Cass Review

Jackie Doyle-Price Excerpts

Monday 15th April 2024 Commons Chamber

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

The report is very welcome, but it has been a long time coming. One issue I would like to put to my right hon. Friend is the whole failure of governance that it shows. In particular, NHS England’s specialist commissioning requires challenge. As she explained, what was initially commissioned as a treatment course for a small minority of people has been allowed to expand unchecked and without any consideration of the ethics of what was being done to children. What will she do to ensure that does not happen again? Secondly, the Tavistock clearly enjoyed the popularity brought by being at the front end of what was seen as a set of cutting-edge treatments. Frankly, the governors allowed that to get in the way of what they should have been doing: ensuring patient safety. What does she propose to do about that as well?

[Victoria Atkins]

I thank my hon. Friend, who in her parliamentary career has done so much to shine a light on this sort of behaviour. She has espoused worries, both publicly and privately, about the children and young people at the heart of this matter. Looking to the future, the Tavistock clinic has shut. As I said, it stopped admitting patients a year ago. The new services that are already in place—the two new hubs, with plans to expand further across the country—are about ensuring a multidisciplinary approach to young people, so that, with exactly the experiences Dr Cass sets outs so starkly in her report, children are treated as human beings and patients, not as siloed conditions. One of the main problems that emerged with the Tavistock behaviour and the way it took place is that gender questioning was siloed in a way that no other health or mental health condition was. We want to move back to a place where clinicians are no longer scared of looking after children and young people with these issues, and that they see it as part of their general practice and general work. That is how we are best going to address the very complex needs of many of these children and young people.

Oral Answers to Questions

Jackie Doyle-Price Excerpts

Tuesday 5th March 2024 Commons Chamber

[Maria Caulfield]

As I have said, we have published our draft Bill, it has undergone pre-legislative scrutiny and I shall respond to the Committee’s recommendations shortly, but this is not just about legislative reform. As a result of the £143 million that we have invested in crisis support, we have already seen less use of the Mental Health Act 1983 because people are being seen earlier: our crisis cafés and crisis telephone services, for example, have led to a 15% reduction in the use of the Act.

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

It is a number of years since we promised to reform mental health legislation that reflects a time when people with severe mental ill health were viewed as problems to be managed rather than as individuals. I believe that we on these Benches, as Conservatives, should be doing everything we can to empower people and respect their liberties. It simply is not right that in the 21st century people’s health conditions are being managed through the forced administration of drugs, which pays no respect to their liberties. May I reiterate the urgency with which measures should be introduced, particularly as people with lived experience have relived their trauma to provide the benefit of their experiences?

[Maria Caulfield]

I absolutely entirely agree. That is why the Government published the draft Bill in January last year, and why it underwent pre-legislative scrutiny. I gave evidence to the Committee, and we are working our way through its detailed recommendations and will publish our response shortly. However, that is in addition to our significant reform of mental health services, particularly earlier intervention and crisis cafés. We have seen the impact of that: 15% fewer detentions under the Mental Health Act, 8% fewer admissions to hospitals and 12% fewer admissions from our mental health crisis telephone centres, which are now available across England 24/7.

Building an NHS Fit for the Future

Jackie Doyle-Price Excerpts

Monday 13th November 2023 Commons Chamber

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

My hon. Friend is making some compelling points. It strikes me that disposable vapes are often available at the point of sale where we used to find things such as chewing gum and packets of Polo mints. That makes it very easy for children to access them. Does she think that regulating point-of-sale products is a massive tool to tackle the problem? Let us remember that established tobacco companies have to have their multi-use vapes on sale behind the screens that tobacco is sold behind.

[Dr Johnson]

I completely agree that putting vapes where children can see them makes them more available and makes children want them more. That is why they need to be in plain colours and flavours and out of the sight and reach of children. My understanding is that that is part of the Government’s consultation, and I hope they legislate and make regulations as soon as they can.

Overall, the King’s Speech is a good one, and I am proud to support it.

--- Later in debate ---

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

It is not really surprising that, having spent two years of this Parliament with large chunks of the economy and the NHS shut down while we fought a disease, we still face challenges coming out of that. When I listen to speeches from around the Chamber, with the constant wish lists for more and more money, I think we all ought to remind ourselves of that. We should also remind ourselves that lots of people who run businesses up and down the country are being taken for granted, with additional burdens being put on them. They are carrying the additional debt that we, the guardians of the taxpayer’s pound, have taken on, given what we have spent. In fighting the pandemic, we have taken on what is, in effect, a wartime debt. We must recognise that that has consequences. We would all have been much better off and could have afforded to be much more generous with taxpayers’ money had we not been through that.

Let me focus on some issues that were included in the King’s Speech and some that were not. One issue that was not included is reform of the Mental Health Act 1983. I add my voice to those around the Chamber who have expressed regret about that. I was the Minister who commenced that work five years ago, and it is particularly personal to me, because we raised expectations that we really were going to deliver parity of esteem by changing the Act. The Mental Health Act was passed in 1983, an era when we viewed people with severe mental health issues as a problem to be managed. We all wanted to look the other way; it was not something we wanted to deal with.

We have seen a sea change in public attitudes towards that issue, and it was finally being recognised in government. It was a privilege for me to sit down with a lot of campaigners, who told me of their experiences. What makes it personal to me is that I witnessed them reliving the trauma that they experienced under detention. I feel personally responsible for the fact that, having raised their expectations five years ago, we have let them down by not legislating.

My message to those on the Front Bench is that the legislation, although it was not in the King’s Speech, could still be brought forward. I encourage them to do that, because until we do, we are not genuinely delivering parity of esteem. It is all very well saying, “We are putting more resources into schools and we are tackling suicide prevention,” but they are two different things. We need a proper approach to dealing with severe mental ill health that will enhance the rights of people who are having to be treated.

There are occasions where people need to have their liberty taken away, but it is not an absolute; they still have ownership over what happens to them. When we hear stories about people in detention being constantly medicated by drugs, that is not something that I equate with our society. It is important that the Government’s first priority is to make sure that they do their best for the most vulnerable.

Another item of legislation long-promised that was not in the King’s Speech was the ban on conversion therapy. I issue a word of warning to the House. It is clear to me that there is a majority in this Chamber for a ban on conversion therapy. It is also clear to me that every one of us, I would hope, would wish to see abusive and coercive practices designed to cure people of their sexuality banned or outlawed. The thing that bothers me is that when we are talking about these abusive and coercive practices, we use the term “therapy.” Therapy is designed to alleviate distress. The practices we want to outlaw cannot in any way be described in such a manner.

I have been pleased by the engagement I have had with Government and campaigners on all sides about how we get the language on this right. We have moved a long way in the right direction, but we are looking at abusive practices designed to cause harm. I know that lots of discussion is happening, but I say to those Members perhaps thinking about bringing forward a private Member’s Bill to resurrect the ban on conversion therapy: can we just remove this term “therapy” from anything designed to change people’s sexuality? We know that ultimately therapy should be used only to describe processes designed to alleviate distress.

Turning to some more local issues, I want to talk about the national health service in south Essex. For a long time, we have had a challenging position in south Essex. We sit right next to London. We know there are much more attractive places to work for NHS professionals when there are the great teaching hospitals in London. We have always found it difficult to recruit the staff we need in south Essex. In fact, in Thurrock we have been without enough GPs for decades. When we have an NHS dealing with the backlog caused by the pandemic and waiting lists, we are seeing some acute problems. I was drawn to an article in the press just this weekend, where I read that along the Thames—just a little bit down the road in Southend—as many as one in five people are awaiting treatment on a waiting list. I am sad to say that was not a surprise to me.

Going back to 2015, the Ministers at the time gripped the challenge with the provision of health in south Essex. Great focus was put on it. There was a proposal for developing the integrated care system. We looked closely at what made the best health economy, and there was recognition that improving primary care in south Essex should be a priority, but we seem to have lost that focus. My challenge is this: what has happened to our commissioning system for that to happen? We thought that moving towards ICSs would give a better focus, but it seems to have fundamentally failed.

Six years ago, as part of the process, my local NHS brought forward a proposal to close what remained of Orsett Hospital in Thurrock. That hospital ceased to be a general hospital decades ago, but it retains a great deal of affection among my constituents, mainly because most of them were born there. I took it upon myself to support my local NHS when it said that it wanted to close what remained of that hospital and reinvest it in new services in the community. I was prepared to take the political flak. It is difficult to deliver that message to constituents, but I believed the local NHS when it said that it would bring new facilities—it promised me an urgent treatment centre in Grays in my constituency, and three new integrated medical centres—but I have not received any one of those things in six years.

I took the flak and persuaded my constituents that that was in their best interests, and now I look a fool. That is basically because there is a circular system in the NHS commissioning system whereby lots of papers get produced but there is no actual delivery. We really do need to get to grips with that. When we raise issues about the NHS, people think, “How dare they criticise our doctors and nurses.” Actually, we are not; we are criticising failings in how services are commissioned. Every time we look at this, we never see any improvements.

In Tilbury, I am looking at the hoardings around a site where we will build an integrated medical centre—they have been there for two years. We have cleared the site and it is ready, but we are still getting that circular conversation with the NHS in south Essex. That really needs to change.

I will use the last bit of my time to talk about the covid inquiry and what it tells us about how Government works and what we should be doing with our institutions. It is really not very pretty, is it, to see some of the film that is coming out? As we move on from the King’s Speech and we are having a new Government assembled in front of us, we should reflect on some of the really bad behaviours being highlighted as part of the inquiry. In the last few years we have seen some very bad behaviour here in Parliament, as well as in relationships between Ministers and civil servants in Whitehall.

We should remember that the impartiality of our civil service is to be valued. The way in which our Governments have operated has given us stable government for decades. We have seen a massive expansion in the number of special advisers, which has led to the marginalisation of junior Ministers in this place and a subsequent lack of accountability. Here is where the action should be. Ministers are responsible to Parliament for what happens in their Departments, and special advisers seem to be breeding apace but doing nothing to improve the quality of that government.

Mental Health In-patient Services: Improving Safety

Jackie Doyle-Price Excerpts

Wednesday 28th June 2023 Commons Chamber

[Steve Barclay]

The hon. Gentleman raises an extremely important point, and he is right that a particular downside of out-of-area placements is often the distance from families. Indeed, one can see in the data that there is often a corresponding uptick in issues of harm. The crux of his point is very valid. That is why we are committed to building new facilities, with three new hospitals for mental health announced in the statement I gave on the new hospitals programme; that included three new mental health ambulances. This is also about preventing people from needing in-patient care through our crisis cafés, our earlier intervention in community services and the interplay with 111. More fundamentally, it is about giving greater power to commissioners on a place-based basis. The reforms through integrating health and social care, having fewer targets from the centre and allowing more devolved decision making mean that those areas that want to put more money into in-patient mental health, for example, have greater flexibility to do so. The point the hon. Gentleman raises is extremely important and it is exactly what we are facilitating.

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

As my right hon. Friend observed, a non-statutory inquiry is generally more fleet of foot than a statutory one. It is so disappointing that the failure of staff to engage in that process has brought us to where we are now. That would indicate a very poor culture and sets the tone for how this inquiry will be taken forward. Let me remind him that one reason we are so anxious to get the Mental Health Act reformed is that kind of behaviour towards patients. Too many in-patient settings see patients as an inconvenience to be managed, rather than having their real welfare at heart. Will he therefore redouble his efforts to make progress on this, because many people who have been through the other side want to see that progress?

[Steve Barclay]

First, I do not want to wait for legislation before we make changes. Indeed, under the leadership of Paul Scott, who joined EPUT in 2020, investment has been made, with an extra £20 million being put into the in-patient wards and a further £20 million into community services. We are keen to make further progress on that. On the wider issue of legislation, I know that my hon. Friend, as a former Government Whip, is particularly acquainted with how the legislative process works, but the Government take her comments, and those of the House, on engaging staff in this process seriously, and we are working very actively on that.

Recovering Access to Primary Care

Jackie Doyle-Price Excerpts

Tuesday 9th May 2023 Commons Chamber

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

I congratulate my right hon. Friend on his announcement on pharmacy, for which I have been calling for a number of years. We ought to be making more use of this massively skilled body of medical professionals, particularly to free up GPs. For many people, they are the front door to the NHS more than the GP surgery is. Could he confirm that, for the additional work that they will be doing to support our NHS, they will get some reward?

[Steve Barclay]

First, I commend my hon. Friend because this is an issue that she has championed and she has been right to do so. These are degree-qualified clinical roles, so it is sensible that we make far better use of the skills that they offer. We saw during covid just how much value they offer to their communities. I confirm that they will be paid for these roles; that is what the additional funding is all about. She has been right over the years to highlight the importance of pharmacies and what they can offer, and that is what this announcement is all about.

Women’s Health Strategy for England

Jackie Doyle-Price Excerpts

Wednesday 20th July 2022 Commons Chamber

[Steve Barclay]

We are already doing so on things such as the 75 family hubs that we have put in place. Again, a key part of this strategy is to then look at having women’s hubs, particularly in those areas where there is greatest disparity.

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

I welcome my right hon. Friend to his place and the appointment of Dame Lesley Regan as the women’s health ambassador. I know them both to be very passionate and outcome-focused, and, between the two of them, I hope that we will make some headway. He rightly talks about how women do not feel listened to, and we know that women go for many years suffering from very common gynaecological conditions that do not get diagnosed. What role does he think that more public health education about healthy menstruation and what constitutes a healthy period can play to make sure that women are more empowered to look after themselves and get treatment earlier?

[Steve Barclay]

I thank my hon. Friend for her warm welcome. I agree with her about empowering patients, women in particular, with information. That is why part of the strategy is to focus on the information provided on the NHS website. There is also the need to work with trusted partners—to look at where people go for their health information, and how we can better empower them. For example, in the consultation, we heard of patients being told that heavy bleeding was normal—that it was something that they had to accept. Again, that was an issue highlighted by respondents in the call for evidence. It is about making sure people realise that, where there are issues, their voices are heard. That is at the heart of the strategy that we have set out.

Endometriosis and Polycystic Ovary Syndrome

Jackie Doyle-Price Excerpts

Monday 1st November 2021 Westminster Hall

[Taiwo Owatemi]

I thank the hon. Lady for raising an important point. We absolutely need funding for holistic care for both endometriosis and PCOS, especially for mental health support.

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

The hon. Lady is articulating the case extremely well. Does she share my opinion that one reason the conditions are looked at only from the perspective of their impact on fertility is that the medical establishment too often views women’s biology purely from the perspective of incubating babies, and does not think enough about the impact on general wellbeing?

[Taiwo Owatemi]

I thank the hon. Member for raising such an important point, which I will come to later. I know from speaking to many healthcare professionals that some are passionate about endometriosis and PCOS but would like more funding and support, so that their colleagues and all within the medical profession get the necessary medical education in their curriculum.

Endometriosis and PCOS are about so much more than having difficulty conceiving, but funding decisions made by Whitehall treat them as though they are not. That is why it is so upsetting, but unsurprising, that the Government response to the petition discussed funding for fertility treatments. In fact, when most young women start to see symptoms at puberty, pregnancy is the furthest thing from their mind.

With that in mind, I will talk about a constituent of mine, a 14-year-old girl who was ostracised and relentlessly bullied by her peers for her excessive facial hair and acne and for weight-related reasons. She experienced such debilitating pain in her lungs and lower abdomen that she was hospitalised during a GCSE exam. After five years of calling hospitals, three painful exploratory surgeries, countless GP appointments and several specialist referrals, she was finally diagnosed with endometriosis and PCOS. The only treatment her GP could offer her was generic birth control pills, which no evidence-based studies confirm as definitive treatment for either disease.

--- Later in debate ---

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

May I associate myself with your words, Mr Mundell, and with the words of the two previous speakers in regard to Sir David Amess, who was a great personal friend of mine? I was so happy to be able to work with him on this cause. He brought to it his characteristic passion and commitment, and frankly, he was good at keeping us all on the ball. We will miss his leadership, but we will endeavour to make sure that the points he campaigned for are delivered. As has been mentioned, he took up this issue when he was visited by his constituent, Carla Cressy. The cause is one of the main beneficiaries from the sales of his book, “Ayes & Ears”, which is available in all good bookshops; I encourage everyone to make their donation there.

As the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) has outlined, Sir David led an inquiry for the all-party group on endometriosis. As many as 11,000 members of the public got involved in it, and that is quite an achievement for an all-party group. It is a testament to the fact that he always used good publicity to draw attention to the issues that he really cared about.

For a condition that affects 10% of women, there has been staggeringly little focus on endometriosis. If something affected 10% of men, would we be having this kind of debate? I think not. We really owe it to all the women who suffer for years with the most debilitating and chronic pain and disability because of this condition. I am grateful to the hon. Member for Coventry North West (Taiwo Owatemi) for mentioning the obsessive focus on fertility, because the truth of the matter is that women who suffer from endometriosis start to suffer from it the moment they start their periods.

We could do so much if we had a greater understanding of what a healthy period is. We are all brought up to think, “This is your lot in life; it’s all quite normal.” We might be struggling with the most debilitating pain and thinking that everybody else is going through the same thing, when in fact they are not and we are suffering from very unhealthy periods. We need much more understanding not just in the medical profession, but among girls, so they can be more alive to problems and not wait eight years for a diagnosis. As the hon. Lady said, endometriosis is often diagnosed only when women are trying to get pregnant, by which time so much damage might have been done. If the condition had been diagnosed earlier, treatment could have been given to alleviate it.

We often talk about funding, and one of the biggest challenges in the NHS is not so much the quantum of funding but whether we spend it wisely. If we gave people tools to look after their conditions and enable them to know when they are suffering from ill health, we would reduce the amount that the NHS has to spend on the condition. It is a no-brainer. I am pleased to see the Minister in her place. She has had to listen to me bang on about these issues many times—I never miss an opportunity to beat Ministers over the head when it comes to women’s health—but I know she gets it.

We need to think properly about the wellbeing of women, and the impact that their biology and gynaecology have on wellbeing, and we must think beyond childbirth and pregnancy. Only last year Baroness Cumberlege produced her report “First Do No Harm”, one of the headline conclusions of which was that women are not heard. When women seek medical advice, they are belittled, diminished, shunted along and told, “This is all very normal.” That must stop, because women are important. Women will have healthy pregnancies if they get support earlier. We will all be better off, because we will have less work absence, a more productive economy and less demand on the NHS. It is a no-brainer. I ask the Minister for more research into endometriosis and more awareness so that people can be diagnosed earlier.

[David Mundell (in the Chair)]

I will now impose a formal time limit of three and a half minutes on speeches.

Menopause (Support and Services) Bill

Jackie Doyle-Price Excerpts

2nd reading
Friday 29th October 2021 Commons Chamber

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

It is a great pleasure to follow the hon. Member for Swansea East (Carolyn Harris), who has given a tour de force presentation of her Bill. She brings her characteristic charm and leadership with which she approaches all her campaigns. I am sure that when she was drawn at No. 3 in the private Members’ Bill ballot, the Government gave a collective intake of breath and thought, “Oh, my goodness! What is she going to bring in?” She has used that position to bring forward a Bill on a very important subject, which, as she says, affects 51% of the nation’s population. I am hugely grateful to her, not least because I have been banging on about exactly these subjects myself for a while. She is quite right when she says that there has been barely any reference to this debate or these issues in Hansard. Dare I say it, but that is because for a long time there just were not enough women in this place.

[Thangam Debbonaire (Bristol West) (Lab)]

I thank the hon. Lady for giving way on that point, because this point was burning inside me while I listened to my hon. Friend the Member for Swansea East (Carolyn Harris) making her fantastic speech. Does the hon. Lady agree that this debate is one of the benefits of a truly diverse Parliament? Any time anybody asks us why it matters that there are more women in Parliament, here we have it—this debate would not have happened without more women being in Parliament, with all of our diverse experiences, alongside our male allies. Does she agree?

[Jackie Doyle-Price]

I could not possibly disagree with that. The really sad thing is that it has taken a century of women having the vote to get to a critical mass where we can now finally discuss these things. I hope that we will make up for lost time. This Bill is a very important one.

One of the most important things that this Bill will achieve is that society will start taking these subjects seriously. There is so much about women’s health that has been taboo for a very long time. I have spoken a lot previously about problem periods, and about the fact that endometriosis continues to go undiagnosed, causing massive problems for women and girls who suffer with it. It says everything. Again, one in three women suffer fibroids. We all think that it is normal. We all think that this is what a woman’s lot is, and we are encouraged to suffer in silence, and it really should not be that way. It is interesting to make that observation in the wake of the Cumberlege report, “First Do No Harm”, which, obviously, looked at these issues from the perspective of vaginal mesh.

Over and over again, we see the same issues raised. Women are not heard. The quality of conversations that women have with their medical practitioners is just not good enough. Too often, women feel fobbed off. That struck me when I was a Minister in the Department of Health and Social Care. A number of female colleagues would share with me their experiences. I just thought, “For goodness’ sake, we are pushy, opinionated women who are elected to this House! If we are not being heard, then God help the rest of the female population.” It is really important that we shine light on what can be expected. As the hon. Member for Swansea East so eloquently explained, presenting to a GP with symptoms, which ended up with her being sent away with a prescription for anti-depressants for something that all women will go through just is not good enough. I cannot believe that we are still having this conversation. The more that society in general understands what comes with menopause, the more that we will be able to have those sensible conversations and the more that we will be able to manage our conditions well. We must acknowledge this throughout society. We have to start in schools and make sure that everyone understands the life course around women’s health and what they will go through.

[Sara Britcliffe (Hyndburn) (Con)]

I thank my hon. Friend for giving way and the hon. Member for Swansea East (Carolyn Harris) for bringing this Bill forward. On educating people, one of the first times that I actually understood this issue was as a result of this Bill, so it is key for women and men to learn about the subject at a young age so that we can go forward.

[Jackie Doyle-Price]

My hon. Friend puts that extremely well. The fact of the matter is that, even as women who are well-informed and interested in this subject, we still do not necessarily know what to expect. It is also the case that boys and men need to understand these things too.

Hon. Members will know that I chair the all-party pharmacy group and I can advise the House that the National Pharmacy Association is fully in support of this Bill. It fully supports the exemption of HRT from prescription charges. It also expressed its willingness to play a much bigger role in terms of the education and support of women going through menopause. We know that, a lot of the time, the conversations that patients can have with their pharmacists are less intimidating and less formal than those they might have with their GP. Again, lots of things are available over the counter that can help alleviate the symptoms of menopause, but also a lot of advice can be given about generally looking after wellbeing. I say to the Minister that I know that pharmaceutical bodies will be very keen to play their role in making sure that there is a much wider understanding and in giving more support to women going through the menopause.

My hon. Friend the Member for Devizes (Danny Kruger) raised the important issue of the half a billion pounds of potential waste of prescriptions. We must make better use of pharmacists to review prescriptions, because they often tend to know more about the drugs that are being dispensed than thfe GPs who are writing the prescriptions. If we can play a better role in enabling pharmacists to review the prescriptions that their patients are presenting to them, we might go a long way to making those savings and getting more bang for our buck from the billions of pounds that we spend on our NHS. I encourage the Minister to look constructively at that suggestion, because the issue of misdiagnosis and the cost of drugs is significant.

The hon. Member for Swansea East has raised the issue of vaginal dryness. That leads me to make the observation that if we had applied as much attention to vaginal atrophy as we had to erectile dysfunction, we would be much better off—wouldn’t we? I cannot help but come to the conclusion that if this were happening to men, we might be in a better place. Look at what happened when Viagra was invented: within a year, it became available over the counter. That really begs the question of whether women are being treated fairly in this context. It does not feel like it to me. Again, I am sure that the Minister will be quite sympathetic to that point.

I ask the Government to look constructively at that issue, because we could liberate some of these drugs and make them more available over the counter. We have recently made the mini-pill available over the counter, which is really important given that one in three pregnancies is unplanned, and increasingly those unplanned pregnancies are women in their 30s, rather than teenagers. We have got to the right place when it comes to making contraception more available over the counter, but it took an awfully long time—much longer than making Viagra available over the counter. We must take these matters seriously.

On the subject of vaginal atrophy, I pay tribute to my constituent Sue Moxley. Sue used to be the beauty editor of The Sun. She is now better known for being the singing partner of her husband, David Van Day. She has spoken very publicly about her issues with vaginal atrophy. Again, she echoed the point that it happened to her completely unexpectedly. She was not prepared for it at all and it was incredibly difficult for her to find out information about what she was going through. In the end, having had a number of referrals, she experienced a direct laser-based treatment from Italy to improve the supply of collagen to the vagina, and it was transformational. I ask the Minister to look at that treatment. It is a direct physical treatment; it will not suit everybody, but neither does HRT. We have to ensure that we have a diverse range of treatments available, depending on people’s conditions, because, as the hon. Lady mentioned, everyone’s experience of menopause is very different.

One other issue that Sue raised with me was that it was suggested to her that women who have not experienced childbirth tend to suffer menopause worse. That raises another question, because if that is true, women should all know about it. There is lots about our life courses and experiences that will impact our health, but I would suggest that not enough research is being done into these things. For 51% of the population, I think we deserve better, so I encourage the Minister to look at that.

I have a few final points. The hon. Lady mentioned that HRT has had a bad press. A study in—I think—2001 suggested an increased risk of breast cancer as a consequence of HRT. In fact, that increase was very small, and the impact that study has had on women’s wellbeing has been far more damaging. Let us look at what goes on further through life. If more women were encouraged to take HRT, there would be massive savings for the Government. When we look at social care and why people go into residential care towards the end of their lives, we see that one of the biggest causes is falls and frailty. If we could encourage more women to take HRT—if it suits them—we would have fewer problems with osteoporosis and the injuries that lead to it. It makes perfect sense—we are spending to save.

[Tom Randall (Gedling) (Con)]

I join my hon. Friend in her congratulations to the hon. Member for Swansea East (Carolyn Harris). It was Teresa Gorman who said:

“HRT keeps you out of hospital, out of an old folks’ home and out of the divorce courts.”

Does she agree that it is surprising that one third of women who visited a GP were not made aware of HRT, and that greater awareness of it will help improve women’s health?

[Jackie Doyle-Price]

My hon. Friend puts the point so well: it is incredible that so long after the former hon. Member for Billericay was making her campaign, we have not moved on—we have almost stalled. However, the hon. Member for Swansea East is turbocharging it so that we can make up for lost time. From a Government perspective, it is frankly a false economy not to make HRT more widely available.

The hon. Lady made the crucial point that there is not enough training of medical professionals about these issues, either. That must be addressed as a matter of urgency. I fully support the Bill and congratulate the hon. Lady and all the campaigners she has worked with to get us to this place. It is clear from the mood in the Chamber that the House is with her, and amen to that! Women are back in charge.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a privilege to speak in the debate, and to follow the right hon. Member for Romsey and Southampton North (Caroline Nokes) and the other Members who have spoken so far. I think that by speaking out about the menopause, Members on both sides of the House, women and men, will be giving a voice to 13 million menopausal and perimenopausal women in the country whose needs have been downplayed or ignored for too long.

I must begin by paying tribute to my hon. Friend the Member for Swansea East (Carolyn Harris), a phenomenal campaigner who is working across party lines, and with organisations up and down the country, to push this agenda, make a practical difference to women’s lives, and get the job done. I am very proud to stand alongside her today.

I feel that at this point I should make a personal declaration of interest in this topic, as many of my colleagues have already done today. To be honest, I am not really sure when the symptoms first started, but they have been building steadily over the last year—the truly terrifying sense of anxiety and panic that I had never experienced before; feeling completely exhausted, sore and aching all over, wondering in the evenings if I could make it up the stairs to go to bed, let alone do the exercise that has always been such an important part of my life; the itching, the hair loss, and just feeling downright low; and above all, what I can only describe as the catastrophically bad sleep, night after night. I would finally emerge in the morning drenched with sweat, thinking, “How on earth am I going to make it through the day?”

Like so many other women, I had absolutely no idea what was going on. I thought that there could be reasons for each of those symptoms individually, but together they felt overwhelming. 1t was only when a friend of mine recommended that I check out the MegsMenopause website that the penny finally dropped. This was something real, something really was happening, it had a name, and there was something that I could do about it that might start gradually getting the old me back.

[Jackie Doyle-Price]

I thank the hon. Lady for being so honest and open about this. She has just said that she did not know what was happening to her. Given that she is an intelligent, well-informed woman, does that not illustrate the importance of better education about this condition?

[Liz Kendall]

Absolutely. I must be honest: I was in a quandary about whether I was going to say anything today, but, like the hon. Lady, I thought, “If we in this place, with the power, influence and authority that we have, are too nervous to speak out, what does that say? “ We need to be leaders and champions, and I hope that we are all making a small contribution to that today.

I must say that I have had a very good experience with my GP. Two weeks ago, I did an online survey. A few days later, I had a phone consultation and I got my first HRT prescription last week—ironically, on the same day as the Backbench Business debate on World Menopause Awareness Month—but I know that millions of other women are nowhere near as lucky. Almost one in 10 women have to see their GP more than 10 times before they get proper help and advice. Two thirds of women suffering low mood or anxiety, like my hon. Friend the Member for Swansea East, are wrongly given antidepressants instead of HRT, often for many years. Around one in three women will end up having a hip fracture due to osteoporosis unless they take HRT, as was rightly mentioned by my hon. Friend the Member for Bradford South (Judith Cummins).

The objectives at the heart of this Bill—to raise awareness of the menopause, to make it easier for women to access HRT and to improve the education and training of health professionals—are absolutely essential. I hope when the Minister rises to speak, she will set out the steps her Government will take to make these goals a reality, because frankly, getting women the right diagnosis and the right treatment at the right time is a no-brainer. It is better for women and it is better for the taxpayer, because it will stop women having to have lots of unnecessary doctor’s appointments. It will stop them being put on the wrong medicines for years, leaving the real issue untreated and undiagnosed, and it will reduce the likelihood of women getting conditions such as osteoporosis when they do not need to, which can lead to much more serious and expensive NHS care, such as hip and other operations.

There is lots more I could say on that issue, but I want to use the remaining time I have to talk about the impact of menopause in the workplace, an issue rightly raised and championed by the right hon. Member for Romsey and Southampton North. There are currently more than 4.3 million working women aged 50 to 64. We are the fastest growing group in the UK workforce, often at the peak of our experience, with all the skills and talent that that brings, but 80% of women say that the menopause has affected their working lives.

Around 14 million days are lost at work every year due to menopause, and a quarter of menopausal women at work find the symptoms so debilitating that they are considering reducing their hours, changing their working patterns or leaving the workplace altogether. Women lose their income and careers, businesses lose their talent and the Treasury loses their taxes. Where on earth is the sense in that?

The fundamental problem is that the vast majority of women are too embarrassed, worried or frightened to speak out or discuss the issue with their bosses or line managers. I think the reason for that is the double whammy of sexism and ageism. If a quarter of men in their 50s were considering quitting work or reducing their hours, you can bet your bottom dollar that it would be at the top of the workplace agenda and a solution would pretty quickly be found. Women should not have to suffer in silence. We have to remove the ignorance and stigma about the menopause. It is not a women’s issue or a private matter, let alone a joking matter; it is a mainstream, no excuses, no ifs or buts workplace issue, and it must be addressed. Again, I hope when the Minister rises, she will set out the steps her Government intend to take on this vital issue.

In conclusion, Members will know that I have never been one for revolutions, but on this issue I make an exception.

Covid-19 Update

Jackie Doyle-Price Excerpts

Monday 14th June 2021 Commons Chamber

[Matt Hancock]

The hon. Gentleman refers to political point scoring, and then makes points that he knows are not supported by the facts. As I have said to this House before, when the decision was taken on the 2 April change to put Pakistan and Bangladesh on the red list, test positivity of travellers returning from Pakistan was 4.6%—three times the 1.6% positivity of returning travellers from India. Those are the facts—the basis on which the decision was taken. I am not quite sure, but I think the hon. Gentleman asked at the end of his question whether we can now take those countries off the red list and put them on to the amber list. I do not support that approach, because it is important to keep this country safe.

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

My right hon. Friend will understand my dismay because, as we have discussed between ourselves, economic harm and the sustainability of businesses is a real concern of mine. I worry about the distress that this announcement has caused. Let me take one particular sector of international travel businesses: cruises. The cruise industry has been closed for international sailing for more than 15 months, and there really needs to be clarity if we are going to save the sector, which supports 90,000 jobs and is worth £10 billion a year to the British economy. I ask my right hon. Friend to really make it clear to the chief medical officer that the cruise industry needs its own road map to be able to embark on international travel again.

[Matt Hancock]

My hon. Friend makes a strong and important point. I get the impact on business—of course I do—and especially on international cruises. I am glad we were able to work with the cruise industry to get some domestic cruise trips going again, admittedly in a small way, essentially to pilot it. It is more difficult on an international front. I am very happy to work with her and my right hon. Friend the Transport Secretary on what more we can do.

Covid-19: Community Pharmacies

Jackie Doyle-Price Excerpts

Thursday 11th March 2021 Westminster Hall

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

I beg to move,

That this House has considered community pharmacies and the effect of the covid-19 outbreak.

It is good to have you in the Chair for this important debate, Sir Graham. It is an honour for me to chair the all-party parliamentary group on pharmacy, not least because so many colleagues are big fans of the pharmacy sector. I am pleased to be introducing this debate this afternoon and to see so much support from Members who recognise the huge contribution that our community pharmacists have made during the pandemic. They are the front door to the NHS, and their doors have never been closed throughout the last year. We are all very grateful to them.

That contribution has not been without consequences for pharmacists, both financially and in terms of their own personal wellbeing. This debate is a chance for me to make a plea that the Government and the NHS fully appreciate the contribution made by our community pharmacists and ensure that they are recompensed adequately for it. Pharmacists can play a much fuller contribution to primary care, as they have shown over the past year, and they should be supported to do so.

Let us look at some figures. According to the Pharmaceutical Services Negotiating Committee, community pharmacists dispense 1 billion prescription items every year. They deliver healthcare advice at a rate of 48 million consultations a year. To put that in context, that saves nearly half a million GP appointments and 57,000 A&E visits every single week. That, by any stretch, is a service that is offering good value for money, and it deserves better support from us.

Community pharmacies are part of the NHS family. We often talk about “our NHS,” but what do we actually mean by that? Quite often, people think of our hospitals, and the doctors and nurses who work in them. For me, the NHS is every single person who works in dispensing health services, be they a nurse or paramedic working in a hospital trust, or somebody working independently, either as a GP or a pharmacist. We must ensure that whoever they are and wherever they are employed, if they are delivering NHS services, the NHS should ensure that they are adequately recompensed for it.

I am pleased to see the Minister in her place. I am preaching to the converted, frankly, as she is a huge supporter of pharmacists. I know that the contribution made by the sector over the last year has not gone unnoticed by her. Those working in the sector have also felt well supported by the recognition they have received from the Secretary of State for Health and Social Care and the Prime Minister. It is a level of support they are not used to and they are grateful for it, but perhaps now is the time to look beyond words of thanks and see that reflected in deeds.

I am sad to say that while the sector is getting that support from Ministers, it does not always get it from the machinery of the NHS or from the Department of Health and Social Care. The truth is that there are some people in our health establishment who view pharmacists as nothing more but glorified retailers. They are not. They are medical professionals who go through a substantial amount of training, and they do not all work for Boots and Lloyds. Most of them work independently, in small shops on our high streets, in the heart of our communities, and for those, 90% of their income comes from the NHS.

I am sad to say that I attended a discussion in which a DHSC representative asked, “Why can’t pharmacists earn money from other sources?” My answer to that is, “Why should they?” They are providing medical services. We have a contract with society that the NHS will meet the cost of those services, and the pharmacy sector should not be expected to go scrabbling around for other business to subsidise work that is done for the NHS. That is not the deal, and I think we need to properly take that on. Their fundamental business is the dispensing of prescriptions, which is an integral part of delivering an NHS that works for all patients. The NHS therefore has a duty to ensure that it is supporting a functional community pharmacy sector. It is not the job of independent providers in our pharmacy sector to be subsidising their NHS work through what they can sell. That is fundamentally not the ethos of our national health service.

As such, I am very clear that we need to put our pharmacists on a more secure financial footing if we are to maximise the use of this sector in delivering good primary care services, and we need to look at how it is supported and how it sits with GP services in our primary care system. My challenge is for DHSC and the NHS to look properly at whether, and how, they can make sure that pharmacies get a fair deal. It is fair to say that our pharmacies are held in very high esteem by the patients who use them. That has been especially true during the pandemic, when patients often found that their pharmacy was the only ready source of advice.

Our 11,500 community pharmacies have been open every day for every single one of us, but that has not been without real costs, as I mentioned. Our pharmacists today are facing debts simply because they stayed open. They had to supply their own personal protective equipment. They had to invest in keeping their shops covid-secure. They had to deal with staff absence due to sickness or self-isolation, and they had to deal with the increased wholesale prices of medicines.

To be fair, like most of the NHS, community pharmacies did receive funding to ensure that they could remain operational, but that was only ever advanced as a loan that needs to be paid back. That is now threatening the operation of some of our pharmacy businesses—as many as one in five, as estimated by Ernst and Young. It simply cannot be right that, in stepping up to the challenge posed by the pandemic, some pharmacies have unwittingly crippled their businesses, as the additional costs are not being properly reimbursed.

The covid pandemic has highlighted that we are long overdue a conversation about the role of pharmacy and its place in the NHS, and the all-party group stands ready to play its part in having that debate. Central to this will be the following principles. First, pharmacies can play a fuller role in primary care. GPs will face additional pressures as we come out of the pandemic. Pharmacies can give that support, but they should be properly supported in doing so.

Secondly, we will be living with covid forever, and it looks as if regular vaccination will become as big a part of our lives as the flu vaccine. I really want to see pharmacists fully engaged in that. There has been disappointment with the number of pharmacists engaged so far, which I think is due to constraints on the supply of the vaccine, but I hope that will be properly addressed as we go forward.

Thirdly, we need a plan to deal with the £370 million loan to the sector. To be brutally frank, when we look at the sums given to other areas of the economy, and indeed to the NHS, our pharmacies can be forgiven for feeling a little hard done by. It will mean curtains for some businesses that acted in good faith after being promised that the NHS would receive all the money it needed to fight the pandemic. No pharmacist should be out of pocket for stepping up to this challenge, and we really do need to look very closely at this. Fourthly, we need to make this sector understand that it is valued, and we should encourage people to work in it.

To end, I can advise the House that the all-party parliamentary group on pharmacy held an inquiry in December in which we surveyed the opinions of pharmacists. We found an overstretched workforce responding heroically to the challenge of a pandemic, with an attitude of doing what needed to be done, and I salute them for that. The survey also told a story of businesses being saddled with debt for doing the right thing, and it found a workforce who felt undervalued and burnt out by the professional pressure they faced. Let us have a conversation about how we secure our finances for the future. Let us properly thank pharmacists for everything they have done to support us in the last year. If we do not, we will miss them when they are gone.

--- Later in debate ---

[Jackie Doyle-Price]

No one watching this debate could be left without the impression that our pharmacists are regarded with huge respect and affection, not just by Members of Parliament but by our constituents. We heard the Chancellor say that the NHS will get everything it needs to fight the pandemic, but it is fair to say that some of us feel that pharmacists have perhaps not been treated as fairly as they should be. I recognise that that is fully connected with the future sustainability of pharmacy, and I look forward to having this debate again in due course.

Question put and agreed to.

Resolved,

That this House has considered community pharmacies and the effect of the covid-19 outbreak.