HIV Prevention

Nigel Evans Excerpts

Thursday 12th March 2015 Commons Chamber

[Mike Freer]

The right hon. Gentleman makes a good point. If he bears with me for just a minute, he might find that I am in agreement.

We have to accept that many teenagers will become sexually active, yet sex and relationship education—SRE—remains poor. The National Aids Trust recently published a report showing that in SRE there is little teaching about, among other things, same-sex awareness or HIV transmission. Teachers can be nervous of sex education full stop, let alone same-sex issues, sexual health or, in particular, HIV. That is compounded when schools struggle with homophobic bullying, which can contribute to teenagers feeling uncomfortable about seeking advice or information about their attractions or about having a safe sexual relationship when the time comes.

[Mr Nigel Evans (Ribble Valley) (Con)]

Is my hon. Friend as alarmed as I am by recent newspaper reports in which it appears that an increasing number of youngsters are being bullied or harassed at school for being gay, and in some cases even being taunted by teachers? Surely there has to be a completely different attitude in the 21st-century UK.

[Mike Freer]

My hon. Friend makes a very good point, and I agree entirely. In the Department for Education—I apologise to my hon. Friend the Minister for straying away from health, but this is a cross-Government issue—work has been done to fund teacher training on dealing with homophobic bullying, but we need to go one step further and make it integral to teacher training, not an add-on paid for by schools and local education authorities. One of the problems is that if gay men or men who declare as MSM are bullied for showing any form of attraction to other men, for seeking advice or for showing that inclination in any shape or form, they will simply not seek that information. In school they may be afraid of being bullied, whether by other schoolchildren, teachers or other members of staff. They will close down and withdraw, and as a result they might make ill-informed decisions about their sex lives.

In my view, therefore, it is time for SRE to be made compulsory and inclusive. I appreciate that that is not the view of my colleagues in the Department for Education, but I think that they are wrong and that they need to reassess that. We are talking about people’s health and future relationships, so this is too important to get hung up about the ideology of compulsion.

There is also the issue of new technology. When I was at school, in the dim and distant past, sex education was skirted around and pupils, if they were lucky, were given a rather dusty old book with some rather dodgy drawings—clearly that did not teach me very much. Today, teenagers have access to technology. They are accessing sex differently, and accessing information differently, so we need to educate and inform differently. The increasing use of dating apps—I use the term loosely —means that increasing numbers of teenagers are finding sexual partners through their phones. Are colleagues in Government and in health authorities nimble enough in using that technology effectively to ensure that appropriate sexual health messages are there too? Are we constantly playing catch-up, or can we innovate too? How can we intervene differently to support those who are HIV-positive? I said that we need to start with education and that we need to use technology, but when people present as HIV-positive, how can we intervene differently?

It is true that new anti-retroviral drug treatments—ARVs—have transformed the lives of those who are HIV-positive, and they help most people to live near-normal lives, but it is still a life-changing diagnosis. ARVs have to be taken every day for the rest of the person’s life. Relationships can be harder to find and to maintain because potential partners often reject someone who is HIV-positive. Despite anti-discrimination laws, few employees volunteer their HIV-positive status. To my knowledge, only one Member in the history of this House has ever declared his HIV-positive status. That former Member is now in another place. People will not volunteer their HIV-positive status for fear of discrimination—not just overt discrimination but the subtle passing over for promotions or snide comments in the workplace. Then there is the fear of shunning or harassment by co-workers. Despite all the work over the years, some people still believe that HIV can be transmitted through saliva or through sharing crockery and cutlery— 30 years after a major education programme.

All these factors combine such that the human cost of HIV-positive status can be significant. Despite the medical breakthroughs and ARVs, the costs of depression, isolation and the fear of being open remain. We still have work to do to ensure that health education is provided in the workplace, and not just in health education teaching or clinics. The impact on mental health is often missed by health services and sexual health clinics. Sexual health clinics should be more about general well-being and not just sexual health. It should not just be about treating a symptom. If someone goes in with gonorrhoea and comes out with a pill, it is “Job done” for many clinics, but what if they are treating someone who is presenting as HIV-positive? What is the back-up? What about their mental health? Are we providing that total well-being package?

I mentioned chemsex, where men use drugs that enhance sexual performance combined with drugs such as crystal, methedrone or GHB. This can lead to reduced sexual inhibitions and so increased risk-taking. I understand that someone presenting at a sexual health clinic who has chemsex is more likely to have broad sexual issues, and the clinic will deal only with those issues, while the drug-related issues will often be subject to referral to a drug treatment facility. That is often a separate facility and the referral may take six, eight, 10 or 12 weeks, during which time the person who has been interested in seeking treatment falls through the cracks. The separation of treatments, particularly for those involved in chemsex, not only breaks the treatment plan but increases the chance that the patient will not take up the treatment referral, and so behaviours are not changed.

Only this week I had the chance to visit 56 Dean Street and Dean Street Express in Soho. They are absolutely stunning facilities that look nothing like what we imagine the NHS to look like. It was not clinical and there was no plastic seating—it looked for all the world like an attractive boutique hotel. Dean Street Express has harnessed technology. Rather than someone having to go into a clinic, stand at a counter and announce to the world why they are there, or having to sit in an open waiting room, with everyone looking sheepish because they may recognise somebody else, they can book in using technology. They can also swab themselves, and then use the technology. That is the way forward if we are to make the system friendly and receptive, to innovate and to make it worth while and easy for people to seek help and treatment. Most importantly, it provides help on total well-being, not just sexual health. In my view, the Department of Heath should look at rolling out that innovative technique.

I have mentioned the black African community. It is a difficult community to reach, and I do not have any answers, but we need to work harder to reach it, whatever the method—perhaps through its community groups or churches—both to educate and to support those who disclose themselves as MSM or those who are afraid of doing so for fear that their own community will reject them.

We have to accept that people will make poor choices and have unprotected sex, which leads me on to intervention. I pay tribute to the PROUD report. Its initial studies show that post-exposure prophylaxis and pre-exposure prophylaxis—treatments taken immediately after suspected exposure to HIV or as a preventive measure—work. The initial findings show that they are cost-effective approaches to the prevention of transmission, or at least to ensuring that infection rates drop dramatically.

I accept the fact that the use of PEP and PrEP has cost implications. I understand that PrEP costs up to £6,000 a year, but we should compare that with cost of treating someone who is HIV-positive. The lifetime cost of treatment for a person with HIV is between £250,000 and £330,000 a year, so a £6,000 investment could save between a quarter and a third of a million pounds a year.

I have outlined some of the human and financial reasons for understanding what is driving up infection rates, and the action we could take. That brings me to my last point, which is that we need to increase testing. We need to make it easier and less clinical so that people do not fear that it means always having to go into clinics. A clinic is not a friendly—to overuse the pun—environment.

If clinics are used, they should at least make routine tests for HIV across the board so that people who are HIV-positive can have early intervention. Early diagnosis and early treatment dramatically improve the lives of individuals and reduce transmission rates. Let us remember that 25% of those who are HIV-positive do not know it. Easier and faster testing will help to reduce the number of transmissions and new infections. That should include the roll-out of home testing, because it must be right to make testing accessible and easy.

We often shy away from talking about sex, and we certainly find it uncomfortable to learn about sexual practices outside our own experience. Yet if we are to tackle the issues, we have to deal with the problems that exist and with the world as it is, not as we might like it to be. That is why I call on my hon. Friend the Minister to explain how we can redouble our efforts to educate and innovate in HIV prevention.

NHS Mental Health Care

Nigel Evans Excerpts

Wednesday 11th February 2015 Westminster Hall

[Mr Hancock]

I am sorry. I was quoting the Minister, Mr Chairman. He stated that 25% of young people with mental health problems had access to mental health services, which he described as both “dysfunctional and fragmented”. That cannot persist. That cannot be right in a society that claims to care and aims to try to deliver services that are perfect for it. There are serious problems with mental health services and the way in which young people are treated. So many of them have ended up in prison, because there are simply no beds available.

If I may, I will talk about my own experiences. I was very fortunate. I will praise my own GP, Dr Chhabda, who was excellent and got me help. I have praise for Talking Change, where I had several sessions, and for Dr Barker and his intermediate crisis team at St James’s hospital. They were of enormous benefit to me. Subsequently, I was under the care of Simon Kelly, the psychiatrist who looked after me when I was in hospital for a long time.

What did I learn during that long period of mental illness? I learned about the stigma. When I was in hospital for several weeks with major heart surgery, the problem was obvious to people—I did not worry about telling them that I had had major heart surgery—but for the last two months of my being in hospital getting over a mental breakdown, I was worried about how I would explain to people where I had been. I was making myself ill with the worry of how I would explain to people that I, this strong person who could fight off most things, was suddenly unable to do so and had to seek help.

But I was not alone. The other people, who have become close friends of mine, were going through the same thing: the GP who did not know how he was going to go back to face his patients, and the dentist who did not know how he was going to work things out. Many other people, from different professions and none, were struggling with the reality of going home to face their immediate families with what had gone wrong with them, and there was little or no help coming from outside the hospital to give them the support that they needed.

In the rest of the time that I have in politics, and in the rest of the time that I am alive, I want to fight to lift once and for all the stigma attached to mental health issues and be proud to say that I was broken but I got fixed, because of the love and skill of the people who were there to help me.

Some of the people whom I met in hospital had travelled long distances. One was from the Minister’s own constituency in Norfolk. There was not a single bed available, from the coast of the North sea, where this person lived, to the waters of Southampton, where a place was available. That was the nearest place. They were transported down there and eventually transported back.

Other people I met in the hospital came from Truro. They had been brought from the furthest edge of our country to the edge of Southampton, because no bed was available. Ironically, when they arrived at the hospital, they came in an ambulance with a driver plus two nurses, and they stayed for four days. Then they were transported all the way back to Exeter, because a bed became available nearer there.

What sort of society are we living in? Somebody at the lowest ebb of their life is transported across the country, away from their family and support networks, because there are no beds available. The way in which people are treated is a national disgrace. We could see in the faces of the people that they knew it would not be possible for their families to come and visit them, because of the enormous distances involved. We have got to do something about that. We cannot allow that situation to persist.

There is the situation of somebody whom the NHS sends into a hospital for a detox programme. They are given a six-day detox programme, probably costing several thousand pounds, and then, on a Friday night, they are told that they have to go 50 miles up the road to spend two nights in a Premier Inn, with no support available over the weekend to help them. For anybody going on a full-time detox programme, the minimum time is 28 days. The NHS will spend a lot of money several times, but limit it to six days and then give the person little or no support when they are out. That cannot be right. No Government should be proud of the record that we have on mental health issues.

[Mr Nigel Evans (Ribble Valley) (Con)]

I am pleased to stand alongside my hon. Friend and I congratulate him on the debate that he has secured today. Mental health is one of the Cinderella conditions that people tend not to want to talk about, because of the stigma that my hon. Friend talked about earlier on. If someone has a broken leg, it is fine, but if someone’s mind is broken or there is a mental health issue, nobody wants to talk about it. It is easier to sweep it under the carpet.

Will the Minister understand that we really need to get to a situation in which the stigma is no longer there? All we need to do is to give people the help that they need—and, indeed, the hope that they need—as if they had a broken leg or a broken arm, so that they can get back to normal living.

[Mr Hancock]

I agree entirely. We lucky ones who are privileged and proud to be in this House of Commons must use whatever elements are available to us, whether in speeches here or outside this House, to do more to expose this issue.

I was fortunate because the people I was in contact with were able to put me through a series of different things. They saved my life—I have no doubt whatever about that. I could not stand my life any more and, like so many people, I realised that far too late. I had probably left it six months too late, and because of that my recovery took much longer.

There are others outside the system—people and organisations that try to help. They include Talking Change, which is in my constituency. However, I say to the Minister—through you, Mr Pritchard—that the crisis care service is at breaking point. Services are understaffed and under-resourced; they are overstretched. As for talking therapies, which a lot of people mention and which I have heard the Minister himself praise in the past, 40% of the people who want to use them have to wait more than three months just for an assessment, and that assessment is normally carried out on the telephone. I urge the Minister to try that interview over the telephone. Then, if they are lucky, they will receive some treatment, but one in 10 people wait more than a year to get even the chance to talk about the problems that have driven them to the edge of the abyss, so that they are living in total despair. In addition, a third of the people who are assessed have to wait more than three months to start the therapy.

I ask this Government and whoever is in power after 7 May to really mean what they say about mental health services. There is a crying need for that. When I heard the Deputy Prime Minister talk about mental health services, I thought, “Oh! Maybe we’ll get somewhere and something might happen.” I live in hope, but my experience—having looked into this issue in quite some detail—tells me that the same promises have been made many times during the past 20 years.

I was someone who felt that he could tough out most things, but in the end I had to succumb to the stress and strain I was under, to such an extent that I had no alternative but to seek real help. However, there are literally thousands of people out there who are affected. A quarter of the population of this country will come into contact with mental health problems at some time during their life. Unfortunately, so many of them are disappointed by what they get in the way of treatment from the NHS.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

Thank you very much indeed, Mr Pritchard, for calling me to speak. It is good to serve under your chairmanship.

I congratulate my hon. Friend the Member for Portsmouth South (Mr Hancock) on securing this debate; I know that he has been trying to secure such a debate for some time. I particularly congratulate him for speaking out about his own mental ill health, because it is at the heart of changing attitudes and addressing the stigma that he and other hon. Members have talked about that people who have been successful in life should speak out and explain that they themselves have suffered mental ill health. Every time someone speaks out about their own mental ill health, that makes it easier for a youngster to be open about their own issues and seek help. That is the critical change that is needed, so that mental health comes out of the shadows and we lose the embarrassment about discussing it.

I commend to hon. Members the brilliant campaign, Time to Change, which this Government have funded, along with Comic Relief. It is all about tackling stigma. Interestingly, attitudes are changing. They are being measured on a regular basis and the dial is moving; people feel more able to talk about their mental ill health.

[Mr Nigel Evans]

I am extremely grateful to the Minister for what he has just said. When I was 27, I had depression for a year. I did not know where I was; I did not know whether I was going to come through it. It was awful. I received support from a lot of people who loved me and who got me through that particular period. Then I became an MP and eventually Deputy Speaker of the House of Commons.

The one thing that we must give people is hope, and I hope that the Minister’s response to this debate will be one not only of understanding—he has already expressed that—but of hope for people out there and their families, who look on, feel dejected and want support.

[Norman Lamb]

I totally agree. I hope to be able to convey some sense of optimism, actually, because, despite all the challenges that my hon. Friend the Member for Portsmouth South referred to, there are very some exciting things happening, which are laying the foundations for genuine equality for mental health. We have legislated in this Parliament for parity of esteem, but to be honest I am not interested in empty rhetoric—our words must mean something for people in need of help.

My hon. Friend referred to many aspects of the system that need to improve significantly. I will deal briefly with one—the issue of beds. We must be a bit nuanced here. It is absolutely clear that when there is a moment of crisis a bed must be available, and available locally. Incidentally, we should also look at places such as recovery houses. Increasingly, there are lots of third sector organisations that provide recovery houses around the country and it is often better for people to go into a place such as that than to be an in-patient admission, which might not be the best thing therapeutically for them. But the idea that in a middle of a crisis someone is shunted somewhere else in the country, or even put into a police cell, is really an outrage in a civilised society.

The interesting thing is that when I came into this job I realised more and more that I was operating in a fog. The data that we are absolutely used to when it comes to physical health, and the scrutiny of that data and evidence, have simply been lacking when it comes to mental health. Traditionally, we have not collected the information about access to services and what is happening to people on the ground, and that has been a fundamental issue that I have sought to address.

On out-of-area placements, I had no idea from the data that came to me about what actually happens around the country. Last week, we finally got the first sight of real data, which will now be provided on a regular basis, so that we can hold trusts to account if they fail to meet local need. The fascinating thing is that there are many trusts around the country that have no out-of-area placements at all under existing financial circumstances, while there are others that completely fail and are sending many people out of area. We need to understand why that is happening and address the causes, whether they are in commissioning, in the provider organisation or because of lack of funds, because some areas have demonstrated that that is not necessary.

Ebola

Nigel Evans Excerpts

Monday 13th October 2014 Commons Chamber

[Mr Hunt]

The hon. Lady speaks extremely wisely and there is cross-party agreement on that matter. That shows why it is so wrong to make an artificial division between helping people abroad and helping people at home. I think we have a moral responsibility to help people in the poorest countries abroad in any case, but in my time in this House there has been no better example than this one of how doing so is in the interests of people in the UK, too. It helps to make us more secure, and we can be incredibly proud of the work we are doing as a result.

[Mr Nigel Evans (Ribble Valley) (Con)]

The Secretary of State has spoken about multiple points of entry, and major connection points are via Schiphol, Charles de Gaulle, Madrid and Frankfurt. Has he spoken to his opposite numbers in those countries to see whether they are following the best practice that is being rolled out in the United Kingdom? Will he ensure that those who are manning the points of entry in the UK have the ability to deal with children, because if a parent is detected with symptoms, their children will have to be properly looked after?

Oral Answers to Questions

Nigel Evans Excerpts

Tuesday 10th June 2014 Commons Chamber

[Mr Hunt]

I thank the right hon. Gentleman for that question. He is absolutely right to suggest that the lessons of Francis need to be applied to the care home sector, to general practice and to all out-of-hospital care every bit as much as they are applied to NHS hospitals. That is why we have legislated in the Care Act 2014 not only for a chief inspector of general practice but for a chief inspector of adult social care, Andrea Sutcliffe, who has made an excellent start. She is going around all the care homes, and she is bringing back the rigorous Ofsted-style analysis that was unfortunately taken away by the last Government. That will mean that we have proper transparency in standards. Going back to an earlier question from my hon. Friend the Member for Lichfield (Michael Fabricant), we also need to do more to help whistleblowers working in care homes. Because there are so many care homes, we cannot depend solely on the inspectors to get this right. We have also introduced the ability to prosecute offenders, which did not exist before.

[Mr Nigel Evans (Ribble Valley) (Con)]

T3. The fears of the people of the Ribble valley that the old Clitheroe hospital would be closed and not replaced were allayed when the new hospital was built. It recently opened with 32 in-patient beds, radiology, diagnostics and other facilities. Will the Secretary of State come to Clitheroe to have a look at this brand-spanking-new hospital, which is being welcomed by the local community, and to say thank you to the staff there for all they do? If he does so, I promise to take him for a pint of healthy real ale afterwards in the Campaign for Real Ale pub of the year in Pendleton in the Ribble valley, to celebrate the opening of the new hospital.

[Mr Speaker]

What a generous fellow the hon. Gentleman is!

Tobacco Packaging

Nigel Evans Excerpts

Thursday 7th November 2013 Commons Chamber

[Mr Nigel Evans (Ribble Valley) (Ind)]

It is a delight to take part in this important debate, and I declare my interest in the register. Although I no longer own a convenience store in Swansea, I suspect over my lifetime I have sold more cigarettes than everybody in the House has consumed.

I see this as a non-partisan issue. It should be evidence-based. We are talking about treating the sale of a legal commodity completely differently from the sale of any other commodity, and before going down that route, we should ensure that our decisions are properly evidence-based.

I do not smoke, apart from the odd cigar—it is just the odd one—but I am cognisant of the fact that there are over 12 million smokers in this country. The vast majority of them are adults and this is all about individual choice and liberty. The hon. Member for North Antrim (Ian Paisley) made an important point when he said he believes we are going in the direction of possibly banning cigarettes and tobacco completely, and we should be more honest about that. If these products have the consequences that were described by the hon. Member for Stockton North (Alex Cunningham) and my hon. Friend the Member for Harrow East (Bob Blackman), that is perhaps the direction in which we will be going. My hon. Friend spoke emotionally about the loss of his parents through cancer. I lost my own dad through cancer as well, and it is hideous seeing loved ones dying in that way.

My father switched brands. He used to smoke Senior Service, then Player’s, and I even think he toyed with Capstan Full Strength at one stage, and as he was dying he switched to Silk Cut—but all far too late, of course. The fact is that anybody who has seen someone die of cancer knows it is hideous.

As has been said, we need education. People must be properly educated about the damaging effects of smoking, and the damaging effects it can have over a lifetime.

I think it is right that we should wait for the evidence from Australia and any other countries that are about to embark down the route of standardised packaging. I know there are World Trade Organisation issues and European Union issues and these will all be dealt with in the right arenas. The EU is looking at standardising 65% of the packaging as far as the health warnings are concerned and making the sale of packs of 10 illegal.

There have been a number of changes to smoking laws in this country, including the banning of smoking in public places. Indeed, we have the Smoking Room in this Parliament where nobody is allowed to smoke, and I have always joked with friends when they leave the pub to have a quick cigarette outside that, given the cold winters in the United Kingdom, pneumonia will become a smoking-related disease. We have brought in these rules, however, and in many cases they are sensible.

It has always struck me that there was a very good argument against banning tobacco advertising. Advertising is influential and therefore important, of course, and it was always the advert at the bottom of the advert that I found most important. The advertisers could put anything on top—“the fat lady sings” adverts, or the Marlboro ones which we had to look at very carefully to work out whether they were advertising cigarettes or something else—but it was the advert below, which was the health warning saying “Smoking kills”, which was always more persuasive to me than anything else displayed.

[Mr Nuttall]

Does my hon. Friend share my concern that if branding is banned, tobacco companies may use the money they currently spend on branding to cut the price of cigarettes?

[Mr Evans]

That is exactly what is going to happen, and I think one hon. Member intervened to say that that is part of the evidence from Australia. A lot of people like brands, such as Benson & Hedges or Regal, but others will go for the own-brand—whatever is cheaper. If it is £1 cheaper than the more expensive brands, that is what they will go for. Some people, I swear, will smoke the dust off the floor if it is sold at £1 cheaper than a branded pack. The point my hon. Friend raises therefore has got to be looked at as a possibly unintended consequence of bringing in standardised packaging.

I visited Clitheroe grammar school a few months ago and the issue of why the Government have delayed introducing standardised packaging was mentioned. I thought about it for a while and then I said to the pupil concerned, “Right: how much cannabis and ecstasy is consumed in the UK?” The pupil said, “Oh, quite a lot,” to which I said, “I think you’re probably right. Do us a favour: describe to me the packaging on cannabis or ecstasy.”

I ask Members to think about that for a second. What is the packaging for cannabis or ecstasy? There is no packaging. They come in foil or see-through bags, or in an envelope, perhaps. Clearly, people are not buying these products because of the packaging, standardised or otherwise. They buy them because they want them. That is a strong counter-argument to the proposal to get rid of branding.

[Mr Kevin Barron (Rother Valley) (Lab)]

Surely the answer to the question is that if those things were legal, health warnings would be on them, and quite right, too.

[Mr Evans]

Certainly there is no health warning on cannabis and ecstasy, and we know they kill a lot of people.

[Jake Berry]

Surely if making something illegal stops people consuming it, the fact that it is illegal for those under 18 to buy cigarettes would already stop any children taking up smoking.

[Mr Evans]

We know that is not an effective law, but that does not mean we should not have that law.

I believe we ought to look at education for young people. I do not want to see young people taking up cigarettes or any tobacco products at all. Doing more in the schools is vitally important, as is doing more through public health education campaigns. Will the Minister tell us what plans the Government have to roll out health campaigns particularly aimed at young people, to discourage them from starting to consume tobacco products?

I believe we should wait until we get the proper evidence from Australia and other countries about the impact of standardised packaging. Once we have the evidence, it will be appropriate to decide whether or not to introduce standardised packaging. As I said at the outset, tobacco would be the only product sold in the UK where the state entirely governed the packaging. Before we go down that slippery slope, which may be extended to other products in the future, we should make absolutely certain we have the science and evidence to back up the decision.

Accountability and Transparency in the NHS

Nigel Evans Excerpts

Thursday 14th March 2013 Commons Chamber

[Mr Cash]

rose—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Please resume your seat, Mr Cash.

--- Later in debate ---

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Eight Members are trying to catch my eye and we will finish at 5 o’clock, with Charlotte Leslie having the last two minutes. In order to accommodate everybody, as well as interventions, the time limit is now five minutes.

--- Later in debate ---

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I am encouraged by the speech from my hon. Friend the Member for South West Bedfordshire (Andrew Selous) because it shows that accountability is not just about supervising organisations, regulators, targets, safeguards, mechanical things and statistics. Accountability is about creatively getting the intelligence into the system about what is happening and reacting to it positively, welcoming it and generating the complaints so that more intelligence comes into the system. That is the kind of accountability we want.

As Chairman of the Public Administration Committee, I feel I can add a new dimension to the debate because of what we are thinking about in our inquiry on the future of the civil service. We need to ask ourselves, “What does accountability feel like?” We think we know what accountability feels like, but my goodness, it goes up and down a bit. During the previous Parliament we felt very accountable in some periods, every single one of us. What do we want accountability to feel like in the health service? With the greatest respect to my hon. Friend the Member for Wycombe (Steve Baker), the lawyers must be the last resort. We do not want accountability to be about finger-pointing, blame and holding people to account. Indeed, that is part of the disease that afflicts the health service. We want accountability to be about nursing staff on the ward feeling accountable to each other for sharing information, accountable to the patients and welcoming the information they receive from them, and accountable to their managers and holding them accountable for what they do not feel is being done, in an atmosphere of trust and co-operation.

What is chilling about the Mid Staffordshire story is the question of what accountability felt like in that hospital at that time? To whom did people feel they were accountable. What did they feel they were accountable for? There must have been almost an atmosphere of “Apocalypse Now” in the hospital, in which nobody knew where to turn.

In the evidence we are receiving about the civil service, we have had powerful testimony from an adviser to our Committee, Professor Andrew Kakabadse of Cranfield university, who rather chillingly points out an obvious truth. Very few people who work in a failing organisation do not know that it is failing. Most people in a failing organisation know that it is failing. What is wrong? The answer is that they do not know how to talk about it. They do not know what to say, who to tell—or, if they try to tell people, it will be bad for them—or what to do. So people often just leave failing organisations, saying, “I can’t do anything about it.” I bet most of those on the board of the hospital trust knew it was going wrong and did not know what to do. There is this idea that this was just an isolated case, but it represents a systemic failure. There is absolutely no escaping that.

I remember the Paddington rail crash. One’s instant reaction was, “Well, the driver went through a red light; it must have been his fault,” but everybody knew that there must have been something much more fundamentally wrong. Something was wrong with rail safety. In aviation, when there is a plane crash, it is very rarely the pilot’s fault. Even if it is down to pilot error, that will be down to pilot training and that will be a system failure. We need to look at this issue in an holistic and sensible way.

The reaction of the NHS to the Francis report was immediately to reach for statistics and to start doing things. It immediately started a storm around our local hospital, the Colchester General, by latching on to one statistic and naming it as one of the hospitals being investigated, even though—I have written to Andrew Dilnot at the UK Statistics Authority and got a reply from him—a single statistic should never be used in such a fashion. In fact, the Colchester General is in the top quartile of its class of hospital, so that was entirely unnecessary. My wife has just had a knee replacement in that hospital. I was completely confident that she would get good nursing care and she indeed got very good nursing care.

There is now an uncomfortable atmosphere surrounding this issue. There is an atmosphere of denial, and this relates to Sir David Nicholson. Is he still in denial? Is the system still in denial? Can the system change dramatically enough unless people are seen to take responsibility for the culture? It is difficult to argue that he has not been individually responsible for the broad culture in the national health service that has led to this pass.

[Mr Deputy Speaker (Mr Nigel Evans)]

I am sure the House wishes Anne Jenkin a speedy recovery.

Medical Implants (EU and UK)

Nigel Evans Excerpts

Wednesday 6th March 2013 Commons Chamber

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I am giving the hon. Gentleman a little leeway but the matter under discussion is as on the Order Paper, so I would like reference to be made to that, rather than a general debate.

[John Pugh]

I am coming to that, Mr Deputy Speaker. In a way, that illustrates my point, because what we are actually debating is the supplementary estimate. My hon. Friend the Member for Gainsborough and I were tasked with looking at how the House debates supplementary estimates, and the answer we came to was this: not very well. Our report, a copy of which is in the Library for hon. Members to consult, testifies to that finding, and we produced adequate evidence for it, because the report was co-ordinated to some extent by the Treasury, which keeps a close eye on these things. I am suggesting that the work of examining the nation’s finances is boring, dull and, at times, anorakish, but it certainly needs to be done, and it probably should be done by Parliament, and on occasions like this.

Merton and Sutton PCT (Prescribing Policy)

Nigel Evans Excerpts

Friday 1st March 2013 Commons Chamber

[Anna Soubry]

I was coming to that in due course.

Apart from making these comments at the Dispatch Box, I cannot advance Mr Aziz’s case, because I do not know his case. I know what the hon. Lady has said, and I know that he has been through, to use these awful words, due process. His application has been considered. Having looked at what the PCT says in its letter, I can see that his case has been through all the sorts of processes that one would expect. I hope and pray that in the course of all that and through the various appeals that he has made, everything has been properly considered by the PCT.

It strikes me, however, that the most obvious thing that should have been done has not been done. Nobody seems to have sat Mr Aziz down—this is not the hon. Lady’s job, because she knows no more than I do—and explained things to him. If there is a good reason, he should be told. If it is about the money, we need to know exactly what the problem is. I suggest that those who may be listening, whether they be in this building or watching on television, should sit down with this man and discuss the way forward for his treatment. They should provide him with an explanation, because he is not just a human being—and it does not matter whether he is a good or a bad man—but one who is extremely ill with a life-threatening disease. Somebody needs to sit down and do a proper job on this, just like the hon. Lady has done in bringing the case to the House.

I despair—we should not have to be here, but we are. The emergence of the clinical commissioning groups will lead, I hope, to a far better system. They will make decisions based on their own knowledge and understanding as clinicians. They will also, in many ways, be far more accountable than primary care trusts have been. Every CCG will have a representative on the upper-tier local authority’s health and wellbeing board. The theory that generated the highly controversial legislation that went through this place is that it would be much better for decisions to be made at a more local and accountable level by those best placed to make them, namely health professionals.

I fear that I have not been able to answer the question asked by the hon. Lady and Mr Aziz, whom I wish well, as we all do. I hope that, as a result of this debate, which the hon. Lady quite rightly called for, people will sit down and not only perhaps have a rethink, but certainly give a human being an explanation, if for no other reason than because, at the end of the day, he pays their wages. On those somewhat positive remarks, I hope that this matter might be concluded to everybody’s advantage.

[Mr Deputy Speaker (Mr Nigel Evans)]

As we conclude proceedings, may I wish you all a happy St David’s day.

Question put and agreed to.

Accident and Emergency Departments

Nigel Evans Excerpts

Thursday 7th February 2013 Commons Chamber

[Mr Sharma]

I disagree with that. The evidence shows that all these decisions are finance-led. It is not to do with the clinicians’ or consultants’ proposals. That may apply in the hon. Gentleman’s constituency, but I can assure him that it is not true of west London.

My hon. Friend the Member for Ealing North (Stephen Pound) will join us later and the hon. Member for Ealing Central and Acton (Angie Bray) will speak later, too. I thank them for their support for our campaign. I would also like to acknowledge the tremendous efforts of my hon. Friend the Member for Hammersmith (Mr Slaughter), who would be in his place here were it not for his Front-Bench duties in the Justice and Security Public Bill Committee. Back in June, when North West London NHS announced its plan to close four of our A and Es, my hon. Friend organised a public meeting, which gave rise to the Hammersmith “Save our Hospitals” campaign. He has been at the forefront of the community campaign in his own constituency and has been instrumental in organising MPs of all parties to come together for this debate. He asked me to mention particularly the threat to Charing Cross hospital, which will lose not merely its A and E but 500 in-patient beds, turning a world-class hospital into a local urgent care centre.

My hon. Friend would have reminded us that this is the second time he has defended Charing Cross from closure. He stands now with his constituents, as he did in the last century during the dark days of John Major’s Government, holding a candle for Charing Cross at its Sunday evening vigils. That light did not go out, and I am sure it will not be allowed to go out now.

Let me now raise some of my specific concerns—as well as welcoming you to the Chair, Mr Deputy Speaker. I have very grave concerns about the way in which the consultation was carried out in north-west London. It was carried out over the Olympic summer months, with an impenetrable document of 80-plus pages and a response document with leading questions that set community against community, doctor against doctor, and hospital against hospital. There were also significant parts of the consultation period when no translated materials were available for many of my constituents who speak various community languages. That was totally unsatisfactory.

Notwithstanding those difficulties, some people in Ealing were able to complete the consultation and overwhelmingly rejected the preferred option that means the closure of Ealing’s A and E, maternity, paediatric and other acute services, and the closure of Central Middlesex, Hammersmith and Charing Cross A and Es. Moreover, a majority of respondents across the whole of north-west London rejected the fundamental premise of the proposed changes—that acute services should be concentrated on fewer sites. I fear that such an inconvenient consultation response will be ignored and ridden roughshod over.

Equally, I fear that the clinical opinion of Ealing’s GPs and hospital consultants who opposed the preferred option will be ignored, despite this being one of the Government’s four tests for such reconfigurations. The clinical concerns are real and should not be brushed over. Let me address some of the key concerns.

First, the scale of change being proposed in north-west London and the associated risks of such large-scale changes is causing great concern. Taking out in one go four of nine A and Es that serve a population of 2 million—set to grow continually over the next 20 years —is a high-risk strategy. Concerns over A and E capacity are growing, as hospitals up and down the country say that their A and Es are full and that they are putting patients on divert to other hospitals. This has happened recently at Northwick Park hospital—one of the hospitals that Ealing patients are meant to be treated at if the four A and Es close. If these proposals go through, yes, there are plans for some increased investment at both Northwick Park and Hillingdon A and Es, but there are well over 40,000 patients a year using Ealing hospital’s A and E alone, in addition to those currently attending Central Middlesex, Charing Cross and Hammersmith—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I think the hon. Member was told that he had a 10-minute limit imposed on him, as applied in the previous debate. Sadly, however, his time is up. If he wants to make a concluding remark, however, I think the House would allow him to do so.

[Hon. Members]

Hear, hear.

[Mr Deputy Speaker]

We will give the hon. Member two minutes to conclude.

[Mr Sharma]

Thank you very much, Mr Deputy Speaker.

Let me finally say to the Minister that there should be a moratorium on all A and E closures until a proper, considered and full review of A and E services has been carried out, as opposed to the current rushed review. I hope that the Minister will listen.

[Mr Deputy Speaker (Mr Nigel Evans)]

I am extremely grateful to you, Mr Sharma, for your understanding.

From now on, Back-Bench speeches will be limited to eight minutes.

--- Later in debate ---

[Mr Burrowes]

I commend my hon. Friend for his continuous efforts, although perhaps he should take his seat since he has given way.

[Mr Deputy Speaker (Mr Nigel Evans)]

That is my job, not the hon. Gentleman’s.

[Mr Burrowes]

My hon. Friend has continuously stood up, not just in the House but in his constituency, against the closure of the A and E in Chase Farm and for securing health improvement in Enfield. He has secured a cross-party delegation meeting with the Secretary of State, at which we want an assurance that the £10.6 million being invested in primary care in Enfield ensures we get effective primary care improvements before the reconfiguration.

--- Later in debate ---

[Mr Virendra Sharma]

How disappointed I am that the Minister failed—utterly failed—to address the issue—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Sadly, time has defeated us.

Suicide Prevention

Nigel Evans Excerpts

Wednesday 6th February 2013 Commons Chamber

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. The debate will finish at 5.55 pm and the two Front Benchers still have their winding-up speeches to make. Will hon. Members therefore be mindful when they are making their contributions so we can get everybody in?

--- Later in debate ---

[Mark Durkan (Foyle) (SDLP)]

Like other hon. Members, I congratulate the hon. Member for South Antrim (Dr McCrea) and his colleagues on giving the House the opportunity to discuss this very important issue, which, as we have heard, touches many people in many ways, and in ways that they find hard to express or represent. For all the reasons that we understand, it is important that we in the House—again, in our own inadequate and inarticulate way—not only try to express our feelings and represent the feelings of those who have lost people through suicide, but try to feel our way towards some sort of policy answer and structural response to a very serious problem that is growing in many ways.

It is not just because the statistics are better collated that we can say that the problem is growing. There are issues, and people can analyse and compare the different statistical bases over the years. It is a problem that has gradually been able to express itself a bit more. Reference has been made to the fact that it has been a taboo subject. The first time that I heard of suicide was when I was in primary school in the late 1960s, and a family friend committed suicide. She was a great friend of my mother—she was great to all my brothers and sisters whenever we were in her fruit and vegetable shop—and I remember that my mother’s distress as a friend was based not only on all the usual questions that arise from suicide and the loss of a lovely friend. It was also based on the fact that her friend was denied a Christian burial and denied the rites of her own Church. That is what taboo meant then. Luckily, Churches have become more enlightened and many people have helped them to become more enlightened. So we can celebrate the fact that spiritual enlightenment can inform Churches in different ways, and their response to something that they class as a sin can change and develop. That has been very positive and has helped all of us as a community in many ways.

I have found the debate hard. I agreed with many of the points, and I also felt many of the points. I have experienced suicide in my family more than once. I also have experience of suicide by people whom I regard as close—good friends, family friends and so on. All the things that all the right hon. and hon. Members have said are so, so true. We are stuck with that—the questions that will never leave, and the answers that will never come. There are people finding and developing answers, however. Maybe they are not answers to the particular suicide that has grieved me or grieves other members of my family and extended family, but answers as to how we may be able to get on top of the problem and as to how we can avert such tragedy and prevent it from afflicting other people as well.

In many cases some of those answers are being driven by the families and the very people who have experienced suicide, and by the professionals who have witnessed that, provided support and said, “There has to be a better way. There has to be more that we can do. There has to be more that we can do together.” The hon. Member for Bridgend (Mrs Moon) referred to the work of the all-party group and the report. I do not speak often at the all-party group, for reasons that people will understand; I find it hard to contain my emotions on these things. One thing struck me as I was listening to people give evidence to the group—people who did not know which area I represented. A few times when people from parts of England were giving evidence about their experience and the things that they were trying to do in their area with their trusts and well-being boards, they referred to what they called the Derry model, which they wanted to see in their area.

That is because in my constituency, in my city of Derry, as other hon. Members have said, we have grave levels of suicide, but there has been a strong community response and the local Western Health and Social Care Trust has tried to engage strongly on it. The trust has a suicide liaison officer, Barry McGail, who does not just work well locally, but is globally active and is part of progressive policy-pushing networks on the subject. When people spoke about the Derry model, part of what they meant was that suicide liaison service.

The service is notified of a suicide by the police within 24 hours and its staff make family contact. They are there at the wakes, able to talk to the family and friends. They are able to bring leaflets and draw attention to other services in a sensitive way, so the issues are immediately picked up and the people who might be most emotionally affected or vulnerable after the suicide—other family members, friends, classmates and so on—can be identified and supported. That has worked well and has helped families through and has helped them feel that they are helping others, which is so important.

More widely in Northern Ireland, we have a self-harm register, another positive development. It is run now by the Public Health Agency and is co-ordinated on a north-south basis. The register provides up-to-date information on people who may have attempted suicide or have self-harmed, so that the right services can be in touch with them or they can at least know that services such as counselling and other opportunities are available for them. Again, that is important in prevention. It is also important to learn the lessons of experiences and making sure that things that are known to one service are not lost to the knowledge and intelligence of another service that may be the right one to provide help.

Some hon. Members have referred to the media in this regard. Of course, the media have particular responsibilities. They need to be very careful and sensitive in how they present any film or TV storylines depicting suicide. If they make suicide simply the natural conclusion to a narrative, that is completely wrong. Unfortunately, too often in the media it seems as though the suicide itself makes the statement, and that is very dangerous. Equally, the media, whether the print media or any other kind, need to be very sensitive in how they cover deaths by suicide. If they treat speculation about clusters—the hon. Member for Bridgend, who is unfortunately no longer here, has experienced this directly in her constituency—in an insensitive, invasive, exploitative and sensational way, that can add to the problems. It can not only add to the suffering and stress of families, but put more families at risk of loss and distress.

Over a dozen years ago—this is not a new problem in Northern Ireland—people like Barry McGail worked on developing guidelines for the local media to use. One of the guidelines in circumstances where a suicide took place was for the media not to treat it in a way that linked it to a single dramatic event. I found myself in a situation where there was a suicide in another family that followed a death in my own family. With the support of education professionals, people like Barry McGail, and other people in the Western health board, I tried to prevail on the media not to treat the young man’s suicide as a “Romeo and Juliet”-type story. It was a struggle to get the media to comply with guidelines that had been drawn up sensitively with their own co-operation, and unfortunately we did not succeed in all instances. The media do have responsibilities in this regard.

Then there is the new media, with the digital age and all the opportunities that are there. In relation to the sites that offer methods and techniques of suicide and appear to be encouraging it, Barry McGail says that although most young people will engage in social media, most of them will want to do so positively. As well as trying to police and shut down all the negative, dark sites, we need to think of more ways of making sure that there are far more positive connections and real pathways of assistance and communication. We need to develop new things such as apps that will be suitable for young people, in particular, who could be at risk.

That is not to say that only young people are at risk of suicide. In my constituency and elsewhere, it affects the old and the young—mothers, fathers, and children. However, one of the things that gives me heart is that people who have been through these dark difficulties, and who are still not out of all that darkness, are desperately trying to remedy the situation through different networks, charities and support groups. In my town, they are supported by people such as those at Foyle Search and Rescue, who do such a good job in helping families who suffer following suicide in the river. When we were building the new iconic peace bridge in Derry, they worked with us to prevail on the architects to understand that it needed to be designed in a particular way with rails shaped so as not to lend themselves readily to suicide attempts.

Foyle Search and Rescue houses and accommodates various groups of families who have come together. We also have groups such as Zest for Life, which work so well to counsel people who are suffering from problems, and HURT (Have Your Tomorrows), which particularly helps people who have been suffering from addiction or dependency and have specific vulnerabilities. These groups are succeeding in helping to reduce and to solve the problems, but they constantly come up against funding difficulties. There is also the issue of making sure that all the policies and services can mesh together.

Finally, another positive feature in Northern Ireland is the ASIST—applied suicide intervention skills training— model, which has been borrowed from Canada and is working well where people engage with it. The big problem, however, is getting GPs to engage with it—they are not—because they are the vital cog and the key people. The issue has come up in the work of the all-party group on suicide and self-harm prevention. As the hon. Member for Bridgend will know, one of the questions that constantly comes up is: how do we get GPs involved in and engaged with this? Their input is vital and they are vital channels, but in their absence, people’s sense of purpose starts to wane and get weaker.

I am not blaming GPs. Obviously, there are a lot of pressures and demands on them, so they need time out of their practice to do this. We need to see what locum support and other things are available to allow them to play their part in the very good efforts that are being made and to make good the investment being provided by the Department of Health, Social Services and Public Safety. Other Members have been right to acknowledge the work of that Department, including that of the current Minister, Edwin Poots, and his permanent secretary, Andrew McCormick. We should also acknowledge the work of the previous devolved Ministers. It is a pity that the ministerial group did not meet for about 18 months, but that does not mean that other good work was not going on. For that work to be done, it needs to be supported, and I hope that today’s debate will help to support and encourage those people who deserve it in their important work on such a huge issue.

[Mr Deputy Speaker (Mr Nigel Evans)]

To resume his seat no later than 5.35 pm, I call Kevan Jones.

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

I congratulate the Democratic Unionist party on securing this debate. It is a privilege to follow a very moving speech by the hon. Member for Foyle (Mark Durkan).

The right hon. Member for Belfast North (Mr Dodds) is right to say that the reasons for suicide are complex. The question that most families usually ask is: why? My constituency has a great organisation called If U Care Share, which was set up by Shirley Smith, whose 19-year-old son, Daniel, hanged himself a few years ago, having not showed any of the signs referred to by the right hon. Gentleman. He was, the family thought, a perfectly happy, contented teenager. The family then wondered what they could do. They set up If U Care Share, and Shirley, her husband, Dean, and their children, Ben and Matthew, go into schools to talk to young people about suicide and people’s feelings. People should not be ashamed to open up and talk about their feelings. They also work with youth clubs and the Football Association to get their message across.

The hon. Member for Pudsey (Stuart Andrew) noted how the highest number of suicides seem to be among men, and the hon. Member for Upper Bann (David Simpson) mentioned the figure of 6,000. I have just looked up the figure and it is about 4,500 who are actually men. As the hon. Member for Pudsey has said, mental health is not an issue that we talk about. I might sound like a broken record, but we need to keep talking about mental health.

Today’s debate is good because, as the hon. Member for Foyle has said, we are talking about one of the great last taboos. The more we talk about mental health and the effect of suicide—not just on the individual and the lost opportunities for them and their family, but on society—the better we can draw up the systems to help.

There is nothing wrong about talking about mental health, or about people admitting that they need help. As the right hon. Member for Belfast North has said, that is the big step that needs to be taken in most cases. We need to get the message across, not only to young people, but to everyone, that if they are in distress they need to ask for help. In my area, the statistics show that an older generation of men in their 30s and 40s are committing suicide. A reason for that might be the issue of the economic role of men in society, which has been mentioned. Unless we talk about it and put it on the national agenda, we will continue to come up against these issues.

I have just one point to make. We need to join up the services, because the roles of the voluntary sector and the NHS are vital. GP commissioning could have great benefits, but it also brings great risks. I fear that when GPs commission services, mental health services might again be seen as the poor relation. We need a joined-up approach if we are to prevent the tragic losses that are now at a level which most people would say is unacceptable.

I will finish by saying—again, I will sound like a broken record—that the more we speak about these issues, the better it is, because it will help young people and others who are in distress to take the major step of getting the help that is there if they only ask for it.

[Mr Deputy Speaker (Mr Nigel Evans)]

To resume his seat no later than 5.45, I call Mr Jim Shannon.