Diabetes Technologies
Baroness Blackwood of North Oxford Excerpts(7 years, 5 months ago)
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Mr George Howarth (Knowsley) (Lab)
I congratulate the hon. Member for St Ives (Derek Thomas) both on raising this very important subject and on the constructive and helpful manner in which he raised it.
I intend to confine my remarks to type 1 diabetes and, in particular, young type 1 diabetics. I should say that I am indebted to both Diabetes UK and the Juvenile Diabetes Research Foundation for the very helpful briefing that they provided and for the important work that they do on behalf of people with diabetes.
Diabetes, whether type 1 or type 2, is a life-changing condition regardless of the age at which it is diagnosed, but for young type 1 diabetics, it is also a lifelong challenge. Young type 1 diabetics face a daily and lifelong routine of monitoring glucose levels and administering the appropriate doses of insulin. It is not insignificant that one quarter of hospital admissions for ketoacidosis are of 16 to 25-year-olds; that is quite a shocking statistic.
At the same time, dealing with the transition to adulthood, with all the attendant biological, psychological and physiological changes that occur, can be even more challenging for young diabetics and their families. Many young diabetics face bullying. The hon. Member for Upper Bann (David Simpson) referred to a problem in schools. Quite often, because of the misconception about what type 1 diabetes is, young diabetics will face taunts: “Well, it’s your own fault because you don’t eat properly”, “You’re overweight” and so on. It is bad enough that young diabetics face bullying in school. Very often, as the hon. Gentleman signified, schools simply do not know how to deal with this issue.
One thing about being a type 1 diabetic is that because their blood glucose levels can be very unreliable, they sometimes need to take glucose, which means that at a certain point their absolute priority is to eat something. They have to be able to eat something to even out their blood sugar levels, yet all too often teachers will not allow them to use the classroom in those circumstances.
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
indicated assent.
Mr Howarth
I see the Minister nodding. This really is a problem. Schools need to be advised on how to deal with these situations, so that in every classroom the teacher is aware, whether or not they have a type 1 diabetic in their class, of what they are supposed to do in those circumstances. The lack of understanding in many schools—not all of them, as some deal with the matter very well—must be tackled.
However, I do not want to be overly gloomy about the problem. Organisations such as the JDRF and Diabetes UK, in conjunction with others, including the all-party parliamentary group for diabetes, of which I am a member, are both raising the profile of the way type 1 diabetics are being failed by the healthcare system and suggesting constructive ways of improving the situation. Later today there will be the launch of a report, not specifically on type 1 diabetes but on how services can be better organised. That is the result of many months of taking evidence from expert organisations. I hope that Ministers will study that report closely.
With regard to progress, scientific research is making great headway. The hon. Member for St Ives, who opened the debate, highlighted some of the scientific research going on and the technologies that are available. It is in my view highly likely that a cure will be found well within the lifetime of today’s young diabetics. Building on the technology that already allows automatic continuous glucose monitoring and automatically pumped insulin, an algorithm for combining the two into an artificial pancreas already exists. The hope is that it will not be long before that technology becomes the norm. More development work is going on, but the research and tests that have been carried out indicate that that system works and can bring about a massive improvement in the lives of young people and others who suffer from diabetes, because it enables them to keep their blood glucose at an even level.
I want to say a few words about a particular problem that some young type 1 diabetes sufferers experience. As we know, as a society we face a problem—particularly, although by no means exclusively, among young women—as regards body image. The media, magazines and society in general put forward an idealised view of what a woman or, for that matter, a man should look like. We know about eating disorders that arise from that wholly inappropriate promotion of a “perfect” shape. I do not profess to be an expert on this issue, but my experience of life is that human beings come in all shapes and sizes, none of which is more acceptable than another—but that is just a personal view. However, some young type 1 diabetics discover—this is easy to find out through social media—that by manipulating their insulin intake, they can achieve rapid weight loss. To some young people, that sounds like a great thing to be able to do. Someone can lose perhaps half a stone in a week simply by not taking the amount of insulin that they require. Of course, the problem is that it leads to major medical complications and, in some cases, can end fatally.
Those who do fall into the habit, which amounts to a highly specialised eating disorder, need to be able to access support from diabetologists and from either psychological or psychiatric specialists. All too often, though, that support is not available—at least not in one place—at the time when the young person needs it most and they are left trying to negotiate a sort of medical specialists ping-pong game between, on the one hand, diabetologists, who do not understand the psychological problem that the young person is experiencing, and on the other hand psychologists or psychiatrists, who do not understand all the scientific and medical issues about their diabetes. I know that that is not the Minister’s specific area of responsibility—[Interruption.] Oh it is, she tells me, great—but I put in a plea for her to really give some thought to how those services can be co-ordinated in such a way that means those young people are not left travelling from one place to another, often with long distances involved, to try to access support, when all they can get is somebody who understands one aspect of their disease and the particular manifestation of that disease they have. We are not talking about tens of thousands of young people; we are talking about hundreds, but nevertheless these are young lives and they need to have proper access to all the services that they require.
I will conclude with a couple of questions, which are asked in an entirely constructive spirit. Can the Minister give an assurance that the Government will take an active interest in the research that is going on into technology, and that it will be properly supported? Does she agree that the achievement of making these technologies normal, particularly the artificial pancreas, needs to be pursued with absolute rigorousness? That could be delivered very quickly if the Government took an active interest in it. Will she commit—both through the technological means and better treatment design—to ensuring that the various services that can prevent serious complications are properly integrated so that the medical ping-pong is overcome?
I hope that I have not gone on for too long. Knowing you as I do, Mrs Gillan, I know that you would have told me if I had. Again, I thank the hon. Member for St Ives for giving me the opportunity to say the things that I wanted to say. I am sure that the young diabetics around this country who have the opportunity to do so, will be glad that at least their plight has been raised by at least one Member of this House.
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
It is a pleasure to serve under your chairmanship, Mrs Gillan. I thank my hon. Friend the Member for St Ives (Derek Thomas) for giving us the opportunity to have such an important debate. His timing is impeccable, as always, as I found on the Science and Technology Committee, of which he was such an excellent member—we exist in a mutual admiration society. This debate follows on from world diabetes day last month. I want to add my voice to the tributes already paid to the all-party groups on diabetes and on vascular disease and to Diabetes UK for the work they do on this issue. It is invaluable, as we have heard from the very high quality and personal contributions this afternoon.
As the shadow Minister says, diabetes is one of the biggest health challenges facing this country today. The figures are truly sobering. Almost 3 million people in England are currently diagnosed with diabetes and we estimate that a further 940,000 remain undiagnosed. Furthermore, around 5 million are at high risk of developing type 2 diabetes. If nothing changes, by 2025 more than 4 million people will have the condition. As the right hon. Member for Knowsley (Mr Howarth) said, type 1 diabetes affects 400,000 people in the UK and its incidence is increasing by about 4% a year. It is not preventable, so the emphasis is on improving the lives of people with type 1 diabetes and helping them to manage their condition.
I absolutely associate myself with the words of the Prime Minister: the message should be that people are able to live full and active lives, and the Government are there to do whatever they can to support them to do so. I shall certainly undertake to study the upcoming report mentioned by the right hon. Gentleman and consider its proposals carefully.
Type 2 diabetes is much more common. Diabetes as a whole is a leading cause of preventable sight loss in people of working age and is a major contributor to kidney failure, heart attack and stroke. As my hon. Friend the Member for St Ives said, diabetic foot disease, including lower limb amputations and foot ulcers, account for more days in hospital than all other diabetes complications put together. We are determined to change that.
According to Public Health England and Diabetes UK, 5 million people in England are at high risk of developing type 2 diabetes, and one in 10 will develop the disease if current trends continue. Type 2 diabetes is largely preventable and manageable through lifestyle changes, as the shadow Minister has testified—I was very impressed by her testimony today.
There is also a huge financial cost—as well as a personal cost—to diabetes and its complications. It already costs the NHS in England more than £5.6 billion a year, and that continues to rise. In addition, the annual social care costs associated with supporting people with diabetes are estimated to be £1.4 billion. Managing the growing impact of diabetes is one of the major clinical challenges of the 21st century. That is why preventing type 2 diabetes and promoting the best possible care for all people with diabetes is a key priority for me and for the Government.
It will not surprise my hon. Friend the Member for St Ives to hear that, as the Minister for Public Health and Innovation, I believe he is absolutely correct to highlight the role that modern technologies, properly used, can play in the care of people with diabetes. We are extremely fortunate to have a thriving, world-class life sciences industry in this country—it is one of the jewels in the crown of our industrial sector. That is why we are investing an extra £2 billion a year in research and development by the end of this Parliament to help to put post-Brexit Britain at the cutting edge of science and technology, as the Chancellor announced today.
The development of new, innovative technologies is continuing at pace and is revolutionising health systems throughout the world. However, that will not help if patients do not benefit from it, so we want to make sure that patients here benefit as quickly as possible. As my hon. Friend the Member for St Ives said, we can do better. That is exactly why we commissioned the accelerated access review to support the NHS to become a system that embraces innovation and works in collaboration with innovators to get products to patients more quickly. The review was published last month. We are carefully considering its recommendations and will respond as soon as we can.
It is not surprising that we are seeing the emergence of technologies that have real potential to improve the lives of people with diabetes in the context of such a thriving life sciences sector. As many colleagues have mentioned, key to managing diabetes is monitoring and controlling glucose levels. Various technologies are available. Insulin pump technology is prime among these and is recommended by NICE as an option for people with type 1 diabetes. Many people are already benefitting from blood glucose monitoring with testing strips and a machine to read blood glucose levels, as well as continuous glucose monitoring. The shadow Minister went into great detail about how that already provides hundreds of readings a day to provide a clear picture of people’s glucose levels.
People also benefit from flash glucose monitoring, where the glucose concentration and trend is shown when the monitor is waved over the sensor. Other devices are also available; I understand that many people are already finding them useful in reducing hyperglycaemic and hypoglycaemic attacks. In some cases, as my hon. Friend the Member for St Ives said, such devices can offer life-changing support to patients living with diabetes. They can play a particularly valuable role for certain patient groups, including children and teens, when they are properly managed, as the hon. Member for Upper Bann (David Simpson)—who is not in his place—said earlier.
Clinical commissioning groups are responsible for commissioning diabetes services. In doing so, they need to ensure that the services they provide are fit for purpose, reflect the needs of their local populations and are based on the available evidence, taking into account national guidelines. In the end, none of the guidelines can supersede the best judgment of clinicians, formed with their patients, about the best treatment option for them. I know that NHS England is actively investigating the potential of technologies for use within the NHS with manufacturers and patient groups to understand and identify areas of need and barriers to adoption so that they can improve access.
Looking to the future, artificial pancreas technology, as was mentioned, continues to be developed. One system has recently been approved by the US Food and Drug Administration, and a European licence is being pursued. Large randomised clinical studies of similar systems are now beginning, and several are expected to come to market in the next five years. Teams in the UK, including in Cambridge and London, are leading on some of this work, but these technologies need to be used optimally as part of holistic treatment pathways so that we get the best patient outcomes from them. That is exactly what the NHS innovation accelerator aims to deliver.
The NHS innovation accelerator is supposed to realise the commitment in the five-year forward view to create the conditions and cultural change necessary for proven innovations to be adopted faster and more systematically through the NHS for the benefit of patients. This is being delivered in partnership with all 15 academic health science networks. AHSN initiatives are patient-facing. Monster Manor, for example, is a free app launched by the Oxford AHSN—which I mention very selfishly—diabetes clinical network to encourage children with type 1 diabetes to track their blood glucose readings and become more engaged in their diabetes management. By logging readings, players earn rewards that help them to advance through the game.
The Yorkshire and Humber AHSN is implementing a locally developed set of tools to support general practice and community pharmacy in fostering greater self-care and health literacy among patients with diabetes and encourage them to do something to prevent severe hypoglycaemic episodes. A particular benefit of the AHSN network is the best practice sharing system, which is now in place, to ensure that improvements in one area can more quickly spread across the whole country.
Another example of accelerator innovation is the internet of things innovation diabetes test bed, which is funded by the Department. This enables people with type 1 or type 2 diabetes to do the right thing at the right time in self-managing their condition. It can be difficult to manage any long-term condition, so help is particularly valuable. People get a real-time view of their own data so they can take prompt action to prevent their condition from getting worse. This also encourages more timely and appropriate interventions from healthcare professionals. It is hoped that using technology in this way will also create genuine partnerships between patients and their healthcare professionals.
Realistically, the only way we are going to make measurable progress in halting the diabetes epidemic is to put strong measures in place to prevent those at risk from developing type 2 diabetes in the first place. Healthier You, the diabetes prevention programme, is the first type 2 diabetes prevention programme of its kind to be delivered at scale nationwide anywhere in the world. By 2020, the programme will be made available to up to 100,000 people at risk of diabetes each year across England. Those referred will get personalised help to reduce their risk, including education on healthier eating and lifestyles, and physical exercise programmes tailored to the individual. Building on that, NHS England is investing an additional £40 million each year to support CCGs in promoting evidence-based interventions to improve the care that all people with diabetes receive. In line with the points that my hon. Friend the Member for St Ives made, NHS England is encouraging GPs to refer people who are at high risk of diabetes into the national diabetes prevention programme, although referrals also come through the NHS health check, so there are two routes.
The role of structured education is widely recognised to be hugely important. The Department, NHS England and Diabetes UK are working together to improve the take-up of such education, including through digital and web-based approaches. Furthermore, NHS England is planning to make additional investment from 2017-18 to support the expansion of structured education to help patients to understand their condition better and manage it themselves more successfully.
The right hon. Member for Knowsley made some important points about the interaction of mental health services and diabetes provision. There is already significant activity to tackle the challenges of negative body image, and the Government announced a body image taskforce in 2010. It reports annually and is led by the Government Equalities Office. Simultaneously, in response to the priorities put forward in the five-year forward view on mental health, we are currently significantly improving care pathways for eating disorders. I have not so far investigated the specific challenge of how young diabetic patients interact with that context, but as a result of the right hon. Gentleman’s comments I undertake to do so.
I hope I have demonstrated not only the Government’s commitment but my personal commitment to harnessing new and innovative technologies as part of our drive to improve outcomes for the millions of people already living with diabetes and the many others at risk of developing the disease, as well as to sending out the clear message that diabetes does not in any way limit the ability to live an active life and to contribute well.
Oral Answers to Questions
Baroness Blackwood of North Oxford Excerpts(7 years, 5 months ago)
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Gavin Newlands (Paisley and Renfrewshire North) (SNP)
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
The Department is working closely with Public Health England, the national health service, local authorities, schools and other partners as we implement the childhood obesity strategy. We have already taken firm action, including consulting on the soft drinks industry levy and launching a broad sugar reduction programme.
Stuart C. McDonald
Channel 4’s “Dispatches” programme has comprehensively demonstrated how the former Prime Minister’s obesity strategy was drastically watered down by the time of the final publication. Both Public Health England and the Health Committee agree that control of in-store promotions of unhealthy food is absolutely vital. Why was regulation of such promotions ditched from the Government strategy?
Nicola Blackwood
We have made no secret of the fact that we considered a range of policies before publishing the childhood obesity strategy, which is a world-leading strategy and one of the most ambitious in the world. It will cut childhood obesity by one fifth in the next 10 years, and I am determined that we do not get lost in a debate about what it could or should have been, but instead get on with implementing it. Our children deserve no less.
Gavin Newlands
A few weeks ago, I hosted a Westminster forum on the implementation of the strategy, at which there was much consternation about why another important recommendation—the creation of a 9 pm watershed to reduce children’s exposure to junk food advertising—was cut. Does the Minister not realise the seriousness of the obesity crisis, and can she explain why that important measure was dumped?
Nicola Blackwood
Current restrictions on the advertising of less healthy food and drink in the UK are among the toughest in the world, so I am pleased to reassure the hon. Gentleman and his constituents on that fact.
Mr Mark Harper (Forest of Dean) (Con)
May I draw the Minister’s attention to some excellent leadership from the private sector? Lucozade Ribena Suntory, which is based in my constituency, announced last week —rather buried in the news from the United States of America, I am afraid—that it was going to take 50% of sugar out of its soft drinks by reformulating all its new and existing products. That demonstrates really good leadership and is an example to other companies.
Nicola Blackwood
I welcome my right hon. Friend’s question. He is absolutely right. We very much welcome the actions of not only Lucozade but Tesco in cutting the sugar in their drinks. It is proof that doing so is possible and meets the expectations of many consumers.
Maggie Throup (Erewash) (Con)
Recent data from the national childhood measurement programme shows that obesity rates have risen for the second consecutive year. With that in mind, will the Minister outline what further steps she has taken to make the childhood obesity plan for action into a true strategy?
Nicola Blackwood
As I have been saying during this Question Time, I am absolutely determined to focus on implementing the plan that we have. It is one of the most ambitious in the world, and it will deliver a reduction of a fifth in childhood obesity over the next decade. However, we have been clear that this is not the final word; it is just the beginning of the conversation. I would welcome contributions from my hon. Friend, who is a dogged campaigner on this issue.
Keith Vaz (Leicester East) (Lab)
Yesterday, on World Diabetes Day, the Prime Minister opened the new headquarters of Diabetes UK and said that the number of cases of diabetes increased by 75% in the last decade. The Minister and I attended the launch of the Food Foundation’s declaration on how to tackle obesity. Which of the 10 measures put forward by the foundation has she decided to accept?
Nicola Blackwood
The right hon. Gentleman is absolutely right to raise this issue, and we are considering the contributions from the Food Foundation, which are very important. He is right about the role that obesity plays in triggering diabetes. That is why we are focusing on preventing type 2 diabetes through the world’s first national diabetes prevention programme, which aims to deliver at-scale, evidence-based behavioural change to support people to reduce their risk of developing type 2 diabetes.
Philip Davies (Shipley) (Con)
May I urge the Minister, in tackling childhood obesity, not to go down the line of nanny-state proposal after nanny-state proposal, but instead to look at Active Movement, which is in operation in a number of areas around the country? It builds exercise into the average day of children in schools, and it is already making a great difference to childhood obesity levels.
Nicola Blackwood
I very much welcome the hon. Gentleman’s support for a key plank of the childhood obesity strategy, which is helping all children to enjoy an hour of physical activity every day and which will include physical movement as well as specific physical education.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
Another target that “Dispatches” uncovered was to be scrapped was the target to halve childhood obesity by 2026. This was compounded by recent national childhood measurement data showing that obesity is on the rise and that obesity rates are more than double in deprived areas compared with more affluent ones. Instead of squandering this opportunity, the Government should be pushing ahead with a comprehensive and preventive strategy. Can the Minister explain, therefore, why this significant target was dropped from the Government’s plans to tackle childhood obesity?
Nicola Blackwood
The hon. Lady is right to say that the childhood obesity strategy is one of our key priorities for tackling health inequalities in the UK. Obesity prevalence for children living in the most deprived areas is double that for those living in the least deprived areas, and the gap continues to widen. That is exactly why we will press ahead with the plan, but, as she has said, this is just the beginning of the conversation and we will continue to fight obesity as a government priority.
Ms Angela Eagle (Wallasey) (Lab)
Julie Cooper (Burnley) (Lab)
The Secretary of State and the Minister will be aware that Capita has wreaked havoc in GP surgeries across the land, placing extra pressures on already overstretched NHS staff, compromising patient safety and breaching confidentiality. Last week, I met a group of practice managers who told me that some patient records have been missing for months, while others have turned up apparently half-eaten by mice. Given that this contract was introduced to save the NHS money, will the Minister tell us how much it is costing to rectify the mess and what steps she is taking to compensate GPs for the expenses they have incurred as a result of ill-conceived and poorly implemented contracts?
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
The hon. Lady is right that the current delivery of this contract by Capita is unacceptable. I have met NHS England and Capita regularly to make sure that rectification plans are in place. We are assured that these steps are now in place and that the programme will improve.
Tom Pursglove (Corby) (Con)
Mr Virendra Sharma (Ealing, Southall) (Lab)
Nicola Blackwood
The hon. Gentleman is absolutely right that diabetes is a major health risk in the UK. That is why we have rolled out the first ever NHS diabetes prevention programme this year on 27 sites, covering nearly half of England and referring nearly 10,000 people. Next year, the second wave of the programme will reach a further 25% of the English population. The aim is for the NDPP to be rolled out across the whole of England by 2020 to support 100,000 people at risk of diabetes each year.
Robert Neill (Bromley and Chislehurst) (Con)
Chris Law (Dundee West) (SNP)
Nicola Blackwood
The obesity plan is one of the most ambitious in the world. It will reduce obesity by a fifth by cutting the amount of sugar in our food, helping all children to engage in an hour of physical activity a day, and making it easier for families to make healthy choices. We already have some of the toughest advertising rules in the world, and we have consulted Scotland closely on these arrangements.
Henry Smith (Crawley) (Con)
Stuart Blair Donaldson (West Aberdeenshire and Kincardine) (SNP)
Climbing obesity rates are expected to lead to increases in type 2 diabetes, cardiovascular disease and the need for joint replacements, which will put even greater pressure on the NHS. Given such threats to health, does the Secretary of State really think that now is the time for timidity and sucking up to business?
Nicola Blackwood
As I have made absolutely clear today, I am determined not to allow the House to get lost in a debate about what the plan could or should have been. Our children deserve more from us. We should not politicise this debate; we should get on with delivering the plan that we have before becoming involved in a lengthier conversation about what a long-term obesity programme should be.
Antoinette Sandbach (Eddisbury) (Con)
Andrew Bridgen (North West Leicestershire) (Con)
Nicola Blackwood
I know that the British Lung Foundation has called for a taskforce on lung health. Given that a million people have been diagnosed with COPD and a further million remain undiagnosed, the Government and the NHS are keen to work with the NHS and the voluntary sector to find practical and innovative ways of improving outcomes for patients with respiratory disease, and I will consider my hon. Friend’s proposal as part of that process.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
The number of nurses working in mental health has fallen by 15% since 2010, from 45,384 to 38,774. Why is that, and does the Secretary of State believe that it will achieve real parity of esteem for mental health in our country?
Bob Blackman (Harrow East) (Con)
We recently had an excellent debate in Westminster Hall on the Government’s tobacco control strategy. When will they publish the new strategy, which was promised for publication this summer?
Nicola Blackwood
The UK is a world leader in tobacco control and we have a proven record in reducing the harm caused by tobacco. We should be proud of the fact that smoking rates among adults and young people are at the lowest ever level, but my hon. Friend is right to push for the tobacco control plan because there is unacceptable variation. We are working on developing that plan, which we will be publishing shortly.
Danny Kinahan (South Antrim) (UUP)
In Northern Ireland in 2014-15, 870 deaths were due to the cold weather. Will the Minister engage with other Ministers to ensure that fuel poverty is looked at by all Departments, so that the pensioners who raised this in Parliament do not suffer from the health matters that are killing them off?
Capita Contract (Coventry)
Baroness Blackwood of North Oxford Excerpts(7 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I congratulate the hon. Member for Coventry North West (Mr Robinson) on securing a very important debate. As the hon. Member for Stretford and Urmston (Kate Green) said, his business acumen was clearly on display. The importance of this debate is clear from the presence of a clean sweep of Coventry Members, but I know that the issue is important to colleagues across the House, so I am pleased to respond to the debate this evening.
I will start with Coventry, as it is in the title of the debate. Coventry is at the forefront of providing extended access to GP services seven days a week through the GP access fund, and it is doing excellent work to ensure that frail or elderly patients can avoid unnecessarily long hospital stays, using integrated neighbourhood teams to make sure that patients have the right primary and community care in place. As has been made clear by the speeches and interventions that we have just heard, excellent primary care such as this relies on effective and efficient support services. The hon. Member for Coventry North West is therefore right to be concerned that the service provided by Capita under the primary care support services contract in Coventry and elsewhere has so far fallen well short of the standards that we expect, and GPs have borne the brunt of these failings, as we have heard today.
It is true, as the hon. Member for Bristol South (Karin Smyth) said, that NHS England needs to make efficiencies. I was pleased to hear that the hon. Member for Coventry North West supports that in principle, and I am happy to confirm that all the savings that are made through this contract are ploughed straight back into frontline NHS services.
It was always clear that Capita’s services needed to be at least as good as those that they replaced. Quality was always part of the tender process. The contract was let via a competitive tendering process, which was subject to scrutiny not only by the Department of Health but by the Treasury, and the bids were assessed for quality, not just cost. Capita put forward the most credible of any of the bids accepted on the short list, and at the time both the Department and NHS England had every confidence that the programme would be a success. However, it is evident that Capita was inadequately prepared for delivering this complex transition.
Mr Robinson
First, does the Minister agree that part of the process preceding the award of the contract should have been to assess whether Capita was ready for it? That is precisely the point that I was trying to make and that my hon. Friends referred to in the debate. Secondly, how can the Minister talk of savings? How can any savings have been made when 9,000 patients records have been missing for more than two months, without which they cannot attend doctors surgeries? It is illusory to speak of savings. There are none, unless the Minister would care to tell us where they are and how they came about. I would be pleased to hear that.
Nicola Blackwood
The hon. Gentleman’s point about scrutinising whether Capita was competent as part of the tendering process is purely common sense and obviously that should have been done as part of the process. If he will allow me, I will come to the other points in the course of my speech. I would like to concentrate on how we resolve the problem that we find. We need to make sure that GPs and their patients receive the service to which they are entitled.
We want to restore acceptable services, and the contract contains sufficient financial incentives to ensure that Capita shares that goal, which is an important part of the contract and process. Let us be clear that the problems encountered with medical record transfers and overdue payments are entirely unacceptable. The Department shares that view. Both Capita and NHS England are co-operating fully with the Information Commissioner’s Office to address the implications for information governance, and I accept the need for urgent action to address the impact that this is having on patients and practitioners. That is why I have been holding regular meetings with Capita’s chief executive for integrated services, Joe Hemming, its new managing director for primary care support, Simon England, and NHS England’s national director for transformation and corporate operations, Karen Wheeler, and I will continue to hold such meetings.
Both NHS England and Capita openly acknowledge that the service has not so far been good enough. NHS England has demanded and received rectification plans from Capita for the six most affected service lines and has embedded a team of seven experts within Capita to support it as it resolves these issues.
As the hon. Member for Coventry North West said, it is also about having the right resources in the right place at the right time. Capita has informed me that it is adding around 500 more full-time equivalent staff to the service, at its cost, and that it is improving the training provided to ensure that new staff understand the importance of the service to both patients and practitioners.
I know that these problems have caused great inconvenience and distress, but with reference to risk—the hon. Member for Bristol South raised this point—NHS England has assured me that it is not aware of any direct cases of patient harm that can be attributed to service issues. However, NHS England is working closely with regional and local medical directors, so that we can be assured of patient safety. In particular, Dr Raj Patel, medical director of NHS England Greater Manchester, has joined the embedded team to ensure that clinical risks and concerns are appropriately addressed.
The priority now is to deal with any backlogs, particularly with medical record requests, and to ensure that services are stabilised with the capacity to deal properly with new requests. There has been progress on that, which is encouraging. The backlog of medical record requests has reduced from 17,262 to 3,465 in the past two weeks. Capita assures me that it has an effective triage system in operation for new requests and is confident that the situation will not recur. However, I will be monitoring the situation closely.
Kate Green
On the point about reducing the backlog, which is something the Bodmin Road practice in my constituency has raised with me, it is not just Capita that needs to put in extra resources; the GP practice is now receiving an onslaught of incoming records, but it does not have the personnel to manage them.
Nicola Blackwood
The hon. Lady is absolutely right to raise the impact on GP services in recent weeks and months, and I will move on to that point later.
Capita has piloted a new way to move medical records. I think that is the pilot in west Yorkshire to which the hon. Member for Stretford and Urmston referred, but it was not a pilot for the overall Capita project. Capita assures me that ultimately it will be more reliable and secure by tracking the end-to-end movement of every record. It is piloting that approach in west Yorkshire and plans to be ready to roll it out nationally in March 2017. I am aware that some GPs were left short of basic supplies as a result, including syringes, and that they have had to source those from other suppliers at their own expense. NHS England tells me that it has reimbursed practices for any costs incurred from having to buy local supplies of needles and syringes.
I know that many of the hon. Members’ GP constituents have experienced frustration with Capita’s contact centre. I share those frustrations. Capita assures me that the contact centre has improved the way it responds to urgent queries by investing in more staff, improved processes and enhanced training. Capita is confident that these measures will deliver a quality service to customers. We will monitor its progress closely, including through meetings.
Karin Smyth
I am listening carefully to the Minister, and it is obviously reassuring to know that Capita, NHS England and the Minister are having these conversations at a national level. In those discussions, has any consideration been given to my point about the loss of local, specialist knowledge and expertise? Is any consideration being given to putting back some of those local arrangements, given the importance of primary care to the entire system?
Nicola Blackwood
I shall come a little later to the problems with the existing system that meant it needed to be replaced. However, the hon. Lady’s point about the value of institutional knowledge, especially among NHS workers and personnel in other roles, is very important. They have been engaged in a lot of consultation processes as we try to put this issue right with NHS England and Capita. If the hon. Lady writes to me, I will be happy to give her more detail.
I also expect Capita to address issues with the courier service. I am aware of several steps that have been taken to ensure that all practices receive regular collections and deliveries. Both NHS England and Capita have taken steps to demonstrate that they are committed to restoring their reputation and re-establishing a quality service, and I am encouraged to see them working in partnership to do so. That said, I recognise that GPs, and ophthalmologists in particular, have suffered financial detriment as a result of late processing of payments. NHS England is working with Capita to explore what can be done to support affected stakeholders, and I have made it clear to Capita that I expect it to consider compensation as an option.
Some have suggested that the old model for provision of primary care support should be reinstated, but we must remember that it relied on localised services that did not connect with one another, with much duplication across processes. The quality of these services varied greatly—in some areas, it was outstanding; in others, it was quite poor. That was simply unsustainable. Furthermore, the system was unable to generate useful management information and so, honestly, issues such as the ones that we now face would be very unlikely to have surfaced. They would have gone unreported.
A new model, with efficient and modernised processes, is the right approach to deliver to our primary care providers the service that they deserve. The Department and I will continue to closely scrutinise Capita and NHS England as they work to resolve current problems and build a quality service that is sustainable. I acknowledge fully that there is a long way to go before the service can be considered acceptable and that Capita has much to do to earn the trust of practitioners and patients.
This is clearly a live issue. I want to be clear today: I am listening. The issue is at the top of my priority list and will remain there until I am satisfied that an efficient and effective service is being delivered that meets the needs of patients and providers.
Question put and agreed to.
Care Homes for Older People
Baroness Blackwood of North Oxford Excerpts(7 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I thank my hon. Friend the Member for North Devon (Peter Heaton-Jones) for securing this important debate. He is a doughty campaigner. As he said, it is almost a year to the day since he last raised the issue in the House and he has taken much action since. I pay tribute to my predecessor, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), for his work. He has laid great foundations for the work we are doing now. As he said, care homes play a vital role in our society, but the decision to move into a care setting or place a family member there can be exceedingly stressful. It is essential that the public have confidence in the quality of care that they seek. Poor care, abuse and neglect are completely unacceptable at all times, whatever the cause, and we are determined to stamp them out.
My hon. Friend the Member for Horsham (Jeremy Quin) is right that we must learn from the mistakes of the past. That is why in October 2014 we introduced a tougher CQC inspection regime based on the five important questions that matter most to people: are services safe, caring, effective, well led and responsive to people’s needs? It is why we brought in a new criminal offence of ill treatment and wilful neglect, and why a fit and proper person test has been introduced to ensure that providers do not recruit directors who are known to have been responsible for unacceptable standards of care.
The CQC can and does take robust action against providers that breach regulations and standards, from issuing warning notices and fines, through imposing conditions on a provider’s registration, to cancelling that registration altogether. During 2015-16, the CQC took 901 enforcement actions in adult social care, ranging from warning notices to prosecuting providers.
The CQC now has specialist inspection teams, which under the leadership of the chief inspector of adult social care include people who have personal experience of care. Inspections are required to take into account the views of service users and their families. Furthermore, the great majority of its adult social care inspections are now unannounced. The timing of inspections is based on assessment of provider risk, but their frequency in usual circumstances can be expected to be at least every 24 months.
The CQC’s fundamental standards that registered providers are required to meet include two very important registration requirements. The first is the duty of candour, which requires providers to be open with service users about all aspects of their care and to inform service users where their failures are in their care. The second is, as I have said, a fit and proper person requirement for directors that ensures that accountability for poor care can be traced all the way to the boardroom if necessary. These standards now give the CQC an effective power to prosecute providers in cases where a failure to meet standards results in avoidable harm or a significant risk of such harm.
Jeremy Quin
Will my hon. Friend or one of her ministerial colleagues kindly meet me and my hon. Friend the Member for Crawley (Henry Smith) specifically on that point in relation to Orchid View? We would be most grateful if that was possible.
Nicola Blackwood
I am absolutely sure that the Minister with responsibility for this area will do so.
The point I am making is that together we now have a more robust inspection standard and the fundamental standards to ensure greater accountability for providers of unacceptable standards of care. The CQC now has a much stronger baseline of information that tells us about the quality of adult social care across the country. From October 2014 to the end of July 2016, it inspected and published ratings for more than 16,000 adult social care services, out of a total of some 25,000.
As my hon. Friend the Member for North Devon highlighted, I recognise that delivering this more comprehensive inspection programme has taken longer than originally planned. The National Audit Office itself acknowledged that the CQC would have been hard pressed to have been aware of the amount of work needed to complete the initial round of inspections and re-inspections. The CQC acknowledged that it experienced early difficulties in recruiting sufficient inspectors with the right specialty and calibre. These problems are now resolved and the Department agreed with the CQC that it should consider the quality and rigour of inspections, and having the staff to carry them out, as the most important issue. The CQC is now on track to complete adult social care inspections by their published deadline of March 2017. We are closely monitoring its progress towards that delivery date.
We should be pleased that this work is starting to bear fruit. We have seen improvements since the observation that
“four in ten establishments are not reaching a required standard.”
At the end of July 2016, 72% of all adult social care services were rated good or outstanding, compared with 60% when the CQC published its findings in the 2014-15 “State of Care” report. The 2015-16 report shows that about 70% of care homes were rated good or outstanding, and 2% of all adult and social care services were inadequate at the end of July 2016, compared with 7% when the CQC published its last report. These quality ratings matter, because they are an important starting point for driving improvements. They are an encouraging early sign that this is happening.
The regulation of adult social care has three key roles to play: to identify poor practice and to take action to protect service users from the risk of harm; to encourage improvement by identifying areas of weakness; and to highlight and share good practice and success. All those roles are built on the foundations of effective use of data and rigorous inspection. The evidence shows that this is now happening. I would like to quote the National Audit Office, which confirms that the
“CQC has made substantial progress since 2011 and its new regulatory model strengthens the way it monitors and inspects hospitals, adult social care providers and GPs”.
We are by no means complacent, and we recognise the work that needs to be done to ensure that we are exactly where we want to be. Care homes look after some of the frailest people in society, and if there is a possibility of a home closing, or of other serious problems, it is completely understandable and reasonable for the families to have the reassurance that it will end up in the position they want it to be.
In recognition of the wider social care challenges, the Government are giving local authorities access to £3.5 billion of new support for social care by 2019-20. Since April, councils have been able to introduce a new social care precept, enabling them to increase council tax by 2% over the existing thresholds. This could raise up to £2 billion a year for social care by 2019-20. In addition, from April 2017, the spending review will make social care funds available for local government, rising to £1.5 billion by 2019-20 and to be included in the better care fund. Together, the new precepts and the additional better care fund contribution means that social care spending will increase in real terms by the end of the Parliament. Funding issues, however, are no excuse for poor care or—worse—abusive treatment. It does not cost any more to treat someone with kindness and compassion and to respect their dignity.
Finally, I want to address the important concerns around complaints that have been raised this evening. I know my hon. Friend is due to meet the Minister with responsibility for community health and care shortly on this matter and that he has previously met the Minister with responsibility for care services, the local government ombudsman and the CQC’s chief inspector. On the earlier point that he raised, I want to assure him that there is a statutory requirement for care home providers to operate a complaints system. Care homes are held to account for the effectiveness of the complaints process by the CQC.
We know from discussions we have had that the system is not working perfectly. Despite the progress we are making, we still hear too many stories that highlight people’s real concerns about quality and safety in social care—and we are determined to do better. We also hear that those receiving care or their families can be reluctant to make a complaint for fear of the consequences, especially if it is about a care home where someone is living. Indeed, only this week there was a story on the “Victoria Derbyshire” show about care homes banning relatives who made a complaint about the quality of care. We find that completely unacceptable. It is right that people and their families should feel able to raise concerns without fear of reprisals.
Ministers and the sector are looking to develop an adult social care quality strategy that will look at complaints and the culture of why people fear speaking up, as well as how we can improve the system to make it easier for them to complain. Care homes must have a complaints procedure, and if people are not happy with the response they receive the local government ombudsman can investigate complaints on their behalf. It is clear that everyone—not just the Government, and the CQC in its role as regulator, has a part to play in bringing about improvements in the quality of adult social care.
The Government are committed to improving the quality of social care, because care homes play a vital role in our society. There are many good and even outstanding homes, and we need to encourage them to share best practice so that it becomes the norm everywhere. We know that while a robust regulation and inspection regime is a key part of encouraging providers to improve, it is not the only influence. Sustained quality demands a commitment from everyone—from staff and providers to commissioners, funders and regulators—to make adult social care the best it can be. We are committed to working with all parts of the care system to make sure that we achieve just that, because our constituents deserve no less.
Question put and agreed to.
Social Media and Young People's Mental Health
Baroness Blackwood of North Oxford Excerpts(7 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I shall do my utmost, Sir Alan. It is a pleasure to serve under your chairmanship.
I congratulate my hon. Friend the Member for Cheltenham (Alex Chalk) on securing this very important debate. Contributions have at times been distressing, but they have been hugely important. He is right to raise awareness about the impact of social media on young people’s mental health. I thank all constituents and colleagues who have bravely allowed their stories to be shared today; it does have an impact and it is important.
As the hon. Member for Strangford (Jim Shannon) said, in recognising the harms that are occurring on social media, we must not reject the positive role that social media can play. Instead, we have to put social media in their place and know that, like any tool, their impact is dependent on how they are used. How we use social media depends on our intentions, for good or ill, and on our skills.
For the disfranchised and those without a voice, social media have provided a powerful medium for advocacy and outreach, and at times messages that would not otherwise have been heard have found a global reach. Even for the most vulnerable groups, the evidence shows that by no means all influences on social media are negative, and that only a minority of people will use social media to exploit and harm others.
The Samaritans undertook a consultation as part of its Digital Futures project, which looked at how people use online sources in relation to suicidal and self-harm content. The study found that, as well as negative experiences, those who took part in the research also highlighted using the sites to build peer networks. Three quarters of those who took part said that they looked for support online.
If we can harness the power of online platforms, we can use them to deliver the effective prevention interventions that many Members have called for, to raise mental health awareness, and to provide advice and support. Indeed, many of the support organisations that help our young people and adults who experience emotional challenges and issues of poor mental health have a presence on social media. As the Minister with responsibility for public health and innovation, that is something I must encourage.
As constituency MPs and Members of this House, we can all cite examples of social media platforms being used to inflict harm, whether through grooming or cyber-bullying, or of the anxiety and low self-esteem caused through hyper-use, which some Members have described. The Government reject the laissez-faire attitude that says this is all just an inevitable by-product of our connected world and shrugs its shoulders. No child should be groomed, bullied or harassed online, or simply left without the skills they need to critically and sensibly engage with social media.
That is why we are working in partnership with industry, the community and schools to address the challenges. New technology and social media continue to be misused to exploit and target the vulnerable. We have been clear that we expect social media companies to respond quickly to incidents of abusive behaviour on their networks. We have robust legislation in place to deal with internet trolls, cyberstalking and harassment, and perpetrators of grossly offensive, obscene or menacing behaviour. We are absolutely clear that these are crimes, and will be treated as such.
The Child Exploitation and Online Protection Centre has available various resources, which can be accessed via its website. The “Thinkuknow” programme has web resources to educate and empower young people at risk of sexual abuse and exploitation. I hope that some of them may access that if they are watching the debate. We know that the worst cases of bullying, including cyber-bullying, can lead to serious depression and even thoughts of suicide. A recent study by the national inquiry into homicide and suicide found that bullying—the sense of there being “no escape” was articulated by many colleagues—was a factor in the suicide of children and young people. I particularly thank Declan, the constituent of the hon. Member for Glasgow South (Stewart Malcolm McDonald), for allowing his story to be told and may I say how sorry I am that he had to go through that experience. We know that we must do better.
That is why all schools are required by law to have a behaviour policy and measures to tackle bullying in all forms among their pupils. Schools are free to develop their strategies, but they are clearly held to account by Ofsted. That is also why the Government Equalities Office announced £4.4 million of extra money to tackle bullying, and why over the next two years four anti-bullying organisations will go in to support schools to tackle bullying and to improve the support that is available. In particular, the GEO has invested £500,000 in the UK Safer Internet Centre to provide advice to schools and professionals on how to keep children safe, and a further £75,000 in CEOP to support a national roll-out of Parent Info, which is delivered through schools, to stop parents feeling helpless because they are not digital natives. It is a free service and helps parents to show their children how to use the internet and mobile devices appropriately.
We are also working with the UK Council for Child Internet Safety, which brings together 200 organisations to form the digital resilience working group to take forward work to equip children and young people to identify and respond to risks online, including cyber-bullying and negative influences.
We know, as colleagues have said, that young people, as well as their parents and carers, continue to feel the impact of unrealistic representations of body image, which have a pervasive impact on social media. My hon. Friend the Member for Cheltenham may be aware that the Government launched a body confidence campaign in 2010, which publishes a regular progress report on how we are addressing negative body images to tackle the very “compare and despair” trap that he so rightly highlighted. I agree with him about the importance of prevention and resilience building. A great deal of work is under way to try to target the sources of online abuse and harmful content upstream, at source.
Central to tackling the challenges posed by online bullying, exploitation and self-image will be supporting young people, as well as those who care for them, to build resilience. This year, Public Health England’s £337,000 Rise Above campaign is intended to do just that, building the resilience of young people by providing online information and tackling issues that include body image and online stress.
Alongside supporting young people in developing resilience, we know that parents and schools have a role to play in preventing mental ill-health, and we will continue to work with the Department for Education to improve mental wellbeing in schools, and to support children and teachers in addressing mental health issues through educational resources and by providing single points of contacts for mental health in schools.
My hon. Friend rightly highlighted the good work of the DFE in developing the MindEd web-based tools for children and parents. We are looking for ways in which those tools can be developed further to support local areas and to improve online contact.
Underpinning all of that is the need to tackle the stigma around mental health in all areas of society. That is why we have increased funding for Time to Change, which is our national anti-stigma campaign, to ensure that young people are confident in coming forward to get the help that they need. Underpinning all of that is our programme to reform and improve mental health support for young people. That is why we have increased investment in mental health to £11.7 billion, and local clinical commissioning groups are required to increase spending on mental health each year. That is part of a holistic strategy to improve key areas of mental health services, such as perinatal mental health, services to tackle eating disorders and better crisis care resolution in the community, as laid out in “Future in mind” and “The Five Year Forward View for Mental Health”, so that we can give young people with mental health problems the care and support that they deserve.
My hon. Friend was right when he said that we need to have the proper research in place, because this is an emerging area. That is why the Mental Health Taskforce asked the Department of Health, working with relevant partners, to publish a report by February 2017 to set out a 10-year strategy for mental health research. The final 10-year strategy planned for publication will identify the needs of mental health research. It will include a specific focus on the mental health of children and young people.
We know that there is much more to do and my hon. Friend is aware that the Lords Select Committee inquiry into children’s access to and use of the internet is currently under way. We are watching that closely and will look at its recommendations about online safety and the role that the Government, regulators and media companies can play to protect our children online because we know that more needs to be done.
We recognise the challenge of social media for young people up and down this country. We are determined to do our part to equip them with the tools they need to meet that challenge, not only in terms of their mental health but to protect them online, to make them more resilient and alert to the risks, and to make them confident digital natives who can critically and sensibly harness the power of digital tech for good.
Chronic Urinary Tract Infections
Baroness Blackwood of North Oxford Excerpts(7 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I thank the hon. Member for Hornsey and Wood Green (Catherine West) for securing this important debate and for all the hard work she, alongside the Cystitis and Overactive Bladder Foundation, or COB, does in campaigning on behalf of people with urinary tract infections. I know that this issue concerns colleagues from across the House and I am pleased to see a number of them here, and welcome the right hon. Member for Islington North (Jeremy Corbyn) to the debate. It demonstrates the importance of this subject for so many of our constituents.
Interstitial cystitis, often referred to as painful bladder syndrome, or PBS, is a debilitating and lifelong condition which affects over 400,000 people in this country. Its effects not only cause great and often frequent physical pain, but, as those affected often have to urinate up to eight times an hour, it can also threaten their ability to sleep, work, attend school and maintain a social life. This in turn can, of course, have an adverse effect on the quality of life and even the mental wellbeing of those with the condition. It is therefore clearly crucial that those presenting with symptoms consistent with PBS are diagnosed as quickly and accurately as possible in order to receive the most effective treatment to minimise the devastating effects of the condition. We are alive to that.
I understand that PBS can be a challenging condition to diagnose and that both the hon. Lady and COB have concerns over the effectiveness of the NHS tests for diagnosing urinary tract infection using dipsticks in the urine and mid-stream urine specimens. I am also aware of the work of Professor Malone-Lee and the research that he and his team of researchers at University College London have carried out in this area. I know that she recently invited Professor Malone-Lee to speak to MPs on this matter and I am grateful to her for raising awareness of his findings, as this is one of the most effective ways of sharing best practice and changing behaviours.
I am the first Minister for public health and innovation, and I am always interested to hear of any new developments that could lead to more effective diagnosis and better outcomes for NHS patients. Enhancing the quality of life for people with long-term conditions is hugely important to this Government and an overarching indicator in the NHS outcomes framework. The earlier a condition such as PBS can be identified and receive the appropriate treatment, the more the patient will be able to manage their condition and maximise their quality of life.
Our National Institute for Health Research invests around £1 billion each year, and finding innovative solutions to help patients better manage chronic conditions is a vital part of this investment. The NIHR recently awarded about £l million to the University of Newcastle to run a trial looking at alternatives to prophylactic antibiotic treatment for recurrent UTIs. Another study is looking at the effectiveness and acceptability of urine collection devices to reduce contaminated urine samples in women presenting with symptoms of UTI. That is designed to improve accuracy of diagnosis.
We know that UTIs can be a serious burden for individuals and for the healthcare system, and we believe that clinician-led NHS commissioning should be responsible for making decisions about individual treatments on the basis of the available evidence, taking into account the relevant guidance from the National Institute for Health and Care Excellence as appropriate. NICE publishes quality standards to define clinical best practice for the diagnosis and treatment of conditions. These standards are designed to help those commissioning and providing services to understand what a good-quality service looks like and to identify where improvements can be made. NICE published a quality standard on urinary tract infections in adults in June 2015. The quality standard comprises quality statements concerning the diagnosis, treatment and management of urinary tract infections. Quality statements 1 and 2 offer specific guidance on ensuring more accurate diagnoses of UTIs in adults. However, I understand that NICE has not yet addressed the specific issues relating to detecting UTIs raised by Professor Malone-Lee and his team of researchers.
As hon. Members will no doubt be aware, NICE guidance is kept up to date through periodic assessments of new evidence. The evidence surveillance team at NICE has been asked to take into account any publications emerging from Professor Malone-Lee’s work when it next considers the relevant guidance for review. I would encourage Professor Malone-Lee, the Cystitis and Overactive Bladder Foundation and the hon. Lady to take this opportunity to ensure that NICE is kept updated with the latest research, whether it is existing work or research that is produced in future, as I have no doubt that it will be helpful in improving guidance in this area. Furthermore, NICE is an independent body—fiercely independent—and if there are any concerns about an existing NICE quality standard or other guidance, I would encourage those concerns to be taken up with NICE directly.
In more general terms on continence care, NHS England published new guidance in November 2015 to help to improve the care and experience of people with continence issues. This includes the most up-to-date evidence to support commissioners and providers. Once again, I am grateful that this important matter has been brought to my attention, and I hope that any further research will be considered by NICE in any future guidance so that we can continue to make improvements in the diagnosis and treatment of people with such a painful and debilitating condition. I will of course be happy to meet the hon. Lady and patient representatives to ensure that we can make the necessary progress in this area.
I know from personal experience the impact that a chronic, difficult-to-diagnose and hard-to-manage condition can have on a patient’s quality of life. An early and clear diagnosis and a clear treatment pathway can truly be the light at the end of a very dark tunnel for many who are suffering with PBS. I hope that, as a result of the dogged championing of this cause by the hon. Lady and many others, and of the more robust evidence of innovative treatment options that NICE can evaluate, we will be able to offer the genuine hope and certainty that is clearly so urgently needed.
Question put and agreed to.
Young People’s Mental Health
Baroness Blackwood of North Oxford Excerpts(7 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) and my hon. Friend the Member for South Cambridgeshire (Heidi Allen) for initiating this debate on the Youth Parliament Select Committee report on young people’s mental health. I want to add my voice to those from both sides of the House in paying tribute to the Youth Select Committee for its powerful report—it is an important and timely intervention. As my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) said, Rhys Hart was, by all accounts, a remarkably effective Chair, and the 10 members were dedicated and focused. They won the admiration of the House of Commons staff who were involved, and they made particular mention of that to me before this debate.
The hon. Member for Ilford North (Wes Streeting) demonstrated quite clearly that he is an elected president of the BYC, with his particularly eloquent speech. He is right that we should thank those young people who have had the courage to speak up on their mental health experiences and opinions, and who have allowed us to refer to them today, because the value of those first-hand stories in this Chamber cannot be overestimated.
I would like to make a particular point of thanking the constituents of my hon. Friend the Member for High Peak (Andrew Bingham), Lucy Boardman and Martha Banks Thompson, and my own Youth Parliament representatives, Tara Paxton-Doggett and Rowan Ibbotson, who spoke to me about the mental health campaign. A number of colleagues have spoken about the impact of meeting the Youth Parliament representatives. As has been said today, what is important now is to prove that we have not just heard them; we have listened to them, and we are taking action on their words. That is why this has been such a moving and necessary debate.
Members have shared some very personal experiences of mental health and the services and support that they and their constituents have received. All of us will know the cases that haunt us. All of us know that we need to do better. As colleagues have said, over half of all mental ill health starts before the age of 14, and 75% has developed by 18. We know the distress that mental health problems cause to individuals and all those who care for them, and we know that the earlier we intervene, the better.
Children’s and young people’s mental health is a priority for this Government. Not only has the Health Secretary made it his personal priority, but so has the Prime Minister. It is time for a step change in the way that we deliver mental health services in the UK, and we are determined to deliver that. But we must not underestimate or under-sell some of the progress that has already been made, because that is thanks largely to the efforts of dedicated NHS staff, stakeholders, voluntary services and others. We have heard some success stories today, and it is important that we praise those involved for the hard work that they do in the face of great challenges.
We agree with recommendation 3 that funding needs to increase, as many colleagues have said. That is why we have increased investment in children’s mental health, with an additional £l.4 billion. While we do believe that it is right that local CCGs, led by clinicians, are best placed to prioritise their spending to meet the needs of local populations, we have been clear that this money is provided for mental health services, and we are requiring CCGs to increase their spending year on year.
Nicola Blackwood
I was attempting to deal with that point, but obviously not being very clear. As I said, we have been listening to these requests. We are looking very closely at how effectively the money is getting to the frontline, but at the moment we still believe that local clinicians are best placed to decide how to target these services. However, we have put in place a requirement for CCGs to increase spending on mental health year on year. We are also very clear that STPs must reflect the NHS mandate, which says:
“We expect NHS England to strive to reduce the health gap between people with mental health problems, learning disabilities and autism and the population as a whole”.
That will require great strides to be made in improving care.
Nicola Blackwood
One of the ways in which we are ensuring that money reaches the frontline is through driving accountability through transparency. Mental health services have lagged behind the rest of the NHS in terms of data and our being able to track performance. That is why the NHS will shortly publish the mental health dashboard, which will show not only performance but planned and actual spend on mental health. This is real progress.
Barbara Keeley
Let me make a couple of points in addition to the useful points made by my hon. Friend the Member for West Ham (Lyn Brown). First, it is clear that CCGs are ignoring the Government’s requests, so we will need more action than the dashboards and transparency that the Minister has mentioned. The Secretary of State will need to go back to CCGs and make the position very clear to them. Secondly, as other hon. Members and I have said, there is the question of local authority funding. Over £1 billion has been taken out of various services for children and young people such as children’s centres and youth services. That is a factor too. Those two things need to be addressed.
Nicola Blackwood
It is not fair to say that CCGs are ignoring the funding that is coming through. Moreover, it will not be possible for them to ignore what is going on when transparency and accountability is put in place with data sets that clearly show not only performance down to CCG level but the amount of funding that CCGs are given and the amount they are spending. These data will be much more detailed than before. In January, we introduced the first ever provider-level data set on children’s mental health services, and that will provide data on outcomes, length of treatment, source of referral, and location of appointment.
Mr Kevan Jones
The Health and Social Care Act 2012 contained one provision that I welcomed—allowing CCGs and others to commission services in the third sector, for example. A lot of the good work in this area is done in the third sector, but the problem lies in how the contracts are drawn up, because they are either too big or too complex for smaller organisations to bid for. Will the Minister look at that?
Nicola Blackwood
I am happy to look at it. We are very clear that there is a vital role for the voluntary sector to play in delivering some of these services. We hope that local transformation plans will be part of the way in which this is clarified. The programme to deliver transparency and accountability will be essential if local areas are not only to design effective services that match the needs of their local populations, but to be held to account for delivering them. I will not beat about the bush. We recognise that a complex and severe set of challenges faces children and young people’s mental health services. This area has been undervalued and underfunded for far too long.
While I am happy to investigate funding formulas such as those mentioned by the hon. Member for Ilford North in relation to Redbridge, I agree with him that leadership and accountability are also key to making the changes that we need. That is why we are committed to delivering real changes across the whole system, not just in funding, and to building on the ambitious vision set out in “Future in mind”. I pay tribute to my predecessors for the work they have done to bring those forward. As the hon. Member for Dulwich and West Norwood has said, we need to go further to drive through these changes, which young people have told us they want to see.
Children want to grow up to be confident and resilient, and they want to be supported to fulfil their goals and ambitions. We are placing an emphasis on building in that resilience, on promoting good mental health and wellbeing, on prevention—it is so important, as the shadow Minister has said—and on early intervention, as a number of the recommendations propose. We are looking, in particular, at how we can do more upstream to prevent mental health problems before they arise.
Barbara Keeley
The Minister is about to move on to intervention. Before she leaves funding, which has been pretty key, does she believe that the 8% of the budget spent on young people’s mental health—1% for CAMHS—has been anything like adequate? I did put that question to her. If she does not think that that is adequate, could Ministers tell us what they think it should be? If CCGs are ignoring Ministers’ continual urges to them to make pledges, will there be sanctions against CCGs that do not put in that extra funding?
Nicola Blackwood
I think I have already answered those questions. The Government have been clear that we think that mental health funding for children and young people, as well as for other areas of mental health, needs to increase. That is why we have increased mental health funding to local areas and we are putting in place measures to improve accountability and transparency, and the STPs, to make sure that that can be tracked locally. We are going to see how it works in the first instance.
Nicola Blackwood
I must continue.
Another issue that was raised is the fact that children and young people want to know where to find help easily if they need it. I want to make sure that I respond to all the issues that have been raised, otherwise it will not be fair to the young people who wrote the report. Children want to know that they can trust such help when they find it. Young people are clear that they want a choice about where they can get advice and support; they want to be able to get it from a welcoming place, based on the best evidence about what works; and they want the opportunity to shape the services they receive. Many colleagues have spoken about co-production.
“Future in Mind” committed to sustaining a culture of continuous evidence-based service improvement, as well as improving transparency and accountability across the whole system, as I have mentioned. A big part of that is producing the datasets that I have mentioned, which will give local areas the ability to hold their CCGs to account. Those datasets will include information on funding. As the hon. Member for Neath (Christina Rees) told us so eloquently—Matthew’s maiden speech has made its mark on all of us—young people want, as we all do, to tell their story only once rather than having to repeat it lots of times to lots of different people. We are committed to delivering a much clearer and more joined-up approach, with services coming together and communicating more effectively.
As numerous other colleagues have said, young people do not want to have to wait until they are really unwell—until they have reached a higher threshold—to get help. Asking for help should not be embarrassing or difficult. They should know what to do and where to go. If they do have to go to hospital, they should be on a ward with people around their age and close to home. So we are delivering a step change in how care is provided and ensuring that access is improved so that children and young people can easily access the right support from the right service at the right time, as close to home as possible. I recognise that this is a process.
“Future in Mind” is more than just a report. It is more than just words. It has already brought together key players, focused efforts and given us a clear trajectory for improving services. It is only the start of the journey, however, and we need to maintain the effort, focus and political momentum from this place and in our local areas.
In February 2016, the “Five Year Forward View for Mental Health” set out the start of a 10-year journey to transform NHS care across all ages. The hon. Member for North Durham (Mr Jones) was absolutely right to say that similar problems can be tracked across to adult services. The report was clear:
“The NHS needs a far more proactive and preventative approach to reduce the long term impact for people experiencing mental health problems and for their families, and to reduce costs for the NHS and emergency services”.
A lot of it is simply common sense. The five year forward view for mental health is underpinned by additional funding, which I have already spoken about, and the NHS England implementation plan sets out in detail where and when that money will become available. It builds on the foundation of local investment in mental health services and the ongoing requirement, which I have referred to, to increase that baseline by at least the overall growth in allocations.
“Implementing the Five Year Forward View for Mental Health” sets out clear objectives, which will support improvements to the services that young people will receive. I think it would be helpful if I say exactly what they will be, as they will make practical changes. The first is a significant expansion in access to high-quality mental healthcare for children and young people. At least 70,000 additional children and young people each year will receive evidence-based treatment. By 2020-21, evidence-based community eating disorder services for children and young people will be in place in all areas, ensuring that 95% of children receive treatment within one week for urgent cases and four weeks for routine cases. By 2020-21, in-patient stays for children and young people will take place only when clinically appropriate; will have a minimum possible length of stay; and will be as close to home as possible, to avoid inappropriate out-of-area placements. Inappropriate use of beds in paediatric and adult wards—this has already been referred to—will be eliminated.
All general in-patient units for children and young people will be commissioned on a place basis by localities, so that they are integrated into local pathways. That is designed to address some of the concerns that have been raised today. As a result, the use of in-patient beds should reduce overall, with more significant reductions possible in certain specialised beds.
Those objectives are supported by a refresh and republication of the local transformation plans, which have been mentioned. The plans set out how local areas will work together to improve services for children and young people with mental health problems across the whole care pathway. The plans are, in fact, the richest source of information available to date about the state of children and young people’s mental health services across England.
NHS England has also commissioned a number of thematic reviews as part of an analysis of the LTPs. In July, it published the children and young people’s mental health LTPs, which provide a summary of the key themes. It is fair to say that, essentially, they found that there was a lot of variation in local areas in terms of approaches, quality and priorities. We have heard about that in some of the stories that have been told today. The LTPs are a starting point. They are living documents and are not designed to just go in a drawer. They are reviewed and refreshed at least once a year, and we are clear that children, young people, families and carers must be involved in the process, for the exact reason given by the shadow Minister, which is to increase accountability and effectiveness and to make sure that the plans actually work.
A number of key themes have emerged from the report recommendations and the LTPs. Recommendations 5 and 6 comment on the need to support the workforce. We acknowledge the need to address the capability and capacity needs of the workforce—from GPs and A&E, to the mental health specialist—to deliver on our ambition to transform mental health services. In line with the eight specific workforce recommendations of the taskforce report, we will work with Health Education England and others to develop a five-year mental health workforce strategy, which we will publish in 2017. That is a serious response to a serious problem, and it is designed to address a lot of the challenges that have been raised today.
As many Members have rightly said, access to services is a priority area and we need to address it. We know that young people do not want to wait until they are really unwell to access services, and we do not want that to be the case, either, so we are tackling the issue. In August 2015, NHS England published an access and wait standard for children and young people with eating disorders, as I have said. From January, compliance with that standard has been monitored via the data collected through the mental health services dataset. It is, therefore, being held accountable and the aim, as I have said, is that 95% of young people will be seen within a clinically appropriate timeframe by 2020. That is just the first of the waiting time standards.
NHS England has commissioned the National Institute for Health and Care Excellence and the National Collaborating Centre for Mental Health to develop a new evidence-based treatment pathway for children’s mental health. The project will report in March, recommending maximum waiting times for referral to treatment. An England-wide quality assessment will then be used to establish a baseline and trajectory to achieve those national waiting time standards in local areas. The matter was also raised by the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who is no longer in her place.
We are also taking action on particularly vulnerable groups of children and young people. In April, Alison O’Sullivan and Professor Peter Fonagy were appointed as the co-chairs of the expert working group for looked-after children, established to lead the development of models of care for looked-after children’s mental health, which has historically been a blind spot. The expert working group is about practical outcomes—not just what is needed but how it should be delivered, without jargon, proposing concrete milestones and measures. We expect that work to conclude by October 2017.
However, ensuring access to services will not be enough if young people do not feel confident and safe seeking help. All children and young people should feel able to go for help when they need to, without fear of discrimination or stigmatisation. We have made a lot of progress in tackling stigma in recent years. The fact that young people have been willing to tell their stories demonstrates that.
Time to Change is a campaign that aims to tackle the stigma around mental health. In October, it was given £20 million in funding from the Department of Health, Comic Relief and the Big Lottery Fund. We are committed to ensuring that the Time to Change initiative, which is run by charities such as Mind and Rethink Mental Illness, will work with schools, employers and local communities to do more and go further to reduce discrimination and to raise awareness. It is developing a targeted campaign for young people, working with experts by experience.
As “Future in mind” and “The Five Year Forward View For Mental Health” both made clear, co-production is now a fundamental principle in the way we seek to develop and improve services, and anti-stigma campaigns are no exception. However, as many colleagues have said, to make that work, and to see the progress that is so desperately needed, we also have to work closely with colleagues across government, in particular the Department for Education, but not exclusively.
We are determined to continue that collaboration, as recommendation 2 proposes. We have been working closely together to ensure that the vision of “Future in mind” becomes a reality. We are also working together to consider what more can be done upstream to intervene early—an issue raised by the hon. Member for West Ham (Lyn Brown) and many others—and to provide the right interventions as soon as they are needed. The report’s recommendations will be a valuable resource for us as we do that, including the recommendations on attainment, Ofsted, teacher training and a whole-school approach, which was highlighted by my hon. Friend the Member for High Peak. We know that this is the weakest link in our current process and we are prioritising activity in that area to ensure that young people get the support they need right from the start.
A number of colleagues have mentioned the issue of online pressures and cyber-bullying. That matter has been taken extremely seriously by the Government Equalities Office, which announced in September £4.4 million of funding to tackle bullying. That includes a number of measures to underpin the fact that all schools are required by law to have a behaviour policy with measures to tackle bullying among pupils, and they are held clearly to account for their effectiveness by Ofsted. However, we know that more needs to be done, including to support parents. That is why the GEO has also invested £500,000 in the UK Safer Internet Centre to provide advice to parents on how to keep children safe and provided support to the Child Exploitation and Online Protection Centre to support a national roll-out of parent information through schools.
Today’s debate has been important because it has provided an opportunity not just to reply to the details in the Youth Select Committee report, which is so important, but to test the Government’s commitment to mental health reform. I am grateful to colleagues for the time they have taken today to raise concerns, to champion good practice and to propose innovative solutions. I hope that, in my response, our commitment to reform mental health services is beyond doubt. I also hope that it is clear that I believe that it is only through concerted political will, allied with the extraordinary and selfless determination of the mental health workers throughout this country, that we will have any hope of achieving our goal of mental health services that are accessible when and where they are needed.
I look around the Chamber and I hear speech after speech expressing determination to see a change. It gives me courage because great reform requires long-term vision, non-partisan partnership and fine minds. I have seen all three of those today, not just in the excellent Youth Select Committee report, but in all colleagues’ speeches. That truly is a firm foundation for the tough task ahead.
Tobacco Control Plan
Baroness Blackwood of North Oxford Excerpts(7 years, 7 months ago)
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The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
It is a pleasure to serve under your chairmanship, Ms Buck. I congratulate the hon. Member for Stockton North (Alex Cunningham), my hon. Friend the Member for Portsmouth South (Mrs Drummond) and the right hon. Member for North Norfolk (Norman Lamb) on securing the debate, and the Backbench Business Committee on allowing it. The importance of the debate is shown by the fact that we have the Chair and former Chair of the Health Committee and a former Health Minister present, as well as our newly appointed shadow Minister, whom I welcome here today; there was not much chance to do so in Health Question Time.
As hon. Members have made clear, despite the continuing decline in prevalence, smoking remains the largest single cause of preventable and premature death in this country, with approximately 17% of deaths annually caused by smoking. I want to be clear from the outset that the Government remain committed to reducing the number of people who smoke by stopping them before they start. We have a clear track record in reducing the harms caused by tobacco, which has already been mentioned.
We have made good progress through a comprehensive package of measures, many of which were brought about by my predecessor, my hon. Friend the Member for Battersea (Jane Ellison), with a lot of support from the all-party group on smoking and health; I thank its many members who are here today. We have introduced standardised packaging and the ban on displaying tobacco in small shops. We have maintained a high duty rate on cigarettes and hand-rolled tobacco, and we have ended smoking in cars with children in them. Such measures have played a part in ensuring that the public are protected from the harms of tobacco. We now see that 80% of people support the smoke-free places legislation, which shows a change in culture and attitude.
We have also continued to support people to quit smoking, with Public Health England running media campaigns such as Stoptober. As the Minister responsible for public health and innovation, I am pleased to see the innovative use of digital tools such as the Stoptober app and social media messaging, which have allowed campaigns to reach out to groups in which smoking rates remain high and target them more effectively. That approach has proved extremely successful and was responsible for 130,000 people successfully quitting for 28 days in Stoptober in 2015.
I have heard the concerns about the lack of use of mass media, and I will look at the evaluation of Stoptober and see whether there has been any impact. That strategy has been used so that we can have a more focused targeting of high prevalence areas and groups by using the most efficient social media channels, but we will examine the evidence to see how effective that has been. As today is so close to the halfway mark for those attempting to quit during the campaign, I take this opportunity to wish them all the best in reaching 28 days smoke-free. I want to tell them not to give up.
As the former Chair of the Health Committee, the right hon. Member for Rother Valley (Kevin Barron), said, it is notable that one of the most significant disruptions to smoking in recent years has had nothing to do with Government intervention. We have seen considerable take-up of e-cigarettes in the UK, and we know that almost half of the 2.8 million current users are no longer smoking tobacco. We need to continue to embrace developments that have the potential to reduce the burden of disease caused by tobacco use. However, we need to recognise that the use of such products is not risk-free. We need a regulatory framework that minimises risks to users and targets the promotion of products at existing smokers and not at children. I have heard the comments made today about e-cigarettes.
Nicola Blackwood
I am looking closely at PHE’s expert independent review. I have asked officials to examine that closely, and they are updating the review of the evidence each year. I do not have a date for this year—I know the right hon. Gentleman asked for it—but I will write to him when I find out exactly when that will come forward.
Our approach has been comprehensive and has seen smoking prevalence fall in all age groups for both men and women. As various Members have said, adult smoking prevalence in England is now just under 17%, the lowest rate since records began, and we should take a moment to be proud of that. However, as others have said, we cannot be complacent. Smoking continues to be one of the largest causes of social and health inequalities in this country. It accounts for approximately half of the difference in life expectancy whereby, as the Prime Minister said, those on the lowest incomes die an average of nine years earlier than others. The Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston), said it so well: it has an even greater impact on healthy life expectancy, which we also need to focus on.
At national level, smoking prevalence is declining year on year. There remain significant regional and demographic variations—an issue raised by the hon. Member for Stockton North, the shadow Minister and others—with the prevalence in some population groups, such as those with mental health conditions, at more than twice the national average. That point was particularly raised by my hon. Friend the Member for Harrow East (Bob Blackman) and the former Health Minister, the right hon. Member for North Norfolk. I shall certainly look at the report that was mentioned, “The Stolen Years”.
Regional variation means that rates of smoking during pregnancy can range from anywhere between 2% in some areas to 27% in others. That is another issue that we must focus on. Given the wide variation in smoking rates across the UK, it remains crucial that local councils have the flexibility to consider how best to respond to the unique needs of their local population and tackle groups in which prevalence remains high.
Alex Cunningham
The Minister talked about local authorities having flexibility. Will she support ring-fenced funding in this area, which we discussed earlier?
Nicola Blackwood
Ring-fencing is a highly political question, but I recognise that some difficult decisions have been made right across Government to reduce the deficit and ensure sustainability. Councils have been given £16 billion of public health funding across this Parliament, on top of further NHS prevention funding. The big question is whether that is being targeted at the right public health priorities.
We have been looking at that issue closely in my office. Local PHE centres are working with local commissioners to try to ensure that evidence-based service provision remains a priority. Nationally, PHE has been putting together a range of tools to support local commissioning decisions and has convened a round-table of experts to review the situation and propose a range of actions. However, I recognise that ensuring that the right services are prioritised will require more than just providing data about cost-effectiveness and smoking prevalence. The sustainability and transformation plans are supposed to be part of the answer.
Norman Lamb
On the adequacy of public health budgets, does the Minister think it is rational in any way to increase in real terms the budget for the NHS while reducing in real terms the budget for public health?
Nicola Blackwood
Prevention is a core part of the NHS five year forward view and should be embedded in NHS funding, public health funding and social care funding, as the right hon. Gentleman has stated. We are looking for the STPs to show a joined-up plan for how prevention, acute delivery services and social care will work together. PHE can and does advise and support local councils to tailor their services effectively, but we need to see how we can improve that. The local tobacco control profiles are one way in which we are doing that, but we must ensure that we see some of that work implemented.
At national level, to help drive a reduction in variation, the Government are committed to publishing the new tobacco control plan that all Members have mentioned, which has tackling inequalities at its heart. The plan will build on our success so far and will include renewed national ambitions. We have to maintain the proactive, comprehensive and non-partisan approach we have seen so far. The UK is recognised as a world leader in tobacco control strategy, and we intend to maintain that. However, I am afraid that on this occasion I will not be able to match my predecessor by announcing the date of publication. [Hon. Members: “Oh!”] I know; I feel inadequate.
My hon. Friend the Member for Harrow East is right in identifying my desire to ensure that the plan is evidence-led. It is reasonable for a new Government to want to check that the plan offers the best possible strategy, based on evidence. On something as important as a tobacco control plan, which is a golden moment, we have to ensure that we do not publish the plan until we get it right. It has been valuable to have the opportunity to listen to and engage with this debate, so that I can hear from colleagues as expert and engaged as those present before going forward. I assure all Members that the Government see the issue as a matter of urgency and are pressing forward with the plan as quickly as possible. I will certainly take away the suggestion from the hon. Member for Stockton North about incorporating respiratory health monitoring into the NHS health check.
I would like to go through a few of the points that we have discussed before I finish. As I have highlighted, it is right to turn our focus to population groups in which smoking prevalence remains higher than elsewhere. In particular, we must turn our attention to reducing health inequalities in populations who already suffer from poorer health and social outcomes, such as those in routine or manual occupations or those who suffer from mental health conditions.
As my hon. Friend the Member for Totnes said, improving maternity outcomes and giving children the best start in life is an important priority for this Government, and supporting pregnant women to quit smoking will be an important factor in working towards that. We all know that smoking during pregnancy increases the risk of stillbirth, as the shadow Minister said, and of problems for a child after birth. We also know that babies born to mothers who smoke are more likely to be born underdeveloped and in poor health. Tackling that was a priority under the previous tobacco control plan, during the period of which smoking prevalence among that group fell by three percentage points, but more can be done to reduce it further and, most importantly, to tackle the variation I mentioned. We will look at that.
Alongside limiting babies’ exposure to smoke during and after pregnancy, we must continue to work to end the cycle of children taking up smoking in the first place. As the percentage of 15-year-olds who regularly smoke has fallen to 8% and continues to fall, we must press our advantage and work towards our first smokeless generation. That would be something that we could genuinely be proud of. Restricting access to tobacco remains key, and we will want to maintain the enforcement of measures mentioned today, such as age of sale laws. Evidence shows that children who have a parent who smokes are two to three times more likely to be smokers themselves. Continuing to support adults to quit is therefore vital to ending the cycle of children taking up smoking and must remain a key part of tobacco control in the future.
In order to achieve our ambitions for the population groups I have mentioned, and to reduce smoking prevalence across all populations to even lower rates, we have to continue to draw on the things that we know work. This is an area in which we have a strong evidence base, and that work will include continuing a programme of evidence-based marketing campaigns such as Stoptober and monitoring the evidence base for e-cigarettes.
Finally, the right hon. Member for North Norfolk is right to say that tobacco use is a global issue and an international priority. Our new tobacco control plan will need to reflect that. As a world leader on tobacco control, the UK will continue to work closely with others to reduce the burden that smoking places on individuals, families and economies across the globe. As he said, we are investing official development assistance funds over five years to strengthen the implementation of the WHO’s framework convention on tobacco control. The project will be delivered by the WHO, and through it, we will share the UK’s experience in tobacco control to support low and middle-income countries to put effective measures in place to stop people using tobacco. That will happen through capacity sharing. We will carefully monitor the progress of that initiative to ensure that it delivers results, using very effective evaluation measures. I am happy to have further discussions about that with the right hon. Gentleman, if he would find that helpful.
We can be proud of the progress that successive Governments have made on helping people to quit smoking, preventing them from starting in the first place and creating an environment that de-normalises smoking. With prevalence rates at an all-time low, there is no question that good work has been done, but as the issues raised in this debate clearly show, there is more work to be done. The Government are committed to doing that work as a matter of urgency. I will take away the comments made today, which are incredibly helpful to me as a new Minister, and I will ensure that as we finalise the new tobacco control plan—
Mrs Hodgson
I am very grateful; I thought I could just catch the Minister before she finishes. Can we expect the tobacco control plan this year or next year?
Nicola Blackwood
The hon. Lady will have to wait and see.
In conclusion, the Government recognise this area as a top priority and will continue to work on it as such.
Oral Answers to Questions
Baroness Blackwood of North Oxford Excerpts(7 years, 7 months ago)
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Julie Elliott (Sunderland Central) (Lab)
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
The National Institute for Health and Care Excellence recommends that exercise referral schemes should be provided for people at increased risk of ill health, and it is right that such schemes are developed on a local basis to meet the needs of the population. Our NHS five year forward view strategy prioritises prevention, and the GP physical activity clinical champion programme has taught more than 4,500 healthcare professionals to provide advice on physical activity in routine clinical consultations.
Julie Elliott
In the north-east, only 33% of adults participate in weekly sport, compared with 38% in London. This has a knock-on effect on people’s health throughout their lives. What are the Government doing to address these geographical health inequalities?
Nicola Blackwood
The hon. Lady is absolutely right to raise this question. Inactivity costs England an estimated £7.4 billion a year, and regular physical activity reduces the risk of developing many health conditions by between 20% and 40%. People who exercise regularly can reduce their risk of developing certain kinds of cancer. We are particularly pleased that, in addition to the GP physical activity clinical champion programme, Public Health England has secured funding from Sport England to pilot an education cascade model involving midwives, physiotherapists and mental health nurses and, with the support of the Burdett Trust for Nursing, will soon be launching a pilot involving 21 clinical nurse champion programmes to embed this knowledge in practising nurses. It will, however, be up to local areas to ensure that they make the best of these programmes by targeting them at their local area.
John Cryer (Leyton and Wanstead) (Lab)
On the behaviour part of the question, what can the Minister do to combat what seems to be an emerging picture of over-consumption of painkillers and to enforce NICE guidelines on their use?
Nicola Blackwood
The hon. Gentleman raises an important issue relating to drug and alcohol misuse. We have prioritised this question as one of the local statutory requirements. We have given £16 billion to local health authorities for public health delivery, and we will expect them to prioritise this issue.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
Lack of physical activity contributes to obesity. With today’s Health questions falling on World Obesity Day, as I am sure the Minister is aware, it is vital that we recommit our efforts to reversing rising obesity levels in the UK. An opportune moment would have been the childhood obesity strategy—sorry, the plan—that was published over the summer, but sadly it did not go far enough. Therefore, will the Minister commit today to ensuring that the plan is fully realised as a preventive strategy to change behaviours and help to make the next generation healthier than the last?
Nicola Blackwood
I congratulate the hon. Lady on her appointment. I am particularly pleased to see her in her place. She has played an important role in the all-party parliamentary group on breast cancer. We are very proud of the childhood obesity plan. It is based on the best available evidence, and it will make a real difference to obesity rates in this country. The Government are also consulting on the soft drinks industry levy, and we have launched a broad sugar reduction strategy. She is absolutely right to say that we must now work hard to ensure that we deliver on that with the NHS, local authorities and other partners as we move into the delivery phase of the plan. We are proud that it is a world-leading plan.
Johnny Mercer (Plymouth, Moor View) (Con)
Simon Danczuk (Rochdale) (Ind)
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
The scientific evidence for the UK chief medical officer’s low-risk alcohol guidelines is available on the gov.uk website. The guidelines were published in August, following testing through public consultation to ensure that the advice is as clear and usable as possible. We received 1,019 responses to the consultation.
Simon Danczuk
There is an overwhelming scientific evidence base that shows the health benefits of moderate drinking—something to which I can attest. Does the Minister not agree that the chief medical officer should highlight those benefits more?
Nicola Blackwood
For many people, drinking alcohol is part of their normal social lives, and we are perfectly clear that these guidelines are advisory. They are in place to help people make informed decisions about how they drink and decide whether they want to take fewer risks with their drinking. They are not designed to label everyone who drinks as a problem drinker or to prevent everyone who wants to drink from drinking, but I point out to the hon. Gentleman that Rochdale has more than double the number of admissions to hospital where alcohol is a factor than the best authorities in England.
Byron Davies (Gower) (Con)
Following on from that answer, will the Minister reassure the House that public health guidance given to consumers of alcohol is realistic and will not undermine responsible drinking campaigns, penalise responsible drinkers or damage the vital role that pubs play in our communities?
Nicola Blackwood
As I have said, these guidelines are simply intended to be advisory. They are intended to give the best possible information and advice and to put all the evidence in one place so that people can make the best possible decisions with their drinking.
Greg Mulholland (Leeds North West) (LD)
Campaigners on alcohol abuse have acknowledged the importance of the pub, which is a controlled sociable environment in which to enjoy a drink compared with the unrestricted supermarkets. Will the Minister have a word with her colleagues in the Department for Communities and Local Government who continue to preside over a system in which profitable wanted pubs are demolished and in which supermarkets are built on the site against the wishes of local communities?
Nicola Blackwood
The hon. Gentleman plays a very important role as chair of the all-party save the pub group and has been a dogged campaigner for the pub. We are very clear that social drinking is not the target of these low-risk guidelines. I am happy to meet and discuss this issue with my DCLG colleagues.
Maggie Throup (Erewash) (Con)
Sadly, very few people are aware of the link between alcohol consumption and obesity and of the long-term impacts of life-limiting diseases—not just cirrhosis. To ensure that the impact of obesity is integral to the alcohol consumption guidelines, will the Minister, on World Obesity Day, put tackling both adult and childhood obesity even higher up the Department’s agenda?
Nicola Blackwood
The hon. Lady is right to raise the hidden risks of alcohol consumption, which is exactly why a widespread analysis of the evidence was conducted through this guideline exercise. She is right to say that obesity should be a top priority for the Government. We will analyse her question and look into it.
Psychosis: Early Intervention
Baroness Blackwood of North Oxford Excerpts(7 years, 8 months ago)
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The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
It is a pleasure to serve under your chairmanship for my first outing as a Minister, Sir Roger, and I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this important debate. He has rightly pointed out that many areas of our mental health services are not yet meeting the standards that patients and their families deserve and have a right to expect, and he is absolutely right to say that improving access and waiting times for early intervention in psychosis must be a top priority among those. I assure him that both I and the Government share his determination and sense of urgency in such matters.
I think we can agree that for far too long as a nation we tolerated poor mental health services in this country, and we all know the terrible price that some have had to pay for our collective failure to step in earlier. That time is now over and we are in the process of creating a mental health service that we can be proud of—one in which, no matter where someone lives, they will be able to access the services they need when they need them, and just as importantly, one that people feel safe and confident using.
But we have to be honest about this, or we will get discouraged and lose momentum: it is not going to happen overnight. Although there are already some areas of outstanding practice that we should be encouraged by, we are, in general, coming from a low base, and only a sustained effort over the next few years is going to bring about the change that we are all demanding.
For that reason, I would like personally to thank the right hon. Member for North Norfolk for his pivotal role in securing parity of esteem and for supporting the introduction of the first waiting time standards for mental health services. With the previous Prime Minister, the Health Secretary and my predecessor, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), the right hon. Gentleman has set us on the road to better mental health services. Now we have to follow it through, no matter how bumpy the journey may become at times. I hope that he will meet me and give the benefit of his advice, because I suspect I am going to need it.
I would also like to thank everybody who has contributed to today’s debate. Some have given moving accounts of personal experiences or those of family members or friends. Others have taken the opportunity to raise difficult constituency cases. I know that all here today are committed to keeping mental health at the top of our agenda as the Government shape their new programme.
That brings me on to the challenges of the early intervention pathway for psychosis, which is designed to deliver the improvements to psychosis care that are urgently needed, as the right hon. Gentleman so clearly laid out. He pointed out that psychosis is more common than people realise: it affects one in 2,000 people in England in any given year. We know that the early intervention in psychosis programme is crucial in ensuring that mental health services maximise their opportunity to intervene at the earliest possible moment to prevent patients from relapsing, so that they are less likely to be admitted to hospital and have less severe symptoms. As the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) so expertly described, such services are recognised as the best model for helping young people to recover from the first episode of psychosis. They have the potential not only to save the NHS tens of millions of pounds but to reduce the serious impact of psychosis on those patients’ lives and those of their families and carers.
The hon. Member for Strangford (Jim Shannon) asked about funding. When waiting times for mental health were introduced for the first time, they were backed by £120 million of investment. In addition, we have invested £33 million in developing EIP services. Further funding for early intervention in psychosis was announced in NHS England’s “Five Year Forward View for Mental Health” implementation plan earlier this year. That funding is designed to support delivery of the target to ensure that 60% of people who experience their first episode of psychosis receive treatment with a NICE concordant package of care within two weeks of referral by 2021.
Norman Lamb
I am encouraged by what the Minister is saying. I assume that the money she has talked about that will be allocated is part of the baseline that CCGs will receive and not a separate allocation. The question is how she ensures that CCGs actually spend the money as intended.
Nicola Blackwood
As the right hon. Gentleman is aware, this work is in its early stages. He is right that services are working hard to develop this process. NHS England has set out in its implementation plan how the services will need to grow and improve to meet the new standards. In particular, it has noted that the current block contract arrangements can result in poor transparency on spend per patient, as he has seen with his freedom of information request.
NHS England has been looking at alternative funding models that will link an element of payment to achievement of quality and outcomes, including the EIP access and waiting time standard. When there are variations in spend, we will need to consider the reasons for that and ensure that necessary action is taken to address any impact on the quality of care available. I hope that reassures the right hon. Gentleman.
In addition, the Royal College of Psychiatrists College Centre for Quality Improvement has been commissioned to undertake continued assessment and quality improvement work. This will be through a quality improvement network, supported by an annual self-assessment that will be independently validated and scored. All early intervention in psychosis services are going to be expected to participate. The first results will be published in April 2017, but any earlier results will be published before that. It is intended to provide a transparent assessment of services across England. This will give us a clear picture of service provision and enable us to target areas where additional development will be required, so that we can ensure that the standard is met and that people receive the care they need.
The right hon. Gentleman also mentioned the important issue of age caps. The most likely age for a first episode of psychosis to occur is between 14 and 35, as has been pointed out.
Nicola Blackwood
Currently, the block contracts make it less transparent than it should be and we are working to address that.
I had moved on to talk about the age cap. As I was saying, psychosis is most likely to occur between the ages of 14 and 35; consequently, services have traditionally been commissioned in this age range. However, a sizeable proportion of presentations take place after that, which is why NHS England guidance is clear that services should be available to people up to the age of 65. We are working with local commissioners to ensure that service provision is expanded to cover all age ranges. A regional assurance process is under way to assess providers’ and commissioners’ progress in making that happen. This is intended to deliver transparency across England on the plans currently in place, and, where it is not happening, to highlight where further development is required. Again, the Royal College of Psychiatrists CCQI’s assessment work and the development of robust data, which I will come on to in a minute, will enable us to see areas that are not providing services for people up to 65 and to target development accordingly.
However, none of that will happen without the right people to deliver it. To improve access to NICE-recommended psychological therapies, we have to ensure that there are the staff numbers and the appropriate skills mix to deliver the full range of treatment to those who need it. The modelling undertaken by NHS England for additional investment to achieve the new standard incorporates the costs of the necessary workforce development. Health Education England has a targeted work programme under way to increase the number of EIP staff trained to deliver cognitive behavioural therapy for psychosis and family interventions, with £6 million invested in training this year.
Finally, as the shadow Secretary of State pointed out, to ensure consistently good performance against this standard and future waiting times standards, we need robust data. I am very happy to meet her to discuss that point. We know that the data need to improve and we are working hard to make that happen. The right hon. Member for North Norfolk is well aware that we are starting from a low base on data availability and quality in mental health, but we cannot let that stop our progress or our ambition.
We are implementing the EIP waiting time standard with a clear expectation that providers will meet that standard. We are working simultaneously with the NHS, NHS England and NHS Digital to ensure that the data become robust enough so that we can hold providers and commissioners to account for meeting that standard. Data on mental health are behind that of physical health, and it will take time to get the data of the same quality. We know that from the improving access to psychological therapies data, which took some time to develop to a good quality. However, the IAPT pathway and standards are now an exemplar and represent a good model for development of other data sets. Encouragingly, data have started to flow via the mental health services data set from March this year, including experimental data on EIP. That is not robust, but there has been significant progress so far. We are currently working across Government to deliver a robust five-year mental health data plan to take us to 2020. The data plan, as recommended by the “Five Year Forward View for Mental Health”, will address the need for substantially improved data and information about mental health services for adults and children.
I hope that this response will show that we are committed to ensuring that there is no gap between rhetoric and reality on the ground. The right hon. Gentleman was right to identify funding, age caps, staffing and skills shortages and data limitations as the key challenges that we are grappling with in the implementation of the EIP, but we have in place work streams to address all those factors. We also agree that we require a systemic review of implementation to challenge and support local areas to implement the EIP more effectively. That is why we have asked independent experts at the Royal College of Psychiatrists to do exactly that. As I have said, they will be reporting in April 2017, but they will report as they go along with any earlier information so that we can make progress as quickly as possible. In the meantime, I will certainly write to him with a response on the detail of his dossier, and I entirely agree with all those who have made the point that we need to share best practice between devolved nations on these issues.
Today’s debate has been very important not just on the details of the EIP, but to test the Government’s commitment to health equality. I am grateful to all colleagues who have raised concerns today. I hope that our commitment to reforming our mental health services is now beyond doubt, but I know, as I look around the Chamber today, that I have heard in speech after speech the determination to see change, and I take courage. Great reform requires long-term vision and non-partisan partnership. I have heard all three of those here today and that truly is a firm foundation for the task that we have ahead.
Motion lapsed (Standing Order No. 10(6)).