NHS Long-term Plan

Lord Beamish Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

My hon. Friend makes an important point. Things like the daily mile, which I have participated in, are an incredibly important part of this. Prevention is about public health and the whole NHS, but it is also about more than that. We talk a lot in the House about the rights that the NHS gives us—the right to care that is free at the point of use, according to need—but we also need to talk about the responsibilities that we have, including the responsibility to use the service wisely and the responsibility to ourselves and our communities to keep ourselves healthy. That part of the debate needs to continue and be strengthened, at the same time as ensuring that the NHS is always there for us.

[Mr Kevan Jones (North Durham) (Lab)]

Under the Government’s public health proposals, County Durham will lose 38% of its budget—or £19 million. The Secretary of State said that we should be listening to clinicians. Clinicians in County Durham are clear that they want that budget protected. Can he tell me what those clinicians are missing? Is it not a fact that this Government are quite clearly going to remove money from deprived areas such as County Durham, while more leafy areas, including Surrey, have an increase in their budgets?

[Matt Hancock]

That is obviously not right. Indeed, there is a whole section of the plan on reducing health inequalities, which is extremely important.

Mental Capacity (Amendment) Bill [Lords]

Lord Beamish Excerpts

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[Matt Hancock]

The hon. Lady is not quite right about the three-year period, because there are review points, meaning that it involves a twice-possible one-year extension, so she is not quite right about the relationship between that and what happens under the Mental Health Act. However, she makes an important point about the links between the Mental Capacity Act 2005, this Mental Capacity (Amendment) Bill and the mental health Bill that we propose to bring forward.

We considered putting the two Bills together, but we did not do that for two reasons. First, it would simply be a big Bill that included two separate regimes, and we would not want the full Mental Health Act powers to be applied across the board, and I think there is a broad consensus behind that. Secondly, the view of Sir Simon Wessely, who ran the review into the Mental Health Act, is that we need to get on with this while taking the time to get the Mental Health Act update right. Combining the two was seriously considered, and I considered it again when I became Health and Social Care Secretary and asked for further advice, but we came to this conclusion, which I hope the hon. Lady will support.

[Mr Kevan Jones (North Durham) (Lab)]

I do not disagree with Sir Simon Wessely’s conclusions about that, but the review does contain suggestions that could be transferred into this Bill. For example, the use of tribunals instead of the Court of Protection in some cases would make them a lot simpler, cheaper and better for the person involved.

[Matt Hancock]

The right hon. Gentleman is quite right. To start to deal with the serious number of cases that we need to make progress with, the interface between this Bill—hopefully on the statute book by then—and the Mental Health Act provisions will be considered as we develop the draft mental health Bill. The truth is that the current system causes unnecessary suffering, and the case for reform could not be more urgent. That is why we are bringing forward this Bill now. Age UK, the UK’s largest charity working with older people, says we have a crisis in the current system that is

“leaving many older people with no protection at all… If we lose this opportunity we’re unlikely to get another one in this Parliament and it is profoundly unfair on the older people and their families…to have to wait any longer…doing nothing is not an option.”

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[Mr Kevan Jones (North Durham) (Lab)]

We judge a civilised society by how it treats its most vulnerable citizens, so getting this legislation right is vital. My hon. Friend the Member for Stockton North (Alex Cunningham) said, “There by the grace of God go we all,” and I agree: we could all find ourselves or family members involved in this. The right hon. Member for North Norfolk (Norman Lamb) raised the issue of the Cheshire West case, which demonstrates that we do need change because we have got people whose human rights are being denied at the moment. It is not the case, therefore, that we can just do this at our leisure.

Is the Bill flawed? Yes, in its current state it is, but change needs to happen among the voluntary sector and others and we need to put some principles behind this, and one of them must be putting the person at the centre of the legislation. We should also only use these measures where there are no alternatives; they should not be used as a recourse of first resort or for financial or convenience reasons.

The review of the Mental Health Act 1983 introduced the least restriction principle and that should be written into this Bill. It is also key to ensure that individuals and families not only know their rights, but have access to them. Also, the length of detention should be kept to a minimum, and certainly kept under regular review. The care plans of individuals must be kept up to date with the individual’s situation, too. The access of individuals and families to independent medical advocates must be a central part of this Bill as well, and if people do not have family or relatives an independent advocate should be appointed to them automatically. The possibility of conflicts of interest has been raised and I am not yet happy that this Bill addresses that. There are issues that need to be looked at. Referring to the Mental Health Act again, having second opinions is important; we must tighten that up in this Bill.

A lot of this could be covered in the code of practice. The Government have not yet produced that, and it needs to be produced before the Bill goes any further. It would also be important for it to be incorporated into the Bill.

Reference has been made to the interface with the review of the Mental Health Act. I have read it and know Simon Wessely, and he is clear in that report that he does not want this legislation held up, and he does not think that fusing the two Acts would be a way forward. He makes a suggestion on how to use the two Acts: for objection we use the Mental Health Act, and for not having capacity we use this mental capacity Act. He also deals with the issue of cases that cover both, offering some ideas around tribunals and judges and court protection. I would also like the Minister to address the issue around 16 and 17-year-olds and how this interplays with the Children Act 1989 which gives certain rights to parents.

The right hon. Member for North Norfolk said that the situation needed to change, because people are now being detained who are not having their human rights observed. I have to say that I agree with him, and that is why I cannot support the reasoned amendment. Throwing the Bill out at this stage would be a huge mistake. I plead with the Minister to look at a number of things. The delaying of the Committee stage that the right hon. Gentleman mentioned would be important, and I believe that we should extend the sittings of the Committee if we need to. We ought to take as much time as possible in Committee. With good will, we can get there.

Is the Bill perfect? No, it is not, and I am not happy with it as it is outlined, but we can get some changes into it. I know that the Minister is an advocate for the sector and that she is passionate about doing the right thing, and it is not beyond the wit of man or woman to get to where we should be. To throw the Bill out at this stage would be a mistake, because my fear is that it would not come back, owing to a lack of legislative time. That would mean that the legal crisis would continue. Also we would be missing an opportunity to change the legislation. We can make the necessary changes if the good will is there.

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[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

I will be brief, as I am aware that others wish to speak.

The privilege we have as a Parliament is to defend liberty, so any action we take to seek to deprive a person of their liberty should always be weighed against their best interest. I was not greatly aware of the deprivation of liberty safeguards until the Bill was tabled and I received lots of representations from constituents who work in the social work sector. They are concerned that, although the Bill may be well meaning, it does not necessarily have at its heart protections for the best interests of the people to whom it might apply. I have always listened when a doctor tells me something is not right and I am unwell, and we should listen when a social worker tells us that the Bill’s provisions for depriving a person of their liberty fall short of their expectations.

My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) made two excellent points. First, if we are to take away a person’s liberty, there has to be no possibility that the process could be abused for whatever purpose. I fear that, in some of the arrangements for moving away from a local authority-based system to a responsible body, the potential exists, however small that potential may be, for an unscrupulous person who is not necessarily working in the best interest of an individual to exercise that power simply to maintain a business model in their own facility or care home. Such cases may be few and far between, but we have seen many situations across the country where one or two individuals have taken advantage of people in vulnerable situations, and I am not convinced that the Bill, as currently written, goes far enough to provide safeguards. [Interruption.] The Minister shakes her head, and it would be wonderful if she could address that in her summing up.

[Mr Kevan Jones]

Will my hon. Friend give way?

[Gareth Snell]

I am sorry, but I cannot give way.

My other area of concern is the independence of advocates. I am fortunate to have a family who can speak up if a relative were ever in such a situation, but there are countless people across the country who do not have somebody who can stand up for their best interest and represent what might be right for them. The Bill contains no provision properly to strengthen the independent advocacy rights and make them robust so that everybody who might be subject to the liberty protection safeguards is able to be represented and have their views considered, which is important. [Interruption.] The Minister is nodding, and I would welcome it if she offered some sort of guidance and further clarity on how the Bill will deliver that. From where I sit, from what I have read and from the evidence given to me by social workers, there are several holes in the Bill that do not stand up to scrutiny.

I suspect the Bill will get its Second Reading, and I hope several of those holes will be identified and considered in Committee. At the moment, my fear is that the Bill is well intentioned but simply does not bear scrutiny. There is therefore a potential for exploitative people to take advantage of vulnerable people and, as a Parliament, we must make sure to address that.

Gosport Independent Panel: Publication of Report

Lord Beamish Excerpts

Wednesday 20th June 2018 Commons Chamber

[Mr Hunt]

We do have to ask those questions, and we have to be able to respond to the concerns of my hon. Friend and his constituents about how we can be absolutely certain there will not be a closing of ranks. My experience, however, is that doctors are very quick to want to remove those of their number who are letting the profession down because this damages everyone’s reputation. There are some very difficult questions for the GMC and for the NMC. Because their processes took so long, I do not think they can put their hand on their heart and say that they have kept patients safe during that period.

[Mr Kevan Jones (North Durham) (Lab)]

The legislation regulating both doctors and healthcare professionals is now 35 years old. It is inefficient, outdated and—as I know from a constituency case in which the individual concerned is into the fifth year of her complaint to the GMC—not user-friendly for the complainant. The GMC and other healthcare professionals want change and the Secretary of State’s Department has already consulted on change, so will he give a guarantee that he will bring forward legislation to ensure that the system is not only effective, but effective for patients who make complaints?

[Mr Hunt]

The right hon. Gentleman is absolutely right: we have a regulatory landscape that is very complex, does not achieve the results we want, and forces regulators to spend time doing things they do not want to do and does not give them enough time for things they do want to do. Obviously, because of the parliamentary arithmetic, if we are able to get parliamentary consensus on such a change, that would speed forward the legislation.

NHS Long-Term Plan

Lord Beamish Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

I am happy to look again at that issue, which I have looked at in the past for my hon. Friend.

[Mr Kevan Jones (North Durham) (Lab)]

I welcome any new money for the NHS, but does the Secretary of State agree that prevention is better than cure? Durham County Council has had its public health budget cut every single year for the last eight years. Can he tell me how much of this new money will be going to public health, or is he now going to have another fight with the Treasury to get it to release more money for public health?

[Mr Hunt]

Today’s announcement is for NHS England’s core frontline services, but the right hon. Gentleman is right about the critical role of public health. Many of those services are delivered by the NHS, and we are very clear in what we are saying today and in a further announcement we will make in due course that there cannot be a transformation of the NHS without a proper emphasis on public health.

Mental Health Act: CQC Report

Lord Beamish Excerpts

Tuesday 27th February 2018 Commons Chamber

[Jackie Doyle-Price]

My hon. Friend reached the nub of the issue in that final point. Commissioning is a matter for local commissioning groups. However, through the CQC report, the work that we are doing through the mental health investment standard and the scrutiny applied by NHS England, we are trying to ensure that there is a consistent application of good-quality services around the country. We find some centres of excellence and some areas in which the service is less patchy, but when it is less good it obviously leads to worse outcomes. We are determined to do our best to promote the best possible services throughout the country.

[Mr Kevan Jones (North Durham) (Lab)]

I welcome the Government’s outlawing of the use of police cells for those experiencing a mental health crisis, and I do not question the Minister’s commitment to improving the service, but the system is fragmented. There have been local authority cuts, including cuts in community services. The Health and Social Care Act 2012 leaves local commissioners to decide where the money goes, which has led to a confusing local picture and fragmentation. Do we not need to give people clear pathways out of hospital, and to ensure not only that the money goes to the right places, but that individuals know their rights and that local agencies know their responsibilities?

[Jackie Doyle-Price]

The hon. Gentleman’s point about people knowing their rights and providers and commissioners knowing their responsibilities is crucial to the whole issue, and I think it probably underlies the lack of parity of esteem hitherto. When it comes to the role of central Government, we want to continue to rely on local provision and local commissioning, but we also need to be clear about the standards of performance that people should be able to expect. We are being more transparent about where services are being delivered well and where they are being delivered less well, but I think the work that Sir Simon Wessely is doing will shine a light on exactly that, and will enable us to engage in a much more meaningful debate about what is appropriate.

Autism Community: Mental Health and Suicide

Lord Beamish Excerpts

Thursday 30th November 2017 Commons Chamber

[Dr Cameron]

That is an extremely important point. We must bear it in mind that for young people with autistic spectrum disorder, there is often a family-systemic approach, with carers are at the forefront of providing support, and they need the best resources possible.

I also thank the many citizens from across these isles who have contacted me to give their own poignant personal accounts. These accounts have been harrowing to read—and more harrowing for them to experience—and make us realise just how absolutely vital this debate is.

I also want to extend a personal warm welcome to the youth patrons up in the Gallery today representing Ambitious About Autism. Their recent campaign and research project, “Know your normal”, has been helping many people and raising important awareness. I pay specific thanks to the hon. Member for South Cambridgeshire (Heidi Allen) and the right hon. Member for Chesham and Amersham (Mrs Gillan), who have worked tremendously hard on this debate, on behalf of people with autistic spectrum disorder, through the all-party group over many years.

As a psychologist, I know that progress has been made on autism and mental health over the many years since I started in 1990, when waiting lists were extremely long—possibly a year and more—and services were very limited. However, much more must be done across the United Kingdom.

[Mr Kevan Jones (North Durham) (Lab)]

I accept the point that the hon. Lady is making, but I have to tell her that waiting lists in Durham are still two years long.

[Dr Cameron]

That is an excellent point, and that situation is clearly unacceptable. The Scottish Government and the United Kingdom Government are introducing waiting times initiatives across the United Kingdom. We are finding that the experience on the ground for young people with autism and their families, and indeed across the lifespan, is that, despite the waiting times initiatives, the waiting times that are expected to be in place are not the reality. We need to address that issue seriously.

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[Mr Kevan Jones (North Durham) (Lab)]

I join right hon. and hon. Members in congratulating the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) on securing the debate, and thank the Backbench Business Committee for granting it. The hon. Lady pointed out, as did my hon. Friend the Member for Blaydon (Liz Twist), that the percentage of people who take their own life is nine times greater among people with autism than the general population. As my hon. Friend said, autism is linked to depression and anxiety.

I welcome the debate because it is another example of this House talking about mental health. People know that I think the more we talk about it, the better the debate gets. I think people should be congratulated on that. I place on the record my thanks to the charities and the army of volunteers who work with adults and children with autism, because they are unsung heroes.

I want to raise two points. One is about waiting times; the other, which the hon. Member for East Kilbride, Strathaven and Lesmahagow raised, is about how we develop pathways. In Durham, we currently have a two-year waiting list for autism diagnosis. I have tried to get to the bottom of why that is. It is only when you meet some of the parents of the young people that you see what a tragedy it is. The pressure on those families is so great that I suspect some are developing mental health issues. I am really concerned about the lost opportunity for those children, because everyone only gets one chance at education, and there are cases where children have been out of school for nearly a year, waiting for diagnosis. I am aware, as I think we all are, of the pressures that there are on child and adolescent mental health services and social services, but we must try to streamline the pathway to early diagnosis.

The hon. Member for Bexhill and Battle (Huw Merriman) spoke about schools. The most appalling thing I have seen is that a school excluded a child with autism, even though he had a diagnosis, because “he was too difficult”—and clearly affecting the league tables. We should monitor that, because it is a disgrace. Thankfully, the local authority stepped in and put that right, but the pressure on that parent and the child is unacceptable.

We are talking about mental health and a Health Minister will reply to the debate, but this issue is wider than just health. We have made great strides in terms of parity of esteem, and the point that the hon. Member for Berwick-upon-Tweed (Mrs Trevelyan) made is right. We are winning that battle. Now we need to win the next battle, and that is how we hardwire mental wellbeing into public policy. That is not just health; it is education, housing, social care, local authorities—

[Liz Twist]

And employment.

[Mr Jones]

And employment, as my hon. Friend says from a sedentary position.

There is another big problem that a lot of individuals with autism encounter. They go through the school system. Education finishes and they transition into work. I know of quite a few examples of this from my constituency. A lot of these young people, who are perfectly capable of engaging in some type of employment, seem to get lost in the system. The pathway that the hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned must therefore continue from diagnosis all the way through an individual’s life and involve a cross-section of services, not just health. To get that idea hard-wired into the system, the Government must make sure that, from Cabinet Committee level downwards, consideration of mental health and mental wellbeing forms part of the process of policy making in each Department. The last Labour Government did something similar with veterans.

[Kevin Brennan]

I am grateful to my hon. Friend for giving way, because I know that time is short. Does he agree that those Cabinet Committee-style discussions should involve ensuring that the Ministry of Justice and the Home Office understand the ways in which people with autism come into contact with the criminal justice system and understand the behaviours—such as stimming, which is often misinterpreted and ends up with people being arrested—that those individuals exhibit?

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[Mr Jones]

I totally agree, because autism is not just a health issue. The hon. Member for Berwick-upon-Tweed made a very good point. How many times have we seen people reacting to a child in a supermarket kicking off, as it were, with no recognition of the fact that the child is on the autism spectrum or of the challenges that that poses for the parents? We need to hard-wire that idea in.

The Government also need to look at health funding. I accept that they have committed to more funding for mental health, but the system that was set up in the Health and Social Care Act 2012—I hate to come back to it—makes it more difficult for the money that goes in at the top to get to where it is needed on the ground. If I were a Health Minister, I would be completely frustrated by the fact that I was pushing a lever that was not connected to anything. Clinical commissioning groups and others are taking money that should be going to mental health and diverting it towards other priorities, which I accept they see as important.

I finish by again congratulating the hon. Member for East Kilbride, Strathaven and Lesmahagow and everyone who has spoken. The debate has allowed us to shine a spotlight on mental health again—that is a good thing—on autism, which is not widely understood in the broader community, and on the particular challenges faced by those on the autism spectrum who suffer from mental illness.

Mental Health: Pharmacists

Lord Beamish Excerpts

Wednesday 25th October 2017 Commons Chamber

[Mr Kevan Jones (North Durham) (Lab)]

I wish to use tonight’s Adjournment debate to raise the sad case of my constituent Alison Stamps, a 33-year-old pharmacist who sadly took her own life on 25 May 2015. I will outline the circumstances of the case, but will also raise wider concerns that I and her family have around the operation of Boots UK and how it dealt with her death, as well as my broader concerns concerning pharmacists and mental health issues.

Alison was clearly an exceptionally bright and talented individual. After finishing at Pelton Roseberry comprehensive school in my constituency in 2000, she went on to study—

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Motion made, and Question proposed, That this House do now adjourn.—(Rebecca Harris.)

[Mr Jones]

Alison went on to study biology at Durham University and graduated in 2003. She then began work as an audit and accounting technician at Sunderland city hospital before choosing to return to university—the University of Sunderland—to study for a four-year masters degree in pharmacy. While she was at Sunderland, Alison was awarded the prize for the best overall student in the first year, before going on to be awarded the Royal Pharmaceutical Society’s award for the best student on a masters degree programme in 2012. Her achievements were remarkable, and clearly she was dedicated to public health and the pharmacy profession.

Alison began work at Boots’ Tindale store in Bishop Auckland in August 2013. Her parents tell me that she enjoyed the work but increasingly complained about the long hours and demands it placed upon her. By mid-December 2014 she was clearly overwhelmed by what she was having to do. Her store manager noticed that she was losing weight and looking unwell. Following a conversation with the store manager, Alison expressed how down she felt. The store manager provided her with a phone number for an independent counselling service and encouraged her to speak to her GP and her family. Like many people in Alison’s position, she felt she could not speak to her family or strangers about her situation. Still concerned, her manager arranged an appointment with a GP for Alison and even attended the appointment with her. I understand that the GP indicated that she should take antidepressants, but Alison did not wish to do that. The GP gave her a crisis number to ring and also suggested some other coping mechanisms.

At this point, I would like to commend the actions of the store manager, who I think genuinely tried to help Alison. I understand that she reported her concerns about Alison to her area manager, and I have had it confirmed by the director of human resources at Boots that this case was referred and flagged up with the firm’s central HR department. It appears that all that happened, however, is that the store manager was advised about what counselling was available, but no alarm bells rang in Boots’ central HR department that one of its pharmacists was in a crisis situation and no action seems to have been taken. Instead, it was left to the store manager to do her best to assist Alison in her time of crisis.

This raises serious concerns about how Boots as a company handled the case. Having been made aware of Alison’s situation, no attempt seems to have been made centrally or high up in the organisation to intervene directly. This was a young woman not only holding down a responsible job dispensing medicines but who was clearly in a severe mental health crisis. Throughout this time, the store manager was also aware that Alison was self-harming—she had confided in her that she had cut her legs. For six months, Boots was aware of Alison’s situation but simply left it to the store manager to deal with it, although I put it on the record again that she did a great job in trying to help, and she did it to the best of her ability.

Sadly, on 25 May 2015, Alison took her own life in a room at the Hardwick Hall hotel, having taken an overdose of prescription medication. At the coroner’s inquest, it was determined that Alison had taken her own life while suffering from depression. Her parents, Mr and Mrs Stamps, attended the inquest. So did representatives from Boots, who made no attempt whatsoever to offer sympathy or speak to the family. The coroner invited those present to introduce themselves, but because it was a public hearing, the Boots representatives chose not to do so. Mr and Mrs Stamps felt, I think understandably, that their attitude was very legalistic—that they were concerned with their fears about the possibility of a legal case as a result of Alison’s death, rather than with having a compassionate understanding of how her death had occurred.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on raising an issue in which he takes a great interest, as is clear from other occasions when he has spoken in the House. I believe that this very sad case highlights for all of us the need to ensure that those in the workplace are given adequate training to offer support to workers with depression or other mental health issues. Does the hon. Gentleman agree that the Government must initiate, or make available, courses for all small and medium-sized enterprises, which would be free of charge and which would provide tools for employers that would enable them to help such staff members?

[Mr Jones]

As I have said on other occasions, I think that mental health in the workplace is one of the big issues that we do not talk about. I think the hon. Gentleman’s suggestion should be considered, but what struck me about this case was that it involved not a small employer but a huge multinational company, which should have had the capacity within its organisation to provide assistance.

[Liz Twist (Blaydon) (Lab)]

Does my hon. Friend agree that all employers could benefit from having policies to support staff when they are at work, and when, sadly, an employee dies by suicide? Should not employers be encouraged to take up programmes such as those developed by the Samaritans, Business in the Community and Public Health England for the benefit of staff?

[Mr Jones]

I agree with my hon. Friend. I know that she is involved with the Samaritans, and I congratulate her on the work that she does. Yes, there are a lot of tools out there for companies to use, but they must take them seriously rather than treating them as a tick-box exercise. Policies of this kind must actually be used in the workplace, and people must be trained so that if they encounter a case like Alison’s, they do take it seriously. That is what I would have expected from a large company such as Boots.

Anyone who has looked at the details of this case cannot but be moved by its tragic nature, and by the failure of Boots to exercise its duty of care at a national level. Mr and Mrs Stamps are certain that the long hours and the workload that Alison faced were a contributory factor in her death. I have spoken to representatives of the pharmacists’ trade union, the Pharmacy Defence Association. They made it clear that there are increasing demands on pharmacists, not only in terms of workload but as a result of staff cuts. Last year an article in The Guardian highlighted the situation at Boots, including many emails from Boots’ pharmacists claiming that profit was being put in the place of pharmacists’ health, and that they were increasingly being asked to hit targets for medicines use reviews—the company is paid £28 per review by the NHS—rather than concentrating on dispensing and the care of patients.

Those pressures are putting an increasing strain on pharmacists who work for companies such as Boots, but, like Alison, many choose not to complain, because they fear that if they do so they will lose their jobs or their professional qualifications will be withdrawn. That is a particular issue in the context of mental health, and in professions such as pharmacy. People remain silent for fear of the consequences of speaking up. I think that pharmacists need a system like the one that has been introduced for GPs. Many GPs also do not want to talk about their mental health problems because they fear that they will be disciplined. I think that that was Alison’s fear: she feared that if she raised issues relating to her mental health, she would be taken down the disciplinary route and lose her job.

I suggest to the Minister that that needs to be looked at. Pharmacists should have a system similar to that for GPs. I have done some work on this with GPs. The NHS has the GP health service, which is a confidential service for both GPs and trainees. I have met some of its staff, and it works very well in allowing GPs to self-refer confidentially. The GP health service can help doctors with anything to do with mental health, including stress and depression. The effort that has been made to ensure that there is GP support needs to be replicated for pharmacists, because I can say from a personal point of view that, with the best will in the world, giving someone with depression a helpline to ring is not the answer. People do not ring them; I can say from personal experience that I would not have done so when I suffered from depression. The work done for GPs offers a way forward that I ask the Minister to explore.

I also have to raise questions with the Minister about the role of the General Pharmaceutical Council. Following Alison’s death and Mr and Mrs Stamps coming to see me, I wrote to the GPC asking for its opinion of the case. It wrote back saying that its role was to protect patients by

“setting and upholding standards for individual pharmacists and pharmacy technicians.”

I understand that the GPC has been aware of complaints concerning Boots’ working practices for pharmacists, but has taken no action against that company or—so far as I can see—any other company about how pharmacists were being employed. That raises the question of what this regulator is actually doing.

It is also disappointing that the regulator sees itself as a peripheral player on the issue of workplace pressure and stress, and the pressures put on pharmacists. This stance by the regulator allows employers such as Boots to preside over poor working conditions without any threat of sanction. It says that its job is to protect patients, but if a pharmacist has a severe mental health problem that is being created by workplace pressures and stress, that must be putting patients at risk. The potential danger of mistakes being made will be heightened if pharmacists are under such pressure.

In response to Alison’s death it seems as though Boots was most concerned about its own reputation. At the time, its main concern appeared to be whether any controlled drugs were missing from the pharmacy where she worked. It would appear that the drugs that Alison took to end her life came from the unused drugs that were returned to the pharmacy by patients. Although there is a register of these drugs, I wonder whether there should be tighter regulation because it is up to individual pharmacies whether the drugs are recorded. There should be a process of monitoring how the drugs are collected, registered and ultimately destroyed.

While doing the research for this debate I tried to find statistics on mental health problems and suicide among pharmacists. I am not aware of any statistics being held centrally that show this information. We might look into collating such figures to inform this debate, which is clearly ongoing.

Alison Stamps’ death is a tragedy, not only for her family but for us all as citizens, as we have lost a bright, conscientious young lady with much to offer. Her life was, sadly, cut short by circumstances she thought she could not face. It is quite clear that lessons need to be learned and that changes need to be made, not just in the way we regulate pharmacists but in the way we employ them and treat them in the workplace. Alison’s employer, Boots, should take stock not only of how it is dealing with her case but of how it employs other people within its organisation. It would be right to finish with something that Mr and Mrs Stamps said in a letter to me when they first raised the case with me. They said:

“It is clear that Alison was a victim of corporate greed and collateral damage by an uncaring company intent only on its own agenda.”

Oral Answers to Questions

Lord Beamish Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

Our plans envisage treating another 70,000 children every year by 2020-21, but that is still not enough. It will take us from one in four children needing help to one in three. That is why we are publishing a Green Paper on child and adolescent mental health.

[Mr Kevan Jones (North Durham) (Lab)]

One of the staffing shortages is actually in children and young people’s services. In County Durham in my constituency, the waiting time for autism diagnosis is two years. I have raised this with the mental health trust and NHS England, but the problem seems to be with the clinical commissioning group. What can the Secretary of State do to ensure that the extra money that he has pledged to put into the service actually gets to the service?

[Mr Hunt]

I would like to thank the hon. Gentleman for speaking out about mental health, like so many colleagues in this House, which makes a massive difference to the Time2Change campaign. It is unacceptable for someone to be waiting that long, and I do not want to stand here and defend it. I will certainly look into the individual case that the hon. Gentleman raises, but the fact is that many Members will know of similar cases. The money is starting to get through to the frontline. It is not just money, though; it is also capacity, and having trained mental health therapists—nurses; psychiatrists—and that is why we are boosting their training, too.

Clinical Commissioning: North Durham

Lord Beamish Excerpts

Wednesday 23rd November 2016 Westminster Hall

[Mr Kevan Jones (North Durham) (Lab)]

I congratulate my hon. Friend the Member for City of Durham (Dr Blackman-Woods) on securing the debate.

The decision of the North Durham CCG raises some fundamental questions about how the NHS is run in North Durham, and our constituents’ relationship with the NHS. As my hon. Friend described, there was no consultation of my constituents about the decision, which was taken in secret. There was no transparency at all, nor any consultation with Members of Parliament in the CCG area or any local elected officials. The decision changes the fundamental relationship of trust between a patient and their GP. My constituents have never been asked for permission for our private medical information to be passed to a private company—and neither have I or my hon. Friend. We have not been asked whether the company has our individual permissions. In many cases I do not think constituents have even been told by their GPs that the information is being passed to a private company.

What is the legal position on the giving of my private medical information, and that of my constituents, to a third party? Who is responsible for ensuring that it is secure? Do I have a right, given that it is my personal medical information, to withhold permission for it to be passed to a private third sector organisation? I certainly do not think that patients in North Durham are being told that that is happening. As my hon. Friend the Member for City of Durham said, the website does not give the impression that the information is being given to a third party.

The way the decision was taken was shameless. As my hon. Friend has already said, we met the CCG in September and there was no mention of the contract at all. I want to ask why. One of my constituents, Keith Johnson, raised concerns and the CCG responded:

“GPs have responsibility to make best use of NHS resources and need up to date evidence and advice to be able to treat patients in practice or to refer on appropriately. Unnecessary outpatient appointments are a large cost to the NHS.”

I do not think anyone would disagree, but that is the job of GPs; it is not up to a private sector organisation, or anyone else who has never seen the patient, to decide whether they should be referred to a specialist.

My concern is not just the way the decision is being implemented, but the fact that it fundamentally breaks down the trust that we all value, and the confidentiality between us and our GP. I am also concerned that the more articulate constituents and patients will insist on getting care; some others will not. There will be rationing of care, depending on people’s ability to make their case. That goes to the principle at the heart of the NHS—care being free at the point of need.

I have questions about the way the contract was let. We have had no information about how that happened. Was it by competitive tender? Did any individuals employed by the CCG have any pecuniary interest in awarding the contract? How will it be evaluated? What ability will patients have to say whether they agree with the outcomes? I challenge the North Durham CCG to publish the contract and all information and decision making about how it was awarded, because the cloak of secrecy around it is a disgrace. I also challenge it to scrap the contract and answer a basic question: why is it treating its patients with such contempt?

--- Later in debate ---

[David Mowat]

I was explaining the purpose of the policy and the fact that this referral mechanism was used widely in 2007. A King’s Fund report from 2010 sets out the pros and cons of using referral management—I suggest the hon. Lady reads it.

These things are not new. They are a mechanism by which a consultant, or a GP with a specialist interest in the area of what is being referred—there are six areas of referral in this CCG, as the hon. Lady said—has two to three days to either accept that the referral goes on to the secondary system, or to contact the GP and have a discussion about what the best alternative pathway might be. There is an appeals process if the GP does not agree with that decision.

The hon. Lady asked where else such referral management was being done across the NHS in England. It was introduced in 2007, as I said, and it is being done very commonly. It is being done in Bromley, Cambridge, Peterborough, Imperial in London, and Southampton. I saw a similar system in Tower Hamlets to the one working in her area—indeed, the GP was very proud of the way they reacted, with an email referral system, when there was every possibility of things not going ahead.

This is not rationing. It is completely wrong to say that. It was brought in by the CCG, which is GP-led. If the GPs in the CCG do not agree with it, they have the mechanism to replace the chairman of the CCG.

[Mr Kevan Jones]

I understand what the Minister is saying, but what about the patient? Where does the patient come into this? If I go to my GP and he says I need a referral, that is between me and my GP. If it was not for my hon. Friend the Member for City of Durham (Dr Blackman-Woods) or the BBC raising this, none of my constituents—or myself and my hon. Friend, who are patients of the CCG—would have known about it. Will the Minister please answer the point about the patients?

[David Mowat]

The point I was in the middle of making—which I will finish making—is that if the GPs in the CCG have difficulty with the scheme, they have the mechanism to replace the CCG chairman and therefore to not go ahead with the scheme, so the GPs in his area are presumably content with it.

[Mr Jones]

The patients are not being consulted.

[David Mowat]

The fact is that the GPs vote for the head of the CCG who has put the scheme into place. On the patient issue, which is a fair one, if the patient expresses a preference to go to a secondary or an acute hospital and have an appointment, which could typically be six to eight weeks away, of course that is part of the process, and of course the referral management schemes will take that into account.

[Mr Jones]

I am sorry, that is not the case. In North Durham, patients have not been told about it. If I went to a GP who said I needed a referral, I would not be told that. What the Minister is saying is in complete contrast to what he told me during a debate on coeliac disease a few weeks ago, in which he condemned CCGs for not consulting people before awarding contracts.

[David Mowat]

We are moving around a little bit here, but I will come to the point about consultation. The GP that the hon. Gentleman refers to is a part of a CCG that has made the decision to extend the North Tyneside pilot to North Durham. All I am saying is that those GPs are part of the CCG and that presumably the CCG is doing this because it believes the clinical out-turns are right. We have a locally driven system. I will make some progress on the benefits of this for patients.

--- Later in debate ---

[David Mowat]

I am going to talk about the About Health situation and the people who have been awarded the contract in North Durham. It is a one-year pilot that builds on the one-year scheme in North Tyneside. I think it started last month; it covers six disciplines and it does not cover urgent referrals, in particular cancer. All the national requirements for referral-to-treatment times still count in exactly the same way. The local CCG performed a risk analysis before it decided to take the scheme forward and build on what happened in North Tyneside, and the scheme is monitored.

I have been told that a very important feature is that there is a clear GP appeals process. If they are not happy with a decision that has been taken, that process can happen very quickly.

[Mr Kevan Jones]

What about the patients?

[David Mowat]

The GP represents the patients in the health system; that is the fact of the matter. If there are out-turns that are detrimental to patients, as the hon. Member for City of Durham implied, that is a serious situation and should be investigated.

About Health is CQC-regulated—with all that goes with that—in exactly the same way as a GP practice. It is staffed by NHS consultants and GPs with a particular interest. As I said, there is a two or three-day turnaround, and they have to have the same indemnity cover as everybody else. Part of what the CCG is doing is to save money—that is true. Inappropriate outpatient appointments mean that more people than necessary are working. If that can be reduced, there is a cost saving to the national health service. It is about optimising pathways.

[Mr Jones]

Will the Minister give way?

[David Mowat]

I will make a little bit more progress and let the hon. Gentleman in later.

This is about stopping inappropriate treatment; it is absolutely not about rationing. If it was about rationing, the whole referral management system would not have been first introduced by the last Labour Government. I think it is incredible that that point has not come across more strongly.

One of the concerns is that About Health is a private company. It is a private organisation that has won the contract, and the local CCG made that decision. Fair questions were asked about the confidentiality of patient records, in terms of them going across a boundary to a private company. My first point, which is an obvious one, is that GP practices are all private companies. Every partner that works in a GP practice works in a private company, in the same way that the GPs who work for About Health are working for a private company. However, all the requirements around patient confidentiality that About Health needs to make sure are in place apply in exactly the same way as they do in every other part of the national health service.

[Mr Jones]

The point about that is that I, as a patient, have not given permission for that. The way this has been done—with no consultation, which the Minister says is wrong—means that no one knows what is actually happening.

[David Mowat]

I was going to come to the point about consultation—I do not have a great deal of time left now. It is right to say there was no consultation on this, and that is because this is an administrative process change. There is no service change—

[Mr Jones]

That is absolute nonsense.

[Geraint Davies (in the Chair)]

Order.

Coeliac Disease and Prescriptions

Lord Beamish Excerpts

Tuesday 1st November 2016 Westminster Hall

[Mr Kevan Jones (North Durham) (Lab)]

I beg to move,

That this House has considered coeliac disease and prescriptions.

It is a pleasure to serve under your chairmanship, Mr Bailey. I am grateful for the opportunity to hold a debate that raises awareness of the problems facing those who suffer from coeliac disease and of access to gluten-free food prescriptions. It would be remiss of me not to thank the work of Coeliac UK, the national charity that represents people with coeliac disease, for not only supporting the campaign around the prescription of gluten-free food, but for its work to support sufferers.

Coeliac disease affects one in every 100 people in the UK. I declare an unwelcome interest: I actually suffer from coeliac disease, although I do not get prescriptions for gluten-free food. It is also worth noting that there are some half a million people in the UK who are completely undiagnosed, according to Coeliac UK.

Coeliac disease is a serious medical condition in which the body’s immune system attacks its own tissue when gluten is eaten. The only medical treatment currently available for sufferers is a strict adherence to a gluten-free diet for the rest of their lives. In the late 1960s, gluten-free food was first prescribed to prevent long-term health complications. However, that rationale has now been challenged by some clinical commissioning groups, despite the fact that their position lacks supporting evidence for withdrawing such prescriptions.

[Jack Dromey (Birmingham, Erdington) (Lab)]

I am grateful to my hon. Friend for bringing such an important debate on an issue that affects so many people. Does he agree that it is absolutely wrong that David Lissaman, a pensioner in my constituency, who thus far has been able to get gluten-free food on prescription, now faces the prospect of losing that as a consequence of the clinical commissioning group’s review? He is a good man who served his country well. In his own words, he will “have to find ways” of significantly reducing the amount of food that he eats, which, because of his other health problems, could put him at risk.

[Mr Jones]

I agree, and I shall refer to certain demographics—pensioners being one—that are particularly affected by these proposals.

Some 40% of CCGs in England are now choosing to restrict or remove support for patients with coeliac disease, which is leading to increasing health inequalities and, basically, a postcode lottery for NHS care, depending on where someone is diagnosed. The CCG’s rationale for going down that route seems to be justified on cost grounds alone. Indeed, Coeliac UK has made a number of freedom of information requests to try to get more details on why CCGs are changing their policies.

I will take a moment to read an example of a response to Coeliac UK’s FOI request, which came from North East Essex CCG, where sweeping assumptions have been made that are completely devoid of any systematic research. That CCG stated:

“We appreciate that there is a large cost-differential between supermarket value brands and GF [gluten-free], but many people within the CCG buy their bread from bakers or do not buy the supermarket value brands and the cost differential is therefore much reduced.”

That type of anecdotal evidence, used by CCGs to justify their decisions about patient care, is in direct conflict with a paper produced in September last year entitled “Cost and availability of gluten-free food in the UK: in store and online”. It said:

“There is good availability of gluten-free food in regular and quality supermarkets as well as online, but it remains significantly more expensive. Budget supermarkets which tend to be frequented by patients from lower socioeconomic classes stocked no GF foods. This poor availability and added cost is likely to impact on adherence in deprived groups.”

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

I congratulate my hon. Friend on securing this debate. The issue does not apply only to elderly people. I have had a number of young people write to me about this, who are very concerned that they may not be able to get gluten-free foods on prescription any more. Has he looked at the possible costs for people who are at the lower end of the earnings scale?

[Mr Jones]

My hon. Friend raises an interesting point. There is evidence—including from my own family—that gluten intolerance and coeliac disease run in families. If a young family includes several children with this condition, the cost could be significant.

[Sir Gerald Howarth (Aldershot) (Con)]

To reinforce the point, my constituent Sheryl Rees has drawn my attention to the fact that her son was diagnosed with coeliac disease when he was two. He is now 11. She pointed out the cost of gluten-free items. For example, a small loaf is £3. A pizza is £4. Pasta is £2 a pack. Basically, she is paying double. She has a family of six. This is really impacting on her family’s budget.

[Mr Jones]

The hon. Gentleman raises an interesting point, especially in terms of families with children. There is also a question of availability in some rural areas. Larger supermarkets stock some of these products at the prices he mentioned and higher, but in other areas the products are not available.

[Kevin Foster (Torbay) (Con)]

Will the hon. Gentleman give way?

[Mr Jones]

I will make a bit more progress.

We have a situation where, in places such as east Essex, the needs of patients are being discounted despite a complete lack of any type of research. I am concerned that more CCGs across the country will begin to use inadequate justifications as a precedent and follow a similar path. That leads me back to my earlier point about the big problem of under-diagnosis. I am afraid we will see a bigger problem if gluten-free prescriptions are not made available to those on low incomes.

[Dr Julian Lewis (New Forest East) (Con)]

On the specific point of failure to diagnose, until 20 years ago I had never heard of coeliac disease, and then I went out with a young lady who, as a teenager, had repeatedly gone to her GP knowing something was wrong. Coeliac disease was never diagnosed until she suffered something analogous to a stroke, which left her permanently all but unable to read. Although she has bravely developed coping strategies over the years, there is no doubt that her life and career have suffered, and she should never have been put in that situation.

[Mr Jones]

The right hon. Gentleman raises a serious point about the life-changing effects that coeliac disease can have. I was only diagnosed by accident, in my 30s; my mother was not diagnosed until she was over 70. Early diagnosis is important, but it is not uncommon for people to live a long time without one being made.

The Health and Social Care Act 2012 included a duty on CCGs to have regard for National Institute for Health and Care Excellence quality standards, but NICE guidance on prescribing gluten-free food for the management of coeliac disease has only recently been published. It says:

“Gluten-free products are more expensive and are usually only available from larger retailers, making access more difficult for people on low incomes or with limited mobility. As coeliac disease can affect more than one member of a family it can also be an additional burden on the family budget”—

as the hon. Member for Aldershot (Sir Gerald Howarth) said.

“To address this, healthcare professionals should help people who may need support to find suitable gluten-free food products on prescription to enable them to maintain a gluten-free diet.”

[Mims Davies (Eastleigh) (Con)]

I declare an interest, having been diagnosed in my late 20s. My cousin and all my second cousins are exactly the same. In fact, at university I was diagnosed with ME because I was so unwell and unable to work at various points.

This debate is an opportunity also to talk about the low incomes and limited mobility that can affect people’s access to these basic items. We must also make a plea through Coeliac UK to supermarkets to ensure that what they provide, which is very expensive, is of better nutritional quality, with lower levels of salt and fat. Although these foods are gluten-free, they might be full of some awful stuff as well.

[Mr Jones]

The hon. Lady raises an interesting point, but I assure her that the products available today are completely different from when I was first diagnosed. The bread then was like cardboard, and today it is very much different.

There is a general duty for GPs to prescribe treatments for health conditions via the FP10 prescribing system where treatment is available, and in the case of coeliac disease that is a gluten-free diet. There is also a duty in legislation for CCGs to reduce inequalities with respect to patient access to services and outcomes, but because of the lack of explicit recommendations on prescribing from NICE, CCGs are being given a fairly free hand to make decisions that run contrary to reducing health inequalities.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing this debate. Prescription of gluten-free food as medication clearly needs to be regulated by the NHS across the United Kingdom. One of my constituents said to me this week:

“The disease is antisocial and can lead to isolation.”

Does the hon. Gentleman agree that the supply of food on prescription can have social benefits, as well as mental, physical and emotional benefits?

--- Later in debate ---

[Mr Jones]

It can. There is some anecdotal evidence about the connection between coeliac disease and mental health. The hon. Gentleman raises an interesting point.

This situation is creating considerable uncertainty for those who rely on access to gluten-free staples on prescription, and it is the vulnerable who are most adversely affected. Individuals with the disease are not eating gluten-free food out of choice or because it is some type of fad or Hollywood diet. They do so because they have to. It is people on fixed incomes or on benefits who receive free prescriptions and those whose households rely on deliveries from community pharmacies who will suffer most if prescriptions are withdrawn.

A number of people have written to me ahead of this debate, and I would like to draw Members’ attention to their cases. Patricia said:

“The diet I and many others follow is not a fad. It is necessary as it will affect my health and wellbeing if not followed, and might actually result in my admission to hospital—an extra strain on the NHS.”

[Rebecca Pow (Taunton Deane) (Con)]

Will the hon. Gentleman consider students in this category? Many of them are on low budgets. They might be tempted not to buy the right food and then end up being sick and in the NHS, costing the state more money.

[Mr Jones]

That is the main point. What some CCGs are doing is a false economy, because one hospital admission will cost more than the annual cost of prescriptions for an individual who adheres to a gluten-free diet.

Another person living with coeliac disease, Janice, who is a constituent of mine, wrote to me saying:

“I strongly believe that these plans will cause more expense to the government when coeliac patients can’t afford shop priced gluten-free foods and don’t stick to their diet and end up with cancer of the bowels”,

as well as other conditions. She went on:

“I am a pensioner and find it increasingly hard to afford luxuries like biscuits and cakes. If I have to add gluten free bread, pasta and cereals to my shopping list this will cause more stress. I cannot have any form of gluten, even in small doses, as I am violently ill.”

As well as a failure to consider the evidence before making decisions to withdraw gluten-free prescriptions, there is also evidence of a lack of public consultation by CCGs. Coeliac UK has been doing a good job of holding CCGs to account. One example it provided is of Trevor, who told Coeliac UK that he has never received confirmation in writing that the policy had changed; he was informed only when Coeliac UK told him. He was diagnosed 10 years ago and has only ever had bread on prescription. He is unable to work and has ongoing medical problems. His nearest shop is a Co-op, which does not stock gluten-free products, and the nearest shop that does is some six miles away. That creates problems for people such as him.

The CCGs that have already removed access to prescriptions for gluten-free products have not outlined or implemented policies that offer alternatives to safeguard patients, such as access to specialist dietary or nutritional advice. When a coeliac patient is taken out of a CCG’s responsibility because their gluten-free food prescription has been withdrawn, that CCG can no longer monitor them or determine the changed policy’s impact on that patient’s health. This is an important factor, and I am concerned that it has not been taken into account by a number of CCGs.

In areas where gluten-free products are not prescribed, there is now no opportunity to encourage dietary adherence nor a prevention strategy for long-term management of people with coeliac disease. Effectively, patients who suffer the condition in these areas will be offered no support by the NHS. Although CCGs are engaged with local authorities and wellbeing boards to explore alternatives, none has yet been put in place.

The NHS has a good track record of involving the public in consultation, but the lack of consultation on the decision to withdraw prescriptions for gluten-free products is a disgrace, added to the fact that charities such as Coeliac UK are not consulted before such decisions are made.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate my hon. Friend on securing this debate. The point he is making is direct and correct. The nine-year-old daughter of my constituent, Helen Frost, has coeliac disease and Helen is worried that prescriptions for gluten-free products may be taken away. The uncertainty is adding stress to a situation that is already difficult to manage.

[Mr Jones]

That is not even taken into consideration, as my hon. Friend says.

My concern is that cutting prescriptions for gluten-free products is a simple and easy target for CCGs under financial pressure. The entire prescription cost to the NHS in 2014 was £26.8 million or 0.27% of the total prescription budget—£194 per patient. The procurement system that the NHS has in place is not working. The market for gluten-free products in the UK in 2014 was some £211 million, but the annual NHS budget was around £27 million or 13% of that total market. I do not know why the NHS cannot negotiate contracts with some commercial companies. Failure in procurement will clearly have an impact.

I turn to the issue of pharmacists. Back when we had primary care trusts, some pharmacy-led supply pilot schemes were set up in a handful of regions in England. When a patient was diagnosed with coeliac disease, the pharmacy-led scheme allowed patients to access gluten-free food and to manage their coeliac disease. However, with the establishment of CCGs, that seems to have gone out of the window—except in Scotland, which has a national gluten-free food service: a pharmacy-led scheme based on pilots in the UK.

Will the Minister seriously consider introducing such a scheme in England? It would save time and money and be a better way of managing people with coeliac disease. It is worth noting that the annual cost of gluten-free food is lower than the annual cost of items that the NHS provides that cost less over the counter—for example, paracetamol and so on. I beg the Minister to consider that, if properly done, what I suggest would save money.

I know the Minister has been in post for only a few months and I am sure he receives many demands for things to be provided by the NHS, but I am also sure his officials have briefed him on the principles of the NHS: that it is a comprehensive service available to all with access to NHS services based on clinical need, not individual ability to pay, and that it aspires to put patients at the heart of everything it does. This issue is about limiting choice because of cost.

In conclusion, the issue needs urgent intervention. It is not fair to individuals and there is a postcode lottery. A pharmacy-led system could be delivered better and more effectively. At the of the day, the people affected have no choice but to have a gluten-free diet. We should not ration care for some of the most vulnerable in our society.