
Insect pollinators benefit both the yield and the quality of many crops. Studies suggest that their activity is worth nearly £700 million to UK food production annually—equivalent to 13% of the value of our agricultural produce. There is no overall assessment of the current impact of the decline on crop production, but we know that a lack of pollinators is already costing apple growers, for example, millions of pounds each year. A further decline would also devastate our wildflower population and change our biodiversity forever. It is important to note that creating wildlife sanctuaries and protecting our green spaces will not only support our bees and insects; it will also have other positive outcomes for everything else. It will have a beneficial impact on our local communities, and on our individual mental health and wellbeing. That is as significant—if not more so—in deprived areas as in our leafy suburbs. Green spaces are places of tranquillity and provide a space away from the hustle, bustle and stresses of modern life—the more the merrier, in my view.
I met my hon. Friend the Minister for Agriculture, Fisheries and Food recently to discuss the protection of pollinators, which, I was pleased to hear, is a priority for the Government. I was pleased to hear about the positive work under way on the national pollinator strategy—an approach setting out how the Government, beekeepers, conservation groups, farmers and researchers can work towards common goals together.
A 2016 report on the implementation of the strategy highlighted positive progress across its actions, including on habitat creation, public engagement, protecting honey bee health and improving our understanding of this issue. Given the importance and value of pollinators, it is right that we should discuss whether there is a need for further legislation to work alongside the strategy and the powers currently in place. The national pollinator strategy is a 10-year plan, which was published in November 2014. It sets out the Government’s commitment to playing a leading role in improving the status of the 1,500 or so pollinating insects in England. The strategy is an important step in protecting bees and other insects.
It is also important to recognise that current legislation includes the provision to regulate the use of pesticides and provide protection for bees and our most threatened species. Those are all positive steps, but I still believe that more could be done. The strategy covers key issues such as supporting pollinators on farmland and supporting bees and insects across towns, cities and the countryside, but it does not emphasise or plan to support pollinator pathways and corridors. Government support so far has focused on temporary habitats and patches of protected countryside. Although those provide some benefits to pollinators, they do not provide the variety of flora or the nesting habitats required for them to thrive.
The best habitats are fragmented throughout the UK, and insects are still confined to small areas—pollinators are not free to fly as they naturally would, but are often stuck in small pockets without the freedom to roam far and wide. That is especially problematic when we develop on land that does not have the connections and pathways to allow insects and wildlife to move to new areas. Almost a fifth of these habitats have been lost. Independent scientific reviews have identified the loss of wildflower-rich habitats as the likely primary cause of the recorded decline in the diversity of wild bees and other pollinating insects. When we develop on green space, too often we lose the local wildlife. This is where the Bill and pollinator corridors come in.
Charities such as Buglife have been working on solutions to our pollinator problems. One option is something it has called “B-Lines”. B-Lines are a series of insect pathways running through our countryside and towns. Along them stretch a series of wildflower-rich habitat stepping stones, providing support for these species and others. They are effectively a road network for insects. B-Lines provide a framework in which to target large-scale habitat restoration, as well as small-scale pollinator resources. The framework helps to encourage landowners, businesses and the public to get involved locally. Going forward, the B-Lines network would ideally be identified within local plan frameworks to ensure a more joined-up approach, so that local authorities, developers, landowners and managers, and other partners, can work together to support pollinator corridors. Co-ordinated habitat restoration will help to ensure that we develop pollinator-friendly landscapes more efficiently and quickly.
The fragmentation of habitats presents a significant threat to species, as they find it increasingly difficult to colonise new areas, particularly as our climate changes. Where there is more continuous habitat, species can spread faster.
Modelling has demonstrated that targeting support at grassland habitat restoration and creation, and creating a channelled pattern of habitats is the most effective way of promoting species dispersal. The Bill will encourage local authorities to reference and support pollinators within their local plans and local environmental strategies. It will help to ensure the increased delivery of the national pollinator strategy locally and importantly it will promote the B-Lines network as a priority for action.
There are some positive case studies which show that this approach can be successful. On the banks of the River Derwent, east of York, a landowner was inspired by the B-Lines idea and proposed the creation of a new wildflower-rich floodplain meadow. The landowner worked with Buglife to turn a six hectare arable field, where flooding was an issue, into a large wildflower-rich habitat, which acted as a new stepping stone for pollinators on the B-Lines network. In addition, it helps to reduce sediment leaching into the river system. It shows that increasing our wildflower networks can have multiple environmental benefits.
In Kent, commercial orchards within the B-Lines network near Maidstone have been increasing pollinator habitat by changing mowing regimes to promote wildflowers between fruit trees. This is a win-win situation: a simple change that results in increasing habitat for wild pollinators and also helps to increase crop yields.
In the north-west of England one of the B-Line partners, Cumbria Wildlife Trust, is working with Highways England to focus on key stretches of the A66 and A595, aiming to use parts of the highways estate and other land to support pollinators and create B-Lines, increasing wildflower-rich habitat and helping to reduce the fragmentation of existing wildflower-rich areas.
B-Lines also provide an opportunity for Government Departments and agencies to prioritise work for pollinators. Buglife is working with both the Ministry of Justice and the Environment Agency to identify key sites, including prisons, seawalls and floodplains, where wildflower habitat creation could be taken forward. I hope that the Bill will place renewed emphasis on that work. The Bill asks the Department for Environment, Food and Rural Affairs to bring forward a mechanism to deliver B-Lines, including a national map of pollinator corridors, which will in turn encourage local authorities to act to support pollinators. Local authorities are of course best placed to know their local environment, understand specific local challenges and the needs of the local population.
Protecting pollinators involves action by many different groups, including large-scale and small-scale farmers. Farmers have played an important role so far. They are the custodians of much of our natural environment and have generally worked hard to support bees and insects. I want to recognise the work that farmers have played in supporting our pollinators and their crucial role in the success of pollinator corridors, as well as the importance of protecting wildlife for our agriculture and food supply too. Protecting pollinators does not need to be an onerous commitment for farmers, the Department for Environment, Food and Rural Affairs or local authorities. It is an example of an evidence based approach with all-round benefits that need not consume huge resources to deliver an impact.
Local Authorities already have a duty to conserve biodiversity under the Natural Environment and Rural Communities Act 2006. The national planning policy framework states that plans should include a strategy for enhancing the natural, built and historic environment and support for nature improvement areas. The Bill is another step towards encouraging local authorities to explicitly reference pollinators within local plans. I am pleased to confirm that it will also involve minimal expenditure for local authorities.
Helping bees and other insects can be easy, as the case studies I mentioned have demonstrated. Whether it is changing the patterns of cutting local verges, decreasing grass cutting in remote areas or working with local charities and housing developers to encourage pollinators in our urban spaces, the Bill does not seek to place a financial commitment on local authorities. Buglife and Friends of the Earth have published a paper that looks at developing local pollinator action plans. The Bill is another way to advance those plans.
You will like this bit, Madam Deputy Speaker. I am going to end on a high. We have an opportunity to make a beeline for the protection and growth of our pollinator population, which I am sure colleagues will flock to support like moths to a flame. DEFRA has been a hive of activity and positive announcements in recent months, and this could add further to their success. There has been a lot of talk and some positive steps. I do not believe that we have been just bumbling along. We must ensure that there is a sting in the tail. Further action must be taken. I had a joke about calling somebody “Honey”, Madam Deputy Speaker, but I will take it out as Mr Speaker has left the Chamber.