Women’s Mental Health

Jackie Doyle-Price Excerpts

Thursday 3rd October 2019 Commons Chamber

[Jackie Doyle-Price (Thurrock) (Con)]

It is, as usual, a pleasure to follow the right hon. Member for North Durham (Mr Jones), who is always a fixture in these mental health debates, as, indeed, is the hon. Member for Bath (Wera Hobhouse), and I congratulate her on securing this debate.

I thank the hon. Member for Lewisham West and Penge (Ellie Reeves) for her very honest contribution. It is about time we were honest about the fact that childbirth is hard and that what happens after we have given birth is hard. We could be forgiven for buying into the myth that it is all hearts and flowers, but the reality is very different indeed for many women and their families. It is absolutely fantastic that she made that very honest contribution today. Those of us in this place need to be frank about our own experiences to make the system better.

It is a glib thing to say that it is a man’s world, but, frankly, it is. On so many levels, the health service, in terms of both physical and mental health, does not work well for women. I was therefore pleased to have chaired the women’s mental health taskforce with Katharine Sacks-Jones from Agenda, and I thank her today for her contribution. It is important that we look at women’s mental health, as distinct from that of men. In the same way, we ought to look at mental health through the prism of other things that end up being discriminatory. For example, there is the whole gamut of neurodiverse conditions, autism and attention deficit hyperactivity disorder. There are more mental health issues in people who have those conditions, and, frankly, we are not doing enough for them. That also plays out in further discrimination against women, because they are often diagnosed much later with autism and ADHD, and they are then not equipped with the tools to manage their conditions.

It was absolutely fantastic to get buy-in from people with real experience on the women’s mental health taskforce. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) talked about perinatal, and that was of course a big part of it. It is interesting that we are debating this issue today, just a day after that amazing debate on the Domestic Abuse Bill, because abuse is often a common factor underlying the prevalence of mental ill health in women.

We set up the women’s mental health taskforce because we were seeing an increased prevalence of mental ill health among women between the ages of 16 and 24. There is no doubt in my mind that an underlying cause is abuse, particularly the rise of sexual abuse and violence.

The women’s mental health taskforce concluded that we needed more by way of community services to support women, and one important part of that was improving the support for victims of sexual violence. I completely agree with the right hon. Member for North Durham about the contribution that voluntary services can make in this space. When I was the Minister, one of the messages I always gave to commissioners was not to medicalise everything. Voluntary services, particularly in mental ill health, can give so much additional support to people. That wraparound support can be as important to someone’s recovery or ability to manage their condition as any medical intervention. In welcoming my hon. Friend the Minister to her post, I ask her to continue giving that message to commissioners, not least because, as well as delivering the services well, voluntary services often provide much better value for money. So let us continue to do that.

I was pleased that earlier this year the NHS published its strategy to deal with sexual violence and to provide sexual violence support services. Within it was a commitment to a lifelong package of care for survivors of sexual abuse. The voluntary sector—the hon. Member for Bath mentioned rape crisis centres—has a huge role to play in making sure we continue to support victims of sexual abuse.

Women are often a secondary consideration in the way we deal with many problems, and by definition that becomes discriminatory. We have had a lot of debates in recent months about gangs and the problem of young men carrying knives and stabbing each other and the fact that there are far too many deaths, but another aspect of that gang culture that is not talked about enough is the grooming of girls. It is almost like Rotherham never happened. We must make sure that when we look at gang culture, we do not just talk about young men stabbing each other or the drug trade that goes with it; we must also tackle the grooming of young women, otherwise the incidence of mental ill health among women aged 16 to 24 will only continue to rise.

One thing not yet mentioned in this debate is the review of the Mental Health Act 1983. We must make sure that when we look after women with severe mental ill health we are not doing harm. We need to deal with some of the practices that still exist in our treatment of people with mental ill health. We used to think of people with mental ill health as an inconvenience to be managed. Thankfully, we are becoming much more enlightened, but there is still poor practice that needs to be weeded out. I repeat that abuse is often the underlying trigger that exacerbates a woman’s mental ill health, and when we treat women, we should not compound that harm by handing over the control of someone who has been sectioned to their abusive partner. Under the Act, however, when someone is sanctioned, the next of kin is effectively given control over them, which only compounds the harm. I have heard some incredibly distressing testimony from people who have been through exactly that. As that work continues, we must empower patients, including women who are victims of domestic abuse.

We have heard reference to eating disorders. We have actually made considerable progress in improving eating disorder services, but we need to do much more for adults. The health service needs to empower women, not just tell them to run along. Many Members will be aware of the campaign by Hope Virgo, the Dump the Scales campaign, but the really telling thing about Hope’s testimony is this: she has been through anorexia, she understands her condition, and she can see when she needs help, but when she goes to her GP, she is weighed and told she does not have a problem. That shows a fundamental misunderstanding about how eating disorders play out and how they should be managed. Members have discussed the need to make sure GPs behave better. One reason GPs do not behave as well as they should when dealing with mental health is that they are not adequately trained. I encourage the Minister to have that conversation with the royal colleges to make sure mental health training is a mandatory part of doctors’ training. The earlier we identify someone who needs help, the more effective that support can be.

I want to finish by picking up on an issue raised by several colleagues, including my hon. Friend the Member for Southend West (Sir David Amess): that of people in prison. We all know that prison should be a place where people go when they have done bad things, but anyone who visits a prison wanders around thinking, “A lot of these people shouldn’t be here at all.” They are people who have fallen out of society and been failed by the state. That is particularly the case for women. The more we can do to get that early intervention the better. We should not be allowing people to fall out of the care of society and then dealing with them only when they become a nuisance. That applies to people who have been through the care system and been victims of abuse.

[Mr Kevan Jones]

Does the hon. Lady agree that one of the problems that pertains particularly to women prisoners is that of short sentences, which do not give enough time for rehabilitation and over time disengage people from services outside and, in a lot of cases, from families and other support networks?

[Jackie Doyle-Price]

The right hon. Gentleman puts it very well. In those instances, we are just doing harm. We should be able to identify when somebody needs help. Just taking them away and putting them in prison without any programme of support only puts them on a conveyor belt to more offending. We need to make sure we are picking people up. There are some fantastic tales of how people do that. I once met a lady who had been convicted of drink driving after she reported herself. She had gone through a period of grief. What good would it have done to make her serve a prison sentence? It would have compounded her grief; she would have been away from her family; and she would have lost her job and probably her home—if she was renting—which would only have put her on a conveyor belt to disaster. We must be much more enlightened and make sure that our prisons are for people who are going to harm society, not people who are harming themselves.

I could say so much more, Madam Deputy Speaker, but time is limited, so I will finish there.

Mental Health Act 1983

Jackie Doyle-Price Excerpts

Thursday 25th July 2019 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

This is probably as well informed and good a debate as I have ever had to respond to. I hope I can do justice to all the good points that have been made, because we have covered all the key issues relating to how we better support people will mental ill health.

I associate myself with the comments about the personal speech of the hon. Member for Bermondsey and Old Southwark (Neil Coyle), which he made in such a dignified way that I was incredibly moved by his story. What struck me about the experiences that he detailed was that they were his normal, which brought it into stark relief that we are talking about the real day-to-day lives of human beings. It is incredible to hear what people have to cope with on a daily basis. He reminded us that the 1980s had the best pop music, and I was reminded of the “Karma Chameleon” lyric:

“Every day is like survival”.

When we are talking about people with severe mental ill health, every day is like survival, so I thank him for that.

The hon. Gentleman’s speech covered everything that we need to tackle and I do not disagree with anything he said. Obviously, some of the charges that he levelled at me are challenging and I do not want to duck them. Everybody is impatient that we are perhaps not doing as well as we would like in helping people with mental ill health. I share that impatience, but I will not promise that it can be sorted overnight. We are rolling out a significant increase in services and in the workforce to deliver them, which takes longer than anyone would wish.

I will try to address the points that have been made. It was a great pleasure to hear from the hon. Member for Croydon North (Mr Reed) and to support him in delivering Seni’s law. In connection with that law, he has reminded us that when deaths happen to people who are detained by the state, we absolutely owe it to their loved ones, and to the person who died, to be open with them. The truth is often anything but, because the associated institutions of the state collude to protect themselves. Other Ministers and I are determined that we are the servants of the people, and those institutions that are there to deliver services for the people should remember that and should engage in a spirit of openness.

I have met Seni’s parents and I could not admire them more for the dignity with which they have borne their experience and the good use that they have put it to. I genuinely feel guilty, however, that we have let them down. Hon. Members will be pleased to know that we have a ministerial board that investigates deaths in custody and what can be learned from them, but I emphasise that we—including colleagues in the Home Office and the Ministry of Justice who, along with me, sit on those boards—are becoming rather concerned that not enough progress has been made. I am glad to be in continued engagement with Inquest, which does a fantastic job advocating on behalf of bereaved families. We need to do more to learn from events when they go wrong.

[Mr Reed]

It is clear from the Minister’s comments that she cares passionately about the issues that we are talking about and for which she has responsibility. A consultation on the serious incident framework started in March 2018 with a promise that the findings would be published in spring 2019. From the temperature today, we know that we are way past spring and into summer, but we still do not have a date for when they will be published. Can the Minister share a date by which we might expect that to happen?

[Jackie Doyle-Price]

I cannot give the hon. Gentleman a straightforward answer to that question but I will write to him with a commitment. It is very boring, but Brexit has diverted officials in the Department. Obviously, no-deal preparations in the health service are a matter of public concern, so we need to make them, but we still need to get on with business as usual. It is an important issue.

The hon. Member for Worsley and Eccles South (Barbara Keeley) mentioned the case of Matthew Leahy. I will go away and reflect on that, but I will give the same message as I gave in response to Seni’s law. Generally, we need to get a proper grip on how we learn from deaths that happen when somebody is in the state’s care, because that is clearly unacceptable. We have coronial reports of all those occasions. People should not be waiting the length of time that they are waiting for inquests. When inquests happen, again, there is usually representation from the various institutions involved and the family can be left feeling very under-represented against a mass of organisations trying to avoid liability. We need to tackle that properly.

We have had those discussions at the ministerial board. My ministerial colleagues in other Departments and I want to get a grip on how we properly hoist in the learnings from coronial reports. I look forward to engaging with hon. Members on that, but I will write to the hon. Lady specifically on the issue of Matthew Leahy. It is worth noting that we are looking at the principles of sexual safety in wards, which is not just about getting rid of mixed-sex wards. People are very vulnerable in those situations and it is all about the care regime.

[Dr Lewis]

Can the Minister tell us in simple terms what the situation is regarding the continuation or discontinuation of mixed-sex wards in mental health acute units?

[Jackie Doyle-Price]

On mixed-sex wards specifically, I cannot tell my right hon. Friend what the proportion is, but we are ensuring that the guidance on sexual safety on mental health wards is being rolled out. I will write to him specifically on that, if he will indulge me.

[Barbara Keeley]

An important point is that Matthew Leahy phoned the police to report the rape, but they concluded that it was part of his delusion—that was the reason they gave for not taking action. In the case of Whorlton Hall, the police also did not act on reports of assault, although assault was clearly going on. The Minister needs to take that problem up with the Policing Minister. It is not acceptable that what someone says is ignored if they are autistic or detained under the Mental Health Act 1983, because the level of sexual assault is disturbing, as my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) said.

[Jackie Doyle-Price]

That is an excellent point, and it plays into a general prejudice that people who are in detention are just an inconvenience to be managed. In the context of Sir Simon’s review, the whole ethos that any reform we make should be about empowering patients brings with it obligations to challenge other aspects of the system, not just the care providers. The hon. Lady is right to say that I need to take that up with the Policing Minister, which I will do as part of rolling out our preparations for the White Paper. I understand the hon. Lady’s lack of confidence when I say that the White Paper can be expected before the end of the year, but that is certainly my ambition, notwithstanding the fact that I know she has been waiting rather a long time for another paper that she was promised.

I can reassure the hon. Lady on the extent of the work that Sir Simon has done and the engagement we have had, especially with service users. Rather like the hon. Member for Bermondsey and Old Southwark, those service users shared with us their personal experiences, often reliving significant distress. Given that they have participated and that we have raised their expectations, we would, to be frank, be letting them down if we did not address that. I do not think that would be in any way forgivable, so, as long as it is on my watch, we will be pushing ahead.

As the hon. Member for Bermondsey and Old Southwark said, we are dealing with legislation passed in 1983, so although this appears to be a once-in-a-generation opportunity to reform this legislation, I hope that that is not the case. The situation is probably more symptomatic of the fact that we have not given this matter as much attention as it deserves, but clearly that has changed. The world has changed in terms of how we debate mental health, and that is welcome. Chiming in with the discussion we have had today, I am keen that we take this matter forward with consensus.

I pay tribute to the leadership that Sir Simon has shown in this review. As well as not ducking the controversial aspects of examining the legislation, he has engaged in dialogue and dealt with them in such a way that it is accepted that Members, peers, service users and professionals need to consider them. I am incredibly grateful for what he has done.

We talk more about mental ill health now, but when it comes to severe mental illness—the hon. Member for Bermondsey and Old Southwark spoke about schizophrenia —that is something that reveals incredible prejudice in people. As we have heard, if someone is able to manage their condition, they can live a full and independent life, but the key is being able to manage the condition with the appropriate support. We still have a lot to do in educating the public and society about the real impact of severe mental illness.

There are so many issues, but I will try to address them all in the time I have. The hon. Member for Bristol East (Kerry McCarthy) asked about out-of-area placements for people with autism and learning disabilities. I must say that this is something that really bothers me. Far too many people remain in institutional care and in out-of-area placements, and nowhere is that more true than in the field of learning disabilities and autism.

It is interesting, once we dig under the issue, to see that we have been very successful in getting people with learning disabilities out of in-patient care and into the community. However, that has been matched by a bigger increase in the number of people with autism finding their way into in-patient care. That tells me—I do not think this will be a surprise to anyone in the Chamber—that we are not doing enough to diagnose autism early enough, and as a consequence we are not equipping people with the skills to be able to live independently.

The ultimate result is that we end up putting people in in-patient care. Quite often, those people are forgotten about and it becomes very expensive to keep them there, so not only are we failing people by not having services for them early enough, but we are adding significant cost to the taxpayer and, frankly, doing harm, because the longer those people stay in in-patient care, the more their ability to live independently diminishes. As far as I am concerned, that is a major failing that we need to address.

[Kerry McCarthy]

I thank the Minister for that. There are two aspects that I have come across. First, it is often when a child reaches their teenage years, which we know are difficult for any child with all the turmoil that is going on physically and mentally, that the anxiety takes over and they eventually go into crisis, and things that perhaps should have been picked up sooner are only picked up then. Secondly, that seems to be particularly true for girls. We know that it is more difficult to diagnose girls with autism than to diagnose boys. I was told yesterday, although I do not know whether this figure is true, that one in four girls in mental health units with anorexia is diagnosed with autism. There is a lot of work to be done in the early years, before they reach that crisis point in their teens.

[Jackie Doyle-Price]

I agree with every word that the hon. Lady says. One of our expectations of the new mental health support teams that we are rolling out into schools is that they will be able to work with schools and to spot people who might be in trouble. She is right that, with girls particularly, autism is under-diagnosed, and by the time the challenges start to have an impact on mental health, it is much more difficult to give people appropriate support. Early diagnosis is key.

I am pleased that we are now setting up a unit within the Department of Health and Social Care to look at neurodiverse conditions and what more we can do to improve service provision for them. I am also pleased that NHS England shares my concern about this and that we can expect more work on it, but there remains a lot to do and I do not shirk from admitting that.

[Barbara Keeley]

There is also the financial difficulty that my hon. Friend the Member for Bristol East (Kerry McCarthy) referred to. Private hospitals that autistic people and people with learning disabilities end up in tend to be very expensive—we know that the placements can be as much as £730,000 a year. The answer is to fund placements in the community. Years ago, when we were moving people out of long-stay mental health institutions, there was a dowry system. The Government do not have a dowry system to help with this, so Transforming Care failed because there was no mechanism to transfer funding from the NHS, which is taking the hit on cost, to cash-strapped local authorities. If local authorities are to continue being cash-strapped, and I hope they are not, some mechanism is needed there. My party has pledged to put in £350 million a year of transfers to make that happen. Does that idea recommend itself to the Minister? I know she is bothered about this.

--- Later in debate ---

[Jackie Doyle-Price]

I partly agree with the hon. Lady. The answer is better help within the community, but I come back to the point that the right hon. Member for North Durham (Mr Jones) made so well. It should not be about beds or in-patient care. The fact that we still have that, and that it is increasing, is a mark of failure. I do not think it should be addressed by reinvestment in in-patient care in the community. The key is putting the support in earlier, and that is what we must aim toward.

The hon. Lady mentions that many of the providers are private, and she is right. One of the challenges I am setting NHS providers is how we can be more innovative, co-commissioning with local authorities to ensure that we have more supported accommodation available in the community, recognising that there will be a saving across the system. I am very clear; I will take it on the chin that local authorities have had more financial challenges than the NHS has as we have tackled public spending, but ultimately, we must think about that person and ensuring that they have holistic care. Silo-based decision making is not doing the people who need our help any good. That is still a work in progress.

The hon. Member for Stockton North (Alex Cunningham) is right about the role of social workers here. I have regularly debated with hon. Members about the workforce challenges that we face in delivering improved mental health services. NHS England is very clear that that will be developed only through new multidisciplinary models of care, in which social workers will play a part. We can also make much better use of people with lived experience in delivering care for people with mental ill health, not least because engaging with mental health professionals can be very intimidating and threatening, particularly for somebody going through a crisis, and someone with lived experience can bring a very different perspective to that relationship. Much more can be done about that. That underlines the point that hon. Members made a number of times about the need for appropriate support services.

[Alex Cunningham]

I wonder whether I can prise from the Minister a commitment to look at the fact that there has been a deterioration in the number of authorities that are working with our health partners. Integration is deteriorating, rather than increasing. The model must be better, and all professionals must work together.

[Jackie Doyle-Price]

That is a fair challenge. We certainly will. One of the difficulties when there is a financial challenge arrangement is that people retreat into their silos and say, “This bill is your problem.” That is not good enough. We have to be better at challenging them when that happens.

I am very clear that commissioners need to be much more imaginative. There is often a tendency to over-medicalise some of these issues. We have heard today that wrap-around services can be delivered much better by the voluntary sector, with better value for money and in a less intimidating way. That can often be more reliable than relying on in-NHS services.

There are two aspects to homelessness. It can often be symptomatic of a mental health issue or addiction; it is symptomatic of the fact that the person needs help. Equally, it exacerbates the issues that those people have. We have made resource available to tackle the holistic needs of rough sleepers, but again we are treating the problem at the crisis end. People struggling with their housing situation will be more likely to need help, so we need to look at what else we can do to support people at that stage.

I was challenged on when we will end the use of police cells to detain people under the Mental Health Act. I want that to be written on the face of the Act, so that there is a clear binding commitment to do that. We have reduced it by 95% so far with places of safety, so I am confident in saying that detention in a police cell is a rarity these days; nevertheless, we need to guarantee that.

On in-patient care and out-of-area placements, it is clear that people recover more quickly if they are closer to their family and friends. As the hon. Member for Bristol East said, there is sometimes a need for specialist support. We need to look at how that interaction happens with NHS England. Specialised commissioning and delivering a very narrow service will inevitably lead to out-of-area placements, but are we doing more harm than good? Should the best be the enemy of the good? NHS England commissions a quantum; it does not scrutinise individual commissioning decisions. That is more likely to happen if it takes place locally. That is still work in progress.

[Alex Cunningham]

Recognising that specialist provision might be 150 miles away, will the Minister accept the recommendation from the APPG inquiry that families who do not have the means should be funded so they can visit and spend time with their loved one?

[Jackie Doyle-Price]

I cannot commit to delivering that, but I can commit to looking at it. I hope that is good enough for the hon. Gentleman.

[Kerry McCarthy]

In the case that I was talking about, the problem was not just that the treatment was so specialised that it was that far away, but that that was when the bed became available. It is a bit of a lottery. The one closest to home was not taking in new patients because it was in special measures. There would have been other places closer. If the person does not accept a bed when one becomes available, they may have to look after a distressed child for an awful lot longer.

[Jackie Doyle-Price]

This comes back to housing. One challenge is getting access to a bed, and another is when the person comes to leave, because we need to discharge people into safe living environments. Are there enough supported housing solutions? No, not always, so the bed remains full. I am having conversations with colleagues in local government to see what more we can do to deliver more supported housing so we can get the pathway going. We could fix it by making more beds available, but that is not really the answer. I am concerned that the longer we leave people in in-patient care, the more harm we do. We have to get that movement through the system. Hopefully, if we do that, people will be less likely to grab the first bed because they can be confident that more will become available more frequently. That is where we need to get to. I appreciate that right now it feels desperate.

There is an issue with quality. The Care Quality Commission has a challenge in deciding whether more harm will be done by taking enforcement action on a place rather than working with it to improve. We see that writ large in TV programmes such as “Panorama”. There is a massive disparity in the quality of care. I challenge the CQC to be a lot more aggressive when we see poor standards of care.

The hon. Member for Bristol East mentioned private providers. People have heard of The Priory. They hear that celebrities go there and they think it is a centre of excellence. The truth is that the care there is less than optimal, but someone with a loved one who needs hospital treatment will not know that. We need the CQC to have a lot more teeth in terms of improving what comes out of its inspections. The system generally needs to support it in doing that.

[Mr Reed]

I am grateful to the Minister for giving me another opportunity to ask a question. While she is on housing, there is a growing issue of vulnerable young people and looked-after children being placed in unregulated, semi-supported homes or hostels. Some of them have severe mental ill health. When they are placed in such settings, they do not receive the support they require and become a danger to other people residing there. That happened in the awful case of Lance Scott Walker, a looked-after teenager in the care of Islington Council. He was placed in a hostel in Ealing, where he was stabbed to death by another young person with schizophrenia. It is clearly inappropriate for young people to be put in those kinds of setting. Is the Minister intervening with local authorities and the Department to try to prevent a repetition of that case?

[Jackie Doyle-Price]

I thank the hon. Gentleman for sharing that case. I was not aware of it. Some local authorities are not as good as they should be in discharging their responsibilities as corporate parents. It is clearly their duty to ensure that looked-after children are housed in an appropriate setting. That issue lies outside my purview, but I will take it up with colleagues in the Department for Education to ensure that we are properly enforcing our obligations towards looked-after children in relation to housing. That is clearly a concern to us.

Gosh—I have so much to get on to. The hon. Member for Bermondsey and Old Southwark talked in particular about Southwark and rightly challenged me by saying that seeing perhaps only 35% of children was not enough. I agree, but I have been really impressed by the efforts made by Southwark on mental health support for the school population. It illustrates the importance of good leadership and working collaboratively with other organisations. I was pleased to visit Charles Dickens Primary School—I do not know whether it is in his constituency.

[Neil Coyle]

It is. They have great expectations for the children.

[Jackie Doyle-Price]

It is a fantastic school. It was amazing how the principle of mental wellbeing ran through the whole school from walking in to the point where the kids pick up a sticker that reflects their mood and put it on the whiteboard, so straightaway the teacher could look out for those who were feeling a bit distressed. The other amazing thing was the teaching assistants, who instead of being based in each classroom all had specialisms and did lots of one-to-one activities outside the classroom. Even more importantly, there was a facility to reach out to parents pre-birth—obviously families tend to go and see schools. I was hugely impressed, and that goes to show how we should be encouraging innovation and imagination with regards to these services. In fact, it is probably the poster organisation to show that mental health is not everybody else’s problem; it is all our problem. The ability for such engagement in school is fantastic, so well done Charles Dickens Primary School.

Members will be pleased to know that Sir Simon Wessely has worked with the sector, and interest groups in the sector, in coming up with his proposals. I am also in regular dialogue with them to discuss the principles. In the spirit with which we all approach reform of the Mental Health Act, we obviously want to keep people safe, so there needs to be the power for potential detention, but most importantly we need to protect the rights of patients and empower them. That is the principle that I really want to underline.

[Barbara Keeley]

We have moved past the point of discussing people with autism and learning disabilities. I take on board the Minister’s concern, but I wonder whether she could answer my question. Under a reformed Mental Health Act, is she looking at—or minded to look at—changing how people with autism are included as if they have a mental health condition? That is important to a lot of people, and Sir Simon did not rule on it.

[Jackie Doyle-Price]

We need to look at issues about autism in the round. The hon. Lady is right that it is currently treated as a mental health issue for the reasons outlined by the hon. Member for Bristol East: it is not diagnosed until a mental health issue materialises. That is really the issue. I would like us to use the 10th anniversary of the Autism Act 2009 to reboot our approach to ensuring that we are looking out for people with autism. In a way, we must go through the same journey with autism and learning disabilities as we have with mental health. That does not really answer the question from the hon. Member for Worsley and Eccles South.

[Barbara Keeley]

It is about the legislation.

[Jackie Doyle-Price]

As far as legislation is concerned, ultimately people with autism who are suffering from mental ill health will be detained under the Mental Health Act. Perhaps we ought to pick up how that interacts with other legislation as we develop the White Paper. The overlap is a clear problem.

I have paid tribute to Sir Simon Wessely. We are all about making sure that our reforms deliver genuinely person-centred care. We should be removing coercion and control as far as we can.

My hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) talked about Georgi Lopez, who addressed the all-party group and whom I had the pleasure of meeting. She tells a compelling story about her contrasting experiences. She readily concedes that on one occasion being detained under the Act was the best thing that could have happened to her, but on another occasion it did her genuine harm. In fact, Members who read Frank Bruno’s book will find exactly the same story. It is almost as if once someone is on that pathway and under detention, they will always be seen through that prism. We need to tackle the underlying prejudice. People who are suffering from mental ill health are vulnerable; they are not an inconvenience. Any services provided by the state need to be working with them to support them, not to do them harm.

Our overall objective when we asked Sir Simon to look at the Act was to reduce the rising number of people detained under it. I hope that underlines the spirit with which we are approaching the inquiry. We also asked him specifically to address the disparities in how the Act is used, highlighting in particular the impact on black and ethnic minority groups, but also on women. It is of great credit to him that he went much further than that and led a full review of the entire Act. Again, that raises the expectations on me to deliver fundamental reform—but that is fine; it is what I am here to do. He did so with such speed, and having taken so many with him, that he has provided exactly the right conditions to approach reform.

Sir Simon built relationships with service users and carers, and I am riding on the back of them. I meet those people regularly to hear directly from them about their responses to his recommendations. We will continue with that. I have been struck by some of the experiences shared with me by service users and family members, which bring home how disempowering it can be. I often talk about the arrogance of medical professionals who, when someone turns up and says, “Fix me,” send them along. That dismissiveness can be more so in mental health than anywhere else. We need to ensure that we put in a regime that treats people with dignity and respect.

At the heart of this issue, the current Act has much too big a disempowering effect, which does too much to remove people’s autonomy and not enough to support their decision making and influence over their own care. It is dehumanising. We should look at detention as the last resort, because it does genuinely do harm. That is not to be critical: staff will act with the best of intentions, but a lot of it depends on culture. When Georgi Lopez shared her experiences, she talked about the two very different cultures of the organisations in which she was detained. When the CQC visits such places and assesses whether they are well led, it must assess the culture and whether patients are genuinely empowered.

I do not think we should duck the fact that sometimes we will have to detain people for their safety and that of others, but we need to ensure that we have the right guarantees in place. I am struck by something that Sir Simon always says: from the moment of detention, release planning should start there and then. A credible care plan is all about getting people back out and re-empowered. It should be based on consent and empowering the patient.

As has been mentioned, Sir Simon’s report contains 154 recommendations. I will work with the Ministry of Justice on a joint White Paper from both Departments, which will come forward by the end of the year. We have already started to implement the recommendations that we can, and I hope that Members are reassured by how, last week, the previous Prime Minister re-emphasised her commitment to making sure that we tackle the issues regarding black and ethnic minority detainees. I know she will continue to have a full interest in these issues from the Back Benches. I reassure the hon. Member for Worsley and Eccles South that if she sees no sign of a White Paper, she has a good ally on the Government Benches to hold the Government’s feet to the fire. I look forward to engaging with all hon. Members on those recommendations when we come forward with our White Paper, for which we should also consider the issues that have been highlighted during the debate.

As I have said, we want to modernise and ensure that people who are detained under the Act receive better care by improving patient choice and autonomy in their treatment. We will introduce statutory advanced choice documents to enable people to express, in advance of detention, their view on the care and treatment that works best for them.

It is important to talk about the role of family, because we have agreed that patients should be able to identify a nominated person who will have the power to look after their interests under the Act. At the moment, the next of kin is the default. I have heard compelling evidence from patients who have said that that is not always appropriate. Family members can often be a source of abuse or additional pressure and harm, so patients want to be able to nominate someone, which seems extremely sensible. I recognise that that will cause some controversy.

[Dr Lewis]

The Minister says that that seems extremely sensible but if, for example, somebody is seriously mentally ill and imagines that their parents mean them harm when they are actually doing everything they can in support, should the parents be locked out from knowing what is happening to their child?

[Jackie Doyle-Price]

We will have to have that debate. My right hon. Friend articulates the opposing position to what I have heard. I regularly hear his example when I chair the national suicide prevention panel. We have had dialogue with NHS organisations and there is a consensus statement setting out the framework by which reports can be given to family members. Equally, patients who are detained under the Act should be able to say which family members should not be consulted about their treatment. For example, we see women who are victims of domestic violence and abuse by their partner and find themselves detained under the Act; their partner would normally be their next of kin, but it would not do those women any good for that person to be contacted.

[Dr Lewis]

I quite agree, but my debate was nearly nine years ago. Is it not a bit late in the day for the Government to say, “Well, we are having a conversation about this?” At the time, there seemed to be some quite sensible rules, but the main problem was that the local mental health authorities were not applying them. If anything, it seems that we are further away from our objectives than we were nine years ago.

[Jackie Doyle-Price]

I think my right hon. Friend misunderstands me. We have a consensus statement that governs how NHS organisations and practitioners should deal with people at risk of suicidality, although there is concern among bereaved families that it is not always followed. Equally, in delivering a service that empowers patients, those patients should be able to identify their nominated person. Those discussions take place much more frequently when people set up new relationships with NHS practitioners. When they change GP, for example, they are invited to nominate a person, in case there are any safeguarding issues.

[Dr Lewis]

I hesitate to intervene one last time. I fully accept the Minister’s point about abusive partners, but what if the person is desperately, seriously ill and delusional, and the mother is not allowed to be told information about their offspring, because they are technically an adult? At what point do you decide that the person has lost capacity to identify correctly with whom information should or should not be shared?

[Jackie Doyle-Price]

That highlights the importance of having a nominated person earlier in the journey. I do not disagree with my right hon. Friend, but he highlights the difficulty of our work to get the balance right between keeping someone safe and respecting their wishes. I fully anticipate that when we produce the White Paper on this issue, he and I will probably have another debate about it. It is important that we get it right, with the safety of the patient in mind while empowering them to make their own decisions.

I have already mentioned that we will end police stations being places of safety under the Act, and that will be included in any legislation. On equalities, we are working with the NHS to introduce the first ever race equality framework to ensure that mental health care providers work with local communities to improve the ways that patients access and experience treatment. An important point is that although we are concerned that under the Act there are far too many detentions of people from black and minority ethnic communities, it is possible that is partly because they find it difficult to access services. We need to address that properly.

To help to address that, we are also launching a pilot programme of culturally appropriate advocacy. Clearly, we will need to make that resource available to ensure that people have access to it. The review said that we need to learn a lot more about that whole issue, so we will work with the National Institute for Health Research, which will launch a call for research later in the year to give us more answers. Jacqui Dyer MBE is our Mental Health Equalities Champion, and she will play a leading role in taking forward the review’s recommendations on tackling the injustices faced by black and minority ethnic services users.

I have spoken for quite some time; I hope I have covered most of the aspects mentioned. On the issue of funding, I have probably bored everyone senseless by saying that we are determined to deliver a much-expanded service, and our focus must be on developing those community services. We have made resources available to do exactly that through the long-term plan, but that is not to say that the issue is not still challenging. However, I hope we will be able to do much more in the community for people with severe mental illness, so that we can treat them in the community rather than have them go into crisis care.

To illustrate that with an example, if we can get people out of beds and into the community, the ability to look after more patients is really stark, so it starts to pay for itself. I discussed that with a clinical director from the NHS, who said that if they remove three people from in-patient beds and have them in the community, the productivity is so much greater straightaway. We rely on good local leadership to crack that and make it happen.

I have covered most of the things I wanted to. I will just reiterate my thanks to all Members who have participated in a very good debate, and I look forward to having discussions on the White Paper as it develops.

Decriminalisation of Abortion

Jackie Doyle-Price Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Diana Johnson (Kingston upon Hull North) (Lab)]

(Urgent Question): To ask the Home Secretary to make a statement on the repeal of sections 58 and 59 of the Offences Against the Person Act 1861 in England and Wales, in consequence of the decriminalisation of abortion in Northern Ireland.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

I have been asked to answer this question. As with other matters of conscience, abortion is an issue on which the Government adopt a neutral stance and allow Members to vote according to their moral, ethical or religious beliefs. As the Secretary of State for Health and Social Care has responsibility for abortion policy, I am an instrument of the House in that regard and I will discharge the instructions of the House in the best interests of patient safety.

The Government have a duty to see that the provisions of the Abortion Act 1967 are properly applied until, and unless, Parliament chooses further to amend that law. The hon. Lady will be aware that the Abortion Act—the legislation affecting England and Wales—is an amendment to the Offences Against the Person Act 1861. Notwithstanding the issues in Northern Ireland, the Government currently have no plans to amend sections 58 and 59 of the 1861 Act in England and Wales.

Abortion is an extremely sensitive issue, and there are very strongly held views on all sides of the debate. Given this, any significant changes to the law require careful consideration and full consultation with the medical profession and others. Moreover, it is right that MPs and peers—or the devolved legislatures, as the case may be—have adequate opportunity to scrutinise any legislation fully. The Joint Committee on the draft Domestic Abuse Bill has also made it clear that abortion is not a matter for the Domestic Abuse Bill, which the House will consider shortly.

The question of potential reform to Northern Ireland’s abortion laws, through the Northern Ireland (Executive Formation) Bill, if no restored Government are in place, should not be cause to reform the system in England and Wales. Abortion in England and Wales is already accessible and serves the needs of women seeking to access such services. The law also provides protection for the medical profession in carrying out its functions and duty of care to women.

As abortion is a devolved matter in Northern Ireland, the Government’s preference remains that a restored Executive and a functioning Assembly take forward any reforms to the law and policy on this issue. It is our hope that devolved government will be restored at the earliest opportunity through the current talks process.

We do, however, recognise the strength of feeling expressed by the House in the amendments to the Northern Ireland (Executive Formation) Bill, which place a duty on the Government to make regulations to reform Northern Ireland’s abortion laws if there is no restored Executive by 21 October 2019. The Government will work expeditiously to take forward this work, should that duty come into effect in the absence of devolved government.

The Government will also work with service providers to ensure that, in the meantime, the scheme provided in England for women from Northern Ireland continues to be fully accessible and that appropriate information is provided to those seeking to access those services. It remains my priority to provide safe access to abortion services under the law, as set by Parliament.

I appreciate this is an emotive issue, on which there are strongly held views, and I am sure it is something we will continue to debate in Parliament over the coming months, but I end by reminding the House that, over the past 50 years, the Abortion Act has ensured that women have access to legal safe abortion, which has contributed to a significant reduction in maternal mortality and has helped to empower women to make informed choices at what can be a very sensitive and difficult time in their lives.

[Diana Johnson]

I thank the Minister for her response, although it is a very disappointing response that does not address the subject of my question: England and Wales. I am also disappointed that we do not have a Minister from the Home Office, because this is a matter of criminal law.

The Northern Ireland (Executive Formation) Bill, which repeals sections 58 and 59 of the Offences Against the Person Act 1861 in Northern Ireland, completed its parliamentary passage yesterday, but those sections still apply in England and Wales, meaning that any woman who ends a pregnancy without the permission of two doctors faces up to life imprisonment. That includes women who obtain pills online, and they might be women in abusive, coercive or controlling relationships, women living in rural areas and women who have childcare responsibilities who cannot access services in clinics.

Despite legal access to abortion in Great Britain, two women a day seek online help on abortion from Women on Web. The Medicines and Healthcare Products Regulatory Agency, the medicines watchdog, has over three years seized almost 10,000 sets of abortion pills headed to British addresses.

The House will be pleased to know that there are no arguments about jurisdiction on repealing these provisions for England and Wales, and we are the competent body to do so. We have voted to decriminalise abortion on two recent occasions, 13 March 2017 and 23 October 2018, which alongside last week’s vote on the Northern Ireland (Executive Formation) Bill clearly shows the will of this House that abortion should no longer be part of our criminal law but should be a regulated health decision between a woman and her doctor. I must stress again that decriminalisation does not mean deregulation, and a whole range of legal and professional regulation would still apply, just as it does to other healthcare procedures.

The situation in which we now find ourselves is unjust, irrational and confusing. The British Pregnancy Advisory Service released polling this morning showing that only 14% of people are aware of the current law and that 65% of British adults and 70% of women do not support the current criminal sanction.

Decriminalisation is supported by the Royal College of Obstetricians and Gynaecologists, the Royal College of General Practitioners, the Royal College of Midwives, the British Medical Association and the Royal College of Nursing, so I ask the Minister again. When will the Government act to repeal sections 58 and 59 of the Offences Against the Person Act, and will there be a moratorium on any prosecutions under these sections in the meantime?

[Jackie Doyle-Price]

I know I will disappoint the hon. Lady, and I know she has been a passionate campaigner on these issues for many years, with the welfare of women at her heart. I answer this question with great respect for her desire, but it remains the case that the Government are not minded to repeal the provisions of the 1861 Act in England and Wales, recognising that we have an Abortion Act that provides for access to abortion services.

From the perspective of the safety of women accessing abortion services, the issues raised by the hon. Lady do concern me. It is not good for the welfare of women that pills are being accessed online. I also observe that the Abortion Act is more than 50 years old and was the product of a very different time. Abortions were then entirely surgical, and the medical abortions to which we now have access are clearly far safer.

This is very much a personal view, and I am not speaking for the Government in advancing this view, but I think that making provision for early abortion and for recognising medical abortion in law will get us much further. We need to make sure we have a safe regime that enables women to access abortion services as safely as possible.

[Tim Loughton (East Worthing and Shoreham) (Con)]

I supported decriminalisation, I supported the regularising of the abortion law in Northern Ireland last week, and on Friday I shall visit my local BPAS clinic. But changing the law is only part of it. Last year, I was out with an ambulance crew and we were called out to a woman who had been at an abortion clinic and taken the pills. She was bleeding heavily and had been taken very ill, and there was no out-of-hours service—this was on a Friday evening. Does the Minister agree, particularly in respect of the availability of do-it-yourself pills on the internet, that it is absolutely essential that, at a very difficult time for a woman who has taken that decision, the ongoing support is there 24 hours a day, seven days a week?

[Jackie Doyle-Price]

My hon. Friend reminds us that this is not always an easy process for women to go through. As with any medical procedure, full consent must be given, based on full information. As long as pills can be accessed via the internet rather than via medical professionals, it is clearly more likely that women will not be informed of the risks of taking the pills. Any medication can have risks and consequences, and women need to be fully advised so that they can manage what they are going through.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Thank you, Mr Speaker, for granting this urgent question. I thank my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) for and congratulate her on securing this urgent question, and thank her for her tireless campaigning on this issue. I share her disappointment that no Home Office Minister was available to respond to this urgent question; waiting for a call is obviously more important. I thank the British Pregnancy Advisory Service for its excellent work on this issue, and for its new campaign, launched today, called #PunishedForPills.

Following the passage yesterday of the Northern Ireland (Executive Formation) Bill, we find ourselves with a discrepancy across the UK when it comes to abortion. As we have heard, sections 58 and 59 of the Offences Against the Person Act 1861 no longer apply in Northern Ireland, but still apply in England and Wales, which means that if a woman does not seek the permission of two doctors before having an abortion, she could face up to life imprisonment in Britain, but not in Northern Ireland. The same goes for women who access abortion pills online. There are a whole host of reasons why women may do that, including not being able to get an appointment at a clinic, which now happens more and more often; not having childcare; living in a rural area; or being in an abusive relationship. Although women in Northern Ireland will no longer be persecuted for accessing abortion pills, the same cannot be said for women in Britain. I know this issue does not fall under the Minister’s brief, but will she ensure that abortion will be decriminalised, but not deregulated, throughout the UK? That would increase access to and the safety of abortions for women throughout the UK.

No one takes abortion lightly—this is a very sensitive issue—but I am sure that we in the House can all agree that women deserve access to safe and legal health procedures, and that includes abortion. A woman’s right to choose is a human rights matter. We need to seize on the momentum of the great result in the Republic of Ireland and deliver equality of rights for women throughout the UK and equality of resources across the whole NHS. The Government need to make this a landmark year in which women’s reproductive rights are fully respected and realised. That is why I call on the Government to repeal sections 58 and 59 today, to make abortion rights equal throughout the UK.

[Jackie Doyle-Price]

I thank the hon. Lady for the characteristically constructive spirit in which she has engaged with this issue. The nub of the point she makes is that decriminalisation must not be met with deregulation. Whatever we do, we must make sure that in repealing those sections of the 1861 Act—if that is what Parliament chooses to do—the regime that replaces it must not only guarantee the rights of women to take decisions for themselves but protect them and keep them safe. That is my priority in addressing this issue.

[Sir Desmond Swayne (New Forest West) (Con)]

My hon. Friend is aware—isn’t she?—that any proposal for repeal will be resisted as passionately in the country and on the Government Back Benches as it has just been advocated by those on the Opposition Benches?

[Jackie Doyle-Price]

I am very aware that this issue rouses passions on both sides of the argument, which is why I reassure the House that, from my perspective, I just want to make sure that I deliver Parliament’s instructions in a way that is safe. I should add that perhaps the way in which both sides of the argument have been debated in the House has not led to good lawmaking, because it has meant that the law has not been revisited in 50 years and has not kept pace with medical advancement.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

The Minister herself just made exactly the case that my good and hon. Friend the Member for Kingston upon Hull North (Diana Johnson) made so powerfully about the need to make sure that the law works for the 21st century. The votes we had in this place in the past two weeks were to recognise that human rights are not a devolved matter and should be available to every UK citizen. Although I enjoy the irony that potentially we could end up with the most progressive abortion laws in Northern Ireland, my constituents in Walthamstow and, indeed, all our constituents in England and Wales deserve to be treated equally as an adult, able to make their own choices.

In reading out what I believe someone had given to her as the Government’s stated position on this legislation, which puts having an abortion on the same level as child stealing and using gunpowder to blow up a building, the Minister said that there would need to be a consultation with medical bodies “and others”. Will she tell us who the others are and why, when it comes to something medical, it is only women who seem to have non-medical professionals getting involved in deciding what their rights to access treatment might be?

[Jackie Doyle-Price]

As with any consultation, “others” would include all members of the public, and everyone here is a representative of members of the public. There are a number of ways that we can get to the outcome of legislation fit for the 21st century. It is the Government’s position that the simple repeal of those two aspects of the 1861 Act is not sufficient to guarantee safe legislation for women in this country. We have an Abortion Act that empowers women to take decisions themselves. Again, I come back to the fact that this is an issue of conscience. As Minister, I will implement the law as decided by Parliament.

[Kate Green (Stretford and Urmston) (Lab)]

I have great respect for the Minister, but I do not think there is any case at all for inviting amateurs to comment on what should be medical, clinical assessments. The criminal law always bears down most harshly on the most vulnerable and marginalised women: very young women, those with literacy or learning difficulties, those with poor language skills and those who may be in an abusive relationship. Will the Minister therefore consider again her stance—the Government’s stance—on the impact of encompassing this offence in our criminal law, and look at steps that can be taken urgently to repeal it?

[Jackie Doyle-Price]

The specific offences to which the hon. Lady refers are a matter for the Home Office. The Government’s position is that they should not be repealed for England and Wales at this point. I absolutely understand the issue she raises with regard to the most vulnerable, and she and I have had discussions on that basis, but that is also a reason why simple repeal is not necessarily the best tool. To have a safe regime in place is also to protect exactly the people she identified. As I have said, from a personal perspective I do not think that the current law is in any way satisfactory, and I hope that in future we can have sensible discussions about how we might modernise it.

[Karin Smyth (Bristol South) (Lab)]

In my role as a member of the British-Irish Parliamentary Assembly, the committee on which I serve, which is chaired by the noble Lord Dubs, has for the past two years been looking at abortion policy across the whole of Ireland and Britain. Our report should have been available already, but there was some disagreement as to its final content. We will be updating it, hopefully for publishing in October. It would be helpful to discuss that report with the Government. As well as online medication, we have found other particularly concerning issues: we need to remember that there are no borders for healthcare for women across these islands, and there are no borders for how women across these islands will continue to support each other. We want to see more equality. Of real concern are the often very traumatic cases of late terminations. The workforce across our islands are not skilled—there are not enough of them and there are not enough good-quality skills. Does the Minister agree that the Government should at least look into those points regarding workforce?

[Jackie Doyle-Price]

Yes, absolutely. I would be delighted to meet the hon. Lady about her report. That there is difficulty in getting agreement comes as no surprise to me but, given the intentions of the people behind it, having that discussion would be useful. Yes, I have heard concerns expressed about skills levels, in particular to perform late-stage terminations, which are incredibly dangerous, as she is aware. I will endeavour to take that forward with the relevant bodies.

[Heidi Allen (South Cambridgeshire) (Ind)]

I sense that the Minister is genuinely trying to help. There is some irony in that we have been trying for so long to amend legislation in Northern Ireland to reflect what we have here, but now it has gone the other way—in the absence of any Executive, with the repeal of sections 58 and 59, Northern Ireland will in fact have more modernised legislation than we have. May I ask her explicitly what she thinks—personally, I suspect—would be the most effective tool to modernise abortion law right across the UK, which the majority of Members want?

[Jackie Doyle-Price]

That is a difficult question to answer given that the matter is now completely devolved. In respect of England and Wales, I think that the most effective method would be to revisit the Abortion Act, which is itself an amendment to the Offences Against the Person Act providing an exemption for women making that choice in those circumstances. My personal view—the Government do not have a view on such matters of conscience—is that, after 50 years, the Abortion Act does not reflect medical practice today, and therefore restricts the choices of women and their ability to exercise those choices in the safest way.

[Liz McInnes (Heywood and Middleton) (Lab)]

Other jurisdictions in Canada and Australia have already removed abortion from the criminal law without any increase in the rate of abortion or in late terminations. The Minister cloaks the issue in words such as “emotive” and “sensitive”, but this is actually a legal issue, and women in England and Wales deserve the same protection now afforded to women in Northern Ireland. Given that this is a legal issue, when will we get an answer from the Home Office, rather than the buck being passed to the Health Minister?

[Jackie Doyle-Price]

At the risk of being flippant, obviously I can only relay the policy given to me by the Home Office. I can give the hon. Lady my views on how we best keep patients safe, but clearly, when it comes down to it, how Parliament decides to manage such issues is a matter for Parliament; the Government and I as a Minister will do as instructed.

[Jo Stevens (Cardiff Central) (Lab)]

Will the Minister give us an example of any other medical procedure or treatment that is a human right that is criminalised by the law in England and Wales?

[Jackie Doyle-Price]

We need to look at exactly what the Offences Against the Person Act says, which is not in the context of a medical procedure. That is why we have the Abortion Act, which provides for a specific exemption by treating abortion as a medical procedure. The Offences Against the Person Act is in effect about foeticide; the Abortion Act amends that to decriminalise women seeking an abortion. That is the difference. If we make it about the Offences Against the Person Act, we are missing the point about England and Wales.



BILLS PRESENTED

Low Carbon Domestic Heating Bill

Presentation and First Reading (Standing Order No. 57)

Sir David Amess, supported by Ian Austin, Mr Adrian Bailey, Sir Graham Brady, Tom Brake, Maria Caulfield, Mr Roger Godsiff, Zac Goldsmith, John Grogan, Tim Loughton, Sarah Newton and Alex Sobel, presented a Bill to make provision about low carbon domestic heating systems.

Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 427).

Asylum Seekers (Accommodation Eviction Procedures) Bill

Presentation and First Reading (Standing Order No. 57)

Chris Stephens presented a Bill to make provision for asylum seekers to challenge the proportionality of a proposed eviction from accommodation before an independent court or tribunal; to establish asylum seeker accommodation eviction procedures for public authorities; and for connected purposes.

Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 428).

[Mr Speaker]

Suggestive of a busy “tomorrow”—we shall await the development of events. Meanwhile, we have an item of considerable parliamentary excitement, namely the ten-minute rule motion, which the hon. Member for East Worthing and Shoreham (Tim Loughton) has been patiently waiting to move.

Oral Answers to Questions

Jackie Doyle-Price Excerpts

Tuesday 23rd July 2019 Commons Chamber

[John Howell (Henley) (Con)]

8. What steps his Department is taking to help prevent mental health illness among young people.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

We are committed to improving early intervention and prevention to ensure that young people with mental health problems do get the best start and the earliest possible treatment. To that end, we are introducing new school-based mental health support teams. The first 59 of these will start being operational by the end of December this year. The next wave of 124 more teams was announced on 12 July.

[John Howell]

With half of all lifetime cases of mental ill health beginning at the age of 14, will the Minister say how well the training promised to constituencies such as mine will help to stop these problems worsening as people get older?

[Jackie Doyle-Price]

My hon. Friend is right: people with mental health conditions do tend to develop them as children. Clearly, the earlier we can give them support to help them manage those conditions, the better for their long-term wellbeing. Equally, however, we need to make sure we have sufficient community services when they leave school and get older, so that having invested in their wellbeing, it can be continued through later life.

[Dr Paul Williams (Stockton South) (Lab)]

Is the Minister confident that the mental health of the 5,000 children with special educational needs who spent time in school isolation booths last year was not harmed, and if not, what representations has she made to the Secretary of State for Education about this practice?

[Jackie Doyle-Price]

The hon. Gentleman, as usual, raises a very important issue indeed. Of course, people with special educational needs will be at risk of mental ill health more than any other cohort of children. I am having regular meetings with the Under-Secretary of State for Education, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), who has responsibility for children and families, about this very vulnerable group. Having targeted mental health provision across mainstream schooling generally and put in such investment, we now really need to home in on the groups at highest risk.

[Jim Shannon (Strangford) (DUP)]

Will the Minister outline what discussions have taken place with the devolved Administrations to ensure that best practice and best results are implemented UK-wide, especially considering that Northern Ireland has the highest level of mental health issues pro rata in the whole of the United Kingdom of Great Britain and Northern Ireland?

[Jackie Doyle-Price]

As usual, the hon. Gentleman raises an extremely important point. Of course, health is a devolved matter, but that is not to say that all four nations cannot learn more from best practice in each place. I am pleased to say that we are now increasing our contact with representatives of the devolved Governments, and we will very much be sharing such best practice.

[Paula Sherriff (Dewsbury) (Lab)]

Referrals to child mental health units from primary schools for pupils aged 11 and under have risen by nearly 50% in three years. BBC research last week also found that primary school children are self-harming at school, and in four cases children under 11 had attempted suicide while at school. This is deeply shocking, so what is the Minister doing to ensure that primary school children will have support from trained mental health professionals when they return in September?

[Jackie Doyle-Price]

The hon. Lady is quite right to raise that, and it is incredibly troubling to see those figures. The investment we are making in mental health support teams will be of assistance. For primary schools that are well led and gripping this issue, there is some very imaginative and innovative practice to bring emotional wellbeing into the classroom from the moment pupils arrive. We need to make sure that those mental health teams start acting as soon as possible. This is something that we need to address collectively with schools and as a society to make sure that we get treatment to people at the earliest possible time.

[Jack Brereton (Stoke-on-Trent South) (Con)]

9. What steps he is taking to improve NHS facilities.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

The Government recognise the importance of reducing inequalities and have included a commitment to that in the NHS long-term plan. We know that public health services, such as immunisation, screening programmes, smoking cessation services and many other initiatives, can significantly improve health outcomes to combat some of the inequalities faced by ethnic minorities and those living in less affluent areas.

[Mr Sharma]

I thank the Minister for her response. After nine years of Tory austerity, advances in life expectancy, which steadily increased for 100 years, have now ground to a halt and have even gone backwards in some of the poorest areas. How does the Minister plan to reverse that damning trend?

[Jackie Doyle-Price]

Life expectancy has been increasing year on year, but it is also true that it is an international phenomenon that that rate of increase is coming to a halt. None the less, life expectancy in England is the highest it has ever been: 79.5 years for men and 83.1 years for women. We will continue to invest in our public health programmes and look at the wider issues facing society that can also contribute to good health outcomes, such as housing, work and so on. There is a lot that can be done; it is not just about NHS spending.

[Tim Loughton (East Worthing and Shoreham) (Con)]

One of the best ways of getting early public health help across the doorstep is by investing in health visitors to give that much needed early support, especially to new parents to help to ensure that every child gets the best start in life. One of the best achievements of the Cameron Government was the creation of 4,200 additional health visitors. Does the Minister share my concern that since 2015, with the responsibility now having gone to local government, there has been a 26% reduction in the number of health visitors? That is something of a false economy.

[Jackie Doyle-Price]

I do share my hon. Friend’s belief that health visitors are probably the most important army in the war against health inequalities. They provide an intervention that is very family-based and not intimidating. It is based on good relationships and means we can provide intervention at the earliest possible time. He is right to highlight the massive investment we made during the Cameron Government. There has been a decline since, which we really must address if we are to get the earliest possible intervention and the best health outcomes for children.

[Dr Sarah Wollaston (Totnes) (Ind)]

We finally got to see the prevention Green Paper yesterday evening, and it rightly highlights the appalling inequality in healthy life expectancy and the fact that being overweight or obese is now the leading risk factor for disability and years lived with disability. Will the Secretary of State please reassure the House that he will act on the evidence? The prevention Green Paper makes it very clear:

“The Soft Drinks Industry Levy…has been hugely successful in removing the equivalent of over 45,000 tonnes of sugar from our shelves.”

The House really needs to hear reassurance that we will not roll back on those kinds of issues.

[Jackie Doyle-Price]

I reassure the hon. Lady that the Government are committed to following the evidence; that is very much a theme in the prevention Green Paper. The evidence will speak for itself. Clearly, she is absolutely right to highlight obesity as the biggest risk factor in impeding healthy life expectancy. That is why, across Government, we should be vigilant about tackling it.

[Mike Gapes (Ilford South) (IGC)]

14. Whether his Department’s decision of October 2011 to close the A&E department at King George Hospital, Ilford, has been rescinded; and if he will make a statement on future services at that hospital.

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[Sarah Newton (Truro and Falmouth) (Con)]

17. What progress has been made on implementing his Department’s strategy and action plan, “Improving lives: the future of work, health and disability”, published in November 2017.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

I am pleased to say that we have made strong progress against the commitments in the Command Paper my hon. Friend refers to, and I thank her for her role in delivering those advances. I can advise the House that the number of disabled people in employment is now 400,000 higher than it was in 2017. There is, however, much more to do, and on 15 July we launched a consultation on measures to reduce ill health-related job loss. We are seeking views on how employers can best support people with disabilities and people with long-term health conditions to stay and thrive in work.

[Sarah Newton]

I thank the Minister for her really helpful response, and I congratulate her on the fantastic work she has done in her position. Last week, the next Prime Minister announced his intention to look again at the tax treatment of at-work referral health services as a benefit in kind to employees, given how crucial fast access to health and support is to so many people. Will the Secretary of State and the Minister work with the new Prime Minister in bringing forward an urgent review, as the current tax regime goes against our focus on prevention and reducing demand on the NHS?

[Jackie Doyle-Price]

Absolutely. We will continue with the emphasis on work being good for people’s health. We need to look at what we can do to make it easier for employers to help their employees, which is good for everybody—it means that everyone can still make an economic contribution, and that we retain the existing workforce, and it is good for people’s wellbeing. We absolutely will look at what we can do to incentivise best practice.

[Gareth Thomas (Harrow West) (Lab/Co-op)]

It is difficult to see how lives will be improved and people supported to stay in work by NHS England’s decision, supported by Ministers, to encourage CCGs to phase out their walk-in centres—I am thinking, in particular, of the three walk-in centres that serve my constituents. I urge Ministers, even at this late stage, to set aside new funding streams so that Alexandra Avenue, the Pinn and Belmont Health Centre can continue to provide a 365-day, 8 am to 8 pm walk-in service to my constituents.

[Jackie Doyle-Price]

I do not share the hon. Gentleman’s view on this. Clearly, it is important for CCGs to have the freedom to determine their best primary care arrangements. Walk-in centres are convenient for people who are in work and who perhaps work away from home, but ultimately, we keep people with disabilities in work by having bespoke support for them, and that is better organised by having good primary care services near the home.

[Mr Paul Sweeney (Glasgow North East) (Lab/Co-op)]

T1. If he will make a statement on his departmental responsibilities.

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[Rachel Maclean (Redditch) (Con)]

T2. Provision of in vitro fertilisation in Redditch has been reduced from two cycles to one. I warmly welcome the work that the Minister has done to increase equity across the country, but what more can she do to address the postcode lottery in this and other areas, such as hip and knee surgery?

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

My hon. Friend is right: the postcode lottery is not acceptable, and patients manage to get around it; my local clinical commissioning group, having funded three courses of IVF, has had to reduce that to two, because demand has doubled owing to the lack of provision in neighbouring CCGs. I have made it very clear that it is unacceptable for any CCG to offer no IVF cycles at all; I have given them that guidance.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

My I pursue the question asked by the Chair of the Select Committee, the hon. Member for Totnes (Dr Wollaston)? We know that obesity is a major cause of cancer and other diseases, and we know that we have severe rates of childhood obesity, so why does the prevention Green Paper say only that the sugar tax “may” be extended to milkshakes? The evidence is clear. Is the Secretary of State not kicking this into the long grass?

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[Kirstene Hair (Angus) (Con)]

I should declare that I am chair of the all-party group on eating disorders. Despite eating disorders affecting 1.25 million people across the UK and being the most deadly of mental health issues, the average time dedicated to training about eating disorders in a five-year medical degree was found to be only three or four hours; in some cases, there was none at all. Will the Minister agree to look into this and perhaps report back to the all-party group?

[Jackie Doyle-Price]

I certainly will. This recommendation was also made by the Public Administration and Constitutional Affairs Committee following its report into the death of Averil Hart, and we are in discussions with the royal colleges to see what more can be done, in terms of training medical staff and doctors in mental health, because we want to make sure that intervention happens at the earliest possible stage, which means that all our medical professionals need to understand it better.

[Paul Blomfield (Sheffield Central) (Lab)]

T5. Constituents of mine recovering from mental health problems have told me that when they have shared their desire to return to work with jobcentre staff, jobcentre staff have used that as a trigger to move them from employment support allowance to jobseeker’s allowance, with, obviously, the financial loss involved in that. Do Ministers agree that whoever is still in their job by the end of the week could usefully talk to the Department for Work and Pensions team about how people with mental health problems can be supported back into work without being penalised?

[Jackie Doyle-Price]

Yes is the short answer, and the hon. Gentleman will be pleased to know that I have regular discussions with colleagues in the DWP to see what we can do to humanise all our processes for benefits claimants, because it is important that when people suffering from mental ill health interact with organisations of the state, we are not causing them harm. I can assure the hon. Gentleman that that is very high on the list of things in my in-tray.

[Sarah Newton (Truro and Falmouth) (Con)]

I greatly welcome the publication of the prevention Green Paper. How will that strategy enable people to keep well by living in warm homes?

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[Helen Goodman (Bishop Auckland) (Lab)]

The Minister with responsibility for mental health is a very sympathetic person. Unfortunately, that does not seem to translate into action. Our clinical commissioning group has stopped funding the voluntary sector to provide counselling, and now it is taking counselling services out of GP surgeries as well. Will she look into that?

[Jackie Doyle-Price]

Yes. What the hon. Lady has just outlined to me flies in the face of the advice that I and the clinical directors of NHS England are giving CCGs. We are clear that voluntary sector provision of additional services is crucial in the support of people with mental ill health. Unfortunately, some commissioners seem to want to medicalise everything, but that is not the key to good treatments, and I will look into it.

[Alison Thewliss (Glasgow Central) (SNP)]

The prevention Green Paper talks about the risk of an opioid epidemic. In Scotland, we feel that that is already here, with 1,187 deaths in Scotland last year, 394 of them in Glasgow. Will the Secretary of State work with the Scottish Government and Glasgow health and social care partnership and support the opening of a medically supervised drug consumption room in Glasgow?

Body Image and Mental Health

Jackie Doyle-Price Excerpts

Tuesday 23rd July 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

I beg to move,

That this House has considered body image and mental health.

I am delighted to open this debate on this very important matter about which a number of parliamentary colleagues are showing increasing concern. How we think and feel about our bodies can affect any one of us at any point in our lives. I am sure I am not alone in not liking my body shape and in wanting to lose more weight. Frankly, we know there is no magic route to that. We just need to eat less and drink more—[Laughter.] I should say: eat less, drink less and exercise more. Too often, however, people are seduced into seeking body shapes that are less than attainable. While for most of us that is an aspiration, for some people it becomes uncomfortable and an obsession that does them no good.

This is a particular issue today, because the pressure on people, especially young people, to achieve an idealised image is everywhere. Often, the images that people are being subjected to are unattainable because those images have been airbrushed and touched up. Those shapes are really not what any normal person could begin to achieve.

[Mr Jim Cunningham (Coventry South) (Lab)]

The Minister is quite right. Some of the television reality shows today put pressure on young people, particularly young girls, to imitate shapes, weight and size, and all that goes with that. This is a timely debate and we need to have a good look at this issue. At the end of the day, young people get very disappointed and that can have an effect on their mental health. That is the important point we should not lose track of.

[Jackie Doyle-Price]

The hon. Gentleman raises an issue close to my heart. When we talk about so-called reality TV programmes, it is as if the people participating in them are normal people. The reality, however, is that they are not normal people. They are semi-professional celebrities who have often undergone enhancements to become attractive to be chosen to go on these television programmes. The whole thing starts to develop insidiously in a culture, making people think that they should aspire to look like that and that it is normal. Everyone is chasing a lifestyle that is frankly not attainable.

We have all enjoyed watching such programmes. I often say that we have become a nation of voyeurs, but perhaps we all need to remind society that there is no quick route to fame, fortune and success—that comes as a result of hard work—and that spending a bit of money on a nip and tuck and a lip filler will not be the route to earning a lot of money. We all need to start to address that, because we have allowed magazines and our media to develop this image. We have been complicit in it happening, because we have enjoyed that entertainment, but we are reaching a position where our society is extremely unhealthy.

The problem has been made particularly acute by the growth of social and digital media, which have increased exposure to unrealistic and unattainable images of beauty. As we all know, when we are browsing on our iPad we can look at one thing and straight away be bombarded with sites that squirrel us down a route where we are exposed to more and more such content. People who are looking at unrealistic body images will see ever more images that they aspire to. There is another insidious thing: a friend of mine was speaking to me only last night and said that she was looking at cosmetic procedures when, all of a sudden, an advert popped on to her screen encouraging her to spend a few thousand pounds so that she could learn to administer lip fillers herself. She thought how horrendous it is that our social media does that.

[Mary Glindon (North Tyneside) (Lab)]

Is the Minister aware of the Be Real campaign’s latest report, “The Curate Escape”, which looks at young people and their images on social media? Two thirds of young people edit pictures of themselves before they put them on social media, and the report makes a lot of really good recommendations. The Be Real campaign has been fantastic in recent years, focusing on health and wellbeing, rather than weight and people watching their weight. If she is not aware of the report, would she like a copy?

[Jackie Doyle-Price]

I thank the hon. Lady for raising that point—I have heard of that campaign. It is disturbing that so many people alter their images. None of us is perfect—God help us if we all were—but for people to think that they need to alter their appearance because they are unhappy with it, and for that to become normalised, is quite a sinister development in society. At the risk of being trite, perhaps we should be telling everyone to learn to love themselves.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Is the Minister aware of the Good Childhood report, which states that girls who share pictures or videos of themselves are less happy with their appearance than those who do not? Is she aware that the Children’s Society is campaigning for a greater understanding of what makes children unhappy, and does she agree that we need to focus on that?

[Jackie Doyle-Price]

Yes. The Children’s Society is doing some excellent work in this space and it always has a lot of expertise to share. We have to address this issue collectively as a society, because if we do not start equipping children with the tools to look after themselves and the right attitudes, that damage is set up for life. The hon. Gentleman is absolutely right to raise that point and I encourage the Children’s Society to engage with us more on what we can do to support it.

The Government recognise that poor body image is a common problem. Approximately 70% of adolescent girls and 45% of adolescent boys want to change their body weight or shape. We also recognise the impact that idealised body image can have on lesbian, gay, bisexual, and transgender people particularly, on ethnic minorities, and on those with disabilities or serious illnesses.

The Mental Health Foundation recently published a very informative report on body image. Some of its findings are shocking: 20% of adults feel shame, 19% feel disgusted, and 37% of teenagers feel shame in relation to their body image. This should make us all stop and think. When it comes to teenagers, we all recognise that going through adolescence is a difficult time, when we are at our most vulnerable, including to the outside influences that tell us that our body shape is not as it should be and that we are not as perfect as we could be. I welcome the recommendations made in the foundation’s report, which is aimed at public and commercial organisations and gives us things that we can do to help ourselves.

Having a negative body image affects the way that we feel about ourselves and it can affect people’s aspirations and confidence. In the most extreme cases, it can lead to eating disorders, depression and even feeling suicidal. I know that the hon. Member for Dewsbury (Paula Sherriff) is as concerned as I am about this issue, and I commend the work that she has been doing specifically on eating disorders. The increases that we are seeing in suicide and self-harm among young people are incredibly worrying. Much of this is being driven by young women and girls, but we must not forget the boys either. It is important that we work to raise awareness of the problems of body image that many people face and hopefully prevent them from developing issues in future.

Clearly, social and digital media companies are key players in this debate, because they contribute to the volume of material that encourages people to think negatively about themselves. Young people are put under such pressure to have the perfect image, the perfect body, the perfect relationship and the perfect clothes—the perfect everything—and that places unrealistic expectations on them. As hon. Members will know, we are in close dialogue with social media companies to encourage them to act more responsibly over the content on their platforms. We have held three summits so far; the most recent was only last week. We have said that, ultimately, we will consider legislation if they do not clean up their act. That said, Governments can always be three steps behind the development of technology, so I would much rather that we worked collaboratively and co-operatively to address this content.

So far, I have been encouraged that the companies have committed to increasing their efforts to protect users from harmful suicide and self-harm content online by coming together to establish and fund a strategic partnership with the Samaritans. That work is commencing. They will look not only at self-harm and suicide, but at pro-eating disorder content. We will continue our meetings with social media companies.

I was particularly concerned to see that a number of sites and materials are available that contain harmful content such as pro-anorexia messages. It is completely unacceptable that this sort of content is easily accessible to vulnerable young people. We are having talks with Amazon about removing books from its retail sites, but we need to ensure that social media companies are vigilant about taking down content published on their sites as well.

In the face of these modern challenges, central to tackling the problems in future is empowering our young people to improve their emotional resilience and wellbeing, so that they feel confident in themselves and in seeking support if they feel they need it. We are investing in massive improvements in mental health provision in schools. We have a new workforce that we are rolling out. We also need to make sure that children can access mental health support and we are investing in more provision in child and adolescent mental health services. As part of making health education compulsory in schools from September next year, it will be absolutely essential that we teach children how to protect their mental wellbeing. That will cover unrealistic expectations about body image. I hope that that will allow young people to recognise what is normal—what is normal, and is there any such thing as normal?—and what is an issue for them and others, as well as to know how to seek the right support when issues arise and to know that it is accessible to them.

Another issue I would like to talk about is gender identity, which has been the subject of quite a number of negative reports in our newspapers in recent months and, indeed, on Radio 4 this week. This is about people’s sense of self and physical appearance and about them wanting to change their gender identity. We have been aware of the issue of gender dysphoria, but there has been quite a lot of comment, and the House and the public need reassurance that the treatments available on the NHS, particularly for children, are appropriate.

To put the issue in context, gender dysphoria is where a person experiences discomfort or distress because there is a mismatch between their biological sex and their gender identity. That is incredibly difficult for anyone to deal with, but young people, in particular, will find it difficult. Many Members will have had representations from constituents about access to services to cope with gender dysphoria—I know that because I have signed many letters on the issue. It is essential that someone suffering with gender dysphoria receives the right support—support that really considers their holistic needs—because gender dysphoria often exists alongside other morbidities, and we must make sure we treat the whole person. Where appropriate, people should receive specialist treatment.

The Gender Identity Development Service for children and young people is provided by the Tavistock and Portman NHS Foundation Trust. There has been lots of concern in the press about that trust, but having discussed the service with NHS England and visited it, I would like to try to give Members some reassurance and to address some of the points that have been made about the service.

The first thing I think the service would like to get across is that gender should be seen as a spectrum. The whole treatment pathway is based on allowing children to explore their feelings in a safe environment. Not all children referred to the service will go on to transition. That is an important point to recognise, because if children have the time and space to work through their feelings, that will perhaps lead to a different treatment pathway.

I know there has been lots of concern that too many children are being referred to the service, but I would like to reassure the House that the service takes children through treatment in a very exploratory way around gender, and more than half of the children referred do not go on to transition. The service will treat each case as individual and complex and will address some of the co-morbidities that come along with gender dysphoria—lots of concern has been raised about the fact that some of these children are also on the autism spectrum.

It is important to recognise that, compared with services internationally, the service is very much at the conservative end of provision, which has led to it being criticised as far too conservative by some aspects of the lobby in favour of more services. However, where we are dealing with children who have not reached the age of majority, and where some of the treatments they may go through may be irreversible, the whole issue of consent is clearly important.

It is important to note that this aspect of service has grown quickly, and it has done so in an absence of public scrutiny. I can understand why there will be some public concern about it, so I would like to reassure the House that I am working with NHS England to do a proper review of the research around this service and the ethics of it to establish a proper framework for consent, recognising that we are looking at treatments that may have long-term consequences.

I can assure the House that the service works hard to ensure that consent is robust and that young people who might receive hormone therapy receive adequate information about the nature and consequences of that treatment. Such consent is not a one-off decision; it requires ongoing dialogue with the service. It will also require some assessment of the capacity and competence of the individuals consenting.

It is important to assure the House that this issue is very much under review. My starting point is that nothing should be undertaken in this space that would be irreversible for anyone under the age of 18. With that in mind, NHS England is putting in place a new policy and a new service specification for children’s services, and will thoroughly consider the issues that have come up in the press recently. Clearly, those issues will be a matter for debate, and many Members will have an interest in them. It is important for public confidence, as well as to enable access to services, that we have a proper, ethical debate around consent and the clinical evidence behind prescribing long-term hormone treatments.

Finally, I want to say a little about cosmetic procedures and regulation. I am pleased to see the right hon. Member for North Durham in his place—he is my conscience on these issues. It is fair to say that they are becoming increasingly common, and as they do so, they are becoming increasingly risky. Increasingly, it is becoming normalised for young women, in particular, but not just young women, to seek cosmetic procedures to alter their appearance.

I was pleased to launch an awareness campaign around cosmetic procedures earlier this year, which I have driven forward to make sure not only that we encourage people to properly consider the risks of any procedure they might undertake, but that they do not just wander down to the hairdressers and book a Botox appointment or a filler but really take steps to make sure they are going to a reputable provider. It is important that people fully understand the risks and where to look for a safe procedure. We have made sure that there is good material on the NHS website, and we are encouraging people to access that information when they are considering having any kind of procedure.

However, there is a really important message that we must give, which is that anyone considering having anything done to their appearance should not seek an operation overseas. There are some very disreputable operators advertising—for example, there are holidays in Turkey with a procedure. That is hugely dangerous, and I am afraid that the NHS is picking up the costs of those procedures. That is obviously something we need to address properly.

We will look at stronger regulation of the sector. Again, I would say that no one under the age of 18 should seek a cosmetic procedure. We have come to think that having some kind of lip filler is just like going to have a haircut, but when it goes wrong the results are much worse than having to let our hair grow back. Therefore, no one under the age of 18 should be seeking such procedures, and we need to do a lot more to make people realise exactly what the risks are.

[Bambos Charalambous]

Obviously, the harm is done with young people early on, and they are very impressionable—we have mentioned reality TV, and the Digital, Culture, Media and Sport Committee is looking at its impact. Does the Minister not think that we should try to teach positive body image at school and provide support at school for people who have concerns about their body image? That would be a wise investment of Government funds and would actually help young people to address their concerns and anxieties at every stage.

[Jackie Doyle-Price]

I agree with that. Through the new personal education that will be rolled out next year, we will have the ability to address that issue. I would just say that we need to be careful about this and to give some scrutiny to what the content of that might be. We have to really make sure that people respect the fact that we are all different and we all come in odd shapes and sizes, but everyone is beautiful. That is a really important message to convey. It will be incredibly challenging to get that content right, and we do need to bring some scrutiny to that.

Body image is clearly a strong contributory factor in many cases of mental ill health. I am pleased that we are starting to tackle some of these issues, but there is a long way to go. We have reached a stage at which the herd has gone so far down the road that the idealised view that everyone is a size zero model, whose perfectly coiffed, long, naturally blonde or brunette hair has no shades of grey and no curls, has taken hold. It will take a long time to turn that juggernaut around, but in the interests of a healthy society we all need to get a grip.

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[Jackie Doyle-Price]

I shall not detain the House for too long, because I think it has heard enough from me for one day. I thank Members for their generous comments, even if they might be career-limiting.

In this debate, however, there is consensus across the House. We all fully recognise the problems that we face and the need for decisive action to tackle them. I will certainly continue to work with all Members to do exactly that, because this is too important and—I make this observation—the people out there expect us to work together more often than not. Such subjects should not be a political football, and it is too important to ensure that we are tackling harms.

The hon. Member for Dewsbury (Paula Sherriff) made the observation that the debate might not be as well attended as previous ones, but to be fair we have had many such debates in this space. Many Members, even if not present this afternoon, clearly have a keen interest. I am utterly at one with her when she expressed her concern about a context in which we have normalised unrealistic body image. Such images have become so normalised that it will take a lot of effort to address it. She also referred to the incident of the lady who, sadly, died as a result of accessing a Brazilian butt lift from a surgeon in Turkey. Unfortunately, she is not the only such person from this country. It is the most dangerous cosmetic procedure that can be undertaken and, as a consequence, is banned in this country. None the less, despite the ban, people are still bombarded with images and with adverts for where they can seek the procedure. That brings home the fact that we need to do much more to make people aware of the risks.

Many Members referred to the influence of advertising, and I am afraid that those organisations that profit from hosting advertising ought to have a duty of care and ensure that the material they carry does not expose people to harm. I therefore welcome the engagement that the right hon. Member for North Durham (Mr Jones) is undertaking with Facebook on exactly that. It is not good enough for social media providers to retreat to the defence of, “Well, we are a liberated platform, regulated by our users.” Where they become a vehicle for things that will cause harm, those social media providers have a duty of care to the people who use their platforms. We must all continue to challenge them on that issue.

We have had lots of references to “Love Island”. Collectively, perhaps we ought to challenge use of the term “reality TV”, because it is not reality TV; it is fantasy TV. [Hon. Members: “Hear, hear.”] So that might be the outcome of today’s debate—let us all talk about fantasy TV from now on, because such programmes promote lifestyles that are not normal or achievable. Let us do that.

[Mr Kevan Jones]

Will the Minister challenge the producers of a show such as “Love Island” to produce a series with real people in it, rather than one with the image that they are trying to portray now?

[Jackie Doyle-Price]

I could give that challenge, but the sad thing is that I do not think that any of us would watch that—although I do not think that many of us watch it now. Frankly, I like my dramas gritty and real. Ultimately, ITV broadcasts “Love Island” because it attracts many viewers—many of them among the most vulnerable group we are talking about. Again, ITV should be much more responsible, although the show is one of its biggest earners. I just regret the fact that we have become such a nation of voyeurs, and we all need to reflect on that point.

It is interesting that, because the people in these so-called reality TV shows are not known to us—they are not celebrities—we do not really see what we are doing to them in these circumstances. I do not know whether any hon. Members used to watch “Big Brother”, but there was an occasion when a contestant on “Celebrity Big Brother” effectively had a meltdown on TV. The public reaction then was very different; I think it seemed more real to people because it was a celebrity and the public were invested in them. That illustrates just how pernicious these so-called reality TV shows are, with their anonymous celebrities. These people suddenly become very exposed, and we have seen the outcome for some people’s mental health when they re-enter the real world. I know that ITV has reflected on some of those risks, but there is much more to do. As I said, let us start calling them fantasy shows.

The hon. Member for Dewsbury also mentioned the whole issue of body-shaming online. We have accepted as normal some really unpleasant behaviour online. I always use the example of drinking and driving. It did not matter that drinking and driving was made illegal; it was only when it became socially unacceptable that people really stopped doing it. We need to get to that stage when it comes to how people behave online. Again, this happens because people do not see others as real people online. When people make abusive comments online, it is because they feel that they are able to. That has got to stop and we need to lead the way.

The hon. Lady also asked what it takes to make the social media companies actually do something about this. In the context of suicide content, it took a death—and it should not take a death. With regards to other content, I suspect that it will also take deaths to get these companies to do something. That really is not good enough. I pay tribute to those who are brave enough to share their experiences of self-harm and suicide as a result of what they have seen online, because they are really helping us to drag the social media companies to where they need to be.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—I never pronounce it right—articulated the fact that this area is an artificial world that becomes more and more intense. When we start using the internet and looking at things on social media, we do find ourselves dragged into a deeper and deeper world of “like” content, and it is easy to cease to be objective in those circumstances. We have certainly seen that with regard to self-harm and anorexia sites; it is just constant. The journeys that some people have been through are akin to grooming. People can find themselves being groomed by online content by sheer accident. Given that context and given how we use devices these days, it is not difficult to see why people are becoming much more exposed to such risks. Safe ways of using the internet—using iPads and so on to access content—has to be central to any education we give children about looking after themselves because that level of intensity clearly causes harm.

The hon. Members for East Kilbride, Strathaven and Lesmahagow and for Bath (Wera Hobhouse) talked about eating disorders, the clinical pathways available and out-of-area places, all of which are issues that really bother me. It has to be said that we have done well on children’s access to help with eating disorders—and I think it was right to do so because if we can tackle these issues early with children, we are tackling eating disorders—but it has highlighted the risks that exist when children cease to be children and become adults. The level of service is not as good when people enter adulthood, particularly through the whole period of transition, and that in itself can cause harm. We have heard about Hope Virgo’s #DumpTheScales campaign and the fact that different clinical standards are being applied for children and adults. That is clearly something that we really need to fix and it is a key priority for me.

I also fully recognise the danger of out-of-area placements for people with eating disorders. Part of people’s recovery has to be the relationships that they have with family and friends. I have seen that very clearly with children and young people. Generally, we need to reduce the number of out-of-area placements for people with acute mental health issues, including eating disorders, but I will not be satisfied until we have no out-of-area placements at all. Having people long term in beds in hospitals is not good for their mental health. Clearly, there are cases where there is a need for intensive treatment and we need to do that, but over time, out-of-area placements really should not be a thing.

The right hon. Member for North Durham, as usual, brought to the debate his very well-informed knowledge of this subject. I join him in paying tribute to Dawn Knight and all the campaigning she has done. She has not been shy about sharing the devastating impact of what she did, telling her story of how she just wanted to enhance her appearance and the result has been absolute hell. Neither is she shy about sharing exactly what the impact will be on the NHS as a consequence of the treatment she has had to have to put it right.

This whole area of cosmetic surgery is growing very quickly, and people are quite naive in thinking that perhaps the more money they spend on a procedure, the better it is going to be. Nothing could be further from the truth, because there are the least virtuous of people in this space. As the right hon. Gentleman says, this is the wild west. These people are profiteers. Part and parcel of enabling people to protect themselves in this environment is to really talk about the risks. There are some absolute cowboys out there. The story that Dawn tells about trying to sue the practitioner who undertook her procedure shows that that is frankly impossible. When people want to become engaged in activity that is borderline criminal, they find ways of making sure that they cannot be held to account for it. Whatever our instinctive view about people’s choice, self-regulation and so on, where there is clear evidence of harm, the Government should act. We really must look at this more seriously. I am happy to continue speaking to Dawn and to the right hon. Gentleman about that.

Clearly, we need to look at the whole issue of dermal fillers. It is classed as a medical device and therefore is not on prescription, but ultimately something is being injected into the face, so we need to make sure that we are doing something about regulation. The right hon. Gentleman mentioned the role of the GMC. As he says, Botox is a prescription drug, but it is clearly being administered by people who are not practitioners. Both the GMC and the Nursing and Midwifery Council have an obligation to uphold their regulatory standards. If someone is using their prescribing power irresponsibly and not being present when the product is administered, then action should be taken, and I shall expect those bodies to do that.

[Mr Kevan Jones]

I agree with what the Minister says, but if we look at some of the adverts—for example, on Facebook—there is no way that people who are signing these prescriptions can actually be present. Her Department should look at this area, because there are clearly people signing prescriptions and then either selling them on for a profit or giving them to people to make money out of these procedures.

[Jackie Doyle-Price]

I am grateful to the right hon. Gentleman for amplifying that point, because we must do that. We give very clear indications that we expect the NMC and the GMC to deal with this. However, we must also send a message to people out there that people will get these adverts about how to become a dispenser of dermal fillers and think that that is all they need to do, having no idea that they are committing a criminal offence. We need to educate them as well.

I will end there, because, as I say, I feel like I have been the Government at the Dispatch Box today. I look forward to continuing discussions with all Members present, who I know care very deeply about this. It is something that we really must tackle as a matter of urgency.

Question put and agreed to.

Resolved,

That this House has considered body image and mental health.

Human Medicines Regulations 2012 Advisory Bodies Annual Report 2019

Jackie Doyle-Price Excerpts

Thursday 18th July 2019 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

The Parliamentary Under Secretary of State (Lords), my right hon. Friend Baroness Blackwood has made the following written statement:

I have received the annual report of the human medicines regulations advisory bodies for 2018, which has been laid before Parliament today in accordance with the requirements of part 2 regulation 12 (4) of the Human Medicines Regulations 2012.

I am glad to acknowledge the valuable work done by the distinguished members of the human medicines regulations advisory bodies and thank them for the time and effort dedicated in the public interest to this important work.

[HCWS1752]

Children and Mental Health Services

Jackie Doyle-Price Excerpts

Tuesday 16th July 2019 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

I thank all hon. Members who have contributed to this afternoon’s debate, which has given me a lot to think about and a lot to address. I pay particular tribute to my hon. Friend the Member for Burton (Andrew Griffiths), who gave an excellent exposition of the challenges before us. I welcome the contributions of all Members. We have covered a lot of content, and I will do my best to address all the points that have been made—there are a hell of a lot.

As the right hon. Member for North Durham (Mr Jones) said, for a long time we have not talked about mental health enough. It has been a taboo subject, and these issues have been left to fester. As a consequence, mental health has been a Cinderella among public services. People with mental ill health have suffered discrimination at the hands of the state in many ways.

We have identified that children’s mental health services have been underfunded for generations, and we will have to fix that—of that there is no doubt. Unfortunately, that takes more than a magic wand. It requires investment and all commissioners to step up to the plate. It requires good partnership working between NHS organisations, local authorities, schools and everyone involved in the system. It is, frankly, a massive culture change, but we need to deliver it. We have heard examples this afternoon of individual children who are being failed by poor service. Frankly, that is the state’s failure, and we are all duty-bound to put it right.

I am grateful that hon. Members have given me these examples, challenging though they are, because they are a helpful reminder to the system that these are individual people. People like Drew should not have to wait 15 months for an appointment. The hon. Member for Barrow and Furness (John Woodcock), the hon. Member for Westmorland and Lonsdale (Tim Farron) and I have talked about the challenges in Cumbria. In terms of delivering the transformation and improvement we are aiming for, we are seeing a real lack of consistency in the speed and quality of services as they are rolled out. Again, that is a challenge for us as a system. In my contacts with NHS England, I am keen to ensure that we get more uniformity in provision.

In answer to the point the hon. Member for Croydon North (Mr Reed) made about ring-fencing funding for mental health services, NHS England will challenge CCGs very directly about how much money they spend on mental health services. We are very clear that they should spend more than the increase in their budgets. Although we have always rejected the suggestion of a ring fence on the basis that they can often be seen as a ceiling, which we do not want, there is now room for some very challenging comments. We really need to start thinking about whether what we have in place is delivering the outcomes that we in this Chamber and we as a society ought to be able to expect.

There is so much to cover that I am sure I will miss something, but there are some points that I really want to emphasise. The right hon. Member for North Durham talked about the role of the voluntary sector. That was music to my ears. I have said repeatedly that good support for people with mental ill health does not necessarily have to be medical—in fact, the wrap-around service that can be provided by just company and comfort is far better delivered by organisations in the voluntary sector, but it is part of our health offering. I am very challenging in telling CCGs and commissioners that they should be thinking about commissioning services from the voluntary sector. Taxpayer funding should deliver the outcomes we want, and the voluntary sector can do that better and cheaper than we can by medicalising the problem. I cannot emphasise that enough.

On delivering more efficient pathways, clearly, the ability to triage people to services that are not medical, are more fleet of foot and can react more immediately provides an opportunity for early intervention that will deliver the better outcomes we want for people.

Looking particularly at individual groups, we heard reference to people with neurodiverse conditions—people with ADHD, ASD and dyslexia. Often, those things go undiagnosed. We need to ensure that, in schools, those people are not just treated as difficult but signposted to places where they might get additional help. We know that earlier diagnosis of those conditions can be the difference between developing mental ill health and not, so we must do better on that. Obviously, the next wave of delivering a transformation for children will involve continuing our pressure on the need to deliver a better mental health service for children, but key to that for me is getting earlier diagnosis of autism and ADHD.

I am not shy about articulating the benefit of that for society; early diagnosis is not just for the benefit of those children, although of course they deserve the best services. We heard about the impact of trauma, and everyone who mentioned it was absolutely right. We have no excuse for failing those people and not putting support around them when they need it. Not only do they deserve that, but by doing so, we win as a society. As I said, those people end up in the care system at best and in prison at worst. Our prisons are full of people who have been failed by the state because we did not give them that hand up when we needed to. We must grasp this issue, and I am not shy about raising that challenge. Yes, it is good value for money—I am sure I speak for all hon. Members when I say that I would rather spend more on health than on prisons, thank you very much. We must ensure that we support people when they need it and recognise the impact of trauma.

Hon. Members will be aware of the work that my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom) led when she was in Government on the support given to people in the first 1,001 days of life. She has a debate on that subject in the main Chamber later this afternoon—in fact, she is speaking now. I am sure she will echo some of the points the hon. Member for Croydon North made. We can see the children who are at risk. The state has every opportunity to support those people and, frankly, we should be a lot more assertive in doing so. As I said, those individuals will benefit, society will benefit and, of course, the taxpayer will benefit because we will not be spending money on failure.

The hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) spoke movingly about the increase in suicide among young people. Collectively across Government, we need a better understanding of the pressures facing young people, which seem to be a lot more acute than they were when I was growing up. Bluntly, I used to play at “Charlie’s Angels”; I did not expect to look like them. That might seem a trite thing to say, but body image puts massive pressure on our young people.

We used to think that kids would be safer in their bedrooms than if they went out to play on their bikes. That is no longer true, because the way people are routed through content when tackling social media leaves them very much at risk. Although we can celebrate the revelations and opportunities that the internet and social media have given our young people, they bring with them risks, and we need to be a lot more on top of those. I am glad to say that I am now in regular dialogue with those companies. To be fair, they are stepping up to the plate at this stage, but that is not to say that we should not consider legislation where we can see that that would bring value in protecting young people.

Obviously, we have made commitments to increase funding. We will continue to do that, because we need to ensure that we meet the unmet need that was alluded to. As I say, money spent early is money spent wisely and money spent less, so we must absolutely continue to do that. The value of early intervention is totally unarguable when expenditure on acute service is so much costlier.

Waiting times were mentioned, and I will take that away. We need to get a much better handle on areas with particularly long waiting times. We have set targets. Some 80% of young people with urgent cases are seen within a week. Again, this comes back to the extent to which we triage services. The really important thing about early intervention and getting support to children at an early stage is our proposals for mental health support teams to work directly with schools—my hon. Friend the Member for Burton alluded to the project starting in his constituency. Those teams will be able to equip the schools themselves with more material and support to help them embed mental wellbeing throughout the curriculum, but they will also be the place for additional support and the place where services are referred.

I thank all hon. Members who contributed to the debate. We are on it, but I would be the first to admit that we still have a long way to go to deliver mental health services for children that we can all be proud of.

Child and Adolescent Mental Health Services: North-east

Jackie Doyle-Price Excerpts

Wednesday 10th July 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

I thank the hon. Member for Washington and Sunderland West (Mrs Hodgson) for the sensitive way in which she has outlined the case of her constituent Jane. We often debate NHS issues in this place, and it is often a case of trading statistics and numbers, but the hon. Lady has reminded us all that there are vulnerable people needing help who are potentially at risk of more harm when the NHS fails them. I will write to her in more detail answering some of the questions that she has posed to me today, but for the moment I will address some of the issues with which I am able to deal.

We have articulated clear ambitions for improving children’s mental health services, but, as the hon. Lady outlined extremely well, this follows decades of under- investment in those services, and there is a way to go from where we are now to where we need to be. The waiting times that Jane has experienced, which the hon. Lady outlined, really are not acceptable.

We will be very clear about our ambitions, but the hon. Lady is also right to highlight that we are very dependent on the performance of individual trusts in terms of delivering that. She set out the challenge as regards the Tees, Esk and Wear Valleys NHS Foundation Trust very well. The Care Quality Commission is giving quite a lot of attention to that trust for one reason or another, and the trust will be made much more accountable. I always say that sunlight is the best disinfectant, and one of the issues that we collectively face is that because mental health has for so long been something we have not talked about enough and has been stigmatised, mental health services have been a bit out of sight, out of mind, and have not had the scrutiny that they should have had.

The comparison the hon. Lady draws with an A&E, saying if it was turning away patients like this there would be an absolute scandal, is right, and part and parcel of achieving parity of esteem is that we must expect the same high performance and standards of our mental health services as we do of our physical health services. I know that the hon. Lady will not let me get away with not taking that as seriously as I possibly can.

We have made some progress, but, as the hon. Lady has heard me say before, I am in no way complacent about where we are. It is not just that we need overall improvement; there is great disparity between various regions and areas across the country, and the hon. Lady represents an area that is particularly challenged. She made some points about waiting time standards, and I am getting quite an inconsistent picture as regards the performance of that trust, which suggests to me that there is something wrong with the data and how things are being measured. Again, we need to hold everyone to account so we can be sure that our waiting list and waiting time data are accurate.

[Mrs Hodgson]

When I spoke to Mr Buckley about the sentence in the letter that said a waiting list was not operated, he explained that that probably was not very accurate, because when everyone is seen and triaged, if they need an appointment to see a therapist they are given one in, say, six weeks, eight weeks or 12 weeks. He said that the fact that they are given an appointment explains why there is no waiting list. So as the Minister rightly pointed out, we will have to drill down on that, because I do not think we are measuring the same thing across all trusts if they are all using different forms of words.

[Jackie Doyle-Price]

There might be something we can do on standardising the approach, but that brings us to another challenge. We apply these targets to try to achieve a standardised service and to ensure that people get treated when they need it, but that encourages some perverse behaviours, and the hon. Lady has just outlined one of them. The challenge for us is how we apply standards of behaviour and targets without driving perverse outcomes and bad outcomes for patients. I still think we have a lot to do on that, and probably a lot of learning. We need to identify those areas that really are doing it well so that we can spread good practice throughout the system.

But there is obviously a good reason why we must make sure we get child and adolescent mental health services much better: because we know that people who suffer from mental health issues tend to develop those conditions when they are children—when they are young. We all know that early intervention is the best way, not least for the individual concerned, because they will suffer less harm, but it is also good for the taxpayer because it costs less money to help people sooner. So we must make sure that we continue to give children’s mental health much more priority than it has had hitherto, and central to that will be greater provision of services in the community.

I am really concerned about the story the hon. Lady has just told. The process that Jane has been taken through appears to have completely failed, and the communication with her and her father appears to be extremely poor. Again, I think we can go away and look at how we communicate with patients and their families, and particularly at the tone that is used. We are dealing with people who are in a very vulnerable position, and to put it bluntly, it should not be “take what you’re given”, should it? Ultimately, our NHS is there to serve all of us, and it needs to do so with sensitivity and tact.

The hon. Lady rightly challenged me about money and the need to ensure that it delivers extra appointments. We are ambitious to see many more children, through the investment we are making, but unfortunately I do not have a magic wand and I cannot roll it all out overnight. As she points out, we need to ensure that we are investing in the appropriate workforce to deliver these services.

I would like to make another point about NHS commissioners. While we are delivering this real step change in mental health provision for children, there are other things that can be done by local health commissioners—and by local authorities, for that matter—while people are waiting for referrals and appointments. There is still additional support that can be given by organisations doing good voluntary work to give wraparound support and take some of the pain out of the experience. I often say that good mental health care is not all about clinical interventions; it is about the wider support that can be given in the community as well.

Our reforms to mental health in schools have that kind of support very much in mind. We are rolling out a new workforce, which is going be based on people who are trained in psychology and therapies, but the ethos will be very much that they are working with voluntary sector organisations that will be able to provide that additional support to people who are going through periods of mental ill health. We want to ensure that many more children who are going through mental ill health are seen, not least because we are seeing increased prevalence and it will take substantial extra effort to ensure that we are providing that service.

I turn specifically to waiting times. We have introduced new standards for mental health services, and in particular, we have introduced targets with regard to eating disorders and to a first episode of psychosis. We are making good progress on those, but as the hon. Lady says, Jane had clearly gone through significant trauma and it would not be unanticipated that that would impact on her mental wellbeing. Our targets for psychosis and eating disorders would perhaps not capture someone with that level of need, but it is still important that she has access to that support. Sunderland clearly has longer waiting times than many other areas of the country. I understand that the trust has been successful in bidding for additional NHS England funding as part of a national waiting list initiative, and I sincerely hope that that will improve access for the hon. Lady’s constituents.

When we hear of cases such as that of Jane, I can understand why people feel that our commitments on transformation ring a bit hollow. I know the hon. Lady will understand that we see this as a long-term process of rolling out improved services. That is the only way we are going to embed the change in culture that we really need in how we prioritise mental health, but we need to redouble that progress, as she says. We are determined that NHS funding for children and young people’s mental health services will continue to rise.

The hon. Lady asked me about making sure there is a proper ring fence. We have demanded that CCGs increase mental health spending on children’s services by more than their budget rises, but I think we will be taking a more interventionist approach. I know that NHS England is having robust discussions to ensure that all commissioners do exactly what is expected of them. We expect to have been able to treat an additional 345,000 children by 2024 through the additional funding, and we are already seeing some benefits.

I understand that in Sunderland, local commissioners have commissioned Mind to work with young people aged 11 to 25 and give direct support in that way. In addition, there is the new Lifecycle service, which includes access to adult therapies—one of the issues the hon. Lady raised. I am told that in Tyneside 90% of young people are seen within five days for triage into the service, but on the basis of what the hon. Lady has told me, I would like to do a bit more digging to make sure that the figure is robust.

We know that the mental health sector is showing imagination and innovation in filling the skills gaps in mental health nursing and psychiatry, but it is worth noting that one of the upsides of us talking about this subject and giving so much more attention to mental health is that it is raising the profile of the sector as somewhere to work. The really nice thing is that people do care about it. Applications for psychiatry are increasing, in part, I guess, because would-be psychiatrists can see that there will be plenty of demand for their services. Although we are making the sector more attractive, providing the workforce will be a big challenge, so we need to encourage more imagination about how that is delivered.

New roles are emerging, such as peer support workers, making use of lived experience. It strikes me that people going through mental health issues often find it intimidating to talk about it and to respond to treatment. Getting support from someone who has been through a similar experience can be enormously important to their recovery, and we want to encourage much more of that. We have the new nursing associates, and we want to encourage more mature workers—perhaps women re-entering the labour market—to explore careers in mental health. We will need much more imagination in the coming years if we are to continue to deliver the workforce we need.

[Mrs Hodgson]

I am sure the Minister can guess what I am about to say. Previously, the nursing bursary was so important for older people going back into the workforce or making a career change, and especially the group of people who now do not even apply for those opportunities. Is there any influence she can exert on the Government, any hope that at some point in this Parliament they will bring back that bursary?

[Jackie Doyle-Price]

I walked right into that one, didn’t I? The hon. Lady is right in the sense that we need to enable people to learn and earn. That is the key. I have conversations with Health Education England about how we can meet our ambitious workforce targets, and I am sure that it will have noticed what she just said and my reply. Applications are increasing despite the removal of the bursary, but I believe we could do more to encourage people who are considering entering the sector, perhaps later in life, when they have a family and they need to earn.

The NHS long-term plan, which contains some very ambitious commitments on mental health, is a huge opportunity for commissioners to think much more creatively about how they deliver their local services, because we are going to have to deliver a step change in the provision of services available in the community.

I have talked a bit about the mental health support teams going into schools, and it is pleasing to see that they are being rolled out. I do not believe we currently have a trailblazer that serves the hon. Lady’s constituency, but clearly if the local trust could work with local schools on delivery, it would make a huge difference to delivering services for children and young people. I believe teams are now covering Newcastle Gateshead, Northumberland and south Tyneside, and they will be testing the four-week waiting time, which she will believe is important, particularly when viewed through the prism of Jane’s experience. Later this week, we will be delivering the next wave of those sites, so let us watch this space—hopefully we will be able to get more provision.

The hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) mentioned the issue of suicide and self-harm, which is clearly a considerable priority for me. We have been fortunate in seeing declining rates of suicide for a number of years, but we are beginning to see it on the rise again among children and young people. We could all speculate as to the reasons for that. They will be complex, because every suicide has its own story, and it is usually an escalation of factors that leads to someone taking their own life. We need to take a good look at exactly what pressures our young people are facing. Clearly, Jane had had adverse childhood experiences. We know they contribute to mental ill health, but other things are involved, too. If we can identify people who are at risk early—clearly, adverse childhood experiences are a good indicator—we can make sure we give that support sooner and then we will genuinely be able to tackle suicide prevention. We are on it, but we have a lot more learning to do on that.

I am really grateful for the sensitivity with which the hon. Member for Washington and Sunderland West has outlined Jane’s case, and I will take that away and respond in detail to the issues she has raised. As a pathway of experience, that clearly is not good enough, but I suspect it is all too common. Sometimes it is useful to use a particular case study to see exactly what is going wrong and what we can learn from. I would, however, say that I am proud of the progress we are making on improving services. We need to do much more. I wish I could do it quicker, but I will do the best I can.

Question put and agreed to.

Paterson Inquiry Indemnity

Jackie Doyle-Price Excerpts

Tuesday 2nd July 2019 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

It is normal practice, when a Government Department proposes to undertake a contingent liability in excess of £300,000 for which there is not statutory authority, for the Minister concerned to present a departmental Minute to Parliament giving particulars of the liability created and explaining the circumstances; and to refrain from incurring the liability until 14 parliamentary sitting days after the issue of the statement, except in cases of special urgency.

I have today laid a departmental Minute proposing to provide an indemnity that is necessary in respect of a Department of Health and Social Care established non-statutory, independent inquiry into the issues raised by the malpractice of the former breast surgeon, Ian Paterson, in the independent sector and the NHS. The actions of Ian Paterson have affected a significant number of patients. The disclosures about the seriousness and extent of his malpractice are deeply and profoundly shocking. The inquiry reflects the Government’s commitments to ensuring lessons are learnt in the interest of patient protection and safety, both in the independent sector and the NHS.

In 2017, the Minister of State for Health announced the establishment of the Inquiry (HCWS323, on 7 December 2017) to be chaired by the right Reverend Graham James, Bishop of Norwich. This indemnity will cover the entire duration of the inquiry’s work, from December 2017 until when the inquiry submits its report, now expected at the end of 2019. The indemnity will cover the Chair and all independent advisers appointed to the inquiry against any liability for any act done or omission made honestly and in good faith in the execution of his or her duty as such, or in the purported execution of his or her duty as such. The indemnity only applies to acts done or omissions made during the course of the inquiry. If the liability is called, provision for any payment will be sought through the normal supply procedure.

The Treasury has approved the proposal in principle. If, during the period of 14 parliamentary sitting days beginning on the date on which this Minute was laid before Parliament, a Member signifies an objection by giving notice of a parliamentary question or by otherwise raising the matter in Parliament, final approval to proceed with incurring the liability will be withheld pending an examination of the objection.

Attachments can be viewed online at: http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2019-07-02/HCWS1683/.

[HCWS1683]

Oral Answers to Questions

Jackie Doyle-Price Excerpts

Tuesday 18th June 2019 Commons Chamber

[Conor McGinn (St Helens North) (Lab)]

3. What his Department’s strategy is to reduce the level of male suicides.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

Men remain the group at the highest risk of suicide and continue to account for three quarters of all suicides. Clearly, targeting suicide in men must be the main thrust of our suicide prevention strategy. We are investing £25 million to support local suicide prevention plans in every local area, and that funding is testing different approaches and sharing best practice. We also announced £600,000 yesterday to support local authorities with exactly these processes.

[Conor McGinn]

It devastates me to have to tell the House that St Helens has the highest rate of suicide in the country, and three quarters of those who take their own lives are men. We know that working class men in deprived areas are 10 times more at risk than those in the most affluent areas, so will the Minister recognise class and community, and poverty and place, as key factors in male suicide and its causes? Will she come to St Helens to see and support the vital work that is being done to prevent the tragic crisis of suicide that is affecting more families in my community?

[Jackie Doyle-Price]

I agree with much of what the hon. Gentleman says, and I would be delighted to go to St Helens, not least because the more we can do to share good practice around combating male suicide, the more we can prevent it. Everybody in this space wants to do more to prevent suicide, and location is important, too, which is why a big part of my plan is to ensure that we are putting in good measures in the places that attract more suicides.

[Chris Davies (Brecon and Radnorshire) (Con)]

A few weeks ago, I held a debate in this Chamber on the subject of suicide in the farming community. What are my hon. Friend’s plans to improve the mental health of males under 40 in rural areas?

[Jackie Doyle-Price]

I am delighted that my hon. Friend is highlighting the farming community. He is right that the incidence of suicide is particularly high in that community, not least because those people work in remote areas, have less engagement with others and have access to the means. We must ensure that all vulnerable men feel that they can reach out to people who can support them. I encourage everybody to get the message out that if we see people who look vulnerable or struggling, we should be comfortable about reaching out to them. We have heard amazing stories of when just the simplest intervention, such as, “Are you all right, my friend?” can make the difference between life and death.

[Dr Sarah Wollaston (Totnes) (Ind)]

Sharing information saves lives when it comes to suicide prevention, but families are too often unnecessarily excluded because clinicians may be unaware of or do not follow the consensus statement guidance on seeking consent and sharing information in the patient’s best interests. I thank the Minister for meeting me and the National Suicide Prevention Alliance recently. She will know that the Matthew Elvidge Trust has highlighted the importance of how consent is sought, and it has suggested the following wording:

“In our experience, it is always much better to involve a family member, friend or colleague whom you trust in your treatment and recovery... This will result in you recovering much quicker. Would you like us to make contact with someone and would you like us to do this with you now?”

The Minister will agree that there is a huge difference between that and just asking someone whether their mum can be phoned. Will the Minister set out how she will raise awareness of the consensus statement?

[Jackie Doyle-Price]

I am grateful to the hon. Lady for her continued interest in this matter. She will recognise the cultural challenge of encouraging all practitioners in the NHS to embrace the change, because we quite rightly have a culture in which discretion is paramount. Practices are in place to encourage information sharing, and I highlight our support for the Zero Suicide Alliance—£2 million was provided last October—and central to its work will be spreading understanding of the consensus statement throughout the NHS.

[Nigel Huddleston (Mid Worcestershire) (Con)]

4. What steps he is taking to ensure that the NHS has sufficient staff to meet its long-term needs.

--- Later in debate ---

[David Warburton (Somerton and Frome) (Con)]

21. What steps he is taking to ensure the long-term provision of adequate mental health services.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

Under the NHS long-term plan, there will be a comprehensive expansion of mental health services, with additional funding of £2.3 billion a year by 2023-24. That will give greater mental health support to an extra 345,000 children, at least 380,000 more adults, and 24,000 more new and expectant mothers.

[Peter Heaton-Jones]

Across the country there is a real challenge in recruiting qualified mental health nurses. Will the Minister work with me and the Devon Partnership NHS Trust to encourage as many qualified professionals as we can to come to work at the excellent in-patient wards at North Devon District Hospital?

[Jackie Doyle-Price]

I completely agree with my hon. Friend; it is important that we have the right workforce in place. That is a considerable challenge, but it is essential if we are to achieve the best outcomes. I am pleased that the Devon Partnership NHS Trust has seen an increase of 47 mental health nurses between February 2010 and February 2019, which shows that it is doing exactly as he says and going out of its way to recruit the best possible people. That work must continue, as is recognised in our “Interim NHS People Plan”

[David Warburton]

I recently met representatives from Somerset’s NHS trust and its child and adolescent mental health services to look at young people’s mental health services and I heard some worrying stories of bed allocation. This has led to teenagers with mental health problems being moved out of the county, sometimes a huge distance from home, or sharing wards with very young children. So what is the Department doing to ensure that young people are not held in care for extended periods, which can exacerbate their difficulties, and that provision is sufficient for them to remain close to family and friends in an appropriate environment?

[Jackie Doyle-Price]

It is essential that we end the practice of out-of-area placements because, as my hon. Friend rightly says, being in close proximity to family and friends is clearly going to aid the recovery of anyone suffering from mental ill health. This has been a particular problem for children and young people, and a particular problem in the south-west, but I can report to him that NHS England is making sure that we have more adequate bed provision across the country, and we will continue to drive down these out-of-area placements.

[Dr Paul Williams (Stockton South) (Lab)]

Somebody is much more likely to need mental health services if they have experienced childhood adversity. The all-party group on the prevention of adverse childhood experiences has looked in detail at the evidence base on policies to prevent this adversity. What is the best thing the group can do to influence the Government’s prevention strategy?

[Jackie Doyle-Price]

I have to say, the hon. Gentleman does it very well: he continually makes noise about this important issue. He is absolutely right that adverse childhood experiences inform people’s future mental health, or mental ill health. We are currently looking at our provision for early years intervention and the first 1,001 days—the hon. Gentleman and I have discussed the importance of that—but we need to make sure that state organisations take advantage of every contact they have with children, to ensure that we pick people up when they are vulnerable.

[Melanie Onn (Great Grimsby) (Lab)]

My learning disabled constituent, who also has mental health and substance abuse issues, was placed in poor-quality housing and left without food and heating by a local care provider called Focus. What is the Department doing to ensure that subcontracted social care providers are fit for purpose?

[Jackie Doyle-Price]

The case that the hon. Lady mentions is clearly very concerning. It is for local authorities to make sure, when they commission care providers, that they are fit for purpose and discharge their responsibilities in the local care plan, but we also need to recognise that people with learning disabilities as well as mental health issues are particularly vulnerable. We need to make sure that local authorities and local NHS services work together more effectively to ensure that care needs are not neglected.

[Robert Courts (Witney) (Con)]

I was interested to see recent comments by the Secretary of State regarding the use of music to combat over-medicalisation—I should declare that I am married to a music therapist—so does that mean he shares my interest in the use of music therapy to combat mental health issues, as well as dementia and other conditions?

[Jackie Doyle-Price]

I am pleased that my hon. Friend has declared his interest in this matter. He is right that mental wellbeing is about not only clinical interventions but very much the kind of things that he describes—wider social prescribing. We cannot overstate the role of the third sector in giving wraparound support to people going through periods of mental ill health. I am giving clinical commissioning groups the clear message that they need to look at what else they commission in this space, alongside clinical interventions.

[Kerry McCarthy (Bristol East) (Lab)]

In Manchester on Saturday, people were giving away free “Unknown Pleasures” t-shirts, partly to mark the 40th anniversary of one of the greatest albums ever made. But, as anyone who knows the history of Joy Division will know, there is also the important related issue of male suicide and people were being encouraged to donate to charities, particularly those that work with young men at risk of suicide. I was sent one of the t-shirts, Mr Speaker, but I thought you might rule it out of order if I wore it. These charities obviously do great work, but they are trying to fill real gaps in the system. How can we ensure, when we consider long-term health plans and long-term mental health services, that there are not gaps that people fall between?

[Jackie Doyle-Price]

The hon. Lady articulates the issue extremely well. The purpose of local suicide prevention plans is very much to make sure that we have a joined-up approach to combating male suicide and to identify exactly where the gaps in the services are. The £600,000 that we announced yesterday for the sector-led improvement package is to enable local authorities to share expertise and to make sure that, holistically, they provide the leadership to make sure that the gaps are plugged. I am grateful for the hon. Lady’s interest in this matter.

[Paula Sherriff (Dewsbury) (Lab)]

This week, the Children’s Society published research to show that more than 110,000 children and young people were turned away from mental health services because their problems were not deemed serious enough—that is despite suicide rates for teenagers almost doubling in eight years and research from YoungMinds that shows that three quarters of parents feel their child’s mental health has deteriorated while they wait for treatment. Why are so few children able to get the support from mental health services that they so desperately need?

[Jackie Doyle-Price]

As the hon. Lady and I have discussed previously, I would be the first person to recognise that we are not where we would like to be in respect of the provision of mental health services, but that is why we are investing an additional £2.3 billion to expand access for children by 345,000. In addition to that, we are investing in a brand new workforce in all our schools so that we can have exactly the kind of early intervention that will not require more lengthy periods of care and treatment. It is essential that we equip all schools and young people with tools to manage their wellbeing.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

6. What recent assessment he has made of the effectiveness of the exception reporting process in the junior doctor contract 2016.

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[Mr Speaker]

Far too long!

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

I thank the Committee for its report, which follows the health ombudsman’s report on the tragic death of Averil Hart. It is clear that we have made significant improvements in eating disorder provision since then, but there is still more to do. We have made considerable progress with regard to treating children, and that progress now needs to be translated to the care of adults with eating disorders. My hon. Friend is right that it is the mental health disorder that has the highest mortality rate. At any one time, 1% of the population will be suffering from an eating disorder, and we need to make this more of a priority to make sure that services are available.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

rose—

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[Andrea Jenkyns (Morley and Outwood) (Con)]

The inquiry into the contaminated blood scandal, the biggest treatment disaster in the history of the NHS, is currently taking place in Leeds. What is the Department doing to compensate the victims of this scandal and to make sure their voices are heard?

[Jackie Doyle-Price]

My hon. Friend will wish to know that we are collaborating fully with the inquiry, and it has raised with us several issues about payments. We have made available an additional £30 million to give to those affected and will consider any conclusions the inquiry ultimately draws.

[Tonia Antoniazzi (Gower) (Lab)]

As the Minister will know, two weeks ago I went to the Netherlands with Teagan Appleby’s mother, Emma, to collect one month’s supply of medical cannabis. The Department laid down the requirements for Emma to meet with Border Force, and she met them by providing a UK prescription. Will the Secretary of State and Ministers meet me to ensure that there is no more ambiguity in a policy that currently criminalises parents in possession of a UK prescription bringing their much-needed medicine into the country?