The National Health Service

Andrew Griffiths Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Jonathan Ashworth]

The Prime Minister promised that new hospital at the Tory party conference, only for the Department to confirm later that Canterbury was not actually on the list.

[Andrew Griffiths (Burton) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

In a few moments.

The Tory candidate for Canterbury, one Anna Firth, helpfully explained that the Prime Minister had “clearly made a mistake”. After all,

“He can’t be on top of every little detail”.

We are talking about the £450 million rebuilding of a hospital.

--- Later in debate ---

[Matt Hancock]

It is thanks to my hon. Friend’s campaigning and bringing to light the importance of the upgrade to the A&E at Walsall Hospital that we have been able to make that investment. There is no greater spokesman for the people of Walsall than my hon. Friend, and I cannot wait to turn left at junction 10 to pay them a visit next time I am going up the M6.

[Andrew Griffiths]

The Secretary of State talks about rejoicing, and Opposition Members have talked about the hospitals that he should visit. He is welcome in Burton at any time. We had £22 million invested in the health village as a result of his last visit, and just this week he has announced another £11 million for two new operating theatres. That proves that it is this Government who are investing in our NHS. It is safe in our hands.

[Matt Hancock]

I will tell the House exactly what happened. My hon. Friend invited me to Burton, and I looked at the changes that needed to happen. I talked to the NHS and we then announced not one but two upgrades as a result, thanks to his campaigning.

--- Later in debate ---

[Matt Hancock]

Yes. My hon. Friend is a brilliant advocate for her local community, and I visited the new medical school with her. She makes an incredibly important point about access to new medicines. We want to bring more access to new medicines, rather than saying that if it is not made by the state, people should not have it, which is the approach outlined in the amendment.

Let me turn to the medicines and medical devices Bill, which was in the Queen’s Speech. The intervention by my hon. Friend the Member for Chelmsford (Vicky Ford) was precisely on this point: the potential of technology to bring forward new treatments and new devices is more exciting now than at any point in generations. The new medicines and medical devices Bill will allow our world-beating life sciences industry to be world leaders.

I do not think that we should insist on a state-run medicine company and I do not think we should be requisitioning intellectual property. We should leave that aside, not least because we already have some of the cheapest medical drugs in Europe. The Opposition seem to want to create a British Rail-style drugs system—inefficient, always breaking down and arriving too late. The Association of the British Pharmaceutical Industry said that under Labour’s plans, $183 billion that the industry spends annually on research and development for new drugs would “disappear”. The ABPI is a sober and respected organisation. The proposals would cost taxpayers billions and risk all the work that goes into saving lives. The industry knows they are nonsense, we know they are nonsense, and in his heart the shadow Secretary of State knows they are nonsense. The country will see straight through him.

[Andrew Griffiths]

I thank the Secretary of State for giving way, because he gives me the opportunity to deliver on a promise that I made to the parents of four-year-old Michal in my constituency, who asked me personally to thank the Secretary of State because it was as a result of his intervention that Michal, who has Batten disease—childhood Alzheimer’s—has access to the drug that will save his life. It is a groundbreaking treatment, and it is because the Government are investing in the NHS that Michal’s life will be saved.

[Matt Hancock]

My hon. Friend is absolutely right. It was incredibly moving to meet, in my office downstairs here in the House of Commons, some children with Batten disease who needed access to world-class drugs. They are expensive drugs, but we needed to get them at a price that was affordable to the NHS. I met the parents and some of the children, and it was incredibly moving. I met some siblings—one had access to the drug and the other did not—and I saw the difference in their development. We negotiated with the company and got the drugs on the NHS. That is how we should be providing world-class drugs. That is how it has been done under sensible Labour Administrations, and I urge the Opposition to reconsider, because even if it may sound good when they look in the mirror, it is not sensible to undermine our world-class life sciences in this way. I hope they think again.

Women’s Mental Health

Andrew Griffiths Excerpts

Thursday 3rd October 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

I hope everyone will concur that this debate has followed on in tone from yesterday’s debate on the Domestic Abuse Bill. I thank everybody for their contributions. I thank the hon. Member for Bath (Wera Hobhouse) for opening the debate. I also thank my hon. Friend the Member for Plymouth, Moor View (Johnny Mercer), who I understand originally secured the debate—when he took up his ministerial position, the hon. Member for Bath took the debate forward on his behalf, for which I thank her.

I give many thanks to my predecessor, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who did a hugely commendable job when she held this position. I am determined to continue the work that she began—not least because I am sure she will be breathing over my right shoulder in every debate that I take part in. I wish to pick up on one of her comments, which fitted the tone of debate. She said that we should all share in this place the results of our own personal experiences. I was not going to mention why women’s mental health is so important to me, but that comment has sat on my shoulders since she made it—as have, indeed, the other brave contributions.

Women’s mental health, particularly perinatal depression, is incredibly important to me because a very close member of my family had perinatal depression and took her own life—and not only her own life but that of her baby and her two existing children. It was an act that has since reverberated through my family, and for many other people. Perinatal depression is incredibly important to me, as is this role, and that is why I take so seriously all aspects of my role but particularly women’s mental health.

Women have broken down barriers, not only in mental health but in this place. I remember well the time when a previous Madam Deputy Speaker was pregnant. She spent most of her time in the ladies’ room at the back because the fact that she was sat in the Chamber and was pregnant at the time was not quite appreciated. Times have changed and sharing our experiences has now become commonplace. I think that has helped to break down the barriers in here so that we can discuss issues that are so important to so many people.

[Andrew Griffiths (Burton) (Con)]

I thank the Minister for sharing her personal story with us. The more we hear from Members from all parties who have themselves suffered from poor mental health or whose families have felt the footprints of poor mental health, the more we will help to break down the stigma and the more we will show to people who are listening to this debate or watching on TV that it can happen to anybody. There is nothing to feel embarrassed about and there is nothing to be ashamed of. The most important thing we can all do is talk about our mental health.

[Ms Dorries]

My hon. Friend is absolutely right: it is about breaking down the stigma in mental health. When somebody breaks their leg, they wear a plaster cast and we can see that they have broken their leg. We cannot always see when someone is suffering from a mental health issue, so it needs to be destigmatised. It also needs to be given the same consideration as physical illness, and I think it is.

Obviously, my speech has now been dumped, because so many points were raised in the debate and I feel that I have to answer them. I shall start with the hon. Member for Bath, who raised so many points when introducing the debate. I want to answer some of her questions. One of her first points was about rape crisis centres; this year, we will spend £35 million and fund 47 sexual assault referral centres, to ensure that when sexual violence occurs, there is the best possible response for victims. The centres are available to all victims—male and female, adults, children, and current and non-current victims of rape and abuse.

I want to mention the approach the Government have taken to mental health. I took up this post just as we announced £2.3 billion of expenditure on mental health. Let me put that into perspective: my hon. Friend the Member for Cheltenham (Alex Chalk) informed me that that is more than half the entire yearly prisons budget; that demonstrates how much money we are investing in mental health. The money is going into many areas, but in almost all areas it will have an impact on women and young girls— and this debate is all about women’s mental health. It is important that women are at the centre of all mental health policy. They should be not just be siloed off into their own particular areas; they should be at the centre of everything.

Hernia Mesh in Men

Andrew Griffiths Excerpts

Thursday 5th September 2019 Westminster Hall

[Ms Dorries]

Of course, Mr Hanson. I am amazed that after 10 years in the Chair I make these mistakes—it is because I am nervous. I am delighted to serve opposite the hon. Lady; it will be great.

This is a serious subject. It is incredibly important to hear the voices of patients who have suffered as a result of inguinal hernia mesh repair operations, because without allowing those patients to be heard, we cannot move forward to find solutions to deal with this issue. I will go off-piste from my speech, because there has been some conflation during the debate of vaginal mesh repair for the purpose of urinary incontinence and inguinal mesh repair for an inguinal hernia. The two operations are entirely different and have completely different outcomes. Vaginal mesh repair is for urinary incontinence. Inguinal mesh repair is for hernia, and without repair, there is a possibility of death. That is because of the pattern of development of an inguinal hernia. It is due to a break in the muscle wall. The hernia is a part of the bowel that comes through the muscle wall, and it can quickly strangulate and develop into peritonitis. The result of that can be death.

[Andrew Griffiths (Burton) (Con)]

I join the debate late on, but perhaps I can be the example the Minister is looking for. I had a double hernia just a few months ago that was treated at Queen’s Hospital in my constituency, where I received fantastic care. Mesh was used to repair a double hernia, which I got as a result of doing too much exercise—I am not as fit or strong as I thought I was. I was nervous about having mesh because I had heard all the rumours about how damaging it could be, so I questioned the consultant and surgeon. For me, it was brilliant: it meant keyhole surgery and a quicker recovery. I say to all those men out there who might be going in for a hernia operation: do not dismiss mesh, because it makes the operation simpler and the recovery time quicker. I recommend it.

[Ms Dorries]

I thank my hon. Friend for his absolute honesty and openness in bringing forward his own case.

The bowel can come through the opening in the muscle wall, strangulate and develop into peritonitis, with dire consequences. The fact is that the alternative method of repair—just to stitch the muscle wall—is nowhere near as effective, and the same dangers can present. There can be a rupture, and the hernia will present again with the same complications.

--- Later in debate ---

[Andrew Griffiths]

I had exactly that conversation: it was my choice whether I had an operation and how I managed it. Also, it was just four months between seeing my GP and having the keyhole surgery at my local hospital, which took an afternoon. The service at the hospital was brilliant; I cannot praise it enough.

[Ms Dorries]

I am delighted to hear that.

I am pleased to say that shared decision making is set out in the NHS long-term plan and I hope we will see more of it in other areas. As the hon. Member for Strangford mentioned, it has the full backing of the Royal College of Surgeons and the Royal College of Anaesthetists. I know from my own experiences in the health service that the role of patient voices is critical at every stage along the treatment pathway. Indeed, as we have said, the Government have asked Baroness Cumberlege to lead a review on the theme of patients’ voices. I will say more about that later.

All of us, including Ministers, regulators and clinicians, must listen to patients, such as the constituent mentioned by the hon. Member for Strangford who has had an ongoing problem, when they raise concerns. Only by listening to those patients’ voices and understanding the issues they have after hernia repair can we learn and develop what we need to do to ensure that it does not happen to people in the future. We must strike a fine balance as we steer through innovation, emerging science, clinical advice and the voices of a multitude of patients.

Hernias are relatively common. One in five men will get an inguinal hernia in their lifetime and it is worthwhile briefly outlining why men are mostly affected. Inguinal hernias are a type of groin hernia, which are the most common type of hernia. Some 98% of them are found in men, as the male anatomy is particularly vulnerable in this region. The main reason to operate on a hernia is to reduce the risk of bowel obstruction or necrosis, which is tissue death. Both of these conditions require major emergency surgery, where there is a risk of death.

Hernia surgery is therefore often a necessity. I have been advised by clinicians that when an individual’s condition indicates surgery, mesh repair is the standard operation for adults with inguinal hernias. It is safer than non-mesh repair in the first instance and is less likely to lead to pain post operation. It is also less likely to lead to hernia recurrence. To address the point made by the hon. Member for Strangford, I hope he understands not only that this treatment is the most effective but that the alternative is more likely to result in complications. Mesh is therefore used in approximately 97% of all surgical inguinal hernia repairs in England.

All the expert scientific advice that Ministers have received does not support a ban. It is important to emphasise that internationally no other country has banned the use of mesh to treat hernias. According to the National Institute for Health and Care Excellence, approximately 70,000 surgical inguinal hernia repairs are performed in England each year, at a cost to the NHS of £56 million a year. These mesh repairs are performed by either open surgery or laparoscopic surgery, as my hon. Friend the Member for Burton described.

NICE has developed guidance which recommends laparoscopic surgery as one of the treatment options for the repair of inguinal hernia. The guidance states that it should only be performed by appropriately trained surgeons who regularly carry out the procedure. This evidence was reviewed by NICE in February 2016 and the recommendations have remained in place since then. The Medicines and Healthcare Products Regulatory Agency and others will continue to review the situation as further evidence and analysis emerges, and will take any appropriate action on that basis. That is why this debate and the recounting of the experiences of constituents is important. They have ensured and will continue to ensure the safety of patients who need treatment.

Unfortunately, no type of surgery is without risk, both during and post surgery. The right balance between risks and benefits for individual patients must be achieved, which places patient autonomy and consent at its heart. I stress that I am deeply concerned to hear about instances where these conversations may not have happened, or have not been conducted in a manner that sufficiently informs the patient. Every patient should expect to receive safe and effective care, and to have an opportunity to raise concerns and feel confident that they will be listened to.

I will talk about the pain and suffering experienced by some men after mesh surgery. The vast majority of patients who undergo surgery using mesh to treat hernias go on to live normal, independent lives. While we do not know the exact number of complications, we believe it is low. However, I understand that those who experience the most adverse outcomes are those who suffer chronic pain or long-term discomfort.

I have been advised that 10% to 12% of men experience moderate to severe chronic pain post surgery. While that number is high, it is lower than for those who have non-mesh repair. I have been advised that acute pain is normal during healing, but chronic pain is not normal. As I said, one example of pain management is to treat chronic pain by injecting local anaesthetic and steroid. Long-term discomfort or pain is fortunately rare, but can still occur in one in 20 inguinal hernia repairs. While this number is still concerning, and, I believe, too high, the risk is dependent on the circumstances of each case. For example, there is an increased likelihood of it where patients have small hernias and where the predominant symptom before the operation is pain. Patients present at the clinic with pain and continue to have the pain after the operation. Both these adverse outcomes—the severity and the longevity of pain—remind us that regrettably complications can arise when any person undergoes surgery.

Suicide Risk Assessment Tools in the NHS

Andrew Griffiths Excerpts

Wednesday 4th September 2019 Westminster Hall

[Ms Dorries]

If I may continue my speech, I hope that I can reassure my hon. Friend on that point.

The Government are committed to a culture of openness, honesty and transparency in the NHS. The legal duty of candour means that trusts need to be open and transparent with patients or their families when something appears to have caused, or could lead to, significant harm. Trusts could face action from the CQC if they are seen to be failing to comply with that duty. I think that some good news will come out later in the year that will hopefully reassure my hon. Friend regarding a new culture that will develop within the NHS to encourage staff and clinicians to be more open about incidents as they happen, so that they share information and we can learn from such incidents.

Our national learning from deaths policy has introduced a more standardised approach to the way that trusts review, investigate and learn from deaths. The national guidance on learning from deaths, published in 2017, is about supporting trusts to become more willing to admit to and learn from mistakes, so that they reduce risks to future patients and prevent tragedies from happening in the first place. The guidance is clear that trusts must engage meaningfully and sensitively with bereaved families and carers as part of that process. I hope that, as a result of those measures, what the Bellerby family went through in 2015 will never be experienced by another family. To support our national policy, the CQC has strengthened its assessment of learning from deaths by trusts.

I will talk about what we are doing to reduce suicides across the NHS more widely. People in contact with mental health services account for around a third of all suicides in England, and arguably some of the more preventable ones. The overall suicide rate among people in contact with mental health services has reduced significantly over the last decade, but numbers remain too high. We must not lose sight of the fact that nobody under the care of NHS services should ever lose their life as a result of suicide. At the start of 2018, we therefore launched a zero suicide ambition, starting with mental health in-patients, but asking the NHS to be more ambitious and look to expand it to include all mental health patients.

[Andrew Griffiths (Burton) (Con)]

I know it is only the Minister’s third day, but the thing that we ask for more than anything else in a Minister is for somebody who cares about their portfolio. It is clear that my hon. Friend really cares about this issue. I am not unique in this, but as one of the few Members who has used NHS mental health services, I can attest to the real value and life-saving contribution that they make. I commend her decision to have that aspiration for zero deaths from suicide in the NHS.

In my constituency, there were 10 suicides last year. That is 10 families ripped apart and hundreds of lives broken as a result of those tragic decisions. Key to a brilliant service is the number of NHS nurses out in the community. Will the Minister, as she develops in her role, look at the numbers on the ground, so that we can be sure that everybody in our constituencies has access to mental health nurses, who can save lives?

[Ms Dorries]

I hope that I can reassure my hon. Friend on some of those points as I whizz forward. We have asked all mental health trusts to put zero suicide ambition plans in place. As already outlined, NHS England is providing funding for suicide prevention to every local area, which includes investment in a national quality improvement programme to improve safety and suicide prevention in mental health services across the NHS.

We are also investing £2 million in the Zero Suicide Alliance, which aims to deliver an NHS with zero suicides across the system and in local communities. It is doing that through improved suicide awareness and prevention training, and developing a better culture of learning from deaths by suicide across the NHS. In June, the then Prime Minister announced that we would encourage all NHS staff to undertake the Zero Suicide Alliance training, which makes all NHS staff more aware and gives them a basic understanding of how to recognise when somebody may be in the space of wanting to take their own life.

My hon. Friend the Member for Thirsk and Malton may be aware that yesterday the Office for National Statistics published the final suicide registrations data for 2018. Concerningly, there were substantial increases in the suicide rate amongst the general population, following three consecutive years of decreases. The latest figures are disappointing, but reinforce why suicide prevention continues to be a priority for the Government and for me personally.

Experts are clear that we need more data to draw firm conclusions from the latest data, and we will continue to work closely with academics and other experts to consider the data in more detail. There has also been an issue over the past two accounting periods surrounding coroners and the way the reporting of suicides takes place. We continue to take action to reduce the devastating impact of suicide. Every local area has a suicide prevention plan in place, and we are working with the local government sector to ensure the effectiveness of those plans. NHS England is also continuing to roll out funding to every local area to support suicide prevention planning.

We are continuing to improve mental health services. Under the NHS long-term plan published in January, there will be a comprehensive expansion of mental health services, with an additional £2.3 billion in real terms by 2023-24. Crisis care is a key element of the plan, which commits to ensuring that by 2023-24 anyone experiencing a mental health crisis can call NHS 111 and have 24/7 access to the mental health support that they need in their community.

We will set clear standards for access to urgent and emergency specialist mental health care. That will be supported by further mental health crisis care services by 2023-24, including 100% coverage of 24/7 crisis provision for children and young people, 100% coverage of 24/7 crisis resolution, and home treatment teams operating with best practice by 2021 and maintaining coverage to 2023-24. We are also investing £249 million to roll out liaison mental health teams in every acute hospital by 2020, which I hope addresses the question my hon. Friend the Member for Thirsk and Malton asked earlier, to ensure that people who present at hospital with mental health needs get the appropriate care and treatment that they need.

To conclude, I again extend my sincere and heartfelt sympathies to the Bellerby family and friends. I assure them that we are doing everything that we can to prevent further suicides, as we understand their devastating impact on families and the communities affected. I thank my hon. Friend again for raising this very important issue. I would be happy to meet him, and Mr Bellerby and his family, to discuss their concerns in more detail.

Question put and agreed to.

Body Image and Mental Health

Andrew Griffiths Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is a privilege to speak in this debate. Indeed, it is always a privilege to speak in debates about mental health, and, having worked as a psychologist prior to coming into Parliament, I always think my timing has been good, because 10 or 15 years ago we would not have been speaking about mental health, and the doors to any conversation about it would have been firmly closed.

I am always grateful that these issues are prioritised by Government. The Minister has been doing a fantastic job in this regard, working cross-party, and she has all our support. I thank her for the work that she has done and I too hope she continues in her position; if I could send in a recommendation or something, I would be very happy to do so.

[Andrew Griffiths (Burton) (Con)]

I am not sure a recommendation from the Opposition Benches will help.

[Dr Cameron]

Indeed.

Body image is a very important issue, and it is an interesting one as well, because it is coming more to the fore through social media and through society in current times, when there is this striving for perfection. As we heard, in the past that might have been about looking through glossy magazines, but now it is all about how glamourous we can look on Facebook or Twitter, how many friends we have, and how many people want to befriend us because of the way we look—because they think that equates with our being some kind of fantastic person, when of course it often does not. And sometimes the most glamorous of people can also be the most shallow, I have to say.

Society is encouraging stereotypes that place great stresses on our young people today, and that has an adverse impact on their mental health. Social media companies must look at this in much more detail in terms of regulation, as we have heard. I have been very pleased to contribute to the work done through the Department, which is looking at issues of social media abuse and the impact of social media on young people’s development and mental health and how they relate to the world. It is almost as if we have become an artificial world rather than engaging with each other in our day-to-day lives just as we are, with all our diverse shapes and sizes being the norm.

[Andrew Griffiths]

The hon. Lady is raising some very important points, and I think we all recognise that young people are under more stress and pressure than ever before, particularly through social media. Does she agree that schools have a key role to play in trying to provide support for young people? I am sure that, like me, she welcomes the new Trailblazer programme that the Government have offered, but does she agree that if we can ensure that young people feel able to ask for support and help in the classroom—in the school environment—we will have a better opportunity to tackle these issues at the very start and help those young people before the problem gets worse?

[Dr Cameron]

Yes, those points are well made. We must do much more in the classroom to help young people grapple with social media issues and pressures, and to develop positive mental health and coping strategies so they can do that. We also have to help parents, like me and others here today, to understand social media; often children are far ahead of us and it can be very difficult for us to regulate what is happening online and make sure it is safe and secure.

I also commend the work of the all-party group on mentoring and the Diana Award. I recently went to a number of their events, one up in Scotland at Holyrood and one at Westminster just a few weeks ago. They are doing fantastic work to help young people who are being bullied in school and to provide peer mentors, because often, as we know, young people listen to other young people rather than parents or teachers. The work they are doing is going a long way in giving young people skills to understand how to challenge bullying, and to promote good mental health and to understand that it is very important that we support each other in society, rather than doing each other down. I commend them for their work.

I am chair of the all-party parliamentary group for textiles and fashion, which is undertaking an inquiry into inclusion in the industry. We have started our inquiry sessions, which have been extremely interesting. We have heard that although the industry is trying to become more diverse and to promote more diversity among its models and in the work that it prints, there are still many challenges and barriers for young disabled people and plus-size people in becoming models or getting into the industry at any level. We hope that the inquiry will highlight and raise awareness of the issues and ensure that the industry lives up to our expectations that it should be inclusive and diverse, just as the United Kingdom is.

The all-party parliamentary group on psychology recently conducted a research study that showed that although the number of abusive posts to politicians was almost equal across the genders, the content was quite different. Whereas male politicians were criticised for their position on a policy, female politicians were much more often criticised for the way they looked, held to account for not wearing the right things in Parliament—according to whoever thought they were the fashion guru—or trying to do them down based on their personality or personal appearance. That shows the stereotypes that must be overcome and the challenges in feeling confident in politics. We must support everyone to make sure we have a diverse Parliament moving forward.

When I highlighted this debate online today, my constituents asked me not to forget to mention how men are affected in terms of body image. That is such a good point. We often speak about the impact on women, and I have been doing that in much of my speech. They said, “Please don’t fail to mention how men are impacted because this is increasingly an issue in society, and the same stereotypes apply: having to be really buff, no matter what your day entails or if you are running about trying to juggle lots of different things. Always having time to go to the gym and to look fabulous and have all the best clothes etc.—these things also put pressure on young men.” I attended a very sad but poignant tribute at the weekend to my constituent Ryan Coleman, who sadly took his own life. We really must not underestimate the pressures on young men’s mental health nowadays in society. It is incumbent on Governments across the United Kingdom to ensure that young men as well as young women feel able to come forward, be referred and take up services; there is often much more stigma for young men in accessing services and acknowledging some of these issues.

We have spoken about cosmetic procedures. I do not have too much detail to speak about on that, but I am aware that there is not much regulation of such procedures and it is important that we get on top of that. As the Minister and the shadow Minister mentioned, when things go wrong, it is not just like having to go back to the hairdressers and getting a different colour put on. Cosmetic procedures can have a permanent impact on people, or affect them for a very long time, so regulation in this market is important. Other markets may be diminishing, but this market is growing exponentially so we definitely need to have regulation in place.

When I worked with people who have eating disorders, we knew from the research that body image was a core part of the issue that people struggled with. It is not just about weight; it is about cognition. It is about how people think about themselves. I worked with young people who were growing thinner by the day and had anorexia nervosa but felt that they were fat. When they looked at themselves in the mirror, they saw themselves as overweight and strove to lose more and more weight. When an eating disorder develops over time, we know that cognition becomes affected. That is why it is very important that people can be referred to local services. I know how difficult that can be.

When I was doing some work in mental health primary care, the problems in referring someone to tertiary care and eating disorder services were almost insurmountable. People had to go through the community mental health team. Weight comes into it again. They might not be quite at the threshold, but everyone in the family and the clinicians knows that the person is developing an eating disorder. We must have services that accept people, and a clear clinical pathway. Otherwise, by the time people arrive at the service that they need, their condition has deteriorated so much that they may need to be admitted to hospital.

We also need to ensure that we can treat people with eating disorders as close to home as possible. They often need cognitive behaviour therapy or family therapy, and families really need to be involved in that care. If the care is taking place 20 or 30 miles away from where the person lives, it is so difficult for families who are grappling with all the other demands on their time to be as involved as they really want to be.

Ahead of Mental Health Awareness Week this year, the Scottish Government announced a new advisory group on body image and young people’s mental health. It is important to have that group up and working; to be thinking about the issues that test young people today. We need to be ahead of the curve. The Scottish Government also recently announced a package of funds for social media advice for young people. We are very aware of the impact of social media. When we are looking through magazines, we can put them down and go off and do something else, but social media is constant. I see this with young people, including my own children: as soon as their phone rings—ding ding—they have to look. Social media is almost like an addiction. I am sure that the companies love that because people are becoming so reliant on it. We need to make sure that our young people have varied lifestyles; that they get out and about in the fresh air, as my mum used to say. I am repeating my mother now. I hope she is listening. I never thought that I would get to that stage, but there you are, I am. It is important for health.

I am extremely pleased to have spoken in this debate. I am pleased that it has been given time in the main Chamber, where it should be, that we are prioritising mental health and that we are discussing the important issue of body image.

Batten Disease

Andrew Griffiths Excerpts

Monday 22nd July 2019 Commons Chamber

[Seema Kennedy]

In answer to my hon. Friend the Member for North East Somerset (Mr Rees-Mogg), I urged BioMarin to get back around the table with NHSE and NICE and come to a fair and reasonable price. NICE has already approved drugs for 75% of rare diseases through its technology appraisal programme, including drugs for idiopathic pulmonary fibrosis and neuroblastoma. NICE’s process and review methods are constantly reviewed, and they are internationally respected. NICE knows that it has to keep up to date with developments in science, medicine and healthcare. There is a periodic review going on at the moment, and that includes extensive engagement with stakeholders.

[Andrew Griffiths (Burton) (Con)]

I thank the Minister for coming today and providing more information. On Friday, I met the parents of Michal, one of my constituents. Michal is four years old, and he was diagnosed with Batten in February. He has already lost almost all his ability to walk and speak, and his parents are desperate to get him access to this drug.

I understand what the Minister says about it not always being helpful to compare access to drugs in different countries, but this drug is available in 20 countries, including Wales. If Michal lived in Bangor rather than Burton, he would be getting the drug that could stop the progression of this disease now. It is simply not acceptable to say, “Let’s not compare what happens here with what happens in other parts of this country, the United Kingdom,” and we need to know more about that.

The Minister talks about her desire to get BioMarin around the table. Time is of the essence for these children —every single day matters when it comes to stopping this disease in its tracks—so will she agree to pick up the phone to BioMarin and personally ask it to come around the table to negotiate with NICE? If Wales can afford to give children this drug, the Minister must have an idea about the scale of the difference between what we can afford to pay in England, and what Wales is paying. We have to find a solution to make this drug available to parents and children here in England.

[Seema Kennedy]

I pay tribute to my hon. Friend and to the parents of Michal. This dreadful disease is so upsetting, not only for the children affected and their families, but for their wider communities. Health care in Wales is devolved. I again urge BioMarin to get back round the table, but I reassure my hon. Friend that I will make contact with the chief executive of NHS England to make sure that he is taking forward negotiations with BioMarin—he is the negotiating party—and I will let my hon. Friend know when I have done so.

Batten Disease: Access to Drugs

Andrew Griffiths Excerpts

Tuesday 16th July 2019 Commons Chamber

[Mr Jacob Rees-Mogg (North East Somerset) (Con)]

Mr Speaker, may I begin by thanking you for allowing me this Adjournment debate and for your personal encouragement to me to bring it forward? My gratitude goes beyond that; I also thank you for the way you so encourage this House to hold the Government—the Executive: those who rule us—to account.

I am also grateful to the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) and the terrific campaign she has been running in relation to Batten disease; she has done more than almost anybody else to highlight it. I note that two of my hon. Friends on the Front Bench, my hon. Friends the Members for Macclesfield (David Rutley) and for Pudsey (Stuart Andrew), have a great interest and a constituency concern in this issue, although they are not allowed to intervene on me for obvious reasons. I want to put their concern on the record. I know that others too might wish to intervene on this very important subject.

This evening’s debate is about my constituent, Max. Max is a little boy; he is eight years old. He is a lively boy, and those of us who have children know what eight-year-olds are like—what a joy they are and how wonderful their spirit is. But Max has this horrible disease. Batten disease is perhaps the cruellest disease that one can imagine as a parent. We all see our children grow; we see them learn to walk and then to talk, and to run and to do all the things that children do. Batten disease means that they then go backwards. It tends to hit at about two—on a child who has shown no signs until then. The talking stops and the walking becomes more difficult. The average life expectancy of a child with Batten disease is between six and 12.

The blow to parents, and to grandparents and families, that this is and must be, is so hard to bear and so difficult; it is so sad for them to see a child who they would hope would be going on into adulthood instead declining, and declining steadily. It is a neurodegenerative disease. To put it in layman’s terms, it is essentially dementia of the young: all that we see of Alzheimer’s in people in their 70s, 80s and 90s is instead happening to a child.

But there is a drug that delays this. It is not a cure and it does not reverse the disease, but it seems to stop its progression—nobody knows for how long. It is called Brineura and it has been shown to be effective on a number of children who have taken it. So far in this country there are only two children for whom it would be suitable who are not receiving it, one of whom is Max. The others are receiving it as part of a trial that has been successful and is still being funded by the drug company—but that might not continue for ever, so there is an argument for them as well. I mentioned earlier the enormous contribution that the hon. Member for Newcastle upon Tyne North has made, and I am very glad to see her in her place; without her, I do not think this really important matter would have achieved the publicity that it has received.

This drug Brineura has been given a quality-adjusted life years rating by the National Institute for Health and Care Excellence of 30, which is the highest rating that it gives. That means that the drug is thought to provide 30 extra years of life of good quality. That is a stunning achievement for any drug, and it has been given the highest rating and the highest amount of funding, but unfortunately that amount of funding is not enough. The pricing cannot be agreed between NHS England, NICE and BioMarin, the manufacturer.

BioMarin is a drug company that needs to make a return on the amount of money it has spent. To be fair to the company, it spent $696 million last year on research and development and made a pre-tax loss of $142 million, so it is not an enormously profitable, rapacious company that is being difficult. One might think, however, that having lost $142 million, it might quite welcome a little bit of income from the national health service. If I were one of its shareholders, I might suggest that it would be a good idea to do something with the national health service so that the company could get some income back on its $696 million of research and development expenditure in 2018. Without an agreement between the buyers and sellers, Max will not receive the drug and his standard of life will decline month by month.

[Andrew Griffiths (Burton) (Con)]

My hon. Friend will know about my constituent, Michal Luc, who is in exactly the same situation. We talk to parents who see their children degenerating and dying before their eyes. Does he agree that they cannot understand how we can argue over money when their children’s lives are disappearing before their very eyes?

[Mr Rees-Mogg]

I completely agree with my hon. Friend.

Generally, I recognise the need for public expenditure constraint. Money always has to come from somewhere; it has to be either taxed or borrowed. However, in a country that spends over £800 billion a year, and £120 billion or whatever it is a year on the national health service, can we not find just over £6 million a year for this small number of children who have a terrible disease that can be held at bay?

--- Later in debate ---

[The Minister for Care (Caroline Dinenage)]

I congratulate my hon. Friend the Member for North East Somerset (Mr Rees-Mogg) on securing this important debate on what is a heartbreaking issue, as I am sure you will agree, Mr Speaker. He and other Members have spoken up movingly and with great passion about and on behalf of their constituents, and I am grateful to them for doing so. I understand how vital it is for patients and their families to be able to access new medicines as quickly as possible. This is one of the hardest types of debates that one has to respond to as a Minister, when we can put ourselves in the position of the families up and down the country who are facing such a desperate situation.

I will endeavour to respond as fully as I can to the issues that my hon. Friend and other Members raised, but I should begin by saying, sadly, that I am unfortunately unable to comment on matters relating to the availability of Brineura, a drug used to treat Batten disease, as this is currently subject to an active judicial review procedure.

As we have heard from hon. Members, Batten disease is a terrible condition that progresses rapidly, leading to loss of speech, mobility and vision, progressive dementia and early death. It is a rare genetic disease, and it is estimated that around three to six children in the UK are diagnosed each year, with around 30 to 50 children living with the condition. Current treatment options are limited to symptomatic relief and supportive care. I fully understand how vital any new treatment option could be to the families of children with this rare and devastating condition.

The Government want patients, including those with rare diseases such as Batten disease, to be able to benefit from effective new treatments. It is in the interests of all NHS patients that we have a system in place for making evidence-based—

[Andrew Griffiths]

On a point of order, Mr Speaker. This important debate is about whether this drug is going to be available for these young children, and you will share my concern that we are not going to get the answers we want because it is supposedly prevented by a judicial review. Can you rule on whether we should be able to have the information we seek in this debate for the parents who are watching?

[Mr Speaker]

I am extremely grateful to the hon. Gentleman for his point of order. He anticipates me, because his discernment is such that he will have observed me in conversation with the Clerk at the Table. Let me say, for the avoidance of doubt, that the content of the Minister’s reply is, of course, a matter for her, and it is not something with which I would seek to interfere. That is not for me.

However, for the purposes of clarification, I want to make this point. I am not aware that this matter is sub judice, as I have not received prior notification that it is. I am not aware that it is, I have not been informed that it is, and the Clerks have not been informed that it is. If it is not sub judice, nothing whatsoever precludes the Minister from commenting on this case. If it is sub judice, as colleagues will know, it is within the competence —I use that term in the technical sense—of the Chair to waive the sub judice rule, which it would most certainly be my instinct to do.

What the Minister says is a matter for the Minister, but it would not be right, as far as I can tell, to say that it is not possible, in a legal sense, for the Minister to comment on this matter. The Minister is the Minister, and the Minister’s answer on the specifics is sought. If the Minister wishes to proffer that answer, she can do so.

--- Later in debate ---

[Caroline Dinenage]

I am very tempted to do so, but I would like to try to make progress on some of the things I can say, and then we can maybe move on to a more satisfactory conclusion.

[Andrew Griffiths]

On a point of order, Mr Speaker.

[Mr Speaker]

Of course the Minister should have the opportunity to do so, but I think it is only right that I hear the point of order, if it is a genuine point of order.

[Andrew Griffiths]

Could you explain the rules to me, Mr Speaker? If it is proved that today’s Adjournment debate is not sub judice and that the information could have been proffered to the House in a way that would have satisfied both my hon. Friend the Member for North East Somerset (Mr Rees-Mogg) and you, would it be in order for the responsible Minister to come to this place to make a statement before the recess, so that those valuable days are not lost? Do you think it would be sensible for the Minister to make that commitment now?

[Mr Speaker]

It is certainly open to the Minister to do so, and I think that it would, without question, be to the advantage of the House if such an oral statement were proffered before the House goes into recess. What I should say to the hon. Gentleman and to other colleagues is that, to my knowledge—forgive me, but I am dealing with this matter literally on my feet—the case has not been set down; it is not listed for court consideration. There are no current proceedings dated. Therefore, as we understand it—my advisers and I—it cannot be said to be sub judice. Sometimes a judgment might be made about the possibility of prejudicing a case—that is a wider consideration–but the real issue is: is it sub judice? Our answer, on the best information available, is that it is not, and so I think a statement would be helpful. Alternatively, if Members wish to exercise their ingenuity in raising important and of course legitimate points of order, and the Minister wishes in the meantime to consult her officials so that a full and detailed response on the specifics can be provided, that is open to her. I recognise that that might be challenging at such short notice and she may not wish to do that, but it would certainly be helpful to have a substantive response, preferably this evening, and a full oral statement before we go into recess. I would say to the House that I am giving the ruling that I am giving both on the basis of a decade’s experience as the occupant of the Chair and on the strength of top-quality procedural advice.

--- Later in debate ---

[Caroline Dinenage]

That is a really good question, and I think that is one reason why NICE is looking again at its systems. It must be possible, because around 80% of new drugs are recommended for NICE approval and approved by NICE. It is clearly possible for new drugs to make it through even when they have not been around for a long enough period to see the very long-term consequences of their impact. It is really important in cases such as this, in which the opportunity—

[Andrew Griffiths]

On a point of order, Mr Speaker. I seek your advice, because we have a precedent for a situation that can arise on numerous occasions. In the nine years I have been in the House, I have heard of many debates in which right hon. and hon. Members have brought forward demands for treatments for rare diseases. We call the Minister to the Dispatch Box to answer—to be accountable. If we have a situation, going forward, where the Minister can claim sub judice, on advice from officials—it is not the Minister; she is taking advice from her Department—and be allowed to hide behind that cloak of anonymity and prevent the House from doing its job, which is to establish the facts and find out the truth behind the matter, that clearly prevents the House from being able to do its job.

You would share my concern, Mr Speaker, that that would prevent Members in this House from serving their constituents in a way that they would be expected to do. Therefore, can you ensure that you will go away today and look at this situation and make sure that, if this procedure has gone wrong, Departments are told very clearly that they cannot hide behind sub judice and that they must be candid with this House, regardless of the advice they have been given by officials.

[Mr Speaker]

That is a most helpful point of order from the hon. Gentleman, to which, essentially, the answer is a simple yes. I will happily go away and reflect on how Departments might usefully be advised to proceed in these matters. Beyond that, there are two points. First, as I have been advised, the matter is not sub judice. It has been suggested to me by a very constructive member of the Treasury Bench that advice to the effect that the case might be sub judice was proffered, though not to the particular Clerk whom I have been consulting, but that advice was not judged to be correct. Put simply, as far as we can see, the matter is not sub judice.

Secondly, however, and this is an extremely important point in the context of the specific debate that the hon. Member for North East Somerset has secured, the issue is that of ministerial intervention, and therefore whether or not the case is sub judice—I repeat that I am advised that it is not—the matter of ministerial intervention is manifestly one for Ministers, and it is therefore a matter upon which a Minister from the Bench can comment and would widely be expected to do so. Frankly, this question of the legal status is not germane to the capacity of a Minister to respond to the specifics of the debate. That is the situation.

--- Later in debate ---

[Caroline Dinenage]

NICE now operates two separate programmes for the assessment of new medicines: first, a technology appraisal programme through which NICE assesses the vast majority of new medicines; and secondly, a highly specialised technologies programme that is reserved for the evaluation of very high cost drugs for the treatment of very small numbers of patients suffering from very rare diseases in England who are treated in a handful of centres in the NHS.

Where NICE recommends a treatment for use on the NHS, NHS commissioners are legally required to make funding available so that it can be prescribed to patients. This is reflected in the NHS constitution as a right to NICE-approved treatments. The intention of NICE is to have a system that means that the public can have confidence that the price paid by the NHS is consistent with the improvement in health outcomes that the medicine brings, ensuring fairness and the best possible use of funding for patients and the NHS.

As I said to the hon. Member for Newcastle upon Tyne North (Catherine McKinnell), NICE has recommended around 80% of products it has assessed. Through its important work, many thousands of patients, including patients with rare diseases, have benefited from access to effective new treatments.

It is right that NICE’s processes continue to evolve with developments in science, healthcare and the life sciences sector. That is why it keeps its methods and processes updated through periodic review that includes extensive engagement with stakeholders, including patient representatives, drug manufacturers and clinicians. In this spirit of continuous development, through the 2019 voluntary scheme for branded medicines pricing and access, which was published in December, the Government announced that NICE would be undertaking a review of its methods and processes in 2019-20 for both its technology appraisal and the highly specialised technologies programme.

[Andrew Griffiths]

I thank the Minister for the honourable way in which she has played a straight bat in what is a very sticky wicket; I am grateful to her for that. She mentioned that she was prepared to come back and make a statement to the House, for which I think we are all grateful. Would she just confirm whether she intends to make that statement before the House rises for the summer recess?

[Caroline Dinenage]

Yes, I will come back and make that statement before the House rises for the summer recess, with the correct legal recommendations.

The NICE review of its methods and processes has now begun. That will be quite helpful for some hon. Members who are questioning whether those processes are as they should be. Although I do not think it would not be appropriate for me to pre-empt the review by commenting in detail on its scope, I can assure hon. Members that it will be wide-ranging and will be carried out with full consultation with stakeholders.

My hon. Friend the Member for North East Somerset spoke about access to the new drug Brineura for his constituent Max. NICE is currently developing recommendations for the NHS on the use of Brineura through its highly specialised technologies programme for the evaluation of drugs for the treatment of patients with very rare diseases. It has not yet published that final guidance. I understand that NHS England and NHS Improvement have been in discussions with the manufacturer of Brineura, BioMarin, for some time to seek a deal that would enable NICE to recommend the drug for use on the NHS, but an agreement has unfortunately not been possible so far. As I said at the beginning, NICE’s assessment of Brineura is potentially going to be subject to legal proceedings.

Let me move on to individual funding requests. Where a treatment is not routinely available on the NHS, including where NICE has not yet made a recommendation on its use, NHS clinicians are able to apply for funding through an individual funding request. This can be done when a clinician believes that their patient is clearly different from other patients with the same condition, or where their patient might benefit from the treatment in a different way from other patients.

In the absence of NICE’s final recommendations on Brineura, I am aware that NHS England and NHS Improvement have recently considered an individual funding request for my hon. Friend’s constituent Max that it has unfortunately been unable to support, because he would not be regarded as an exceptional case to existing policy. I understand how devastating that decision will be for Max, his parents and all those involved. However, if my hon. Friend’s constituents and their clinicians think that the process has not been followed correctly, they can ask for a review of the decision within 28 days. If a patient’s situation changes or more clinical evidence becomes available about the effectiveness of a treatment, they may also submit additional information to be considered and discussed.

--- Later in debate ---

[Caroline Dinenage]

My understanding is that if the manufacturer of this vital drug gets around the table with NICE and suggests a price within a reasonable scale, NICE would be very open to listening. That is my understanding. Certainly, I understand calls from Members across the House for NHS England, NICE and the manufacturer to get around the table to try to find a solution. That seems to me to be the most sensible way forward.

[Andrew Griffiths]

I thank the Minister for giving way again. The language she is using is the same as that we hear in a lot of these debates. She has said that many of these families and young children are receiving the drug on compassionate grounds from the drug company. For a parent whose child is not getting that drug to be told that somebody else’s son or daughter is getting compassion but theirs is not—the Minister is a mother herself, so she will understand this—is like a dagger through the heart. Will she do all she can to ensure that that compassion is extended to all those mums and dads who are looking on tonight?

[Caroline Dinenage]

Of course I will commit to doing everything I can to making sure that all the very valid and easy-to-understand sentiments that have been expressed by Members across the House are sent to all the parties involved in this discussion. I completely share Members’ desire to find a resolution to this and ensure that families get the answers they need. In the meantime, I thank all Members for the part they have played in today’s debate, the questions they have asked and the great interest they have shown in this issue. As I say, I will come back to the House shortly with fuller answers to some of those questions.

Children and Mental Health Services

Andrew Griffiths Excerpts

Tuesday 16th July 2019 Westminster Hall

[Andrew Griffiths (Burton) (Con)]

I beg to move,

That this House has considered children and mental health services.

It is a great pleasure to serve under your chairmanship, Mr Pritchard. We could not be in better hands. It is a delight to have the Minister here. I know she comes to this issue with great personal interest and a commitment to deliver for all our constituents. It is fantastic to see so many right hon. and hon. Members from across the House here to take part in the debate. That is testament to the interest in this place and the concern across the country about mental health, particularly that of children.

I praise the Government for what they have done to date. When it comes to mental health, there is no doubt that this Government get it, making it a priority like no other. They have tackled the stigma of mental health and put in much-needed resources, but although they have done great work, like Oliver, we would all say, “Please, Minister, can we have some more?” because although we are getting on board with the issues, and royals, TV stars, politicians, and people from sport and all spheres talking about mental health, the problem is snowballing, getting bigger and bigger. Such are the pressures and stresses placed on our children’s mental health that this is an ever-increasing problem, which demands our attention, resources and commitment as a Government.

One in eight five-to-19-year-olds—12.5%, or 1.25 million children across the country—have a mental health difficulty, according to the Government’s own survey of November 2018, “Mental Health of Children and Young People in England”. The Local Government Association says that children’s services are seeing more than 560 cases of mental health issues every day. Some 75% of adult mental health illnesses begin before the individual turns 18 and over 50% start before the age of 14. Some 23% of the population are affected by mental health difficulties at some point each year. The economic and social costs of mental illness in England total £105 billion.

[Mr Jim Cunningham (Coventry South) (Lab)]

I congratulate the hon. Gentleman on securing the debate. About 10 or 11 years ago I introduced a Bill that would have provided a specialist to a cluster of schools, to help teachers to identify children with health and mental health problems. Does he agree that the Government should think about that? Secondly, and most important, employers do not recognise the problems young people have with mental health when they start out in industry, nor do they recognise adult mental health problems. Does he agree that more could be done in that area?

[Andrew Griffiths]

I could not agree more with the hon. Gentleman. It is a pity that more people did not share his foresight, so that we could have acted sooner. We are laying the foundations for mental health problems in adulthood. Childhood mental health has a lifelong impact, so it is important that we do not waste a moment. Rates of depression and anxiety among teenagers have increased by 70% in the last 25 years.

[Gloria De Piero (Ashfield) (Lab)]

I thank the hon. Gentleman for securing this important debate. My constituent Elodie Fleet, who is now 18 years old, experienced anxiety, which came to a head at the age of 13. She wanted to see the school counsellor, but her needs were not deemed to be urgent enough because “she hadn’t tried to hang herself or taken a blade to her wrists.” I hope the Minister will say how we can get more counsellors in our schools to deal with people such as Elodie, because she is not alone.

[Andrew Griffiths]

The hon. Lady makes a powerful point. It is true that her constituent is not alone. When I publicised this debate on my Facebook page, I was amazed by the number of parents who got in touch. I was overwhelmed by parents who have either battled through and managed to get to the other side, or are in the midst of fighting to keep their children alive, safe and well. As a parent, I realise what a scary thought that is.

[Rosie Cooper (West Lancashire) (Lab)]

To reiterate that point, does the hon. Gentleman agree that this is a state of emergency? In my constituency, the parents of a 12-year-old boy are being advised that there is a 72-week wait for their son to get help, even though there is a risk of serious self-harm.

[Andrew Griffiths]

I agree that we are in a crisis. The Government are putting record amounts of money in, but the hon. Lady is absolutely right to say that that is an unacceptable wait. I will discuss waiting times later in my speech. Any parent would be terrified at the thought of that long wait and their child being further harmed by it.

[David Simpson (Upper Bann) (DUP)]

The statistics the hon. Gentleman is outlining are horrific. Some years ago figures were released showing that across the whole of the United Kingdom, over 10,000 young people under the age of 10 were manic depressives. That is a horrendous figure. Such a situation puts horrendous pressure on parents and carers.

[Andrew Griffiths]

I have spoken about my own mental health challenges and my battle with depression and anxiety. As an adult it was very difficult to cope with, but for a small child it must be an incredibly hard to have to deal with.

[Andrea Jenkyns (Morley and Outwood) (Con)]

On the social and economic effect, does my hon. Friend agree that we need a more joined-up approach across Departments? Earlier this year, I met chief superintendent Paul Hepworth of West Yorkshire police, who is a fantastic guy. He mentioned that nationally there is a lack of forensic beds for children with severe mental health issues. He told me the story of a young girl who was in police custody with a severe illness; she was suicidal, self-harming and violent towards others. Does my hon. Friend agree that the Government must address this issue, to offer safe space and support for people in dire risk?

[Andrew Griffiths]

I point my hon. Friend to some of the work done in my area by Matthew Ellis, the Staffordshire police and crime commissioner, and the work done by the Prime Minister when she was Home Secretary on how we treat mental health in our police stations. That is very important, but it is even more important for vulnerable young children. She makes a valid point. I will canter through some more points before taking more interventions.

The Government’s own survey shows that one in four children with a mental health disorder are seen by a mental health specialist and over 400,000 children are receiving no assistance at all. The NHS is managing to see only a fraction of the young people who have problems. My hon. Friend talks about cross-departmental working. I am delighted that the Minister is here, because she has done a huge deal to bang heads together and make this a priority. It involves the NHS, local government, the police and so many different areas, which we need to bring together.

The Children’s Commissioner’s analysis of NHS figures from 2017-18 shows that 325,000 children were treated by community services, while another 5,000 are in hospital—less than 3% of the population. Around £700 million is spent on child and adolescent mental health services and eating disorder support. By comparison, services for adults received 15 times more, despite the fact that children represent 20% of the population. While it is important that we are putting money into mental health services, we are turning it on its head. We need to put more money into children’s services, not only because there is such a great demand, but because if we can nip problems in the bud by making that early intervention, we can avoid those services being needed later in life.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on securing the debate; he is making some very good points. As he recognises, CAMHS are the Cinderella services of the Cinderella service—mental health is still woefully underfunded in comparison with many other parts of the NHS. Does he also recognise that CAMHS recruitment is a real challenge? The August 2019 fill rates for higher trainees in the UK stand at only 63% for those entering CAMHS specialist training and at only 23% for learning disabilities, which means that almost 80% of new posts in learning disabilities for new trainees will be unfilled. Does he agree that that is a key issue for the Government to address if they want to improve CAMHS provision?

[Andrew Griffiths]

I absolutely agree with my hon. Friend, whom I congratulate on his work in our NHS; I am grateful that he does such a great job on mental health work in the community. He raises the very important point that it is all very well wanting to deliver these services and putting the money in place, but if we do not have the staff to deliver on the ground, we will always be running to catch up.

[Rachael Maskell (York Central) (Lab/Co-op)]

The hon. Gentleman is giving an excellent speech. In York, we have seen a 26% increase in referrals into CAMHS over the past five years. As a result of such high demand, one referral in four is turned away from the service, including children who are self-harming and have experienced abuse. Surely we need to focus on investment in the workforce, as well as on funding.

--- Later in debate ---

[Andrew Griffiths]

The hon. Lady is absolutely right, and we must not underestimate the immense added stress and pressure for families whose child is self-harming. She makes a very good point.

[Julian Sturdy (York Outer) (Con)]

I congratulate my hon. Friend on securing this important debate. May I follow up on the point made by my colleague the hon. Member for York Central (Rachael Maskell) about the figures for York? Are not parents under huge stress because of these referral figures? In York, CAMHS referral times are peaking and troughing, which has a lot to do with not getting the resources needed. Sometimes referral times are down to six months, but at other times they are longer than 12 months, which has a huge impact on the children involved. It also means that schools are having to take action and exclude young people before they can get the treatment they need.

[Andrew Griffiths]

My hon. Friend is absolutely right, not only about the impact on schools—I will say more later about what we can do in schools—but about the pressure on CAMHS and the massive importance of getting children seen as soon as possible. Just imagine if one of us were having a mental health episode and were told that we could see someone in 12 months who would then refer us for treatment. CAMHS are not the doctors or the psychiatrists who see the patient. They are not the help; they are the doorkeepers to getting help—the triage, as it were. Even when someone gets through the CAMHS door and jumps over the very high bar for getting treatment, it could be many months before they receive it.

It is a great challenge. I know that the Government take it seriously; their 2017 Green Paper “Transforming Children and Young People’s Mental Health Provision” outlined their ambitious new plans for delivering mental health support in schools, and the announcement this week of the mental health services trailblazers is a welcome part of that strategy. I am delighted that my area, Burton, is to be in the second phase of those trailblazers, which I genuinely believe will make a difference. However, figures from the Children’s Society suggest there has been little expansion in the provision available in schools since 2015, so we are starting from a low base. In particular, the figures point to a worrying lack of awareness among parents about the counselling offered in their children’s schools: just under a third are not aware of what is available at all.

I am pleased that the Government have announced that every school, college and alternative provision across England will be offered training as part of the £9.3 million mental health services and schools and colleges link. However, even though my area is one of the trailblazers, priority access to mental health training for schools and colleges will not be available in my constituency until next year. It is clearly needed now. There are so many MPs, constituencies and constituents who want access, so how can we roll it on quicker? To use my “Oliver!” analogy again—

[Anne Marie Morris (Newton Abbot) (Con)]

My hon. Friend is making an excellent speech. May I ask him to reflect for a minute on the particular issues for rural communities, including the distances? The lack of broadband means that the opportunities for dealing with those distances are missed. It seems to me—perhaps we will hear more from the Minister about this—that the Government could use technology more effectively in rural areas. We will certainly not get the help we need in time otherwise. My schools will not be getting help under the new scheme any time soon—we are not even one of the pilots. My teachers are very concerned that they will have more burdens, rather than an added resource.

[Andrew Griffiths]

My hon. Friend, who is always a champion for rural communities, makes an important point about rural isolation. We have known for a long time about the mental health challenges of farmers and rural communities, but it is all the more difficult for young people who are isolated from their friends. We talk about the social media pressure on young people with Facebook, Twitter and so on, but it is even more difficult for kids in isolated rural communities, because they are even more separated. That social media connection is often their only chance to talk to their friends.

[Dr Poulter]

My hon. Friend is making one of the best speeches that I have heard in this Chamber for some time, and is going into granular detail to make his case. In the medical workforce, the numbers of mental health nurses have fallen nationally over the past decade, and we know that there are challenges with CAMHS and LD recruitment. We cannot deliver mental health care without bodies on the ground. Unless we get the workforce challenge right, it will just be rhetoric. We need to start turning rhetoric into reality by recruiting the right number of staff on the ground to deliver high-quality mental health care.

[Andrew Griffiths]

My hon. Friend is absolutely right. It is about not just the psychiatrists and the doctors, but the mental health nurses out in the community. I have witnessed their great work at first hand, so I know just how important they are.

The extensive roll-out—as the Government rightly claim it to be—over the five-year pilot is great, but it will address just 20% to 25% of the country’s need. So many young people will miss out on support until at least 2023 or perhaps even later. The mental health training for schools and colleges announced in the past week is fantastic, but under the NHS long-term plan, an extra £2.3 billion is due to be put into mental health services by 2023-24. That is a lot of money, and I want us to make sure that as much of it goes into children’s mental health services as is humanly possible. If we spend it wisely, it can have a double-whammy effect.

[Louise Haigh (Sheffield, Heeley) (Lab)]

Does the hon. Gentleman agree about the importance of bereavement counselling for children with mental health issues? As shadow Police Minister, one of the most common factors that I see among young offenders is a close family bereavement in their childhood, yet so many children languish on waiting lists for bereavement counselling. Indeed, I had a young constituent who waited for bereavement counselling for three years. Unfortunately, his life was taken by another teenager. That just shows the absolute importance of getting in there and delivering that mental health care.

--- Later in debate ---

[Andrew Griffiths]

The hon. Lady is absolutely right. Trauma in young people’s lives is often the trigger, whether it is sexual abuse, domestic abuse, violence perpetrated by other young people, or bereavement. All those triggers set off a train of deterioration in young people’s mental health that is often lifelong. It is so important that they get the access they need.

Several hon. Members have mentioned waiting times for CAMHS. I have certainly found that my constituents cannot get on Facebook quick enough to tell me about their CAMHS experiences. I do not want to denigrate CAMHS, which have great people doing great work; the problem is that there are just not enough of them and they are under too much pressure. As the hon. Member for York Central (Rachael Maskell) noted, CAMHS are turning away nearly a quarter of children who are referred to them. In 2017-18, they turned away 24.2%, meaning that at least 55,800 children were not accepted for treatment. Of those who were referred, the average waiting time was 34 days for an initial assessment and 60 days for treatment—significantly longer than the four-week standard set out in the Government’s Green Paper. We can all point to examples of much longer waiting times in our constituencies.

One constituent contacted me to say that her son had been self-harming for years. It took them months to get an appointment with CAMHS, and when the appointment happened, her son suffered a meltdown. That is not unusual, due to the pressures that those appointments put on young people. Because he is 15, their GP cannot prescribe anything for him. My constituent has had to watch her son throughout the night to make sure he does not do any permanent damage to himself. Another parent told me how her daughter was discharged from CAMHS, with it saying there was nothing more it could do to help with her anxiety.

Young people have told mental health charity Mind—I am very lucky to have Burton and District Mind in my constituency, which does a great job—that the wait for support is one of the most difficult issues they face. They say that sometimes, they find that their mental health deteriorates while they are waiting; the wait actually makes it worse. In England as a whole, half of those accepted for treatment during 2017-18 were still waiting for treatment at the year’s end. That proportion was lower in my area, east Staffordshire, where it was just over one third. However, that is still a substantial figure.

A school counsellor from my constituency contacted me to say that the waiting lists for referrals to child services outside of school can be months long. She believes that when it is established that a child needs help, a counselling session needs to happen within 48 hours. She goes on to say that too much red tape is preventing children from getting the help they need. I think we all recognise, as the Government have done, that support in school, delivered in a way that is accessible to young people—they feel comfortable asking for it, and know of other young people who have accessed it—is a real help.

One parent told me that she decided to fight to get her son’s care commissioned outside of the county they lived in because of her disappointment with the support she had received. She says that early intervention is key, and that there have been too many endless reports and not enough action has been taken. Another parent in my constituency said that she took her daughter to the GP two years ago. She was referred to That Place in Burton, which is a fantastic facility; she took her for assessment, only to be told that her daughter was not old enough to be accepted. Yet another constituent told me that after a referral for her daughter, aged nine, it took three years for them to see a psychiatrist. That kind of wait is difficult, and all the time, the young people are getting worse.

There is also a problem with the transition from childhood to adulthood. According to the British Psychological Society, about one in six 17 to 19-year olds have a mental health disorder; according to the Children’s Society, 16 to 17-year-olds are the biggest service users of mental health services. However, young people often face barriers to accessing support, and end up falling through the cracks of adult and children’s services as they transition. Some young people who are discharged from children and young people’s mental health services at 18 find it can be very difficult to get a referral to adult mental health services at all, and can end up completely isolated. In some circumstances, young people are not accepted into either children and young people’s or adult mental health services, due to them falling between the gaps.

Again and again, I hear that CAMHS discharges young people on their 18th birthday, and that there is no provision at all for them. The challenges those young people are facing do not magically disappear when they become adults. Just last Friday, I met with a constituent who was getting ready to leave CAMHS and had been left to organise her future on her own. She was not automatically transferred to adult services, and had to organise a private therapist in order to get the ongoing treatment that she needs.

One of my constituents sums the problem up better than I could:

“All the time the kids are getting no support, becoming suicidal, becoming adults with even more complex issues, families are breaking up because of the pressure, parents quitting work to do the job of education/social care/health, and all of this causes more and worse financial pressure later on. No one sees the bigger picture because they can’t afford to. No one sees long term because that’s too expensive. Early interventions are crucial but they aren’t funded. We will reap the whirlwind then wring our hands and say ‘how could we have prevented this’”.

That is absolutely pertinent.

The Government have set a five-year forward view for mental health, which is for one in three children and adolescents with a mental health disorder to access NHS mental health community services by 2020-21. In the new long-term plan, they have set a target that 100% of children and young people who need specialist care will be able to access it by 2028-29. However, that is so far down the track.

[Anne Marie Morris]

I totally agree with my hon. Friend: it is so far down the track. Does it not further concern him that in that same 10-year plan, the NHS talks about “parity of esteem”, but that is in 10 years’ time, and it is very unclear what will be done about the timelines for getting there? As my hon. Friend has said, 10 years is much too long to solve the problems we have today.

[Andrew Griffiths]

My hon. Friend is absolutely right. During that time, babies become children, children become adults, and the problem gets worse and worse. I do not deny the Government’s commitment and determination in this, but it is just not happening quickly enough.

The other thing we need to bear in mind is that, although we have heard about CAMHS and the pressures on the workforce, a huge number of brilliant voluntary sector organisations are also delivering these services. I am very lucky to have in my constituency an organisation called Youth Emotional Support Services, which delivers in schools in Uttoxeter, as well as Burton and District Mind. There are so many great organisations. However, even in my own patch, I have heard that a tendering process is currently going on in which the bar is so high, the requirements so difficult and the boxes to tick so numerous that third sector organisations simply feel unable to compete. The challenge is that the tender to provide the facilities goes to a private company, and the experience, dedication and benefits of those voluntary sector organisations are lost.

I was staggered to learn that some of the children’s mental health charities operating in my constituency are providing 85p of frontline services for every pound they receive. That is tremendous value, representing help for young people, and few businesses could get anywhere near matching that. However, the tender process that we go through makes it impossible for voluntary sector organisations to compete. I hope the Minister will look into that; I will be raising with her my particular issue in Staffordshire.

I think the Minister recognises that in this place, we are simply voicing the real concerns and fears of parents up and down the country. Like a snowball coming down a hill, young people’s mental health is under greater pressure than ever before, and as a result they are self-harming, committing suicide, or getting themselves into a situation in which they will, in future years, suffer from greater mental health disorders, addiction, and so many other long-term problems. I hope that the Minister will go away feeling that she has great support across this House for her campaign to get even more resources and focus on mental health services, particularly for children, because quite frankly our children’s lives depend on it.

[Mark Pritchard (in the Chair)]

I do not propose to enforce a formal time limit of four minutes, but I ask colleagues to be mindful of the number of people who wish to contribute to the debate.

--- Later in debate ---

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

I thank the hon. Member for Burton (Andrew Griffiths) for securing this debate. It is important because the simple way to change attitudes around mental health in this country is to talk about it. The more we do it in Parliament, the better. I pay tribute to all those, including charities such as Rethink Mental Illness, that have made a real step change in the way that we consider mental health in this country. I also give credit to the Minister. She obviously does not know what will happen next week with the change in Prime Minster, but she has been a great champion for mental health in not only doing the work that she does, but caring about it. Sometimes we get a Minster who simply goes through the motions, but this Minister cares deeply about the subject and has made a real difference.

The point about finance is important in mental health. That point has been made over the years not only in respect of adult services, but in respect of children’s services, and it has been made again today. Having the proper workforce is also important. I do not want to relegate those two issues because they are very important in this debate, but the other thing that often does not get spoken about is having a proper pathway into a service, which is a mess at the moment, partly as a result of reorganisations in the health service. We have also had cuts to local authorities and they can no longer afford to fund voluntary sector organisations. Sure Start centres have been cut, and the cuts are having an impact on people’s access to services.

I pay tribute to CAMHS. They get a bad name, but they are trying their best in the impossible job that we give them. We have to try and turn down the pipeline of people going into CAMHS services. The only way we can do that is if we have a proper triage system before going into CAMHS, so that people know whether they can get help elsewhere. We often over-medicalise mental health conditions. The Tees, Esk and Wear Valleys mental health trust in my area has a good pilot that pays for a psychiatrist to sit in a GP’s surgery so that a mental health professional can triage cases as they come in. I do not want to criticise GPs, but they are not mental health professionals. They should have a mental health professional who can triage the cases that need to go through to CAMHS or other adult mental health services and then they can try to help the others.

We need a local network of support organisations, whether it is the voluntary sector, as the hon. Member for Burton rightly pointed out, or others that do fantastic work. He put his finger on the issue of how we tender for mental health services. I am sorry, but the ones that I speak to in County Durham have contracts that are too big and they do not have the capacity to take them on, but they do valuable work in the community. In some cases, it is a way of taking pressure off the pipeline going into CAMHS and adult mental services. Parents want to know where to go, so we need signposts and pathways so that people do not wait 12 months or longer to get into CAMHS, thinking that will somehow answer their questions.

[Andrew Griffiths]

I thank the right hon. Gentleman for giving way and for his great speech. Does he agree that one of the reasons why they tender in that way is because they want to have a uniform approach across the whole country? In reality, if someone wants access to a service, people understand the local charity and are much more aware of it, and more likely to go to it for that very reason.

[Mr Kevan Jones]

I do agree. In my experience the best local examples of mental health support are what is being done by local charities, most of which, frankly, run on a shoestring. They do not ask for huge amounts of money. I think it would be cost-effective for the taxpayer if we directed services into that, but we need that joined-up system. If we do not have it, we can pour as much money as we like into the system and it will not work.

I want to mention one last thing—students’ mental health, which is being highlighted in universities. Will the Minister contact Northumbria University, which is doing innovative work on using new technology to track students and highlight those who are vulnerable? I saw it a few weeks ago on a visit to the university. It is a new model, which could have implications nationally, and I think it is worth looking at. I will finish by just saying, let us keep on talking about this subject.

--- Later in debate ---

[Andrew Griffiths]

At a time when the public look in on this place often with derision and sometimes with desperation about how we behave, this debate has shown Parliament at its best. There was lots of consensus, lots of cases were mentioned in a heartfelt way, and we heard lots of determination to make a difference. I think we all recognise that these issues involve young people in a desperate state and parents who are equally desperate about the future of those children. If we can come together and deliver the early intervention and support mechanisms that can make such a difference later in life, we can literally save the lives of those young people. I thank everybody who contributed to this really positive debate. I hope it is just a springboard for us to go further and ensure we deliver for all those young people across the country.

Question put and agreed to.

Resolved,

That this House has considered children and mental health services.

Cystic Fibrosis Drugs: Orkambi

Andrew Griffiths Excerpts

Monday 10th June 2019 Westminster Hall

[Paul Scully]

It is an unfortunate manner of phrasing. There is no doubt about the fact that median life expectancy has increased. For someone born now, the projection is that they are likely to have a median life expectancy of 47. It is clearly an improvement, and hopefully these drugs will carry on extending that. It is a matter of wording, and I do not think any offence was intended.

[Andrew Griffiths (Burton) (Con)]

I think my hon. Friend will win this year’s prize for taking the most interventions in a debate, such is the level of interest in this debate. I know the Minister will have taken note of the cross-party interest, and I hope that Vertex is also taking note of just how much interest there is among Members of Parliament.

I am here today because Elaine and Chris Colborne came to see about their three-year-old grandchildren, James and Alex. Although it is terrible for any parent—I am one myself—to see their child suffering, it is even worse for a grandparent in some respects. They see the little child suffering, and they also see the anguish of their child—the parent who on a day-by-day basis has to live with the consequences and the pain that comes from CF. This is a hugely important debate and we agree that it is not just about Orkambi; it is actually about the pipeline of other drugs that are coming through. Even if we were to solve the problem with Orkambi, we might be in a situation in which new drugs come forward in the future. We need to tackle the issue, not just this particular drug.

[Paul Scully]

My hon. Friend is absolutely right to say that we are looking at that pipeline, which is so important. That is why this process is different from the kind that NICE is used to. I hope that NICE can be accommodating enough to suit the pipeline, and that Vertex can come back with its triple therapy, which will help so many people.

Healthcare (International Arrangements) Bill (Changed to Healthcare (European Economic Area and Switzerland Arrangements) Bill)

Andrew Griffiths Excerpts

Ping Pong: House of Commons
Tuesday 26th March 2019 Commons Chamber

[Mr Deputy Speaker]

Let’s calm it down a little. In fairness, I think the Minister needs to get to the end of his speech. We cannot have him being interrupted on points of order; it is not good form in this House to do so. What I would say is, “Who knows?” because I cannot predict what the Minister is going to say. He may well get to the points the hon. Gentleman feels are not being addressed.

[Andrew Griffiths (Burton) (Con)]

On a point of order, Mr Deputy Speaker. As a Back Bencher who is keen to see this debate develop and move on so we can get on to other equally important business, what advice can you give me to stop other hon. Members asking pointless points of order in this debate?

[Mr Deputy Speaker]

The hon. Gentleman not making another point of order might be helpful as well. Let’s just get on and move forward because it is in everybody’s best interests to hear what the Minister has to say.