Westminster Hall
(7 years, 7 months ago)
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Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
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Looked-after Children/Social Work Reform
(7 years, 7 months ago)
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Neil Carmichael (Stroud) (Con)
I beg to move,
That this House has considered the Fourth Report from the Education Committee of Session 2015-16, on Mental health and well-being of looked after children, HC 481, and the Government response, Cm 9284, and the Third Report from the Education Committee of Session 2016-17, on Social work reform, HC 201, and the Government response, HC 733.
It is a pleasure to serve under your chairmanship, Mr Gapes. I am grateful to the House for the opportunity to debate the Select Committee on Education’s work on children’s services and the mental health and wellbeing of looked-after children, and on social work reform. Our Committee has a large and growing set of responsibilities, so it is an extremely good use of time to debate two of our reports at once. I appreciate the House’s indulgence. I pay tribute to the specialist advice we have received from Dr Matt Woolgar; Professor David Berridge, our adviser on such matters; and Marion Davis, also one of our advisers. All three contributed massively to the value of our work, and that is much appreciated.
During our inquiries, we heard from children in care, care leavers, foster carers, social workers and other front-line mental health workers. We visited the excellent services provided by Trafford Council, and we took evidence from a young woman in care and two carers with experience of mental health services. Our meetings with children and professionals in Trafford and Westminster were crucial to the recommendations we made. I thank all those who gave their time to speak to us; they spoke in a very helpful and frank manner.
There are significant challenges to overcome in both looked-after children’s mental health and social work reform. The responses from the Government to our recommendations were, frankly, a little disappointing. We need urgent action to solve problems with mental health services for looked-after children, but the Government have not acknowledged the urgency, and have passed the ball to an expert working group, rather than making the immediate changes that the Committee pressed for. Indeed, many of the people contributing to that working group will be similar to, if not the same as, those who contributed to our findings. Our recommendations on social work reform have largely been ignored. During our inquiry, it was clear that there are things that need to change, but again, the Department has not really taken what we suggested on board.
I shall start with the Select Committee’s inquiry on the mental health and wellbeing of looked-after children. Following a report on child and adolescent mental health services by the Health Committee and an update to the Government’s statutory guidance, we felt that it was a policy area that required scrutiny, so we launched our inquiry in September 2015. Almost half of children in care have a diagnosable mental health disorder, and they are significantly more likely to experience poor health and educational and social outcomes than their non-looked-after peers. Let us not forget that children in these situations are children of the state, because of their special circumstances. Our inquiry took evidence from experts including Sarah Brennan, chief executive of YoungMinds; Professor Peter Fonagy from NHS England; and Natasha Devon, founder of the Self-Esteem Team.
In April this year, we published our report. We found that provision for looked-after children with mental health concerns is poor in many areas throughout England. That variance should be of concern to us all. Some local authorities are providing integrated services, with a strong focus on multi-agency working and support for key workers such as foster carers and school staff; others are not. A significant number are failing to identify mental health issues when young children enter care, and services are turning away vulnerable young people for not meeting diagnostic thresholds, or for being without a stable placement. So there is good and there is bad, which is not acceptable. We found that methods of assessing children and young people’s mental health and wellbeing as they enter care are inconsistent, and too often fail to identify those in need of specialist care and support. For that reason, we recommended that all looked-after children have a full mental health assessment, carried out by a qualified mental health professional.
Leaving the care system can be a time of significant upheaval and disruption, and the period is likely to be even more unsettling for care leavers with mental health concerns. In short, it is the cliff-edge problem. We found that support for young people leaving care is inadequate and based too heavily on inflexible age restrictions. We therefore recommended that care leavers be able to access CAMHS up to the age of 25, rather than the current age of 18, and that the initial assessments of those entering care be carried out more thoroughly and consistently.
We received a huge amount of evidence on the capacity of CAMHS to respond and treat looked-after children and young people. We heard too many times that CAMHS refuse to treat young people who are without a permanent settled placement. The young woman we took evidence from, to whom I referred earlier, said that she had been waiting for CAMHS for more than two and a half years, but had been unable to access services because she had moved a staggering 13 times during that period. We recommended that CAMHS never refuse to see children or young people without a stable placement, or delay access to services until a placement becomes permanent. In recognition of the distinct challenges that looked-after children and young people face, we recommended that they have priority access to mental health assessments by specialist practitioners, and that subsequent treatment be based on clinical need.
The Government’s response acknowledged the vulnerability of looked-after children and the need for timely and effective mental health diagnosis and treatment. We are pleased that the Government have set up an expert working group for looked-after children’s mental health and wellbeing; however, having conducted a lengthy and detailed inquiry on the issue, we are disappointed that so many of our recommendations have simply been referred to that group. We will monitor the working group’s progress, and look forward to receiving updates from its co-chairs in due course, because we are very interested in the subject.
Let us move on to the second report. At the start of the year, we launched an inquiry on the Government’s plans for social work reform—and they do have plans. Although the Government had previously made it clear that improving the quality of child and family social workers and children’s services was a priority, the lack of clarity on how the aim would be achieved meant that we believed it was an important area for us to look at. During our inquiry, we heard from social workers, social work academics, local authority leaders, and many more experts in the field.
Social workers deliver an incredibly important service to some of the most vulnerable children in the country, but evidence suggests that they are doing more work than ever before. Children’s social workers are managing increased case loads: we have the highest number of children in care for 30 years, and the number of children subject to a child protection plan has risen by 50% in the past five years alone. Just last month, Sir James Munby, the president of the family courts, issued a warning about what he terms a “clear and imminent crisis” facing care proceedings, because in the past 10 years the number of care applications going through the courts has doubled. Despite those increased workloads, it is important to remember what an important job social workers do. The number of children who die due to homicide or assault has fallen by 69% since 1985 and remains in long-term decline. That is thanks to the hard work of social workers, police and others. This is not a story of social workers not doing things; the question is how they are led and resourced.
Although we can never be complacent when it comes to the safety of children, the Government need to ensure that in making reforms we do not forget about the good work that children’s social workers do across the country, which often goes unnoticed. On behalf of the Select Committee, I thank social workers for what they do, and I want that message to be amplified.
We published our report in July. We found significant weaknesses in the planned reforms, and recommended important changes. Existing career pathways are confusing, and provision of continuing professional development is inadequate and inconsistent. A national career development framework is urgently required. Children’s social workers need much more assistance after qualifying to enable them to specialise. That became increasingly obvious as we carried out our work. During our inquiry, we regularly heard that it is vital that social workers receive a generic start, with specialisation to follow afterwards. In the current system, however, that is far too difficult to achieve.
The Government’s reforms do not focus enough on tackling endemic retention problems. The average social worker’s career is only eight years long, compared with 16 years for a nurse or 25 years for a doctor. Almost a fifth of social work jobs are vacant, and they are mostly filled by agency workers. Poor working conditions, caused by high case loads, negative media coverage and the blame culture, are a threat to keeping good, experienced social workers in place. We need manageable case loads for those workers, and a national workforce planning system to forecast supply and demand. We also need to talk about social work in a positive way. I have done that already, but it is very important that we do so frequently. Without immediate action in these areas, experienced social workers will continue to feel under pressure and undervalued, and will therefore leave the profession.
One of the biggest problems facing social workers is the lack of a professional body. The closure of the College of Social Work in 2015 has led to a significant absence of high-profile leadership for the profession. A new body would take the lead on a number of crucial functions and so drive improvement in the sector, for example by defining CPD and the post-qualifying framework; endorsing courses; promoting practice excellence; and shaping national and local policy. That really is the No.1 priority and could address so many of the retention issues. The Government should halt their regulatory reforms until they have figured out a way to help the sector to replace the College of Social Work.
Finally, we could not ignore the wider context in which children’s social workers operate. While we welcome the attempt to introduce innovation, the Government’s proposals are untested. We do not believe that there should be any expansion of the independent trust model until there is clear evidence that it works. Unfortunately, despite the Government agreeing with us on so many issues in their response, that response seems to show that they are determined on their course of reform and unwilling to reconsider it.
Tim Loughton (East Worthing and Shoreham) (Con)
I declare my entry in the Register of Members’ Financial Interests.
Does my hon. Friend share my frustration that too often there appears to be an obsession with changing structures, titles and the nature of the vehicles delivering children’s social care, when what really makes a difference are some of the things that he has already mentioned, such as making sure that we do not have 20% vacancies for social workers in certain parts of the country—that is why there is such a huge variance in the number of children taken into care in different local authorities—and looking at the quality of the outcomes for these children? We should do that, rather than obsessing about the system, which is supposedly there to help these children. It is the people on the ground and to whom my hon. Friend quite rightly paid tribute—the too-often maligned social workers—who really help, but they are damned if they do and damned if they don’t.
Mr Carmichael
I thank my hon. Friend for making some really strong points. He is absolutely right about the obsession with structure, as opposed to the importance of the people operating within it. That is why I first of all pay tribute to social workers, and believe that their leadership and reputation need to be enhanced and protected through a professional body; that is something that the Government have to think about carefully.
Although we are happy to hear that the Government plan to consult on many of their reforms, we still believe that there is a lack of detail on how to tackle some of the trickier issues, such as the retention of social workers. Moreover, there is a lack of detail on how some of the proposals are to be taken forward, and how extensive and binding the consultation exercises are likely to be.
The Government said in their response to our report:
“We agree that the development of a strong professional body for social work is important.”
However, they also said that they thought such a body
“would be one established by the…profession.”
We are a bit disappointed about that, because we believe that the Government need to be much more proactive in their efforts to replace the College of Social Work. I hope that the Minister will address that point when he rises to his feet.
The sector needs to be more heavily involved in this area, of course, but the Government have previously invested in the College of Social Work, and there is still a key role for them to play in the creation of a new professional body; it is not sufficient for them to say that the profession needs such a body while doing nothing to encourage its creation. The establishment instead of a Government-controlled regulator seems to suggest precisely the opposite: that the task of defining social work, and good social work practice, is being taken out of the hands of social workers. That is the opposite direction of travel to the one that we recommend. That is worrying, and we are concerned that the Government have not fully understood the significance of the move towards regulation, and away from supporting the creation of a professional body.
Social workers face pressurised working conditions, and the Government response suggests that action on that issue is not being taken quickly enough. Our recommendation that social workers nationally have manageable case loads was rejected. That was despite Ofsted saying that the local authorities that were judged to be good had almost always set manageable limits for their social workers—something we picked up on in Trafford. A recent National Audit Office report that was very critical of the Government’s action on improving children’s services also raised the issue of social worker case loads. We are disappointed that no immediate action on this front is planned.
In some cases, the Government’s response was to reject our recommendations without sufficient justification. For example, despite agreeing that the assessed and supported year in employment was important for newly qualified social workers, they rejected the recommendation to make it mandatory. We are unclear as to why they did that.
Both our inquiries revealed the pressures that children’s services are under. Our inquiry on the mental health of looked-after children found that CAMHS are overwhelmed, and that many specialist teams that offered targeted support for looked-after children have been abolished due to financial pressures. In some areas, children’s social workers face having unmanageable case loads, which is leading to low morale and poor working conditions, as was mentioned earlier by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton).
Experienced social workers are exiting the profession in record numbers. As I have said, Ofsted has found that the local authorities that are judged to be good tend to be the ones that give their social workers manageable case loads; the Government must take account of that.
We also found that services were inconsistent across the country. I have already said this, but it is important to note that initial mental health assessments are highly variable. Many local authorities are not meeting their statutory requirement to ensure that all children are properly assessed on entering care. I would have thought that was of fundamental importance. While there are some good authorities—we cannot deny that, and we should always support those that are good—that support their children’s social workers with good leadership, access to continuing professional development and manageable case loads, far too many are still not in that category, or even in the vicinity of it. There are regions with significant retention problems, and it is clear from Ofsted reports that plugging the gap with agency workers does not bring about a satisfactory solution.
Both inquiries found that training and development for professionals in children’s services are poor. Children’s social workers lack a professional body, and their access to CPD is inconsistent and inadequate. Put simply, it is not good enough. A new professional body for social work, created with help from the Government, could define professional standards for qualifying and post-qualifying practice, and be given a mandate to define the CPD and post-qualifying pathways for the children’s social work profession. This debate is about a profession and the people within it, and we believe that they should have an appropriate body.
Training and support for foster and residential carers is highly variable, and many local authorities fail to equip carers with the knowledge and skills needed to support looked-after children with mental health difficulties. Foster and residential carers are professionals who need comprehensive and regular training in how properly to support children and young people in their care. We have recently launched a further inquiry on fostering, and we will look in more detail at the issues in the coming months.
Despite the Government agreeing with much of our thinking, the responses to both reports lacked the determined aim to implement change in an urgent fashion. It is hugely disappointing that the Government referred so many of the recommendations to an expert working group. On such an important and pressing issue, delaying action and effectively passing the buck is not helpful.
Tim Loughton
I share my hon. Friend’s frustration, but the frustration is worse than that: some of the recommendations in his Committee’s excellent reports relate to recommendations made in the Munro review, which reported in 2011. Since then, very little progress has been made on those recommendations, which have been looked at, researched and looked at again, and they remain unimplemented.
Neil Carmichael
I am grateful for my hon. Friend’s support. He underlines points that I have made, but he is absolutely right about the lack of progress since 2011.
I am pleased to have the opportunity to talk about these issues in the Chamber, because both reports are emblematic of our interest in the whole question of children’s services. I thank all the Members who have come to participate. Two of my colleagues on the Education Committee have done so, and I am grateful to them. We have a huge chance to make an important difference in both these critical areas. It is clear that we all share the objective of improving outcomes for children in care, and I do not doubt that the Minister is as keen as we are to see improvement. I am grateful for all that he has done in the past to demonstrate that commitment. We need a response to my questions, and an approach to our two reports that suggests a sense of urgency and a commitment to ensuring that we can deliver a better future for children in need of support and help. I commend those thoughts to the House, and I hope that the Minister will answer my questions in due course.
Jim Shannon (Strangford) (DUP)
I thank the Chair of the Education Committee, the hon. Member for Stroud (Neil Carmichael), for setting the scene so well. As many in the Chamber will know, I have a particular interest in the mental health and wellbeing of children, which the report looks into in some detail. I want to provide some comment on the report, while being ever mindful of the way that the hon. Gentleman has clearly set out the issues, where the needs are, and perhaps where they have not been met but we hope that they will.
The issue of foster children is of particular interest to me. I know that it is of interest to many others, inside the Chamber and outside it. I commend the members of the Education Committee on the report and the hard work and effort they have clearly put into it. They should be praised for that, and I put that on record.
The welfare of children is one of the most important issues that this House can deal with. Decisions made in this place have the ability to help or hinder a child in their progress towards becoming a contributing member of society. We only get one chance to have a great childhood. We do not get a chance to relive it, just as we do not get a chance to relive later stages of our lives. I was blessed to have a great stable home life, with parents who loved and supported us no matter what the issues were. I have attempted to give my sons a great childhood, and I do what I can in my granddaughters’ lives to see them happy and contented.
The thrust and the theme of the report, I suggest, is how we can look after children at the earliest stage. My home is not perfect. As a father I have done things that I probably should not have done. I have made mistakes, and were my boys here they would laughingly list some of my not-so-finest moments—I am sure there are many—but there is love in our home, and that is important. The report gives us a chance to understand the issues in fostering and the need for foster parents.
It breaks my heart that 2,212 children were living with foster families in Northern Ireland as of 31 March. It is a devolved matter, and I understand that. That figure is nearly nine-tenths—88%—of the 2,500 children in care looked after away from home in Northern Ireland. There are approximately 2,095 foster families in Northern Ireland, and the Fostering Network estimates that fostering services need to recruit a further 170 foster families in the next 12 months.
I have spoken about the issues before in the House, and they are real in my constituency. I have a particular interest in fostering, and I meet people every week in my office who are affected by it. It breaks my heart when I meet women who have given their children up because, although they love them, they cannot give them the life they deserve and need or, sometimes, the care they need. Sometimes love just is not enough. Help and support should be available for those brave families who make sacrifices to give their child a good start in life. The issues are real, and the report’s important recommendations would ensure that children who have to be looked after away from home are helped in the best way possible and the strategy in place is the best available.
In particular, I echo the recommendation that the Government amend the statutory guidance to make it clear that a strengths and difficulties questionnaire should be completed as a starting point for every child entering care. I commend the Committee on that helpful recommendation. Children who are put into care feel that loss the most keenly. They feel abandoned, unwanted and unloved, and those feelings can lead to emotional wounds that may never heal if they do not receive the care and attention that is needed. Putting that recommendation in the report goes a long way to addressing the issues that I perceive in the system. The mental health assessment is one step in ensuring that children get the care and support they need for healing to take place, for them to be integrated into society and to make them feel part of society.
I was surprised to learn that the CAMHS team does not help those who are not in a long-term home. While I can understand the rationale—a stable environment helps the process—I have also seen at first hand the tremendous job that the team can do. That is not just in my constituency, but across the whole of the United Kingdom of Great Britain and Northern Ireland. My office has helped many people who would swear by the difference that our local CAMHS team in Newtownards is able to make with children. The team does marvellous work, and I would like to see a wee bit more focus on that. I agree with the Committee report that the CAMHS team must be available to foster children who are put into foster homes for any length of time, and I hope that that is done as a matter of urgency. I commend the Committee for that recommendation, which is a step in the right direction.
The Minister is assiduous and responds to our queries on every occasion, in every position that he holds. I look forward to his response. I congratulate the Committee on its hard work and commend Committee Members who have made a significant contribution on this emotive and essential topic. I look forward to seeing how the system for looked-after children will improve when the recommendations come into action, and how we in Northern Ireland can follow suit.
Lucy Allan (Telford) (Con)
It is a pleasure to serve under your chairmanship, Mr Gapes, in a debate on this very important issue. The voices of children in care are seldom heard and too often their needs are forgotten. When society does take an interest in the needs of children in care, the focus is far more often on their physical needs than on their mental health and emotional needs, which mirrors the way that mental health is generally treated in society, so I am delighted that the Education Committee pursued this inquiry, involved highly respected experts and professionals and brought forward this report and its recommendations.
As the Children and Social Work Bill is currently going through the House of Lords, this is a real opportunity to make substantial change to the lives of the most vulnerable, and I do not want the opportunity to pass us by. I will come on to the Government’s response to the inquiry later, but if the report had not been carried out, I would be more enthusiastic about the setting up of a Government expert working group on the mental health of looked-after children. I gently remind the Minister that the Education Committee has taken evidence from expert witnesses, all of whom are cited in the excellent report. It took a year to get the report to this stage. To start that process all over again by setting up an expert working group, which may well come to similar conclusions, would feel like a reluctance to take meaningful and prompt action.
The mental health and emotional needs of a child in care must be considered as at least as important as any other need that a child in care may face, because, whatever the reason for being in care, these children have suffered the trauma of losing parents, siblings and all that is familiar to them—friends, schools, a sense of belonging, a sense of identity—and may carry with them a stigma or sense of being unwanted or unloved, as the hon. Member for Strangford (Jim Shannon) noted. During their time in care, they may have experienced multiple placement breakdowns, which will only intensify the feelings of loss, rejection and instability. There can be no doubt that children in care will need help and emotional support to overcome that trauma and move forward with their lives. They will need tools to overcome the challenges and build resilience to cope with whatever has come their way.
As has already been mentioned, children coming into care receive statutory health assessments, but mental health is not always addressed and certainly not on an equal footing, as the Committee heard in evidence to the inquiry. Sometimes the difficulties that children in care face are put down to challenging behaviour, rather than being defined and addressed as mental health needs.
I used to sit on fostering and adoption panels and often we would sit around discussing and worrying about smoke alarms and stair gates and the physical needs of children being taken into care. There was always a glaring omission. We would ask foster carers about how much exercise they took or how many cigarettes they smoked, but we did not ask them how they would deal with the emotional needs of a child who had experienced trauma and loss. We did not even attempt to discuss a child’s mental health needs or the help and support foster carers would need in order to address those concerns. That happens because mental health needs are less visible, and for that reason, we must not ignore them. There must be recognition that children in care will have a higher risk of developing mental health problems.
Members will know from surgeries that it is hard enough to access CAMHS when there is a devoted parent to fight a child’s corner. If the child is in care, moving around from placement to placement, they are not entitled to access to CAMHS until they have a stable placement. Priority access is therefore even more important. A child cannot get access if they are 16 to 18-years old and not in school, and yet a child in care is less likely to be in school at that age. Children in care and care leavers will seldom have someone to fight their corner. It is the state that has taken the decision to take the child from their family and, having done so, it is for the state to make adequate provision for their needs.
It is not enough just to say that the help is out there. There are difficulties with the availability of mental health provision for all children, including with accessing and navigating the system. Accessing mental health care, asking for help and overcoming stigma is hard enough for any young person, even with a strong, supportive family, and we have to acknowledge that.
The Minister has done much to support young people in care and care leavers, and I am sure that he will have carefully read the report and its recommendations. He will be more familiar than most with the outcomes for care leavers, and I will not rehearse them here, but it is arguable that those poor outcomes are directly connected to the neglected emotional health and wellbeing needs of young people in care, which is why this inquiry is so important.
Young people in care need help to build resilience to overcome the difficulties that they face, rather than being left to develop their own coping mechanisms, which may so often fail them. A key part of our inquiry was listening to the experience of children in care. As my hon. Friend the Member for Stroud (Neil Carmichael) said, we took evidence from care leavers and foster carers, both in Committee and informally. We met young people in residential care settings and heard about their experiences of mental health provision. Their views informed the report, which is why I urge the Minister to take the recommendations seriously. I hope that the findings of the inquiry will generate greater awareness of the mental health needs of young people in care and the development of a stronger cross-departmental approach, with greater accessibility to mental health care provision for our most vulnerable children.
I have read the Government response. I know that the Minister has long been a passionate advocate for children in care and care leavers. In that context, it was a disappointing response, knowing as I do how much he cares about these young people. I say to the Minister: please do not put the report on a shelf and let it be forgotten. I was concerned to hear my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) say that the Munro report had made similar recommendations, which appear to have been put on the shelf and forgotten. The Children and Social Work Bill is a real opportunity to focus on the mental health and emotional needs of children in care. It cannot be an opportunity that we miss. Children in care need every single opportunity to overcome the challenges that they face. I urge the Minister to do all that he can to ensure that prompt action is taken and the report is not just put aside and left to another day.
Marion Fellows (Motherwell and Wishaw) (SNP)
It is a pleasure to serve under your chairmanship, Mr Gapes. I thank the hon. Member for Stroud (Neil Carmichael) for his sterling good work steering forward these two reports, as chair of the Education Committee, of which I am a member. I thank the hon. Member for Strangford (Jim Shannon) for his well-informed speech and his passion and commitment to foster children and to bringing up children in the best way possible. I make special mention of the hon. Member for Telford (Lucy Allan). As part of the Education Committee, I have seen her strong passion for children in care and especially for their mental health.
I find serving on the Education Committee difficult and strange, because I am used to different circumstances. I do not want what I am about to say to be taken as saying that we always do everything better and well in Scotland, but there are significant differences, which it is my job to bring forward to the Minister for consideration.
Improving the lives of vulnerable families and children should be a key priority for any Government, so it is concerning that the Government have failed to take a robust cross-departmental approach to this matter. We are rightly proud of the way we do things in Scotland, but we continue to review the legislation. The First Minister recently announced a major root-and-branch, independent review of how Scotland treats its looked-after children. We welcome the UK Government’s desire to ensure that children in care have the support they need as they move into adult life.
In Scotland, we implement something called “Getting it right for every child”, which is at the heart of everything we do that affects children. It is child-focused, it is based on an understanding of the wellbeing of the child and on tackling early needs, and it requires joined-up working, which is not necessarily happening in England. The Looked After Children (Scotland) Regulations 2009 absolutely embody the framework of “Getting it right for every child”.
I was at the recent Scottish National party conference when our First Minister made an emotional and heartfelt declaration about what she wants to do for Scottish children, but so much has already been done. There is also demand for children and adult mental health services in Scotland, and there are far too many children who are unseen and whose needs are unmet. Our Minister for Mental Health has taken on board the First Minister’s desire to push forward the needs of children—especially looked-after children—and ensure that their mental health needs are dealt with. For example, in the next five years, the Scottish Government will invest £150 million in mental health innovation. Some of that money will be used to cut waiting lists, but £50 million is specifically earmarked to support better access to child and adult mental health services.
The Scottish Government have also doubled the number of psychologists in the services. The Minister needs to look at that, because it is all very well having services, but if they are not accessible or if people—especially children—have to wait too long, further problems will be created that will have to be addressed using Government funds from other places further down the line. It is vital that we support our children across the UK, especially those for whom we are responsible as legislators. When I was a local councillor, I was a corporate parent, so I know about the responsibilities that many people have. It is vital that we properly look after children early in their lives so they do not develop greater issues.
Many children who grow up in care go on to live useful, helpful lives. The staff who work with looked-after children deserve our support and commendation, because many of them do sterling work and improve children’s lives. However, we know that nearly half of children in care suffer mental health issues, half the adult prison population were in care as children and, worst of all, a young person who has been in care is 20 times more likely to be dead by the age of 25 than a young person who has not. Those facts all reflect on the mental health of children in care.
Much more needs to be done to improve outcomes for those in care. The Scottish Government’s review will look at the underpinning legislation, practice, culture and ethos, but that is on top of what they are already doing. They have already pledged to listen to 1,000 young people’s care experiences. That is happening at all levels. It is only by fully engaging with looked-after children, care leavers and those who deliver services on the front line that we will create a care and social work system that gives vulnerable children the very best start in life and the love and care that all children deserve.
The chief executive officer of Who Cares? Scotland supported the First Minister’s pledge to review what is happening for looked-after children, saying:
“This review has the mandate to literally save lives. It is a line in the sand. The appreciative nature of this review, with care experience at its core, makes it a global first. Care experienced people will now be integral in the design of a system that will give them a much better chance to not just survive, but thrive.”
As I said earlier, I do not want this to be a “We’re doing better in Scotland” speech. I want vulnerable looked-after children everywhere to be given the help they need. However, I encourage the Government to look to Scotland and emulate the drive and good practice there.
Social work was reformed in Scotland quite a while ago—in fact, I cannot remember the exact date. However, I find it difficult to understand why social work in England falls within the remit of a number of Departments. It incorporates education, health, employment, social security and potentially other areas. Education and health are almost in silos and compete with each other to help families and young children, who are at the core of what they do. It is important that the UK Government have a truly cross-departmental approach to social work reform, because that will ensure that disadvantaged families do not fall off the radar, if for example they are referred by officials in one sector and require support from another.
Although it is encouraging that the Government have undertaken a number of reforms to social work in the light of shocking high-profile failings, such as the baby P case, it is disappointing that the evidence shows that the reforms have not been given sufficient time to be implemented and to mature. That point was made strongly, as I have already said, by the expert witnesses who gave evidence to the Education Committee’s inquiry.
There is a real risk that resources will be exhausted on trying to put into practice new structures, rather than improving existing outcomes. For example, the Committee said in its recommendations that it is not convinced of the need to establish a new regulator, as the Government have already spent too much time changing regulatory bodies. Another change would require a further injection of significant public funds and place an unfair financial burden on individual social workers.
If the structure of the social work sector is badly and hastily implemented, it could have an utterly devastating impact on the lives of real people. I think we all agree with that. We could see catastrophic, and potentially deadly, failings in the system, and risk leaving hard-working social workers to bear the brunt of attacks for failings, as they have in the past. It is all too easy, across the United Kingdom, for social workers to take the blame for systemic failures. Nobody enters social work to do things badly; they do it because they want to help. We must help them to help the people who require help.
In Scotland, when social work is reformed, the Government take a holistic approach and meet all the bodies concerned. For example, when the Scottish Government implemented “Social Services in Scotland: a shared vision and strategy 2015-2020”, it was just that: a shared vision. The strategy was developed by the Social Work Services Strategic Forum, chaired by the Minister for Children and Young People. Social Work Scotland and the social work regulatory body in Scotland were involved, as were local authorities and the care inspectorate. I could go on. There were many public bodies involved. The strategy represents a strong commitment to working in partnership across organisations and with Government to deliver that vision for high-quality and effective social work. I am sorry to say that, as a member of the Education Committee, I sometimes do not find that shared vision, so I again urge the Minister to work across existing bodies to push forward social work reform to the benefit of the users of those services.
In Scotland, we have had a joined-up way of working for many years and some of the Select Committee’s expert witnesses actually said that, so I urge the Minister please to look at what we do in Scotland. I am not saying we are a world-beater or that we have the best, but we definitely have a focus and a vision, and we are years ahead in regulation and in working together across all Departments. We want to get it right for every child, which I am sure is also the Minister’s sole objective.
Mrs Emma Lewell-Buck (South Shields) (Lab)
It is a pleasure to serve under your chairmanship, Mr Gapes. I thank the hon. Member for Stroud (Neil Carmichael) for opening this important debate, and his colleagues on the Education Committee for their excellent work on the two reports that we are discussing. I of course acknowledge the Minister’s commitment in this area, and I know that he and everyone in the Chamber are dedicated to improving the lives of our most vulnerable children. That is why it is all the more disappointing to read the Government responses to the reports.
The Committee based its recommendations on an extensive body of evidence from experts in the industry—evidence that clearly showed why more action and less talk are needed. In the “Mental health and well-being of looked-after children” report, the Committee rightly recommended that a dedicated mental health assessment by a qualified mental health professional be completed for all looked-after children, so that healthcare professionals and local authorities have a solid and consistent foundation on which to plan the best care for a child.
The report further recommended that all children who need access to child and adolescent mental health services get it in a timely fashion. That makes total sense when we consider that almost every looked-after child has endured some form of trauma, from those who have suffered the most unimaginable brutality to those whose parents, for whatever reason, cannot care for them or protect them from harm. In fact, as the hon. Member for Stroud said, at least 45% of children entering care have a diagnosable mental health condition, and 75% of children in care have some kind of emotional or behavioural difficulty. It is therefore astonishing that the recommendation was not accepted.
The Government’s record overall on CAMHS is dire, with children waiting years for specialist help. With that in mind, will the Minister tell us what the ratio of CAMHS workers to looked-after children in England is, and whether he think that the number of CAMHS workers is high enough? Will he also tell us what impact he thinks his Government’s cuts have had on CAMHS overall?
I was similarly disappointed that the Committee’s recommendation that CAMHS be made available to all care leavers up to the age of 25 was rejected. The Government believe that the configuration of local mental health services is a matter for commissioners to decide, on the basis of local need. Even the statutory guidance, however, is clear: decisions on the transition between services should be based on the needs, wishes and feelings of the young person concerned, not the cost considerations of local commissioners. Once a young person turns 18, they are referred to adult mental health services, and we all know that the Government’s record on adult mental health is even more concerning, and that budgets for mental health trusts continue to be slashed.
The Government response does not specifically answer the question of how CAMHS provision will be improved, or how they will tackle the huge waiting lists, which lead to unnecessary suffering. From my own experience, I know that there is nothing worse than working with a child or young person who is desperately crying out for professional help that is simply not available. The social workers and carers who have to deal with these situations day in, day out, have to watch the young person in their care suffer while they feel completely helpless. That is why the Government’s rejection of the Committee’s recommendation that foster carer and residential carer training be supplemented with mental health and emotional wellbeing modules is disappointing. If carers are not fully equipped to do their job, their ability to sustain care for a child can be reduced. That could have a devastating impact on a child, who is left to forge—sometimes many—new relationships with different carers.
I noticed that the Government responses deflected many answers on to the new expert working group on the mental health of looked-after children. I make no criticism of the experts appointed to the group, but further consultation is wholly unnecessary, as the hon. Member for Telford (Lucy Allan) said, especially since both the co-chairs have already submitted evidence to the Committee. Consultation will simply cause further delays, and delay means that more children will suffer unnecessarily. Will the Minister tell us how many children he thinks will be left suffering on waiting lists while that review drags on? Does he accept that the condition of many of them will deteriorate as they wait for services? I have seen that myself in children waiting for long-term fostering or for adoption. A child’s pool of potential carers will decrease as their condition worsens, and as the years go by and he or she gets older, the pool decreases even more. For far too many children, that means never getting to feel the security and stability that long-term fostering or adoption can bring—all because of unnecessary delay.
Heartbreaking as that is, there are far worse scenarios for children in the system, which is why social work reform is so important. The Committee’s report on social work reform makes a number of common-sense suggestions. I appreciate that the Minister has a difficult job. Getting things right for children and families is not an easy task; it is difficult and complex terrain. Successive Governments have battled with how to provide the best and safest social care system for children, but now there is an abundance of official and other expert advice to draw on, so we should see some action and results—but we do not.
I imagine that the Minister in his response will tell us about the Munro report, the Step Up to Social Work programme, Frontline, the Innovation programme, What Works centres, partners in practice, the intervention regime and “Putting children first”, the Government’s vision for excellent social care by 2020. What the Minister might not speak about is the recent National Audit Office report, “Children in need of help or protection”, because it finds that actions taken by the Department for Education over the past six years to improve the quality of help and protection services delivered by local authorities for children have not yet resulted in services being of a good enough quality, suggesting systemic rather than only local failure.
In fact, the demand for help and protection is rising. Over the past 10 years, there has been a 124% increase in serious cases—ones in which a local authority believes that a child may be suffering, or likely to suffer, significant harm. Furthermore, the varied spending on social work has been found to be not related to quality. Will the Minister explain why he thinks that all the Government’s initiatives and changes over the past six years are not yielding results? Many of the NAO’s findings certainly echo the Committee’s analysis that there are significant weaknesses in the Government’s agenda, and that the reforms focus on
“changing structures potentially to the detriment of the people delivering this key public service.”
What is needed in the social work profession is continuity, stability and confidence, and a Government who can hold their nerve on how best to help children and families by putting in place and embedding good policies. The Government are failing to get the basics right. Those basics are: reducing social worker case loads; preventing experienced professionals from quitting the profession; training social workers in a holistic way; not fast-tracking them, and forcing them to specialise before they have even been trained in the basics; and amending IT and the bureaucratic process across the board to achieve the goal of getting social workers where they want to be—out from behind their desks and seeing the families with whom they work.
It is an absolute must that we start looking after social workers. A new professional body could go some way to assist us in that. It is simply no good demanding excellent social workers and excellent practice if social workers are not appropriately supported, including with safe working environments. Social work is a dangerous profession, with unmanageable case loads, impenetrable bureaucratic structures and poor pay. It makes me angry that social workers are not afforded the same protection and status as other professionals. We all need to remember that for every social worker who becomes unwell and cannot do their job, there are sometimes up to 40 children who lose the help and support of that social worker, who, for many of them, is the only constant in their life. Such a working environment would not be tolerated in Parliament; Parliament should not tolerate it for our social workers. Why will the Minister not implement the Select Committee’s recommendation about the wellbeing of the workforce?
A common feature of the Government’s response to the Select Committee’s recommendations on social work reform was deflection to future initiatives and reports, and future analysis of initiatives that are already in place. All I know about the future is that our children’s futures are at risk under this Government. The overall fact remains that the Government’s response does not tackle the crisis in social work because it does not address how to deal with the significant increase in the sheer number of people accessing the service. To do so, the Minister would need to admit what we all know: that the Government’s closure of Sure Start units and removal of early years help and family support, and their cuts, punitive welfare policies and austerity measures, are impacting everywhere, and nowhere more starkly than in the children and family social work arena, which by its very nature is interlinked with wider societal and economic issues. The Minister does not need to take my word for it; he could listen to the chair of one of the Government’s expert panels, who has said that
“investment is welcome, but we have to recognise that is against a backdrop of other financial pressures…and a history of disinvestment across the system for quite a number of years.”
The Opposition welcome the Select Committee’s work, but not so much the Government’s response, or their inability to accept the overall consequences of their policy making, and the drastic impact that those policies are having on everyone, but most importantly, vulnerable children and families.
The Minister for Vulnerable Children and Families (Edward Timpson)
It is a pleasure, as ever, to serve under your chairmanship, Mr Gapes. I welcome this debate and the interest that the Chair of the Select Committee, my hon. Friend the Member for Stroud (Neil Carmichael), has shown in prioritising these issues for inquiry by that Committee.
There is a lot of ground to cover. It is always encouraging to get a ringing endorsement of everything that the Government are doing, but there are clearly still some elements of concern that I need to address. In so doing, I recognise, as others have, that hon. Members who are present share my commitment to improving the lives of vulnerable children. That is our joint mission and the underlying motivation for everything that we do in our privileged roles.
The Government have participated in and responded to the Select Committee’s inquiries, but I want to take the opportunity to provide some further detail and, I hope, reassurance that we have a comprehensive, considered and compassionate plan to help to bring about the improvements that we all want to see to vulnerable children’s lives. I remind hon. Members that in July this year we published our “Putting children first” strategy. I am grateful to the hon. Member for South Shields (Mrs Lewell-Buck) for reminding everyone of that important document, which I believe represents the most thorough and ambitious reform agenda in this area for some considerable time. I am not complacent, and neither is that report, but it is a serious attempt to try to get children’s social care to where it needs to be.
The strategy sets out fundamental reforms across each of the three pillars on which the social care system stands or falls. The first and foremost of those is people and leadership. I agree with my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) that our system stands or falls on the quality and commitment of the people driving it. The second pillar is practice and the environment that we create for that practice to be able to improve, which we must do in a way that does not stifle practice through over-regulation and process-driven activity. Again, I agree with the hon. Member for South Shields that we do not want social workers sitting behind computers; we want them to work face-to-face with families to try to improve their lives, and we want to avoid risk-averse behaviours, of which process-driven activity is often a part.
The third and final pillar is governance and accountability. We need to be sure that what we are doing is effective and actually works. We must develop innovative new models for the pursuit of practice excellence, which has to be at the heart of this work, and remain firmly focused on improving outcomes for children. Only by taking action across those three fundamental pillars will we bring about the kind of transformational change that is needed in children’s social care.
As other Members have acknowledged, children’s social workers can have a genuinely life-changing impact on our most vulnerable children. Our vision is of a social work profession made up of fully confident and highly capable social workers who have been trained in the right way and have the right knowledge and skills, and access to the right supervision and support.
Mrs Lewell-Buck
The Minister may be coming to this, but I am curious: how will the Government measure the success of “Putting children first”?
Edward Timpson
I will come to how we will ensure that we are making progress. Several milestones are set out in “Putting children first”, which is a programme of work through to 2020. We will be able to measure progress by whether inspections of children’s services and our outcome measures for children in care improve, and we will have a whole suite of indicators that will give us a strong understanding of whether the work we have done and the measures we have put in place are having a positive influence.
Over the last six years, we have begun to lay solid foundations for achieving that vision. We have appointed a chief social worker, who has introduced the first definitive statements of child and family social work knowledge and skills. Working across Government with the Department of Health, we have developed the first four teaching partnerships, whereby employers and universities work together to ensure that university courses provide students with the right on-the-job skills. One of the problems in the past—I have seen this for myself—has been that too many social workers have come into practice without any first-hand experience of what it is like to be in a child protection situation. We need to change that.
We have invested almost £50 million since 2010 in Frontline and Step Up, which I make no apologies for mentioning. Those programmes have brought more than 770 high-calibre recruits into social work. We have expanded our assessed and supported year in employment programme to support newly qualified social workers entering the profession. To help the Chairman of the Select Committee on whether ASYE should be mandatory, I can tell him that 151 of the 152 local authorities take part in that course. We want to review that and see whether that level is maintained, because we think ASYE is an important part of social workers’ early experience of gaining professional knowledge.
We are under no illusions about the remaining challenges; there is still much more to do. The recent National Audit Office report on child protection performance was a timely reminder that the performance of children’s social care services is still far too variable across the country. We must acknowledge that although many local authorities provide a consistently effective core social work practice, the majority still struggle to do so.
The reviews by Professor Eileen Munro, Sir Martin Narey and David Croisdale-Appleby, among others, have given us a much deeper understanding of the issues faced by children’s social care. They describe a system in which initial social worker training is not universally preparing students for the challenges of the job, as I alluded to, and those already doing it often lack the time, specialist skills and supervision needed to achieve real change for children and families. The reviews also describe a system that focuses too much on management and is governed by prescribed approaches rather than excellent practice, and conclude that services have not always been designed around vulnerable children and that innovation has not been given enough space to thrive.
We are determined to address those challenges, as outlined in our “Putting children first” strategy. Going further and faster on our plan to drive up the skills and status of the children’s social work profession is central to that endeavour. To that end, I am working in partnership with my colleagues in the Department of Health to establish a new, bespoke independent regulator for social work that will set higher standards for social work both in what is expected of professionals in order to practise and in what is expected from universities and others providing initial social work education. It will also create a more rigorous approach to continuing professional development in social work—an area the Chairman of the Select Committee rightly raised—ensuring that social workers continue to develop throughout their careers, as called for in the report. In the past there has been too little recognition of the role this area has to play.
I am also bringing forward a new system of post-qualifying assessment and accreditation for child and family social workers. That is a key plank of our reforms, because it will provide, for the first time, a consistent way of ensuring that child and family social workers have the right knowledge and skills to do their jobs well. The new assessment will incentivise employers to invest properly in the development and support of their staff, as well as ensuring a mechanism for recognising the specialist skills that child and family social workers possess. Again, that work aligns with the recommendations of the Select Committee’s report. The consultation, which hon. Members are keen to see, is planned for publication before the end of the year, and I am sure they will want to contribute.
The assessment and accreditation system will also, for the first time, establish a consistent, clearly structured and well supported career pathway for child and family social workers, which will allow them to deepen their skills as they take on additional responsibility and, crucially, keep them in touch with practice. One of the problems we can all recognise is that in the past too many good social workers, as they gained experience, rather than remaining close to families and working their own cases, moved into management and behind desks. We therefore lose that expertise and the new crop of social workers coming through do not get the support they could have gained from those experienced social workers if they are no longer working with them.
Practice skill and expertise will be the most highly prized and rewarded asset across the whole career, from newly qualified social workers all the way through to practice leaders. Together, the reforms provide an opportunity and a solid platform from which to raise the status of child and family social work in the way the profession needs and deserves. They create the conditions for a strong, confident social work profession where practitioners are properly supported to thrive in very challenging front-line posts. The profession, and the children and families it serves, should expect no less.
I want to address the point made by the Chairman of the Select Committee about a professional body. It is right to say that over three years the Department for Education, with support from the Department of Health, spent more than £8 million of public money trying to set up the college of social work, but despite that significant investment the college was unable to secure the sufficient membership required to make it sustainable. However, I re-emphasise, as I did in evidence to the Select Committee, that it is important that there is a strong professional body for social work. It has to be sustainable, but also have a sense of ownership by the profession. It cannot be top-down; it has to be a bottom-up organisation. We want to continue to work with the British Association of Social Workers, other representatives of the workforce and the Department of Health to see how we can start to nurture and craft a professional body in that mould so that we have something that truly represents social workers and can go into bat for them when they need that.
It is also important to recognise that giving social workers the right knowledge and skills and setting high standards for practice will not on its own bring about the step change we need. Excellent social workers need to work within supportive and permissive organisations where they are given the flexibility to use their expertise in ways that have the greatest impact on children and families. As Eileen Munro identified, good social work is not about following processes and procedures, but too often that is what we have turned it into. We need a dynamic practice system where testing and evaluating new ways of working and learning from the best is the norm. We see that in other parts of public service, so why not in children’s social care?
It is our children’s social care innovation programme that is starting to foster that way of working. We have already funded over 50 projects and announced £200 million more for the future. We are also developing the first ever What Works centre for children’s social care. That is an important development, because for the first time there will be a repository of good practice for social workers to use and have confidence in for the work they do. We are also overhauling the serious case review process to better extract national learning when things go wrong.
We want to go further. The Children and Social Work Bill, which is currently before Parliament, includes a new power to innovate. Through that power, we are looking to say that, ultimately, excellent front-line social work practice should be defined not by the Government or Parliament but by local practice leaders, with more freedom to operate within a clear, safe statutory framework. Our “partners in practice” local authorities—eight of the highest-performing authorities—see the power as an important and potentially transformative opportunity.
The power has been criticised by some in the Lords. It is right that we debate that and that the quality of debate in Parliament is strong, but let us have a debate based on facts, not on unfounded propositions. Let me be clear: we do not want to privatise child protection services and we will not privatise child protection services. Indeed, there are already clear legislative restrictions on the outsourcing of children’s social care functions. It was never the intention to use the power to innovate to revisit those. However, to put it beyond doubt, we are amending the Children and Social Work Bill to rule out any use of the power in that way.
We will not remove fundamental rights or protections from children either. Our aim is to strengthen, not weaken protections. We want to let the best local authorities, led by leading-edge practice leaders, work in ways with more potential to make an actual difference for children instead of watching and waiting, hamstrung by excessive prescription.
I will quote from Eileen Munro, because we still value her views on how we are performing and the work we are doing:
“I welcome the introduction of the power to innovate set out in the Children and Social Work Bill. This is a critical part of the journey set out in my Independent Review of Child Protection towards a child welfare system that reflects the complexity and diversity of children’s needs. Trusting professionals to use their judgment rather than be forced to follow unnecessary legal rules will help ensure children get the help they need, when they need it.”
She is not a lone voice: the Children’s Commissioner, the Society of Local Authority Chief Executives, the Children and Family Court Advisory and Support Service, Catch22, Achieving for Children and the children’s social worker all hold similar views.
Mrs Lewell-Buck
The concern about the Children and Social Work Bill seems to be that the Government have been completely unable to say exactly which functions local authorities will be able to opt out of. Bearing in mind that a lot of the functions they have around children protect them from harm and keep them safe, is it not understandable that there is huge concern out there about where the Government are going with that?
Edward Timpson
Perhaps I can give the hon. Lady some examples of primary legislation where local authorities have asked that they be able to use the power to innovate where that is currently restricted in law. Under section 25 of the Children Act 1989, independent reviewing officers must be appointed for every looked-after child and they have to have regular reviews. We know that children often say that they do not like that. There are children who are in very stable placements for whom that can be disruptive and they ask for that not to happen, whereas other children need more intense oversight from an independent reviewing officer. That is one example of where local authorities want to have that flexibility.
There are also some anomalies that I am not sure many people appreciate. For instance, under section 66 of the 1989 Act, any child who is not cared for by a family or a guardian for 28 days counts as privately fostered and as such receives the same duties as other looked-after children, with visits and so on. That ends up capturing children coming over to language schools, which the local authority have to go and visit, to check on their welfare, despite those children being on a foreign exchange trip. Those are just some examples of measures where the local authorities that have shown an interest—we have to remember that this is a permissive power—would want some flexibility, in a safe and controlled environment, to test to see whether there is a different way of providing services that is absolutely focused on improving children’s outcomes more than anything else.
Edward Timpson
Briefly, because I want to make sure I finish my speech. I have not got on to mental health yet.
Mrs Lewell-Buck
Just one quick point for clarity: am I right to assume that the Minister is saying that anything is open as long as the local authority applies to the Secretary of State, or will it be just the two examples he has given? I am struggling to see what exactly is in the mix. This seems to be open to anything.
Edward Timpson
There are restrictions to the legislation that local authorities can apply to be disapplied. A local authority has to make the application itself and it has to consult with the local area. It then has to submit that application to an expert group, which will consider it and publish its findings. Even then, there has to be an affirmative resolution in both Houses before that local authority can test out that new way of working. I met the hon. Lady yesterday to talk a little bit about this and other areas of shared interest. I am happy to provide her with more details and I also suggest that we agree to meet again, so we can make sure that all of the information is provided.
The chairman of the Education Committee, my hon. Friend the Member for Stroud, raised the issue of trusts, which I will touch on briefly. I in no way think that creating children’s social care trusts is a panacea for all ills. In most cases, when a local authority fails it will be able to improve its services with the right support, as is happening in Cumbria, Surrey and Buckinghamshire at the moment. However, where failure is persistent or systemic, it is right that we look carefully at whether the capacity for improvement exists in the local authority. We now have commissioners who go in and undertake a three-month review before reaching their conclusions and recommendations on the way forward.
Leaving services within council control is sometimes found to be the best approach to securing improvement, as in Bromley and Dudley, for example. In other cases, local authorities themselves agree that an independent trust model will create extra improvement capacity and help to turn things around, as is the case in Birmingham and Sunderland. Sometimes, where failure is deep-rooted and an authority does not have the capacity to improve itself, service control must be removed by my Department. I will not apologise for doing that. We cannot simply sit back and watch authorities fail over and over again, year after year, without trying new ways to bring about improvement. There is a growing bank of evidence following recent Ofsted inspections in Doncaster and Slough of services improving following the move to a trust after years of failure. Ofsted has particularly highlighted the strengthening of leadership and management in those trusts, which are critical components of any successful organisation.
To give the Chairman of the Committee an opportunity to respond and conclude the debate, let me now turn to my hon. Friend’s interest in the mental health and wellbeing of looked-after children and care leavers. I thank members of the Education Committee for their insightful report and commend them for their ongoing interest in this important area. I know all too well, from my personal experience, the nature of the challenges that children in care often face and the impact that can have on their mental health and the health of those who care for them. That is why my Department is taking strong action to improve support for children in care and care leavers, including the introduction of the staying put duty, so that all young people leaving foster care can continue living with their foster families after the age of 18. More than 50% of 18 year-olds in foster care have taken up that opportunity.
We are also undertaking a national stocktake of foster care to better understand current provision and how needs are matched with skills. I look forward to working with the Education Committee in looking at the evidence it gathers for its own report in this area. We are piloting the staying close programme, which enables young people leaving children’s homes to maintain links with those homes, as recommended by Sir Martin Narey’s review of children’s residential care. We published a new, cross-Government care leavers strategy, “Keep On Caring”, which sets out what we will do right across Government to ensure that care leavers get the support they need and also outlines our ambitions for trialling new and innovative ways of working. We are also taking legislation through Parliament that will, for the first time, define what it means to be a good corporate parent for children in care and care leavers.
When the state decides a child’s needs are such that we must take on parental responsibility, it has an overwhelming duty and responsibility to be the very best corporate parent it can be. It is right that, like all good parents, that responsibility continues when young people reach early adulthood. The new corporate parenting principles ensure that responsibility is given the weight and significance it deserves across the whole country. I hope hon. Members will support it.
Central to delivering our responsibilities as corporate parents is the promotion and support of the mental health and wellbeing of children in care and care leavers. That is an issue we take very seriously and on which we want to make timely and sustainable progress that tackles the shift in mindset needed around mental health and brings improvements to practice. Only this week, my noble Friend Lord Nash introduced an amendment to the Children and Social Work Bill that will explicitly capture the role of local authorities in promoting the mental health of looked-after children as a core part of the definition of a good corporate parent, which is significant.
I share the concerns of the hon. Member for South Shields about child and adolescent mental health services. They have been undervalued and underfunded for far too long, and we need to do far more to tackle that. The Government are investing £1.4 billion over the life of this Parliament to drive improvements in mental health services for children and young people. In addition, we are making a specific investment of more than £10 million to support the mental health of young people in secure children’s homes, who are some of the most vulnerable people in our society.
In order to get mental health support for children in care right, the Department of Health and the Department for Education have, as hon. Members have said, established an expert group to ensure that the emotional and mental health needs of children and young people in care and adopted from care and of care leavers are better met. It is a collaboration between social care, education and health colleagues, parents and carers and care leavers themselves. It is a comprehensive piece of work to map out the care pathway for a looked-after child in need of mental health support; it is not just looking at the point of entry into the care system.
The principle of having a mental health assessment for all children being brought into care is instinctively attractive, but I know—and I know others who share this view—that we have to look at each child individually. There will be some children who, at the point they come into care, are still suffering great trauma from an event that has led to them going into care. That is not the right moment for them to have such an assessment. There are other children, such as newborn babies and others, for whom it would also not be appropriate.
The expert group is gathering pace and gathering that evidence. As my noble Friend Lord Nash said on Report, we will take seriously its recommendations. Those may come during the duration of the group’s work and may also include potential changes to legislation. That is a commitment we have made, and we want to make progress and make sure we do not lose this opportunity.
The reports discussed today pose a range of challenges to the Government. I welcome the healthy debate they have generated, because they help to keep the issue at the top of the agenda and maintain the momentum, not just for me and my Department but right across Government. I share the ambition of other hon. Members, and we are united in our commitment to improving the lives of our most vulnerable children. Hon. Members should be in no doubt that I recognise and accept that there remain deep-seated issues we need to resolve, but I and the Government are more determined than ever to show the resolve and commitment needed to rise to those challenges with our clear and ambitious plan for fundamentally reforming the system. Our vulnerable children deserve no less.
Neil Carmichael
It is a great pleasure to wind up the debate. I thank the Minister for his commitment to the issues we have raised and for the answers he has given to many of our questions. I have no doubt that he is determined to improve the lot of our children in care and of our social work profession as a whole. I am pleased that he referenced Eileen Munro’s focus on judgment and I look forward to seeing that developed further. It is encouraging that he is going to help to nurture and craft a professional body. That is important for social work. We certainly found in Trafford that effective leadership, good training, good continuing professional development and a combination of levels of leadership amounting to a delivery that was unified, transparent and open was extraordinarily beneficial. We want to see that across the whole country to deal with the variance in local authorities that the Minister acknowledged.
My hon. Friend the Member for Telford (Lucy Allan) referred to our forthcoming inquiry into fostering. We look forward to hearing from the Minister about the Department’s fostering stocktake. We have written seeking information about that in readiness for our inquiry.
The Minister can be absolutely sure that we will not rest until we see improvement. The work we have done, the fact we have charged the debate, as the Minister acknowledged—we are grateful for that—and also the changes taking place in the Bill currently going through the House, not least Lord Nash’s amendment, are all good signs. I leave the debate with the sure knowledge that the Education Committee believes these matters are important and urgent.
Motion lapsed (Standing Order No. 10(6)).
National Arthritis Week
(7 years, 7 months ago)
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Jim Shannon (Strangford) (DUP)
I beg to move,
That this House has considered National Arthritis Week 2016.
It is a pleasure to serve under your chairmanship, Mr Betts. I am delighted that today, for the first time in five years in this House, there is a dedicated debate in Parliament examining the impact of arthritis. It is a privilege to speak in this House; that opportunity is not something we take for granted. It is good to come along to expound and inform on an issue that is so important. I am very pleased to see the Minister in his place. I think he and I will be in this position many times, debating health issues that interest us. It is good to see right hon. and hon. Members here. I know they will all make significant contributions.
Arthritis, along with musculoskeletal conditions, has a massive impact on people’s everyday quality of life. While I am disappointed that we have not spoken sooner in the past five years about this topic, I am pleased that time has been allocated today by the Backbench Business Committee, which I thank, for such an important debate that enjoys cross-party support. Opposition Members seem to be well balanced, and I am pleased to see the hon. Member for Congleton (Fiona Bruce), who is always here; I thank her for that and look forward to her contribution.
I should make it clear at the outset that the title of this debate is a slight misnomer, as the National Arthritis Week campaign has been replaced by the “Share Your Everyday” campaign, led by Arthritis Research UK, which is encouraging the public to share their stories of living with arthritis so that research is better targeted at the issues affecting most people with arthritis. We need to break the stigma of talking about pain and loss of dexterity and mobility, so that we can help to alleviate it. I urge Members to show their support for the campaign by sharing their own stories. I know there are Members here today who will do so, and that will be a very effective way of underlining this issue.
We should begin by discussing arthritis, because the burden on the individual is clear and substantial. It brings pain, isolation and fatigue and stops people doing the things that matter to them, keeping them from the world of work, from enjoying leisure time and from spending time with their families. Those are all key issues. I want to thank Arthritis Research UK—some people from it are in the Gallery—for supplying us all with notes and information to help the debate develop. We thank it for the hard work it does.
Arthritis should not be seen as a by-product of old age. For some it is, but for others it is not. The examples that I, along with others, will give show that arthritis is not only an elderly person’s ailment. It affects thousands of young people and millions of working-age people. One in five people over 50 have osteoarthritis in their knee. There is a young girl in my constituency who I went to appeal with several times. She suffers from chronic inflammation of the bowel—a by-product of severe arthritis, which led to her being medically retired at the age of 28. This is not an elderly person’s disease by any means.
The burden of arthritis on society warrants greater debate. Arthritis has an impact in a number of ways, particularly on our health and care system. Each year, 20% of the population consults a GP about musculoskeletal problems. The NHS spends £5 billion per year on arthritis— its fourth largest programme budget. That puts into perspective the enormity of what we are looking at today. I was struck by the stories shared on the Facebook page set up for this debate, so many of which are genuinely heart-breaking. One that stood out was that of a young girl of 27 who is waiting for a hip replacement, having suffered from arthritis since she was 20. That underlines, again, that this is not an old person’s disease. It knows no barriers, no age restrictions and certainly no class or creed barriers.
There is also the issue of workplace absence, with 30.6 million working days lost to the economy each year. The indirect cost to the economy of arthritic conditions is £25 billion. We do not necessarily want to focus on the financial aspect, but we can look at the figures as an indication of how important it is to address this issue and to raise awareness through this debate.
The scale of the burden is growing, with an ageing and increasingly physically inactive population. The numbers are sure to rise in the coming years. I briefly want to describe some of the characteristics of arthritis. When we talk about arthritis, we are talking about a number of different musculoskeletal conditions within the categories of inflammatory conditions, joint conditions and fragility falls and fractures, which are key factors.
The first group is inflammatory conditions, such as rheumatoid arthritis, where the immune system rapidly begins attacking the joints in the body. Those conditions affect around 1% of the UK population, including people of all ages, and have serious consequences. The second group is a range of conditions that cause musculoskeletal pain, the most common being osteoarthritis. Some 8.75 million people have sought treatment for osteoarthritis, with the true number of sufferers likely to be even higher. As is often the case, we are just scratching at the surface. The gradual onset means the condition mainly affects the elderly, but 2.36 million working-age people in the UK have sought treatment for knee osteoarthritis. Lower back pain, the most common form of disability in the UK, also falls into this group of conditions.
The final group is osteoporosis and fragility fractures. Osteoporosis is a silent and painless disease, but it causes fragility fractures after falls from standing height that afflict mainly but not exclusively elderly patients. The disease causes weakening of the bones and some 300,000 fragility fractures in the UK per year, of which 89,000 are hip fractures. The impact of those fractures on elderly, frail patients can often be severe, taking away their mobility, independence and, in some cases, their lives. We have to consider that.
Arthritis is not inevitable. Preventive measures must be the focus in tackling it. We need to address the risk factors for arthritis and musculoskeletal conditions. Links between being overweight or obese and long-term conditions such as heart disease, cancer and diabetes are well known—I declare an interest, as a diabetic. I am glad to say that I am almost back to the weight I was before I got married, which is quite something. I am trying to keep off all the sweet things, if I can. However, being overweight or obese is also a major risk factor in various forms of arthritis. It is the single biggest avoidable cause of osteoarthritis and increases the likelihood of developing inflammatory conditions such as rheumatoid arthritis.
Every one of us, as an MP, is aware of these issues because our constituents come to see us. In many cases, we deal with related benefit issues, and that is how we come into direct contact with people affected by arthritis.
Christina Rees (Neath) (Lab/Co-op)
I am grateful to the hon. Gentleman for securing this really important debate. These conditions cause not only physical but psychological problems. A girl came to see me, aged 19. She said:
“Arthritis is unpredictable. It flares up suddenly. Medication problems make it difficult for me to manage. It is hard to explain to my friends why I cannot do something I could do last week, because I look so normal.”
Does the hon. Gentleman agree that we have to look at the damage these problems are causing youngsters in their everyday lives, including in how they associate with their friends?
Jim Shannon
I thank the hon. Lady for her intervention and for outlining how arthritis can affect people at the age of 19. I am aware of a constituent who is even younger, which really surprises me.
Rising levels of obesity, combined with our ageing society, could lead to a near doubling in the prevalence of osteoarthritis in the UK by 2035. The Government need to make sure that musculoskeletal health is always included in assessment of the population’s health locally and nationally; that the benefits of physical activity for people with musculoskeletal conditions are emphasised in health promotion messages; and that, when programmes targeting lifestyle factors such as obesity and physical inactivity are being designed and delivered, their impact on musculoskeletal health should be explicitly included. So there are many things the Minister could respond to, and I look forward to that.
Above all, the Government need to make sure that effective physical activity services are available locally. This is crucial, and I hope colleagues from all parties will join me in calling for a National Audit Office review of physical activity services for people with osteoarthritis so that services help people across the UK to maintain good musculoskeletal health. We need to address that.
I want to speak about benefits as well. I know about osteoarthritis and rheumatoid arthritis because I have sat across a table from a person helping them fill in disability living allowance forms, now personal independence payment forms. People tell me their story, because we need to know their story when we help them fill in the forms. We need to know what they have done and what they have discussed with their GPs and consultants. The issues are very clear. I know that the Minister is not responsible, but for the record I implore the Department for Work and Pensions to make sure that, when it comes to filling in PIP forms, people have their full medical story told. They need an understanding person at the other end of the phone. I am not being disrespectful to anybody, but sometimes when we phone up about PIP, the person at the other end of the phone does not understand the medical details. I respectfully and gently say to the Government that we need someone on the phone who understands the medical condition and understands the issues and can therefore empathise with the person who does their 10-minute interview at the first stage of their PIP form before they do the full form. I think every MP would recognise that particular issue.
As I mentioned earlier, falls and fractures are a pressing public health issue among older people. Falls are the second greatest contributor to the burden of disability in the UK and a major cause of mortality. Around 300,000 fragility fractures occur each year in the UK, including some 89,000 hip fragility fractures, with 1,865 cases submitted to the national hip fracture database in Northern Ireland. Hip fractures are the most common cause of accident-related death in older people, resulting in some 14,000 deaths in the United Kingdom every year. We know that 20% of hip fracture patients die within four months of their injury and 30% within a year. This is a growing problem. Projections show that by 2036 hip fractures could account for 140,000 hospital admissions in the UK each year, with care and treatment costs rising to £6 billion. Let us put that into perspective and do the sums. Let us address the issue early on and do away with the cost impact further down the line.
We need more joined-up treatment in such cases because, once a first break occurs, it is vital that a second break is avoided. A fracture liaison service, the FLS, which provides targeted assessment and treatment for those with fractures, is widely regarded as the best way to address the problem of preventing future fractures. It is both a clinically effective and a cost-effective solution. Despite this, only 37% of local health services in England have a fracture liaison service. We need local commissioners to ensure that a fracture liaison service is linked to every hospital and held to account for commissioning fracture liaison services that cross the boundaries between health and social care so that the two marry. It is important that it does so. Arthritis may not kill, but it attacks what it means to live. The normality of life will never be the same with arthritis.
The condition limits people in doing the things that matter to them, but with greater personalisation and help in managing their condition, the NHS, care services and our welfare system can help people push back the limits of their condition. Too few people with arthritis currently have a care plan. Many people cannot quickly access physiotherapy without a GP referral, and people with arthritis need more help so that they can be in work, which is where most of them want to be if only that was possible. People with arthritis know how their condition affects them better than anyone else. Personalised and person-centred healthcare is therefore essential to move forward.
Care planning is an approach that people with long-term conditions can use to manage their health and wellbeing. It is based on a two-way conversation with a healthcare professional where goals are shared and actions agreed. If we could arrange that, we could help them. A better system should be in place to make sure that that happens. This can offer important benefits to people with arthritis, yet only 12% of people with arthritis currently have a care plan. If it is only 12%, there is something wrong and we must address that. That number needs to increase if we are to enable more people to manage their condition.
There are other tools that health and care services can use to enable people with arthritis to manage their conditions more effectively. Physiotherapy is a clinically effective therapy that can substantially reduce pain and restore movement for people with arthritis. Again, is it available for everyone? If it is not, it should be. I gently ask the Minister how can we make that happen. I look to the Minister, as I always do, for a sympathetic and understanding response.
Self-referral to physiotherapy is a system that lets people go directly to an NHS physiotherapist without a GP referral. This system is associated with improved health outcomes and patient experience. It is good that it is cost-effective and reduces the burden on GPs. All people with arthritis in Scotland and across much of Wales can already access physiotherapy directly. We have many friends and colleagues here from Scotland, and I know that they will make contributions that I suspect will indicate what is being done in Scotland. I must say I am envious of some of the things being done there. I would love to see those things in place in Northern Ireland and across the whole of the United Kingdom.
In the rest of the UK, for example, only a third of clinical commissioning groups in England offer self-referral and it is still only being piloted in Northern Ireland. That needs to change. When inflammatory conditions such as rheumatoid arthritis strike, delay can be a major risk factor and the clock starts ticking once symptoms develop. Early identification and treatment is needed rapidly to control disease, minimise long-term joint damage and avoid lifelong pain and disability, but the NHS does not currently assess people with rheumatoid and other forms of early inflammatory arthritis—EIA—quickly enough, and national guidelines are not being met. Again, I gently say to the Minister: if the guidelines are not being met, what are we doing to improve that?
A recent clinical audit by the British Society for Rheumatology found that only 20% of people who see a GP with suspected rheumatoid arthritis or EIA are referred to rheumatology specialist services within three days, and only 37% of people referred with suspected rheumatoid arthritis or EIA are seen by a specialist within three weeks. Again, that needs to be addressed and I again look to the Minister for a response on that. Local commissioners across the UK need to achieve earlier diagnosis of inflammatory conditions. Arthritis and other musculoskeletal conditions are the most common diseases in our working population, and as the population gets older, an even greater proportion of workers will have conditions that include osteoarthritis and back pain. Those workers want to keep working, so we have to improve the system of healthcare to enable that.
Many people with arthritis want to work, and they can with the right support. However, only two thirds of working age people with a musculoskeletal condition are currently in work, compared with 74% of those without health problems. What is more, the rate of employment for people with arthritis is 20% lower than for people with no condition. We need better support to enable people with arthritis to work and we need to promote the Access to Work scheme that is in place, which pays for practical support and equipment. It is good that we have such a system, but I want to see better utilisation of it and fiscal incentives for employers to provide health and wellbeing initiatives that promote musculoskeletal health.
It is vital that more is known about people with arthritis so that research can be targeted at what matters most to them, but, worryingly, key data are not being collected. Arthritis Research UK is working to increase the quality and availability of data about the experiences of people with arthritis and about the public services that improve their quality of life. Arthritis Research UK and Imperial College London have developed a model for estimating prevalence using the existing NHS data currently available in England. I encourage all Members for English constituencies to visit the Arthritis Research UK website to get access to the data, which I understand will soon be available in Scotland, and later in Northern Ireland and Wales. We have a lot to do to catch up.
However, not enough data on people with arthritis are being collected, and that limits our understanding of the prevalence of the condition and action that can be taken in response. Moreover, data that are collected are not uniformly classified across the system. Definitions of musculoskeletal conditions used in other national data sets, such as those for benefits, are inconsistent. National survey content may need greater co-ordination. Again, I say gently and with respect that it is a question of how to do things better. I am speaking very quickly, Mr Betts, because I am conscious that other Members want to speak. I am probably rushing faster than usual, but I hope everyone can follow what I am saying.
A pivotal issue is the need to protect and build the UK’s excellence in medical research, so that researchers can continue working on a cure for arthritis. How important it is to find a cure. The centres funded by Arthritis Research UK have been at the forefront of research aimed at improving the lives of people with arthritis in the UK. It is marvellous and encouraging that they have uncovered breakthrough treatments that push back the limits of the condition. In the 1990s, centres supported by Arthritis Research UK—it has given us all the information—discovered that a molecule called tumour necrosis factor was causing the disruptive auto-immune inflammation of joints. The anti-TNF therapy that they developed has freed millions from the pain and disability caused by rheumatoid arthritis; it was also an inspiration for the field of biologics, medicines that use the body’s own molecules to combat diseases. It is crucial that that work, and the work of all medical research charities, should be supported by the Government in the long term with a real-terms increase in science spending. It is not something for the Minister to respond to, but I would seek his assistance and support on that point.
Within the life sciences sector, substantial investment by medical research charities drives improvements in health and generates wider societal and economic benefits. In 2013, medical research charities invested about £1.3 billion in UK medical and health research, which represents more than a third of all publicly-funded medical research in the UK. The Government have recognised that our science base is a vital national asset— a view that I and all Members present, including the Minister, subscribe to—and they have reaffirmed their intention to make Britain the best place in the world for science. We all support that ambition. It is crucial to uphold that commitment, through a real-terms increase in science spending over the long term.
That would include bolstering the charity research support fund, which provides an uplift to support charity-funded research in universities. It is a marvellous asset, investing a lot of money in research. That joint funding of research ensures that charitable donations are invested directly in research that meets the needs of people with medical conditions. In 2013, the Government’s £198 million investment through the CRSF leveraged some £833 million of investment by charities in English universities. That is a significant, marvellous, gigantic sum of money to help to find cures. When the House debates rare diseases—and we do our best in these matters—we often refer to the good work done by charities, universities and the relevant partnerships.
Christina Rees
My arthritis is in many ways self-inflicted; it comes from a lifetime of playing sport. I have no cartilage in my right knee, which is severely arthritic. Then there is my lower back—I do not think anything much works any more. Does the hon. Gentleman think that there should be more research on people who have played sport and become arthritic? In this day and age we advocate participation in sport, without really looking at the long-term consequences.
Jim Shannon
The hon. Lady is right and I think many of us recognise what she says. We encourage people who are obese to do more sport. We encourage young people, rather than playing on computers and laptops, as they so often do, to take part in more physical activity. However, we must consider the side-effects of that as well, and ensure that we help with them. I hope that what I have said about responding early has been taken on board. With an early response to signs of deterioration, the hon. Lady might not today be in as much pain; although I can tell hon. Members that I have seen her moving around the House, and she moves at some rate. The hon. Lady is obviously not completely restricted, and I say well done to her.
Without the CRSF there would be less funding to invest in world-class research. The UK’s medical research landscape is currently undergoing major change with the formation of UK Research and Innovation through the Higher Education and Research Bill. I expect that the whole House would agree that is crucial that the CRSF should increase in line with charitable investment, within the new research funding system, to safeguard research in the long term.
I look forward to hearing the remarks that will follow in the debate, including the personal experiences of arthritis of Members’ constituents—and perhaps also those of Members themselves. Much more can be done to improve the quality of life of people with arthritis, and to push back the limits of that worrying condition. We have an opportunity in Parliament to play a huge part in ensuring that our constituents get a better quality of life. I look forward to hearing the speeches of the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), and of the Minister.
Mr Clive Betts (in the Chair)
The hon. Member for West Ham (Lyn Brown) has apologised in advance for having to leave early on account of new Front-Bench responsibilities. It is normal protocol for hon. Members to stay for the whole debate, but on this occasion I accept her apology.
Lyn Brown (West Ham) (Lab)
I thank the hon. Member for Strangford (Jim Shannon) for securing this important debate, and for his excellent contribution. I also thank the charities, such as Arthritis Research UK, that work every day to reduce the suffering brought about by joint disorders.
Last week was National Arthritis Week. The pain of arthritis is often invisible. Trying to explain its constant, chaotic pain to someone who has not lived with it can be very hard. A survey conducted by Arthritis Research UK found that 28% of women with arthritis feel that people do not really understand the pain they face. Despite trying to talk about it, they feel lonely with the disease. That is why today’s debate is so important. By talking about arthritis in this place, we can begin to tell people that they are not alone.
I want to do that in a literal sense, by sharing my experiences of arthritis. In March 2015, we were two months away from a general election, which, as Members on both sides of the House know, is a difficult, stressful and busy time to be a politician. As part of the shadow ministerial team, I was driving up and down the country with my tiny dog Cara in tow, visiting fire stations and sharing Labour’s plans for the future of the fire service. It should have been an exciting spring, sharing a vision that I was passionate about, and introducing my little four-legged friend to a bunch of soppy but very brave firefighters. However, it was made difficult as I had been experiencing mobility problems for quite a while, and it was not unusual for me to be in constant pain and experiencing stiffness. However, until that point I had been able to fight through. I had not considered that I had a condition.
In March, I finally hit a brick wall. I felt completely and utterly drained of energy and could barely walk more than a few steps. I had to drag myself up the stairs of my house by pulling on the bannister. I was unable to stand at street stalls for any length of time, or go canvassing. I contacted voters only on the phone, or at meetings where I could be completely sedentary. I needed help putting on my bra. I felt humiliated, embarrassed and a complete and utter failure. At the worst, I was struggling to stay awake for more than six hours a day. It can be imagined what that did to my mental health. The stress of not being able to fight that election on my own terms was overwhelming. The tiredness and pain were looked after by a specialist, but throughout that period I had no idea whatever of what the problem was. At times like that, the internet is not a best friend. My imagination was in overdrive. Only the support of good friends, comrades, my wonderful husband and my family got me through that election.
Let me be clear. I do not want to come across as some kind of stoic hero. I am not. I cried, mainly in my doctor’s surgery as I was trying to get some answers. The staff must have thought I was completely wet. I found it really difficult to cope with the condition and the demands of work at that time. I know that many people have that feeling, and it is little wonder that musculoskeletal conditions account for one in five working days lost to ill health in the UK.
Despite being referred to my arthritis service in November 2014, it was early May 2015 before I was finally diagnosed with seronegative inflammatory arthritis. I now know that fatigue is very common among sufferers of arthritis due to pain, stress and sleep disturbance. More specifically—this is not very well known out there—fatigue is a symptom of inflammatory arthritis. Chemicals called cytokines are found in the inflamed tissues and cause extreme fatigue.
At that point I was put on a course of methotrexate, which thankfully caused the aggressive nature of the condition to begin to recede, but it was still quite aggressive, and I needed additional medication to get me to where I am now, taking methotrexate and injecting myself every fortnight with CIMZIA, a biological injectable medicine. The pain and restrictive movement have now subsided considerably. A number of colleagues have told me as I walk around the House that I seem to be doing much better, and I am.
When I first met my arthritis specialist, she asked me what my goals were. I said I wanted to be able to walk Cara again, to wear heels and to play tennis, which would be some feat as I have never played tennis before. She laughed and said, “Let’s keep this realistic and start with walking the dog.” I am happy to say that with the support of the NHS I can now walk Cara for over an hour, almost entirely pain-free. At Christmas last year, I bought a pair of blue polka dot shoes as an incentive and a symbol of hope. I have worn them twice and, although they are not as high as those of the Prime Minister, or indeed our former shadow Chief Whip, my right hon. Friend the Member for Doncaster Central (Dame Rosie Winterton), they are a symbol of the progress I am making. What is more, I have just enrolled on a course of tennis lessons, which I will start in March next year, two years after I hit that dreaded wall.
I have had good treatment, advice and support, and I thank my doctors for that from the bottom of my heart. Ten million people in the UK suffer the pain of arthritis and not all are as lucky as I have been. Moreover, I am told that with an ageing population and rising physical inactivity, the number of people living with arthritis will rise. We must make sure that every patient has access to excellent treatment. Due to the high cost of the drugs and the guidelines of the National Institute for Health and Care Excellence, most patients have to wait at least a year before they can access the transformative biologics that have made such a huge difference to my life. I had to wait just over a year, and that year was hard.
The wait means that we are not controlling the condition at an early stage or enabling patients to stay active, independent and in employment. Surely this wait is not cost-effective to industry and the economy. I know that this is ultimately an issue for NICE, but making these drugs more widely available will transform arthritis care for many, as it has done for me. Let us be honest: there are problems with traditional treatments. Although methotrexate has been really important for me, it can have long-term negative effects on the liver, but coming off it is certainly not an option for me at the moment. I urge the Government to support research on the long-term effects of existing drugs, and to continue to support vital research into new treatments and life-saving drugs, so that we can help people to live pain-free into old age.
I will be positive: there have been substantial breakthroughs in arthritis treatment as a result of research funded by Arthritis Research UK. They include treatment for rheumatoid and inflammatory arthritis, and treatment to prevent miscarriages in women suffering from antiphospholipid syndrome, which again is something I have. If only I had known a couple of decades earlier.
World-leading scientists, working in British institutions, such as Leeds, Birmingham and Keele Universities, the Kennedy Institute at Oxford, and St Mary's hospital, London, developed these treatments. The biological treatments I am on have been developed here in the UK. We should be so proud of these achievements, but we must make sure that our medical research sector remains at the cutting edge. Now more than ever, the UK’s excellence in medical research is under threat. Many of us warned before the EU referendum that funding for medical research would be hit if we voted to leave. Vicky Forster, a researcher, wrote in The Guardian:
“many scientific disciplines will lose EU funding post-Brexit”.
That is certainly the case with arthritis.
Figures provided by Arthritis Research UK show that between 2011 and 2015 the EU contributed over £2.5 million to its projects. Those researchers have gone on to secure more than £18 million of European funding to support the next stage of their work. It should be a priority for the Government to maintain our world-leading medical research sector. To do this, they need to ensure that overall investment in UK science and research is protected and grown in the longer term.
The risk to research posed by Brexit does not stop at funding. Sir Paul Nurse, director of the Francis Crick Institute, said:
“Science thrives on the permeability of ideas and people and flourishes in environments that pool intelligence, minimise barriers, and are open to free exchange and collaboration.”
Leaving the European Union threatens this melting pot of ideas. In 2014-15, Arthritis Research UK committed more than £30 million to research that was hosted in the UK, but had collaborators in 13 European Union countries. If the Government want to make sure that our medical research sector remains as vibrant and as successful as it is, it is important to maintain the current ease with which those involved in medical research are able to travel and work across the EU and the UK.
We should be truly ambitious as a country and aim to expand arthritis research and medical research more generally, not merely preserve what we have. I have been told that structures need to be in place to encourage our NHS clinicians to participate in research. At the moment, this is not possible due to the demands on the NHS and a medical culture that puts research second.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
I commend my hon. Friend on making this excellent debate so moving. She shows how important this issue is. She is a living, breathing example of why research is so necessary. She looks 10 years younger than she did last year.
Mr Betts in the Chair
I say to the hon. Lady that four other hon. Members want to speak, and there are only 20 minutes left.
Lyn Brown
In conclusion, Mr Betts, I hope that sharing my experience today has helped to play a small part in letting people who live with arthritis know that they are not alone. I was lucky to have good treatment. I can now walk Cara, wear heels and look forward to playing tennis. I want the Government to make sure that the UK remains a world leader in medical research, so that we continue to find ground-breaking treatments and more of the 10 million people living with arthritis can live their lives relatively pain-free.
Several hon. Members rose—
Mr Betts in the Chair
Four hon. Members want to speak, which means five minutes each. I call Fiona Bruce.
Fiona Bruce (Congleton) (Con)
Thank you, Mr Betts. I shall try to speak quickly, but possibly not as quickly as the hon. Member for Strangford (Jim Shannon), who I think holds the record in this House. I commend him for leading the charge in calling for this debate and for an excellent speech, in which he made some recommendations that I fully support.
As hon. Members are aware, Arthritis Research UK runs an annual campaign to shine a light on the experiences of people with arthritis, and the stories that have emerged are compelling. They give an insight into the pain, isolation and fatigue that is suffered daily by millions of people throughout the UK and caused by this debilitating disease. The campaign is powerfully titled “Share Your Everyday”. I have also heard stories from my constituency of Congleton of people living with arthritis and the detrimental impact on their quality of life. Time prevents me from quoting all the stories that I have, but I will give voice to one of those people. A lady called Christine Walker has given me permission to share her experience, and I pay tribute to her for her bravery in campaigning over many years, as I now know, to raise the profile of the need for greater support for those who suffer from arthritis.
Christine has severe osteoarthritis. The pain started in her knees when she was in her 30s. By her 40s, both hips were affected and she experienced pain doing everyday tasks such as getting out of the car. In her 50s she started to develop painful nodules on her fingers and had problems gripping objects. It became increasingly challenging for Christine to hold a pen, or a needle to sew. Chopping food was difficult, and paintbrushes slipped out of her hand. She even went so far as to say:
“Sometimes I just wanted to get a knife and chop off the lumps on my fingers; they were so painful.”
Of course, Christine is not alone. As we have heard, Arthritis Research UK states that back pain, for example, is very prevalent. Indeed, in my local authority area of Cheshire East, it is endured by more than 66,000 people—almost 18% of the population. Arthritis Research UK further states that about one in seven people in the UK lives with arthritis. At that national level, three in four people live with arthritis or joint pain. The Daily Telegraph and Arthritis Research UK have indicated in a recent survey that that pain stops them living life to the full. Just like Christine, many people are suffering severely owing to this crippling condition.
As the leading cause of pain and disability, arthritis is estimated to cost the NHS £5 billion a year. As we have heard, one in five people consults their GP about a musculoskeletal problem such as arthritis every year. That equates to 100,000 consultations every day. About 21% of patient visits to GP surgeries relate to arthritic conditions, and that goes up to more than 30% in the over-50s. The prevalence of these conditions is set to rise even further with growing levels of physical inactivity, obesity and an ageing population. That is why I greatly support the proposal from the hon. Member for Strangford that we improve advice to prevent, rather than just try to cure, this disease.
Why does arthritis so often find itself at the bottom of the heap, as far as acknowledgement of medical conditions is concerned, with treatment and care too often inadequate or inconsistent? The first annual report of the national clinical audit of rheumatoid and early inflammatory arthritis, published on 22 January 2016, identifies that although most services offer prompt educational support and agree targets for treatment with their patients, quality standards are not always met, so sufferers like Christine are often told that they can do little more than take painkillers. Unless prompt and decisive action is taken, people like Christine throughout the UK will be forced to continue to suffer terrible pain, isolation and fatigue. We need to accept that arthritis is a common and long-term condition that warrants the kind of treatment, monitoring and support that is available for other conditions. When we speak to people like Christine, it emerges as evident that a major focus must be on greater investment in patient education programmes, equipping and resourcing people to manage their condition better and endure less pain.
I want to relay Christine’s story as I come towards the end of my speech. In 2010, after years of having to rely simply on painkillers, Christine, along with about 250 others with hand arthritis, was invited to join a study funded by Arthritis Research UK at Keele University. It was run by Professor Krysia Dziedzic at Keele’s Arthritis Research UK primary care centre. The trial tested the effectiveness of exercises; an occupational therapist taught participants strengthening and mobilising movements.
Christine described the experience as life-changing. She was shown how to squeeze out a dishcloth and hold a kettle with two hands, and told about gadgets that would help her to open cans, peel vegetables and slice bread. Tasks she had avoided were possible again. The trial showed her practical ways of coping and made an enormous difference. NICE guidance recommends that those diagnosed with this condition be offered the opportunity to take part in such activities, including self-management programmes. We must ensure that NICE best practice guidelines are met in that respect. Much work is being done, but it needs to be offered much more widely.
I would like to give the last word to Christine and Arthritis Research UK. Christine says, “Taking exercise to help with my arthritis was a life-saver”. A rehabilitation specialist at her local gym in Cheshire taught her how to exercise better. She began a programme to build her muscles and paid more attention to her diet. She says:
“It’s all about strengthening problem areas—quads, hamstrings, calf muscles and the upper body…By doing this, I’m taking pressure off joints and easing pain. And today I keep the pounds at bay through healthy eating, reducing the pressure on my knees and hips…Because I have stayed active, I can keep gardening and have fun with my grandchildren.”
We should be giving that kind of help to everyone in this country.
Arthritis Research UK says:
“We need MPs to speak up for people with arthritis in the debate and call for decisive action so that everybody can live fuller lives with arthritis today, and without it tomorrow.”
Philip Boswell (Coatbridge, Chryston and Bellshill) (SNP)
It is a pleasure to serve under your chairmanship, Mr Betts. I thank everyone who has contributed to this important debate. Arthritis is a disease that affects many; most people know personally someone who suffers from it. I particularly thank the hon. Member for Strangford (Jim Shannon) for bringing this important issue and debate to the House.
The hon. Gentleman mentioned some of the good work carried out in Scotland. One initiative that is worth mentioning is self-referral for physiotherapy. A multi-centre national trial involving 26 general practices and 3,000 patients in Scotland identified that an average episode of care was more cost-effective when it followed self-referral for physiotherapy than when it followed GP referral. That equated to a saving of 25%. If the initiative was rolled out across Scotland, it would provide an average cost-benefit of £2 million a year. I hope that the Minister is listening.
A common misconception about arthritis is that it is a disease that primarily affects older people—something touched on by hon. Members in the debate. Arthritis affects people of all ages and takes many forms, a number of which, such as rheumatoid arthritis, can begin at a very young age—again, that was highlighted by the hon. Member for Strangford. Many individuals in the working-age population face the prospect of managing this long-term degenerative illness while in employment. Arthritis is not always a visible condition, and the prevalence of the disease among the working population can easily be underestimated.
In fact, according to Arthritis Research UK, musculoskeletal disorders are the most prevalent diseases in the UK working population. Worryingly, the statistics indicate that not enough is being done by employers to support employees affected by these conditions. It may be surprising to many people, but musculoskeletal problems cause the greatest number of working days lost; 30.6 million working days are lost each year. Back pain alone costs the economy about £10 billion a year.
Unfortunately, due to a lack of support, only just under 60% of people of working age with arthritis are in work. However, the responsibility to support those with arthritis lies not only with employers, but with the Department for Work and Pensions and the wider UK Government. The role that this Government must play in assisting those with arthritis and other musculoskeletal disorders in the workplace has become even more important with the growth of the gig economy and the prevalence of those who are self-employed, a large portion of whom are not self-employed by choice.
I have one constituent, whom I will not name, whose story is incredibly pertinent to the debate. My constituent was diagnosed with rheumatoid arthritis at the age of 14. For those who do not know, three quarters of people with rheumatoid arthritis are of working age when diagnosed. Two years after onset, one third of those diagnosed will have stopped working. Within 10 years, half are unable to work. The Disability Discrimination Act 1995 requires employers to make provision for employees with disabilities and long-term conditions. However, my constituent does not have an employer because he is self-employed. As I said before, this is not through choice, but from necessity, given the increased flexibility seen in the workplace over the past few years—by flexibility, I mean the mechanisms implemented for the erosion of workers’ rights that is so prevalent in our society today.
As my constituent is self-employed, he does not have the same protections as those who work for traditional employers. He cannot take time off work, as that would directly affect his income. He is not entitled to sick pay, and often finds himself having to work despite flare-ups. As he is a joiner—a job that is much more physical than others—he is particularly affected during a flare-up; even something as simple as driving to a job can be a struggle. However, he enjoys his work, has invested his career and a number of years in building up his skill set and, in addition, has a family to provide for and simply cannot afford to retrain for a different role. In many ways, he is stuck between a rock and a hard place, and he has both my sympathy and my full support.
The UK Government are not just failing to support those who are self-employed; there are also substantial failings in support for those employed in a traditional sense. As I am sure many of us here can attest, numerous constituents come to us for help because they have their personal independence payments unfairly stopped or reduced after assessments. This is of particular concern for those who struggle with arthritis, which is very much an invisible disability—a point touched on by the hon. Member for Neath (Christina Rees). In addition, symptoms can fluctuate in severity, which can make an accurate assessment of the impact of the disease difficult in a time-restricted interview setting. In a recent survey, almost three quarters of people with musculoskeletal conditions who had a face-to-face work capability assessment said that they did not feel that they had received sufficient support to help them get back to work. Clearly, more action needs to be taken.
In summary, no one should have to take redundancy because of a lack of support for a manageable long-term illness. I look to the Minister and his Government to do more to support arthritis sufferers. Let us see whether there is indeed such a thing as a caring Conservative. The test will be in the action of the Government, rather than the words of their spokesperson.
Liz McInnes (Heywood and Middleton) (Lab)
It is a pleasure to serve under your chairmanship, Mr Betts, and an honour to be mistaken for my very athletic hon. Friend the Member for Neath (Christina Rees). I thank the hon. Member for Strangford (Jim Shannon) for championing this debate. I know from my role as the chair of the all-party parliamentary group on medical research that this debate on arthritis has been a long time coming, given the five-year hiatus in discussing the issue in this House.
First, I pay tribute to the courage and strength of the 10 million people living in the UK who suffer from the disease of arthritis and musculoskeletal conditions. Secondly, we must celebrate the work, commitment and endeavour of thousands of carers who look after, whether in a personal or professional capacity, those who suffer from this illness.
Mr George Howarth (Knowsley) (Lab)
Although I do not, as far as I know, have an arthritic condition, I do have an impacted disc. Frankly, when it flares up, without the support of family members, and in particular my wife, I would be in an impossible situation. It is important that we pay tribute to all those carers and family members who support people with these conditions.
Liz McInnes
I thank my right hon. Friend for that relevant intervention. We must never forget the usually unpaid work that carers do and the vast contribution they make to keeping people out of hospital and saving the NHS money.
As many other hon. Members have done, I also thank Arthritis Research UK for the work it does highlighting the issues around this disease, which affects nearly one in six people in the UK. Arthritis Research UK provides the support that people with arthritis need, such as in-work help and funding for accessibility, social care and medical research. Arthritis Research UK spent £6.6 million on research this year, and during 2014-15, it committed £30.9 million of funding across Europe with its research partners. As many hon. Members have mentioned, it promoted World Arthritis Day, which was last week, and the excellent “Share your Everyday” campaign.
I was fortunate enough to be able to table an early-day motion, which garnered signatures from across the House, recognising the issues and people I have just spoken about. To date, that early-day motion has attracted 44 signatures, and I thank all those hon. Members who supported the motion; hopefully, after this debate there might be more.
Before entering this House, as a biochemist in the NHS, I worked at the forefront of patient care and research and development. The work on arthritis research in the UK is pioneering; it is uncovering new ideas and breakthrough treatments that will end the way in which arthritis limits lives. In the 1990s, it was UK scientists who discovered that a molecule called tumour necrosis factor—one of the cytokines that my hon. Friend the Member for West Ham (Lyn Brown) referred to—was the key molecule causing the destructive autoimmune inflammation of joints that leads to the problems of arthritis. The anti-tumour necrosis factor therapy that they developed has freed millions from rheumatoid arthritis and has also inspired the field of biologics—medicines that use the body’s own molecules to combat diseases. That is something we should be very proud of.
The crucial work of all medical research charities is supported, in the long term, by Government through a real-terms increase in science spending. It is essential that that is continued, and that we back research and development, now and post-Brexit. The Government also need to play their part in supporting medical research funded by charities. The charity research support fund provides an uplift to support charity-funded research in universities and to contribute towards the full economic costs of research—costs such as lighting, heating and maintaining labs. This may seem a minimal ask, but it is the basis and foundation of what scientists, and the laboratories they use, require to continue their vital research.
This joint funding approach ensures that charitable donations are directly invested in research that meets the needs of people with health conditions. In 2013, the Government’s £198 million investment through the charity research support fund leveraged £833 million of investment by charities in English universities. That is a staggering amount; without the charity research support fund, we would have less funding to invest in our leading research. We must commit to securing continual funding for this, to help those with debilitating diseases.
Chris Stephens (Glasgow South West) (SNP)
It is a pleasure, as always, to serve under your chairmanship, Mr Betts, and a pleasure to follow the hon. Member for Heywood and Middleton (Liz McInnes). In my time, I want to focus on discussing employment and the personal feelings of people with arthritis, because it is astonishing that only 59% of working-age people with arthritis are in work.
I employ a senior case worker, Pam Wilson, who was diagnosed with rheumatoid arthritis and osteoarthritis ten years ago, just after she turned 30. She has spoken to me about the taboos of her diagnosis and how people view her condition as being an old people’s problem, which we know is not the case. Arthritis can occur at any age during a person’s lifetime, can be extremely debilitating and, due to its nature, is not visible to others. Pam has described to me situations where she has been described as being lazy and excluded from certain situations in previous employments, purely on the grounds of her health issues. This situation is faced by many arthritis sufferers.
I would like to hear from the Minister today about how we can increase the number of people with arthritis in work. Can we ensure that employers understand these issues? Can we ensure they are working with trade unions, which know about these issues in terms of dealing with employees who require reasonable adjustments in the workplace? Can we look at the Access to Work programme to help those with arthritis? Can we look at the issue sensitively in terms of work capability assessments?
I visited the drop-in organised by Arthritis Research UK last week, talking about the many misconceptions people have about those with arthritis. Pam Wilson is not lazy; she is a hard-working employee in a hard-working team assisting the constituents of Glasgow South West on a daily basis.
As Pam says:
“Yes I have had bad days, some awful days too, but I also have days where I can cope with the pain and medication side effects. It’s all about managing your own expectations of yourself and understanding what your body is telling you. Sometimes though it is other people who don’t understand. They think you’re lazy because you’re not as active as they are, not walking anywhere, not running or cycling places. They are looking at you and think you’re OK. Because people with arthritis do look OK! Time and experience make you put on a face to the world—one that says I’m fine, but inside and behind closed doors we’re struggling in pain, we’re tired. But we still smile and get on with it, grateful that new medications keep us mobile.”
Hopefully this debate will make people understand arthritis. Sufferers are always grateful when someone understands the daily struggle, and it takes two minutes to ask how they are and understand their situation. I look forward to the Minister telling us what more can be done to improve arthritis sufferers’ employment prospects and how we can help to prevent and cure this condition.
Mr Clive Betts (in the Chair)
I thank the hon. Gentleman for being so succinct in his remarks. I call Martyn Day.
Martyn Day (Linlithgow and East Falkirk) (SNP)
It is a pleasure to serve under your chairmanship, Mr Betts. I start by thanking the hon. Members for Strangford (Jim Shannon) and for Congleton (Fiona Bruce) for leading today’s interesting and timely debate. It is surprising that it is the first such debate for five years.
We have heard from many speakers how arthritis affects people, including young people and working-age people, and I thank my hon. Friend the Member for Glasgow South West (Chris Stephens) for his excellent example of a person in work and the real troubles that they face. We have heard how it is a fluctuating condition with symptoms that can change on a daily basis, as well as many personal cases and constituents’ experiences that highlight this problem affecting many people. We all know members of our own families who are affected.
Steven Paterson (Stirling) (SNP)
I do not come to this debate with any great expertise, but my gran suffered greatly with arthritis, which affected the joints in her hands and legs and basically left her housebound. Does he agree that one of the real benefits of today’s debate—I pay great tribute to those who have secured it—is that we can raise awareness of the condition more widely, and that it is incumbent on all of us to go forward from this debate and do that?
Martyn Day
I agree entirely with my hon. Friend.
The scale and significance of this issue has been clearly illustrated by several key statistics that we have heard today. Several speakers have told us how each year, a fifth of the population consult their GP about musculoskeletal problems. There are 30.6 million working days lost each year to arthritis, which account for a fifth of all working days lost. Scottish estimates tell us that 60,000 people have rheumatoid arthritis, and 2,500 people are diagnosed each year. One in five people in Scotland experience chronic pain and one in 20 experience severe, disabling chronic pain, with the back and joints being the most common location for chronic pain. Arthritis Care has estimated that approximately 800,000 to 900,000 people in Scotland alone are living with osteoarthritis.
All those figures highlight the enormity of the issue. However, we must remember that data collection and management is particularly poor for arthritis and musculoskeletal issues and it needs to improve if we are to get a clearer picture of the numbers across Scotland and the rest of the UK. That point was made by my colleague, the hon. Member for Strangford.
On a positive note, Scotland is the only nation in the UK to routinely publish data on chronic pain. That is welcome, as we have one in 20 living with disabling chronic pain that has a serious impact on physical wellbeing and mental health issues. There is no doubt that arthritis and musculoskeletal conditions can be very disabling, and we must take action to raise awareness about the conditions and improve musculoskeletal health —be that by promoting physical activity, tackling obesity or using medicines.
The hon. Member for Heywood and Middleton (Liz McInnes) made a point that we should all echo about carers’ work, which is often overlooked. In my constituency —I am sure this will be the case for most—we have a number of support groups for arthritis sufferers. The central arthritis self-help group in Grangemouth is a good example, with monthly meetings including entertainment and social events, along with talks on health and other subjects. The group also organises outings, hydrotherapy and exercise sessions. As a society, we owe a debt of gratitude to groups such as that for the work they do and to everyone else who is helping sufferers.
There is much that can be done for sufferers. One of the most important things is faster diagnosis of conditions such as inflammatory arthritis, as with earlier treatment, they can be controlled better. In Scotland, there is much focus on tackling obesity, both to prevent and to treat musculoskeletal conditions. We must strive to do more to improve diets and encourage physical activity—in saying that, however, I recognise the point made by the hon. Member for Neath (Christina Rees) about sport-related conditions.
In my area, a good example is Together for Health—often known as T4H—which is a community-based project that works to promote healthy lifestyles in the Armadale and Fauldhouse areas within my constituency and that of my hon. Friend the Member for Livingston (Hannah Bardell). It works in partnership with a range of local organisations, businesses and community groups to promote healthy lifestyles and delivers a variety of activities and events to encourage people to move more and eat better, with the overall aim of reducing childhood obesity.
Key messages of the project include the benefits of a balanced, affordable diet, and encouragement of children and families to be more physically active and spend less time doing sedentary activities. That is not just a Scottish or a UK problem, of course. We have a global ageing population and although the link between arthritis and ageing is well known in our own countries, there are fewer data on how older people in lower and middle-income countries are affected.
What we do know, however, is alarming. The World Health Organisation estimates that 9.6% of men and 18% of women aged over 60 have symptomatic osteoarthritis, and that 25% of those with osteoarthritis cannot perform the major daily activities of life. Taking action internationally is important for the millions of older people who are directly affected, but it also has an impact on the lives of many of those who depend on them. Often older people in developing countries are the main carers of children whose parents have had to leave for work or who have been orphaned due to conflict or illnesses such as HIV.
In conclusion, it is important that we do more locally and internationally to help alleviate these conditions, and we must make preventive measures a greater priority.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
It is an honour to serve under your chairmanship, Mr Betts.
Today we are debating arthritis and what more can be done to help those who suffer from this terrible health condition. It is very welcome that the Backbench Business Committee allowed this debate to happen today, which is in arthritis awareness week and so soon after World Arthritis Day. I also thank the Members from across the House who secured the debate with the Backbench Business Committee, and the hon. Member for Strangford (Jim Shannon) for leading the debate this afternoon. He eloquently and clearly set the tone, and I thank him for that.
As we have heard, this condition can often go unnoticed or ignored by individuals and wider society, and I hope that the awareness work seen this week has helped somewhat in changing that, along with the role that everyone here has played in supporting that culture change. Nearly 10 million people in the UK live with arthritis. The symptoms can vary; there are over 200 known types of arthritis and rheumatic disease. The symptoms include inflammation of the joints, pain, fatigue, stiffness and difficulty moving. It is quite a common misconception that arthritis is a health condition affecting only the elderly, but it can often affect all ages. That is why it is important that we raise awareness, and that more be done to educate the public on the symptoms, and on the support and help that is out there.
However, we must also be aware that, given the ageing population, more people will suffer with arthritis. The number of sufferers is expected to rise by 50% by 2030. It has to be said that the Government’s short-sighted cuts to public health grants will only cause havoc if the proper finances are not put in place to address our nation’s health.
Arthritis may not be a killer, but it does attack the way of life of many people. As has been put so eloquently today, this condition can make life a very painful struggle, with one in 10 people saying that they live with unbearable pain, day in and day out. The words of those who suffer with this condition can make the strongest cases for reminding us just how tough it can be to live with arthritis.
In the words of Sharon—I am not talking about myself in the third person here, Mr Betts—who suffers with psoriatic arthritis,
“It’s the forgotten condition that no-one thinks is important. It affects everything. It’s exhausting, depressing and makes you feel angry and frustrated.
It robs you of the life you thought you were going to have, the one you planned with your family. It robs you of a sense of purpose. You can’t do what you want, when you want, it’s unpredictable.
Life has to be adapted and constantly changed. The drugs make you feel sick and depressed and have side effects as long as your arm. It becomes important not to look back at what is lost and make an effort every day to look forward and think positively. But it’s invisible, other people don’t see any of that, you just look a bit stiff.”
Those are extremely powerful words and should be a reminder to us all of how important it is to do more to help those suffering with arthritis.
Hearing the stories and experiences of those who live with the condition is important to help raise awareness. That is why the aim of the awareness campaign “The Future is in your Hands” for World Arthritis Day last week was to highlight the stories of those who suffer. It reinforced the comments made by the chief medical officer back in 2012, who said that osteoarthritis, the most common musculoskeletal condition, is a
“generally unrecognised public health priority”.
The Government must listen to contributions of medical experts such as the chief medical officer, and to the expert opinion of those who experience arthritis. They must then act to do more to help those suffering with the condition.
The Government could help to prevent the development of arthritis with preventive measures that relate to obesity and physical activity. Studies have shown that obesity is the single biggest avoidable cause of osteoarthritis in weight-bearing joints. With two out of three obese people developing osteoarthritis, it is important that we seriously get to terms with addressing obesity; that will create an environment in which those suffering with arthritis can flourish, rather than struggle.
One key way to alleviate symptoms and support people who suffer with arthritis is by promoting physical activity, as it has been shown that regular physical activity can be beneficial in helping to reduce the impact of the condition on people’s lives. My hon. Friend the Member for Neath (Christina Rees), who is no longer in her place, pointed out that it was a lifetime of sporting activities—she is a very well-known squash player—that probably caused, or exacerbated, her arthritis. However, the National Institute for Health and Care Excellence has published clinical guidelines that recommend exercise as a core treatment for people with arthritis, irrespective of the severity of their condition.
We need to know which services are out there, so that we can help people acquire the recommended treatment. That is why it would be beneficial for the National Audit Office to conduct a review into physical activity services for people with arthritis. That would help to ensure that we, as policy makers, have the necessary information to drive the policy agenda, and would help to map areas with a shortfall in support and services for those with arthritis. I hope that the Minister will shed some light on plans to undertake that work. Such an investigation would also be important in the light of the cuts to public health grants under this Government. Those cuts are a false economy, and compound the problems accessing services for people who are seeking to manage and improve their lives.
I quoted the following figures to the Public Health Minister at about this time last week from this very spot, but they are worth repeating to the Minister here today. In the autumn statement, the former Chancellor announced further cuts to public health grants, which amounted to an average real-term cut of 3.9% each year to 2021. That translates to a further cash reduction of 9.6%. That is in addition to the £200 million of cuts to public health grants announced in the 2015 Budget. The Minister must bear those figures in mind when responding to the debate and whenever the Department takes action on public health issues. It really is a false economy to cut funding to already overstretched and burdened public health services, as that will obviously exacerbate the problems with those services in the long term.
The need for further awareness of arthritis and its symptoms was clearly shown in a UK-wide survey of more than 2,000 people conducted by Arthritis Care last year, which found that more than a quarter of arthritis sufferers had waited two years to seek help after their symptoms began. When asked why, some 52% said that it was because it did not occur to them that they could have arthritis, and 28% felt that nothing could be done to address their arthritis. I hope that those who have listened to this debate have heard, loud and clear, that help is out there, and that delaying seeking that help will not aid them or their long-term health and wellbeing. That point was made eloquently by my hon. Friend the Member for West Ham (Lyn Brown), who, I think hon. Members will agree, looks 10 years younger than she did a little over a year ago.
Raising awareness is vital. Last week, world-famous performer Robbie Williams gave a candid interview explaining that he suffers with arthritis and describing the impact that has had on his performance; as a Robbie fan, that concerns me. The more we talk about the condition, and the more that high-profile people, such as the MPs here today, talk about their experiences, the better.
There have been so many eloquent and personal accounts in this debate. I particularly mention the brave and moving account of my hon. Friend the Member for West Ham. She will be playing tennis soon with our own parliamentary tennis champion, Mr Speaker, and I, for one, definitely want a front-row seat for that one. My hon. Friend is a true inspiration to the 10 million arthritis sufferers across the country.
I hope that the Minister has listened not only to the debate and contributions from Members present, but to the voices of those outside this place who have called on the Government to do more for those living with arthritis and the pain that comes with it. There are many ways for the Government to do something, and ideas have come from across the House to steer the Minister in a direction that will help the 10 million people who suffer with the various levels of pain associated with arthritis. Let us hope that this time next year, when we recognise National Arthritis Week again, we will have helped more people to lead a healthier, happier and more pain-free life.
The Parliamentary Under-Secretary of State for Health (David Mowat)
It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) and the hon. Member for Foyle on leading the charge—[Hon. Members: “Strangford!”] I beg your pardon; I meant the hon. Member for Strangford (Jim Shannon).
Jim Shannon
I have more hair than the hon. Member for Foyle (Mark Durkan), but not much more.
David Mowat
Don’t take it as a compliment. It has been a long day.
It seems extraordinary, thinking about some of the subjects we debate, that it has been five years since we have debated this subject in the House of Commons. The debate has been such a pleasure, and I am sure that hon. Members here will see to it that it is not five years before we debate it again. An objective of having a debate in Westminster Hall is to raise awareness. People watch these things, so it is right that we do that and it is important that we do it again next year.
I have been a Minister for about two months, during which time I have met many people, so it has probably been remiss of me not to have met with Arthritis Research UK yet. I am keen to do that. Its representatives are pushing at an open door if they would like to come and see me. As the hon. Member for Coatbridge, Chryston and Bellshill (Philip Boswell) said, it is about action, not words. We will organise that meeting if Arthritis Research UK would like it to happen.
Several hon. Members have mentioned the statistics, but I will repeat them because they are so important. Some 10 million people in the UK—one in six of the population—have an MSK condition. The most common, with 3 million sufferers, is osteoporosis. One in six is an extraordinary figure, and there are 200 variations of MSK conditions. One in 10 people in the UK suffers chronic pain as a consequence of arthritis.
The numbers are mind-boggling. Some 20% of GP consultations are due to MSK conditions, and this at a time when our GP services are stretched in Scotland and in England. MSK conditions account for 30% of GP consultations for the over-55s, and some 7.5 million working days are lost each year. This long-term condition alone costs the NHS between £4 billion and £6 billion, so it is right that we are having this debate.
There have been a number of interesting and useful speeches. Westminster Hall is sometimes a better place to debate such topics. The hon. Member for Strangford talked about lifestyle factors and preventive factors, and he and another Member made an interesting point about DWP and PIP. We need to be more joined up in how we deal with some of these long-term conditions, particularly as they become more prevalent. He also talked extensively and knowledgeably about research—he has clearly been well briefed—and about what we are doing.
The hon. Member for West Ham (Lyn Brown) made an excellent speech about her personal experience, and she emphasised the overlap with mental health. She talked about first suffering from this during her election campaign last year. In fact, it prevented her from canvassing. I note that she got 36,000 votes and her vote went up by 6%. I do not know whether those factors are related. Well done on 36,000. We pass on our congratulations and awe at her performance.
David Mowat
Maybe it was. The hon. Lady also talked about the delays to the start of her treatment and the one-year delay before she got the right drugs, which have been so transformative for her. That is an impressive story.
The hon. Lady also talked about the concerns about the consequences of Brexit. The Government have made it clear that, whatever version of Brexit we end up with, science research will continue to grow in real terms and ongoing scientific programmes will continue. I was a remainer, and we often talk about the money that Europe gives to programmes. She said that £2.5 million was given to a particular programme, which should be seen in the context of the £20 billion that flows in the other direction. The real point is that we understand the need for science and will continue to ensure that that funding happens.
The hon. Member for Neath (Christina Rees) made a good intervention about the consequences of sport and the unpredictable flare-ups that she has. She made the interesting point that arthritis can be invisible for much of the time before flaring up. The right hon. Member for Knowsley (Mr Howarth) is right to remind us of the role of carers. I remind Members that we are putting together a carers strategy, which will focus on unpaid carers in particular. That will come out at the end of this year. We are talking to a number of charities about that because it is important, given the stress and strain on our various systems.
Mr George Howarth
I am grateful to the Minister for giving way and for the thoughtful way in which he is responding to the debate. For the sake of completeness, I should say that my impacted disc results from playing rather over-enthusiastic football in the fourth division of the Liverpool Shipping league, which the Minister will know is not a lofty place to play. Unfortunately many of my sliding tackles were badly mistimed, to my detriment.
David Mowat
I thank the right hon. Gentleman for his intervention. The fourth division of the Liverpool Shipping league is probably a higher division than I played in during my very short football career.
Due to the time, I will not refer to every speech. The Scottish National party spokesman, the hon. Member for Linlithgow and East Falkirk (Martyn Day), talked about what Scotland is doing on managing obesity and chronic pain. I would like to see England learning more lessons from Scotland’s health system; and, I humbly suggest, vice versa—I also include Wales in that. Health is devolved and we are beginning to do things in different ways. Sometimes things will work well, and sometimes things will work less well. One of the highlights of these debates is to hear what happens in other nations, and those remarks are interesting.
The shadow Minister also gave a good speech. She talked about budgets and health spending, particularly public health spending—she has now been able to tell two Health Ministers about that issue—and it is true that the public health budget was cut. The UK spends above the OECD average on health and adult social care, which has not always been the case. We are not the highest spender—we spend 9.9%, but France and Germany probably spend about one percentage point more—but we are above the OECD average. It matters very much how effectively we spend that money. There are always decisions to be made, and those decisions are sometimes difficult.
What are we doing? I will not be able to answer all the points in great detail other than to say that MSK is a priority because it is so important. MSK is one of the national programmes within NHS England, and in 2013 we appointed a clinical director, a gentleman called Peter Kay, who is running a £5 billion programme covering a number of areas and seven strands of work, which I will briefly run through.
First, we need to ensure good awareness of the signs and symptoms of MSK. That is about public health and things such World Arthritis Day and the UK “Share your Everyday” campaign. It is also about the important Public Health England activities that we have heard about. We ran a successful public health campaign on arthritis last year, and we need to maintain that pressure.
Secondly, we need high-quality clinical guidance to diagnose and manage the disease. Thirdly, we need to provide holistic care, support, and planning in partnership with patients. Fourthly, and this is important, we must spread best practice across the NHS—I would go further and talk about spreading best practice across the health systems of all the Administrations within the UK. Fifthly, we have heard a lot today about the benefits of physical activity for MSK patients, notwithstanding some of the issues experienced by the hon. Member for Neath and the right hon. Member for Knowsley. Fitness and exercise are of course a preventive measure for nearly everything, particularly for MSK diseases.
Penultimately, we need to do more to enable people to remain in work and to return to work. Finally, we need to invest in research. Those are the seven streams of activity, and I will talk a little about the one that has been spoken about most this afternoon, which is what we are doing to keep people in work. As I said, the points about DWP and PIP were well made, and I will see that that is reflected to DWP Ministers.
Philip Boswell
I am delighted to hear about the open door to Arthritis Research UK, which has been excellent in championing the rights of arthritis sufferers, preventing the onset of arthritis, developing a cure for arthritis and transforming lives. Arthritis Research UK’s work is considerable, and it is worthy of our support. I thank the Minister for his words and his initial actions.
David Mowat
I thank the hon. Gentleman for those words. It occurs to me that I have to give the hon. Member for Strangford time to say a few words at the end. I will write to Members about the various specifics that have been raised. I will now sit down and allow him half a minute or so. I apologise for there being so little time.
Jim Shannon
I especially thank the right hon. and hon. Members who have made such fantastic contributions —every contribution and intervention has been great. The attendance has also been great. It is genuinely refreshing to have a Minister who understands the issue and is able to respond. We will take him up on his offer to have a meeting with Arthritis Research UK—I thank him for that. I look forward to working on behalf of constituents from across the whole of the United Kingdom of Great Britain and Northern Ireland.