Covid: Vitamin D

Nadine Dorries Excerpts

Thursday 17th June 2021 Westminster Hall

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

It is an absolute pleasure to serve under your chairmanship, Mrs Murray, I think for the first time. I offer my warm congratulations to the hon. Member for Strangford (Jim Shannon) on securing the debate. I am sure if he had not secured it, he would have contributed to another debate in here this afternoon. I intended to say this yesterday, but I did not get the chance: I would like to send my warm and best wishes to the hon. Gentleman’s mother. He will know why I am saying that. It is a delight to be here today to respond to him.

I will try to respond directly to all the points that were made today, if not specifically then more broadly, but I am always here if hon. Members want to ask me for more specific details. We consistently review the data and the latest information as it emerges on covid-19. Our objectives are to ensure that people are not made adversely ill by covid-19 and that as many people as possible stay out of hospital, off ventilators and improve as quickly as possible.

That includes the progress we have seen in treatments for those suffering with the virus, including longer-term preventive measures, such as our strategy to reduce obesity, which we know is one of the few modifiable factors of covid-19, and the implementation of the vaccination programme.

Some 78.9% of adults in the UK have now received the first dose of the covid-19 vaccine, and 56.6% have received the second dose. Everyone who has spoken, including the shadow Minister, the hon. Member for Nottingham North (Alex Norris), and the SNP spokesman, the hon. Member for Glasgow East (David Linden), has congratulated volunteers and those who have run and operated the vaccine programme across the UK, and I add my congratulations. It has been phenomenal, and we have much to be thankful for. I am sure that everyone will join me in acknowledging the dedication of volunteers who have answered the clarion call and turned up. I think the hon. Member for Glasgow East said—it may have been yesterday—that they have donned the vest and got out there, and they are still doing those jobs. That is just amazing.

Since the start of the pandemic, there have been reports that vitamin D may reduce the risk of coronavirus. I have to sound a note of caution here because, when looking at the data and the evidence, we cannot cherry-pick the odd report here and there. I am not accusing anyone of doing that, but we have to take a more robust view of the data and look at it in the round.

I will pick up on the points that the hon. Member for Strangford made about BAME communities. To date, the UK Biobank’s most robust data on covid, vitamin D and ethnicity has not found a link between vitamin D concentration and ethnicity that could reduce covid-19 infections. There was no link, sadly. It would really be encouraging for us if the data showed that vitamin D prevented people from catching covid—that would be quite amazing—and we are certainly working on and searching for that data, but we do not have it yet.

On 14 January, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), responded to a debate on this matter, in which the hon. Member for Strangford also participated. I welcome the opportunity to debate it further and set out the measures that we are delivering. As my hon. Friend said:

“Several nutrients are involved in the normal functioning of the immune system; however, there is currently insufficient evidence that taking vitamin D will mitigate the effects of covid-19.”—[Official Report, 14 January 2021; Vol. 687, c. 597.]

Last December, the National Institute for Health and Care Excellence, the Scientific Advisory Committee on Nutrition, and Public Health England published rapid guidance in response to the queries that the hon. Member for Strangford and others have raised on vitamin D in relation to covid-19. The data was reviewed by an expert panel and included the best available scientific evidence published to date, including both randomised controlled trials and observational studies. The expert panel supported existing Government advice and the recommendation for everyone to take 10 mcg of vitamin D supplement throughout the autumn and winter to protect their bone and muscle health. However, the panel concluded that there is currently not enough evidence available to support taking vitamin D to prevent or treat covid-19.

There are still significant gaps in the current evidence, as was the case in January. To date, studies have not reached the high level of data quality required to revise the guidance. The current evidence base is mixed and dominated by low-quality studies, with substantial concerns around bias and confounding evidence. There are lots of studies out there, but some of them do not have the quality and the robustness of data and evidence that are required.

Currently, studies are unable to demonstrate a causal relationship between vitamin D and covid-19 for anyone. That is because many of the risk factors for severe covid-19 outcomes are the same as the risk factors for low vitamin D status. Owing to the lack of reliable evidence, the NICE guidance recommends that more research be conducted on the subject. Government guidance continues to stress the use of high-quality randomised control trials in future studies.

At present, more than 90 trials that are looking at the efficacy of vitamin D as an intervention for covid-19 across all stages of the disease are either under way or due to publish, either in the UK or internationally. Given that 90 trials are currently under way, possibly—hopefully—the evidence and data that we require will come our way soon. I would be really disappointed if those 90 trials do not give us the evidence we want. Let us hope that they do.

Some of the trials are of the high quality that we require to produce the data, and will answer key questions. NICE, PHE and the Scientific Advisory Committee on Nutrition are monitoring new evidence from trials as it becomes available.

The long-standing Government advice is that, every year, between October and early March, everyone is advised to take a supplement containing 10 mcg—400 international units—of vitamin D a day. Vitamin D helps to regulate the amount of calcium and phosphate in the body and to protect bone and muscle health. In April and autumn 2020, PHE reiterated the advice and also ran a public awareness campaign throughout December 2020. That had a specific focus on BAME communities, where vitamin D supplementation is important.

Vitamin D is made in the skin when exposed to sunlight during the spring and summer months and the PHE advice to continue taking vitamin D supplements is therefore particularly important for those who were shielding, care home residents and prisoners, as well as those who choose to cover most of their skin when outdoors, as these groups are likely to have reduced sunlight exposure. Importantly, individuals with dark skin are more at risk of not having enough vitamin D and are advised to take the 10 mcg of vitamin D supplements all year round.

We have actively supported the uptake of the PHE recommendations. Over winter 2020-21, the Government provided a free four-month supply of daily vitamin D supplements to adults on the clinically extremely vulnerable list who had opted to receive the supplements, all residents in residential and nursing care homes in England, and the prison population, where Her Majesty’s Prison and Probation Service made supplements available across England and Wales.

The Government prioritised groups that were asked to stay indoors more than usual over spring and summer 2020 due to national restrictions. The supplements were provided to help support their general health and, in particular, bone and muscle health.

Recipients of the Healthy Start scheme are also offered supplements containing vitamin D by the Government. Guidance on vitamin D can be found online, and we encourage individuals to buy 10 mcg vitamin D supplements from retailers such as supermarkets, chemists and health food shops.

As research continues on the impact of vitamin D on covid-19, we will continue to monitor evidence as it is published. We have committed to keeping this under review and, as I have said, we are committed to keeping the 90 trials that are under way under review, some of which are high quality, producing robust information.

[Jim Shannon]

Does the Minister have any indication of when the trials will be completed and when the evidence will be sought and got?

--- Later in debate ---

[Ms Dorries]

I do not believe all the trials start at the same time or aim to finish at the same time and there are 90 different trials, so I cannot give the hon. Gentleman a concise answer to that question. I reassure him that we are in the same place. If the trials proved that vitamin D had an effect on covid-19, we would be the first to shout about the results. As soon as they report, we will be delighted to receive the information.

Public Health England and the Scientific Advisory Committee on Nutrition and NICE will update further advice and the Government welcome any further studies into this emerging area. It may not just be 90 trials, as we may see even more.

We have been clear that our decisions are based on robust evidence. That position remains. I am sure hon. Members understand the importance of that and the reason why that has to be. We know that vaccines are the way out of this pandemic. Vaccines are the best way to protect people from covid-19 and they have saved many thousands of lives.

Looking to the future, we know that excess weight is one of the few modifiable factors for covid-19. It is a sad fact that obesity has played a large role in the impact on and outcomes for people who contract covid-19. Therefore, supporting people to achieve a healthier weight is crucial to keeping people fit and well as we move forward.

We launched “Tackling obesity: empowering adults and children to live healthier lives” in July 2020 and, as part of delivering the measures set out in our strategy, we confirmed in December 2020 our intention to legislate to stop the promotion of high fat, salt and sugar products by volume and prominent location, both online and in store, in England from April 2022. In the Queen’s Speech on 11 May, we confirmed our intention to introduce advertising restrictions for products high in fat, sugar and salt on TV before 9 pm and online. Currently, the House is debating legislation to introduce mandatory calorie labelling for large out-of-home food businesses such as restaurants, cafés and takeaways.

I hope that Members here today and Members from across the House will support the measures in their passage through Parliament, because we believe that they will be a key part of the tackling obesity campaign, which is so important in relation to covid-19. Helping people to achieve and maintain a healthy weight is one of the most important things that we can do to improve the nation’s health, and we are committed to meeting the challenge. My right hon. Friend the Prime Minister has been clear that

“we…must have a care for the health of our population and we will be happier and fitter and more resistant to diseases like Covid if we can tackle obesity.”

I will finish by saying that I think the objectives of everybody in the debate today are the same. I hope, along with other hon. Members, that we receive the robust data that we need; and if we do not, we continue with what we are doing, rolling out vaccines and dealing with the challenge of achieving a healthier nation via tackling obesity.

[Jim Shannon]

I want to thank all those who took part in the debate. First, I thank the hon. Member for Glasgow East (David Linden) for his contribution. Many things that the Scottish Parliament does on health issues interest me. He knows this, because I have said it to a health spokesperson for his party. I always listen intently to everyone, but in particular to the Scottish Members about how Scotland has done things, because it has done many things that I believe we could replicate across the whole United Kingdom.

One of the great things about these debates is that we can learn from one another and then, hopefully, take some of the good things from elsewhere and bring them in where we are, in the same way as we have done in Northern Ireland. The hon. Member for Glasgow East referred to what the Scottish Parliament is doing on vitamin D and to taking it all year round. It is perhaps a step ahead of us, so I thank him for describing that.

I am very pleased, as always, to have the hon. Member for Nottingham North (Alex Norris) here. My apologies to his wife; she can have him for the rest of the day—is that the way to put it? He has responsibilities here and has done well; I thank him for that. I also thank him for making, as always, an in-depth contribution, which lets us know where the Opposition, in the form of the Labour party, are and what they are doing.

We can probably all agree—I think the Minister is absolutely right, by the way—that we are here to support each other and the Minister. She outlined a very robust strategy for health—

[Ms Dorries]

I want to let the hon. Gentleman know that I have received a response on when the trials are due to conclude. Most are due to conclude this year.

[Jim Shannon]

Now, that was a quick answer! How many people get an answer to a question they asked 15 minutes ago? That is brilliant. That reinforces my comments about the strategy that the Minister referred to—the restrictions on adverts before 9 pm, the obesity and covid-19 death connection, and all the things the Minister referred to. Hopefully, some of the 90 trials—I never realised that there were that many trials going on—will produce high-quality data, which is what the Government needs to act upon.

I am hopeful, and I thank everyone for their participation. In particular, I thank the Minister for her excellent response and for reassuring me, the shadow Minister, the hon. Member for Glasgow East and those who were not able to come today but are watching the debate and would have wished to participate. Today, we have hope for the strategy. If the high-quality data is there, this can be a reality. I genuinely believe in my heart that this can benefit people, but we need the data to prove it. Our job, and the Minister’s job, is to receive that data and work on it. We have had that commitment. If the data is correct, we will have that.

Thank you for your chairmanship, Mrs Murray, as always. We do not always say that to the Chair, but thank you for chairing the debate well, as you always do. I also thank the staff, who work away in the background behind the screens. If we did not have them, this would not work at all.

Question put and agreed to.

Resolved,

That this House has considered the value of vitamin D as a defence against covid-19 infection.

Health and Social Care

Nadine Dorries Excerpts

Thursday 17th June 2021 Ministerial Corrections

The following is an extract from the debate in Westminster Hall on 16 June 2021.

[Ms Dorries]

On the next steps, public consultation on the White Paper has ended. I note that the hon. Lady said that she would like her comments to be considered, and they will be—they have been heard and duly noted. I reassure her that the stakeholders, many of whom represent her community and interface both with the Department of Health and Social Care and with other organisations and arm’s length bodies, have been fully engaged in the White Paper for the reform of the 1983 Act and in the consultation. I stand to be corrected, but I think we have accepted 124 of Sir Simon Wessely’s 127 recommendations. We meet him regularly to look at how we can enhance and implement those recommendations.

[Official Report, 16 June 2021, Vol. 697, c. 129WH.]

Letter of correction from the Minister for Patient Safety, Suicide Prevention and Mental Health, the hon. Member for Mid Bedfordshire (Ms Dorries).

An error has been identified in my response to the hon. Member for Dulwich and West Norwood (Helen Hayes).

The correct response should have been:

[Ms Dorries]

On the next steps, public consultation on the White Paper has ended. I note that the hon. Lady said that she would like her comments to be considered, and they will be—they have been heard and duly noted. I reassure her that the stakeholders, many of whom represent her community and interface both with the Department of Health and Social Care and with other organisations and arm’s length bodies, have been fully engaged in the White Paper for the reform of the 1983 Act and in the consultation. I stand to be corrected, but I think we have accepted 124 of Sir Simon Wessely’s 154 recommendations. We meet him regularly to look at how we can enhance and implement those recommendations.

Miscarriage Research: The Lancet

Nadine Dorries Excerpts

Thursday 17th June 2021 Commons Chamber

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

First, I pay tribute to the hon. Member for Sheffield, Hallam (Olivia Blake) for how brave she is. She moves everybody to tears when she talks about her story, because it is personally so touching. I responded to her debate the first time in Westminster Hall. So she has not elaborated on her own situation in the way she did then, but she is so incredibly brave to do what she does and to champion women who have suffered from miscarriages. I also want to say that I worked closely with her mother, Judith, at the beginning of the covid outbreak and her mother must be very proud of her. Her mother is a formidable lady, I have the hugest respect for her and I am sure she is incredibly proud of the hon. Lady today.

I thank everybody who has shown a particular interest in this subject, both in the Chamber and in the Westminster Hall debates that have been held. I also thank Tommy’s, in Coventry—for those who might think I am talking about a hospital over the bridge—a charity that does incredible work to support families through their pregnancy journey, including those who sadly miscarry, with funding research centres and specialist clinics to help us understand why pregnancy sometimes goes wrong and how we can prevent complications and loss, and to provide specialist care for those women who need it. Tommy’s petition to improve miscarriage care has drawn a huge amount of support, and I am glad this deeply important issue has the attention it deserves.

The three papers published in The Lancet provide an important insight into the prevalence, effects and costs of miscarriage, which is the most common complication of pregnancy, experienced by an estimated one in five women. We know that miscarriage can significantly impact the emotional and psychological wellbeing of women and their families. It can be extremely isolating for women and their partners, with long-term complications.

Women who have suffered miscarriage are 3.8 times more likely to die by suicide, and it takes only one miscarriage to increase the likelihood of a suicide for a woman. Such difficult experiences should not be faced alone, which is why as part of the NHS long-term plan we are improving the access to and quality of perinatal mental healthcare for mothers and their partners affected by their maternity experience, including miscarriage.

Mental health services around England are being expanded to include new mental health hubs for new, expectant or bereaved mothers. The hubs will offer treatment to about 6,000 women in the first year for a range of mental health issues, from post-traumatic stress disorder after miscarrying or giving birth, to a fear of childbirth. The new hubs will also provide specialist training for midwives and other maternity staff, as well as reproductive health and bereavement services.

The series in The Lancet highlights the unacceptable inequalities in women’s chances of having a miscarriage; for example, black women have a 40% increased relative risk of miscarriage compared with white women. It also provides evidence of the importance of maintaining a healthy lifestyle before conception and during pregnancy for all women, to reduce the risk of miscarriage. Women who smoke in the first trimester are 1.2 times more likely to have a miscarriage than non-smokers. Women with a low body mass index, under 18.5, are 1.6 times more likely to miscarry and those with a BMI of 30 are 1.9 times more likely to do so. This is the information that we know.

The NHS is open for all, and no woman should feel that they cannot seek help. The earlier women come forward during their pregnancy, the easier it is for the NHS to make sure that they receive the right support to reduce the risks. A pregnancy lasts about 40 weeks, but a lifetime approach is needed to address some of the reasons why some women are at more risk than others. Tackling health inequalities and levelling up society is a priority.

While there is still more to do, good progress has been made to improve maternity safety and achieve our national maternity safety ambition. Since 2010, the stillbirth rate has fallen by 25%. Some 98,000 women now receive care from the same midwife team throughout their maternity journey—so-called continuity of care—which is up from 10,000 women in March 2019, and this was throughout covid as well. This helps to reduce baby loss, pre-term births, hospital admissions and the need for intervention during labour, and to improve women’s experiences. It is so important that the voices of women, including those who have suffered miscarriages, are heard. That is why I pay tribute to the hon. Lady, because here in this place she champions those voices.

In March, I announced that the Government are embarking on the first women’s health strategy for England—something that I was absolutely committed to start and finish when I first became a Minister in the Department for Health. This strategy is first and foremost about listening to women’s voices. The call for evidence recently closed, and we have seen an incredible response. Over 112,000 women from across the country came forward to share their experiences in the online survey. The call for evidence specifically asked about women’s experiences with fertility, pregnancy and baby loss, which is such an important area of women’s health. We are analysing responses closely to make sure that the strategy reflects what women identify as their priorities, and we will consider the recommendations made in the Lancet series as part of this work.

I am looking forward to visiting Tommy’s National Centre for Miscarriage Research in Coventry myself in the coming months. Its research into the causes of miscarriage and search for solutions and treatment are incredibly valuable. I look forward to meeting the authors of the Lancet papers and talking to some of the patients to hear about their experiences of miscarriage and miscarriage care. I would like to extend an offer to meet the hon. Lady so that we can discuss this issue further too. Every miscarriage is a tragedy and it is only right that parents are supported through difficult times.

The hon. Lady asked particularly about the recommendations that were made, so I will go through them and what I am doing about each one. Recommendation 1 was to

“ensure that designated miscarriage services are available 24/7 to all, taking into account local conditions and resources.”

I am including recommendation 1 in the women’s health strategy as part of the work that we are doing specifically about those issues.

Recommendation 2 says:

“Treatment and care must be standardised and equitable. Appropriate care must be given to everyone after 1, 2 and 3 miscarriages in line with a ‘graded model’ of care.”

I am not putting that into the women’s health strategy because, as a Minister and not an obstetrician or a gynaecologist, I do not decide what the guidelines or the recommendations are on miscarriage. We are politicians, so we look to the Royal College of Obstetricians and Gynaecologists, which is reviewing the guidelines regarding recurrent miscarriages and is expected to publish that review later this year. I am sure that it will include the findings of the Lancet papers. I hope that the recommendations will also be taken into account in the review of the guidelines.

Recommendation 3 is:

“To acknowledge that miscarriage matters to parents and take steps to record every miscarriage in England.”

The story of the hon. Lady’s friend was disturbing, and recording and data are so important, so I am putting that recommendation into the women’s health strategy to be part of our review.

On the women’s health strategy, the 112,000 responses was a huge number and it will take some time to get all those responses together and group them into the areas in which people have responded, and then in each of those areas take forward our policy recommendations. So I have asked for both those recommendations to go into the section on miscarriages, paternity, baby loss and pregnancy. I hope that the hon. Lady is happy with that. It is incredibly important that we get it right, and to get it right we need the recommendations to be fully evaluated. I look forward to going to Tommy’s so that I can talk to people further about this.

The national bereavement care pathway was developed with this in mind, to improve bereavement care and reduce variation in the care that families receive after miscarriage. I believe that 63% of England’s trusts are now fully signed up and all those that remain have formally expressed an interest in the project that Tommy’s has run. The hon. Lady is absolutely right in what she says about the response. I am really impressed with the 112,000 women who have taken the time to respond to our women’s health strategy, and I believe that Tommy’s must be equally impressed with the response that it has had from women. Women are really standing up and making their voices heard, because projects such as these are giving them the opportunity to do so.

Finally, I would like to take this opportunity to urge those women who have suffered a miscarriage: help the NHS to help you. Please do not suffer in silence. Please reach out and seek support, and the first placej to do that is with your GP or in the hospital where you receive care.

Children and Young People’s Mental Health

Nadine Dorries Excerpts

Wednesday 16th June 2021 Westminster Hall

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

It is a pleasure to serve under your chairmanship, Sir Gary. I thank the hon. Member for Twickenham (Munira Wilson) for bringing forward this important debate. We have had a number of interactions and I know how genuinely important the issue is to her. I am aware of the meeting she had with the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar). I will give some information, but also reassure her that we are continually working on these issues. More has happened as a result of her meeting. I know she is genuinely very concerned about this issue and has been since the day she arrived in Parliament.

As the Minister, I speak to all stakeholders, trusts, organisations and just about everyone involved in the area of mental health, particularly among children and young people. It is incredibly important that we keep our language and our comments about children and young people both proportionate and responsible. There is not a mental health pandemic. I will go on to explain what I mean by that.

It is very important that we divide wellbeing from mental illness, not least because we do not want mental illness to fall by the wayside in people’s awareness and understanding of mental health, because the conversation is dominated by mental health and an overarching title that is not appropriate. Mental health is divided—it is not just a catch-all title. We have people who suffer with serious mental illness and childhood mental illnesses, such as schizophrenia, psychosis and eating disorders. I congratulate the hon. Member for Bath (Wera Hobhouse) on her speech; we have discussed eating disorders many times, and she is compassionate and is compelled to improve eating disorder services for children and young people in the UK. I thank her for her commitment to the issue.

It is incorrect to describe 140,000 children as having been turned away. The measurement of progress against the five-year forward target is based on two contacts with NHS services—this is an important point. Many children and young people have one session. After that, it is jointly decided to close their referral. To quote the 140,000 figure is misleading. One session is thought enough to provide them with the help they need or, more importantly, to provide pathways to their carers, parents and those who accompany them to the appointment. The expansion of Every Mind Matters, which was developed by Public Health England, to include children and young people under the age of 18 has been a huge boost. It is wrong to say—to misquote—that 140,000 children have been turned away. It is important to look at the reasons why.

I began by saying that I speak to stakeholders, trusts and others. I would like to quote from a letter a trust sent to MPs, following a debate on the issue only days ago. The trust said: “Partner organisations work incredibly closely to ensure children and young people receive the services they need.” It was referring to the narrative used by parliamentarians. It said that frontline staff had worked tirelessly throughout the pandemic and had taken the additional investment that the Government had provided to increase their workforce, and that to describe their services as failing had an impact on the morale and wellbeing of dedicated frontline staff and those who are delivering services to children and young people. It went on to say that the statements that were being made caused concern and alarm to children and young people and their families at an anxious time.

We have a responsibility in Parliament when we are talking about mental health, particularly of children and young people, to keep language proportionate. For me, talking in a debate about children throwing themselves off a bridge is completely beyond the mark and I am afraid that I think that that type of language is exactly what the trust was referring to—[Interruption.] The hon. Member for Tooting (Dr Allin-Khan) is commenting from a sedentary position. I reiterate my comments, Sir Gary. It is important that we consider the families and the people that we are representing and do not make inflammatory statements.

I have heard first hand from NHS staff that thousands of children and young people have had to adapt to the challenges of covid-19. It has been an incredibly tough year for everybody, and many children and young people have felt anxiety, apprehension and a gamut of emotions that adults also felt when faced with the unknown, sudden and rapid change to routines as well as a lack of understanding of what would happen and how life was to continue. However, many people are resilient, and many of those children and young people, who at stages reported they felt all those emotions and were included in that statistic of one in six, came through once there was a greater understanding of what was happening and how it was going to work. They were incredibly resilient, and we should be proud of those children and how they helped others too.

We take the pandemic and the mental health of children and young people extremely seriously. I work seven days a week on what this Government do, what we provide and how we assist. Although I have been criticised by the hon. Member for Tooting for talking about the investment we provide, we cannot provide services without the money for them. We cannot increase our mental health workforce if we do not provide the money to train people and to provide those services and that is exactly what we have done. I have no shame in quoting the figure of £2.3 billion a year that is going into mental health services—more than any Government has ever ploughed in, plus an additional £500 million to a mental health recovery plan for the pandemic this year, of which £79 million has gone into eating disorder services based in the community. We hope that that funding will allow around 22,500 more children and young people to access community health services.

[Wera Hobhouse]

The Minister has quoted the numbers for what the Government have made available. As I said, unfortunately a lot of that money has not reached the frontline. Will she make CCGs accountable and that money goes where it is meant to?

[Ms Dorries]

It is a constant pressure for me to ensure that. NHS England has worked incredibly hard to establish community-based services. It is important to say that the uptick in eating disorders came before the pandemic—it was spotted before it struck. We can have another debate on why we were beginning to see that rise in eating disorders, and the hon. Member for Twickenham and I have had that discussion. I am proud of how the NHS has rapidly looked at how we can deal with this exponential rise in eating disorders, because that is where our problem is.

We know exactly who has been affected by the pandemic, in terms of mental health services. We know from the referrals that have gone to our partners across the board and to local services. I am saddened to say that eating disorders are our toughest problem at the moment because of the exponential rise—over 22% over the past year.

NHS England is using that money. As I said a moment ago, having the workforce to provide services is really important, so we have accelerated the number of mental health support teams that we are putting in. The first question I asked when I took up my ministerial post was: “Can we have more mental health support teams in schools faster? Can we accelerate the long-term plan so that we get more areas covered quicker?” It took the pandemic to make that happen, but now—I have not even used my speaking notes; I have gone completely off piste—I think we have another 112 school areas covered. I will write to Members attending today to give them the figures on mental health support teams. We have managed to accelerate the programme by over a year as a result of the £500 million of funding that we put in.

Something that we can really shout about is that we have people coming forward. Mental health was never an area where people really wanted to work. I remember during my nurse training that we were given the option to take 12 weeks’ maternity or 12 weeks’ mental health, and my entire cohort took 12 weeks’ maternity. Nobody went to do the mental health training. Now—the pandemic has highlighted this—we have 100 applications for every place in university for people to train in mental health. That means mental health support teams to go into schools, deal with eating disorders and work with children and young people. When we put that kind of money in, run those kinds of courses and have the commitment to accelerate mental health workers, we do not see those results overnight, but that work is being done now to ensure we have the results. We want to ensure that people come out of universities and go into mental health support teams in schools. I have seen the work they do and how they work with children and young people.

Time has whizzed on, and I would just like to make a few points. The hon. Member for Lewisham West and Penge (Ellie Reeves) spoke about young mums and infant mental health. I am totally with her. That is why I worked so hard during the lockdowns to ensure that we kept support groups open for mums and young babies, and particularly those that give mental health support to mums. That included all sorts of groups, such as playgroups—Monkey Music is one that somebody used—where mums could meet together with their young babies. I argued for that and made the case for supporting their mental health. During the pandemic, those groups were kept open for young mums because I felt it was so important that they were supported.

[Sir Gary Streeter (in the Chair)]

May I remind the Minister to leave one minute at least for the hon. Member for Twickenham (Munira Wilson)?

[Ms Dorries]

I am going to sit down.

[Liz Twist]

Will the Minister give way?

[Ms Dorries]

I do not think there is time.

[Sir Gary Streeter (in the Chair)]

You have one minute of your time left.

[Ms Dorries]

I have not got time, I am so sorry. There is only one minute left.

The hon. Member for Twickenham asked about data. That data is produced on the mental health dashboard every quarter. There is work ongoing, but I will come back to her on the details of it. I do not know whether she has access to the dashboard and the data, but I will make sure she does. If the hon. Member for Blaydon (Liz Twist) would like to speak to me when the debate is over, I will come back to her on the points she raised. I will sit down now to give her a chance to respond.

Reform of the Mental Health Act: White Paper

Nadine Dorries Excerpts

Wednesday 16th June 2021 Westminster Hall

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for bringing this debate to the House and for raising important concerns on behalf of her constituents in what was a truly constituency oriented speech. We both come from Liverpool, which is an incredibly diverse city. I recognise many of the points she raised in her speech and thank her for that.

The hon. Lady spoke about the consultation, which was wide reaching and had a huge response, including from Mind, which she spoke about. Mind has worked very closely with us throughout the development of the mental health White Paper and contributed strongly to the consultation process. It is a very important stakeholder and we work very closely with it.

The Mental Health Act exists so that people with severe mental illness who present a risk to themselves or others can be detained in hospital and treated, which, I am sure the hon. Lady will agree, is necessary at times, unfortunately. Outside the cases where we know that people are safest in hospital and require hospital treatment, no mental health treatment is better delivered in a hospital than in the community. Our goal is for people to receive community mental health treatment close to where they live and to their families and work, in order to prevent them from having to be admitted as hospital in-patients. There are times, however, when detention is, unfortunately, necessary. We are taking steps because it is time to modernise the Act so that it works better for people.

In 2018, the Government asked Professor Sir Simon Wessely to review the Mental Health Act. I thank the hon. Lady for her comments about him. We asked him to review the Act because we were concerned about the rising rates and numbers of people being detained under the Act and the racial disparities in those detention rates. Sir Simon’s independent review of the Act clearly shows that it does not always work as well as it should for patients, their families and communities. It goes too far in removing people’s autonomy and it does not give them enough control over their own care.

In response to Sir Simon’s review, in January the Government published the White Paper on reforming the Mental Health Act, setting out our proposals to make the Act work better for people. These are once-in-a-generation reforms that will give people greater control over their treatment and let them have the dignity and respect they deserve. Through these reforms, we will give patients a voice in their own care, which we know leads to better engagement in treatment. We will put care and treatment plans, and advance choice documents, into statute for the first time. I will address in a moment some of the individual points made by the hon. Lady.

Patients will be more closely involved in the development of their own care and can have confidence that if they lose capacity because of illness, their preferences on drug treatment, named next of kin and choices for the future will be properly considered. We will also make it easier—this is incredibly important—for patients to challenge decisions about their care. We are creating a new right for patients to choose a nominated person who will best look after their interests. I am sure the hon. Lady knows that, until the reform of the Act, it was still the case that if a woman was detained in hospital, it was her husband, father or next male relative who—regardless of how remote that person was to her life or experience—was nominated to make decisions on her behalf. That is one of the reasons why I personally think that this new provision is so important—it is so that that anyone can choose their nominated person, regardless of whether they are a relative, next of kin or someone in their family. That person is nominated during a time of wellness and remains the nominated person in the future. That can lead to patients having a far greater degree of control over their treatment, and a feeling of control over decisions taken on their behalf.

We are increasing patients’ access to the independent mental health tribunal to provide vital independent scrutiny of detention. The reforms also seek to address the disproportionate number of people from black and minority ethnic groups detained under the Act. Black people are currently four times more likely than white people to be detained under the Act, and 10 times more likely to be placed on a community treatment order, as mentioned by the hon. Lady. Our plans to enhance patient choice, increase scrutiny of decisions and improve a patient’s right to challenge aim to address those concerning disparities.

On the criminal justice system, our proposals include key improvements to how we manage offenders with acute mental disorders and support them to access the care they need as quickly and as early as possible. We will improve the timeliness of transfers from prisons to mental health hospitals where individuals become well when in custody—I am sure that the hon. Lady is familiar with that situation from her previous experience—so that people in the criminal justice system get the right care, in the right place, at the right time, while continuing to fulfil our duty to keep the public safe.

Finally, we want to improve how people with a learning disability and autistic people are treated under the Act. The right community services would prevent needs from escalating. In future, the Act should be used only where there is a treatable mental health condition and admission is therapeutic, close to home and for the shortest time possible. There have been far too many examples of poor practice and quality failings in in-patient care for people with learning disabilities and autistic people. Therefore, we are proposing reforms to limit the scope to detain people under the Act where their needs are due to their learning disability or autism alone. We are firmly committed to developing community based services to support people with learning disabilities and autistic people, and to reduce reliance on specialist in-patient services. We have put forward proposals to ensure that that is available. These once-in-a-generation reforms will be instrumental in bringing the Mental Health Act into the 21st century.

On the points raised by the hon. Lady, CTOs are incredibly important and we are increasing the scrutiny of when they are used—and the frequency of that scrutiny—so that they are used only when appropriate and for no longer than necessary. That has been one of the failings so far, and it needs to be addressed. They will now be monitored and kept in place for no longer than is necessary. We are taking action to address racial disparities across the use of the Mental Health Act. Those CTO disparities are, of course, happening in the communities represented by the hon. Lady.

The hon. Lady mentioned Seni’s law. We are clear that restrictive intervention and restraint should only ever be used as a last resort, when all attempts to de-escalate a situation have already been employed. The Mental Health Units (Use of Force) Act, also known as Seni’s law, received Royal Assent in November 2018. The purpose of the Act is to increase the oversight and management of the use of force and acts of restraint in mental health units, so that force is only ever used as a last resort. We published the draft statutory guidance to the Act for public consultation in spring, and are committed to publishing the final guidance and commencing the Act in November.

We have made a huge amount of progress, but unfortunately, and sadly, we have been delayed by covid. The Department’s resources have all been focused on covid over the last 15 months. I met Seni’s family and the hon. Member for Croydon North (Steve Reed) only a few weeks ago to discuss this. They were absolutely delighted to hear that we will make huge progress from September to November, and that by November the Act will hopefully be live. I commend them for the work and the campaigning that they have done—they are still campaigning.

The disparity in the use of force and restraint speaks to the communities that the hon. Lady represents. The Mental Health Units (Use of Force) Act will be instrumental, along with reform of the Mental Health Act 1983, in improving her constituents’ mental health experiences of detention and in-patient treatment.

On the next steps, public consultation on the White Paper has ended. I note that the hon. Lady said that she would like her comments to be considered, and they will be—they have been heard and duly noted. I reassure her that the stakeholders, many of whom represent her community and interface both with the Department of Health and Social Care and with other organisations and arm’s length bodies, have been fully engaged in the White Paper for the reform of the 1983 Act and in the consultation. I stand to be corrected, but I think we have accepted 124 of Sir Simon Wessely’s 127 recommendations. We meet him regularly to look at how we can enhance and implement those recommendations.[Official Report, 17 June 2021, Vol. 697, c. 4MC.]

I want to thank and reassure the hon. Lady. I absolutely understand why we are reforming the Mental Health Act and the reason why we supported and assisted the enactment of Seni’s law. It is because we are absolutely committed to improving the experience of mental health in-patient detention for all, and especially the communities she represents. We are very aware of the fact that black men are four times more likely to be detained under the Mental Health Act, and we very much want to change that. That is why we have accepted so many of Sir Simon Wessely’s recommendations.

I thank you, Ms Nokes, and I thank the hon. Lady for securing this debate. I always look forward to an opportunity to speak about mental health, particularly the reform of the Mental Health Act, which I very much look forward to championing later in the year.

Question put and agreed to.

Patient Safety

Nadine Dorries Excerpts

Thursday 10th June 2021 Written Statements

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

I would like to inform the House of the launch of a public consultation on proposed legislative provisions governing the appointment and operation of the patient safety commissioner for England.

As my colleagues will be aware, on 14 December 2020, the Government tabled an amendment to the Medicine and Medical Devices Bill to establish an independent patient safety commissioner for England. The Medicines and Medical Devices Act 2021 (MMD Act) achieved Royal Assent on 11 February 2021 and on 11 April established the commissioner position and its main duties and powers.

The introduction of a patient safety commissioner also acts on the second recommendation of the independent medicines and medical devices safety review, “First Do No Harm”, published in July 2020 by Baroness Cumberlege.

The patient safety commissioner will add to and enhance the existing work that has been done to improve patient safety by acting as a champion for patients. Listening to our patients is integral to our healthcare system and the commissioner will help to make sure patient voices are heard.

The core duties of the commissioner are to promote the safety of patients in the context of the use of medicines and medical devices and to promote the importance of the views of patients and other members of the public in relation to the safety of medicines and medical devices.

Under the MMD Act 2021, (paragraph 6 of schedule 1) the Secretary of State is able to make legislative provisions about the appointment and operation of the commissioner, for example, the terms of office, finances and other support for the commissioner. As is required by the MMD Act, the Department has launched a public consultation to gather views from interested persons on the detail on the appointment and operation of the commissioner. Consultation responses will be carefully considered and will feed into the required secondary legislation.

This consultation will help to ensure that the provisions governing the appointment and operation of the patient safety commissioner are as comprehensive as needed, so that the commissioner will be able to work for, with and in the best interests of patients.

I would like to take this opportunity to reassure the House that the Government continue to prioritise work on this initiative. The launch of this consultation represents good progress in setting up of the commissioner.

The consultation can be accessed using the following link:

https://www.gov.uk/government/consultations/the-appointment-and-operation-of-the-patient-safety-commissioner.

[HCWS80]

Menopausal Symptoms: Support

Nadine Dorries Excerpts

Wednesday 9th June 2021 Westminster Hall

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

I thank the hon. Member for Swansea East (Carolyn Harris) for securing this really important debate. It is our second session today, and I think she knows that there is nothing she has brought forward in the House that has not had my full support. I mentioned in our previous meeting that, when it comes to women’s health, and particularly in relation to the menopause, there is no place for politics. Women’s health is above that.

I congratulate and thank the hon. Lady, and I hope she will not mind if I use her debate, once again, to talk about the women’s health strategy. The reason is that we have had more than 100,000 responses to the call for evidence, which is just amazing. Many of the responses were from perimenopausal women, women experiencing the menopause and post-menopausal women, like me—I will not go into my own experiences but, like most women’s, they were not pleasant. As the menopause is a feature of the women’s health strategy, I urge people here today, and those listening who have networks, to send the link out, because it closes on the 13th, which is Sunday, so we have five days to go. We need as many women as possible to respond, because that will give us a mandate of more than 100,000 voices, and give us the evidence and data that we need to proceed with the development of policy.

I would also like to put on the record my sympathy for all women who have felt that they have not been listened to when discussing, or even attempting to discuss, the menopause with their healthcare providers or employers. The hon. Lady said it is referred to as “women’s troubles”—there is this taboo. There has actually been a taboo about women’s health issues since Aristotle—or since the beginning of time. It has been ingrained in the system and into us as women that it is something that we do not raise or talk about, yet we all suffer from it at some stage or another.

The hon. Member for Bradford South (Judith Cummins) raised osteoporosis. I will come on to some of the health conditions that women can experience as a result of the menopause, but I thank her for raising osteoporosis. Sadly, women are more susceptible to osteoporosis, because bone loss becomes more rapid after the menopause as a result of the reduction in oestrogen levels. So many of our problems in the menopause are a result of the reduction of oestrogen levels. Additionally, women tend to have smaller bones than men and a slightly longer life expectancy. But although women live longer than men, we live a longer period of time in poorer health. Declining oestrogen levels when we are perimenopausal, and a lack of oestrogen when we are menopausal and beyond, contribute to that poorer health.

The hon. Member for Newport West (Ruth Jones) raised the issue of mental health. Again, having talked to leading doctors in the field of menopausal treatment, we know that women will be given half a dozen prescriptions for anti-depressants before getting a prescription for oestrogen, even though what they actually needed was the oestrogen replacement.

I heard the point made by the hon. Member for Pontypridd (Alex Davies-Jones) about employer-led facilitation of the menopause, but one of the things that I hear a lot from women is, “I don’t want a fan on my desk. I don’t want special treatment at work. I want the HRT. I want the oestrogen, because when I have the oestrogen, I am the same as everybody else. I want to laugh again. I want to live again. I want to feel normal again. I want to have the same energy levels again, and the only way I can do that is if my GP will listen to me and give me the HRT that I want—the oestrogen.”

Today I spoke to ex-servicewomen who were talking about the menopause and wearing heavy clothing. If they were on HRT, the thick jumpers and uniforms would not be an issue for them, because they would not be going through the hot flushes. There are many women’s voices and experience of the menopause to be heard, and I am afraid it is not just as simple as saying that we want employers to give leave or to put fans on desks. One woman said to me, “I’ve been told that I can have my desk moved to be near the window, which is a prime position. I don’t want that; I just want my doctor to give me HRT.” That is actually the nub of the issue with HRT and the menopause for many women, particularly when it comes to osteoporosis. We are hearing evidence, and we will hear more, that HRT delays the onset of dementia and so many other things. Some of the research that doctors are now using to set guidelines for HRT is from 2004 and earlier.

The hon. Member for Swansea East chose a really opportune time to have this debate. I hope that she continues to take this campaign further, because we need someone with her—I hope she will not mind my saying this—flamboyancy, tenacity and ability to get gender issues to the top of the agenda. I really hope that she will continue and take this issue forward, because that is what we need. We need women like us—women on the Back Benches, women in my position and women such as the hon. Member for Swansea East—to raise this issue, because the only way we can break down taboos is by making them no longer taboos. We need to talk about this issue, and it needs to stop being something that no one wants to discuss. Women have to do it.

We are consulting on the women’s health strategy over the summer—it closes on 13 June—and the menopause is playing a huge part. We will sift through the information over the summer period, and we will come back with our findings in October/November, when officials have the time to sift through it, take up the themes and get the evidence out. That will be an amazing collection of women’s experiences and what they have gone through—not being listened to, being closed down, and not being given the treatment they want—with most of it within the healthcare arena. We know that women are not listened to in the healthcare arena. As a result of the Cumberlege report, the Paterson report and so many other reports, we know that this is the case.

To help ensure that women receive the best possible care, NICE published guidelines on the diagnosis and treatment of the menopause in 2015. It states that clinicians should adopt an individual approach or stages of diagnosis in the investigation and management of the menopause. I was accused of possibly patient-shaming when I said that women should feel empowered to be able to stand up for themselves and to challenge decisions that are made about their healthcare. I know myself, I know other women and I have heard from many women as part of the women’s health strategy who say that they know they are menopausal or perimenopausal, but their doctor insists on giving them a prescription for anti-depressants. One woman was told by a doctor to take a walking holiday before going back to him. Women know they are perimenopausal and should feel empowered to speak up about their situation.

NICE guidelines are not mandatory, although health and care clinicians are expected to take them fully into account. That is something that we need to continue to raise. Women may view various risks differently, according to their medical history, and the impact of the menopause symptoms on their daily lives.

In 2019, the Medicines and Healthcare Products Regulatory Agency published updated safety information to enable women to make informed choices about whether, and for how long, to use HRT. Despite that, as I said, I have heard that many menopausal women seeking treatment are not receiving either the appropriate advice or the medication that they need to manage their symptoms.

I am committed to looking into that further. One of the reasons why I said that I hope the hon. Member for Swansea East, with her profile and her ability to take on difficult issues, will continue to champion this is that it will help everything we do in this place—all that women do in this place will help.

We are committed to supporting women at all stages of their lives to enable them to reach their potential. Half the population will go through the menopause, obviously, but one in four women in the workplace are menopausal or have completed the menopause, and 53% of women state that menopausal symptoms impact on their work. That is why I raised the issue of those women who were not given the treatment that they seek. What they say is that they just want treatment so that there is no impact on their work. We have to do more to combat that, for the sake of women and of our economy.

A number of organisations are working to change the approach to menopause in the workplace, such as the Chartered Institute of Personnel and Development, the Faculty of Occupational Medicine and the NHS Staff Council’s health, safety and wellbeing partnership group, which has produced guidance on the menopause for employers. I encourage employers to refer to that guidance. I would be interested to know how many employers do refer to it, do develop policies in their work- place on the back of it, or even know that it is there.

Hon. Members asked about education in schools. In order to break down the taboos about menopause, there must be access to high-quality information to produce productive conversations. Health education is compulsory in all state-funded schools. From September 2020, relationship education became compulsory in all primary schools, and relationship and sex education became compulsory in secondary schools. Pupils are taught about intimate and sexual relationships, including facts about reproductive health and sexually transmitted infections, as well as facts about menstrual health, fertility and the menopause. That is a landmark step to ensure that all the population are educated about women’s health issues from an early age.

That was a challenge. When I was growing up, I had never even heard of the menopause. I do not think that even my daughters, now in their young adult life, had heard about it when they were growing up. It was just not discussed. Now, it is being taught in schools, which is a huge step forward.

Hon. Members know how brilliant our NHS staff are. This year, they have provided amazing care in the most difficult and testing circumstances. However, training is important at undergraduate, medical school and all levels. Individual medical schools set their own medical curriculum, which must meet the standards set by the General Medical Council. The GMC monitors medical schools to ensure that those standards are maintained. Importantly, all new qualified doctors must be able to recognise how normal human structures and physiology apply or change at significant age milestones and at the menopause. From 2024, the GMC will introduce the medical licensing assessment, which all UK medical students will need to pass to join the medical register. I am pleased that assessment includes knowledge of the menopause.

Things are moving and things are changing, but it is too slow. I think I said to the hon. Member for Swansea East that it is like turning the direction of a tanker on the ocean—it takes not just a Government, a Minister or a person; it takes all of us as women to start talking about the menopause and to start campaigning here. From my perspective, the women’s health strategy is my start.

I am excited to tell the House about a new menopause pathway improvement programme led by NHS England and NHS Improvement . The programme brings together key stakeholders and partners representing clinical colleges, menopause specialists, the workforce and women to develop evidence-based care pathways for women, aligned to NICE guidance and accounting for all demographics, to increase access to and delivery of optimal perimenopause and menopause care for women. It includes plans to increase access to education packages for clinicians who provide menopause care and a workforce support model that will be pioneered in the NHS and shared with all other industries and sectors. This programme of work feeds into the all-staff retention programme board, supporting the retention work specifically for those at risk of leaving the workforce—namely, female nurses aged 50-plus.

I again thank the hon. Member for Swansea East for securing the debate, and I am grateful to hon. Members for their invaluable contributions on this really important topic. While there is some good work under way, I am determined to make rapid progress to improve the support available to women experiencing the menopause and end the stigma that still surrounds many areas of women’s health. Following analysis of the call for evidence for the women’s health strategy, we will draw the work together and take an end-to-end look at women’s health from adolescence to menopause. That approach will ensure that women have better, more open conversations about their health and receive important treatments, including during the menopause.

Point of Order

Nadine Dorries Excerpts

Tuesday 8th June 2021 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

I am grateful to the right hon. Gentleman for having given me notice of his intention to raise this point of order. Mr Speaker shares his concern that sensitive correspondence appears to have been passed from the Department to a private company for a response, and Mr Speaker will be drawing this matter to the attention of the Leader of the House to ensure that these important issues are understood across Government and not only by the people who are paying attention to this particular point of order this afternoon.

The 2016 guidance produced by the Cabinet Office on the handling of parliamentarians’ correspondence goes into some detail, which I will not quote in full now, but the right hon. Gentleman is right in pointing out that that guidance says that

“departments should treat correspondence with great care to ensure that confidentiality is not broken.”

It also states that

“official replies to letters from MPs should only be authorised in exceptional circumstances”.

It would appear that guidance has possibly not been followed in this case.

I would have said to the right hon. Gentleman that I would make sure that the Minister gives an answer, but I am delighted to say that the Minister in question is here in the Chamber, so I shall call her to respond to the point made by the right hon. Gentleman.

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

Further to that point of order, Madam Deputy Speaker. I thank the right hon. Member for North Durham (Mr Jones) for the advance notice of his point of order, because the very short time that I have had has enabled me to do some investigation, and enabled officials to investigate, to find out what has happened.

The chronology is that the Department was passed a letter sent to me by the right hon. Gentleman on 26 May. The letter raised some very serious concerns about the conduct of a doctor working for a cosmetic-surgery provider referring UK patients for consultations with a former doctor who was struck off by the General Medical Council in August 2020 and is now based in Italy.

The right hon. Gentleman and I have had a number of conversations about the cosmetics industry and issues of this nature, so he will understand why I have taken this matter so seriously. Due to the nature of the allegations and the potential implications for patient safety—which I take very seriously, particularly when they pertain to women—my Department raised the issues set out in the letter with the GMC and it was also passed to the Care Quality Commission, which is responsible for regulating providers of cosmetic surgery in England, to enable it to consider the issues that were raised. The CQC needed to go back to the provider to find out whether the allegations were true and what had happened.

I take the complaints very seriously. I assure the right hon. Gentleman that, as he is aware—we have spoken about this—I had not even seen the letter yet myself. I can only believe that the letter was shared with the GMC and the CQC to ascertain what happened in order to inform a letter that I would then send to the right hon. Gentleman. I have yet to see the letter. I take these complaints incredibly seriously and my Department is reviewing how this information and the letter were handled and how the information was leaked. I will write to the right hon. Gentleman once our inquiries have been satisfied and, as he and I have previously discussed, I shall also write to his constituent.

[Madam Deputy Speaker]

I hope that the right hon. Gentleman is satisfied that the point that he has raised has been taken very seriously by the Minister. The House will be pleased to know that the Minister and her Department are taking this matter very seriously indeed, and I will happily tell Mr Speaker that that is the case.

I shall now briefly suspend the House for three minutes in order that arrangements can be made for the next item of business.

Oral Answers to Questions

Nadine Dorries Excerpts

Tuesday 8th June 2021 Commons Chamber

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

What recent assessment his Department has made of changes in waiting times for mental health treatment.

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

We are transforming mental health services through the NHS long-term plan, investing an additional £2.3 billion a year by 2023-24. Where national waiting time targets exits, the majority are being met. Targets for eating disorder services are sadly not being met, but additional resources have been allocated to increase capacity and address waiting times. We are working on the consultation responses for the Mental Health Act White Paper, and we will bring legislation forward when parliamentary time allows.

[Ian Levy]

After a career working in mental health for almost 30 years, prior to entering this House, I was delighted to be asked to become a board member for a local charity, Anxious Minds, which is based in Blyth town centre. Its aim is to improve mental health and wellbeing for local people. Will my hon. Friend assure me and those who worry about the toll that this pandemic has taken on the vulnerable that she will do everything she can to ensure that mental health is given the highest possible propriety as restrictions begin to ease?

[Ms Dorries]

I thank my hon. Friend for his years of service working in mental health. Mental health is one of this Government’s top priorities, and I assure him that we are doing our utmost to ensure that mental health services are there for everyone who needs them. Through the NHS long-term plan, we are expanding and transforming mental health services in England and investing an additional £2.3 billion a year in mental health services by 2023-24.

In addition, we have published our mental health recovery action plan, backed by a one-off targeted investment of £500 million in addition to the £2.3 billion, to ensure that we have the right support in place this year. The plan aims to respond to the impact of the pandemic on the mental health of the public, specifically targeting groups that have been most impacted. We have set up a cross-Government ministerial group to monitor progress against the actions listed in the plan, and the group will also identify areas for further action and collaboration.

[Damian Hinds]

I welcome the priority put on young people’s mental health, which is perhaps more important now than ever. Will the Minister give an update on progress on implementing the proposals in the children and young people’s mental health Green Paper, particularly on mental health support teams in Hampshire and nationwide?

[Ms Dorries]

We are making good progress on implementing the Green Paper proposals, and I am pleased to say that we have established 11 mental health support teams in Hampshire. Nationwide, there are currently 180 mental health support teams, covering around 15% of pupils in England. Over 200 more are in training or being commissioned, and we expect to have around 400 in place by 2023-24, covering 35% of pupils. We recently announced £9.5 million to train thousands of senior mental health leads among school and college staff.

[Lloyd Russell-Moyle]

Last year, in my NHS trust 37% of children referred to mental health services were turned away. That was up from 28% the year before. That is 2,649 children not getting treatment despite referrals from professionals. That will be exacerbated, of course, by the acute children’s mental health unit at Ticehurst being shut and no new hospital provision commissioned.

It is not just Sussex Partnership NHS Foundation Trust that is failing; it is services across the country. In 2019, 140,000 children were turned away from child and adolescent mental health services, and some experience exceptionally long waits. Is the Minister comfortable with these huge numbers of children being turned away from treatment? Does she think that these waiting times are acceptable? What message does she have for those children and families who do not receive the treatment that they desperately need?

[Ms Dorries]

The short answer to that question is no, and that is why we have committed an additional £500 million to address some of the issues that the hon. Gentleman highlights. However, I must reiterate that the majority of our targets, where they have been set, are being met. Sadly, in eating disorders—I hold my hands up—we are not meeting the targets that we want to, but as he may be aware, we are trialling four-week waiting targets for children and young people. The results of that review and pilot will be available soon.

We continue to look at ways in which we can increase access to services for children and young people. Children and young people have told me themselves, via organisations such as Barnardo’s, that they want their mental health services delivered in a different way. They do not want to go and sit in a village hall or a hospital, or wherever they may receive their services from community practitioners; they want some of their services delivered via their phones, laptops or computers. Obviously, one-to-one services have to be available where they are needed, but children and young people are demanding a change, and we are going through that change now.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

My hon. Friend the Member for Brighton, Kemptown (Lloyd Russell-Moyle) raises a very important point and, frankly, I am shocked that the Minister seems so relaxed about it. Across the country, there are numerous children who have waited more than 400 days for help with autism; 280 days for post-traumatic stress disorder; 217 days for suicidal ideation; 195 days for treatment after an overdose—I could go on and on. Children should not have to wait so long for treatment. That will have a scarring impact on their development. These waiting times simply are not acceptable, so will the Minister apologise to these children, and can she explain where it went so wrong?

[Ms Dorries]

I do not believe that meeting almost all our targets for NHS waiting times for mental health services, with £2.3 billion a year of investment into our NHS and no NHS mental health service closing during the entire pandemic, has been a failure. Of course I am sorry for those children and young people who cannot get access to services as quickly as they want; that is exactly why we committed an additional £500 million and established a mental health recovery plan: so that we can put community services in place to reach those who have been impacted most by the pandemic over the past 15 months. We have a long-term plan in place, with the investment that the NHS tells us that that long-term plan needs to provide the very services that we want to provide. The mental health of children and young people is this Government’s priority. We will continue to invest, and are proving to continue to invest, to make sure that those children and young people access the services they need.

[Robert Largan (High Peak) (Con)]

What steps his Department is taking to support the full restoration of GP services as part of the covid-19 recovery.

--- Later in debate ---

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

What steps the Office for Health Promotion plans to take to promote mindfulness in supporting good health.

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

Work on the scope and organisation design of the Office for Health Promotion is ongoing. We will present more detail on our plans for the OHP in due course. Public Health England’s “Better Health—Every Mind Matters” social marketing campaign aims to inform and equip the public to look after their mental health. Its NHS-endorsed website offers guidance on the actions that people can take to improve their mental wellbeing, including by practising mindfulness and reflection.

[Margaret Ferrier [V]]

Research shows that mindfulness training can contribute to improvements in obesity, eating behaviours, addiction and mental health and wellbeing. Will the Minister ensure that the Office for Health Promotion looks at the evidence of how mindfulness can help with how we all manage our health?

[Ms Dorries]

There is emerging evidence on the mental health benefits of mindfulness, which can take the form of meditation or wider approaches that incorporate a mindful approach. As the hon. Lady may be aware, I have been particularly concerned that we separate out mental illness and wellbeing and mindfulness. We should focus on mental illness, which needs intense clinical intervention in NHS services, but also look at mindfulness and wellbeing. That is why I mentioned “Every Mind Matters”: the facilities are there.

[Mr Laurence Robertson (Tewkesbury) (Con)]

What steps he is taking to increase the range of work carried out by pharmacies.

Injectable Vitamin B12

Nadine Dorries Excerpts

Wednesday 26th May 2021 Westminster Hall

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

It is a huge pleasure to serve under your chairmanship, Dr Huq, for what I think is the first time. I remember chairing a debate when you were an MP speaking, so the tables have turned. I thank my hon. Friend for bringing forward the debate. She raised many points in her speech, and we have only 15 minutes, so to do them justice in detail I will ask my officials, who are listening in, to provide a detailed answer to each of her questions.

I will speak about something that I have not prepared for, but I will use this time because it is so important and because my hon. Friend said something in her speech that made me think about something else. First, I thank your constituent Tracey Witty, and your constituents and other women who suffer from B12 deficiency. Every time you spoke about an individual case, you mentioned a woman; you did not once mention a man. I furiously fired off a few questions while you were speaking, and it is true that more women suffer from pernicious anaemia and vitamin B12 deficiency than men. That leads me to the women’s health strategy.

On 18 March, we launched a call for evidence for women to tell us about the problems they have in accessing healthcare services. I hope Tracey is listening, but if not, I hope you will get this back to her. Tracey will have a network of contacts of women suffering with this issue and, for it to be addressed, we need to hear those women’s stories. There is a simple link to the women’s health strategy on gov.uk, and it will take three to four minutes to complete a response on a phone or iPad.

It is so much less difficult—rather than easier—to change policy if you have the evidence. The default in health is male and I am afraid that it is very difficult to get change for many conditions that affect women. To cite an example, the response by Dame Sally Davies is from, I think, three or possibly four years ago and there has still been no major change. NICE will come forward with recommendations, but that may not be for another 12 or 18 months. It is not fast enough. My point is that that is because it is women, and women’s voices are just not listened to. I am trying to change that. I am trying to put women at the heart of health strategy and health policy.

I am sorry to use a few minutes of my response to get this point over but, as well as you raising this issue here, which is vital, Tracey could have a massive impact if she and the women she knows use the forums and platforms she is aware of to post the link to ensure that women are aware and can respond to the women’s strategy call for evidence. It is vital that my hon. Friend is here raising this on behalf of Tracey, but if we could have hundreds or possibly thousands of women responding, that would be incredibly powerful, because that would give us evidence—data. It would be not one constituent of yours putting a story forward; it would be lots of them.

[Dr Rupa Huq (in the Chair)]

Order. Minister, you will remember the thing about saying “you”—you used to say it—and you have done it a few times. Dame Eleanor Laing, who is our boss nowadays, is quite hard on it and said, “Don’t let anyone get away with it.” I let you do it a few times, but if you can use “my hon. Friend”, that is better.

[Ms Dorries]

When I was in Chair, I told people off all the time for exactly the same reason. I am absolutely sure that because we had a big gap with no debates over covid, I have slipped back into a habit I had prior to becoming an MP 20, 16 or 15 years ago, or whenever it was. I apologise.

[Dr Rupa Huq (in the Chair)]

You don’t look that old!

[Ms Dorries]

Well, I am, I can assure you.

To finish my point, if my hon. Friend could ensure that her constituent responds to the call for evidence, that would absolutely be more powerful and useful than anything I have to say in my response to her speech. We will respond to her points in detail.

I will address some points made by my hon. Friend. She asked specifically about making B12 injections available to purchase from pharmacies. As she said, the MHRA is the body responsible for medicines licensing in the United Kingdom, and it is committed to making more medicines available over the counter, so I think we would be pushing at an already open door. The MHRA is committed to doing that where it is safe to do so, as an important element of the self-care agenda to empower patients.

My hon. Friend mentioned the role of pharmacists. We have seen them step up during the covid pandemic and the vaccination programme. That was an incredibly important point. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), whose portfolio includes pharmacy, is constantly looking at ways to increase and enhance the role of pharmacists, and this could be a useful way of doing so.

I used to be a nurse and gave vitamin B12 injections years ago. I was trying to rack my brains, but do not remember ever having given one to a man, but I am sure that I did, because men suffer from such symptoms, too. It is a really interesting phenomenon and, with a bit of imagination, working with clinicians and harnessing the expertise and knowledge of pharmacists, we could find a new way of doing this.

The MHRA has an established process and procedure for moving medicines from prescription-only status to over the counter, which I will refer to as OTC, when it safe to do so. An OTC is a medicine that is not likely to present a direct or indirect danger to human health, even when used incorrectly, if used without the supervision of a doctor; or is not frequently and to a very wide extent used incorrectly, and as a result is not likely to present a direct or indirect danger to human health; or does not contain substances or preparations—there is an entire list, which we will include in the letter to my hon. Friend.

To date, the legal classification of all currently authorised medicines for injection, including vitamin B12, is prescription only. Other factors support that position, in addition to the fact that the product is injectable. The main reason why it would not be a suitable candidate for reclassification under existing guidelines is that the product is considered to meet the prescription-only medicines requirements, as set out in legislation.

Pernicious anaemia, or any other cause of vitamin B12 deficiency, cannot be self-diagnosed and requires the expertise of a medical doctor. Contrary to my hon. Friend’s remarks NICE guidance also states that when a patient presents with the signs and symptoms of pernicious anaemia, they should undergo a full blood count as part of the diagnostic process.

We are also aware that there is a high risk of off-label use by patients. She mentioned that private clinics are injecting for wellness. That is currently authorised for use only in maintenance therapy for pernicious anaemia every two to three months, depending on the type of pernicious anaemia. Anecdotally, we hear that patients consider that a more frequent administration of the medicine would be appropriate to their particular clinical symptoms. Any reclassification of the medicine would not change either the dose or the frequency of the treatment set out in the terms of the product’s marketing authorisation.

I am also led to believe that the evidence of lifestyle abuse of unlicensed formulations of B12, which, although not necessarily relevant to the patient group including Tracey and others whom my hon. Friend mentioned, is also taken into account in determining the legal classification of the medicine. That is an issue that has to be considered: there are people who would abuse those formulations.

Just because there is a particular group that would over-use and abuse the availability, we should say that we are not going to look at this. Although that is not in my speech, and it has not been advised to me, I am making that point. We should not use that as a reason to say, “We don’t go there”. This affects more women than men—I do not apologise for banging on about that point—and therefore we should be pushing those barriers back as part of the women’s health strategy and looking at different ways to deal with it.

Taken together, these issues mean that the criteria for prescription-only medicine have been reached, and changing the classification would therefore not be appropriate—but that part of the information that I have been given needs to be challenged. We need to ask, “Why not?” It is vital that we get the evidence back from the network to the forums that Tracey knows. I note that this issue has been before Health Ministers in recent times, and as I mentioned, Dame Sally Davies, our previous chief medical officer, did engage with the medical royal colleges to raise awareness of the condition. However, it has taken too long—I think Dame Sally retired three years ago.

Following on from that interaction, NICE has worked to develop and publish an updated clinical knowledge summary on pernicious anaemia, which sets out clinical guidance on diagnosis, treatment and management of the condition that should be followed by general practice physicians and others responsible for the care of patients who suffer from this condition. The updated guidance was published in July 2020, and it should now be a regular part of clinical interventions in general practice and secondary care.

I would be interested to know what Tracey’s experience of that is, and whether she believes that the guidance has been implemented, particularly based on the experience of other women that she has been speaking to on these forums. Has it been implemented? Are GPs aware of it? If those women could let us know those answers in their responses to the women’s health strategy, that would be incredibly important. It is also important to evaluate the impact that this guidance has had on the clinical management of pernicious anaemia before considering further regulatory options. NICE usually produces guidelines as quickly as possible—it is an amazing organisation that does very good work—but we need to move a little bit faster on this and other women-related issues.

As for my hon. Friend’s question about private injections of B12, as I said, there are two separate types. Licensed products must be administered by prescription and by a suitably qualified healthcare professional, so that is where we are at the moment. It is important to note that private clinics are not providing the same injectables to clients as GPs are; they are providing injectable vitamin B12 products that are not licensed medicines for general health and wellness purposes. Of course, if clinics make medicinal claims for unlicensed vitamin B12 products that they offer, the MHRA would take action. Also, when classifying products, the MHRA are bound by case law to consider products on a case-by-case basis and cannot automatically classify all vitamin B products as medicine, so they do not all meet the criteria to be classified as licensed medicines. That is another important point.

In closing, I thank my hon. Friend for continuing to raise this important issue on behalf of her constituents and everyone affected by the condition. We will continue to work with and support the NHS and NICE—which are actively engaged with this issue— and clinicians to understand the importance of B12 deficiency and guarantee that patients are receiving the best possible care. I think the women’s health strategy will really help with that and will possibly be the boost we need to move this forward through the evidence we can gather.

I will finish on that point, because Tracey and the others who use the same platforms, my hon. Friend, and others who complete the women’s health strategy could give us important evidence that we need to enable us to push forward. I am not saying that means we do not know what policies we are going to develop from the women’s health strategy, but if enough women respond and say that this is an issue, that gives them a voice and it gives us a lever to pull. However, one of the biggest issues here is the time it has taken to bring about change. The guidelines have gone in; I would be interested to know how they have bedded in, and whether people such as those on Tracey’s forums think they are being used and have led to any benefit. We would also be interested to hear what the problems are with prescribing, and the issues that they have with administration.

Question put and agreed to.