Tag: Norman Lamb

Below is the text of the speech made by Norman Lamb, the Liberal Democrat MP for North Norfolk, in the House of Commons on 3 July 2019.

I beg to move,

That this House calls for a fundamental review of whistleblowing regulation to provide proper protection for a broader range of people.

I thank the hon. Member for Stirling (Stephen Kerr) for his support in making the application to the Backbench Business Committee and all the other MPs who supported the application. I also thank the Backbench Business Committee, the Chair of which is sitting in front of me, for enabling this incredibly important debate to take place. I want to start by telling four brief stories to illustrate why facilitating whistleblowing is so important.

I was the Minister in the then Department of Health who initiated the review led by James Jones, the former Bishop of Liverpool, of the horror of what happened at Gosport War Memorial Hospital. In his report from June last year, the very first chapter deals with the nurses who tried to speak up in 1991 about what was happening in that hospital. However, the report refers to the silencing of those nurses’ concerns and to a patronising attitude towards them, although they were trying to do the right thing. The consequence of not listening to those nurses is the extraordinary and horrifying conclusion of the report, which is that over 450 older people died following the inappropriate prescribing of opioids. These old people had gone in for rehabilitation but came out dead.

In this context, we can often be talking about life and death situations, so enabling and empowering people to speak up can literally save lives. That, at its most clear and stark, is why this matter is so important. The horrific scandal at Gosport hospital could have been stopped if those nurses have been listened to, but they were not, and that is an outrage in itself.

Scrolling forward to 2013, Dr Chris Day, a brave junior doctor working in a south London hospital, raised safety concerns about night staffing levels in an intensive care unit. It is in all our interests that brave people should speak out about safety concerns in any part of our health service, but perhaps particularly in intensive care units.

What happened to Dr Day, because he spoke out, is wholly unacceptable. He suffered a significant detriment. His whole career has been pushed off track, and his young family have been massively affected. Junior doctors in that unit were put in the invidious position of being responsible for far too many people compared with national standards, so he pursued a claim against both the trust and Health Education England. The NHS spent £700,000 of public money on defending the claim and, in large part, on attempting to deny protection to junior doctors who blow the whistle against Health Education England. Lawyers, disgustingly, were enriched.

Late last year, the tribunal that eventually heard Dr Day’s case ended early after he was threatened with a claim for substantial costs. He and his wife could not face the prospect of losing their young family’s home, so he caved in. That is surely scandalous treatment of a junior doctor. He was defeated by superior firepower. ​We have the grotesque spectacle of the NHS, of all organisations, deploying expensive QCs to defeat a junior doctor who raised serious and legitimate patient safety issues.

Justin Madders (Ellesmere Port and Neston) (Lab)

I pay tribute to the right hon. Gentleman’s work on Dr Chris Day’s case to get the answers we deserve on how he has been treated. Many whistleblowers face an inequality of arms at tribunals. They have often lost their job by that point, and they face a very difficult situation, with highly paid QCs running rings around them, which is often the result of employers trying to find loopholes in the law to avoid liability.

Norman Lamb

I thank the hon. Gentleman for his support in pursuing the Dr Day case, and I completely agree with the points he makes.

Sir Robert Francis, in his 2015 “Freedom to Speak Up” report, spoke about how NHS whistleblowers who had given evidence to him overwhelmingly experienced negative outcomes, and he talked of a hostile culture of fear, blame, isolation, reprisals and victimisation—in our NHS, for goodness’ sake.

Those stories continue. The impact on individuals can be devastating and profound. They can be ostracised, abused and disadvantaged in their career, with dire consequences for their mental health. One nurse who tried to expose wrongdoing said, “I would never put myself in that position again. I would rather leave.” What a damning indictment of how we treat people in our treasured and cherished public service.

Mr Andrew Mitchell (Sutton Coldfield) (Con)

The right hon. Gentleman and I have both worked on the general issue of whistleblowing. I pay tribute to his leadership on the matter, along with that of my hon. Friend the Member for Stirling (Stephen Kerr), who I hope will catch your eye later, Mr Deputy Speaker.

The right hon. Gentleman is making some very good points, and we know two things. First, we know there is strong concern across the country about how whistleblowers are being treated. We see it in the west midlands, and he is articulating the point. Secondly, we know whistleblowers help to ensure proper accountability and transparency. In my view, the work that he and others are doing on whistleblowing has not received anything like the amplification it requires.

Norman Lamb

I totally agree with the points the right hon. Gentleman makes, and he makes them well. I will come on to discuss them in a moment.

Dr Caroline Johnson (Sleaford and North Hykeham) (Con) rose—

Norman Lamb

I will give way briefly, but I am nervous about the Deputy Speaker and overstaying my welcome.

Mr Deputy Speaker (Sir Lindsay Hoyle)

Let me just reassure you on that. I hope I do not make anybody nervous.

Dr Johnson

I thank the right hon. Gentleman for giving way, as he is being most generous with his time. He said that the doctor was feeling under pressure from the overwhelming firepower and the potential to incur ​the NHS’s substantial costs. What support did his union, perhaps the British Medical Association or defence unions such as the Medical Defence Union or Medical Protection Society, offer him on legal costs?

Norman Lamb

Shockingly, the BMA abandoned him, and that is a story in itself, which needs exploring further. Not just in the NHS but across the economy, people are often literally on their own, faced by expensive lawyers. I speak as a former employment lawyer and I know what happens in employment tribunals. They were intended as a layman’s court, but they are anything but that these days.

The third story I want to mention is that of my constituent Mark Wright, a successful financial planner at RBS. Things started to go wrong after he raised concerns about unacceptable practices in the bank—this was before the crash. On 17 September 2008, immediately after the collapse of Lehman Brothers, an intranet statement was put up in RBS saying that the group was “well capitalised”. That was clearly an attempt to reassure staff, including staff shareholders, customers and investors that the bank was secure. Of course when the bank crashed, those staff shareholders lost a fortune, and many, including my constituent, believe that they were badly misled by that intranet statement.

Mr Wright’s mental health was destroyed as a result of trying to challenge the bank, as was his career. He made a complaint to the Financial Conduct Authority, which reported his name back to the bank, for goodness’ sake. The FCA was later criticised by the Complaints Commissioner. I pursued his complaint with the FCA and it denied knowledge of the intranet statement repeatedly to me, yet an internal FCA email has emerged, after a subject access request to the Complaints Commissioner. It was dated 14 March 2014 and it said

“the intranet notice that Mr Wright refers to was online between 17 September 2008 and January 2009… as staff used it to take reassurance that all was well which would tend to support Mr Wright’s allegations”.

That was an email within the FCA, yet we were never informed of that email or of that finding in that explosive document.

Clearly, the FCA has a copy of that intranet statement, yet it will not or cannot disclose it to us. The FCA says that the law does not allow it to do so. RBS, which is part state-owned, will not disclose it, yet clearly it is in the public interest that it should be disclosed. I believe I was misled by Andrew Bailey, the chief executive of the FCA, who told me, in effect, that Mark Wright’s allegations offered nothing that was not already in the public domain and he referred to an intranet statement by Fred Goodwin, which he said had been

“in the public domain for nearly 10 years”.

Yet the intranet statement has not ever been in the public domain. The Treasury Committee, which had looked into this, had never received a copy of it. So I was misled, and we have a regulator that is too close to the banks; that failed to protect Mr Wright’s disclosure or his identity; that, crucially appeared to fail to take the allegations about the misconduct of that bank seriously; and that cannot or will not put a crucial statement into the public domain. Let us just think about the damage caused by bankers in the run-up to ​the crash. Had we empowered people like Mark Wright to do the right thing, rather than destroyed them and ignored them, we might just have prevented the disgusting behaviour and greed of bankers, and we might now have seen some of those responsible for destroying our economy behind bars. As it happens, they have got away with it.

The fourth and final story is of foster carers throughout the country who are frightened to raise concerns about any behaviour from the council that they deal with. Of course, the council refers children into their care, so if a foster carer is concerned about the behaviour of a social worker and expresses concerns, that council can just stop the flow of children to them, and so their income stream—their ability to earn a living—disappears. This has a chilling effect on the willingness of any foster carer to speak out about child protection concerns, because they fear losing their livelihood.

Dr Philippa Whitford (Central Ayrshire) (SNP)

Does that not highlight how, whether in finance, the NHS or anywhere else, this happens in situations with a power differential and a hierarchy? Someone has power over someone else and can make them lose their job or lose what they love doing, so there is a constant threat.

Norman Lamb

The hon. Lady is absolutely right. We need effective legislation to redress that imbalance of power.

All the cases I have outlined highlight the value and importance of enabling people to expose wrongdoing. Effective protection for brave people who decide to speak out is first of all vital for that individual—they should be celebrated, not denigrated—but it also benefits us all if we give them protection. As the right hon. Member for Sutton Coldfield (Mr Mitchell) said earlier, this is actually an issue of good governance. It is about keeping organisations honest; protecting businesses from fraud, crime and other wrongdoing; and maintaining the highest possible standards. Good protection for those who speak out acts as a deterrent against bad behaviour; closed, secret cultures, which cover up wrongdoing and destroy those who try to speak up, deliver poor public services or cheat customers in the private sector, particularly in financial services, or lead to the toleration of bullying, sexual harassment and so on. So often, non-disclosure agreements are the final step that keeps the wrongdoing secret, slamming shut the door on proper scrutiny. Things need to change.

The question is: does the current law work? Palpably, from the examples I have given, it is clear that it does not. First, it leaves out key groups—not only foster carers—that simply are not covered by the legislation. It leaves out job applicants, volunteers and priests. Just think about the abuse of children by so many priests over the past few decades. Had priests been given the protection to speak out, perhaps we would have prevented some of that dreadful abuse. The legislation leaves out non-executive directors and trustees. It leaves out relatives and friends of the whistleblower when they are victimised because of what the whistleblower has done. It leaves out someone who is victimised by being presumed to be a whistleblower—if a company thinks that someone has spoken out, even if they have not, and does something like dismissing them, that person has no rights under the legislation because they are not actually the whistleblower. That is a ludicrous situation.​

Ann Clwyd (Cynon Valley) (Lab)

I am grateful to the right hon. Gentleman for giving way and am sorry that I was not here at the start of the debate. Some time ago—I think when the right hon. Gentleman was at the Department of Health—I was the co-author of a review of the NHS hospitals complaints system. One reason why we were not more forceful on the point he is making was that we thought legislation was in the pipeline, or that there was an attempt to put things right for potential whistleblowers.

I am still concerned. In my own local authority area, Rhondda Cynon Taf, the Cwm Taf health authority has just been heavily criticised for maternity deaths. One of the people involved got in touch with me anonymously. I did not know what to do with the letter—I did not want to pass it to the authorities—so I passed it to the Royal College of Obstetricians and Gynaecologists, which was at that time completing a report on the Cwm Taf health authority. It is still a major problem and people are afraid. Even when they think there is greater understanding and leeway, people are afraid. We have to put that right.

Norman Lamb

I totally agree with the right hon. Lady. Sir Robert Francis, who did the report in 2015, recommended the introduction of “freedom to speak up champions” in the NHS, and that has happened. However, this is an administrative process within trusts that, I am afraid, simply has not worked—that is the brutal lesson that we have to learn.

For those who are covered by the legislation, the law does nothing to enable a concerned person to speak up in the first place. For example, the law is silent on standards expected from employers, and it offers only inadequate protection after the event—after the person has been destroyed by a cruel organisation. The individual who then tries to pursue their rights under the legislation is too often faced by highly paid lawyers and is pressured into non-disclosure agreements, which, as I indicated, can result in wrongdoing never being exposed. Indeed, we know that the terms of some non-disclosure agreements are unlawful because they seek to shut up the individual and to stop them speaking out, even when a crime is involved.

Only a tiny percentage of cases that are pursued to the tribunal actually end up with a decision of the tribunal. To succeed, someone must show that the reason—or, if there is more than one reason, that the principal reason—for a dismissal is that the employee made a protected disclosure. They therefore open themselves up to false claims that other reasons existed. If the tribunal decides that there were other reasons, either the person’s claim is dismissed or their compensation is reduced.

There is no full definition of the range of disclosures that are covered by the legislation, so the protection is completely uncertain. Disclosure has to be to a prescribed person, but what happens if someone does not know who to report their concerns to? They could easily find themselves entirely unprotected—for trying to do the right thing.

Mr Mitchell

Will the right hon. Gentleman give way?

Norman Lamb

I am conscious that I am trying the patience of the Deputy Speaker, and I need to get to the conclusion of my remarks.​

The brilliant organisation Protect highlights the fact that a number of laws, such as in the utility sector, make it an offence to disclose certain information and include no public interest defence exceptions for whistleblowing. Even if there is awful wrongdoing, the person is prevented from speaking out, because they would commit a criminal offence. That surely has to change.

The brutal truth is that brave people who do society a service by exposing wrongdoing are not adequately protected, and many have no protection at all. After Gosport, I met the Prime Minister and made the case for reform. I explained to her that these are life or death situations in many cases. I have heard nothing from the Prime Minister at all since then, and that was last summer. It is time for a fundamental review by the Government and for new legislation. Such a review needs to listen to all the interested parties—to the all-party group on whistleblowing, to Protect and to Compassion in Care, which has set out proposals as part of what it calls Edna’s law. All must be involved, and we must look at international best practice.

The all-party group has a report due out soon. It follows a comprehensive survey, which included getting the views of very many people who have tried to whistleblow, and it will offer vital evidence to the Government. It will propose an office for the whistleblower, which could be of extremely powerful value in supporting people and would be a centre of excellence, providing guidelines to employers, monitoring activities and providing support, advice and training to members of the public, public institutions, private sector bodies and so on. It is a very important proposal.

I want a commitment from the Minister to undertake a thorough review, because it is long overdue. I also want a commitment to ensure that if the UK leaves the EU, it will at least meet the standards of the proposed new EU directive and preferably go much further. The UK was a pioneer, but the legislation is flawed and inadequate. New legislation to deliver high standards of governance in the public and private sectors is long overdue. We need safe space for brave people to do the right thing; effective mechanisms to hold people to account for wrongdoing that is uncovered, including potential criminal sanctions; and effective compensation and support for those who suffer as a result of speaking out.

Below is the text of the speech made by Norman Lamb, the Liberal Democrat MP for North Norfolk, in the House of Commons on 1 April 2019.

It is a pleasure to follow the hon. Member for Bexhill and Battle (Huw Merriman), and I agree with the points that he made.

This is the first time I have contributed to any of these debates—I have managed to avoid doing so until now—but I have worked with right hon. and hon. Members across this House. Incidentally, I pay particular tribute to the right hon. Members for West Dorset (Sir Oliver Letwin), for Leeds Central (Hilary Benn) and for Normanton, Pontefract and Castleford (Yvette Cooper) and the hon. Member for Grantham and Stamford (Nick Boles). It has been a pleasure to work with people who have been united in a desire to find a way forward, and united also in recognising that there is an absolute need to avoid leaving the EU with no deal.

I believe it is essential now that we seek to build consensus, and I feel that for two reasons. First, we are in a perilous state: there is a real danger to this country. There is a high risk that, unintentionally, we could end up in just a few days’ time crashing out of the EU with no deal. The damage to the economy would be profound. The hon. Member for Birmingham, Erdington (Jack Dromey), with the right hon. Member for Meriden (Dame Caroline Spelman), has made very well the points about the absolute importance of protecting manufacturing industry, and the auto industry in particular. As Chair of the Science and Technology Committee, I should also say that the damage to our science community from crashing out with no deal would be profound, and it seems to me that we have to avoid that at all costs.

The second reason why I think it is important to build consensus is that we live now in a horribly divided country, with entrenched positions and intransigence on both sides. This is deeply damaging to our country, and we risk damaging the social contract. I think we play with fire if we do not recognise the danger, and I do ​not think enough people have been seeking to find ways of bringing this country together again, rather than maintaining the divisions.

I approach this as someone who campaigned for and voted for remain. It may be odd to say this, but I respect the alternative point of view. I have my own criticisms of the EU, and I always have done. It is massively over-centralised, and I think it needs substantial reform—it needs to be more dynamic and more flexible—yet I was clear in my mind that I should support and campaign for remain. However, I lost, and we now need to find a way forward out of this mess. No route is perfect and no route is risk-free; danger is everywhere.

It is vital that Parliament today actually supports a way forward, rather than rejecting everything yet again. Another day of everything being defeated risks inflicting further enormous damage on this institution and of leaving the country feeling that it is without leadership. The country is crying out for leadership. I want this Parliament to agree on a Brexit deal that, as far as possible, protects jobs, the economy and the funding of public services, and maintains the closest possible relationship with the European Union—and then I want that settlement to be put to the people of this country in a confirmatory referendum.

The Prime Minister opposes the single market and a customs union, and her red lines have stayed rigidly in place all the way through. She says she cannot support those because they were not in the manifesto, but in 2017 she failed to get a majority. Just as in the coalition the parties coming together had to make compromises—a party cannot get everything in its manifesto if it does not have a majority in Parliament—this necessitates compromise. The Government Chief Whip was absolutely right to say that the election changed everything, yet the Prime Minister has failed to recognise that. She has failed to reach out and has stuck rigidly to red lines that are inappropriate in a balanced Parliament.

I will vote to support a customs union, the argument for which was put very succinctly and effectively by the right hon. and learned Member for Rushcliffe (Mr Clarke). Manufacturing industry in our country demands that we remain part of the customs union, and that is why I will support it. It is not sufficient on its own, but it is a building block. I will also support common market 2.0. It is not perfect, but it seeks to ensure the closest possible economic relationship, protecting the economy and jobs.

I would say to the people who support a confirmatory referendum that motion (E) says that nothing in this House should be approved without a confirmatory referendum, but we have to agree what this House decides. They should please engage in that process, come together and support a deal that protects jobs and the economy—and then put it to the British people.

Below is the text of the speech made by Norman Lamb, the Liberal Democrat MP for North Norfolk, in the House of Commons on 2 February 2018.

I want to start by making it clear that I recognise absolutely that there is intolerable pressure generally across the emergency care system, and there are serious issues that have to be addressed particularly around handover delays, and I include within that the sense that there is quite a variation from one hospital to another and we need to understand why it appears as though some hospitals are more successful than others in addressing this.

I also want to make it clear that it is not my intention to focus on the adequacy of funding of the NHS in this debate; that is for another occasion. The question I want to address here is whether the East of England Ambulance Service NHS Trust is doing all it can with the resources it has.

I also want to place on record my understanding that we have incredibly committed clinical staff in this trust, and I want to express my gratitude to them; they are often working under intense strain, frequently dealing with extraordinarily distressing and sensitive personal situations, and they do so admirably. I should also express my gratitude to the Minister for meeting me this morning to hear more about my concerns, and for the seriousness with which he listened to them.

My reason for calling this debate is that I met a senior employee of the trust, who is a whistleblower in effect, and who came to me with deep concerns about what is going on in his service. I found the testimony to be very credible and I took the concerns extremely seriously. I have seen a list of 40 cases of potential patient harm associated with delays in response times, including 19 cases where patients lost their lives.

Fiona Onasanya (Peterborough) (Lab)

Simon and Michelle came to see me about this very issue. Their 999 call was downgraded, and as an unintended consequence, they lost their baby girl, Darcey, in what appears to be one of a catalogue of failures in the interaction between the ambulance trust in the hospital.

Norman Lamb

I am grateful for that intervention, and the hon. Lady is doing exactly the right thing in pursuing that matter on behalf of her constituents. They deserve answers to the concerns that they have expressed over that tragic case.

Beyond the list of 40 cases, I understand that a further 120 incidents of potential patient harm and a potential 81 patient deaths have been associated with delays over this period of time. One case, which is not on the list of 40 that I have seen, concerns a constituent who does not want her family’s name to be mentioned. She has written to me as follows:

“My Mum had been ill from Boxing Day and finally on New Year’s Day she deteriorated to such a level that I had to call an ambulance. When I first logged the call they advised me that as she was still breathing we would have to wait an hour before a team could get to us. Mum’s health deteriorated further to a point that I had to place another call to the ambulance call centre as she had suffered a stroke and then a heart attack and had stopped ​breathing. My sister and I had to perform CPR whilst waiting for the crew. When they finally arrived, although they tried, they said that there was nothing they could do and she was pronounced dead.”

I should say that my constituent commends the crews that attended for the work that they did.

Clive Lewis (Norwich South) (Lab)

I have great respect for the right hon. Gentleman for bringing this debate to the House today. Does he agree that this is due to a systemic crisis, rather than to individual failings? Since publicising this issue in the Chamber some weeks ago, I have been inundated by cases of people from across the country, not just the east of England, who have experienced similar failings in the ambulance service. We must make it clear that this is not just about blaming managers at the East of England Ambulance Service NHS Trust; it is also about accepting that the Chancellor of the Exchequer and the Secretary of State for Health bear responsibility for what is happening to ambulance services across the country.

Norman Lamb

I thank the hon. Gentleman for his intervention. Ultimately, the Government are responsible for keeping the people of this country safe, with emergency services that work effectively. That is ultimately what we are debating.

This is not something that just happened over the Christmas and new year period. Just last Friday, the 91-year-old mother-in-law of some close friends of ours in south Norfolk fell on to a cold stone floor. They called 999 at 8:45 pm, but the ambulance did not arrive until 4 am. It left at 4.45 to go to the hospital, but she had to wait in the ambulance until 6 am. She then had to wait on a trolley for two more hours. That is intolerable; she is 91 years old. This could happen to a family member of any of us; we all have a stake in this. We have to recognise that it is intolerable. Another constituent has told me about his 92-year-old mother who broke her leg. She had a nine-hour wait, during which she developed hypothermia. Then a car arrived, rather than an ambulance, and she had to wait another 40 minutes for the ambulance. That is simply intolerable.

I am told that, according to the assessment of many people internally, the service over that period was unsafe, and that no assurances have been given that the trust would be able to provide a safe service in the future, if there were to be a period of very cold weather or a flu epidemic, for example. That is a matter of serious concern to the people of the east of England. On several occasions during the period, there were more than 200 999 calls that could not be responded to at the moment they came in, because no crews or ambulances were available.

The Care Quality Commission told me this morning:

“This is a service that is in crisis”.

It also said:

“Patients are at risk”.

However, the CQC appears to have confidence in the leadership of the trust. I fear that it is being complacent in its attitude, and that it is not taking seriously enough the number of patient harm incidents that I have referred to. I have deep concerns about whether any family member of mine, any constituent, or anyone else across the east of England who has to rely on the service will get a service that will protect and safeguard them in ​their hour of need. I am told response times in North Norfolk are dire—not just that the trust is not meeting the target but that the long tail beyond the target is deeply concerning. I do not have the assurance that we need.

The concerns appear to have been recognised because a risk summit was convened. According to the official guidance, a risk summit is normally triggered

“if there are significant and serious concerns that there are, or could be, quality failings in a provider or system.”

The guidance further states that a risk summit should be called

“only as a last resort”.

Well, we clearly have a last resort here.

My central plea to the Minister is that we need an independent governance review, and I would like a specific response to that because I genuinely believe it is needed, but I would like to raise the following specific concerns. I understand there was a £2.8 million underspend in the trust in month nine of the financial year. How can that be justified? Is the Minister satisfied with that?

I am told that more than 100 staff have been recruited but are currently on a waiting list to start. Some have been on the list for more than a year. I am told there has been no recruitment in Norfolk, which is where response times are at their worst. Staff have left without being replaced.

There was an independent assessment in August 2016, never published, by Operational Research in Health, which said that hundreds more staff are needed across the region to run a safe service. Why has that never been implemented? The only area where there has been recruitment of late, according to adverts online, is in Bedfordshire and Hertfordshire, the best-performing areas. The impression I am left with is that it is all about hitting the national target, rather than ensuring that all parts of the region are safe.

Interestingly, the online job advert has just been changed to include other counties, but the public board papers say there are no vacancies in those other counties. At the same time, lots of additional management posts have been created. There is a new deputy director of human resources, an associate director of HR, a deputy director of strategy and sustainability and other deputy director posts.

The trust has also doubled its spend on lease cars, which in November 2017 was up from just under £500,000 to nearly £1 million, with directors and deputy directors making no contribution. I am told that directors and deputy directors drive around in Jaguars, Range Rovers, Mercedes and Audi A5s. Is the Minister comfortable with that? The policy allows discretion by the director but, with a service that is under such strain, for me it is a question of judgment and culture in this organisation.

I am told there was a very late sign-off of the plan for the Christmas and new year period following the letter from Professor Keith Willett, so the trust was not better prepared than ever, which is the Government’s mantra. Did meetings take place between the trust’s chief executive and the chief executives of hospitals where the delays were at their worst in the run-up to the Christmas and new year period? We have a right to know.

The trust issued a statement that it had not been made aware of any patient safety issues internally, but that is not true. I have a copy of an email from a constituent to the chair of the trust on 9 January ​specifically referring to the fact that someone in the trust had come forward to raise patient safety concerns. Is that acceptable? It is a wholly misleading statement to the public. Does the Minister feel comfortable with that?

Is it acceptable that neither the chief executive nor the chair of the trust has been prepared to be interviewed publicly since the new year? When there have been so many patient safety incidents, surely they should be being held to account for that service on television and radio.

There has been a big issue about director presence over Christmas and new year, with claims and counter-claims having been made, and we need to get to the bottom of it. Will the Minister ensure that we are told who was actually on duty all the way through the Christmas and new year period? By that, I mean on duty and in the region—not at home in some foreign country—leading the service in this region. It was new year’s eve before REAP 4— Resource Escalation Action Plan 4—was declared. That is the highest level. Many people in the organisation felt it should have been happened before that, so that mutual assistance could have been secured from surrounding trusts. Why did that not happen?

A report was commissioned last year from SSG Health—a “phase 2 report”—on how the trust can save money. It has never been published. I have tried to get hold of it under freedom of information but my request has been refused. Will the Minister ensure that it is now put into the public domain? Given the scale of the crisis, which the Care Quality Commission has acknowledged, we have a right to know what that report says and what is being done about it. It cost more than £500,000 for this report on how to save money. That shows the scale of the culture problems that we face.

On late finishes, staff regularly work 14-hour to 15-hour shifts, but no data has been available from the trust to the staff side since February last year. In September, the trust removed the staff support desk, which was there to provide support to staff who were working very long shifts. No data has been made available by the trust to the staff side on “tail breaches”—these very long delays in getting to patients. The trust claims an exemption under FOI. That is symptomatic of a trust that fails to be open with staff representatives and with the public it is supposed to be serving. A constituent of mine who has worked for the trust has been declared “vexatious” for making FOI requests about patient safety issues, for goodness’ sake. How about that for the culture of this organisation! The matter is now with the Information Commissioner.

I believe, and I think the Government believe, that trusts should be entirely open; there should be an open culture, encouraging staff to speak out about patient safety issues. Will the Minister send a clear message to end the embargo on FOI requests, so that we can find out what is going on in this trust, rather than have it being kept from the public gaze? This is an issue of the utmost concern to the people of the east of England. People in this region need reassurance that they will be cared for and that the response will be there when they need it. It is frightening for anyone, but particularly for older people, to wait interminably for an ambulance to ​arrive when a loved one is very ill and potentially dying. This is intolerable in a civilised society and ultimately it is the Government’s responsibility to ensure that there is a service there to serve the people of this country.

Below is the text of a speech made by the Health Minister, Norman Lamb, to the Royal College of General Practitioners on 10th October 2013.

Good morning everyone, I would like to thank you for inviting me here today.

I was greatly encouraged by the positive views on integration that have already been spoken about today.

I think we are living in a time of great opportunity. For any Western democracy, I believe the stars are aligned to deliver better and more integrated care for people with mental illness.

Today’s conference covers both integration and mental health – two things which I am incredibly passionate about.

But from the patient’s point of view, despite the advances in mental health, too many people don’t get access to the care and support they need – they don’t get holistic care.

And, if we are being honest, there is an institutional bias against mental health within the NHS.

But we are also here to talk about the potential for integrated care and to focus on that care from the patient’s view point.

This is not about organisational change but about the model of care which is shaped around the needs of the individual patient, not the needs of the organisation.

Unfortunately, over the years we have institutionally separated mental health and physical health in the NHS.

Later today I will be making a speech to colleagues in the department about the importance of mental health.

I know that poor mental health can start in the workplace – 1 in 4 workers will experience stress, anxiety, depression or another condition during their working life.

Mental health is the single biggest cause of disability in the UK, bigger than cancer and cardiovascular disease. So it is important for people to feel that they can speak up when they feel like their mental wellbeing is suffering.

But it is also important to remember today what ramifications someone’s mental health can have on their physical wellbeing.

A few weeks ago, Rethink released a shocking set of statistics.

People with serious mental health problems – like schizophrenia – on average die 20 years younger than people with no mental health issues. And more than 30,000 people with severe mental health problems die needlessly every year.

These statistics make for difficult reading. But they are well-known.

Those people died because their poor mental wellbeing had a dramatic impact on their physical health. Conditions like heart problems, diabetes and addiction to smoking, physical health problems which were exacerbated by their mental health.

And last week, new research from Taiwan suggested that people with depression are three times more likely to develop Parkinson’s disease.

I am pleased to mention here that the Department will shortly be embarking on a major new strand of work on reducing premature mortality. Mental health will form an absolutely integral part of this – and that is crucial. To address these frightening figures, we have to tackle physical co-morbidities and adopt a whole-person approach.

There are organisations out there doing some incredibly innovative work around improving people’s mental health so their physical health doesn’t suffer.

In fact, one of them has helped organise this conference.

The emergency mental health service at South London and Maudsley FT – or the A&E of the Mind as it has been called – where people who come in to A&E with severe mental health issues are seen quickly, diagnosed and discharged – is incredibly innovative.

I want to see this sort of service replicated elsewhere. I want to see this become the norm, not the exception.

The health service is very good at treating physical health emergencies.

The system may be under pressure, but when someone breaks their leg, the health service swings in to action. When someone has a stroke, there are a raft of doctors, nurses and specialists at the scene to deal with them quickly.

But is this replicated for mental health emergencies? In some areas yes – having a positive impact on wellbeing and lowering the pressure on local services – but often, mental health services are slower to act.

I’m not the only one who thinks this.

I’ve heard from many charities and health organisations that crisis care for people with mental health problems is not reliable.

One example of this is a constituent of mine. A lady who had recently moved to Norfolk, her son had suffered severe mental health problems in his 20s. One day she found ligature marks on his neck, she took him to the local A&E, they both had a half hour discussion with a junior doctor.

This put that doctor in an invidious position – he had no mental health training up – and then the patient was released, with no mental health specialist being involved in the process.

The next day, she found him hanged in her own home.

I found it heart wrenching and shocking to hear that, but I know it is not isolated. This happens too often.

I was in an A&E Department recently, I was there for some hours looking at some really amazing work in that Department, but out of hours there is no mental health specialist there. Yet we know that a mental health crisis often happen in inconvenient times of the day or night.

And we are working with a range of organisations to develop a single national Crisis Care Concordat – one national agreement setting out what local areas should provide for people who have a mental health crisis.

The A&E of the mind is a great way to treat people with mental health issues in a timely fashion, in exactly the same way that physical health emergencies are treated.

I would like to see more services like the Rapid Assessment, Interface and Discharge – or RAID – in Birmingham. I visited them to hear about the great work that they are doing.

They offer training and support for City Hospital Birmingham A&E staff for when there is a person attended who has both a physical and mental health emergency – like people who have self-harmed, or people who have alcohol problems and mental health difficulties. We know that many people who have self-harmed turning up at A&E do not get the assessment and referral that they so desperately need. Out of everyone who turns up to A&E, they are the ones who are most prone to taking their own lives.

In Birmingham, they have managed to provide around the clock care as well as make huge savings. For every £1 spent in the RAID service, it makes £4 worth of savings from dealing with people’s mental health issues before they become a crisis.

These kind of innovative approaches make it obvious that we need to change the way we think about how we look after people’s mental health.

And, more to the point, we need to look at how we can improve the way health and mental health services can work together.

My overarching goal is to make sure that mental health has equal priority with physical health, and that everyone who needs it gets access to the best available treatment.

It is outlined in the Health and Social Care Act that there needs to be equal importance given to mental health with physical health, and we will be able to hold them to account for the quality of services.

I am acutely aware that, the whole time we discuss parity of esteem, we need to continually challenge the health system to make certain we can make a reality of this.

Yet often, the health service provides few interconnecting bridges between the two. And where those bridges are present, sometimes they are rickety, not up to scratch for people to traverse.

The discussions that are happening today are going to be hugely important in improving and building those bridges, those services.

I hope that this leads to a ground swell in new evidence and research on building more integrated services across the health service.

What I also wanted to cover today is how my department is trying to make the health service more integrated – more bridges being built between physical and mental health services.

We want to forge together new bonds between health and care settings, but also inspire the health service to be creative and think around the issues of integration, much like you will be doing later today.

This focus on holistic care has, frankly, been lost recently.

And when it was, it was normally in spite of the system, rather than working with it.

Now, integration is written throughout primary legislation.

Now, there is a legal process for encouraging this type of joined-up working.

There has never been a legal duty on the NHS to specifically promote the integration of services, and the Care Bill will place the same duty on local authorities.

But an important point on this is giving professionals the power and the freedom to decide for themselves how this should work.

Although it isn’t enough to point to legislation and say “now go and become integrated”.

A line of legislation isn’t going to cause in itself an eruption in the creative minds of the health and care service which I mentioned earlier.

The term ‘silo working’ is often employed to describe the health and care system.

And when we look at any local health service in the abstract, yes, it is a series of people, working in a series of buildings, often miles apart from one another.

But that separation isn’t just physical, it is also cultural. Our NHS is a diverse and mixed institution, and each part of that system works differently.

How do you make those services work together?

It takes encouragement.

And there are two parts to this.

The first part is to show that they need to work like this.

Because the simple fact is that doing nothing would provide us with a health service that is not value for money and ultimately be sustainable.

The statistics scream out for action.

By 2026, 3 million people will have three long-term conditions. There are 1.9 million people with them now.

Between now and 2030, the number of people over 85 will double.

And we know that the rate of the England population with a mental health problem increased from 15.5% in 1993 to 17.6% in 2007. An increase of 2.1% might not sound like a lot, but we are talking about over a million more people being affected by a mental health condition.

The health makeup of our society is changing, and we need to change with it if we’re going to rise to the challenge of an aging population with more complex health needs.

The second part of the encouragement is about inspiring people to work together.

And I believe we are leading by example on this.

My department is working across the health sector – with NHS England, the Local Government Association, Monitor and others – and has set out a vision of how health and care can become better integrated.

But we will also be working alongside a number of pioneering organisations that have really exciting ideas for integrating health and care.

We put a call out for bids in May, and the response has been really positive.

We have had over 100 bids from across the country, across a wide range of services – an overwhelming, and in all honesty, unexpectedly high level of interest.

It showed to me just how creative and efficient our health and care services can be, shaking off the idea that these services are systemically bureaucratic.

It also showed me that there is an extraordinary pent up energy out there. People want to do things different, people wanting to work better for their patients.

These have been whittled down to a shortlist and we will select the very best proposals, sharing their learning right across the country.

We are not too far off announcing who these trailblazers are going to be, and I am looking forward to the prospect of exciting new approaches to treating both physical and mental health in a holistic way.

Nor do I want to limit the number of pioneers to those we select within this process. This is about championing exemplars to encourage others everywhere.

The culture I want to instil in the Department and in NHS England is one of experimentation, to say that you can do things differently if it makes sense, if it is rational and if it offers better care for patients.

What I consider the most exciting part of our integration work is how we are funding integration across the country.

Through the Integration Transformation Fund, we are providing £3.8 billion to encourage people to work better together.

What I want to see is exactly what is in the name of the fund: a transformation.

It plans to make sure that health and care services work together;

That organisations act earlier to prevent people reaching crisis point;

That seven-day services are offered so people can access them when they need to; and

That care that is centred on individual needs, rather than what is convenient for the system.

It is ambitious, that’s true. But I want organisations to be ambitious and think what they could do with some of this money.

What I want to see is the funding used to break through the barrier to integrated health and care, including mental health.

I want to see plans to improve the care that people receive.

I want simple, clever and creative ideas that present a way for people to move seamlessly through the health and care system.

Another example, which I am happy to be able to announce today, is the clinical trial which Kings Health Partners are going to be undertaking into medically unexplained symptoms.

You will be hearing more about this later today from the team themselves, but it will be taking place in Lambeth and Southwark and will focus on people who experience unexplained symptoms like dizziness, chest pains, headaches and fatigue, which can disrupt people’s day to day lives.

They will bring a team of physicians, psychiatrists and psychologists together, who will assess and treat people who present with medically unexplained symptoms, backed by £2.5m of funding. This kind of cross-cutting work is incredibly exciting – and important – and I wish them luck in their trial and look forward to hearing about the results.

So in closing, I want to wish you the best for what I know will be a thoroughly interesting conference.

One of the great frustrations of this job is that the schedule is so heavy that you can’t stay to listen to the work being presented.

I think the conversations you will be having today will help end the mind-body dualism of the health service.

If we want to offer better care for patients and those that use the health service, we need to be able to treat a person holistically.

In short, we need them to be treated as a person, something much greater than the sum of their parts.

Thank you.

Below is the text of a speech made by the Health Minister, Norman Lamb, on 11th September 2012.

A reshuffle is a strange thing.

I’ve followed the health reforms pretty closely so I’m relatively up to speed.

But often, new ministers find themselves in departments where they know only the bare bones of the policy. And they’re expected to turn themselves into experts overnight.

I’ve been an MP long enough to hear my fair share of new ministers read out speeches in the Commons and clearly have absolutely no idea what they’re talking about. The crueller members of the opposition can sometimes make it a bit of a trial for them.

But the machinations of government can’t just creak to a halt as the new people find their way around. So new ministers rely on ever-present civil servants to guide them. They rely on ministers who haven’t been reshuffled to keep a hand on the tiller. And they rely on their fellow new ministers to be conscientious, decisive and creative about their own parts of the portfolio.

In other words, for reshuffles to work, every part of government needs to be supportive of all the other parts.

The same is true if we want to make people healthier and improve local services.

The difference, of course, is that poor integration in reshuffles mean ministers looking a bit stupid.

But in the wider world, it is a lot more important.

Disjointed care can and does impact on people’s lives in a big way. Whether it’s:

• The girl with cerebral palsy who has to start using completely different services when she turns 16,
• The man with bipolar disorder who sees a different community psychiatrist each appointment,
• Or the elderly lady who dies in a strange hospital because there’s disagreement over who should provide the services to allow her to die in her own home.

At the moment, those sort of situations are all too common.

To put a stop to them, all parts of the system have to work together.

That’s when things really get better. Not just with health and social care, but with other factors that affect health, like housing, work and education.

One of the reasons I was so eager to be a minister is so I can push that hard.

The consensus behind integrated care is pretty universal. In government, in think tanks, in patient groups everyone sees it as A Good Thing.

But that’s not enough. We need to transfer it from the academic papers and into the health & wellbeing boards, hospitals and community centres.

It takes a lot of political oomph to do that.

I want to provide that oomph.

From my first day in my new office, I was asking to talk to the Department of Health’s experts on integration. Reading the latest research.

And the first thing on my agenda is to arrange a roundtable with the Kings Fund and a wide spread of other groups, to work out a way of translating consensus into results.

One thing we can be sure of is that there is funding to really get things going.

As announced in the Care and Support White Paper Caring for our future, over the two years from 2013/14, an extra £300 million will go from the NHS to local authorities to get health and social care services working better together. That’s on top of the £2.7 billion transfer to local authorities that was announced in the 2010 Spending Review.

And there will be an extra £200 million over the next five years spend on better housing options for older and disabled people.

On top of that, there is more money for priority services, like January’s one-off £150m to reduce delayed transfers of care.

That sort of money opens doors. But because of the financial situation that we all know about, that money – and people’s existing budgets – needs to produce results.

Everyone needs to do their bit to get the most from their money. Delivering better services and better outcomes, in ways relevant to individual areas.

That’s why I was so pleased to see that the Care and Support White Paper clearly sets out what we are going to do to further integrate services.

One of the big issues is that ‘integrated care’ itself is a problematic phrase. Understandably, when you’re talking about such a broad concept, there’s a lot of disagreement over what it means.

So one of our early tasks will be to try to at least agree a working definition – one that allows everyone to be clear about what we’re working towards.

Then we want to build on some of the projects already underway that touch on issues of integration, like the four community budget pilots that are cutting red tape and reducing duplication in specific areas.

We will take the lessons from those pilots and share them across the country, so everyone can benefit.

To gauge our progress, we will also take heed of the Future Forum’s calls to measure people’s experience of how their care is being integrated. We want to explore how best to do that via the outcomes frameworks, so integration is given just as much importance as any other big NHS issue.

We will use different payment systems to put money in the hands of people who can improve integration. The Year of Care tariffs, for example, which take a long-term view of people with long-term conditions. And we want to see similarly innovative payment systems across the health, care and housing sectors.

And of course, throughout all this, in the spirit of integration, I want to make it quite clear that expert organisations like the Kings Fund, the Nuffield Trust are central to everything we’re doing.

We have already accepted the Future Forum’s recommendation following the joint Kings Fund and Nuffield Trust report that far more work is needed to integrate all public services.

The White Paper said we would work with the NHS Commissioning Board, Monitor, and the Local Government Association to support evidence-based integration across the country.

And we have set up a new joint unit in DH across health and social care to look specifically at how the recommendations of your report can be taken forward.

But your input won’t stop there. I want to hear about your suggestions, your criticisms and your research. So every change made specifically to increase the integration of care is itself the product of co-operation and shared endeavour.

That is also true for publicly funded groups like the NHS Commissioning Board and Monitor. We will work closely with them to make sure we are reading off the same hymn sheet.

There isn’t enough time to go into all of it, but I’d also like to quickly mention some other measures in the Care and Support White Paper that will help integrate services:

• Personal health and care budgets, so people can control their own care.

• And more attention than ever paid to important ‘hand-off’ moments where someone’s care goes through a big transition – like when a terminal illness means someone starts using end-of-life services.

Those are all steps in the right direction.

But as I said earlier, for integration to work it can’t just be seen as a health issue, or a social care issue. Everyone has to buy into it and do their bit to make people healthier.

Health and wellbeing boards

Health and wellbeing boards will bring previously disparate people together to do just that.

The NHS, local government and communities themselves. To understand what local needs are and work out how to meet them.

I’m really delighted that you have all been so open with each other about your experiences of setting up health and wellbeing boards.

Through events like this, and through the National Learning Network for health and wellbeing boards, you are coming together with your colleagues around the country to share what you’ve learnt.

But like all ambitious changes, it won’t be easy.  A lot of ways of working will have to change. People will have to move out of their comfort zones and look at what is better for local people, not what is better for their own organisations.

Because this is about real change, not just meetings and working groups. If health and wellbeing boards are no more than committees then we will have failed.

The real work of health and wellbeing boards will be outside the boardrooms, with communities, providers, local organisations, voluntary and community groups, GP practices.

Leaders in all those groups will need to get better at working together. The NHS Leadership Academy, ADASS, LGA and the National Skills Academy will all help by developing skills and supporting individual leaders.

And the new Social Care Leadership Qualities Framework and Leadership Forum will help as well.

But in the end, it will come down to individual leaders themselves, and how willing they are to embrace a different way of working.

I’ve only been a minister for a week. But I’ve already got a clear picture of how grateful everyone in the Department of Health is to groups like the Kings Fund for the support they have given to projects like the National Learning Network for health and wellbeing boards.

I hope we can continue to work together to build on that.

So please, tell me about your experiences of how care can be brought together. What works and what doesn’t.

My roundtable will be one place we can discuss how to progress, but to be sure, this won’t be a here today, gone tomorrow issue.

I give you my word that I will push integration as hard as I can.