This week: Jess Phillips, Labour MP for Birmingham Yardley
Why she matters: Ms Phillips is one of Labour’s most articulate and outspoken backbenchers. An MP since 2015, she is best known for her campaigning on domestic violence, annually reading out a list in the House of Commons chamber of all the women killed by their partners. Her first book Everywoman was a critical and commercial success, and its follow-up Truth to Power: 7 Ways to Call Time on B.S is published in October.
Calling for better joint working between public sector agencies has “become a platitude like something from The Handmaid’s Tale,” says Jess Phillips, “I’m not sure the phrase means anything anymore.
“Even in my experience of joint commissioning, ownership was never shared equally; it always falls to one department or another.”
She stresses good local examples of care integration do exist, for example, in tackling knife crime.
“In [Birmingham’s] Queen Elizabeth Hospital, the Red Line service do seem to have a really good relationship between [accident and emergency] and family liaison, especially in cases of deterrence and proper evidence-gathering. They’ve framed an effective cooperative network for situations where a place of emergency care delivery is also a crime scene.”
This sort of approach, however, is “incredibly rare” and health remains the hardest sector to engage, she says. Its response is often “woeful, you just get a ‘not their business’ sort of response”, claims the MP.
This clearly frustrates Ms Phillips.
“In almost every serious case [of domestic abuse], the one public sector professional the victim had always seen was a healthcare provider. In that context, it’s a huge missed opportunity.”
The one group of health professionals she exempts from criticism are health visitors and school nurses, but she claims their numbers have been “cut to smithereens by austerity” and local authority tendering practices post the Lansley reforms.
“When they put the services in Sandwell and West Birmingham out to tender, those health visitors and school nurses came to my constituency office for help to fill out the tender documents for the service they’d delivered for years”.
‘The system has lost it’
For Phillips, this is “proof perfect [that] the system’s lost it… It’s an outrageous use of the public funding and the skills and time of trained clinical professionals to have them sitting there doing tender documents with me.”
The MP previously managed a charity providing women’s refuges. Does she see the current physical and mental offer to victims of domestic abuse as adequate?
“No. Not at all. There’s no formal relationship between vulnerable women living in supported accommodation, and the NHS.”
This is in sharp contrast to services for other disadvantaged groups.
“There are some formal schemes for street homeless in big cities” she says by way of example, “and GP practices can be commissioned to give care for those people, [but] there’s literally nothing [similar] formalised for women in refuges, even on a locality basis.”
At the same time, public service cuts mean refuges are facing an ever-growing workload for which they are often ill-equipped to tackle.
Refuge staff are increasingly “having to [deal] with service users’ drug abuse”, says Ms Philips, but this added burden – among others – is not recognised by commissioners.
Recalling her time in the sector, the MP says: “We had protocols about drug related programmes [and had a] partnership with a local drug service.
“Similarly, with mental health needs, we [used to] rely on the local NHS mental health trust.
“As I was leaving that sector, there was a massive spike in the number of women self-harming and with other [mental health] problems. Self-harm is something for which refuges would classically refer to MH services, but that whole network collapsed when every other such service got cut”.
She adds that the situation is now “far worse”.
The Birmingham MP concludes: “Those women [are now] left in social care to be babysat 24 hours a day.”
Ms Phillips has similar concerns about drug abuse services and has spoken publicly about her brother’s experience of drug addiction.
“Generic drug services were as supportive as they could be with their big caseloads. However, the [treatment] models he [was offered] were largely around getting you onto a ‘prescription and methadone’ programme, against which he personally pushed back. His view is that you should not leave addicts on a script for years: you should see them monthly, to ensure they’re still alive!
“My brother needed proper end-to-end trauma support. And they [don’t] have that capacity in the state sector.”
Don’t want to go to rehab
She continues: “In the private sector, it’s just really expensive rehab, and I’m not entirely sure [their] services have sustainability [of recovery] at their heart.
The most effective treatment, “which made him an enthusiast to the point of being evangelical, was the 12-step programme. [But] I don’t think commissioners and the NHS know how to work in partnership with The Fellowship [the mutual support groups which are an integral part of the programme]. The outcome framework of The Fellowship is simple: people will be in the programme for life – so it’s hard to contract for”.
The running down of community services is reflected in the contents of Ms Phillips’ post bag.
“You get very little casework about secondary care. People are much more likely to focus on not being able to get treatment in primary care [or] see the same midwife throughout a pregnancy. There’s a lack of continuity of care.
“[However], the biggest chunk of constituency complaints about the NHS are about mental health services, and the inability for people to get care for their children in MH services. They’re having to go terribly long distances to get higher-tier MH care.”
There is also, Ms Phillips stresses, “such a worrying lack of specialist beds for young women”.
These women, she says, often present at her constituency surgeries having had their benefits stopped by assessors who fail to take their mental health problems into account.
“These assessors seem to think that if you can walk 25 metres, even if you want to kill yourself every metre of the way, then you don’t need benefits”.
She rolls her eyes: “People with severe trauma, or personality disorders, are often being sent to a couple of sessions of healthy minds. That seems a terrible idea.”
The Birmingham MP also says: “The police have become like a mental health service. I went out on call with my local police force recently, and almost every call was about an unmet mental healthcare need.”
Despite the travails of the NHS, the MP believes the biggest threat to city’s old and vulnerable is the decline in social care provision.
“It feels like it is non-existent”, she declares. “Nobody in Birmingham gets it without a fight.”
Much of her casework concerns children of older parents or families and friends of severely ill people, “who’ve already jumped through 900 hoops”.
Yardley is on the Solihull-Birmingham boundary, and their different funding policies produce a postcode lottery, Ms Phillips notes. One of the councils has a slicker bureaucracy, “so posher people can jump the queue through no fault of their own”.
Ms Phillips’ involvement with local charities supporting the care system has shown her how they struggle because of doubts over future funding from local and national budgets. She observes that while topping up social care budgets is now localised through the council tax precept, “in Birmingham that just doesn’t work with such huge, gaping holes in the local government budget already.
“We’ve got to spend billions more on social care. This is a massive funding crisis and we have to be honest”.
The Labour MP thinks we “need something like a new national insurance for old age. We will all get old and/or have old parents, and some of us will need social care. I think the country at large is much further down the road of getting this than the politicians. They don’t want social care funding to be a political football, which it was in the 2010 and 2017 general elections. They want us to work together, find a solution and put in in all parties’ manifestos.
“If we did that, I think [the] British public would be like, ‘Great, they’re fucking finally acting like grown-ups’. The public are at the point of expecting a solution on social care as big and radical as the idea of universal free education”, she concludes.
Babylon come
Babylon/GP At Hand have recently begun expanding in the city and Ms Phillips’ local trust, University Hospitals Birmingham, is proposing a partnership for ‘virtual A&E’ and digital outpatient appointments.
Ms Phillips has mixed feelings about the arrival of Ali Parsa’s baby.
“To the younger, affluent constituents I’ll never hear from, I could see [digital GP services] would be a help and, speaking personally, I don’t mind it.
“On the UHB initiative, I understand the idea of doing something innovative for people and hospitals. [But] many of my constituents can be at the more vulnerable end of the spectrum, and I’m reticent about this replacing face-to-face services, especially with what I know about more vulnerable people’s tendency to missed appointments, particularly in cases of domestic abuse.”
Ms Phillips is not convinced online-first services would work for her older constituents: “Birmingham City Council moved all housing applications to digital by default, and I spent months in the constituency office shouting questions to slightly deaf 90-year-olds like, ‘Do you identify yourself as LGBT?’”
The NHS: Not Labour owned
It is unlikely Ms Phillips will achieve senior ministerial office under the current Labour leadership. Which is a pity as she has a decent pedigree for a potential health and social care secretary.
Her mum, Jean Trainor, was a senior figure in the National Association of Health Authorities, the forerunner of the NHS Confederation, and full of hard-won wisdom.
“Mam used to stress all the time about the size of the NHS machine and how that made it so difficult to change things. You can work 10 years and move it an inch.”
Despite her mother’s strong commitment to the Labour Party, she remembers how the long-running, and still ongoing, debate over the number of hospital beds was one in which her mother’s pragmatism led to her diverging from the party line.
“In the 80s and 90s, Labour was wedded to the idea of more beds, but, towards the end of her time in that world, she was annoyed by that obsession. She became much more interested in the idea of services that help people live well.”
Ms Trainor also taught her daughter about the importance of communicating across the political divide.
In her case, this meant working closely with Conservative health secretary Virginia Bottomley.
“My mum’s view was that despite their political differences, Bottomley did try to do the right thing. She genuinely believed most politicians who did job of health secretary really cared. Her take was that the NHS is not just the Labour Party’s to own”.
Coming up to date, Ms Phillips suggests an incoming Labour government’s biggest impact on the NHS is that “they would stop outsourcing [and] there’d be a rise in wages for NHS staff, and proper pay.”
But she also claims: “I think the NHS would be in a better position under a Labour government because it just always is. History tells me that waiting times reduce.”
If there is any political or influential figure you would like HSJ to interview, please email alastair.mclellan@wilmingtonhealthcare.com.
Next week: Manchester mayor and former health secretary Andy Burnham
The past five Bedpans
NHS ‘privatisation’ documentary ‘Under the Knife’
Tory power-broker Danny Finkelstein on Boris Johnson
Inequalities guru Sir Michael Marmot
You can read all 38 Bedpans here
4 Readers' comments