NHS Bursaries
Debate between Lord Lilley and Lisa Cameron(8 years, 7 months ago)
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Mr Peter Lilley (Hitchin and Harpenden) (Con)
It is a pleasure to follow on from the hon. Member for Ilford North (Wes Streeting), who made a thoughtful speech and highlighted an important point about the different study load of those training to be nurses, compared with some of us when we were at university. I do not think that that invalidates the Government’s proposals, but it is an important point to take into account.
Like the hon. Gentleman, I congratulate the Opposition spokesman on calling the debate, which has been an important one, and I congratulate the Minister on a characteristically thoughtful, reasonable and lucid response to it. I cannot help observing that the debate demonstrates the value of having people in this House who come from genuine professions, rather than having reached here purely as a result of being political professionals. There has been considerable input from those who have studied, worked or been in the national health service.
Although it is an Opposition debate, there are some points that we can all agree on. First, we should agree that we need to recruit, train and retain enough nurses to staff our health service to meet the needs of the British people. Secondly, we can agree that it is wrong—morally wrong—to rely on recruiting nurses from poor countries, who have had to bear the cost of their training, to meet our failure to train enough nurses ourselves. Thirdly, we should not be turning away British people who want to train as nurses when we need more nurses. Surely all of us can agree on those three points. We can debate how best we finance the recruitment, retention and motivation of sufficient nurses in this country, but we should all agree that that is the objective.
My initial interest in this topic came a couple of decades ago and resulted from my first career as a development economist working in Africa and Asia. I discovered while I was in the House that we were denuding Africa of nurses. We had recruited more than one in eight of all the nurses in sub-Saharan Africa and brought them to this country. That could not be right. I lobbied against it and the then Prime Minister promised that there would be no active recruitment from Africa, but seven years later I discovered that we had recruited another 60,000 nurses. We were continuing to recruit at several thousand a year, but we were promised that that would cease.
What I blame myself for is that it took me so long to realise that the problem did not lie so much in recruiting from Africa and other poor parts of the world as in our failure in this country to train enough nurses of our own. I did not ask why we were not doing so until I was talking to people in my local NHS, who told me that they were recruiting abroad, mainly in southern Europe but also in Asia, and they were doing so despite the fact that they would have preferred to recruit and employ nurses from the University of Hertfordshire, whom they described as excellent, well trained and in every way desirable. I asked why they did not recruit more, but they said that they could not recruit enough. Even if they recruited the next several years’ worth of output, that would not meet the needs of Hertfordshire’s health service, which is why they were recruiting abroad.
Dr Lisa Cameron
Does the right hon. Gentleman agree that it is ironic that through our international aid programmes we are assisting developing countries to pay for trainee placements in clinical establishments such as hospitals abroad, yet we do not afford the same rights to our NHS trainees here?
Mr Lilley
It is certainly bizarre that we pay African countries to train nurses and promptly recruit them to come here, so we are getting them cheaply trained abroad. I do not mind particularly the manner in which their training is financed.
The problem faced by my local NHS was that it could not get enough nurses from the University of Hertfordshire. I spoke to the University of Hertfordshire, which said that there was no lack of applicants—it turned away three quarters of applicants to its highly regarded nursing courses—but it was not allowed to expand. It had taken me decades in this House to realise that we had a system that limited the number of people we were recruiting. I duly lobbied the Government, and it may be because of my lobbying that we now have this proposal for bursaries, though I suspect the Government reached the decision on their own evidence.
The sad truth is that successive Ministers of all parties—we should recognise that—have bucked the question of how we train enough people in this country. Ministers tend to have a time horizon of roughly the time it takes to train a nurse, so why put up with diverting resources into training when the output of extra nurses will come after they have ceased to be Health Ministers? I am glad that this Secretary of State for Health and his fellow Ministers have addressed the question. However, we should recognise that it is symptomatic of a wider problem across British business in both the private and the public sector that we have a culture that does not put enough emphasis on training. It is particularly bizarre that we allow unlimited numbers of people in universities to study art history and media studies—very valuable subjects—but restrict the numbers who can train to be nurses, when we know we have a crying and desperate need for more.
I am agnostic about the best way to finance the training of more nursing recruits. Clearly, if nurses bear the extra cost, that will have to be reflected in some way in their remuneration. The Minister told us that they will actually be no worse off, so I suppose the assumption is that they will not have to repay much of their loans. It is a somewhat artificial feature of the public finance rules, but it is a feature of them, that perhaps the only way of not borrowing the money from the public ourselves is for the nurses to borrow it and for us then to write off their loans. However, whatever the financial system—the end of bursaries and their replacement with loans is probably the only option—we have to pay nurses enough in the long run to recruit, retain and motivate them.
There is one other issue we should look at before we close the debate. There are 200,000 trained nurses who maintain themselves on the register at their own expense, but who are not currently working in the NHS or elsewhere—they may be taking time off to raise a family, and they may be thinking about coming back some time. We must be much more flexible and creative about providing patterns of work that meet the family needs of those trained, valuable, caring and experienced people if we are to bring them back into the health service. That, too, will help to meet the needs of the health service, as the Government are trying to, sensibly and wisely, in the measures they have brought before us to replace bursaries with loans.
Cannabis
Debate between Lord Lilley and Lisa Cameron(9 years, 2 months ago)
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Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
I thank the hon. Member for Newport West (Paul Flynn) for securing this debate today. It is an extremely important debate, which has been brought forward in response to an overwhelming petition by the public.
Cannabis is the most widely used illegal drug in the UK. Although it appears that there has been a steady reduction in its use since 1996, between 2013 and 2014 about 2.3 million 16 to 59-year-olds reported using cannabis. Frequent use of cannabis is also about twice as likely among young people, with nearly 5.3 million 16 to 24-year-olds reporting having used it during the same time period.
Despite Government and media warnings about health risks, many people see cannabis as a harmless substance that helps them to relax, and as a drug that, unlike alcohol or cigarettes, might even be good for their physical and mental health. Proponents for decriminalisation have also highlighted the potential medicinal properties of cannabis, and argued that legalising the production, supply and use of cannabis would also have a number of benefits for society as a whole. We have heard many of these arguments today.
Transform, a charitable think-tank that campaigns for the legal regulation of drugs both in the UK and internationally, argues that the current approach of prohibition is failing and will never be successful in protecting individuals or society from the misuse of drugs. It highlights that the unintended consequence of prohibition is that it creates an illicit market, which allows the drugs trade to be monopolised by organised crime factions.
A number of my constituents who feel extremely strongly about this issue have contacted me in the run-up to this debate. One of them, Paul, who wished to be mentioned today, supports a motion to decriminalise cannabis due to its medicinal properties, and he has told me that he feels that criminalising a substance produced from organic matter and that holds medicinal potential while allowing “over the counter” sale of many more harmful substances could be viewed as disproportionate, as could driving someone to use the black market to gain hope or relief from a medical condition, such as multiple sclerosis, because nothing else offers the same relief.
On the other hand, medical bodies have reported evidence indicating the significant potential harm that can be caused by cannabis. I am a clinical psychologist who specialised in addiction and forensic populations in my previous career, so the impact of cannabis on mental health is of particular interest to me. Literature published by the Royal College of Psychiatrists in 2014 has highlighted several issues of concern in this regard. While it is acknowledged that not everyone who uses cannabis will develop mental health problems, even among those in the groups in society identified as being the most vulnerable, the royal college’s publication highlights the growing evidence that people with serious mental illness, including depression and psychosis, are more likely to use cannabis or to have used it for long periods in the past. It also appears that regular use doubles the risk of developing a psychotic episode or long-term schizophrenia.
Research has found that adolescents who use cannabis regularly have a significantly higher risk of developing depression, anxiety and psychotic illnesses such as schizophrenia and bipolar disorder. A longitudinal study of 1,600 Australian adolescents, already described by the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), found that while children who used cannabis regularly had a significantly higher risk of depression, the opposite was not the case, with children who already suffered from depression no more likely than anyone else to use cannabis to ameliorate their problems. The study found that adolescents who used cannabis daily were five times more likely to develop depression and anxiety in later life.
Evidence also shows that individuals who use cannabis, particularly at a younger age—around 15, which is when many people start to use it—have a higher than average risk of developing a psychotic illness. It has been found that the increased risk is related to increased use, and that those who use cannabis are also at risk of an earlier onset of illness compared to those who do not.
Available research shows that people with a family history of psychotic illness, or those who have certain characteristics or a certain vulnerability, may be at an increased risk of developing an illness following the regular use of strong cannabis. As has been eloquently described, research also indicates that the UK market has been flooded with stronger varieties of cannabis, such as skunk, which contain higher quantities of tetrahydrocannabinol, or THC, which is cannabis’s main psychoactive ingredient. It has been found that there is a higher risk of developing a psychotic illness from cannabis if it has high levels of THC, and if people are regular users. The easy availability of the stronger varieties carries a specific risk to young people with a genetic predisposition. In addition, it has been highlighted that cannabis with high amounts of THC can cause cognitive problems, such as with short-term memory and processing speed.
While in the past it was thought that cannabis was not addictive, current evidence suggests that it can be, particularly if it is used regularly and heavily.
Mr Lilley
We obviously listen with great respect to the hon. Lady because of her expertise, as we did to my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who has similar expertise. I just wonder whether the studies that she and he have mentioned consider the prevalence of the illnesses in society as a whole, and whether the recent decline in cannabis use has led to a decline in the incidence of the illnesses. Similarly, when there was a rise in the use of cannabis, did that lead to a rise in their incidence? Is the incidence greater in countries with high cannabis use than in countries with low use, or has such research not yet been done?
Dr Cameron
The studies I mention do not specifically answer the right hon. Gentleman’s questions, but they indicate that people with particular vulnerabilities might be more likely to develop mental health problems, along with individuals with heavy and sustained cannabis use. It was not necessarily that a vulnerability was required for someone to go on to develop depression or anxiety.
Regarding physical health, it appears that the main risk from cannabis is that from the tobacco that it is often smoked with, although the British Lung Foundation reported in 2012 that cannabis smoking carries a greater risk of smoking-related disease than tobacco alone. It has also been reported that cannabis can affect fertility, and new research has found that the cannabis plant contains cancerogenic mutagens that can affect the lungs.
In conclusion, it is my position that further research, and perhaps the addressing of the level of schedulisation of cannabis, would be particularly helpful for medical conditions, and that at some point in the future there might be a case for prescribed use for certain conditions, where it is shown to have an ameliorative effect on an individual’s health. Overall though, there appear to be significant mental—and some physical—health concerns associated with cannabis use, which make it necessary for careful consideration to be given to the most effective methods of managing and addressing the issue and to any changes to legislation.