Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 27th November 2018 Commons Chamber

[Jackie Doyle-Price]

The reasons for health inequalities are complex, but obviously we encourage people to make the lifestyle changes that enable everyone to live longer. I simply do not accept that the direct causality that the hon. Lady has outlined is as clear as that. We will focus on programmes that help people to lead healthier lives with better diets; that tackle tobacco control; and that prevent diabetes.

[Andrew Selous (South West Bedfordshire) (Con)]

As it is the most deprived children who are most overweight, will the Minister call on Kellogg’s to follow the example of Nestlé and put traffic light colours on all its products so that people can make healthier choices?

[Jackie Doyle-Price]

My hon. Friend makes an excellent point. Clearly the more we can do to educate people to make informed choices to improve their diet, the better. He is absolutely right: poor health among children used to be indicated by being underweight, but now being overweight is very much an indicator. I congratulate any food manufacturer that is taking action to address the problem.

Prevention of Ill Health: Government Vision

Andrew Selous Excerpts

Monday 5th November 2018 Commons Chamber

[Matt Hancock]

Public Health England is trialling PrEP, and I am willing to work with the hon. Gentleman and others to ensure that we do everything we can in this space. The truth is that outcomes are improving in many areas of sexual health, and we have to ensure that we get the right treatment to the right people at the right time.

[Andrew Selous (South West Bedfordshire) (Con)]

The Secretary of State’s focus on clean air and reducing childhood obesity is massively welcome. In the Netherlands, half of all children cycle to school. In the UK, it is 3%. What more will he do across Government to up that figure?

[Matt Hancock]

I am working with the Department for Transport. Transport Ministers feel very strongly about this question. The document details some of the things that we are going to do, but I am sure that there are a lot more.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Matt Hancock]

I welcome the hon. Lady’s commitment to this area. Clearly it is very important to have the workforce in place. As she said, we are making progress, but we still have more to do. As far as the international approach is concerned, the response to the summit was that many countries came together, because collectively we all face the same sorts of challenges. I am in absolutely no doubt that the leadership shown by some countries, including the UK, is warmly welcomed.

[Andrew Selous (South West Bedfordshire) (Con)]

The links between poor mental health, suicide and gambling addiction have been made clear to the Health and Social Care Committee. In that regard, will the Secretary of State make it clear to the Treasury that many across the House want to make sure that action on fixed odds betting terminals is taken forward so that we can have good results in the areas of mental health and suicide prevention?

[Matt Hancock]

My hon. Friend knows my personal strength of feeling about tackling the scourge of fixed odds betting terminals. The links between gambling addiction and mental health issues—and indeed, directly to suicide—are clear in the evidence, and we must address them.

Social Care Funding

Andrew Selous Excerpts

Wednesday 17th October 2018 Commons Chamber

[Matt Hancock]

I have seen that proposal from the Alzheimer’s Society and we are looking at it now. At the same time, we are working on both the Green Paper for the future of social care, which will come before the end of the year, and the long-term plan for the future of the NHS. The interaction between the two is important.

[Andrew Selous (South West Bedfordshire) (Con)]

Does the Secretary of State accept that there is actually a lot of support on the Government Benches, the Opposition Benches and, indeed, across the country for the Joint Select Committee’s proposals. The concept is that, if everyone who can afford it pays something, that means that no one has to lose everything, and that is not only worth while, but urgent.

[Matt Hancock]

I will come on to the proposed funding reforms. My hon. Friend is right that there is support for reform across the House, but there is support for different types of reform in different parts of the House. I respect the shadow Opposition spokeswoman, but it would help if she could bring more clarity to the Opposition’s position, updating the proposal that they put forward in 2010, which I will come on to in some detail. That will help if they want to genuinely contribute to this debate.

Of course, social care is not only a challenge of old age. The number of people of working age with care needs is also growing. Many of us in this House will know the pain and difficulty of helping a loved one who needs constant care or faces dementia. Such pressures bring long-term challenges, and we must ensure that both the NHS and our social care system can respond to the challenges we face.

Integrated Care

Andrew Selous Excerpts

Thursday 6th September 2018 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

It is a pleasure to contribute to this important short debate this afternoon. As has been said, for most of our constituents, this world of ICPs and various other acronyms is a bit of an enchanted forest or secret garden that they do not really understand—they just want their healthcare to go on being delivered properly and professionally—but it does of course matter. I completely agree with the Chair of the Health and Social Care Committee, my hon. Friend the Member for Totnes (Dr Wollaston); we need to keep seeing this from the patient’s perspective.

Like many others, I was struck by the clarity with which Don Redding, the director of policy at National Voices, explained how this should look from the patient’s perspective. He said that patients

“want to feel that their care is co-ordinated, that the professionals and services they meet join up around them, that they are known where they go, that they do not have to explain themselves every single time, and, therefore, that their records are available and visible.”

That is a succinct, powerful way that encapsulates what we are all trying to achieve—what the Government are doing and the purposes in this debate this afternoon. The last part of that sentence—making sure that their records are available and visible—is highly topical, given what the new Secretary of State for Health and Social Care said this morning. He is absolutely right to make sure that the NHS has the technology so that its brilliant workforce get the information they need to give first-class patient care, and that patients can use that technology to their own benefit and to the benefit of the health service generally.

I remember a Department for Work and Pensions initiative from some time ago that was called “Tell us once”. In terms of benefit claims, all of us as Members of Parliament will have had constituents who come in and recount giving their details, endlessly, to different parts of the Department for Work and Pensions. The principle should be the same in health. Our constituents’ time is precious. It is not just Members of Parliament who are busy people; our constituents lead highly busy, demanding lives, juggling work, family and everything else. The more we can make it simpler to capture what they say once, the better for them and the better for hard-pressed NHS staff, and it has to lead to a better outcome. I hope that is part of what our excellent new Secretary of State, who follows the last excellent Secretary of State, is looking to achieve, in light of his speech in Manchester this morning.

There were various highlights in the Committee’s inquiry. The one that stood out for me above all others was our visit to the Larwood practice in Worksop. I have spent a large part of the summer speaking to every single general practice in my constituency. I asked them to tell me about the pressures they face and what the NHS and the clinical commissioning group can do to help them, because I am very aware that general practice is under a lot of pressure. I know the Government are recruiting 25% more doctors, which is brilliant, and last year 3,157 of those doctors went into general practice, which is also brilliant, but we have to retain them as well and some of the workload pressures are challenging.

When the Committee arrived at the Larwood practice, it was incredibly exciting and invigorating, because we saw a practice that was joining up primary care, secondary care, social care and the voluntary sector. It was using paramedics and had its own pharmacy on site, so that people are not sent down the road in the rain to get their prescriptions. There was a buzz about the place. The GPs who worked there were bright-eyed and bushy-tailed, because I think they knew they were delivering a good service and serving their patients well. I am aware of the variability across general practice. If integrated care is going to mean something, the Larwood practice—which was selected for us by NHS England because it is doing well—and practices like that show the way. My challenge to the Minister is, how do we help all those other GP practices to rise up and perform in the same way?

Although not the direct subject of the report, the other huge area of integration that is so important that I cannot fail to mention it is the join-up between health and social care. The Committee wrote a separate report on that earlier in the summer, jointly with the Housing, Communities and Local Government Committee, which I thought had excellent recommendations. I am absolutely convinced that integrated care providers will not succeed in providing the integrated care we want unless social care has been put on a proper and sustainable financial footing so that it really does work hand in glove with our NHS at every level, primary and secondary.

Our report has been really useful in slaying a few myths about privatisation. Some of those myths have been around for a very long time. When Simon Stevens gave evidence to the Committee, he did a particularly good job—he went back through some of the allegations of privatisation of the past 20 years or so and showed that, over that period, those various allegations had not proved well-founded.

I very much welcome the Government’s commitment to amend the legislation where necessary, and where helpful to provide better-integrated care. That is a sensible and pragmatic step, which I would expect from the Prime Minister and the Government. It is very welcome

I very strongly agree with what the hon. Member for Stockton South (Dr Williams) said about prevention. He said something very true about the Committee that I have never forgotten: he said that we are a Health and Social Care Committee, but sometimes we could be mistaken for an NHS Committee. That is not because he and I do not think that the NHS—the organisation that is there to look after our health—is absolutely brilliant, but because health is wider than the NHS.

Unless we are absolutely passionate about dealing with childhood obesity—I am the chair of the all-party parliamentary group on obesity—and improving air quality levels in our inner cities, where children with asthma and other illnesses are deeply affected by breathing in poor air every day; unless we get more of our fellow countrymen and women walking and cycling; unless we do something about reducing the proliferation of takeaways, which sell highly calorific food; unless we do something about getting our supermarkets and big food producers to do better in producing healthier food, we will not succeed in this key area of prevention.

It comes down to detailed things such as planning policy for local authorities, which should not have to fight a rearguard action against the Planning Inspectorate to limit the number of takeaways in an area. They absolutely need to ensure, as we build new houses—which we desperately need to do—that cycle routes are built into new housing developments so that as many people as possible, including children, can cycle to stay fit and healthy.

It is worth noting that the integrated care partnerships are helping that to happen. The Committee heard from Ian Williamson from Manchester Health & Care Commissioning. When we were in Sheffield, he said that he thought conversations were now starting up about how Manchester could reduce childhood obesity and reduce the emissions and pollution that harm the local population. Such conversations are happening, but we need more than conversations; we need action, and we need to join up these different policy areas and produce results, because they are urgently needed.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I, too, welcome the opening speech of the hon. Member for Totnes (Dr Wollaston), who is a superb Chair of the Committee. The marketisation in NHS England goes back more than 30 years—it has certainly been happening for most of my career. It started with terms such as “resource management”, and in 1990 the internal market—the purchaser-provider split—was introduced. In the early 2000s under Labour, private companies started to introduce independent treatment centres. The Health and Social Care Act 2012 turned it into a massive external market and created the pressure to put all possible contracts out to tender.

The problems are well known. If we base a system on competition and not on collaboration, we inevitably create fragmentation and destroy integration. That has broken up patient pathways and made the system very confusing, to the point that CCGs were looking to employ what they called primary providers, which would have been another layer of cost and health organisation, to try to join things up for patients. Thankfully that has been shelved, because there is a sense of going in a different direction, but up to now there has been a repeated sense that everything can be solved through a healthcare market. That is why, in Scotland, we have grave concerns. One of the 24 powers coming to Scotland is power over public procurement—we do not see the market as the solution to everything.

Just five years on from the actual on-the-ground changes of the Health and Social Care Act, NHS England is facing another big reorganisation. As other Members said, unfortunately the rushed sustainability and transformation plans and the lack of consultation with both the public and staff has created anxiety and fear. As is now recognised, the term “accountable care organisations”, which was copied from the American system, was a PR mistake of the highest order.

In 1999 in Scotland—after devolution—we simply went in a different direction. We merged trusts and then abolished them in 2004. We got rid of primary care trusts in about 2009. We already had an area-based health service for the entire population—not just for people registered with their GP—based on per-capita funding. That meant that we could start to look at how to integrate acute hospitals with community hospitals and even local village hospitals for step up and step down—not everyone who is unwell and cannot be at home needs to be in some big, shiny 10-storey block, and might just need a bit of extra care for a few days, so there is an argument for community hospitals.

In 2014, we started looking at integrating health and social care. Because of the fragmentation in NHS England, it will be necessary to integrate health first, and then integrate social care. Integrating social care is much more challenging because it is made up of different players in the market and is done in a different way. As the hon. Member for Totnes pointed out, the overarching difference between free healthcare and means-tested social care creates major challenges.

[Andrew Selous]

The hon. Lady used the term “village hospital”, as well as the term “community hospital”. “Village hospital” is a new one to me. Could she elaborate on what it means?

[Dr Whitford]

It is not a particularly formal term. I simply mean that there has been a tendency to think that, because community hospitals cannot provide the full range of acute healthcare, they have no place, whereas someone might require only a low-level of in-patient care, such as an elderly person who has a urine infection and lives on their own may need intravenous antibiotics, fluids or extra care. Such hospitals allow us to have much more healthcare—things such as minor injury units—close to the public. The more we take forward to people, the less worried they will be about the fact that we are coalescing specialist services. If they see services coming towards them, they will not have the sense that everything is being taken away. We have utterly failed to impress on the public that healthcare is not about buildings, but very much about people and services. That is what integrated care should be about.

Perinatal Mental Illness

Andrew Selous Excerpts

Thursday 19th July 2018 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

It is an enormous pleasure to follow my colleague on the Health and Social Care Committee, the hon. Member for Stockton South (Dr Williams). I commend him for a tour de force of a speech, which was extremely comprehensive. I will not speak for as long as he did and I will try not to cover the points that he did, because this is a large area and there is a lot to say about it.

It might be a little surprising to some that two men are opening this debate on perinatal mental illness, but I strongly disagree with anyone who thinks that we should not be, because the strapline of the Maternal Mental Health Alliance is that this is “Everyone’s Business”. That is exactly what it is. We need men advocating and agitating, if this issue is to be taken seriously and dealt with properly.

The Health and Social Care Committee and the Education Committee, in a report earlier this year in response to the Government’s Green Paper on transforming children and young people’s mental health, included a contribution from our excellent Children’s Commissioner for England, Anne Longfield. In evidence to both Select Committees, she said:

“I would like to see a comprehensive starting point that looks at children from birth and pre-birth onwards, and recognises that problems develop along the way; and the earlier and the nearer to home they can be treated, the better it is going to be for the child.”

I think that is a really important point. While there is a lot to be commended in the Government’s Green Paper, we know that in early intervention the earliest years are key.

The Prime Minister and the Chancellor have allocated an extra £20 billion to the Department of Health and Social Care. That gives us an enormous opportunity. Quite properly, the Government are not rushing decisions on how that money will be spent. We will be thoughtful and considered, to ensure that we make wise choices. For my money, prevention and early intervention would be a good use of that money. I am sure that the Minister will push hard in the Department, to ensure that this area is prioritised.

The hon. Member for Stockton South, who spoke so well, talked a lot about the GP checks. I want to press the Minister on how this is supposed to be working at the moment, so that we can learn from it and get it right when the GP contract is renewed in September. My understanding is that Ministers have made it clear that all GP surgeries must offer a six-week post-natal check, to assess how a woman has experienced her transition to motherhood, which includes a check on her mental health. Further, I understand that GPs who opt out from doing so receive a reduction in funding. Until fairly recently, Ministers had been informed that only four practices in England had opted out. Given that information from the Department of Health and Social Care, and given that we are paying for that service and it is supposed to be happening, how is it that 22% of the women in the National Childbirth Trust survey said that they were not asked about their emotional or mental wellbeing at their appointment? Are we, as taxpayers, paying for a service that many GP practices are not providing? I ask the Minister to address the oversight and accountability of GPs in this area.

I realise that we need more GPs. The good news is that 3,157 medical students qualified as doctors and went into general practice this year. That is the highest number ever. We are increasing by a quarter the number of medical students we are training in this country and not before time, because other countries have been training more than we do. Globally, we need 2 million more doctors. I want to see a lot more British doctors—bright British children able to come into this fantastic profession. Of course, we are grateful for the doctors we have from all over the world, but we need to train more of our own and that is exactly what we will do.

The reality, which I understand, is that a lot of GPs, because of the pressures of the job, are working part-time, not full-time. I learnt recently that the average GP works four days a week, rather than five. We also know that a number of them are leaving general practice in their mid-50s, which is a crying shame. We cannot afford for them leave in their mid-50s. We cannot force people to work as GPs, but in their 50s they have so much experience and they are so needed. There is an issue of making the role of the GP less stressful and more enjoyable. In general, the Government need to think more about ensuring that public servants across the board have greater job satisfaction, so that they enjoy and look forward to going to work each day. If we have more GPs and they are less stressed, they should be able to do this work better.

I do not think I received a briefing from the Royal College of General Practitioners for this debate—perhaps I missed it. I am grateful for the briefings we had from a number of Royal Colleges and different organisations, all of which have been extremely helpful, but it would be good to have the full involvement of the Royal College of General Practitioners in addressing the incredibly important issue of perinatal mental health. Hon. Members are absolutely right to raise the training issue.

Earlier this week, I chaired the all-party parliamentary group for supporting couple relationships and reducing inter-parental conflict. We were looking at the issue of loneliness. New parents are one of the groups in society who often feel quite alone, if they do not have all the support networks that we would ideally like them to have. Someone at that meeting said that raising mental health touched on GPs’ anxiety that they would open a Pandora’s box of issues that would take them some time to deal with. GPs generally work to 10-minute appointments. We need to ensure that they have the time, in a relaxed environment, to go into these issues properly. It cannot be done in a rush or on a tick-box basis.

I want to pay attention to the important role that fathers and the partners of women with newborn children have in this area, because it needs to be properly recognised. Unsurprisingly, mothers report that fathers are their main source of emotional support. Yet fathers can sometimes feel left out and not as fully involved as they could and should be in dealing with perinatal mental illness, while the mother of the child wants the father to be involved. We have not always done as well in that area as we should.

I understand that there is evidence that a father’s involvement in pregnancy increases the likelihood that a woman will receive pre-natal care in her first trimester by 40%. The Royal College of Midwives also reports evidence that teaching massage and relaxation techniques to fathers to assist during labour is an effective way of increasing couple satisfaction and decreasing post-natal depressive symptoms, as well as providing psycho-social support for women. We also know that the mother’s relationship with her partner is a key determinant of antenatal maternal stress. This suggests the importance of assessing and addressing a range of attitudes and behaviours on the part of expectant fathers—not just domestic abuse but their own mental health, substance abuse, hostility, infidelity, rejection of the pregnancy and so on. Those issues must be dealt with, because they will have a huge impact on the wellbeing of the mother.

As I have said, poor paternal mental health has an impact on maternal mental health. Research suggests that a father’s mood and anxiety disorder can exacerbate the effects of a mother’s poor mental health and escalate the risk of a child developing emotional and behavioural problems, while fathers with better mental health can provide a buffer against the negative impacts. Fathers and partners are very important, and I am grateful to the Centre for Social Justice for pulling together some of that research.

Again, I am grateful to the Centre for Social Justice for drawing my attention to Greenwich Mind, which is a practical example of a service that provides answers to some of the issues that I have described. It works in partnership with Tavistock Relationships and other local providers to run post-natal support groups and parenting workshops in local children’s centres for parents with or at risk of depression. Those activities specifically focus on the co-parenting relationship, not least in terms of how it is affected by adjusting to parenthood. Evaluations show that relationship quality and mental health improved as a result. That is an example of a good service that we need to see more of.

We must remember the wise words of the hon. Member for Stockton South about the impact that maternal mental health has on children’s development. The health and mental wellbeing of our children is key. I also serve as a vice chair of the all-party parliamentary group on adverse childhood experiences. We are a bit behind the curve in this area in England. The research in America is overwhelming. As an English Member of Parliament, it concerns me that the understanding of it is better in Scotland than in England; the same could be said for Wales and Northern Ireland. I look forward to the time when England is at the same level of understanding.

I will not repeat what the hon. Gentleman said about the earliest years of a child’s development, but those issues really matter. The wellbeing of the mother—indeed, of both parents—in those early months is critical for how our children develop and for giving them the best chance to flourish.

--- Later in debate ---

[Rosie Duffield (Canterbury) (Lab)]

It is a pleasure to serve under your chairship, Mr Davies, and I congratulate my hon. Friend the Member for Stockton South (Dr Williams) and the hon. Member for South West Bedfordshire (Andrew Selous) on securing this debate.

We should judge the success of our society by how we treat our new mothers—it really is that simple. I am here today to speak up for better-quality, more consistent and well-funded services for perinatal women.

I am not a new mother. In fact, my youngest teenage son is sitting just over there in the Public Gallery and Members may be able to tell from his towering 6-foot frame just how long it has been since I was recovering from giving birth to him, the second of my two gigantic children. Even so, I remember those special early days for all the many wonderful, and some horrible, reasons that all mothers will know.

We do not discuss post-natal truths enough in the UK. Women will sometimes share with their friends the gory details of their experience of giving birth, but we rarely ever see in the print media, on TV, or in films what happens after a baby is born. If the fairy tale does not end when Cinderella weds her prince, as most fairy tales do, it most certainly has ended by the time Cinderella has entered her third trimester and is waddling around the palace. Nobody wants to hear about Cinderella’s third-degree tear, the fact that her boobs leak, the possibility that she may experience incontinence, or the fact that, even though she has a wonderful, healthy baby in her arms, she just cannot stop crying. But fairy tales are out of date and so is the fact that we do not talk about perinatal experiences—both external and internal experiences—with the honesty we need.

Things are changing, however. After all, we are here today saying that what is on offer to post-partum women in the UK just is not good enough. It is outrageous that women in one quarter of the UK are still without access to specialist perinatal mental health services. How can the mental healthcare of new mothers still be a postcode lottery? It is not as if mental health changes are uncommon after a woman has given birth. In fact, 81% of women say they have experienced at least one perinatal mental health condition either during or after their pregnancy.

I know from talking to friends, family and, indeed, constituents how imperative perinatal mental health support is. We must remember that three quarters of women who say they have experienced a perinatal mental health condition had no previous history of mental health problems. For those who have experienced mental health problems before giving birth, changes to the brain’s chemistry post-birth, combined with post-partum isolation, can trigger the return of symptoms that they had previously experienced, often in their teenage years.

Speedy referrals and access to early treatment is vital for those who experience mental health issues during or after pregnancy. What is so worrying is that it takes more than four weeks for 38% of women in the UK who are referred to be seen. In fact, there are cases of women suffering post-partum who have the courage to seek help from their doctors and health visiting teams but who still have to wait beyond a year for help after referral. That is a whole year that these women are waiting for help in what is often one of the most turbulent, joyous, change-filled and complicated times in any mother’s life. Any service that keeps people waiting for more weeks that I can count on the fingers of one hand is completely unfit for purpose.

We must close the funding gaps that cause huge waits—it is reassuring to hear that the Government intend to do that—and end omissions in service provision. We must also ensure that maternity services do not remain overstretched and understaffed. We must bring back full bursaries for midwives and related healthcare qualifications, which will allow staffing gaps to be filled with the much-needed new caring talent that will have the capacity to offer continuity of care to high-risk women in pre and post-natal moments of vulnerability. The erosion of higher education bursaries, especially for nurses, midwives and other healthcare students, was yet another example of this Government knowing the cost of everything but the value of nothing.

There is another reason why we must act and act soon. A study by the department of anthropology at the University of Kent, which is in my constituency, shows that post-partum depression discourages mothers from having more than two children. The decision to have children, or the decision to have more children, is a woman’s choice alone. However, that choice must be made without the pressures and limitations that come with poor funding of post-natal care. A choice made through fear is no free choice at all.

I completely echo colleagues’ calls for there to be much greater depth in the maternal six-week check. The baby’s check by the doctor and the mother’s check by her doctor must be separate. A woman’s six-week check cannot be limited, as I so often hear it is, to a few rushed questions. I have been told of women being asked only about the contraception they plan to use, with no questions at all about their physical or mental wellbeing. I have heard from friends that their doctors simply asked them, “Are you feeling okay?” That is not a proper question. As any mother will say, the moment their new new-born is in their arms, the definition of what was previously considered “okay” is thrown of out the window. Time must be put aside for proper, in-depth questions and for real insight.

After all, as we have already heard, according to the Royal College of Midwives 42% of women with post-natal depression never even mention it to a healthcare professional, and three quarters of those women stay quiet because they feel guilty about having such thoughts. Moreover, many women are led to believe that serious mental health issues are merely a bout of the baby blues. We urgently need proper training and proper conversations to create an environment where mothers feel safe, well-informed and able to talk about any difficult experiences.

I acknowledge that even the most thorough six-week check for women would not always pick up on everything. Post-natal depression can sometimes manifest slowly. One study suggested that the majority of women experiencing symptoms did not report them until six months post-partum or later. To tackle that, I urge that the maternal mental health check by health visitors at three to four months is reinstated. Even taking more time at that early point when a woman is sat with her GP at the six-week check will save lives. A couple of weeks ago, I attended the NCT’s #HiddenHalf event, where several brave women attested to just that.

[Andrew Selous]

Has the hon. Lady had a chance to look at the clinical evidence base for the effectiveness of the three to four-month check? Is she aware of a good base of evidence from clinicians that it is a sensible use of money at that point?

[Rosie Duffield]

I thank the hon. Gentleman for that intervention. I have not looked at the issue in that kind of depth. I have been working on it with local women and local groups who suggest that it would be good to reinstate it. I will look into it further.

The women at the #HiddenHalf campaign event said that their lives had been saved by a fortuitous visit to the right GP at the right time, but they know they were the lucky ones. The mother’s six-week check must also allow time for a full physical health check to prevent long-term and often totally avoidable health complications resulting from difficult deliveries. Furthermore, it is my belief that a course of pelvic floor physio should be provided for every single woman who has experienced a vaginal birth, as happens in France. I am working with a group of women on health policy for post-partum women. This debate focuses on the perinatal health symptoms of the hidden half, but many of the mental health conditions that health visitors report are triggered by the physical trauma of a difficult birth and women having to reconcile themselves to a completely new sort of body.

Those of us here today will not stop campaigning and raising the issue until the situation changes for new mothers and new families who need our help. We should get the full truth of post-natal motherhood out there and become a country that can rightly say, “There’s lots of help here for you. We will assist you and your families for as long as it takes. We are here to champion and celebrate you in being the happy, healthy, supported mother that you ought to be able to be.”

--- Later in debate ---

[Jackie Doyle-Price]

The hon. Gentleman earlier used the phrase “spend to save”, so the answer is yes, because obviously if we make interventions earlier and they help people to help themselves, there is a long-term saving to the NHS. That is the exact spirit in which we are entering the 10-year plan for the NHS. I look forward to hearing suggestions from the APPG—get in touch with us soon.

I thank everyone who has contributed to the debate and hope that we can go forward with the shared objective of doing the best we can for new mothers. By that I mean not only improving services, but giving support in general to women who are going through the experience of motherhood. As many Members have said, we are offered a fairy tale fantasy about how everything is perfect and wonderful, when actually there is a lot of associated vomit, pain and misery—joyful as the experience is overall. We need to tackle the taboo, because the fact that we think that everything is a perfect fairy tale means that the pressure on those women who are struggling makes them feel like failures. They are not: it is all entirely normal.

I am always struck by the fact that one in three women suffers from incontinence. People do not know about it, because everyone suffers in silence and just gets on with it. I often ask, “How would it be if one in three men suffered from incontinence?” We would hear about that a lot more. We need to be generally more open and give women the message: “Do you know what? It is normal to feel you are struggling, and feel miserable, because you have gone through a life-changing experience and a physical trauma. It is inevitable that it will affect your mental health.” Giving them the message that it is normal is half the battle, because they will realise that they are not a failure but just need to manage and work through the situation. We need the right services in place to help them.

[Andrew Selous]

Is the Minister aware of the Best Beginnings “Baby Buddy” app, which has videos of parents sharing their experiences to help reduce the isolation some parents feel? It encourages women to take the time to look after themselves and their relationships, if they are with a partner. Does she agree that that is practical? It is free and lottery funded. It is not making a profit, as far as I am aware. I think it is run by a charity. Things like that can be helpful to mothers who might otherwise be quite isolated.

[Jackie Doyle-Price]

That sounds like a good resource, not least because it means women can get access to help in a more anonymous, less threatening way. We need sufficient tools to be available for women—and families, for that matter.

We have heard constantly throughout the debate that women are not always asked about their mental health in GP health checks. For that matter, they are not always asked about their physical health either; it is all about the baby. One of the challenges we have in improving the way in which we deliver health comes from the fact that an NHS practitioner faced with a patient will focus on the immediate problem and not the patient’s holistic needs. There is a need to consider mother and baby together. A baby cannot be looked at in isolation. The role of the mother, and the relationship with the mother, is part of the child’s welfare. We need to spread better practice in that regard.

[Andrew Selous]

I agree very much about looking at the mother as well as the baby, but does the Minister agree that, where there is a relationship with a partner, dad must not be left out, and that working on the couple’s relationship is a key matter, given that mums probably look to their children’s parent more than anyone else for emotional and practical support?

[Jackie Doyle-Price]

I thank my hon. Friend for being my conscience—we absolutely must not forget dad or partner, or for that matter the wider family. Members have expressed concern about the declining number of health visitors, and the beauty of having a health visitor is exactly the fact that they develop a relationship with the family and can talk to dad as well. Quite often, dad feels excluded from the process.

Adult Social Care: Long-term Funding

Andrew Selous Excerpts

Thursday 28th June 2018 Commons Chamber

[Mr Betts]

Yes, I completely agree with that. We have got to get on with it. If we agreed everything now, it would probably take two or three years to put it in place. That is why we suggested the stop-gap measure of the extra business rates in 2020 being made available for local authorities. We thought that was a very important solution. If we get it right, we can have stability for the long term. The Germans did this over 20 years ago. They have a stable system and it works. They have just put extra money into it with general public support, because everyone trusts the system. That is the position we have to get to.

[Andrew Selous (South West Bedfordshire) (Con)]

I, too, pay tribute to the hon. Member for Sheffield South East (Mr Betts) for the way he chaired the Committee; it was very collegiate and consensual, which really helped us in our deliberations. He may remember that when we visited a care home the residents and families of those receiving care accused this Parliament of a lack of courage for not having addressed this difficult issue for so long. Does he agree that there is a real sense of urgency? When the Government produce a Green Paper in the autumn, we need to get on with it. There is no reason why we cannot move this forward quite quickly. As he said, Germany has done it since 1994. Frankly, it shames this country that Germany has had a good system in place for so long, while we have not.

[Mr Betts]

I completely agree. If we are still talking about this in two or three years’ time we will have failed. We have to get some decisions and get on with it. As politicians, we are often very good at coming up with ways to spend money. In this report we have actually come up with ways to raise money, which is the difficult part. We have done the heavy lifting for both the Government and the Opposition Front Benches. We now say, “We’ve handed the pass over to you. Get on and run with it and make it work.”

Childhood Obesity Strategy: Chapter 2

Andrew Selous Excerpts

Monday 25th June 2018 Commons Chamber

[Steve Brine]

There is no mention of breastfeeding in the plan, but that does not mean that I and my colleagues do not see it as a very important part of the early years programme. In areas that I represent, as well as, I am sure, in other areas represented by colleagues, local authorities are often actively engaged in making sure that breastfeeding is a very important part of a child’s start in life.

[Andrew Selous (South West Bedfordshire) (Con)]

It was the drive and passion of Alderman Eric van der Burg, a right-wing politician, that led to results in bringing down child obesity in Amsterdam. What more do we need to do to get local authority leaders here to see that this is actually part of their core business, not a fringe activity?

[Steve Brine]

As my hon. Friend will remember from my speaking to the Health Committee, I have also been to Amsterdam, but unfortunately not for as long as the Committee members were. The whole-systems approach taken by Mayor van der Burg and Amsterdam is very impressive and has resulted in a 13% reduction in child obesity. Local authorities can learn from their attempts to market their cities, areas and regions, and I would suggest that having a good, healthy community and a good, healthy look when people walk out of the airport and do not see massive adverts for unhealthy fast food is an important part of that.

ME: Treatment and Research

Andrew Selous Excerpts

Thursday 21st June 2018 Westminster Hall

[Carol Monaghan]

I thank the hon. Lady for her intervention. Merryn’s is not an isolated case, and neither are those of my constituents—I am sure that Members present have all heard constituents describe the same situation.

The PACE trial, which recommended CBT and GET, influences how health insurers and the DWP make their decisions. Insurance companies refuse to pay out unless a programme of GET has been undertaken, and many people who apply for benefits are told that they must carry out GET—or, indeed, that they appear well enough to work. PACE is unique in UK medical history, in that it was part-funded by the DWP. The links of some of its main authors to health insurance companies are troubling. One of those authors, Professor Michael Sharpe, states in his briefing for the debate:

“Several of the investigators had done small amounts of independent consultancy for insurance companies, but this was not relevant to the trial. The insurance companies played no part in the trial.”

I will leave hon. Members to make up their own minds about that.

Healthcare professionals worldwide are starting to take note. The US Centres for Disease Control and Prevention and the Health Council of the Netherlands have both abandoned GET. If those countries acknowledge the flaws of GET, why are ME sufferers in the UK having to fight so hard for similar acknowledgement? The ME community hopes that GET will not feature in the NICE guidelines for ME treatment after they are revised.

Some argue that CBT is provided as a treatment for many illnesses, including heart disease and cancer, and that ME patients’ rejection of it is irrational. The key difference is that cancer patients receive biomedical treatment in addition to CBT, rather than having CBT to the exclusion of biomedical interventions. Biomedical treatment for ME is woefully lacking. There are reports from the US that certain antiviral drugs improve the condition, but without properly funded research to identify biomarkers for ME, we do not have the answers.

Diagnosis is currently based on a patient presenting with known symptoms. Although there is no biomarker for ME, that does not mean there is no biomedical test for it. The two-day cardiopulmonary exercise test, which can objectively document the effects of exercise, could be used as a diagnostic tool. In simple terms, people with ME perform adequately or even well on the first day but have reduced heart and lung function on the second. That relates to the point made by the hon. Member for Alyn and Deeside (Mark Tami) about the DWP and the fact that someone’s presentation may be good one day but not the next.

That protocol involves two identical tests separated by 24 hours, the collection of gas exchange data and the use of an exercise bike to measure work output accurately. That type of testing reveals a significant performance decrease on day two among people with ME, in terms of their workload and the volume of oxygen they consume before and during exercise. Results from a single test may be interpreted as deconditioning, which may lead to harmful exercise being prescribed. However, the objective measurements of the two-day test remove the issues of self-reporting bias and the question of effort—in other words, the results cannot be faked.

Those results support the strong and consistent patient evidence of the harm that can occur as a result of inappropriate exercise programmes. However, there are moves afoot to categorise ME as a psychological condition. NHS guidelines on medically unexplained symptoms class ME as such a condition. The Royal College of Psychiatrists states:

“Medically unexplained symptoms are ‘persistent bodily complaints for which adequate examination does not reveal sufficient explanatory structural or other specified pathology.’”

[Andrew Selous (South West Bedfordshire) (Con)]

I just want to pick up on the hon. Lady’s point about ME being classified as a psychological condition. Does she agree that that is a little curious, given that the World Health Organisation states in its “International Classification of Diseases” that ME is a neurological condition? My understanding is that the United Kingdom is legally obliged to follow that classification.

[Carol Monaghan]

I thank the hon. Gentleman for his intervention. Worryingly, the WHO is looking at reclassifying ME, too—we should all be aware of that—and its current classification of ME as a neurological condition has been ignored in terms of the treatment we have offered to patients here in the UK.

The Royal College of Psychiatrists goes on to state that symptoms are

“not due to a physical illness in the body. However, they can be explained, but to do this, we need to think about causes that are not just physical.”

Under the new “Improving Access to Psychological Therapies” guidance for people with long-term conditions, patients who present with ME are classified as people with medically unexplained symptoms who should undergo CBT therapy, in conjunction with other treatments—in other words, graded exercise therapy. However, as ME is classified as a psychological condition, patients risk getting trapped in the psychological care pathway.

--- Later in debate ---

[Sir Edward Davey (Kingston and Surbiton) (LD)]

I congratulate the hon. Member for Glasgow North West (Carol Monaghan) on securing the debate and all hon. Members who will participate in it. It is essential that we speak for the millions missing, and it is great to see so many people in the Public Gallery.

What I find so shocking is that scientists seem not to want to have the debate. I hope that right hon. and hon. Members across the House find it shocking that the hon. Member for Glasgow North West was written to by a scientist and called out. I have seen scientists writing in journals such as the Journal of Health Psychology calling out the PACE trial, so the idea that the scientists who produced that work have gone unchallenged by other scientists is simply not true. A huge amount of evidence from eminent people in the science community questions the PACE trials, including the methodology, the evidence they used and how they treated their patients, as the hon. Lady said. Therefore, it has been proven not to be the case that the NICE guidelines, built on that questionable evidence, are the only way in which we should consider this disease, and she did that well in a previous debate.

It is great that the NICE guidelines are to be reviewed, but my concern is that that will take some time. I am sure that is the right process; we must get it right and ensure that the voices of ME sufferers are heard. Scoping working groups have been set up in which ME sufferers have been able to participate, and that is welcome. But I find it quite scary that the current guidelines will be in place until October 2020. I have listened to my constituents and read about those of other right hon. and hon. Members who feel that if they are prescribed according to those guidelines and go through all that, it makes them more ill. Far from helping them, it makes them deteriorate. Indeed, I have a constituent who feels that the programme she was put through set her back two or three years.

Real harm is being caused by some of the therapies recommended in the guidelines. If that is the evidence from ME sufferers—I am not a scientist, but from what I have read, that experience is widely shared—it is up to the Minister, working with the chief medical officer and others, to question whether the NICE guidelines should be suspended, at least with respect to GET. If GPs, perhaps because they have not been trained, are making medical prescriptions for treatment following NICE guidelines because Ministers and the chief medical officer have not acted, if that treatment is harming people, and if that continues until October 2020 there will, as I said in my intervention, be a case for those who are harmed to go to court and seek compensation.

No one wants that. To avoid it, surely there must be a way in which Government Ministers, working with NICE and the CMO, can issue guidelines directly to GPs and medical professionals to say, “Be careful before you prescribe GET. Ensure that you have read the evidence. Ensure that you have talked properly to the patient.” With many drugs and pharmaceuticals, there are sometimes side effects. Therapy does not work for everybody. Where is the warning in the NICE guidelines of the side effects of GET? That is serious, because people could be seriously hurt in the period between now and the conclusion of the NICE review.

I will move on to research. Looking at the work that Invest in ME Research has done, for example, setting out the calls for research in this country over two decades or more, I find it quite disturbing that those calls have been ignored. Only charities have enabled a meagre amount of research to be done. Some £5 million was set aside for the PACE trial; if we could have a small amount of that money to start real, biomedical research into ME, we would be making a step forward.

[Andrew Selous]

Does the right hon. Gentleman share my concern that, as I understand it, there are roughly two and a half times more people with ME than with multiple sclerosis, yet there is 20 times more research on multiple sclerosis than on ME and, of what little ME research there has been, the vast majority has been through psychological and behavioural studies rather than the biomedical approach?

[Sir Edward Davey]

I share the hon. Gentleman’s concern. I should say that we still need a lot of research into MS, so it is not one or the other, but given the incidence of ME, as he rightly says, the case for research into the biomedical aspects is strong. Invest in ME Research makes a number of proposals in its recent report. For example, it proposes a ring-fenced fund of £20 million a year for the next five years for biomedical research. That recommendation comes from a detailed report; it is not just plucked out of the air. That sort of figure would show that the Government mean business.

I am aware that Ministers cannot stand up at the Dispatch Box and say, “Yes, of course we will direct research money into this probe; I myself will do it.” I am not suggesting the Minister can do that today. I know he cannot. He has to work with research councils and others to direct the research. I am also aware that if researchers do not make proposals, sometimes research moneys cannot be granted.

Gosport Independent Panel: Publication of Report

Andrew Selous Excerpts

Wednesday 20th June 2018 Commons Chamber

[Mr Hunt]

That is the big question we have to answer for both the House and the British people. However, I would say to the hon. Lady that I am confident that, where there is unsafe practice, it is surfaced much more quickly now in the NHS than it has been in the past. I am less confident about whether we have removed the bureaucratic obstacles that mean the processes of doing such investigations are not delayed inordinately so that the broader lessons that need to be learned can be learned.

[Andrew Selous (South West Bedfordshire) (Con)]

One of the reasons for the growing success of the “Getting it right first time” programme is the creation of clinician-agreed datasets. Will the Secretary of State give the House an assurance that there will in future be proper analysis of the data on the excess number of deaths and the use of this particular type of drug in excessive amounts? Such analysis would have shown this hospital as an outlier, so questions could have been asked, as is now happening successfully with the GIRFT programme.

[Mr Hunt]

I thank my hon. Friend for his championing of the GIRFT programme, which is incredibly powerful and successful. He will have noticed that we announced last week that we are expanding it into a national clinical information programme, which will cover more than 70% of consultants. What is disturbing in this case, though, if I may say so, is that the data was really around mortality, and we have actually had that data for this whole period. There is really nothing to stop anyone looking at data, and we can see a spike in the mortality rates in this hospital between 1997 and 2001. They go down dramatically in 2001, when the practices around opiates were changed. That is why we have to ask ourselves the very difficult question about why no one looked at that data or, if they did, why no one did anything about it.