Social Media and Young People's Mental Health

Baroness Blackwood of North Oxford Excerpts

Wednesday 2nd November 2016 Westminster Hall

[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.

[Sir Alan Meale (in the Chair)]

I call Alex Chalk to sum up—briefly.

Chronic Urinary Tract Infections

Baroness Blackwood of North Oxford Excerpts

Friday 28th October 2016 Commons Chamber

[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

Thursday 27th October 2016 Commons Chamber

[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.

[Lyn Brown]

Has the Minister considered the request from my local mental health providers that the Government consider ring-fencing the money for mental health so that it gets passed to the frontline?

[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.

[Lyn Brown]

This is happening in Newham, but not elsewhere. How long is the Minister going to wait for it to happen elsewhere before taking action?

[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.

[Wes Streeting]

rose—

[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

Thursday 13th October 2016 Westminster Hall

[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.

[Kevin Barron]

Will e-cigarettes, or vaping, be in the new tobacco strategy?

[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]

Will the Minister give way?

[Nicola Blackwood]

This is literally my last sentence, but I will.

[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

Tuesday 11th October 2016 Commons Chamber

[Julie Elliott (Sunderland Central) (Lab)]

1. What steps he has taken to support GPs in prescribing effective interventions to change behaviour and promote physical activity.

[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)]

2. If he will visit Plymouth to discuss how its city council has pooled health and social care budgets.

--- Later in debate ---

[Simon Danczuk (Rochdale) (Ind)]

3. If he will publish the full scientific evidential basis for his Department’s alcohol consumption guidelines; and what representations he has received on those guidelines.

[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

Wednesday 7th September 2016 Westminster Hall

[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.

[Ms Abbott]

Is the Minister saying that there is currently no way of making sure that CCGs spend the requisite proportion of their funding on mental health?

--- Later in debate ---

[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)).

Southern Health NHS Foundation Trust

Baroness Blackwood of North Oxford Excerpts

Wednesday 8th June 2016 Westminster Hall

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Member for Fareham (Suella Fernandes) on securing this vital debate and on her work with the all-party group on Hampshire and Isle of Wight. Everything that has come out or been dragged out since the tragically avoidable death of Connor Sparrowhawk, “Laughing Boy”, has highlighted the severe failings of Southern Health and the wider questions they raise about the treatment of learning-disabled people in the NHS. The facts that have emerged are awful beyond belief and are a shocking indictment of the leadership of the Southern Health trust and the appalling neglect of the most basic care needs and human rights of learning-disabled people.

As the hon. Lady said, we all owe enormous thanks to the courage and determination of Connor’s mother, Sara Ryan, and her family, as well as the other families of those who have died and suffered. Without them, there was a real risk that the hideous truth of neglect at Southern Health might not have been fully exposed. Connor’s family and other families have been let down so badly and shamefully by Southern Health, which did not share information that the family had a right to. The family were treated as the enemy at Connor’s inquest and did not even receive an apology until Southern Health was directly pressed to give one. Even today, as Sara went for mediation with Southern Health on her human rights case, it had not released background papers, as it was supposed to have done.

The Mazars report happened only because of the determination and persistence of Connor’s family. As we have heard, the failings it exposed were shocking beyond belief and have been confirmed by the CQC reports. It is important to remember some of the hideous statistics that the hon. Lady quoted; we should remember that each one is a human life. Of 10,306 deaths, 722 were categorised as unexpected, of which only 272, or 37%, were investigated as a critical incident. A lower proportion—30%—of deaths in adult mental services were investigated. Appallingly, less than 1% of deaths in learning disability services were investigated. Liaison with families was appalling, with 64% of investigations not involving the family.

I will quote what the My Life, My Choice charity from my constituency said in a letter yesterday to the new chair of Southern Health. It is a charity of learning-disabled people, for learning-disabled people. This is how things look from the perspective of people with learning disabilities. It said:

“You suggested that the Mazars report was not very important, or not true. We think it is a very important report. Our members are very worried about people with learning disabilities dying, and their deaths not being properly looked into. We know from Connor’s case that the truth is not always told, so investigations need to happen. Our members are scared because people with learning disabilities do not get the same standard of healthcare as everybody else. The Mazars report told us that if we die, our deaths will not be taken seriously.”

Someone has to take responsibility for what happened. To the families and to the public, it is unbelievable that the chief executive and medical director of Southern Health are still in post. We all understand that due process has to be followed, but nearly three years on from Connor’s death, we must ask: how long will it take before those responsible are properly held to account? That is important not just to atone for a wrong; it is crucial because of the signal it sends to others responsible for the care of learning-disabled and other vulnerable patients. It is crucial in re-establishing public confidence that those leading the provision of care are responsible and are held responsible for their actions.

I look forward to the Minister’s response to this debate. With Sara Ryan I met the Secretary of State, and I have talked and corresponded with the Minister. I know that they too are both concerned to see matters put right at the trust, and to apply the lessons more generally in the healthcare system.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

The right hon. Gentleman is making a powerful speech. His point that no one, no matter how vulnerable, should feel fear when they go into our health services is something that should give us all pause for thought in this Chamber. But it is not only about accountability in this case; it is also about making sure that those who are watching us as we go through the process know that an independent, verifiable process will be put in place so that nothing like this can ever happen again, not only at Southern Health but throughout our mental health services.

[Mr Smith]

I very much agree with the hon. Lady, my neighbour and friend, on that important point. I look forward to the Minister’s response as to what the independent oversight will be to ensure security in future.

It will be helpful if the Minister can update us on progress in relation both to the Southern Health trust and to wider concerns in the NHS, and if he can say when he expects the CQC to publish its opinion on the trust’s response to its warning notice, with the possibility of enforcement action being taken. Will he also say when he expects the Government to be in a position to make a definitive statement on the action they will take on the conclusion of the Care Quality Commission’s wider investigation into deaths throughout the NHS? It is an enormously important issue to get right.

We all have to learn from these appalling events. We have to apply the lessons and put in place procedures and the culture so that learning-disabled people and others receive the care, treatment and respect that they deserve, and so that they can be confident that they will get that. An NHS that truly fulfils its duty of care, in which Southern Health so lamentably failed, is the only thing that can come close to a fitting memorial for Connor Sparrowhawk.

--- Later in debate ---

[The Minister for Community and Social Care (Alistair Burt)]

It is a pleasure to serve under your chairmanship, Mr Hanson. I thank my hon. Friend the Member for Fareham (Suella Fernandes) for securing this important debate on the governance of the Southern Health NHS Foundation Trust. I also thank all Members who have spoken, by way of either significant speeches or interventions. The number of colleagues from the area who are involved—from across the House—gives an indication of how seriously we all take this issue. I urge the trust’s representatives to read the report of this debate extremely carefully, so that they absorb everything said by my hon. Friend and all those who have spoken in support.

May I begin by once again apologising to all the patients and families who have been affected by the failure of the trust to provide safe care for its patients? I met Sara Ryan yesterday when I visited the National Forum of People with Learning Disabilities. I had an opportunity to have a conversation with her, and I met more parents and families today before the start of this sitting. Nothing that an official can write on a piece of paper can adequately describe what it is like to meet and talk to families who have been involved in the sort of things that we are talking about here. This is not the first time I have had such meetings: I have had them since coming into post a year ago. It is impossible to convey simply and straightforwardly all that people feel.

What worries me most—I have said this to families in private and I say it again here—is that I hear the same things again and again. I hear about the frustration and concern about the time taken to get anything done when it has been agreed that something should be done, about the time taken to get any answers about what might be done in the first place, and about the defensiveness in the attitude of the institution being dealt with—my hon. Friend the Member for Eastleigh (Mims Davies) described it as a bunker mentality. I do not know whether it is a reflection of a professional attitude—because clinicians and others see things every day—but it is genuinely upsetting to hear people who have lost their loved ones talk about the lack of simple sympathy from those who deal with them. I have heard from enough people in enough different parts of the country to know that what I am hearing is not a one-off.

I also get distressed when I hear through the system that people can be difficult. People have every reason to be difficult, but that is not an acceptable way of describing people who are concerned and upset.

Because this point is made in place after place, as the hon. Member for Liverpool, Wavertree (Luciana Berger) knows well, by many different types of people, I am not sure that the system’s response deals adequately with some of the individual issues that have arisen over the past year—I will come to that later. I say to the parents and families involved that their individual contact, when they get the opportunity, with Members of Parliament and Ministers is not time wasted. It is easy to say that people will feel that only when they see something done, but the contact has a profound impact on officials and Ministers alike.

The first duty of any care provider is to keep its patients safe. The reports of inaction, bordering on complacency, set out in the recent Care Quality Commission report were truly shocking. I responded to an urgent question on the safety of care and services at the trust on 3 May, and I welcome the opportunity provided by today’s debate to update the House on the actions taken in response, several of which pick up on issues raised by the hon. Member for Liverpool, Wavertree and others.

As hon. Members are aware, NHS England commissioned a review by Mazars in November 2014 of deaths of people with a learning disability or mental health problem in contact with the trust between April 2011 and March 2015, in response to serious concerns surrounding the avoidable death of Connor Sparrowhawk. On publication of the report in December 2015, my right hon. Friend the Secretary of State for Health asked the Care Quality Commission to carry out a focused inspection of the trust to review its governance arrangements and its approach to investigating and learning from incidents, as well as its progress in responding to Monitor’s action plan.

On 12 January, Monitor announced further regulatory action in response to the Mazars report, including the appointment of an improvement director for the trust. The CQC inspection took place in January 2016 and led to a warning notice and an announcement of further regulatory action by NHS Improvement, which were both published on 6 April 2016. On 5 May, following the resignation of the trust’s chair, Mike Petter, NHS Improvement required the trust to appoint Tim Smart as the new interim chair. Those actions were in response to the persistent failure of the trust’s senior management to address the environmental and governance risks identified by CQC as far back as October 2014.

The hon. Member for Liverpool, Wavertree and others asked about what has been happening. The issue is split into looking at what has happened and—to use that terribly clichéd phrase—what lessons can be learned, and what is happening now and what confidence people can have in the future. That is vitally important.

I have sought assurances from NHS Improvement and CQC that the regulators are now able to oversee a rapid programme of remedial action by the trust, and I understand that the following measures are now in place. First, at monthly progress review meetings, NHS Improvement challenges the trust’s death and incident reporting action plan and its progress. Secondly, at the request of NHS Improvement, the death and incident reporting action plan is currently subject to external scrutiny. Thirdly, Alan Yates, the improvement director, is acting as a direct link from the trust to NHS Improvement, providing support and constructive challenge to the trust’s board in its oversight of the implementation of the action plan and providing assurance to NHS Improvement and other stakeholders about the trust’s approach.

On the work being done to bring the governance question to a swift conclusion, and in answer to the hon. Lady’s question about pace, the interim chair has already overseen improvements to clinical governance and the trust’s response to the CQC warning notice and NHSI licensing conditions. In parallel, he has commissioned an external review of the capability of the board, which extends to executive and non-executive directors and will inform a decision on leadership by 6 July. That will give the chair, whom I met a couple of days ago, the opportunity to review current capabilities with a view to the future. It is important that he has done that.

Tim Smart has also been in discussion with clinical commissioning groups and other trusts across the local health economy about the provision of services in accordance with the NHS five year forward view, and what that might mean for Southern Health. The transfer of the learning disability service in Oxford to Oxford Health will have been completed by the middle of October.

I spoke to Tim yesterday, and I am absolutely clear that he is right to insist on the highest standards of governance, with leadership concentrating on the real business of the trust—patients and their care. We have an imminent deadline, processes are in place and I am confident that a better Southern Health will emerge, but my confidence counts for very little. It is important that I am able to say that to colleagues with confidence, but the real confidence Southern Health has to gain is that of its patients and families and those who are involved. Having met some of them today, I know that that is a difficult hurdle to overcome, but it is the most important one. A description of processes and what people such as me are doing is not sufficient.

It is necessary that I have said what I have said to colleagues, and that I put on the record that I am confident that NHS Improvement’s review process and its ability to make management and executive changes—which will be carried out by Tim Smart, a newly appointed, experienced chair—is a good response to what has happened. The right person is in place with the power and ability to make the necessary decisions, but any confidence in them will come from the quality of the actions taken as a consequence of the powers invested in the chair and NHS Improvement. Unless actions that have the confidence of people are seen to be taken, something will be lacking. It is important that the chair’s judgment is relied on at this stage, and that I am able to reassure colleagues that the way in which NHS Improvement is working with the chair, and the powers that it and CQC have, are appropriate at the present time, but we must see what happens next.

[Nicola Blackwood]

The Minister opened by expressing his frustration that, since taking his post, he has been hearing about similar failings again and again. Of course, it is not just us in this place who hear about those failings, but the public and patients too. Every time they do, they lose confidence in the ability of the health service and the Government to address those failings. What in the steps that the Minister and Southern Health are proposing will break that mould? What will be different about the response this time? How will our response to this crisis restore the confidence of our most vulnerable constituents?

[Alistair Burt]

I will address that a little later, if I may, but I will come to it.

I should also answer the right hon. Member for Oxford East (Mr Smith) on the chain of accountability for NHS Improvement, and on who makes the decisions there. The decisions are made by Jim Mackey, who leads NHS Improvement. He is a direct appointment of the Secretary of State, so the Secretary of State invests his confidence in Mr Mackey, who makes the decisions on the work of NHS Improvement.

I will now turn to some of the issues raised by my hon. Friend the Member for Fareham and others. First, on the position of Katrina Percy, I need to be clear: Ministers have no authority to intervene in such matters, and nor would it be right for them to do so. I have been assured by Jim Mackey, the chief executive of NHS Improvement, that agreed processes are in place to review the performance of the senior leadership team and to make any changes that are in the best interests of patients. A Minister has to leave that there, and is not able to express any further view. That there is confidence in decisions taken is clearly of huge importance to Members in the Chamber, as they have expressed, and to others. A process is in place to decide that, and it will be decided by the chair.

I share my hon. Friend’s concern that inspectors have pointed to repeated failure by the trust to close out necessary improvement actions until the beginning of the year. NHS Improvement has asked the improvement director to ensure that the trust does not treat actions as complete until sufficient robust evidence supports that claim. The repeated failure to complete actions is one of the things that I will come on to in answer to my hon. Friend’s questions. When people are told what to do by a serious regulator, why do they not just do it? Why do they not do it in Southern Health, but do it in other places? What is the point of accountability and what is the process whereby in other parts of public service something is demanded by a regulator—say, in the acute part of the NHS—and something therefore happens, but something does not happen if dealing with those with mental health or learning disability issues?

Brain Tumours

Baroness Blackwood of North Oxford Excerpts

Monday 18th April 2016 Westminster Hall

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

I am humbled to speak after hearing so many moving personal stories. I am here because of Skye. Skye was five when he tragically died in August 2014, not from the medulloblastoma that he was diagnosed with but from the severe side effects of his treatment—the Milan protocol. We now know that a number of other children also developed similar side effects, and the Milan protocol has now been withdrawn. Skye’s mother, Sally, is here in the Gallery today and since his death his family have shown extraordinary courage, raising awareness of, and funding for, childhood brain tumours and setting up the charity Blue Skye Thinking to support research so that all children diagnosed with brain tumours have a better chance of survival. However, Skye’s story illustrates that, although much is working in childhood cancer treatment, some key areas are in need of urgent improvement.

[Mr Andrew Smith (Oxford East) (Lab)]

As the hon. Lady knows, I lost my dear wife, Val, to secondary tumours and it is a year to the day since she started to have palliative care. I very much share what the hon. Lady said about Skye’s case. Does she agree that, more generally, there is a cruel paradox? Progress is being made in treating other cancers but, because of the blood-brain barrier, that increases the number of people who survive to get a brain tumour. That is a further compelling argument for more research.

[Nicola Blackwood]

The right hon. Gentleman, and friend, has made an important point and I hope the Minister will respond to it. However, we should note at this stage that the overall story of childhood cancer over the last 30 years is positive. Eight in 10 children with cancer survive five years or more, compared with just three in 10 during the 1960s. We should congratulate the Government on that because it is clear that the work and funding we put into fighting cancer is money well spent. As we have heard, unlike most cancers, brain tumours are on the rise and research is underfunded, and because the money spent on cancer is effective, we must put that right.

I want to focus on childhood cancers, for obvious reasons. Despite causing more than a third of childhood cancer deaths, brain tumours receive only 6% of childhood cancer funding. Childhood cancers account for less than 1% of cancer diagnoses in the UK and of that 700 children are diagnosed with a brain tumour every year. It is the most common form of cancer affecting children and the most lethal, killing 160 children every year.

We must consider childhood cancer funding in its own right because children’s cancers are biologically very different from adult cancers and to treat them effectively requires specifically tailored research and treatment. The effect of the funding shortage, ethical challenges and small cohorts mean that 50% of childhood cancers are part of a clinical trial and the remainder are treated using standard treatment guidelines such as the Milan protocol. There are risks with that approach.

As we have heard, cancer treatment is a brutal regime and can cause long-term disability. That is particularly true of childhood brain tumour survivors, 60% of whom are left with life-altering disability. In a few cases like Skye’s, these effects can be fatal.

[Kevin Foster]

My hon. Friend is making some powerful points, as other speakers have. Investment in this area is vital. The costs of caring for those lifelong disabilities as well as preventing deaths are why the Government should invest in this area—invest to save money in the long run.

[Nicola Blackwood]

My hon. Friend makes a good point. This is not a subsidy; it is an investment that will reap a return.

Currently, there is no formal infrastructure to collect and share data about standard treatment guidelines. Consultants working incredibly hard to save the lives of young patients struggle with their inability quickly to access information about the potential adverse effects of very tough treatment regimes. In all my correspondence about this with NHS England and others, the response is, “We’re trying, but it’s very difficult.” That is not good enough because all life-saving cancer innovations are difficult and, given the stakes, I simply cannot accept that the problem is insoluble. The architecture for collecting the data is in place, but the lack of formal data collection requirements and a single responsible body can have devastating consequences.

Currently, the National Cancer Registration Service and Public Health England are developing a pilot to improve data gathering and I welcome that, but it seems that it will be retrospective. It may yield research benefits, but it falls short of the real-time data necessary to guide clinicians. When Skye’s consultant noted that he was deteriorating fast, she could not easily find out whether any other children on the Milan protocol had experienced the same side effects and she was reduced to phoning colleagues ad hoc to ask their opinion one by one as Skye got worse. In the end, it was too late.

In so many ways, we are making tremendous strides in the UK in tackling cancer, including childhood cancer, but the absence of monitoring the adverse effects of standard treatment for childhood cancer can lead to lifelong disability and death. In an ideal world, all childhood cancers would be the subject of a full clinical trial, but we must recognise the challenges associated with research into childhood cancers where cohorts of rarer cancers can be incredibly small and ethical issues are more complex, making it difficult to recruit participants. This means that even with increased funding, which is clearly essential, some childhood cancers will have to be treated through standard treatment protocols.

I hope the Minister—I believe he is a man of action—will listen to the arguments that all of us here have made today about funding concerns and take action to rectify data gathering and standard treatment protocols. If those adverse effects are properly collected, recorded and shared, we may be able to avoid more cases like Skye’s and to increase survival rates of childhood cancers even more.

Childhood Cancers

Baroness Blackwood of North Oxford Excerpts

Wednesday 25th February 2015 Commons Chamber

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

Skye was born on 5 November 2008. He was a happy, healthy young boy with a wonderful sense of humour who loved his younger brother, Jesse. In July 2013, he became unwell with nausea and vomiting and after many visits to the GP and the failure of medication to help, he was referred to the John Radcliffe in Oxford where he had a CT scan and was diagnosed with a brain tumour. That was 27 August 2013.

Skye was operated on less than a week later and tissue analysis identified the tumour as a grade IV metastatic medulloblastoma, the most commonly occurring paediatric brain tumour. It is an aggressive form of primitive neuroectodermal tumour, which originates in the cerebellum, the part of the brain which controls movement and co-ordination. Although Skye’s tumour had been caught early, it had already metastasised throughout the brain and spinal cord. Surgery was quickly followed by what is known as the Milan protocol: four cycles of chemotherapy over 11 weeks, and a further five weeks of hyper-fractionated radiotherapy. After a four-week period of recovery, Skye had high-dose chemotherapy that confined him to hospital for seven and a half weeks.

He then had four weeks rest at home, and was due to head back to hospital on 14 May 2014 for another round of high-dose thiotepa, but a urinary tract infection delayed the treatment until 28 May, which in hindsight was fortunate. Instead of getting stronger, it became apparent that Skye was getting weaker and an emergency MRI scan on 20 May revealed widespread white matter lesions within his brain and spinal cord, which caused a flurry of correspondence between consultants across the UK and abroad. He was quickly started on high-dose steroids to combat the inflammation.

It was initially diagnosed as radionecrosis, which had been brought on by the combination of therapies that he had had to endure. It was later confirmed as radio-chemo neurotoxicity. His parents were told that that was highly unusual and very rare. We now know that a number of other children have also developed severe neurological side effects and the Milan protocol was quickly withdrawn from use in the UK. He was in a state of paraplegia, with double incontinence, and very poor use of his upper limbs and hands. Skye sadly died at home on 29 August 2014.

I did not meet Skye and I only met his parents some time after his death. They are in the Gallery tonight and have demonstrated to me the most extraordinary bravery in the face of losing their child in this most distressing of ways. They have set up Blue Skye Thinking, a charity that supports research so that all children diagnosed with brain tumours will have a better chance of survival and a better quality of life post-treatment. They continue to support many other parents whose children are suffering from cancer today.

I have taken some time to explain Skye’s story in detail this evening because it illustrates only too well some of the things that are working in childhood cancer treatment at the moment and some of the things that need improvement. The overall story of childhood cancer treatment over the past 30 years is a positive one. Eight in 10 children with cancer survive five years or more, compared with just three in 10 in the 1960s. Short-term survival is also high: fewer than 10% of children die within a year of diagnosis and only 2% die within 30 days.

I congratulate the Government on that. Ministers have demonstrated a clear commitment to fighting cancer and the work and money that has been put into the system to improve cancer survival rates are bearing fruit and proving that the money is being well spent. However, we should not allow these headline statistics, encouraging though they are, to blind us to the fact that, rare though childhood cancer is, it remains the leading cause of death in children and teenagers in the United Kingdom. Childhood cancers account for just 1% of cancer diagnoses in the UK. For research purposes that is a small cohort, but 700 children and young people are diagnosed with a brain tumour every year.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for bringing this matter to the House today, and for allowing me to intervene. Cancer Research UK has given me some figures today showing that 60 people are diagnosed with cancer each day in Northern Ireland. When Josh Martin, a young boy at secondary school, went into hospital to have his appendix removed, he was found to have progressive cancer. His family started the Pray for Josh campaign, which is being supported by his family and by the Churches. It has not only given great comfort to the family but helped to highlight the scourge of cancer and the fact that funding for drugs and help for families are very important. One of the organisations that can help is Macmillan Cancer Support. Does the hon. Lady agree that the support of such organisations can be important for families at times like these?

[Nicola Blackwood]

The hon. Gentleman is absolutely right to say that this is about not just Government funding but the way in which funds are given, and charities in particular play an important part. The fundraising that they do through individuals is vital.

As I was saying, 700 children and young people are diagnosed with a brain tumour every year, and that makes it the most common form of cancer affecting children and young people. It is also the most lethal. Brain tumours kill more children and young people than any other cancer—around 160 children a year—but despite being responsible for more than a third of childhood cancer deaths, brain tumours receive only 6% of childhood cancer funding. That funding matters because children’s cancers are biologically very different from adult cancers and treating them effectively requires specifically tailored research and targeted treatment regimes. At the moment, only about 50% of childhood cancers are part of a clinical trial; the remainder are treated using standard treatment guidelines. As Sally and Andrew Hall discovered, that can have serious consequences.

Cancer treatment is harsh at the best of times, and recent studies show that while many survivors of children’s cancers go on to live healthy lives, others face long-term disability and reduced immunity. Radiotherapy, the gold standard in terms of its efficacy in treating cancer, can also have damaging long-term consequences for the developing child. This is particularly true of childhood brain tumour survivors, 60% of whom are left with a life-altering disability. In a few cases, the side effects can be so severe as to be fatal. That is what happened in Skye’s case.

The Milan protocol, under which Skye was treated, was a standard treatment guideline, because as with about 50% of other childhood cancers there is no clinical trial available. It has become clear that there is currently no formal infrastructure in place to collect, record and share data, particularly on adverse effects of treatment, about standard treatment guidelines. I understand that before 2008 the responsibility for collecting and sharing data for clinical trials and for standard treatments fell under the remit of the Children’s Cancer and Leukaemia Group. Subsequently, clinical trials monitoring was tightened, and the CCLG’s “Guide to Clinical Trials” states:

“Clinical trials are very closely monitored by a number of different individuals and organisations. This will include the Chief Investigator…the working group…and relevant staff within the clinical trials unit. An Independent Data Monitoring Committee may also be established to oversee the conduct of the trial. At a national level, there will be an ethics committee and the national regulatory body. If there are any concerns about the conduct of the trial or the results, a trial may be stopped early.”

By contrast, in a letter responding to my concerns about the issue, the National Cancer Intelligence Network, told me that

“all of us in the field accept that (adverse effects in Standard Treatments) is something that should, under ideal circumstances, be a part of the data that we routinely collect. Such data are, however very much more difficult to collect than might be imagined and adverse effects were never part of what the CCRG (Childhood Cancer Research Group) or the CCLG themselves collected outside of a clinical trial. There are no nationally agreed datasets relating to adverse effects and few clinicians systematically collect and collate data of this sort...but it is clearly something that we in the NCIN should be considering.”

I am grateful that the NCIN has recognised that these data should be collected and collated, but I do not think that considering doing it is a sufficiently robust or urgent response to the problem, given the gravity of the consequences if a standard treatment goes wrong.

Clearly, in an ideal world all childhood cancers would be the subject of a full clinical trial and new targeted therapies being developed to reduce the long-term risks, but all of us know the challenges associated with research into childhood cancers, where cohorts of rarer cancers can be incredibly small and the ethical issues are more complex, making recruiting participants more difficult. Obviously, I am going to urge the Government to do whatever they can to fund and encourage more research into childhood cancers. I am going to ask the Minister to consider whether having only 6% of childhood cancer funding going to the biggest killer in childhood cancer represents getting the balance right, and I am going to ask her to maintain investment in the Health Research Authority programme to streamline the regulation and governance processes for clinical research in the NHS.

[Mr Brian Binley (Northampton South) (Con)]

May I say that, as a cancer sufferer, I welcome my hon. Friend’s courage in bringing this debate? May I pay tribute and offer my sorrow to these parents? May I also say that our Front-Bench team need to take on board the problems? I have seen parents, week in, week out in Northampton general hospital, and I know the case she is making is a real and heartfelt one. I hope that we will get good words from the Minister.

--- Later in debate ---

[Nicola Blackwood]

I thank my hon. Friend for his intervention and his support. I wish to emphasise the need for investment in the HRA streamlining programme, because I believe it will have a significant impact on reducing the resource and time required to set up trials across multiple sites in the UK, and that can only be good for research into childhood cancers, as it will be for research into all cancers.

I particularly want to focus today on the complete absence of data collection, recording and sharing on standard treatments of childhood cancers in the UK. I am very disappointed that having written to the life sciences Minister about this issue in early December I have yet to receive a substantive response. This issue could not be more serious for the treatment and long-term outcomes of children with cancers, especially brain tumours. Consultants around the country who work with incredible dedication to save the lives of their young patients struggle with their inability to quickly access information about the potential adverse effects of very tough treatment regimes, and it is a problem that we must try to fix. The architecture for collecting the information—the NCIN and the CCRG—is in place, but the lack of a formal data collection requirement and of a single responsible body can have devastating consequences for families.

When Skye’s consultant noticed there was an unexpected problem with Skye—the severe white matter damage shown on the MRI scan—she immediately tried to see whether any other clinicians had experienced similar issues. This was important in order to ascertain what other symptoms to look out for, what other treatments could be tried and what other outcomes they had had. Despite the fact that we now know that other children had been suffering in a similar way and that different treatments had been tried, she could not easily obtain this information; it was a matter of phoning around individual colleagues in an ad-hoc way to ask them one by one, and all this took place while Skye deteriorated. Time in such situations is of the essence so this is an unacceptable situation and it cannot be allowed to continue. Had there been a system in place to monitor adverse effects, things might have been different.

In so many ways, we are making tremendous strides in tackling cancer in the UK, including childhood cancer, but the complete absence of monitoring for adverse effects of standard treatments of childhood cancers can lead to life-long disability and death. I hope the Minister will take this away and take urgent action to rectify the situation. I also hope she will arrange for myself and Sally and Andrew Hall to meet the appropriate representatives from her Department to address this issue, once and for all. If details of those adverse effects are properly collected, recorded and shared, we might be able to avoid those consequences in more cases, increase childhood cancer survival rates and improve the quality of life for survivors even more.

Oral Answers to Questions

Baroness Blackwood of North Oxford Excerpts

Tuesday 13th January 2015 Commons Chamber

[Dr Poulter]

The hon. Lady makes very important points. I have certainly seen in my clinical practice that some women present when there are domestic violence issues or other issues in the home, and such issues can be heightened and exacerbated during pregnancy. A lot of work is now going on to improve the awareness of all NHS staff of domestic violence and, more broadly across training, of mental health issues.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

For many people with mental health problems, the first emergency service with which they come into contact at a point of crisis is the police. What steps are the Government taking to ensure that such a crisis is treated as a health crisis, not a criminal incident, and will the Minister undertake to do whatever he can to ensure that no children end up in a police cell as a place of safety?

[Dr Poulter]

My hon. Friend makes an important point. It is absolutely right that we do not want people with mental health problems to be looked after in police cells. A lot of work has been going on. The Government have set up the crisis care concordat to look at exactly that issue, and as a result the number of people with mental illness going to police cells is now falling rapidly.