Coeliac Disease and Prescriptions

Debate between Lord Beamish and Jack Dromey

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.”

Policing and Crime Bill (Sixth sitting)

Debate between Lord Beamish and Jack Dromey

Committee Debate: 6th sitting: House of Commons
Tuesday 12th April 2016 Public Bill Committees

[Jack Dromey]

First, the Police Minister is right to be frank: this set of proposals will put pressure on not just the police but a whole range of other agencies. I note what he said of Her Majesty’s inspectorate of constabulary and its PEEL reports, and I add that the College of Policing and the Home Affairs Committee will keep this matter under review. I also welcome the proposed memorandum of understanding so that we can make the new system work. On that basis, and given those assurances, we will not press our amendments to a vote.

Amendment 148 agreed to.

Clause 50, as amended, ordered to stand part of the Bill.

Clauses 51 to 59 ordered to stand part of the Bill.

Clause 60

Restrictions on places that may be used as places of safety

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

I beg to move amendment 157, in clause 60, page 68, line 29, at end insert—

“( ) Before a house, flat or room where a person is living is used as a place of safety the patient must first be offered one of the following locations as an alternative place of safety—

(a) a residential accommodation provided by a local social services authority under Part III of the National Assistance Act 1948 or under paragraph 2 of Schedule 8 to the National Health Service Act 1977;

(b) a hospital as defined by the Mental Health Act 1983; or

(c) a mental health care home.”

This amendment would require that a patient was offered a health-based place of safety as an alternative to their, or someone else’s, home being used as a place of safety.

Policing and Crime Bill (Third sitting)

Debate between Lord Beamish and Jack Dromey

Tuesday 22nd March 2016 Public Bill Committees

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

It is a pleasure to serve under your chairmanship, Mr Howarth. Amendment 156 is a probing amendment; I will not divide the Committee on it. As I said on Second Reading, I welcome what the Government are doing through the Bill to amend the Mental Health Act 1983, in particular ensuring that people in mental health crisis do not end up in police cells. I have a little bit of sympathy for the police in terms of how they deal with such individuals. The police are not the appropriate people to deal with those in mental health crisis, but sadly they are sometimes the only ones available. The dedication of our policemen and women is such that they will not turn away people in that type of crisis. The purpose of my amendment is to probe whether we can get more collaboration between the police, the health service and other agencies, including local government.

In February 2014, the mental health concordat was agreed between the third sector, the police, local authorities and the NHS. It is important to read the joint statement, which states:

“We commit to work together to improve the system of care and support so people in crisis because of a mental health condition are kept safe and helped to find the support they need—whatever the circumstances in which they first need help—and from whichever service they turn to first.

We will work together, and with local organisations, to prevent crises happening whenever possible through prevention and early intervention. We will make sure we meet the needs of vulnerable people in urgent situations. We will strive to make sure that all relevant public services support someone who appears to have a mental health problem to move towards Recovery.

Jointly, we hold ourselves accountable for enabling this commitment to be delivered across England.”

I accept that there is no statutory basis for the concordat, which is a problem, but I think it is important to draw the Committee’s attention to the final sentence of the joint statement:

“Jointly, we hold ourselves accountable for enabling this commitment to be delivered across England.”

Well, currently there is no mechanism by which those organisations—I am not criticising any individual—are held accountable for delivering what they promised in the concordat. There is a desperate need for that.

The concordat’s aims are very good. I have seen some very good examples of joint working between all services, including the police, fire service, ambulance service, NHS and local authorities up and down the country. There are examples of mental health professionals being co-located with police officers and triage teams, and that is certainly working very well. In my local NHS trust, community psychiatric nurses are appointed in A&E because, unfortunately, A&E is one of the places to which people in mental health crisis turn because they are unable to get help elsewhere—even though, as everyone knows, that is the last place they need to be. Having a mental health professional has clearly helped in my local hospital by ensuring that people in mental health crisis do not sit around for hours on end getting no form of treatment.

I accept that this is not necessarily just a police problem; it cuts across other Departments including Health. The amendment questions whether we can use the Bill to put the concordat on to some type of statutory basis and to provide for a presumption that local authorities and others should work together locally to deliver the concordat’s aims, to which most people would sign up. Is the amendment about money? No, it is not. Properly implemented, it could save money. Time that the police spend dealing with people in mental health crisis is time that they are not spending doing other things that they are perhaps better qualified to do. Perhaps the Minister could look at this issue and talk to his colleagues in the Department of Health, so that on Report we can have an indication of how this operation could be enforceable. I do not think that it should fall solely on the shoulders of the police.

[Jack Dromey]

My hon. Friend speaks with great authority on this crucial issue. He makes the point about police time. The Oleaster centre in Birmingham, a collaborative venture between the NHS, the police and the local authority, has seen the average police time spent on a section 136 incident reduced from 14 hours to five hours. Does my hon. Friend agree that there is a powerful argument, regarding not just appropriate treatment of those suffering from mental illness, but the efficient use of police time, for having such facilities nationwide? What he proposes would be very helpful towards that end.

[Mr Kevan Jones]

I do. The example to which my hon. Friend refers is replicated in other parts of the country where the police have in many cases taken the lead, working jointly with the NHS to set up those facilities. They make the experience better for those individuals who are in crisis. As he rightly says, they provide a more efficient way to deal with police time. Without a provision to enable this, I fear we will do all the work in the Bill on changes to the Mental Health Act 1983, which I welcome, but end up saying, “This is what we want to happen but will it happen in practice?” The example in his constituency shows that where there is a will and local drive, this can happen. My fear is that we will get a patchwork quilt of provision across the country. It would be helpful if we could make co-operation to deal with these issues statutory. I will come to another point later when we talk to amendments relating to the Mental Health Act.

I commend the Government’s aim to prevent people in mental health crisis from going to police cells. However, unless there is alternative provision in place, that will not happen. The need to monitor what happens to individuals should be recognised. If we reach the point, which we all want, of having no one in police cells, but without the people concerned getting adequate care elsewhere, we will have failed them. I will address that point later. I am now interested to hear what the Minister has to say.