Acquired Brain Injury
Liz Twist Excerpts(6 years, 6 months ago)
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Liz Twist (Blaydon) (Lab)
I am glad to be able to take part in this important debate.
Over the past few months, I have had the pleasure of taking part in the all-party parliamentary group on acquired brain injury, led by my hon. Friend the Member for Rhondda (Chris Bryant). I confess that I first joined what was then a new group at the request of a constituent and friend who works with the charity Headway in the north-east. He was keen that the problems faced by people with an acquired brain injury should be properly and thoughtfully considered, and for action plans to be devised that would seek to help resolve those problems. It was only during the course of the meeting that I had one of those lightbulb moments, realising that one of my family members actually has an acquired brain injury. That is a classic example of one of the difficulties faced by many people with an acquired brain injury; it can be an invisible disability that is not recognised.
This evening I will talk about the issues facing children with acquired brain injury, particularly in education, which was one of the topics on which the APPG heard evidence. Department of Health data shows that in a four-year period, 39,000 under five were admitted to hospital because of falls. Many of these children will be discharged as fully recovered, although the outcome of traumatic brain injuries in children may not become clear until their brain is fully matured. In fact, despite the early years being a key point in brain development, it is also the time when children are most vulnerable to injury. Sadly, it is also the least supported age group.
The APPG heard from the Child Brain Injury Trust in one of our meetings that children are very different from adults after acquired brain injury, because their brains are still developing and will continue to do so until they are in their mid-20s. This means that the full extent of their injuries and subsequent difficulties may not be realised until their brains have fully matured. Up to 70% of children and young people return to mainstream education following their injury.
As we heard in the APPG, in common with many other groups there is a lack of interim access to rehabilitation, whether residential or in the community—community being the main issue for children and young people—so schools and teachers are the main source of rehab for these young folk. Unfortunately those teachers, including special educational needs co-ordinators and educational psychologists, do not have access to training in how to deal with children returning to school with acquired brain injury. Of course, we know about the pressure that teachers already face in their work. Many young people do not have a formal diagnosis of acquired brain injury, so they can be misdiagnosed as being on the autistic spectrum or as having attention deficit hyperactivity disorder. This can be a real detriment to their outcomes and future development.
It is not just at school that children and young people face problems. In the family, the emotional and psychological impact of an ABI can completely change their world. They often face a lack of services in the community, isolation, and a lack of access to funding support and information. They may also be unable to access counselling. They are balanced between child and adolescent mental health services and other non-neurological services, as specialist neurological specialist for children are scarce. Where people live matters; there are few areas of excellence, with the excellent services mostly based around major trauma units.
I could say a great deal more, but I will cut my speech short in view of the time limit. I will just finish by saying that our children deserve better than what they have at present. Children with an acquired brain injury need to have their condition recognised, and need to be supported to do the best they can at school and to improve their life outcomes. I hope that this debate will help to raise awareness, and lead to positive improvements for them and other people with acquired brain injury.
NHS Outsourcing and Privatisation
Liz Twist Excerpts(6 years, 7 months ago)
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Liz Twist (Blaydon) (Lab)
On 6 March, I had the good fortune to secure a debate in Westminster Hall on wholly owned subsidiaries in the NHS and was shocked to find how many hon. Members—they were not just Labour Members—had experience of local NHS trusts setting them up. The NHS trust that covers my constituency, the Gateshead NHS Foundation Trust, has set up a wholly owned subsidiary company. It is also advising other trusts on how to do the same.
The Gateshead NHS Foundation Trust is a very good trust, but I am concerned that it has transferred staff who provide the maintenance, cleanliness and operation of the hospital to a wholly owned subsidiary company. There are two ways in which trusts can save money by setting up a subco: through savings on VAT thanks to a loophole—the Treasury appears to be willing to look the other way—and through future savings in staffing as new staff are employed outside “Agenda for Change” pay, terms and conditions. Importantly, there are also savings on pensions because those staff are denied access to the NHS pension scheme.
The savings are coming off the backs of staff, many of whom—porters, cleaners and catering staff—are already on the lowest scales. “Agenda for Change” was introduced to provide a fair and equality-proofed pay system for all NHS staff. It is bad enough that staff working for contractors in the NHS, such as those formerly employed by Carillion and now employed by companies such as Serco, which took over some of Carillion’s contracts, are not on that pay system, but the fact that NHS trusts voluntarily and even eagerly take measures to get around the system is simply outrageous.
Let us be clear: we know the problem is underfunding of our essential NHS services. This Government have failed to provide adequate funding right across the NHS and some trusts have taken the decision to set up these subcos in an effort to make that money go further. We understand that on the Labour Benches. But it is beyond the pale to ask lower-paid staff to make the savings from their own pay packets. All of us, on both sides of the House, say how much we value the NHS workforce, but that means not only nurses and doctors, but the staff who make the hospital work. They are an essential part of the NHS team, and the Government must ensure that they are treated fairly, now and in the future.
There is another concern about these subcos. There is a real concern that they are being set up ripe and ready for privatisation: a neatly packaged organisation, vulnerable to the vagaries of the market. This is not the NHS we want. We want an NHS that recognises the value all of its staff, from cleaners and porters to allied health professionals such as occupational therapists and radiographers, from maintenance staff to nurses and, yes, doctors. We need an NHS that does that so that we can provide the best possible care for patients. We need to ensure that we maintain these services in the public sector, and I know that there is huge support from my constituents for ensuring that our NHS services are directly provided by NHS staff.
Earlier today we heard that staff at Wrightington, Wigan and Leigh NHS Foundation Trust are taking industrial action against a proposal to transfer them to a subco. More than that, they are striking against the privatisation of NHS services. I wish them, and staff in other trusts standing up for our NHS, every success.
Social Care
Liz Twist Excerpts(6 years, 7 months ago)
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Liz Twist (Blaydon) (Lab)
I want to touch on some of the social care workforce issues. Social care is what we rely on when we need help—whether that is residential care when we need to go into a home, or care in our own home. We rely on social careworkers, residential careworkers, and home careworkers and support workers if we need help at home. These are staff who deal with our most personal needs at a time when we might be at our most vulnerable, yet we fail to value adequately the work that they do and the care and sensitivity with which, on the whole, they deliver it. I know how vital that support is and how well and compassionately it can be delivered when it is at its best, as we briefly had that support for both of my parents recently.
These are staff who are often under pressure to meet impossible visit schedules, who are on the frontline of looking after our families and neighbours, and who are on the lowest pay grades, too. They are predominantly female. As has been mentioned, Unison, the trade union that represents many of these staff, conducted a survey of the staff in social care with Community Care magazine. It showed a picture of staff feeling stressed, working more hours than they are paid for each day, and staff shortages that put pressure on others. It gets more basic than that: many staff are not even being paid the national minimum wage let alone the national living wage; domiciliary care staff are not being paid for the time that it takes to travel between visits; and staff on zero-hour contracts—Unison estimates that there are about 300,000 of them—are facing uncertain and often disrupted hours.
Unison has been pushing an ethical care charter for home careworkers and a residential care charter, too—here I should mention the “sleep-in” staff who are not being paid the national minimum wage. I am sorry that the Minister is not in her place at present, because when she touched on this matter she appeared to suggest that the Government are looking at legal ways not to pay sleep-in payments at the national minimum wage rate. Perhaps she, or one of the other Ministers, could correct me if I misheard that point. These staff deserve, and are entitled, to be paid for the work that they do.
It is no wonder that staff turnover is huge in the sector, varying from 31.8% in the residential sector to 44.3% in domiciliary care. These are not just trade union figures. Yesterday, the Health and Social Care Committee and the Housing, Communities and Local Government Committee, which are working together on adult social care, heard from the chief executive of Care England, the providers’ body, who also highlighted the huge problem of turnover in staff. This is not good for employers and it is certainly not good for the people for whom these careworkers work.
This is no way to provide care for the most vulnerable people in our communities—they deserve the most compassionate care that meets their needs—or to treat the staff who provide that care. This is not just about the staff. They are under such pressure because, year after year, this Government have cut funding to local councils, which provide the care, at the same time as those councils face a huge rise in demand. We know that the care market itself is fragile and failing.
Our social care system is not working as it should do. If we are to make it work, we must ensure that funding is provided now and that the care staff are treated properly. We must give social care equity with NHS services. Our older people, and those who care for them, deserve nothing less.
Jackie Doyle-Price
I do not disagree with that point. That is why we need to embark on a process of reform and really get it right. We are embarking on the process on that basis.
A number of Members, including the hon. Member for Blaydon (Liz Twist), mentioned sleep-ins, and I just want to restate what was said, because it seems to have been misunderstood. We fully recognise the pressure on the sector resulting from the ruling on sleep-ins and the fact that the historical liabilities could be a problem. We are working closely with providers, in liaison with the European Commission, to come up with a solution. Hon. Members will understand that the matter is too commercially sensitive for me to say any more than that—[Interruption.] We are working with providers and meeting them on a regular basis.
Liz Twist
I understand what the Minister has just said about sleep-ins and that she is working with providers. We all understand the pressure on those providers, but I asked earlier, are we looking at a way to reward the staff properly for the work they do during sleep-ins, or are we trying to avoid the question?
NHS Wholly Owned Subsidiary Companies
Liz Twist Excerpts(6 years, 9 months ago)
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Liz Twist (Blaydon) (Lab)
I beg to move,
That this House has considered wholly-owned subsidiary companies in the NHS.
It is a pleasure to serve under your chairmanship, Mr Hollobone. I am glad to have secured this albeit brief debate on the issue of NHS wholly owned subsidiaries, and this fairly recent but rapidly developing situation spreading across the NHS. What are these companies? They are organisations set up by NHS trusts as subsidiary companies to the trust, into which a range of NHS facilities management staff are transferred. When I say facilities management staff, I mean all the porters, cleaners, catering staff, estates and maintenance staff, and others who keep our hospitals going. Those staff are an essential part of the NHS.
Rachael Maskell (York Central) (Lab/Co-op)
York Teaching Hospital is about to enter into an alternative management company for the facility staff there. Those are staff that want to work for the NHS, not least because they get the benefit of NHS terms and conditions and pensions. Does my hon. Friend agree that the loopholes in the taxation of the NHS need to be addressed so that those people can remain working for the NHS?
Liz Twist
I most certainly do agree with my hon. Friend. We know that NHS trusts are under incredible financial pressure and are looking for ways to stretch the available funds. Some trusts have seen wholly owned subsidiaries as a way of reducing costs. Those trusts include the Gateshead Health NHS Foundation Trust, which provides excellent hospital services to many of my constituents.
The cost savings come about in two main ways: through saving VAT and by saving on staffing costs. For some, there may be a third area of income—advising other NHS trusts on going down the same path, which is one of the reasons why they are spreading across the country. In November 2017, the then Health Minister, the hon. Member for Ludlow (Mr Dunne), stated that:
“NHS Improvement is aware of 39 subsidiaries consolidated within the accounts of foundation trusts”—[Official Report, 14 November 2017; Vol. 631, c. 129.]
We know that more are being created even now.
Jim Shannon (Strangford) (DUP)
The issue of pensions is very much at the forefront of the minds of myself and others in this House. Does the hon. Lady agree that it is essential that staff working through the front door of the NHS or the back door of the wholly owned subsidiary company must be entitled to retain their NHS pension? Any attack on the pension scheme must be wholly rejected and the trusts must all be made to understand the position on pensions when these types of actions are taking place.
Liz Twist
I most certainly do agree, not just for pensions but also for terms and conditions.
What is the problem with these companies? First, it is that they come at a price, which for the most part is met by the staff who work for them. Secondly, the VAT saved by trusts with these companies is not new money coming into the NHS—the money that trusts save will be lost elsewhere in public services. Already, the Department of Health and Social Care has reminded trusts by letter that they should not engage in any activities that may be construed as tax avoidance, and the loophole could be closed in the future. Thirdly, the establishment of wholly owned subsidiaries leaves the services open to privatisation in the future, continuing the fragmentation of our NHS.
Alex Cunningham (Stockton North) (Lab)
The North Tees and Hartlepool NHS trust set up a limited liability partnership last week. Even according to its own published material, it provides no guarantee of job protection beyond a few months and will create a situation with different employees on very different terms and conditions. Is this not all about Government cuts? Does my hon. Friend not agree that we could see even more staff transferred into this sort of arrangement in order to meet the Government’s cuts agenda?
Tulip Siddiq (Hampstead and Kilburn) (Lab)
My hon. Friend is being very generous in taking interventions. Unite points out that over the past five years, more for-profit companies have won contracts to run NHS services, with the total value of contracts awarded in 2016-17 standing at a staggering £3.1 billion. Does my hon. Friend agree that the Government must compel Her Majesty’s Revenue and Customs to close this tax loophole, so that NHS trusts are not forced to consider outsourcing NHS services?
Liz Twist
I most certainly agree that the issue is a dangerous one that needs to be looked at, and it is a very worrying one because, whatever happens, the staff who have transferred are in a very difficult position.
In the longer term, the establishment of the wholly owned subsidiaries leaves services open to privatisation in the future, continuing the fragmentation of our NHS, which is not in the long-term interests of all who use the NHS. There is no evidence that the plans will improve efficiency or productivity in the NHS. They exploit a tax loophole and seek to exploit the future workforce.
Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)
The hon. Lady and her colleagues are right to highlight the fact that the financial pressure on the NHS is the main driver for this situation. Does she agree that it is very difficult in some services to differentiate between administrators and back-office services, and frontline services? Sometimes, administrators and back-office workers are embedded in clinical teams, and this actually worsens fragmentation and makes it much more difficult to deliver high-quality patient care.
Liz Twist
The hon. Gentleman makes an excellent point. NHS staff, whatever their job, are all part of a team that delivers a service, and they all work together. For example, the catering and cleaning staff who looked after my mum’s hospital ward when she was in hospital recently were also a part of the NHS caring process. I think that is a really important point.
Judith Cummins (Bradford South) (Lab)
One of the major problems with the creation of these wholly owned companies is that they lead to a two-tier workforce in which often the lowest paid staff, such as domestics and security guards, are on worse terms and conditions than other staff. Does my hon. Friend agree that that represents a race to the bottom and is not just bad for those moved over to the new companies but bad for the NHS overall?
Liz Twist
I most certainly do agree, and I will expand on that point shortly.
I want to speak about the impact on staff—some of the same staff we have all been praising in recent days for turning up to work in the snow and coping when we have the only too frequent crises. They are an integral part of the NHS team, as the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said, making it possible for nursing and medical staff and other allied health professionals to do their bit in caring for patients.
On transfer to a wholly owned subsidiary company, staff already employed by the trust will be transferred on their existing terms and conditions. That is, on “Agenda for Change” terms and conditions and pay rates, negotiated nationally and checked to ensure equal pay for work of equal value. They will retain their membership of the NHS pension scheme and a set of decent terms and conditions applying to all NHS staff. The main way that trusts can make savings through these companies is by employing new staff on different, and worse, terms and conditions.
Mike Hill (Hartlepool) (Lab)
On the point made by my hon. Friend the Member for Stockton North (Alex Cunningham) about North Tees and Hartlepool Solutions, as the LLP is called, does my hon. Friend agree that its immediate intention to introduce worse terms for new starters sets a dangerous precedent?
Alex Cunningham
Further to that point, is my hon. Friend aware that the question and answer document produced by the North Tees and Hartlepool NHS Foundation Trust says that NHS staff transferred into the new company can expect a pay rise this year, but nothing is guaranteed in the future? They are already seeing their future conditions eroded, unless the new company awards them the pay rise they will get under the current system.
Liz Twist
That is absolutely correct, and I have raised with my local trust the potential move away from NHS pay rises.
The main way trusts can make savings is by employing the new staff on worse terms and conditions, which means lower pay rates, less holiday, inferior sickness schemes and no access to the NHS pension scheme. As colleagues said, even transferred staff may be moved on to the worse terms and conditions over time. Trusts are doing that to the lowest-paid workers, who are essential to keeping our hospitals going.
Mike Amesbury (Weaver Vale) (Lab)
Does my hon. Friend agree that doctors and clinicians should prescribe only medicines that have a strong evidence base and have been shown to be effective in trials? On that basis, does she agree that wholly owned subsidiaries for the treatment of illness would be ineffective?
Rachael Maskell
The last time there was a segmentation of facilities management, we saw the rise of MRSA and other communicable diseases, so the evidence shows that this is a bad move.
Liz Twist
That is a very valid point, and it must be considered carefully.
We are creating divisions between staff in the facilities management companies and other NHS staff by introducing a two-tier workforce, which health service unions such as Unison—my union—have worked hard to move away from. The setting up of these wholly owned subsidiaries is a retrograde step. It insults and undervalues the staff who do essential but less visible jobs in the NHS. It deprives them of the pension scheme that their colleagues have access to and exposes trusts to equal pay claims. Equally important, it risks breaking up our NHS—perhaps not today, but in the near future.
I have been looking at the health press in preparing for this debate, and I have seen that there are plenty of companies out there willing to advise on setting up NHS subsidiary companies and look at the benefits of such companies. There are no such advantages. There is no reason why NHS staff working together cannot produce a better NHS. Indeed, they are doing so all over the country. We need to stop this trend of establishing wholly owned subsidiaries in the NHS. We must respect all our hospital staff and prevent the fragmentation and privatisation of our NHS.
Stephen Barclay
The trust has stressed that the organisation remains in public ownership. Let me deal with the hon. Gentleman’s substantive point—it was also raised by the hon. Member for Bradford South— that this is about exploitation. I discussed that point with the trust ahead of the debate.
Previously, the trust had difficulty in attracting and retaining quality maintenance staff because the salaries paid in the local market were about £19,000 per annum. Under the subsidiary company, multi-skilled craftspeople are employed at about £25,000 per annum, plus a performance bonus, attracting better-qualified staff and ending retention issues, in exchange for the fact that they do not have access to the NHS pension.
Stephen Barclay
I will happily give way to the hon. Lady in due course.
That is not about exploitation; it is about empowering members of staff. They get higher pay in the short term in return for a less generous pension. The hon. Member for Stockton North might disagree—
Stephen Barclay
I signalled that I will give way to the hon. Member for Blaydon. She called the debate, so she should go first.
It is not accurate to say that this is simply about exploiting people if their base salary is increasing from £19,000 to £25,000, as it is in that trust. One can look at the wider bundled package of benefits and total remuneration, but one cannot describe a salary increase of £6,000 as exploitation.
Liz Twist
The Minister is raising an issue of great concern to me, which I have discussed with the chief executive of the foundation trust, so this is not coming as news to him. If we move away from a structured pay system and give additional salary payments over and above allowed recruitment and retention bonuses, we are laying the trust or the organisation open to the claim that they are not providing equal pay for work of equal value. A huge amount of work went into creating “Agenda for Change” to avoid exactly that problem and to address recruitment and retention.
Stephen Barclay
The hon. Lady is ignoring the fact that that already happens in the NHS, for existing trust staff: some staff opt out of the NHS pension, and not all the staff who TUPE-ed across in this arrangement were in the NHS pension. Once again, those on the Labour Benches want to deny the choice and options that apply to NHS staff.
Stephen Barclay
Within the NHS as a whole—nothing to do with subsidiaries—there is a range of treatment of staff on pensions. First, there are the legacy pension arrangements for staff in previous schemes and, secondly, people opt out of existing pension arrangements in the NHS. Again, it is a complete mischaracterisation of this debate on subsidiaries to suggest that there are differences. The point, however, is that there are also differences in pay, as has come out of this debate: the maintenance staff for whom the trust is paying a premium can be paid so because of the subsidiary.
Liz Twist
I thank the Minister for giving way—the only way I can get a response in is by intervening. I have a few separate points. First, on the Labour legislation, is it not strange that the subsidiary companies have only started to appear in this form since 2014? As my colleagues said, that is a reflection of the fact that we have a shortfall in funding for the NHS. Secondly, I want to mention the path lab example the Minister gave. As I said in my speech, there is no reason why existing NHS staff in the NHS trust cannot make the improvements—they do all the time—
Motion lapsed (Standing Order No. 10(6)).
Hospital Car Parking Charges
Liz Twist Excerpts(6 years, 10 months ago)
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Bambos Charalambous (Enfield, Southgate) (Lab)
I congratulate the right hon. Member for Harlow (Robert Halfon) on securing this important debate.
It is clear from hon. Members’ speeches that the scandal of hospital parking charges must come to an end. Gravely ill people and people visiting relatives while in a state of distress should not be treated as cash cows by hospital car park operators. It is shocking that half of all trusts last year charged disabled people to park in some or all of their disabled parking spaces. We need to address the ridiculous inconsistency whereby hospital parking is mainly free in Wales and Scotland while trusts charge for parking in Northern Ireland and England. It is time that all hospitals abolished parking fees. Drivers must not be punished for being sick, visiting loved ones or attending medical appointments. People do not choose to be ill and should not be asked to pay for a no-choice hospital visit.
Many of my Enfield, Southgate constituents have approached me about this issue. A mother contacted me to say that after her husband took their son to the North Middlesex University Hospital accident and emergency unit with breathing difficulties in the middle of the night, he was later presented with a parking charge notice. I do not believe that people rushing to hospital with gravely ill children should be put into the position of having to worry about such matters. Imagine if my constituent had spent extra precious moments scrambling for change for parking while his son struggled to breathe. Would that have been a sensible and responsible thing for the parent of a seriously ill child to do? Of course not. That is exactly why we must get rid of these charges.
I have also been contacted by a father who had to take his young daughter to the emergency department. Throughout the evening and into the night, my constituent had to leave his daughter to feed more money into the car park meter because she was being kept in for such a long period of time—it ended up being overnight. My constituent kept paying into the machines, which failed to give him receipts when requested, leaving him unsure how much time he had left. My constituent reported seeing other people in various states of distress walking around the car park and seeming unsure of what to do. Two weeks later, my constituent received a notice telling him that he had not paid for all the time that he had been in the car park. Again, we must ask whether this is an appropriate way to treat the parents of very ill children.
We have all heard in the press about desperately ill patients who have been forced to quit work and left with bills for hundreds of pounds due to their frequent visits to hospitals. Then there are hugely unfair cases of NHS staff who have had parking charges deducted from their wages, but then have been unable to get a space and have been fined for parking in the wrong bay. Several elderly constituents have contacted me to say that they face relatively high parking charges for their regular hospital attendances.
This Sunday, 4 February, is World Cancer Day, and many of us know people who have had treatment for cancer. Anyone who knows the effects of chemotherapy will be aware of how debilitating the treatment can be. People often need a carer to help them to make the journey home. Considering the frequency of treatments for cancer and other illnesses, surely car parking charges are nothing more than a tax on the sick. As the hon. Member for Telford (Lucy Allan) pointed out, many people have no choice but to drive to their local hospital due to the infrequency of public transport.
Liz Twist (Blaydon) (Lab)
My hon. Friend talks about travel difficulties. Does he agree that reductions in the number of bus services in many areas mean that there is no alternative to parking in hospital car parks? In constituencies such as mine, which has no hospital, that means frequent journeys for people who require treatment.
Bambos Charalambous
My hon. Friend makes an excellent point. People in rural areas or who live far away from their local hospitals are unfairly affected by having poor transport networks to ferry them to hospitals, so they have no choice but to travel by car.
The right hon. Member for Hemel Hempstead (Sir Mike Penning) made the excellent point that other emergency workers are not being required to pay to park at their police or fire stations. In addition, hospital staff, by taking up parking spaces, are reducing the number of spaces for patients and visitors. NHS staff should be able to park for free, but they should also be able to afford to live nearer the hospital. It is therefore ironic that we are in a situation in which NHS trusts are forced to sell land that could have been used to house NHS staff locally.
Another pressure on North Middlesex Hospital has been the fact that the closure of the accident and emergency unit at Chase Farm has resulted in far more visitors to its A&E unit. Those additional visits meant that, between Christmas and new year, the hospital ran out of acute beds. One can only imagine how busy the hospital car park was during that period.
Many hon. Members have made excellent contributions about the need for the Government to abolish car parking charges. It is time that those unfair charges were scrapped and the NHS properly funded. For the sake of NHS staff, parents and visitors, I ask the Minister to bring forward measures to scrap car parking charges as soon as possible.
Male Suicide
Liz Twist Excerpts(7 years ago)
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Ged Killen
I hope that is the case and I think that, certainly, younger men are more likely to talk about their feelings than the older generation. Although there has been a strong downward trend in suicide rates in Scotland, in 2016 there was an 8% increase. Hopefully, that will go back down, but the issue still needs to be addressed, which is why it is important to have debates such as this.
Liz Twist (Blaydon) (Lab)
My hon. Friend is making a powerful speech. He talked about the Samaritans research, which showed, in summary, that less well-off men are ten times more likely to die by suicide than more well-off men. Does he agree that it is important that the Government try to tackle the problem through a suicide prevention strategy and through identifying specific ways of helping to address the rate of male suicides?
Ged Killen
My hon. Friend is absolutely right and I hope that the Minister will touch on that. I note that suicide is treated as a health matter.
Jackie Doyle-Price
In a nutshell, we all need to become much more aware about when people might show signs of mental ill health. I hope that through the programmes that we are running, the priority that we are putting on mental health will do much to raise awareness.
Obviously, we are trying to do much more in schools, following the publication of “Transforming Children and Young People’s Mental Health Provision: a Green Paper”, but the category of people that the hon. Member for Rutherglen and Hamilton West referred to miss all that attention. Working-class men who work on building sites are not “meant” to have mental health problems, so when they have them, nobody pays any attention, because the environment is very masculine. The hon. Gentleman identified that. They are certainly not going to seek help, so it is not surprising that that particular group of people has a very high incidence of suicide. There is a general role for public awareness.
The point that the hon. Member for Midlothian (Danielle Rowley) made about bars is a very interesting one. We are keen to use mainstream media to highlight the message. One of the reasons that we support Time to Change, which the hon. Gentleman referred to, is exactly that—to get out those populist messages to raise awareness among the whole general public, so that we can all identify when someone is in trouble.
Jackie Doyle-Price
I was not aware of Mates in Mind, but it sounds like an excellent initiative that I would be keen to support. Ultimately, we would not worry about showing up to a hospital with a broken leg, so why should we worry about seeking help when we do not feel so well mentally? There is nothing unmasculine about reaching out for help—nothing at all. We just need to make that much easier for people.
The profile of suicide has never been higher, and that is testimony to the progress we are all making—this debate is a great help—in tackling the taboo of talking about it. We need to be a lot more open about it. We must strive to reduce suicide among the whole population, but as the hon. Member for Rutherglen and Hamilton West said, men are at the highest risk. Despite suicides among men having reduced in England in the past few years, the number of men who die by suicide remains too high.
The hon. Gentleman and others referred to the Samaritans, which I cannot praise enough. We are pleased to continue to support its prevention work. Frankly, given its outcomes and the lives it supports, it is a fantastic organisation and fantastic value for money. That just goes to show that personal interventions—often anonymous ones—are of most use in this area. People in this position often self-medicate using alcohol, so, as the hon. Member for Midlothian said, a stranger in a bar saying, “Are you all right, my friend?”, could make all the difference and save a life. We should encourage people to support exactly that kind of organisation.
As I said, the ONS found that construction is among the occupations with the highest incidence of suicide, so I am keen to hear more about the initiative that the hon. Member for Blaydon (Liz Twist) mentioned. It is worth noting that that kind of work is often transient: people move around to do it and it is often seasonal. We need to be sensitive to the fact that people who move in and out of work often experience additional mental pressure.
We are approaching Christmas. If there is a time of year when people feel particularly lonely, it is Christmas. Every Member here is showing an interest in this issue, so I do not need to tell them this, but we all need to be aware that people will feel lonely and will often be at their lowest ebb at Christmas, so that is when acts of kindness can mean the most.
Jackie Doyle-Price
I could not have put it better. That is a fantastic message to send out. I hear what the hon. Gentleman says, and I am pleased that the Royal Mail has done a lot more in this space, no doubt in partnership with the trade union. Again, I pay tribute to all that work.
As part of my support for World Suicide Prevention Day this year, I visited the Samaritans and met some of its volunteers. They have to do a good number of hours a week to maintain their status, which shows fantastic commitment on their part. I think we would all thank them for the work that they do. I am pleased that we have agreed to fund the Samaritans helpline until 2022 to support that work.
We have heard that men are much less likely to seek professional help and are more likely to engage with services outside traditional clinical settings. We need to send a positive message that there is no shame in seeking professional help, which is exactly why we are investing in those services. As the hon. Member for Rutherglen and Hamilton West said, we could have the best and most accessible services in the world, but they would be pointless unless people were willing to use them. We really need to tackle that sense of shame.
Many excellent initiatives in local communities seek to do exactly that. The Men’s Sheds Association provides opportunities for men to meet others and to engage in activities together in familiar settings. Andys Man Club engages men through sport while making it easy for them to seek advice about things such as relationships and debt, which we have heard often contribute to the mental health crises that can lead to suicide. The Government also support the Sport and Recreation Alliance’s mental health charter, which aims to do the same. As I mentioned, we have given Time to Change, which is designed to tackle stigma, £30 million since 2012, and we will continue to support it until 2020. I hope that that indicates clearly our direction of travel in raising awareness.
As the hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) outlined, there are good messages that we can send. My message to the public is: “Reach out. If you think someone is in difficulty, send them a text or give them a phone call. Keep your eye on people who might be feeling down, because feeling down one day can suddenly become feeling rock bottom another. Listen and don’t judge when people are feeling unhappy about circumstances.” People with mental health difficulties lose perspective, and the smallest things can become absolutely huge. It is often said—this is one of the wisest proverbs—that a problem shared is a problem halved, and it can be more than halved when someone is having a mental health crisis.
Liz Twist
The Minister rightly emphasises the need for personal support and the need to talk. Will she address socioeconomic issues? In its “Dying from Inequality” report, the Samaritans shows that socioeconomic factors are really important in whether people consider ending their life by suicide. Will the Minister talk about that?
Jackie Doyle-Price
Socioeconomic issues determine when and how people seek help—that is the key. It is clear that that means suicide levels are higher among lower-income groups. We need to tackle that by developing tools that are accessible to that audience. Time to Change has a great track record in that respect, having improved the attitudes of 3.5 million people in recent years. I encourage anyone who has not seen its campaign to have a look at it and at how it engages people.
As I am running out of time, I will quickly go through some of the other points I wanted to make. Local suicide prevention plans are critical to tackling suicide in the long term. We need services that people can access directly. I am keen that we do more work with the Association of Directors of Public Health and the Local Government Association to ensure that local suicide prevention plans are rigorous and deliver the right outcomes. We do not want them to be just a box-ticking exercise: they need to deliver and reduce the impact of suicide.
The cross-Government suicide prevention strategy for England has been updated to focus on high-risk groups, such as middle-aged men, and widened to include self-harm, as I mentioned. That means that suicide plans will be more targeted than ever at those who need the most support.
The hon. Member for Rutherglen and Hamilton West raised the issue of deaths being registered within eight days and pointed out that it can take longer in England. The ONS continues to try to improve the timeliness of published data about suicide, and we will definitely look at that.
Although our efforts should be about reducing the risk of suicide for everyone in our communities, it is fair to say that men remain at the highest risk and are therefore a priority. We are looking to local areas to develop strong local partnerships and implement innovative ways of reaching out to men who may be at risk of suicide. There is clearly a political consensus that we must address suicide prevention. Now is the time for us all to take action to make change a reality for people and communities, and the Government will be tireless in our pursuit of that. I am grateful to hon. Members for attending the debate. Their number illustrates that the House cares deeply about this issue and really wants to tackle it. Let’s make a real difference.
Question put and agreed to.
Deafness and Hearing Loss
Liz Twist Excerpts(7 years ago)
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Liz Twist (Blaydon) (Lab)
It is a pleasure to serve with you in the Chair, Ms Buck.
I am sure most of us know many people who are affected to some degree by hearing loss, and we know the impact it has on their lives. In my own case, both my parents were affected. My dad, who died a couple of years ago, had industrial deafness caused by his work in a factory. The effects of that lasted a long time. I welcome the comments from the right hon. Member for Hemel Hempstead (Sir Mike Penning), recognising the industrial injuries aspect. My mum resisted hearing aids for many years, but the difference they made to her life when she finally gave in was, and continues to be, immense. It is immense to us as well, of course.
That is why I was so concerned to hear from Action on Hearing Loss, which I met recently, that some clinical commissioning groups are proposing restrictions on the prescription of hearing aids to people with mild and moderate hearing loss. Indeed, some have already done so, including North Staffordshire CCG, which was referred to earlier. Not only do hearing aids make a real difference to people with mild and moderate hearing loss, but research shows that they reduce social isolation and depression. New evidence also suggests they can reduce the risk of developing dementia; a study in The Lancet recognised hearing loss as potentially the largest modifiable risk factor for dementia. We can do something about it. I hope the Minister will make clear that hearing aids must be provided where they are needed.
As my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) has clearly set out, the cash limit on the Access to Work scheme has also had a significant impact on many people with hearing loss, limiting their ability to do their job properly, or in some cases meaning that they might not be offered jobs because of the shortfall in financial support. I ask the Government to look again at removing or raising the cap. I also echo my hon. Friend’s call for further work on implementation of the action plan on hearing loss. As he described, some good work has been done already, but I ask the Minister to ensure that the Government step up their work on implementing the plan.
In the summer, I met Erin, a young woman campaigning with the National Deaf Children’s Society to have British Sign Language recognised as a GCSE and made available to all students. I join Erin, and the hon. Member for Waveney (Peter Aldous), in calling for BSL to be a GCSE subject.
Autism Community: Mental Health and Suicide
Liz Twist Excerpts(7 years ago)
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Liz Twist (Blaydon) (Lab)
First, I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—sorry for my pronunciation—for her thoughtful and comprehensive speech, and for setting out the difficulties that people with autism face. I am tempted to say, “What she said,” but I do not think that does justice to the situation.
I just want to touch on a few points. Earlier this year I met Autistica, a charity that does research into autism. If other hon. Members have not seen its report “Personal tragedies, public crisis”, which looks into why people with autistic spectrum disorders die early—up to 16 years early, as the hon. Lady said—I would encourage them to do so. It makes shocking reading. The key points include the point that autism in itself is not a mental health problem, but that eight out of 10 autistic people will face mental health difficulties, such as anxiety and depression. Four out of 10 children with autism have two or more mental health problems. The research also shows that suicide is a leading cause of death among people with autism. Autistic adults without a learning disability are nine times more likely than others to die by suicide, and autistic adults with a learning disability are twice as likely to be die by suicide. Those are shocking figures. Suicide is preventable, and we need to do much more to reduce those figures.
We also need to recognise some of the specific problems people face. As other Members have said, many mental health problems can look different in autistic people. We need to recognise that and make sure that the issue is addressed, and that people have the appropriate treatments and are dealt with properly.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
My hon. Friend is quoting from an excellent piece of research, but is she aware that the autism commission I chair has conducted a piece of work about the spectrum of obstacles and the difficulty that people with autism face in getting through to the right people in the health service? Those two pieces of research are so powerful.
Liz Twist
I thank my hon. Friend for that intervention, and I absolutely agree that the two pieces of work go together and can help us to improve services for people with autism spectrum disorders.
As others have said, it is becoming increasingly obvious that some mental health therapies are not right for people with autism and do not work in the same ways as they do for other people, and we need to do more research into those areas.
It can be difficult for autistic people to approach services for support, and we have already heard about the issues with going to a GP surgery. Autistic people and their families are also left fighting the system too often, because information is not shared.
We need to do a number of things. First, as others have said, we need to diagnose autism much earlier so that appropriate interventions may be offered to people with autism and their families. Secondly, we need to record people who have autism on GP records and collect data so that we can identify the issues and develop appropriate services. It is good that, in the Westminster Hall debate in September, the Government committed to gathering data. I hope the Minister can update us on progress on that.
Next, it would be useful to hear from the Minister what progress is being made on developing the autism care pathway proposed in the “Five Year Forward View for Mental Health”, and whether it will address suicide specifically.
There is concern that suicide prevention measures are not well designed for autistic people. I hope that the Minister will look at what needs to be done differently to reach and support autistic people in crisis.
Finally, none of the recent cross-Government suicide prevention strategies makes reference to autism. Given that we now know that the risk of suicide is so high in the autism community, and that there are very different issues to be considered, as we have heard, will the Minister commit to ensuring that the next strategy looks directly at how to help autistic people in crisis?
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—
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.
Mental Health: Pharmacists
Liz Twist Excerpts(7 years, 1 month ago)
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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.”
Autism Diagnosis
Liz Twist Excerpts(7 years, 3 months ago)
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Bambos Charalambous
My hon. Friend makes an excellent point. Sometimes the private assessment is not recognised by the local CCG, so referral does not take place as planned, leading to more stress on families and children. I have enormous sympathy with her constituent who has faced that situation.
We all know that the early years of a child’s life are so vital for their long-term development. If a child does not get a good start, it is always hard to catch up. Research conducted by the charity Autistica has found that a programme of parent-led video therapy delivered during the early years of an autistic child’s life could significantly improve their communication and social interaction skills. People who are not diagnosed until adulthood can experience depression and have suicidal thoughts.
Liz Twist (Blaydon) (Lab)
Does my hon. Friend agree that Autistica’s research also indicates that people with an autism diagnosis, once they get it, can have an increased risk of mental health conditions? In fact, such young people are 28 times more likely to consider suicide than other young people, and that affects adults who do not receive a diagnosis, too. People who have autism have an increased risk of suicide.
Bambos Charalambous
My hon. Friend makes an excellent point. Other additional conditions can develop, and suicidal tendencies are one of them. Other mental health conditions can similarly manifest themselves in young people in particular. I congratulate her on looking at that research.