Closing tax loopholes to fund our NHS

On Tuesday night the House of Commons voted down the Prime Minister’s EU Withdrawal Agreement.  The Prime Minister showed great statesmanship in the immediate aftermath of the defeat. She made a statement inviting the Opposition parties to table a vote of “no confidence” in the Government.  Jeremy Corbyn MP had previously threatened this but not delivered but on this occasion did accept the challenge. 

I hope the Prime Minister wins and on Monday she will make a statement setting out a plan that will enable MPs from all parties to work together to find a solution to the current impasse.  

I have a section on my website dedicated to the EU referendum and regularly update it. I am easily contactable and always happy to listen to or read the opinions of my constituents. 

Despite Brexit grabbing the headlines, my daily work for you continues at pace. Many and varied issues are raised with me during my weekly constituency meetings. Sometimes these require changes to a particular “system” and working with local people to do this is a rewarding part of my role, especially when I am able to help to bring about positive change.   

A good example was a local business person who told me how overseas sellers were undercutting his business by selling their products online and not paying their fair share of taxes. Having raised this with Treasury Ministers, HMRC has taken action and in 2016 introduced new powers that has enabled the collection of £200m lost VAT. HMRC recently reported issuing over 4,600 ‘red flag’ notices to online marketplaces such as Amazon, ASOS, Etsy and Ebay since 2016. 

The number of overseas businesses making applications for VAT registration has grown to 58,000, in comparison to just 1,650 applications between 2015 and 2016. 

These new rules protect thousands of local entrepreneurs as well as enabling previously uncollected taxes to fund our vital public services. This is just one tax avoidance and evasion measure amongst more than 100 introduced since 2010 that has generated more than £200 billion revenue. 

As regular readers know, I work closely with our local NHS leaders, doctors and nurses. During meetings with local GPs the impact of the increasing costs of indemnity insurance on their ability to provide local GP services was discussed. I raised these concerns with the Department of Health and after a great deal of work with the medical profession, I am pleased that a solution has been found. 

April this year will see the launch of the long-awaited government backed GP indemnity scheme. This was announced in October 2017 and will cover all practice staff performing clinical roles under a General Medical Services (GMS), Personal Medical Services (PMS) or Alternative Provider Medical Services (APMS) contract. 

The scheme will be free at the point of use and will cover all practice work, as well as extended and out of hours services. This will enable more GPs and healthcare professionals to work flexibly and improve the accessibility of healthcare services that we all depend upon.

First published in the West Briton 17/01/19

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Improving our local health services

Dame Sally Davis is the independent Chief Medical Officer for England, and her recently published annual report on the NHS provides invaluable insights. I agree with her analysis when she says, that while the NHS is often a source of national pride, but despite this, a narrative of health being a cost to society prevails. As the late Hans Rosling said, “When things are getting better we often don’t hear about them. This gives us a systematically too-negative impression of the world around us, which is very stressful.” 

Dame Sally says her report “offers cause for optimism and I conclude that it is realistic to aspire to better and more equitable health in the next 20 years. As the NHS has developed its long-term plan for the coming ten years, this report looks at the strategic opportunities over the coming two decades for the health of the nation more broadly.” 

Like Dame Sally, I believe we need to reposition health as one of the primary assets of our nation, contributing to both the economy and happiness. We also must measure and track progress in our development of health as a nation and our fairness as a society in delivering improving health outcomes. I support her recommendation that the Government need to develop a composite Health Index that recognises this and is tracked alongside our nation’s GDP and the Measuring National Well-being programme. 

Health is generally used to mean the ‘absence of ill-health’. We often focus on the NHS as an ‘illness service’ rather than acknowledging the complex interactions in society that influence our health as individuals. Healthcare is often spoken of as a cost to the state and society rather than an investment that generates returns for the individual, communities and the nation. The NHS and public health services are not a burden on our finances – they help to build our future. Moreover, the good health of our nation is the bedrock of our happiness and prosperity. 

Health is an asset that we must protect and promote and is affected by the conditions in which we live and work. These conditions can be health-promoting or health-harming, and often governments, industry, and societies are responsible for those conditions, not the individual. We all have some responsibility for our own health, but we are not individually responsible for the house or neighbourhood we are born into, the school we attended, nor the health environment we live in. 

The health system needs to adapt for each individual and ensure both their environment and the care that they receive is helping them achieve ‘good health’. One example is our local social prescribing, which acknowledges our expanded understanding of physical, mental and social health and is an opportunity for the traditional health service to utilise, enhance and amplify existing schemes, including employment. Our local WinterWellness programme is another. One size clearly does not fit all, and this requires different types of care accessed through different places and different ways. 

 

Investing in the future of our NHS

Ensuring the long term, sustainable funding of our NHS is one of the most pressing and potent political issues facing the country. Demand for NHS and care services only continues to rise as our population changes, as we live longer and new treatments and technologies are developed. 

The Government has worked closely with the NHS to agree a five-year plan of increased funding, with agreed additional investment of at least £8 billion in real terms throughout this Parliament. In addition, the Government has now announced that it will invest a further £20 billion by 2023/24 to transform health and social care so it can improve treatment and deliver better care for patients. 

More money than ever before is being spent on mental health services. I have worked alongside our local NHS to secure investment for a new specialist inpatient unit in Bodmin which is now under construction. This will mean that children and young people do not need to travel out of the county to receive vital care. 

Following the death of two students on the Penryn Campus who took their own lives after their battles with mental health issues, I have secured assurances from the Cornwall Partnership NHS Foundation Trust and local Clinical Commissioning Group that they will work with the University to provide more support to students who are experiencing mental illness. 

While investing more money into the NHS and securing Cornwall’s fair share is important, so too is ensuring it is spent wisely. So, I was pleased that the Government has recently set out plans to enable the NHS to make significant improvements in technology and purchasing. 

A new NHS app will be piloted in 5 areas in England from next month, ahead of a planned national roll-out in December. Patients will be able to download a test version of the app, allowing access to booking GP appointments, ordering repeat prescriptions, access to their medical record, 111 online access for urgent medical queries, data sharing preferences, organ donation preferences and end of life care preferences. 

More than £200 million will also be invested to make a group of NHS trusts into internationally recognised centres for technological and digital innovation. The funding will support new Global Digital Exemplars in acute, mental health, community and ambulance trusts in England to set a gold standard of innovation for other services to follow. 

A new HealthTech Advisory Board, chaired by Dr Ben Goldacre, will highlight where change needs to happen, where best practice isn’t being followed, and will be an ideas hub for how to improve patient outcomes and experience and make the lives of NHS staff easier. 

Our hospitals operate dozens of systems each that don’t talk to each other. GPs, social care, pharmacies and community care are on different systems. Systems crashing is a regular occurrence. The social care system is not at all integrated, when its integration is vital. 

The generic technology available outside the NHS is a million times better. Now is the moment to put the failures of the past behind us, and set our sights on the NHS being the most cutting-edge system in the world for the use of technology to improve our health, make our lives easier, and make money go further. 

A modern health service shouldn’t involve 234 separate trusts spending time and money negotiating different contracts and prices for the same thing. An example of this price variation includes the lowest priced 12-pack of rubber gloves costing 35p, while the highest priced cost £16.47. That’s why the Government’s work to centralise how the NHS buys goods and services is crucial. 

By streamlining the process and freeing trusts up from having to do this, we will save staff valuable time, save huge amounts of money and be able to reinvest the savings into patient care and frontline services 

The Department of Health and Social Care anticipates the new supply chain will generate savings of £2.4 billion over a 5-year period, all to be ploughed back into frontline services. 

 First published in the Falmouth Wave October edition

Delivering improvements to our NHS

Last week I met with local people and representatives of Unison to discuss our local NHS. We all want to see improvements in our local NHS and care services.  

While investing more money into the NHS, and securing Cornwall’s fair share, is essential so is ensuring it is spent wisely. So I was pleased that last week the Government set out plans to enable the NHS to make significant improvements in technology and purchasing.  

These will build on the £20 billion long-term plan to transform health and social care so it can improve treatment and deliver better care for patients. 

A new NHS app will be piloted in 5 areas in England from next month, ahead of a planned national roll-out in December. Patients will be able to download a test version of the app, allowing access to booking GP appointments, ordering repeat prescriptions, access to their medical record, 111 online access for urgent medical queries, data sharing preferences, organ donation preferences and end of life care preferences. 

More than £200 million will also be invested to make a group of NHS trusts into internationally recognised centres for technological and digital innovation. The funding will support new Global Digital Exemplars in acute, mental health, community and ambulance trusts in England to set a gold standard of innovation for other services to follow. 

A new HealthTech Advisory Board, chaired by Dr Ben Goldacre, will highlight where change needs to happen, where best practice isn’t being followed, and be an ideas hub for how to improve patient outcomes and experience and make the lives of NHS staff easier. 

Our hospitals operate dozens of systems each that don’t talk to each other. GPs, social care, pharmacies and community care are on different systems. Systems crashing is a regular occurrence. The social care system is not at all integrated, when its integration is vital. 

The generic technology available outside the NHS is a million times better. Now is the moment to put the failures of the past behind us, and set our sights on the NHS being the most cutting-edge system in the world for the use of technology to improve our health, make our lives easier, and make money go further. 

A modern health service shouldn’t involve 234 separate trusts spending time and money negotiating different contracts and prices for the same thing. An example of this price variation includes the lowest priced 12-pack of rubber gloves costing 35p, while the highest priced cost £16.47. That’s why the Government’s work to centralise how the NHS buys goods and services is crucial. 

By streamlining the process and freeing trusts up from having to do this, we will save staff valuable time, save huge amounts of money and be able to reinvest the savings into patient care and frontline services 

The Department of Health and Social Care anticipates the new supply chain will generate savings of £2.4 billion over a 5-year period, all to be ploughed back into frontline services. 

First published in the West Briton 13/09/18

Making mental health a priority makes good business sense

An estimated 300,000 people lose their job every year because of a mental health problem. Many might have remained in employment had they been given the right support.

Earlier this week I spoke at a CBI event to welcome the launch of Front of Mind, their new good practice guidance which helps employers improve health and wellbeing in the workplace.

People with mental health conditions can make a valuable contribution in the workplace. We need real cultural change in every workplace across the country to prevent valued colleagues leaving a job they love because of mental health problems.

For employers this can feel daunting. Mental health charity Mind found that while employers want to make mental health a priority, a third don’t know where to go for information or guidance.

That’s exactly why practical resources like Front of Mind are so important. Highlighting examples from UK employers that are already leading the way, the guidance shows that successful businesses are taking key three steps: prioritising health and wellbeing from the top, targeting action towards early interventions and embedding good health and wellbeing in workplace culture.

Not only does Front of Mind offer practical tips for employers, it also demonstrates the business case for making progress on workplace mental health.

The impact of mental health issues costs UK employers between £33 billion and £42 billion every year. Clearly, making mental health a priority in your workplace is not just the right thing to do – it also makes good business sense.

We don’t expect employers to do this on their own. Government has an important role to play in supporting people with a mental health condition. We’ve made good progress, with a range of support on offer. Spending on mental health increased to a record £11.86 billion last year, with a further investment of £1 billion by 2020/21.

On employment support, we’re investing £115 million in partnership with the NHS, more than doubling the number of Employment Advisers in Improving Access to Psychological Therapies Services. Our new Work and Health Programme is investing £500 million in tailored employment support, helping disabled people and those with health conditions into a job. And our Access to Work scheme has a specialised mental health support service, which has supported over 12,000 people. More than 90% of people who have used the service were still in their job after six months.

I want to encourage senior managers and business leaders to make a real, tangible commitment to improving workplace culture around mental health. This isn’t an issue for other businesses to deal with, or something we can leave HR to worry about. The leaders of any organisation are pivotal in shaping its culture, and exemplary behaviour has to start at the top.

My vision is of a society where everyone has the opportunity to fulfil their potential and no one loses their job because of poor mental health. It’s now time for every leader in every sector to take responsibility for creating an environment in which people feel able to talk about their mental health condition and get the help they need to thrive at work.

First published in Business Voice

Improving Local Mental Health Services

Last October, in this column, I asked local organisations to work together and consider applying to the new Beyond Places of Safety Fund.

Applications had just been opened for a new £15 million fund to improve support for people who experience a range of mental health conditions that put them at risk of an acute mental health crisis.

The Beyond Places of Safety fund is the successor to the original Places of Safety programme which was established, alongside the Crisis Care Concordat, to confront one of the quiet scandals within mental health system – namely the thousands of people left in a police cell following a detention under the Mental Health Act.

The new funding for the Places of Safety Programme, coupled with the ingenuity and partnerships forged between statutory and voluntary organisations under local Crisis Care agreements, has seen the number detained in police custody following a mental health crisis drop by over 80% over the last five years. New regulations have also come into effect to ensure that police custody is only used in exceptional circumstances under careful medical and police supervision. No young person can be held in custody.

Having spent time with Cornwall Resus and Street Pastors in our local towns on a Saturday night, as well as shadowing staff at A&E at Treliske, I am aware of the challenges that our front line public service professionals are facing with people in crisis.

I listened carefully to their opinions which informed my actions when I was Chair of the National Crisis Concordat, a role I held when I was the Home Office Minister responsible for vulnerable people, domestic violence, drug and alcohol strategy, amongst other matters. I have seen at first hand the difference that funding common sense innovations – driven by passionate third sector organisations, working in partnership with the NHS – are making to how people are treated when they become acutely unwell.

I am delighted that Cornwall is benefitting from the new Beyond Places of Safety Fund.  £1.5 million will be invested in the new hub at Treliske which will enable partners, including Addaction, to ensure that local people have the wrapped around care they need.  Support that not only treats the symptoms but also tackles the root cause of their crisis which can include a wide range of issues from sexual abuse, domestic abuse, and substance misuse to homelessness. Treating the whole person rather than just their mental health crisis should lead to better outcomes for the people concerned as well as reducing demand for emergency care at Treliske.

There may be no magic bullet to stem the rising tide of mental ill health – but innovative community initiatives can make a make a real difference to keeping people safe.

Along with plans to train a million people in basic mental health first aid skills – the first country in the world to have this scale of ambition – we will continue to invest in NHS mental health services, training more professionals, and aiming to treat more people than ever before.

First published in the West Briton 31/05/18

Rising Living Standards and Wellbeing

How does a country measure its success? The most reported measure of success is economic with gross domestic product (GDP) probably most often quoted. Of course ensuring people have the opportunity to reach their potential in their chosen occupation is important and this week’s good news of record levels of people from all backgrounds and ages in employment and growing wages is welcome. More of our children and young people are receiving a good education compared to 2010 and average life expectancy continues to rise. All these measure progress.

There is a growing recognition that how we are doing as a nation is at least as much about people’s well-being as it is about the country’s economic health.

In November 2010, David Cameron established the Measuring National Well-being (MNW) programme. The aim was to monitor and report “how the UK is doing” by producing accepted and trusted measures of the well-being of the nation. Twice a year the independent Office for National Statistics report progress against a set of headline indicators covering areas of our lives including our health, natural environment, personal finances and crime.

The measures include both objective data (unemployment rate) and subjective data (satisfaction with job) to provide a more complete view of the nation’s progress than economic measures can do alone.

The latest update of the Measuring of National Well-being programme published in April provides a broadly positive picture of life in the UK, with most indicators either improving or staying the same over the short-term (one year) and long-term (five years). It shows the strengths and challenges of different age groups in society. These insights can help target services where they are most needed and can have the best impact.

This programme has led to significant positive changes in the development of policy, particularly the promotion of good mental health and a very welcome focus on understanding and treating mental ill health. We changed the law so that mental health is taken as seriously as physical health.

The fastest growing NHS spending is on mental health £11.86 billion last year, with further growth committed.  Spending by local GP NHS Commissioners on children and young people’s mental health services grew by £103 million between 2015/16 and 2016/17, up to £619 million. This is a 20 per cent increase year on year. I am pleased that our new residential children and young people’s mental health service in Bodmin is underway.

Last week, I visited Roseland Community College, an outstanding local school, and listened to children and staff who are participating in HeadStart Kernow. It’s a partnership between Cornwall Council, our local NHS, schools, voluntary sector organisations and the National Lottery. It aims to build resilience and mental wellbeing for children and young people and from what I heard is doing a good job. This vital prevention work matters to children now and in the future as the causes of mental ill health in adults often starts in childhood.

First published in the West Briton 17/05/18