Oral Answers to Questions

Lord Jackson of Peterborough Excerpts

Tuesday 27th November 2012 Commons Chamber

[Dr Poulter]

I thank the hon. Gentleman for his question, and I welcome him to the House and congratulate him on his victory in the recent Corby by-election. I think he has already admitted on the record that there was a lot of scaremongering during the by-election campaign about the NHS locally. One of the main reasons for concerns about the NHS is the indebtedness of many hospitals in the east of England region, because of the record of the previous Government, who signed many of them up to private finance initiative deals. I will restate for the record once again today that, as I understand it, A and E and maternity services at Kettering at the moment are safe, and there is no consultation directly on the table at the moment. He should make sure he gets his facts right before he raises questions in the House.

[Mr Stewart Jackson (Peterborough) (Con)]

Last week it was a great pleasure to visit Age UK Peterborough, whose No. 1 priority is dementia care, which coincides with the NHS priorities that my right hon. Friend the Secretary of State outlined earlier this week. Will he put in place procedures to make available capital moneys for the construction of dementia care facilities locally?

[Mr Jeremy Hunt]

I can announce that we have already put in place such funds, because dementia is one of the biggest challenges we face across the entire health and social care system. We need more capital funds, but we also need massively to increase the shockingly low diagnosis rates. At the moment, only 42% of the 800,000 people with dementia are being diagnosed properly and therefore getting the treatment they need.

Health and Social Care (Re-committed) Bill

Lord Jackson of Peterborough Excerpts

Wednesday 7th September 2011 Commons Chamber

[Nadine Dorries]

I thank my hon. Friend for that comment. That is a different debate, but he highlights an important issue, and it is abhorrent that 147 babies were aborted for cleft palate, hare lip and minor cosmetic issues. I have a godson who had a club foot, and he was a wonderful young boy and is a wonderful young man. I find it quite amazing that anybody would choose to abort a baby because they had a club foot, but that is an issue for another day. The amendment does not cover it, but it is an important point.

[Mr Stewart Jackson (Peterborough) (Con)]

Does my hon. Friend share my incredulity at those Opposition Members who maintain that an organisation such as BPAS—the British Pregnancy Advisory Service—can be independent in its counselling, when in its March 2011 report and financial statement it notes that

“an increase in procedures of 13 per cent against the background of falling national trends in 2010-11”

is

“a significant achievement”?

How can the opponents of the amendment maintain that there is no fiscal link and no conflict of interest?

--- Later in debate ---

[Nadine Dorries]

The hon. Lady makes the assumption that I want women to continue with unwanted pregnancies. That is not the case. I have made the point that abortion is here to stay for any woman who wants an abortion. The amendment simply proposes that any woman who feels that she wants or needs counselling can be offered it—that is all. I find it very difficult to understand why the hon. Lady would feel that anybody in a crisis pregnancy should not be offered counselling. Why should they not?

[Mr Stewart Jackson]

The hon. Member for Cambridge (Dr Huppert), who is currently fulfilling his role as Dr Evan Harris’s vicar on earth, expressed the view that everything is fine at the moment. Does my hon. Friend share my concern that it is routine for primary care trusts absolutely to refuse to reveal the financial relationship they have—for instance, with Marie Stopes or BPAS—on the basis of commercial confidence, and that it takes freedom of information requests to get that information? The system is clearly not working, and if we want transparency and openness, things have to change.

[Nadine Dorries]

My hon. Friend is absolutely right. Not only that, but the accounts of BPAS and Marie Stopes, which are revealed via the Charity Commission, can sometimes be three years out of date—we do not get to see them until three years later. That is amazing when one considers that the Charity Commission is paid £60 million of taxpayers’ money each year.

This, for me, is about the women who have contacted me and asked me to propose this amendment on their behalf, and I have to dedicate some of this speech to them. Every day I receive e-mails and speak to people—

Health and Social Care (Re-committed) Bill

Lord Jackson of Peterborough Excerpts

Tuesday 6th September 2011 Commons Chamber

[Frank Dobson]

I agree entirely with my hon. Friend. A further point is that I doubt whether there is a single constituency anywhere in the United Kingdom of Great Britain and Northern Ireland that has seen more change in health provision than mine. There are not many places where a virtually trouble-free amalgamation of two major and famous teaching hospitals into one has taken place successfully. There are not very many places that have seen more small GP practices getting together in one location and improving their performance. Those things have always been done with my strong support, even when on some occasions, at least at the outset, the ideas were not popular with some local people. Therefore, I do not accept that I do not believe in change. I believe in sensible change, not stupid change, but stupid change is what we seem to be getting.

[Mr Stewart Jackson (Peterborough) (Con)]

I admire the right hon. Gentleman’s chutzpah, but I wonder whether he was missing in action during the last Parliament. Some of us were saying in 2008 that the imposition of independent sector treatment centres—Darzi centres—would have a direct impact on the budget of primary care trusts and would cause the development of structural deficits that would impact directly on poorer areas with smaller primary care facilities. Where was the right hon. Gentleman then, when it came to attacking his own Government on that specific issue?

[Frank Dobson]

I was attacking them! I am sorry if the hon. Gentleman did not notice, but I believe I was the first person to expose the fact that on average the private sector was paid 11% more per operation than the NHS was getting for the equivalent operation. I shall take no lessons from anybody when it comes to opposing some of the daft things that went on. I did oppose them and I am proud to have done so. What is being proposed now, however, goes far beyond that. As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), who has a great deal of knowledge in these matters, has pointed out, there is scarcely any evidence from anywhere in the world to show that a competitive system delivers better health care than a collaborative system.

To ask the essentially collaborative health care system in this country to turn over to being competitive is a bit like asking the Meat and Livestock Commission to promote vegetarianism: it is simply not what people want to do; it is not their approach and nor should it be. It remains the case that Monitor is still rigged in favour of promoting competition. Let me point out—hopefully without putting my glasses on—that clause 58(3) states:

“Monitor must exercise its functions with a view to preventing anti-competitive behaviour in the provision of health care services for the purposes of the NHS which is against the interests of people who use such services.”

However, it does not say that “Monitor must exercise its functions with a view to preventing competitive behaviour in the provision of health care services which may be against the interests of the people who use such services”. Apparently, then, there is a basic, intrinsic and fundamental assumption that competition must be beneficial and non-competition must be harmful. If the Government say that Monitor is neutral, it should be given a neutrality in respect of competition and non-competition. As I think the hon. Member for Peterborough (Mr Jackson) would agree, the unfair competition of some of the independent treatment centres was harmful to and threatened the services provided by neighbouring NHS hospitals. There is clear evidence here of problems within the private sector.

I recall that, a few years ago, United Health—a subsidiary of the US United Health—took over three GP services in my constituency. It bid that it could provide the range of services for less than the local GPs, so it got the contracts. It has not complied with all the conditions that were set, but the primary care trust decided that it could not take it to court because it would be such a lengthy and expensive exercise and it feared that the PCT might not win. Not content with that, United Health recently announced that it was selling the franchise to another private outfit. It did not consult the staff. It did not consult any elected local representatives—neither me nor councillors. Above all, it never consulted the patients. These private sector outfits regard patients as part of the chattels that they can dispose of to maximum benefit and maximum profit.

That illustrates the fact that if we are to have contract-based provision of services, a huge amount of lawyer effort will be put into trying to draw up watertight contracts. What one lawyer thinks is a watertight contract, another lawyer will make a leaky contract by puncturing a hole in it, and we will go over to the system in the United States, where zillions of dollars are spent on court challenges or settlements with the providers of health care.

Furthermore, there is virtually no major American supplier of health care that has not been indicted for defrauding federal taxpayers, city taxpayers, state taxpayers, doctors or patients—and sometimes all five. I thus asked the Secretary of State whether he would rule out giving any NHS contracts to any organisation that had been indicted for defrauding people in another country. He gave me about a page-long answer, which could be summarised as, “No, he would not rule them out.”

We are thus talking about the possibility of European competition law being used to force our Secretary of State to allow people to give contracts to American companies whose greatest claim to fame is that they have defrauded innumerable Americans. I think that that is intolerable. I would have thought that all these anti-EU Conservatives found it rather embarrassing to think that European law was going to be used to allow fraudulent Americans to get contracts working in our national health service. All those things, however, will be possible under the system proposed by the Secretary of State.

Southern Cross Care Homes

Lord Jackson of Peterborough Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

The right hon. Gentleman is absolutely right: we are working hard with the landlords, lenders and others to ensure that those risks are minimised, because the trauma of a hasty care home move and a forced closure leads to exactly those consequences. The Association of Directors of Adult Social Services has published new guidance for its members to manage those difficult decisions and processes and to minimise that risk as far as humanly possible.

[Mr Stewart Jackson (Peterborough) (Con)]

This is not a time for party political point scoring. The House will have been reassured by the Minister’s comments, as will the many residents of Astoria Park Southern Cross home in Park crescent, Peterborough, along with their families. The only point I would make to the Minister is that when the immediate crisis has been resolved, there should be a mechanism to work with key stakeholders such as the Care Quality Commission to understand the lessons of the flawed business model that Southern Cross pursued.

[Paul Burstow]

My hon. Friend is absolutely right, and that is indeed one of the many issues we need to consider as we proceed towards publishing a White Paper next year on social care reform. We have to ask questions about the regulatory framework that existed when that business model was established. We also need to ensure that we have the necessary tools to deal with large care home providers of this sort, where an individual local authority might be unable to cope with the consequences. Those are the issues that we are working with and that we shall continue to work with.

Oral Answers to Questions

Lord Jackson of Peterborough Excerpts

Tuesday 7th June 2011 Commons Chamber

[Mr Burns]

I can give the hon. Lady a categorical assurance that they will be based on clinical outcomes, not political considerations. I hope she will accept that it would be inappropriate for me to say anything further at this point in the proceedings, because we are in the middle of a consultation process at arm’s length from Ministers.

[Mr Stewart Jackson (Peterborough) (Con)]

Over the past 12 months, the Peterborough and Stamford Hospitals Foundation Trust has spent thousands of pounds of public money in connection with a vacant site—the former Peterborough district hospital site— and has yet to take it to market, despite having a £38 million deficit this year. Will my right hon. Friend ask Monitor to ensure that trusts make use of, and dispose of, valuable public assets in a timely way, in the best interests of both the taxpayer and the local health economy?

[Mr Burns]

I hope that I can reassure my hon. Friend by giving him a straightforward yes in answer to that question.

Future of the NHS

Lord Jackson of Peterborough Excerpts

Monday 9th May 2011 Commons Chamber

[John Healey]

My hon. Friend gives good service on the Health Committee and follows the details of the matter more closely than most in the House. He has an important point, because the quality of health services for patients is inevitably affected by the deep and fast cuts in other areas. People in local authorities are experiencing difficulty in continuing to provide good social care, which is causing problems for the people who depend on that care and for the NHS.

[Mr Stewart Jackson (Peterborough) (Con)]

Does the right hon. Gentleman regret the policy of rigging the market in favour of independent sector treatment centres in the last Parliament, which some Conservative Members opposed? Does he agree with that policy?

[John Healey]

The independent sector treatment centres played a part in clearing the backlog and improving waiting lists. They introduced the extra capacity that allowed the Labour Government, through a combination of investment and reform, to achieve the highest levels of patient satisfaction with the NHS ever and the lowest waiting times ever.

Oral Answers to Questions

Lord Jackson of Peterborough Excerpts

Tuesday 8th March 2011 Commons Chamber

[Stephen Phillips (Sleaford and North Hykeham) (Con)]

7. What steps his Department is taking to improve outcomes for cancer patients.

[Mr Stewart Jackson (Peterborough) (Con)]

10. What steps he is taking to improve NHS cancer services.

[Jessica Lee (Erewash) (Con)]

13. What steps he is taking to improve NHS cancer services.

--- Later in debate ---

[Paul Burstow]

I am grateful to my hon. and learned Friend for that question, because part of that pace is, of course, due to the fact that a substantial part of the country is now covered by pathfinder GP consortia, many of which are actively engaging with their colleagues in cancer networks and developing the expertise and experience that will be essential in taking forward their commissioning responsibilities. We have already made it clear that funding will be available in the coming year for the commissioning networks for cancer and that after that it will be a matter for the NHS commissioning board.

[Mr Stewart Jackson]

Cancer specialists at Peterborough City hospital tell me that they are prevented from prescribing drugs to needy patients, even after accreditation by the National Institute for Health and Clinical Excellence, as a result of the necessity for further approval by their local primary care trusts. Will the Minister undertake to tackle that bureaucratic delay, as it is having a significant impact on clinical outcomes in my constituency?

[Paul Burstow]

There are several aspects to my hon. Friend’s question. One is that we need to see much more commissioning for outcomes in cancer services. We must also ensure that full advantage is taken of the cancer drugs fund. I would be happy to look at any specific details of the case he has mentioned if he cares to write to me.

Oral Answers to Questions

Lord Jackson of Peterborough Excerpts

Tuesday 25th January 2011 Commons Chamber

[Mr Burns]

I am sorry to hear about the example that the hon. Lady mentioned; if she would like to write to me with the details, I would be more than happy to look into it. PCTs have a continuing responsibility to provide clinical treatment for their patients. Obviously, once the PCTs cease to exist, that will happen through the GP consortia and the national commissioning board. There is also a legal right in the NHS constitution for patients to be treated when they need to be.

[Mr Stewart Jackson (Peterborough) (Con)]

A number of patient groups across the country are concerned about the future of in vitro fertilisation treatments, particularly when many PCTs downgraded it and put it on a par with things like tattoo removal and cosmetic surgery. Will the Minister confirm that, in future, IVF treatments will fall under the remit of the NHS commissioning board?

[Mr Burns]

Let me reassure my hon. Friend on IVF. PCT commissioners should have regard to the National Institute for Health and Clinical Excellence guidelines for fertility treatment, including to the recommendation that up to three cycles of IVF treatment are offered to eligible couples. To reinforce this, in November last year, the NHS operations board reminded PCTs, through the SHAs, of that responsibility. Indeed, Mr David Flory of the Department of Health has in the last month or so written to PCTs to remind them of their responsibilities.

Termination of Pregnancy (Information Provided)

Lord Jackson of Peterborough Excerpts

Tuesday 2nd November 2010 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I congratulate my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) on securing this debate on a subject in which I know she has had a long-standing interest. She rightly described it as a taboo subject, and the extract she read was moving, evocative and of concern to us all.

The debate comes at a welcome time for me, as I will be meeting representatives from the two biggest independent sector abortion providers later in the month to discuss how we might integrate contraception and wider sexual health provision into the services they provide. It will also be an opportunity for me to raise some of the issues my hon. Friend has highlighted tonight.

I also recently had a useful and productive conversation with a charity that supports young women and men in making informed sexual health decisions. For me and for the Government, reducing the abortion rate is an absolute priority, and to do that we have to ensure that women and men are given information and support to make responsible sexual health choices.

We have seen significant advances in the quality of abortion provision since the Abortion Act 1967 came into force. Early access to abortions has improved and evidence shows that the risk of complications increases the later the gestation. Currently, 75% of NHS-funded abortions take place at under 10 weeks, compared with 51% in 1992. Early abortion means that women have more choice as to the abortion method. Medical abortion using two tablets now accounts for 40% of the total number of abortions, as opposed to only 12% in 2001. However, abortion comes at the end of a failure of many other services in the lives of young women.

Independent sector abortion providers and those organisations that refer women for an abortion are hugely experienced, but are subject to Secretary of State approval and monitoring by the Care Quality Commission. That is why some of the issues that my hon. Friend raises are of considerable concern. We need to ensure that continued emphasis is placed on giving women and men advice and contraception, because it is needed. In the same way, women should be given access to tailored, appropriate and impartial advice on their pregnancy options.

The Government will be responding to the House of Commons Select Committee on Science and Technology recommendation to update advice on the mental health consequences of induced abortion. The Government have commissioned a systematic review of the evidence, and the report will be published in spring 2011.

Interestingly, we have recently seen a substantial increase in the number of men attending family planning clinics—there was a 16% increase in the number of young men attending clinics in 2009-10, with 162,000 attendances. That is a massive 93% increase on the figure in 1999-2000, when only 84,000 men attended. I welcome the fact that young men are taking the issue of sexual health and pregnancy more seriously; I hope that they are taking it as seriously as young women are.

There are some examples of truly excellent, innovative sexual health services that have grown up at local level. However, as my hon. Friend said, the total number of abortions currently being carried out is just over 189,000 a year. Since 1992, the number of abortions has steadily increased, with the exception of the past two years when there was a fall in the number, albeit small. Just under half of teenage conceptions end in an abortion. However, the trend in both teenage conceptions and births is downward and the teenage pregnancy rate for 2008 was the lowest annual rate for more than 20 years. We should welcome that, although we should never be complacent because that figure of 189,000 is still way too high.

Repeat abortion is a continuing issue. Some 34%—one third—of women undergoing abortions had one or more abortions, a figure that has risen from 29% in 1998. Some 25% of repeat abortions were to women under 25. There are also significant and concerning variations between primary care trusts in repeat abortion rates, with rates in some areas as high as 45%. Abortions are traumatic and stressful, and they are not a form of contraception, but sadly they are clearly used as such in some instances. Women are offered a follow-up appointment within two weeks of the abortion. That also provides an opportunity to have another conversation about contraception needs if the woman was unclear as to contraception requirements at the time of the abortion, but that is not always taken up.

[Mr Stewart Jackson (Peterborough) (Con)]

Is the Minister as concerned as I am that it is common practice for independent abortion providers to have their commercial relationship with PCTs and with other trusts in the health service hidden by the caveat of “commercial in confidence”? Therefore, people are not in a position to understand those providers’ commercial relationship with the NHS, and surely that offends against the principles of transparency in the NHS.

[Anne Milton]

Yes. I thank my hon. Friend for raising that point. The issues raised by conflicts of interest and hiding behind commercial sensitivity give rise to considerable concern. That is why I am pleased to be meeting some of the service providers in the next week or so to discuss those issues. It must be pointed out, with the greatest respect to my hon. Friend the Member for Mid Bedfordshire, that although the stories she talked about involved bad practice, there are a lot of instances of very good practice. We should not miss that in the discussion about where things are not going as well as they should be.

Contraception has been free for everyone and is readily available in the community from GPs, family planning clinics and abortion providers, but there are clearly barriers. Why are so many young women and men not using it? A number of factors can lead to risk-taking behaviour, such as sexual violence, alcohol, lack of contraception awareness and self-esteem. We need to use simple, effective messages about safe sex, sexually transmitted infections, condom use and contraception. We need to ensure that young people receive high quality education on relationships and sex and we need to tackle those issues in a holistic and effective way. We need to ensure that young people are equipped to make the choices and the sometimes challenging decisions that they face in their lives. Those decisions are increasingly challenging in this day and age.

Tourette Syndrome

Lord Jackson of Peterborough Excerpts

Tuesday 12th October 2010 Westminster Hall

[Mr Stewart Jackson (Peterborough) (Con)]

It is a pleasure to serve under your chairmanship for the first time, Mrs Main. I am pleased to have this opportunity to raise the important issue of Government policy on Tourette syndrome. I believe that this is the first time it has been discussed in this Chamber.

Most people understandably have little or no knowledge of TS, and what knowledge they do have is coloured by media reports which are either simplistic or exaggerated. The charity Tourettes Action achieved its highest profile and biggest income boost in 2006, when Tourette sufferer Pete Bennett was declared the winner of the seventh series of “Big Brother”, but even that was not without controversy: some commentators accused the show’s producers of exploiting Mr Bennett’s condition to boost ratings in a voyeuristic fashion.

What are the facts about this much misunderstood condition? Put simply, it is a chronic, inherited neuro- developmental disorder characterised by uncontrollable sounds and movements which are called tics. It affects about one in 100 schoolchildren, most of whom are undiagnosed. Tourette syndrome does not affect IQ, but people with the condition do exhibit co-morbidities such as obsessive compulsive disorder, insomnia, depression and autistic spectrum disorders. There is no cure for TS, but tics wax and wane and can change in their nature and severity over time. Despite what many people believe, not all sufferers have coprolalia, which is involuntary swearing or the utterances of obscene words—90% do not have it.

People with TS face many challenges, such as the physical discomfort and aches and pains caused by their tics: 87% of people with TS who participated in a Tourettes Action survey in 2008 answered “yes” to the question, “Do your tics ever cause you pain?” and 66% of children with TS are bothered by aches and pains and physical discomfort. Repeated movements and injuries resulting from tics cause pain, and sometimes children’s impulses are dangerous to themselves.

People with TS also suffer higher rates of unemployment as adults. According to a recent academic study, unemployment rates for people with TS are two to three times higher than those for the whole UK population. A study of the health economic burden of a cohort of adult hospital patients with TS in Germany over a three-month period showed that disease severity has no influence on costs. Additional TS-specific costs totalled €3,404 per patient. The cost was based on calculating direct medical costs, out-patient care costs, drug costs, ancillary treatment costs and indirect medical costs. Direct costs constituted about 18% of the total, while indirect costs comprised 81% of the total. Drug treatments constituted approximately 7% of the total costs and 36% of the total direct costs. Using those figures for adult patients with TS in the UK would correlate to costs of some £1.5 billion a year. Obvious provisos are that health economics estimations may not transfer well from country to country and, just as importantly, the experience of patients seen in a particular clinic cannot necessarily be extrapolated to the number of adults as a whole who are believed to have TS, as many do not receive specialist medical care.

Since preventive therapies are not in sight, possibilities for direct cost reduction are improbable. Nevertheless, a better integration of patients with TS in the working environment has the potential not only to improve patients’ quality of life but substantially to reduce indirect costs, yet wide access to clinical psychology services and specialised habit reversal therapy is not available due to a lack of funding and trained professionals.

A Swedish study of juveniles sentenced for serious offences revealed that 2% had TS, which is double the 1% prevalence figure among schoolchildren up to 18 years old. That could be the tip of the iceberg, as most crimes committed by TS offenders are more likely to be minor offences. TS on its own rarely leads to criminal behaviour, but patients with TS who have behavioural co-morbidities are at risk of being involved with the legal system. Symptoms of TS such as jerking and shouting out could be thought to be antisocial or alcohol-related and waste police time, as well as being embarrassing for the individual.

Likewise, people with TS often have to bear social ostracism, which manifests itself in ridicule, bullying and social exclusion from an early age. Sixty-two per cent. of children with Tourette’s withhold themselves from taking part in social activities because of TS-related problems. Children and young people in particular suffer a generally worse quality of life than healthy young people without TS across all the following areas: psychosocial health, emotional functioning, social functioning and school functioning. Similarly, the burden for parents and carers is significantly higher than it is even for parents of children with other chronic disorders such as asthma, according to a 2003 research paper produced by the American Academy of Child Adolescent Psychiatry entitled “Psychological Morbidity and Caregiver Burden in Parents of Children With Tourette’s Disorder and Psychiatric Comorbidity”.

Above all, education is a major problem for children with TS. Attention and concentration problems are common, and tics are easily misinterpreted as deliberately naughty behaviour by untrained teachers, who are rarely aware of strategies for managing TS in the classroom, or who do not understand that tics can be suppressed and children are often more focused on that than on learning. Tics, which peak in severity at around 10 to 12 years old, can typically be worse at home than at school, and children find homework tough as they are often exhausted by the effort of disguising or suppressing their tics in company. The Journal of Child Psychology and Psychiatry published an article last year which stated that 59% of children with TS have some sort of educational problem that needs support or special education.

The aim of this debate is to develop at least rudimentary cross-departmental working between the Department for Education and the Department of Health, and a commitment to work towards a strategy for Tourette syndrome focused on a few key areas. The first is increased access to services. TS crosses traditional public service boundaries such as physical health, mental health, education and social welfare. That is a challenge for local service providers, who should ensure that individuals do not fall between service gaps. In reality, however, the challenge often falls on the individual with TS or their family.

Access to psychological therapy is particularly difficult for most people with TS. For example, a member of Tourettes Action has waited more than 16 months for a decision on whether she can get habit reversal therapy. Provision of specialised services is sparse throughout the country; that is a second barrier, in addition to the stretched state of psychology services generally. She finds herself caught between various NHS bodies that are reluctant to allow resources to be used for her, and seemingly reluctant, up to chief executive level, to communicate with her in a transparent manner.

That experience is not unique, but more common is the simple lack of use of psychological treatment for TS, although there is a strong evidence base for its efficacy. Such treatments have been proven to be about as effective as drugs in reducing tic severity, but without side effects. Psychological services need to be provided on the basis of evidence in the same way that medical or surgical treatments are expected to be. This is an issue of both funding and professional awareness and training.

That brings me to the awareness of TS by those who work in primary care—the so-called gatekeepers of diagnosis. Commonly, tics will not be observed during a visit to the doctor. They are often suppressible, especially in the general practitioner’s office. Some children will substitute more apparent tics with less apparent ones in the clinical setting, or will wait until they are not being observed to release tics. Others may disguise tics as seemingly purposeful movements such as brushing hair out of the face in concert with head jerking.

Half of the people participating in the Tourettes Action survey, “Evaluation of use of Consultants’ List”, in 2009 did not receive a referral to a specialist or a consultant. Old-fashioned notions of “habits” from which a child will recover, although appropriate to commonly seen transient tic disorders, are sometimes applied inappropriately to children with full-blown Tourette’s, who need further medical attention. Although clinical expertise is not expected of general practitioners, in practice people in primary care are undoubtedly suffering from a lack of awareness.

That brings me to national recognition of the need for consistent specialist services. The Department of Health has not yet perceived Tourette syndrome as an area meriting consideration. There are no National Institute for Health and Clinical Excellence guidelines or other measures commanding the attention of commissioners, which means, effectively, that they do not feel the need to recognise the condition as a distinct issue. Consequently, patients receive different support in different regions, essentially based on the interest or otherwise of local clinicians.

Tourettes Action holds a list of only 44 consultants in the whole of the United Kingdom who have a special interest in seeing people with TS. Those consultants are a mixture of child and adult psychiatrists, neurologists and paediatricians. The list is much in demand by patients and families and has been cultivated over many years. To reduce the problems of a delayed diagnosis and treatment, it would be beneficial if that expertise were spread more widely. A possible strategy would be for a NICE appraisal of treatment options, including psychological therapies, to give support to less-experienced clinicians and to exert top-down pressure on local secondary care services to provide a suitable standard of expertise and provision. Local professionals are key figures, but currently local engagement is patchy.

Better transition from child to adult services is crucial. We need to ensure that appropriate support and services are available after a child turns 18. Tourettes Action receives helpline calls from young people with TS who have become addicted to alcohol and drugs, which they use to self-medicate their symptoms. Those young people have been discharged from children’s services with no ongoing support.

TS-specific support in schools is vital. Children with TS have to live with the consequences of their education. If they are not given the right support in school to which all children are entitled, they are at high risk of ending up facing unemployment and social exclusion. Special educational needs teachers are currently not given any specific training on Tourette syndrome, even though TS prevalence in SEN classes is high. Under current legislation, including the Disability Discrimination Act 1995, schools are obliged to make reasonable adjustments, which could mean measures as simple as exit cards or extra time for examinations, or as demanding as extra staffing. Some children are fortunate to already receive a high standard of support in the education system but many, sadly, do not.

Tourette syndrome has hitherto been treated as a subject of risqué jokes and ribaldry, but for the children and young people afflicted by the condition, who are fearful of its effects on themselves and of the understandable fear and ignorance of strangers, it really is no laughing matter. They, too, deserve a hearing from our policy makers. I hope that the Minister, who has a strong record in his parliamentary career of intervening in cases involving vulnerable people, will reassure us today that there is at least a commitment to develop a policy on the condition, not least because a coherent strategy across government will not only save taxpayers’ money in the long run, but will help to relieve TS sufferers and their families of a lonely burden that they have carried for too long.

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate my hon. Friend the Member for Peterborough (Mr Jackson)on securing this debate and on bringing the attention of the House to a rare and poorly understood condition. He has done a good job of outlining the scope, scale and cost of the condition and the personal impact that it has on many children and their families.

I will set out some of the changes that the Government are making in the NHS that we think will have a significant impact on and will benefit people with Tourette’s. My hon. Friend talked about education, which I will briefly mention, too, particularly in the context of the difficulties that can be faced by children suffering from the condition, which can be, as he said, misinterpreted by teachers. He is right to describe the sheer feeling of exhaustion in children who are trying to suppress and hide the condition. Socially and emotionally, Tourette’s can lead to ridicule and bullying and can often cause difficulties in forming relationships. Although some children grow out of the condition, it is a barrier in many ways, particularly to employment in later life. We need to ensure that we have a psychosocial-physical approach: we need to look at the whole person when designing services around the needs of individuals and their families.

My hon. Friend is right to mention stigma: that is a big challenge that we have to tackle. Today’s debate is a helpful starting point. I welcome his demolishing some of the myths that surround Tourettes syndrome, most notably his confirming that, despite the popular caricature, involuntarily swearing is only present in a tiny minority of cases.

I join my hon. Friend in commending the work of Tourettes Action, which is doing excellent work to build awareness and skills in health and children’s services. As he says, that work demonstrates that better awareness, timely diagnosis and good access to specialist care are critical in improving people’s quality of life. Of course, early detection makes it less likely that the child gets blamed for what might otherwise be mistaken for bad behaviour. Indeed, the condition is stress-sensitive and the relief a child can get from teachers and their classmates understanding their condition can actually improve their symptoms.

The NHS has not always got diagnosis right. My hon. Friend is right to mention the range of services that are provided and their patchiness. The Government have to grapple with that inheritance and ensure that we build on those services and improve them significantly in the coming years. It is clear that young people and children affected by Tourette’s have not always had the right support and services. We need to get better at identifying the condition, referring children to specialists and providing the long-term, integrated support needed to reduce the wider effects. I cannot promise a dedicated strategy specifically for this condition, and I do not think that that is what my hon. Friend is asking for, but I am keen to see that the issues he raised are properly fed into our future plans for the NHS, particularly into developing our thinking on child mental health. In addition to the reassurances that I hope I can give in the time left, I will ask officials to meet Tourettes Action and my hon. Friend to continue this conversation and discuss in more detail the issues he has raised. This debate is not the end of the discussion, but just the beginning of a process leading to the sort of improvements that he has been talking about.

The proposals for the NHS set out in our White Paper give us a powerful opportunity to improve the care and support received by children with Tourette’s. First, patients will have much greater power in the reformed system. We want to give people more information about services, more choice about their treatments and more influence over how health care is shaped in their community. Local health watch organisations will ensure that views and feedback from patients and carers feed into future decisions about shaping local health and social care. By devolving responsibility for commissioning to GP consortiums, decision making will be closer to patients and more responsive to their individual needs. Of course, we have to ensure that GP commissioners are ready and have the skills and awareness that they need to take these decisions. The NHS commissioning board will work with a range of expert organisations to ensure that GP leaders get the right support. There are certainly opportunities for Tourettes Action to contribute to developing family doctors’ understanding of the condition and how to commission for it effectively.

Secondly, there will be a much bigger role for local government in promoting integration and partnership working between the NHS, social care, public health and other local services and strategies. In particular, local government will take on the function of joining up the commissioning of local NHS services, social care and health improvement, and providing greater local democratic accountability for the community.

My hon. Friend mentioned identification and planning of care for children with Tourette's. Under our plans, councils will ensure that GP consortiums and their local partners work together on joint strategic needs assessments for local populations, looking not just at who is on the patient list, but at the wider needs of the population in the locality. That will mean that councils and health organisations will become much better at identifying children's needs, and putting the services in place to meet them. Our proposals for health and well-being boards will provide a place where children’s services, health services, social care and other agencies may come together to ensure that we are better at planning services and dealing with some of the issues that my hon. Friend mentioned.

The third key point is that the new NHS will focus on outcomes, not on processes. The trouble with a top-down and target-driven system is that it creates a culture in which, as my hon. Friend said, what gets measured gets done. If it is not measured, it seems to be neglected. He described perfectly what we have seen and how services have developed over several years. Our proposals will create a level playing field in the NHS between mental and physical health, and will encourage a much more constructive relationship between health and other public services. That is important, and my hon. Friend rightly said that we must ensure that we do not treat mental health services as a poor relation of the NHS. The Government are determined to ensure that that does not happen.

Health services will be judged and, increasingly, paid not just according to the number of procedures or consultations that they carry out, but on the value that they bring to patients’ health and their wider life—my hon. Friend made that point well. That will be a powerful catalyst for bringing services much closer together around the needs of the individual. A child with Tourette syndrome often has multiple and complex needs, as he said. More often than not, they will also have symptoms of attention deficit hyperactivity disorder, obsessive compulsive disorder or depression. They may be seen by a range of health care professionals, including psychiatrists, psychologists and so on. An outcomes-based approach will ensure that all professionals are geared to work together to achieve the best results for the child. Our proposals will be a potent catalyst for change and improvement in this area.

Fourthly and finally, we are in the process of developing a new mental health strategy, which will be cross-governmental and will examine how to support people's emotional well-being and mental health at all ages and across all services, not just health. One of my criticisms of the “New Horizons” mental health strategy was that it did not do enough to tackle discrimination and stigma. We are determined to make sure that in a more public health-oriented mental health strategy, we begin to address those issues more effectively. That must certainly be the case for Tourette’s.

[Mr Jackson]

I am grateful for the Minister’s positive response. Will he undertake to share the results of the wider review of mental health and Tourette syndrome with his colleagues in the Department for Education? An holistic approach is incredibly important, as is the close working relationship between specialist psychology and mental health services. Local education authorities are particularly important in ensuring that children’s educational attainment is the best possible.

[Paul Burstow]

I certainly undertake to ensure that the Minister of State, Department for Education, my hon. Friend the Member for Brent Central (Sarah Teather), who has responsibilities in this area, reads this debate. We recently met the National Advisory Council for Children’s Mental Health and Emotional Wellbeing, and we are discussing its thoughts on how to move forward and to ensure that child and adolescent mental health services are properly reflected in the new mental health strategy that we are developing. That is an issue for further discussion. I have made it clear that I want mental health to achieve parity with physical health in NHS thinking about care. I also want to ensure that CAMHS are not overshadowed by adult mental health services, which should help to drive up the quality of care for children with Tourette’s.

My hon. Friend talked about transitions, which are important. We so often get the transition from children’s services to adult services wrong. I agree that that continues to be a serious weakness and that child and adult mental health services do not work seamlessly together. That was identified as an area requiring improvement by an independent review in 2008 and in the report of the National Advisory Council for Children's Mental Health and Emotional Wellbeing, “One Year On”, which was published in March. One difficulty is that not all child mental health services are replicated in adult mental health provision, and my hon. Friend described some of the services that are rarely available for children. The new commissioning arrangements, particularly the new role for local government, with an outcomes-based approach, give a new impetus to developing better transition services. We must get that right for children, regardless of their condition.

We are also working with the royal colleges and others to promote higher standards of education and training throughout the clinical community. My hon. Friend rightly focused on that, and I welcome the fact that a network of psychologists and other therapists is being established to work with people with Tourette’s. That is a powerful way of moving the agenda forward. I understand that the network hopes to establish a specialist training workshop, led by experts in behavioural treatment for tics, during 2011. I commend that work and look forward to hearing the results.

My hon. Friend mentioned the role of schools and the need to collaborate across Government. I do not have ministerial responsibility for this area, but I draw his attention to the Green Paper on special educational needs and disabilities that the Minister of State, Department for Education, my hon. Friend the Member for Brent Central, is preparing. The aim is to make the system work better for parents, so that they do not have to battle to obtain the necessary support for their children. A call for evidence was launched last month and is due to close this Friday 15 October. If it has not done so, I hope that Tourettes Action will contribute its views. I am sure that this debate will also be a useful contribution.

I thank my hon. Friend for introducing this important debate. He raised some points that are important not just for children with Tourette’s, but for children with a wide range of neurological and mental health problems. Our White Paper provides the chance to refocus the NHS on achieving better results for them all. The outcomes framework will be a central driver for improvement and will ensure that the NHS treats the person, not just the disease, but meeting people’s needs effectively depends on good partnerships with groups such as Tourettes Action to give us the expert knowledge that we need about rare conditions. I am keen to have a strong dialogue with the voluntary sector, and indeed the White Paper is all about opening doors to organisations such as Tourettes Action. I hope that the group’s first step will be to take the opportunity to meet my officials and to respond to the call for evidence by my hon. Friend the Minister of State, Department for Education. I hope that by working together in that way, we can do much better than the legacy that we inherited from the past.