SIR NICHOLAS SOAMES’S QUESTION ON MENTAL HEALTH AND NHS PERFORMANCE
Mental Health and NHS Performance
With permission, Mr Speaker, I would like to make a statement on mental health and NHS performance. This Government are committed to a shared society in which public services work to the highest standards for everyone. This includes plans announced by the Prime Minister this morning on mental health. I am proud that, under this Government, 1,400 more people are accessing mental health services every day compared with 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.
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.