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House of Commons Hansard

Mental Health and NHS Performance

09 January 2017
Volume 619

  • With permission, Mr Speaker, I would like to make a statement on mental health and NHS performance. This Government are committed to a shared society in which public services work to the highest standards for everyone. This includes plans announced by the Prime Minister this morning on mental health. I am proud that, under this Government, 1,400 more people are accessing mental health services every day compared with 2010 and that we are investing more in mental health than ever before, with plans for 1 million more people with mental health conditions to access services by 2020.

    But we recognise that there is more to do, so we will proceed with plans to further improve mental health provision, including: formally accepting the recommendations of the independent taskforce on mental health, which will see mental health spend increase by £1 billion a year by the end of the Parliament; a Green Paper on children and young people’s mental health to be published before the end of the year; enabling every secondary school to train someone in mental health first aid; a new partnership with employers to support mental health in the workplace; up to £15 million extra invested in places of safety for those in crisis, following the highly successful start to the programme in the last Parliament; an ambitious expansion of digital mental health provision; and an updated and more comprehensive suicide prevention strategy. Further details of these plans are contained in the written ministerial statement laid before the House this morning.

    I turn now to the winter. As our most precious public service, the NHS has been under sustained pressure for a number of years. In just six years the number of people aged over 80 has risen by 340,000, and life expectancy has risen by 12 months. As a result, demand is unprecedented. The Tuesday after Christmas was the busiest day in the history of the NHS, and some hospitals are reporting that A&E attendances are up to 30% higher compared with last year. I therefore want to set out how we intend to protect the service through an extremely challenging period and sustain it for the future.

    First, I pay tribute to staff on the frontline. The 1.3 million NHS staff, alongside another 1.4 million in the social care system, do an incredible job, which is frankly humbling for all of us in this House. An estimated 150,000 medical staff, and many more non-medical staff, worked on Christmas day and new year’s day. They have never worked harder to keep patients safe, and the whole country is in their debt.

    This winter, the NHS has made more extensive preparations than ever before. We started the run-up to the winter period with over 1,600 more doctors and 3,000 more nurses than just a year ago, bringing the total increase since 2010 to 11,400 more doctors and 11,200 more hospital nurses. The NHS allocated £400 million to local health systems for winter preparedness; it nationally assured the winter plans of every trust; it launched the largest ever flu vaccination programme, with more than 13 million people already vaccinated; and it bolstered support outside A&Es, with 12,000 additional GP sessions offered over the festive period.

    The result has been that this winter has already seen days when A&Es have treated a record number of people within four hours, and there have been fewer serious incidents declared than many expected. As Chris Hopson, head of NHS Providers, said, although there have been serious problems at some trusts, the system as a whole is doing slightly better than last year.

    However, there are indeed a number of trusts where the situation has been extremely fragile. All of last week’s A&E diverts happened in 19 trusts, of which four are in special measures. The most recent statistics show that nearly three quarters of trolley waits occurred in just two trusts. In Worcestershire, in particular, there have been a number of unacceptably long trolley waits, and the media have reported two deaths of patients in A&E. We are also aware of ongoing problems in North Midlands, with extremely high numbers of 12-hour trolley waits. Nationally, the NHS has taken urgent action to support those trusts, including working intensively with leadership and brokering conversations with social care partners to generate a joined-up approach across systems of concern.

    As of this weekend, there are some signs that pressure is easing both in the most distressed trusts and across the system. However, with further cold weather on the way this weekend, a spike in respiratory infections and a rise in flu, there will be further challenges ahead. NHS England and NHS Improvement will also consider a series of further measures that may be taken in particularly distressed systems on a temporary basis at the discretion of local clinical leaders. These may include: temporarily releasing time for GPs to support urgent care work; clinically triaging non-urgent calls to the ambulance service for residents of nursing and residential homes before they are taken to hospital; continuing to suspend elective care, including, where appropriate, suspension of non-urgent outpatient appointments; working with the Care Quality Commission on rapid re-inspection where this has the potential to re-open community health and social care bed capacity; and working with community trusts and community nursing teams to speed up discharge. Taken together, these actions will give the NHS the flexibility to take further measures as and when appropriate at a local level.

    However, looking to the future, it is clear we need to have an honest discussion with the public about the purpose of A&E departments. Nowhere outside the UK commits to all patients to sort out any urgent health need within four hours. Only four other countries—New Zealand, Sweden, Australia and Canada—have similar national standards, which are generally less stringent than ours. This Government are committed to maintaining and delivering that vital four-hour commitment to patients, but since it was announced in 2000, there are nearly 9 million more visits to our A&Es, up to 30% of which NHS England estimates do not need to be made, and the tide is continuing to rise. If we are going to protect our four-hour standard, we need to be clear that it is a promise to sort out all urgent health problems within four hours, but not all health problems, however minor. As Professor Keith Willett, NHS England’s medical director for acute care, has said, no country in the world has a standard for all health problems, however small, and if we are to protect services for the most vulnerable, nor can we.

    NHS England and NHS Improvement will continue to explore ways to ensure that at least some of the patients who do not need to be in our A&Es can be given good, alternative options, building on progress under way with a streaming policy in the NHS England A&E plan. In this way, we will be able to improve the patient experience for those with more minor conditions who are currently not seen within four hours, as well as protect the four-hour promise for those who actually need it.

    Taken together, what I have announced today are plans to support the NHS in a difficult period; and plans for a Government that is ambitious for our NHS, quite simply, to offer the safest, highest-quality care available anywhere, for both mental and physical health. But they will take time to come to fruition, and in the meantime all our thoughts are with NHS and social care staff who are working extremely hard over the winter, and throughout the year, both inside and outside our hospitals. I commend this statement to the House.

  • I am grateful to the Secretary of State for an advance copy of his statement. I, too, begin by paying tribute to all the NHS staff who are working day in, day out to provide the best possible care to patients during this busy period. Of course, we welcome measures to improve mental health services in this country, as indeed we welcomed such announcements exactly 12 months ago, when the then Prime Minister made similar promises. But does the Secretary of State not agree that if this Prime Minister wants to shine a light on mental health provision, she should aim her torch at the Government’s record: 6,600 fewer nurses working in mental health; a reduction in mental health beds; 400 fewer doctors working in mental health; and, perhaps most disgracefully of all, the raiding of children’s local mental health budgets in order to plug funding gaps in the wider NHS? Could he therefore tell us why the Prime Minister was unable to confirm this morning that money for mental health would be ring-fenced to prevent this raiding of budgets from happening in the future? We welcome measures to improve mental health support in schools. Will the Government offer more resources to local authority education psychologists? What provision will be in place to give teachers suitable training for doing this work?

    On the winter crisis, this morning the Secretary of State said that things have only been “falling over in a couple of places”. Let us look at the facts: a third of hospitals declared last month that they needed urgent help to deal with the number of patients coming through the doors; A&E departments have turned patients away more than 140 times; 15 hospitals ran out of beds in one day in December; several hospitals have warned that they cannot offer comprehensive care; and elderly patients have been left languishing on hospital trolleys in corridors, sometimes for more than 24 hours. And he says that care is only falling over in a couple of places! I know that “La La Land” did well at the Golden Globes last night, but I did not realise the Secretary of State was living there—perhaps that is where he has been all weekend. Will he confirm that the NHS is facing a winter crisis, and that the blame lies at the doors of No. 10 Downing Street?

    Does the Secretary of State agree that it was a monumental error to ignore the pleas for extra support for social care to be included in the autumn statement only weeks ago? Will he support calls to bring forward now the extra £700 million that is allocated for 2019, to help social care? Will he urge the Chancellor and the Prime Minister to announce a new funding settlement for the NHS and social care in the March Budget so that a crisis like this year’s never happens again?

    I press the Secretary of State further on the announcement he has just made on the four-hour A&E target. Is he really telling patients that rather than trying to hit that four-hour target, the Government are now in fact rewriting and downgrading it? If so, does NHS England support that move? What guidance has he had from the Royal College of Emergency Medicine to say that that is an appropriate change to the waiting-time standard?

    The Secretary of State has made patient safety an absolute priority; in that, he has our unswerving support. I am sure he will agree that one of the most upsetting reports to come out of hospitals last week was that on the death of two patients at Worcestershire Royal hospital who had been waiting on trolleys. Will he commit to personally lead an inquiry into those deaths? Does he know whether they were isolated incidents? When does the trust intend to report back on its investigation? Will he undertake to keep the House updated on those matters?

    There is no doubt that the current crisis could have been averted. Hospital bosses, council leaders, patients groups and MPs from both sides of the House urged the Chancellor to give the NHS and social care extra money in the autumn statement. Those requests fell on deaf ears and we are now seeing the dismal consequences. NHS staff deserve better. Patients deserve better. The Government need to do better. I urge the Health Secretary to get a grip.

  • I am happy to respond to the hon. Gentleman’s comments and, indeed, to the comments of all Members, but I shall first say this about the tone of what he said. He speaks as if the NHS never had any problems over winters when Labour was in power. The one thing NHS staff do not want right now is for any party to start weaponising the NHS for party political purposes. I remind him that when his party runs the NHS, the number of people on waiting lists for treatments doubles, A&E performance is 10% lower and people wait twice as long to have their hips replaced. Whatever the problems are in the NHS, Labour is not the solution.

    The hon. Gentleman talked about mental health, so let me tell him what is happening on that. Thanks to the efforts of this Government and the Conservative-led coalition, we now have some of the highest dementia diagnosis rates in the world. Our talking therapies programme—one of the most popular programmes for the treatment of depression and anxiety—is treating 750,000 more people every year and is being copied in Sweden. Every day, we are treating 1,400 more people with mental health conditions and we have record numbers of psychiatrists. The hon. Gentleman mentioned mental health nurses: in this Parliament we are training 8,000 more, which is a 22% increase.

    All that is backed up by what we are confirming today, which has not been done before: the Government are accepting the report of the independent taskforce review—led by Paul Farmer, the chief executive of Mind—which commits us to spending £1 billion more a year on mental health by the end of the Parliament. That would not be possible with the spending commitments that Labour was prepared to make for the NHS in the previous Parliament. It is because of this Government’s funding that we are able to make such commitments on mental health.

    The hon. Gentleman talked about the NHS and gave completely the wrong impression of what I said this morning. I was completely clear that all NHS hospitals are operating under greater pressure than they ever have. He should listen to independent voices, such as that of Chris Hopson—no friend of the Government when it comes to NHS policy—who is clear that in the vast majority of trusts people are actually coping slightly better than last year. However, we have some very serious problems in a few trusts, including in Worcestershire and a number of others. I can commit to him that we will follow closely the investigations into the two reported deaths at Worcestershire and keep the House updated.

    The hon. Gentleman talked about social care, which is where, I think, his politicising goes wrong. Last year, spending on social care went up by around £600 million. At the last election, he stood on a platform of not a penny more to local authorities for social care, so to stand here as a defender of social care is, frankly, an insult to vulnerable people up and down the country, particularly to those living under Labour councils such as Hounslow, Merton and Ealing, which are refusing to raise the social care precept, but are complaining about social care funding.

    The hon. Gentleman talked more generally about NHS funding, but in the last Parliament it was not the Conservatives who wanted to cut funding for the NHS—it was his party. It was not the Conservatives who said that funding the five-year forward view was impossible—it was his party. Labour said that the cheque would bounce. Well, it has not bounced, and we are putting in that money.

    In conclusion, it is tough on the NHS frontline. The hon. Gentleman was right to raise this issue in this House, but wrong to raise it in the way that he did. Under this Government, the NHS has record numbers of doctors and nurses and record funding. Despite the pressures of winter, care is safer, of higher quality and reaching more people than ever before. It is time to support those on the frontline, and not try to use them for party political points.

  • I welcome the Secretary of State’s statement and the Prime Minister’s focus on mental health in her speech today. She spoke of holding the NHS leadership to account for the extra £1 billion that we will be investing in mental health. Will the Secretary of State set out in further detail how clinical commissioning groups will be held to account for ensuring that that money gets to the frontline so that we can deliver progress on parity of esteem?

  • Yes, I can do that. It is a very important point. We have had a patchy record in the NHS of ensuring that money promised for mental health actually reaches the frontline. The way that we intend to address this is by creating independently compiled Ofsted-style ratings for every CCG in the country that highlight where mental health provision is inadequate. Those ratings are decided by an independent committee chaired by Paul Farmer, who is responsible for the independent taskforce report, so he is able to check up on progress towards his recommendations. I am confident that, by doing that, we will be able to shine a light on those areas that are not delivering on the promises that this Government have made to the country.

  • After the Health Committee’s recent inquiry into suicide, I absolutely welcome the extra funding for mental health. I am sure that the Secretary of State remembers some of the discussions that we had in that room.

    I also pay tribute to the staff. Obviously, with my background I know exactly what it is like when A&E is swamped and there is nowhere to put people. The staff across NHS England are not afraid of us discussing this topic and weaponising it. They are in tears; they are exhausted; and they are demoralised. They have never experienced a winter like this. Perhaps the Secretary of State will explain why his figures suggest 19 diverts and only two trusts in serious problems, whereas we are hearing from the Nuffield Trust that that 42 or 50 trusts are diverting, which is a third. That means that the problem is widespread.

    I totally agree with the point about people going to A&E when they do not need to be there, but they are not the people who are three-deep on trolleys waiting for a bed for 36 hours—those are people who need a bed and who are there because they are ill. We have discussed sustainability and transformation plans and NHS sustainability on several occasions. The concern that people have is that, because there is not the money for a redesign, there will be A&E closures and bed cuts. I hope that this incident will show that that is simply not possible. It is not possible for the UK, particularly NHS England, to lose any more beds. In Scotland, we face the same problem of increased demand and shortage of doctors, yet 93.5% of our patients were seen within four hours in Christmas week. The president of the Royal College of Emergency Medicine estimates that in areas of England it is between 50% and 60%. That difference is down to how it is organised. It is the fragmentation and the lack of integration. There are things that can be done. We can use community pharmacies and GPs, and try to bring the NHS back together.

  • I hope that the hon. Lady will not take offence—she has vast experience in this field—if I say that her questions must be judged to be rhetorical, because I did not observe any question marks, although I am sure we will in future.

  • You were handy at that.

  • Yes, but that was then, and this is now. That was when I was a badly behaved Back Bencher like the hon. Gentleman.

  • I will try to interpret the questions in what the hon. Lady said. If she was asking whether the problems in England are similar to those in Scotland, I think that we share problems, particularly across the busy winter period. She has observed that Scotland is also failing to meet the target. She is right to say that bed capacity is absolutely critical, and that is something we have not always got right in England. There have been times when beds have been decommissioned and the alternative provision that was promised has not been made, which has big knock-on effects. When it comes to what happens in Scotland and England, I think that Scotland has gone further than England in the use of community pharmacy, which is to be commended, but England has gone further in our plans to reform and increase investment into general practice. That is what the president of the Royal College of General Practitioners was talking about over Christmas when she said that she was keen for Scotland to match the package that we have in England.

  • I commend my right hon. Friend’s statement. Of course, we all know the work that is done in our local areas by all those working in the NHS at such a difficult time. In relation to mental health, will he confirm that the Prime Minister’s very welcome speech this morning also emphasised the importance of perinatal mental health, and that some of the extra resource will continue the great work on that? Will he also emphasise the point about transparency, because knowing what CCGs are doing assists Members of Parliament not only in calling for extra resource, but in ensuring that our areas do the best they can compared with others, rather than simply making a general point about resources, which is always the easiest point to make?

  • My right hon. Friend did a huge amount of good work on mental health when he was a colleague in the Department of Health. On perinatal mental health, we know that 20% of mothers suffer some form of pre or post-natal depression, which has a huge impact on the child, with lifetime costs of around £10,000 for every birth in this country, caused by lack of proper mental health provision. The plan announced today means that we will be able to treat an extra 30,000 women better—we think that is the number who need to be treated. He makes an important point about transparency. I would put it like this: funding matters, and we have some of the best mental health provision in the world, but it is not consistent. The only way that we can make it consistent is by shining a light on the relative performance of different parts of the country, so that we can bring all areas up to the standard of the best.

  • The Minister says that there are 9 million more patient visits now than there were in 2000. Is he aware that in that climate, shutting hospitals such as the Bolsover community hospital, led by the Hardwick clinical commissioning group, makes no sense at all? He turns a blind eye to it. Will he look at this question, because when those hospitals are shut, the beds are gone forever? Get stuck in.

  • I actually think that broadly the hon. Gentleman makes an important point. It is not just about decisions to downgrade or close A&E departments when there is no alternative provision; it is also about community hospitals, which are very important places for A&E departments and hospitals to step people down to. He is right to say that the NHS—[Interruption.] I am getting comments from a sedentary position. With the greatest respect, this process has been going on in the NHS for decades, and I do not think that we always got it right under both parties, but I think that he is right to say that when there are changes in provision in community hospitals, we need to ensure that we have good alternative plans.

  • In wishing the hon. Members for Morley and Outwood and for Filton and Bradley Stoke all the best in the weeks and months ahead, I call Andrea Jenkyns.

  • Thank you, Mr Speaker. First, I echo some of the points made by the Secretary of State regarding mental health support for expectant mothers. As one myself, I have to say that the midwives have been fantastic. Right from the very first appointments at grassroots level, they mention mental health, so we are feeling the support on the ground.

    I welcome today’s statement, which shows the Government’s commitment to mental health by making it a centrepiece of the agenda. One in 50 young people in Yorkshire receive care for mental health. How will the new approach address the concerns of the young people and their parents, and what measures are in place to reduce the waiting list for child and adolescent mental health services?

  • I add to Mr Speaker’s comments my very good wishes and confidence that my hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) will get superb care from the NHS. I thank her for campaigning on patient safety. I am sure she will be pleased to hear that our principal safety campaign this year is on maternity safety.

    In bald numbers, the plan will mean that we will treat 1 million more people with mental health conditions a year by the end of this Parliament. Of course, many of those will be in Yorkshire. An additional 70,000 young people will get treatment every single year and I hope that will bring down the CAMHS waiting times. We also want to do work in schools to prevent people from getting on the CAMHS waiting list in the first place.

  • The YoungMinds survey published before Christmas showed a failure in 50% of clinical commissioning group areas to spend the full amount of extra investment allocated to children and young people’s mental health. That is scandalous. I note the Secretary of State’s point about Ofsted-style ratings, but does he not need to introduce a system that guarantees that the money the Government promised for children’s mental health is actually spent as intended?

  • The right hon. Gentleman is right to want to ensure that we live up to those promises. He was a Minister when some of those promises were made and they are very important. I would say that we are delivering what he wants. We are on track this year to spend around £1 billion more, compared with two years ago when he was Minister for mental health. It has taken time for the NHS to get the message on mental health, but it is getting through loud and clear.

  • As a frequent user and admirer of the Red Cross, I regard its claims as being grossly over the top. I join the Secretary of State in his tribute to the wonderful work of the frontline staff of the NHS at a very difficult time. Does he agree that the pressures are not going to go away, and that there must be a continuing drive for reform and to do these things better? What exactly are the impediments in the NHS to the sharing of best practice, and what steps is he taking to create a more experienced and better trained leadership who are more prepared for the exceptional medical and management challenges that the NHS now faces?

  • My right hon. Friend speaks extremely wisely. I, too, think that we have to be very careful about the language we use in these situations because many vulnerable people can be frightened if we get the tone wrong. The vast majority of NHS services are performing extremely well under a great deal of pressure. His point about leadership is extremely important and one to which I have given a lot of thought. At the heart of the problem is that we do not have enough hospitals being run by doctors and nurses. Around 56% of our managers have a clinical background, compared with 76% in Canada and 96% in Sweden. To put it bluntly, doctors like to be given instructions by other doctors. Exceptional people from a non-clinical background can do it, but it is hard because doctors have many years of training and are highly experienced people. I have put in place measures to try to make it easier for more clinicians to become our managers of the future.

  • In wishing the hon. Member for Liverpool, Wavertree all the best in the period ahead, I call Luciana Berger.

  • In her speech today, the Prime Minister made a number of hard-hitting observations. She said:

    “there is no escaping the fact that people with mental health problems are still not treated the same as if they have a physical ailment”.

    She reported on the increase in self-harm among young people, and she told us about the shocking reality that, on average, 13 people take their life every single day in England. Given that the Conservative party has been in government for almost seven years, and that the Secretary of State has been Health Secretary for almost four of those years, who does he think is responsible for the terrible failures highlighted by the Prime Minister today?

  • I just think that is a totally inappropriate question—[Interruption.]

  • With great respect to the hon. Lady—she campaigns tirelessly on mental health, and she deserves great credit for that—that is the same as saying that the last Labour Government should have sorted out every single problem in mental health by 2010, and I am not standing here saying that. The truth is that we have made good progress; if she thinks that it is trivial that we are treating 1,400 more people every day for mental health conditions, she should go and talk to some of her own constituents who are getting access to mental health provision, who would not have been getting that access under the policies of the last Labour Government. We have made big strides in our mental health provision, but there is much more to do, and we are determined to do what it takes.

  • Recognising that the supply of extra resources for the NHS will be a vital and continuing issue, is my right hon. Friend not exactly right when he says that equal attention has to be given to controlling demand so that people do not simply instinctively make calls on GPs’ surgeries and A&E departments, which doctors themselves believe are avoidable and which could be dealt with in other ways?

  • My right hon. Friend speaks extremely wisely. At the heart of it, we have a good commitment—the four-hour commitment, which was introduced by a Labour Government. I think it is one of the best things the NHS does: the promise that if someone is ill and needs urgent help, we will do something about it and get them under proper medical care within four hours. However, if we have the situation NHS England now describes, where up to 30% of the people in A&E departments do not actually need to be there, we risk not being able to deliver that promise for the people who really do need it. That is why looking at how we can control demand from the people who do not need to be in A&Es, such as through the significant increase in investment in general practice and other measures, is going to be vital if we are going to crack this.

  • The Secretary of State seems to be blaming the public for overwhelming A&E departments, when he well knows that the reason they go to A&E is that they cannot get to see their GP and social care is in crisis. Will he confirm that he has just announced another significant watering-down of the four-hour A&E target, following the watering-down by the coalition in their first year in office back in 2010? What is he personally doing to address the chronic long-term underperformance of hospitals, such as that at Worcester, where two people died on trolleys, and Plymouth, which is one of the hospitals that had to call in the Red Cross over the Christmas period?

  • I think—probably because of the forum we are in now—the right hon. Gentleman is misinterpreting what I have said, and it needs to be put right. Far from watering down the four-hour target, I have today recommitted the Government to that four-hour target. In just the answer before he spoke—maybe he was not listening—I actually said I thought it was one of the best things about the NHS that we have this four-hour promise. But the public will go to the place where it is easiest to get in front of a doctor quickly, and if we do not recognise that there is an issue with the fact that a number of people who do not need to go to A&Es are using them, and we do not try to address that problem, we will not make A&Es better for his constituents and mine. If he asks what we are doing to turn around hospitals in difficulty, we have introduced the new Care Quality Commission inspection regime and a chief inspector of hospitals—the most rigorous inspection regime in the world, which the Labour party tried to vote down.

  • I welcome the Prime Minister’s announcement and the Secretary of State’s confirmation about the extra support for mental health. I particularly welcome the review to be led by Lord Stevenson and Paul Farmer. As they carry out that review on improving businesses’ ability to support people with mental health problems, will they particularly look at how we can help smaller businesses—those that perhaps do not have the human resource expertise that larger businesses may have—to make sure that people with mental health problems stay in work and are able to get back into work when they fall out of it? They are the biggest single category of disabled people not currently working, and we could make a huge difference.

  • My right hon. Friend will of course know that from his distinguished time as a Minister in the Department for Work and Pensions. He is right. The central problem we are trying to address is that if someone, for example, stops going to work and is signed off work because of severe depression, that is bad for the individual and also bad for the business. Too often, what happens at the moment is that it then becomes entirely the NHS’s responsibility to get that person back to work; the business says, “Well, it’s not our responsibility anymore because they’re not turning up.” With a little bit of help from the business, we could get the person back to work much more quickly, meaning that they recovered more quickly and the business would not lose someone important. That is what Dennis Stevenson and Paul Farmer will be looking into.

  • We will never solve the challenges facing the NHS and social care until there is a long-term settlement for funding both. Does the Secretary of State understand that the social care precept is completely inadequate to filling the gap and will increase inequality, because the areas that most need publicly funded care will be least able to raise that money? Will he speak to the Chancellor and the Communities and Local Government Secretary to look again at this issue and get the funding that social care desperately needs?

  • I agree with the hon. Lady that there are serious funding pressures in social care. We need a long-term solution to this, and we are doing important work on that. The precept is part of the solution. The local government settlement has been adjusted to take account of the different spending powers, or revenue-raising powers, of wealthier counties and wealthier local authority areas compared with other areas. We have to take into account the equality issue, and she is absolutely right to do that. However, if she is saying, “Have we solved the whole problem?”, the answer is no—there is more work to do.

  • I welcome the statement by my right hon. Friend. May I pay huge tribute to everybody working at Nottingham University Hospitals NHS Trust, especially in A&E, and especially over the nine days between Christmas and 2 January? Admissions almost doubled. At one point in the Queen’s medical centre A&E department there were 180 people seeking treatment—that is a record. There were 395 more admissions than discharges in that nine-day period. I pay huge tribute to everybody who is working in our NHS. Can my right hon. Friend give me an assurance that he will continue to work with our hospital trusts, like NUHT, as they bring forward plans to change schemes —it is not just simply about money—and do everything that he can to support them in these unprecedented times?

  • I am happy to do that. I echo my right hon. Friend’s praise for the staff at NUHT, which was particularly pressured over Christmas. They have made particular efforts to improve patient safety and quality of care over recent years. She is absolutely right, and of course I will continue to work closely with her trust and others.

  • At 9.30 am today I received an email from a constituent in Coventry who asked me to bring it to the Secretary of State’s attention; I am delighted to do so. She writes as follows:

    “I am a nurse with 26 years’ experience who has always worked full time and has paid my tax and national insurance without ever having to burden the government, social services or the NHS in my lifetime but have gladly served and given 100%”

    to it. She continues:

    “Unfortunately, my 18 year old daughter has recently become unwell mentally and attempted suicide twice in a 3 week period…I am really sad to say—

    this comes from a nurse of 23 years’ experience—

    “that the care she has been given has been dreadful. I am somebody who works in the NHS so I understand the strains the service is under but I also expect that as a family who give so much to society that when it is our time of need that we can expect a service that meets our needs.”

    I ask the Secretary of State whether he will kindly agree to meet Mrs Hardy and me—Sarah Hardy is the lady’s name—or arrange for her to meet somebody who can give her some sort of reassurance. She continues that she has been waiting six months without any mental health assessment or support from the NHS—six months for a daughter of 18 years of age. Will he agree to do that so that it is not just a case of more hollow words?

  • I am more than happy to meet Mrs Hardy, but ahead of that I would like to look at the particular issue of why she has had to wait for so long. The hon. Gentleman put it very eloquently, and she put it very eloquently, and we owe a huge debt to such people. What she has described with her 19-year-old daughter’s treatment is just not satisfactory: it is not good enough. That is why the Prime Minister talked this morning about the injustice of having to wait so long for treatment, and that is exactly what we are trying to put right.

  • The House of Commons Library has calculated that the real-terms increase in health-related spending between 2010 and 2016 was 9.4% in England, yet it was zero in Wales. Not only are A&E waiting times consistently longer in Wales than in England, but waiting times for routine procedures can be as much as two and a half times longer in Wales. I regularly see constituents in tears who are waiting well in excess of a year for hip operations. Does the Secretary of State agree that the Labour party must start to acknowledge the challenges facing the NHS in Wales and accept responsibility for them? [Interruption.]

  • I think my hon. Friend’s constituents in Wales would be appalled by the reaction we have just had. Labour Members stand on their high horse in complaining about NHS care in England, but when he brings up poor NHS care in Wales, they tut and make noises as though they do not want to hear about it. If they care about NHS patients, they should care about them throughout the whole of the United Kingdom. I am afraid that that just shows the party political agenda. Yes, my hon. Friend is right: NHS care in Wales is worse, and Labour needs to do something about it.

  • I have been contacted by several constituents who have spent 14 hours in A&E waiting for a bed. As well as by social care cuts, we have been hampered by a shortage of A&E doctors. The Department of Health was warned that that would become a growing problem over five years ago, and the Health Committee warned about it again last year. When will this shortage of A&E doctors be ended by the Government—by the summer, by next year, by the following year? The Secretary of State has had seven years. When will he deal with the shortage of A&E doctors?

  • Let me tell the right hon. Lady what we have done about A&E doctors. Their number has gone up by 1,200 since 2010, which is an increase of over 50%. The number of A&E consultants has gone up by 500, which is an increase of over 20%. At the same time, we have recruited 2,000 more paramedics. As a result of those changes, our emergency departments are seeing—within the four-hour target—2,500 more people every single day compared with 2010. That is not to minimise the pressures in the NHS we have had over the winter or to say that there is not more that needs to be done, which is why I outlined a number of things in my statement.

  • The Secretary of State kindly came to see the plans for the emergency room at Worthing hospital and came back six years later to see how it is working and to admire it in operation. I hope that the next time he comes he can look at the Zachary Merton community hospital and the Swandean mental health services as well.

    On child mental health care, may I put it to him that a quarter of the 700,000 teenagers going through each stage each year will have bumps and need resilience, and that their parents and teachers need help? Will he make sure that the Green Paper covers advice to parents and teachers so that they know what is in the normal range of behaviours and what is outside that range?

  • I commend my hon. Friend for his one-man campaign, which I continue to admire on many occasions, against the misinformation put out by 38 Degrees. I thank the staff at Worthing hospital for their fantastic work over the busy Christmas period. As usual, he puts his finger on a very important issue, which is that as we seek to raise the profile of mental health treatment for children and young people, we must not medicalise every single moment of stress. For example, worries before exams are not cause to talk to an NHS psychiatrist. A lot of work on the Green Paper will be looking at how we can promote self-help and at how we can help schools to support people through difficult patches, but we will also look at how we can make sure people get NHS care quickly when it is needed.

  • It is great to see the Secretary of State here today in the Chamber after enjoying his Christmas recess. While he was away staff on the NHS frontline had to work double shifts, the London ambulance service computer system crashed and we found out that the Red Cross needed to be drafted into our hospitals. Will the Secretary of State tell us which hospitals he visited during the Christmas recess?

  • I was in touch with what was happening in the NHS every single day throughout the Christmas recess. As someone who has worked in a hospital, the hon. Lady might question whether it is particularly helpful for NHS hospitals to have visits by high profile politicians right at their busiest periods. I have been very closely in touch. She talks about the problem at London ambulance service. That was a problem staff have been trained to deal with. The staff of her own hospital worked extremely well, but they do not welcome attempts—she is making one this afternoon—to politicise the problems the NHS faces.

  • On the changes to the four-hour standard that the Secretary of State heralded, what can be done to incentivise and upskill GPs who may wish to take a closer interest in minor and moderate illnesses, including the use of nurse-led minor injury units?

  • They have a very important role. Some of the most successful and best-performing trusts, such as Luton and Dunstable, have a very good streaming process at the A&E front door, with good alternatives when it is not appropriate for people to go to an A&E department. We need to learn from that. Nurse-led units can be very important. GP-led units can make a big difference, too. It will not be the same everywhere, for reasons of space if nothing else, but there is a solution that everywhere can adopt.

  • In the past few weeks, we have seen pressures in the NHS that, to a certain extent, the Secretary of State has acknowledged. Given that we are not yet in the midst of a very desperate cold spell, and given that we are not in the midst or throes of a flu epidemic, how can he come here today and complacently suggest he has a grip on our NHS services? Why was he not on top of those trusts he knew were weak? He knew they would be under threat if there was any pressure. What is he going to do when we hit a cold snap and people are suffering from flu in large numbers?

  • I am afraid that I reject that suggestion. The right hon. Lady wants to know what we have been doing over the course of the year. As I said in the statement, we have 1,600 more doctors than we had just a year ago, over 3,000 more nurses, the biggest flu vaccination programme in our history and 12,000 additional GP sessions booked over the festive period. A huge amount of work has been done, with a particular focus on distressed areas. Many of those distressed areas coped extremely well—not all of them, which is why there is more work to do.

  • When the Health Committee in the previous Parliament looked at children and adolescent mental health services, one of the main concerns was the distance travelled by patients—sometimes halfway across the country—to get treatment. Will the Secretary of State expand on his plans to reduce attendance at A&E? Does he envisage a new form of gatekeeper and does he intend to try to keep drunks out of A&E?

  • I would probably use the word streaming, rather than gatekeeper, to ensure that we have good, alternative offers for people who do not need to be in A&E. Frankly, it is not safe for an A&E department to have people there for six, seven or eight hours with a minor injury and no urgent health need. It is distracting for staff and can make it more difficult for them to deal with people who have more immediate needs.

    On distances travelled, as the Prime Minister said this morning it is completely unacceptable for people to have to go 400 miles for a mental health bed. What is the solution? We are commissioning more beds, but the actual solution is to intervene earlier so that people do not get to that stage in treatment where they need in-patient care. We know that if we intervene earlier we can in many cases head off that need and help people to get better more quickly.

  • This afternoon, patients at Nottingham’s Queen’s Medical Centre emergency department are waiting on average for more than four hours. In the last month for which figures are available, 3,500 people had to wait for more than four hours in the emergency department. We cannot go on like this, so will the Secretary of State agree to fast-track the capital we need to increase capacity at Nottingham’s emergency department?

  • I will happily take a look at that. Obviously, when it comes to the allocation of capital, we prioritise any projects that will help us to improve the situation in A&E departments and reduce the stresses.

  • The Secretary of State has acknowledged that there is a shortage of acute mental health beds. That arises from the decision by many health trusts to close beds in favour of putting resources into services in the community. One effect is that people approaching a mental health crisis find it harder to know where to turn for help. Will he explain more about the crisis provision in which we are investing the extra £15 million? Is there a common way of knowing how one can easily access those vital services?

  • I am happy to supply more details. The £15 million is for places of safety—it is very specifically focused on support for the police service so that we can ensure that we live up to our legal commitment from this year not to send young people into police cells when they actually need mental health support.

    More broadly, my right hon. Friend is right that there is a policy change—most people think it is the right thing—to treat more people in the community where we can. What is not working in the way it needs to work is the system that divides people up into four tiers, which means that we sometimes say to people, “We can’t treat you because you are tier 3.” People get sent away, which is not acceptable. That is why we are producing a Green Paper. We want to look at a better way forward.

  • Does the Secretary of State accept that the deepening crisis in the NHS is not solely down to an ageing society, and that failure to provide sufficient funding is the key to the crisis, and therefore that it is possible to address it? What will he do about it?

  • If the hon. Lady is worried about funding, she might explain why funding for the NHS in England went up by double the rate of funding for the NHS in Scotland over the last Parliament—[Interruption.] I will get her the figures on Northern Ireland, but I say that by way of reference. I apologise for my error.

    I agree with the hon. Lady that it is not just about the ageing society; it is about changing consumer expectations and the fact that people want access to healthcare 24/7 today in a way that was not the case 10 or 20 years ago. That in itself is the cause of a lot of the additional pressure.

  • I welcome today’s announcement on mental health. It is absolutely clear that the Government are serious about improving mental health treatment and prevention. The challenge is to translate ambitions into action. Will my right hon. Friend assure me that he will put in place mechanisms to ensure that the proposals and those in the five year forward view for mental health become reality? Specifically, will he look at ensuring that no sustainability and transformation plan is signed off without clear plans and funding for improving mental healthcare?

  • I can assure my hon. Friend that that is happening. Indeed, one of the key metrics by which we will judge STPs is their progress on delivering our mental health targets. She is absolutely right to say that ambitions need to turn into action, but she will find that, because of the comments that she and many other hon. Members have made over the past few years, there is much more understanding in the NHS that mental healthcare is a big priority, and more understanding that we need to stop resources constantly being sucked into the acute sector, as has happened over many years.

  • The Secretary of State recently announced that the Government were pressing ahead with significant cuts to the community pharmacy budget in the Department of Health in the face of huge opposition from Members on both sides of the House, members of the public and healthcare professionals. Given the evidence that one in five people who would usually see a pharmacist for medical advice say that they will make a GP appointment if their local pharmacist is closed—in areas of higher deprivation such as mine, it is four in five—and with the risk that many of those people in desperation will turn up at the local hospital, are the Government in danger of making an appalling crisis in the NHS even worse?

  • As with all parts of the NHS, we have to ask the pharmacy sector to make efficiency savings. Some 40% of pharmacies are clustered in groups of three or more, and it does not make sense for the NHS to continue to subsidise pharmacies that are very close to other pharmacies. Our reforms are designed to ensure, however, that where there is only one local pharmacy that people can access, that pharmacy is protected.

  • Does my right hon. Friend acknowledge the damaging effect that loneliness can have on mental health, and will he join me in welcoming the launch of the Jo Cox loneliness commission at the end of this month?

  • I am happy to do that and to acknowledge the importance of this issue. The latest figures I have seen are that 5 million older people say that their main form of company is the television, which is not acceptable, and we all have a responsibility to do better. It is not just a moral but a practical issue, as loneliness makes people more likely to need hospital treatment, which is of course expensive and challenging for the NHS.

  • The Secretary of State has talked a great deal about preventing people from needing to go to A&E by intervening much earlier, yet surely he must recognise that the cuts to local authorities and social care make it much more likely that people will not be picked up earlier in the progress of an illness but will have to resort to the health service in a much more difficult situation. Can he not now have a discussion with his ministerial colleagues, particularly the Chancellor, and tell them that they have got this wrong and that we have to invest in preventive services? That means refunding local authorities, rather than the 57% cut my authority has had, and investing now in proper social care, not the £5 billion of cuts in social care since 2010, otherwise the pressure on our NHS will just continue?

  • I actually agree with the right hon. Lady’s broad point about the importance of the social care system and its interconnectedness with the NHS. As she well knows—her party’s manifesto reflected this as well—in 2010 we faced a very challenging economic situation, and both parties recognised the need for cuts in public spending. What changed in 2015, however, at least in the Conservative party’s manifesto, was the recognition that we needed to increase funding for the social care system, and with the changes announced by the Secretary of State for Communities and Local Government in December, all local authorities can now increase funding for social care in real terms. I hope that we can start to turn things around.

  • With the recent Education Select Committee report on children in care in mind, I welcome the Prime Minister’s refocus on mental health and the Secretary of State’s continued support for action. What practical steps does he have in mind, given our finding that local integration, effective relationships and the teaching of personal, social and health and economic education all help to produce good outcomes?

  • My hon. Friend is absolutely right—obviously his role on the Select Committee gives him a particular insight—but we do not want to rush to a solution, which is why we have said that we will produce a Green Paper before the end of the year. It is a complex area. Other hon. Members have alluded to the risk of medicalising problems, given that, as we know, all young people at school experience periods of stress, anxiety and worry that are not necessarily diagnosable mental health conditions and which we would not want to make out to be such. This is about thinking through a smart way to improve resilience training and self-help and to educate schools so that they can spot when something is just a temporary thing in the run-up to exams, or whatever, and when it could be something a lot more serious, such as obsessive compulsive disorder, an eating disorder or something else that needs more immediate help. We have today started a big education programme with schools, but we want to go further.

  • I welcome the extra investment, if that is what it turns out to be, in mental health, but I want to press the Secretary of State on the question asked from the Dispatch Box by my hon. Friend the Member for Leicester South (Jonathan Ashworth) about educational psychology and how it will work. I speak as a mother of a child with SEN issues who has relied on clinical and educational psychology in schools. The school that my children currently attend is increasing class sizes from 30 to 33 and reducing the teaching staff—specifically those who engage with SEN children—because of changes to education funding. How does the Secretary of State think that will affect the mental health of pupils in my children’s school?

  • The hon. Lady raises a very important issue. Like her, I have had constituents who found it difficult to access educational psychologists and they have not been able to get approval for the plan that they need. We will consider these issues in the build-up to the Green Paper, and I encourage the hon. Lady to participate in that process.

  • Will the Health Secretary please get the message out there loud and clear to health bosses up and down the country that we need more capacity in our A&Es, so that when my CCG goes to NHS England with a request for £285 million for its appalling plan to downgrade my local A&E, bulldoze Huddersfield royal infirmary and replace it with a small planned care unit with fewer beds, it will realise that that money would be better spend on frontline A&E care in one of the country’s biggest towns.

  • I take seriously, of course, everything my hon. Friend says. I will say that the NHS does not always get these things right. I led a campaign against an A&E closure in my constituency when I was a Back Bencher—[Interruption]—and the Labour party was in power and about to take a wholly mistaken decision, which I was luckily able to persuade the Government not to take in the interests of my constituents. We will look carefully into these issues. On the broader point that my hon. Friend makes, we have to understand across the NHS that capacity matters, but in the long run, we will not solve the problem solely by increasing capacity in A&Es for ever. We need alternative forms of provision. Demand is growing, so we need to find different ways to offer treatment to people who do not need to be in an A&E. That is what we are exploring.

  • I declare an interest in that my husband is an A&E consultant. If the Secretary of State were to speak to him, he would be told that, as we have already heard, the extra pressures on A&E are the result of the almost disappearance of preventive care, social care and other services. The problem is not individuals arriving in A&E who should not be there; it is other services that are referring people to A&E when they should not. Will the Secretary of State take responsibility for his Government’s decisions over the past six years that have now turned out to have been a false economy, because cutting all these vital services back to the bone is what is putting A&E on the brink of breakdown?

  • I agree with the broader principle that preventive care is vital, but with respect, I disagree with the suggestion that services have been cut to the bone. We have 1,600 more GPs—an increase of 5%—and the NHS was protected in the last Parliament. We recognise that there are problems in the social care system, which we are now in the process of putting right. Both at the last election, when the hon. Lady put a lot of input into Labour’s policies, and the one before it, the party promising the most resources for the NHS was the Conservative party, not the Labour party.

  • Everyone knows that the Secretary of State has an impossible job, which he does with humanity and energy. One part of his impossible job relates to the two-tier system, whereby much depends on where people live. In rural north Lincolnshire, people can wait more than three weeks to see a doctor and can wait two hours for an ambulance to come—[Interruption.] Yes, people have waited two hours, lying in the street, in places such as Market Rasen, while they wait for an ambulance. That is not acceptable, and it can be even worse on occasions. This comes on top of long-term lack of investment, which means we lack a psychiatric unit at the Peter Hodgkinson centre in Lincoln. I wonder whether we now need to start an honest discussion with the people about how we are going to devote more resources to health in this country. It could be through social insurance models or even—God forbid, and I know people will not agree with this—charging people who do not turn up for appointments.

  • While I do not agree with moving to a social insurance model, I have some sympathy with what my hon. Friend has said about the broader issue of resourcing healthcare. If there are to be a million more over-65s in the next five years, we shall have to find a way to continue to invest more in our health and social care systems over the decades ahead. We are doing that this year in providing an extra £3.8 billion, and Governments will need to continue to do it in the coming decades.

    My hon. Friend has rightly highlighted a specific problem. I do not have a solution to it now, but I want him to know that I understand that, in rural areas, people can wait too long for ambulances. Our system of targets gives ambulance services an incentive to prioritise the calls to which they can respond quickly in nearby towns, but I shall look into the issue.

  • The Secretary of State tells us that he has a plan and a strategy, so I assume that he is on top of all the facts, but will he assure us that he understands the scale of the problem by answering this question? As of the latest count this week, how many hospital beds were being blocked by people who could not be discharged because no facilities for their care were available in the community?

  • I will write to the hon. Gentleman with the figures.

  • More than a third of A&E attendances at peak times are caused by drunkenness. Behaviour on such a scale is as unacceptable as it is irresponsible. What more can be done to reduce that proportion hugely by this time next year?

  • My hon. Friend has raised an issue of public accountability. These are our national health services, and we need to treat them in a responsible way. It is selfish to behave irresponsibly and impose pressure on an A&E department, because someone else who needs help may not be able to get it.

  • First, may I ask whether the Secretary of State is accusing the Red Cross of weaponising the national health service? Secondly, let me point out that when the NHS makes cuts, the services that suffer time and again are the so-called Cinderella services: mental health services. The only way to prevent that is to ring-fence the funds and force local commissioners to demonstrate to local populations that the extra money is genuinely being spent on improving mental health services. Finally, as we heard from my hon. Friend the Member for Manchester Central (Lucy Powell), when local authority services are cut to the bone, they can only provide statutory services and all the preventive services go—never mind the cuts in social care. What is preventing the Secretary of State from commissioning an all-party group to seek a sustainable, long-term funding model for social care?

  • The Prime Minister has said that we need to find a long-term solution to the problem of funding social care, and that work is ongoing. We recognise the urgency of the situation.

    As for the evidence of whether mental health services are reaching the frontline, we need to establish whether more money is being spent on mental health provision than in previous years, and, as I said earlier, about £1 billion more is being spent than was being spent two years ago.

  • As my right hon. Friend has mentioned, the A&E departments at the Worcestershire royal hospital and the Alexandra hospital in Redditch have been under huge pressure over the past few weeks. Can he reassure patients at both our hospitals that everything possible is being done to alleviate the problem? While I am grateful for the measures that have been introduced, what our trust really needs is agreement on a £29 million bid to increase capacity, and I urge my right hon. Friend to consider that as a matter of urgency.

  • I thank my hon. Friend for her interest—on behalf of her constituents—in what has been happening. Subject to staffing, a new ward will be opened at the trust next week, and a new chief executive will arrive in the spring. We recognise the need for capital spending to increase capacity at both the Alex and the royal, and we will consider that bid sympathetically.

  • The Secretary of State could not resist making his customary political attack on the Welsh NHS. This weekend, I had cause to visit my local hospital A&E department with a family member, and we received a brilliant, speedy and expert service. Will the Secretary of State join me in congratulating the staff at the Royal Glamorgan hospital? Will he also congratulate the Welsh Labour Government on not having to call the Red Cross to any hospital in Wales, and will he further congratulate them on their long-standing emphasis on mental health? Wales spends more on mental health provision per capita than England or, indeed, any part of the United Kingdom, notwithstanding the £2 billion that he has cut from the Welsh budget in the past six years.

  • In the hon. Gentleman’s long list of statistics, what he was not prepared to say is that people wait twice as long for a hip replacement in Wales, more than double the proportion of the population is on a waiting list for NHS care—that is one in seven people in Wales, compared with one in 15 in England—and those in Wales are 40 times more likely than those in England to be waiting too long for a diagnostic test result.

  • Torbay, like many other places, has been under pressure owing to the demographics of an ageing population in the bay area, but does the Secretary of State agree that it is encouraging to hear of work being done in places such as the Chelston Hall practice, which I visited on Friday, to make sure doctors can be available on the day for those who need them and people are sent on to specialists who can help them better, such as a physiotherapist, rather than just taking up vital GP appointments?

  • Yes, indeed, and I congratulate all the NHS and social care staff in Torbay for doing a fantastic job. I also congratulate them on the pioneering work they have done on health and social care integration, which has made a huge difference to my hon. Friend’s constituents.

  • Over the new year, East Midlands Ambulance Service NHS Trust saw life-threatening calls up 42% on last year, and the chair of Nottingham University Hospitals NHS Trust described its emergency department as pushed to the limit, with, as the right hon. Member for Broxtowe (Anna Soubry) said, almost double the normal number of hospital admissions, so clearly these were necessary attendances, but surely many of them could have been prevented. The Secretary of State has already acknowledged the connection between inadequate social care and this entirely foreseeable crisis, so I ask again: will he commit his Government to fund this properly?

  • I find these questions about funding curious coming from members of the Labour party, as, had we followed its plans, we would be spending £1.3 billion less on the NHS this year than what the NHS is actually getting, and I just say to them that the reason why we are able to spend that extra money on the NHS is that we know how to run the economy.

  • All too often, mental health patients have wondered whether this issue has enough leadership, and I am incredibly pleased that the Prime Minister made one of her earlier speeches on this issue, but while no one in this House would oppose an extra £1.4 billion being invested over the course of this Parliament, may I echo the words of the chief executive of Mind that the proof will be in the impact this investment has on patients’ day-to-day experiences? So will the Secretary of State ask the Minister with responsibility to meet with me to discuss plans to build a new psychiatric and dementia care unit at Bath, to service the whole of the south-west?

  • I am happy, on my hon. Friend’s behalf, to ask the Minister responsible to meet him to discuss that psychiatric unit. Of course the proof of the pudding is in the eating, but this is the first time that I can remember that a Prime Minister has made her first major speech on the NHS about mental health and indeed talked, on the steps of Downing Street as she arrived, about the importance of sorting out mental health. That is a sign of the commitment coming right from the top.

  • The fabulous team at Imperial, St Mary’s in west London are featuring in a television programme this week, and the chief of service for emergency care is reported as saying:

    “We’ve just had our worst 10 days on record. There’s nowhere in the hospital to move anybody. What’s happened in the last two years is the whole system, countrywide, has ground to a halt.”

    That is partly because there is more than the equivalent of a ward of patients at any time who cannot move out of the hospital because there is nowhere for them to go. Does the Secretary of State accept that his Government have gone too far in the destruction of local government finance, including for social care, and does he accept that next year, despite all the rhetoric, local government finance will go down, not up?

  • First, I would like to thank the staff at Imperial, who, alongside other NHS staff, have done a fantastic job over a very difficult period. I would say to the hon. Lady that 50% of councils have no delayed discharges of care. It is a problem in many hospitals, but there are many areas that are managing to deal with it. I suggest that the local authorities that serve her constituency should look at the other parts of the country that are dealing with this problem.

  • I welcome the provision of mental health facilities and services for schools, but will my right hon. Friend ensure that the type of first aid that he is proposing will also be made available to MPs and their staff, given the number of people with mental health problems that we deal with during our surgeries?

  • That is an absolutely excellent suggestion, and I will be very happy to take it up.

  • The problems in A&E that we have been hearing about this afternoon are symptomatic of problems elsewhere in the system. At Aintree hospital, whose staff are doing a fantastic job in very difficult circumstances, there are 130 patients who are medically fit for discharge today but social services are unable to support them to go home or to go into care elsewhere. The Secretary of State needs to accept that the cut of £4.6 billion to social services was a mistake. He also needs to accept that the better care fund is simply not delivering. It involves money being recycled from elsewhere in the system. Let us look at the figures for Sefton, which was promised £9 million but has received less than £1 million. If he is serious about sorting out the problems in social care in the long term, he needs to get the funding right. He needs to reinstate all the cuts that have been made.

  • I accept that more funding needs to go into social care, and that is why we are putting an extra £3.5 billion per annum into social care by the end of the Parliament. Despite the very real pressures in social care, however, there are many local authority areas and hospitals that have no delayed discharges at all. Half of all delayed discharges are in just 20 local authorities. As we wait for that funding to come on stream—it is not all coming on stream at the start of the Parliament—there is lots that can be done.

  • I thank the Secretary of State for paying tribute to frontline staff. I declare an interest as someone who worked in the NHS over the Christmas period and who saw at first hand some of the pressures that frontline staff are facing, but I know from my 20 years’ experience working as a nurse that these are winter pressures that are faced every year. On mental health, will my right hon. Friend pay tribute to the mental health care nurses in Sussex and to Sussex police? Through their joint working, they have reduced the number of patients being placed in prison cells as a place of safety by 50%. That is a huge achievement in the county that contains Birling Gap and Beachy Head.

  • I welcome my hon. Friend’s contribution to the House as a practising nurse; it adds greatly to the House. I am more than happy to pay tribute to our brilliant mental health nurses. They have one of the most stressful jobs anyone can have, and I pay particular tribute to the ones in Sussex, which has those tragic suicide hotspots.

  • Given that the cold weather is coming, I want to return to the risk of a flu epidemic. A desperate doctor wrote to me last night to say:

    “Sooner or later, there will be an epidemic and let me tell you: we cannot cope. Another shift, another full hospital. Another gridlocked A&E, more desperate but often implausibly understanding patients. Another 13 or 14 hour shift with one 10 or 15 minute break. Some patients and relatives get angry, some despair, most watch us and realise we can’t physically do anything more.”

    Please help me, as her MP, to represent her, and please help us to have more staff.

  • That doctor speaks for many doctors who are working incredibly hard, particularly in our emergency departments. I would say to that doctor that we recognise the need for more doctors and we are recruiting more doctors, not just across the NHS but in emergency departments in particular. We also recognise that we need to find a different way to deal with some of the patients who come to the hospital front door, so that we can alleviate the pressure. That is what we are looking at.

  • I recently visited Bridewell organic gardens, an award-winning charity in my constituency that improves the mental wellbeing of those suffering from a range of mental health conditions. I welcome the Prime Minister’s announcement this morning raising awareness of the ongoing stigma regarding mental health, as well as the £1 billion investment and the commitment to improving services, but is the Secretary of State prepared to investigate schemes such as the one I mentioned to ensure that treatment of those suffering from mental health conditions is not simply limited to the provision of medication?

  • I am absolutely prepared to do that. We need to be open-minded about the fact that mental health, in some ways, is a relatively new field, and research on what works best is continuing to uncover many new things—much of that research is happening in this country. There has been a big move away from thinking that medication is always the best way forward. We have seen a huge expansion in talking therapies in the past few years in this country, and I am sure that trend will continue.

  • Despite the best efforts of dedicated NHS staff, patients attending one of my local A&Es were told that they would routinely have to wait 11 hours just to be seen. People were routinely on hospital trolleys for up to 20 hours. Mental health patients were sent to Colchester because it had the nearest available in-patient beds for 17-year-olds. Somebody I know waited six hours for a 999 ambulance, despite calling 999 three times. We can do better than that. To that end, I implore the Secretary of State—in fact, I plead with him—to intervene and suspend the needless downgrades of Dewsbury and Huddersfield hospitals, which will cost lives.

  • None of those examples of poor care is remotely acceptable. On my watch and under this Government we will see no return to the bad old days when people were routinely waiting far too long. [Interruption.] We recognise the problems that we have just had, and we are absolutely determined to make sure that we sort them out. If the hon. Lady’s local hospital reconfiguration ends up on my desk because it is referred by the local health scrutiny committee, I will look at the matter carefully and consider whether to refer it to the independent reconfiguration panel.

  • I welcome the Secretary of State’s statement and the Prime Minister’s focus on mental health, particularly the suicide prevention strategy and the £1 billion funding commitment to improving services. Mental health often not only affects the patient but affects their family and those closest and dearest to them—those who care for the patient. Does he agree that raising awareness and addressing the ongoing stigma of mental health is a vital part of our work on mental health?

  • My hon. Friend is absolutely right to mention that. We can approach this area with some optimism about the potential for change. If she looks at our progress on dementia over the past four years, she will see that not a day goes past without something in the newspapers about dementia. The understanding of dementia has changed dramatically. We can change attitudes, and we absolutely need to do so because the only way to get help to people in mental health crisis is if they talk about it openly. That is a vital thing to change.

  • I entirely agree with the comments about the pressures on GP services, preventive health and social care, but I particularly want to ask about mental health services for students. There were three suspected suicides in the first few weeks of term this year at Bristol University, and I know from speaking to Dr Dominique Thompson, who runs the student health services there, that the number of students presenting with mental health issues has grown exponentially over recent years. What can the Secretary of State say to reassure us that students leaving home for the first time to go to university will be in safe hands?

  • I had an interesting afternoon visiting the suicide prevention unit at Bristol Royal infirmary, where I had a good discussion about its pioneering work. I learned a great deal from that visit. We have a particular concern about the very significant growth in mental ill health among women aged 18 to 24. Today, the Prime Minister announced that we have updated the suicide prevention strategy to make sure that all parts of the country can learn from best practice, including places like Bristol.

  • I welcome today’s announcement on mental health, where excellent work is being done, led by Paul Farmer of Mind. Often, the key challenge is to identify those who need help and support, so will the Secretary of State agree to meet the Department for Work and Pensions to look at ways in which we can help to signpost those identified through the personal independence payments process to the additional support and help available?

  • Let me reassure my hon. Friend that those meetings are already happening; we have a health and work Green Paper, and we are particularly trying to speed up access to mental health services for people on benefit whom we can help to be more independent if we address their mental health problem more quickly.

  • I wish to pick up on a point the Secretary of State made about the right sort of patient arriving at A&E. Pat, a frail, elderly constituent of mine who had pneumonia-like symptoms, did not want to go to A&E and put pressure on hard-working staff, so she rang NHS Direct, only to be told there were 100 people in front of her for a doctor’s visit. Of course she thought she was going to die if she was left in her house, so she went to A&E, where she waited 20 hours for a bed. As the Secretary of State knows, that is unacceptable, so does he agree that there is urgent and immediate demand for out-of-hours doctors? If so, what is he going to do about it?

  • The hon. Lady is right to say that we need better alternatives to A&E for people such as her constituent. Sometimes those do not exist, but one thing we need to do is make sure that people who call 111 and need to speak to a clinician can get to do so quickly. One thing we have piloted successfully in other parts of the country is better GP supervision of people in care homes, who are sometimes the most vulnerable patients. We are looking at all these things, but on the broad direction of travel she is right to say that we need to find a better way forward for people such as her constituent.

  • In sparsely populated rural Lincolnshire, vital reforms of health and social care risk being undermined by the performance of East Midlands ambulance service. Our police and crime commissioner says that his officers are routinely acting, in effect, as ambulance drivers. I know the Secretary of State understands the problems we face in rural Lincolnshire, but does he agree that, as currently constituted, East Midlands ambulance service is not serving the rural parts of its area as well as its staff want to and as well as my constituents need it to?

  • As we discussed earlier when my hon. Friend the Member for Gainsborough (Sir Edward Leigh) spoke, there are places where the service that the ambulance service provides to rural areas is not as good as it should be, sometimes because of the perverse incentives relating to how the targets work. I have been nervous about changing the targets, because that can sometimes be taken as a signal to relax and I am absolutely determined that we should meet the current targets, but I did make a commitment to him that I would look into this issue and I will do so.

  • Last year, just 67% of category red 1 ambulance calls in Sheffield were answered within eight minutes. Last week, I met a constituent whose husband died while he waited for an ambulance for two hours and 40 minutes. Can the Secretary of State continue to stand at that Dispatch Box and say that there is no link between the underfunding of our NHS and these irresponsible and completely unacceptable response times?

  • First, of course what happened in that situation is totally unacceptable, but the hon. Lady makes a mistake to continually bring this back to funding, as it is also about demand pressures and models of care. Let me reassure her about the extra funding that has gone into ambulance services. We have about 200 more ambulances and about 2,000 more paramedics, and every day the ambulance service is doing about 3,400 blue-light calls more than it was six years ago. Significant investment has been made, but clearly more needs to happen.

  • The number of mental health patients in police cells is, rightly, down by 80%. People have bravely come to my surgery to talk about when they and their families have been struggling with mental health provision for those between the ages of 18 and 24. I pay tribute to Solent Mind and Southern Health, which are doing their level best to deal with this issue. One issue directly affecting that age group is the tier system, and people not being “sick enough” and not being sure where they should be going. Will the Secretary of State please confirm that he will focus on recruiting specialists in this area, because it is not about funding in my local clinical commissioning group—it is about finding the people to help those in need?

  • My hon. Friend is right on both counts. We need to look carefully at where the tier system is not working, and that should be part of our work on the Green Paper that the Prime Minister announced this morning. It is unacceptable for people to be told that they are not sick enough to get the care they urgently need. All the things we have announced and intend to announce to improve mental health will fail if we do not get the recruitment and training of new staff right. Along with the commitment we are making today to invest more in mental health must come some important strategic workforce planning, which I hope will benefit my hon. Friend’s constituents.

  • The Secretary of State referred to temporary assistance being given to distressed trusts, but is there not a more fundamental ticking time bomb in the form of the sustainability and transformation plans? I draw his attention to the debate I led on 16 December on the north-east London plan, which envisages a deficit of £578 million by 2021 and says that on a “business as usual” case model, with normal-type reductions and savings, there will still be a £240 million gap. That will mean poorer services. There is no capital provision for the closure of the King George hospital A&E and its re-provisioning at Queen’s hospital. Will he look into this matter urgently? There is going to be a massive crisis in my area unless urgent steps are taken to provide more resources.

  • I am happy to look into that issue. I take this opportunity to pay tribute to the staff of both Queen’s and King George hospital, who have not only done very well over the winter but have made great progress in turning around the trust, which, as the hon. Gentleman knows, is in special measures. We are hopeful that it might be able to come out of special measures at some stage this year under its new leadership, but that is obviously a decision for the CQC.

  • Kettering General hospital, which serves my constituency, has a significant problem with delayed discharges. Whatever the issues relating to money, perhaps the problem with social care is the model. Would it not be a good idea if the Opposition were to give a genuine commitment to try to work together to find a social care system for the future?

  • My hon. Friend is right to say that we need to have these discussions in a less politically charged way, because we need to find a solution that will survive changes in Government and be fit for the long term. We miss a trick when we say that the problem is primarily about funding. We have a huge variation in provision, and there are many local authorities where there are no delayed discharges of care, as we discussed earlier. What does not happen enough in the NHS and the social care system is people learning from best practice in other parts of the country. That is what we to change.

  • The Secretary of State has spoken a lot today about trying to avoid unnecessary admissions to A&E. Will he tell me why admissions to A&E on Teesside as a result of chronic malnutrition have trebled under the Conservative Government? Does he think that is any reflection on their broader approach to public policy and tackling poverty in this country?

  • The way to deal with those kinds of terrible problems is to have a strong economy that allows us to support people through difficult periods in their life. We have one of the strongest economies—in fact, I think we will be the strongest economy in the G7 this year. That allows us to do things such as invest in our health and social care system. It is the Conservative party that can deliver that.

  • I have spoken before about the staggering rise in the number of patients presenting at A&E at Addenbrooke’s in Cambridge, and the hospital confirmed to me this morning that it continues to see more than 300 people each day, with high levels of delayed transfers of care. The impact was brought home to me by a constituent, Ann, who told me that on Thursday last week the facilities were so overcrowded that an adjacent seminar room was pressed into use. Bloods were being taken in the room, and she was treated there behind a makeshift curtain, reclining on a standard chair. Those are awful conditions in which to be treated, and in which to have to work. The Secretary of State says that it is not about funding; if it is not, will he come to Cambridgeshire and sit down with his Conservative colleagues on the county council and tell them where they are going wrong?

  • I went to Addenbrooke’s in the autumn and saw at first hand how hard the staff there are working. That is another trust that is in special measures, but it has made huge progress in trying to turn things around. I met several staff in the emergency department as well, and I pay tribute to them for their very hard work. I have never said that it is not about funding; what I say is that it is not just about funding. There is huge variation. In parts of the country, emergency departments avoid precisely the kind of overcrowding that the hon. Gentleman described at Addenbrooke’s. Hospitals that do that very successfully include Luton and Dunstable. We need all hospitals to adopt what the best hospitals do.

  • I welcome the publication of the new suicide prevention strategy, and I welcome the fact that it includes self-harm. I am also grateful for the mention of the work of the all-party group on suicide and self-harm prevention, which I chair. Will the Secretary of State meet Dr Robert Colgate? He has set out a triaging system for mental health, which means that people do not have to wait six to nine months to see a consultant. With the support of frontline staff, they can get an immediate triage assessment and assistance for their condition. Will the Secretary of State meet urgently Dr Colgate, whose work is being peer reviewed by the University of Manchester, to look at how his system, which is being rolled out throughout England, can help us to tackle the problems we have?

  • I thank the hon. Lady for her work on the all-party group. I am more than happy to meet Dr Colgate. The purpose of the refreshed suicide prevention strategy is to try to ensure that we adopt best practice throughout the country. Some areas of the country are doing a very good job in suicide prevention, particularly in co-opting the public so that they understand that they can make a difference, too, but I am happy to explore with the hon. Lady what more can be done.

  • The Secretary of State rightly pays tribute to NHS staff, but the reality is that many of our NHS workers are now at breaking point. They continue to perform their work with care and compassion in spite of, rather than because of, any action taken by the Health Secretary. It is now time for him to act. What commitment will he give to investing properly in NHS staff, and to reversing the process of the deskilling, demoralisation and downgrading of NHS staff that he and his Government have presided over since 2010?

  • With respect to the hon. Lady, who I know cares passionately about the NHS and often asks me questions about it, we now have 11,400 more doctors and 11,200 more nurses in the NHS than in 2010. We protected the NHS budget in 2010, when her party wanted to cut it, and we promised £5.5 billion more for the NHS than her party was prepared to promise at the most recent election. Her characterisation of this Government as not being prepared to back NHS staff is utterly absurd.

  • The Prime Minister’s focus on mental health today is welcome, but does the Secretary of State accept that we will achieve parity of esteem only if we are prepared to accept how far we currently are from it? It is not a recent problem: the lack of recognition for mental health dates back to the inception of the national health service and is driven by our culture and choices as a country, rather than by any particular Government. Nevertheless, does the Minister accept that even the measures set out today, each of which is welcome in and of itself, will only really provide a sticking plaster for the problem? As it stands, on current progress, we are looking at having to wait decades before we achieve parity of esteem for mental health conditions.

  • I thank the hon. Gentleman for his interest in that issue. Sometimes, this is a challenging area. We legislated for parity of esteem, with cross-party support, in 2012. The danger is that such a concept can be nebulous, which is why we asked Paul Farmer, the chief executive of Mind, to look independently at what would be reasonable, fair and sensible progress towards parity of esteem by 2020. He said that he thought it would be a 10-year process, but that this was the right ambition for 2020. It was his report that the Prime Minister accepted this morning. We are making progress against benchmarks that independent people have looked at. The hon. Gentleman is right to say that we will not get there by 2020, but we must make sure that we deliver on that commitment while he and I are both MPs.

  • Very seriously mentally ill people rely on support from a whole range of services, including—obviously—mental health services, but also housing, social services, sometimes the criminal justice system and, crucially, family support services. What is being done to ensure a whole-Government strategy to raise the standard of care, particularly for very severely ill people who need protection from harm both to themselves and, sadly, sometimes to others in society?

  • The hon. Lady is absolutely right. One example where that is particularly true is in addiction services. Highly vulnerable people whom we are trying to help kick a drugs habit may also have a housing problem, a debt problem or a work problem. Unless we solve those problems holistically, we are unlikely to be able to address the health problem that sits at the heart of those challenges. In essence, that is what the STP process is trying to address—I am talking about providing more joined-up integrated services. I am happy to have further discussions with her as to how we can make more progress in that area.

  • In his statement, the Secretary of State promised a Green Paper on children and young people’s mental health before the end of the year. That could be 11-and-a-half months away. One in four people have a mental health disorder, and the Government’s own research says that young people are disproportionately affected. We have all heard stories—I certainly have in my constituency—of young people waiting more than a year for support, including those who have been victims of domestic violence. Schools and parents are picking up the pieces. Young people deserve better. Will he clarify the reasons for what appears to be quite a long delay and commit to bringing forward the Green Paper so that action can be taken more quickly and that this pressing issue is not kicked into the long grass?

  • May I reassure the hon. Lady that we will not be kicking the issue into the long grass? The Prime Minister has made a statement that we will have a Green Paper. There is a very specific reason why we need a bit of time: we want to ensure that the changes that we make—[Interruption.] We are getting a bit of chuntering from the Labour Front-Bench team. They might want to listen to the answer. The reason why we need to take some time is that a number of pilots concerning the improvement of mental health provision are taking place in schools at the moment, and we want to see them go through and evaluate them to inform what we do in the Green Paper. That will take a bit of time, but, at the end of it, we will get a better evidence base for the right way forward.

  • Young people in Sheffield have for some time now been telling me that they are waiting 25 weeks for an appointment with CAMHS after referral. Headteachers are telling me that they are digging into their budgets to buy in support for pupils in crisis, because they cannot access NHS services. Is it not deeply cynical for the Prime Minister to be raising hopes that we will be tackling the mental health crisis of our young people when the measures and the money that have been announced fall so desperately short of what we need?

  • It would be cynical if we raised hopes and had no intention of doing anything about the matter. What the Prime Minister said this morning in her speech was that this was the start of a process. She pointed to those problems and said that we will have a Green Paper to look at how we deal with them in detail, which does take some time. I hope that we will get to a position when we can deal with those problems. The hon. Gentleman is lucky to have Professor Tim Kendall working in Sheffield, as he is the NHS lead mental health psychiatrist and a specialist in homelessness, and he is helping us to shape the strategy.

  • I am grateful to the Secretary of State and to colleagues across the House.